WorldWideScience

Sample records for assisted laparoscopic radical

  1. Outcomes after robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Declan G.Murphy; Benjamin J.Challacombe; Anthony J.Costello

    2009-01-01

    Robot-assisted laparoscopic radical prostatectomy (RALRP) using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology.Controversy has surrounded the procedure since it was first performed in 2000,with many critics highlighting the lack of evidence to support its use.However,despite the lack of level I evidence,many large studies of patients have confirmed that the procedure is feasible and safe,with low morbidity.Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy.Functional outcomes also seem satisfactory,although randomized controlled trials are lacking.This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.

  2. Optic Nerve Sheath Diameter Remains Constant during Robot Assisted Laparoscopic Radical Prostatectomy

    NARCIS (Netherlands)

    Verdonck, Philip; Kalmar, Alain F.; Suy, Koen; Geeraerts, Thomas; Vercauteren, Marcel; Mottrie, Alex; De Wolf, Andre M.; Hendrickx, Jan F. A.

    2014-01-01

    Background: During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath

  3. Initial consecutive 125 cases of robotic assisted laparoscopic radical prostatectomy performed in Ireland's first robotic radical prostatectomy centre.

    LENUS (Irish Health Repository)

    Bouchier-Hayes, D M

    2012-03-01

    We examined the patient characteristics, operative proceedings and the outcomes of the initial series of 125 cases of robot-assisted laparoscopic radical prostatectomy (RALRP) in an independent hospital in Ireland, performed by two surgeons using the da Vinci(®) surgical system.

  4. AB052. The study of laparoscopic radical prostatectomy vs. robot-assisted laparoscopic prostatectomy on sexual function

    OpenAIRE

    Yuan, Jianlin

    2016-01-01

    Objective To discuss the difference in the effect between the laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP) on sexual function. Methods A total of 204 patients with clinically localized prostate cancer (PCa) (T1a~T2c) were included from April 2012 to January 2015, in which 106 underwent LRP and 98 underwent RALP. Age range was 63–76 years [mean 67.7 years± standard deviation (SD) 6.33]. Patient informed consent to participate in the study was ob...

  5. Laparoscopic radical cystectomy

    OpenAIRE

    Fergany, Amr

    2012-01-01

    Objective Laparoscopic radical cystectomy (LRC) has emerged as a minimally invasive alternative to open radical cystectomy (ORC). This review focuses on patient selection criteria, technical aspects and postoperative outcomes of LRC. Methods Material for the review was obtained by a PubMed search over the last 10 years, using the keywords ‘laparoscopic radical cystectomy’ and ‘laparoscopic bladder cancer’ in human subjects. Results Twenty-two publications selected for relevance and content we...

  6. Using a Checklist in Robotic-Assisted Laparoscopic Radical Prostatectomy Procedures.

    Science.gov (United States)

    Jing, Jiamei; Honey, Michelle L L

    2016-08-01

    Robotic surgical systems are relatively new in New Zealand and have been used mainly for laparoscopic radical prostatectomy. Checklists are successfully used in other industries and health care facilities, so we developed a checklist for use during robotic-assisted laparoscopic radical prostatectomy (RALRP) procedures. After a two-month trial using the checklist, we calculated the completeness of each phase of the checklist as a percentage of the number of completed checklists versus total number of compliant checklists in that phase. Operating room personnel participated in an audiotaped focus group and discussed their perceptions about using the RALRP checklist. We collected, transcribed, and reviewed the focus group discussion and thematically analyzed the responses, which confirmed that the checklist served as a guideline and reminder during the setup. Additionally, staff members associated the checklist with improved OR readiness, minimized workflow interruption, improved efficiency, and positive changes in confidence and teamwork. PMID:27472974

  7. Obturator Compartment Syndrome Secondary to Pelvic Hematoma After Robot-Assisted Laparoscopic Radical Prostatectomy

    Science.gov (United States)

    Song, Jun H.; Abbott, Daniel; Gewirtz, Eric; Hauck, Ellen; Eun, Daniel D.

    2016-01-01

    Abstract Obturator nerve injury is a known injury after robot-assisted laparoscopic radical prostatectomy (RALP) and patients often present with motor and sensory deficits in the immediate postoperative period. We describe a 65-year-old male who presented with motor deficits, indicative of obturator neurapraxia after RALP upon waking from anesthesia. Work-up revealed an expansile hematoma possibly compressing the obturator nerve. After evacuation of the hematoma, the patient had immediate improvement of his neurologic deficits. Our patient's clinical vignette illustrates the importance of considering postsurgical hematoma in the differential diagnosis when patients present with signs and symptoms of obturator neurapraxia after RALP.

  8. Obturator Compartment Syndrome Secondary to Pelvic Hematoma After Robot-Assisted Laparoscopic Radical Prostatectomy.

    Science.gov (United States)

    Song, Jun H; Kaplan, Joshua R; Abbott, Daniel; Gewirtz, Eric; Hauck, Ellen; Eun, Daniel D

    2016-01-01

    Obturator nerve injury is a known injury after robot-assisted laparoscopic radical prostatectomy (RALP) and patients often present with motor and sensory deficits in the immediate postoperative period. We describe a 65-year-old male who presented with motor deficits, indicative of obturator neurapraxia after RALP upon waking from anesthesia. Work-up revealed an expansile hematoma possibly compressing the obturator nerve. After evacuation of the hematoma, the patient had immediate improvement of his neurologic deficits. Our patient's clinical vignette illustrates the importance of considering postsurgical hematoma in the differential diagnosis when patients present with signs and symptoms of obturator neurapraxia after RALP. PMID:27579444

  9. Hemostatic hydrodissection of the neurovascular bundles during robotic assisted laparoscopic radical prostatectomy: safety and efficacy trial

    Science.gov (United States)

    Parekattil, Sijo J.; Dahm, Philipp; Vieweg, Johannes W.

    2009-02-01

    Preservation of continence and potency after Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) are two key outcome measures that patients consider when comparing different treatment options for localized prostate cancer. Ensuring that positive surgical margins are as low as possible provides oncologic control. Various techniques to optimize these outcomes have been employed. This study presents the early outcomes for Hemostatic Hydrodissection of the Neurovascular Bundles during 86 consecutive RALPs. Positive margin rates were 12.5% overall (9% for pT2 and 28.6% for pT3); continence at 6 months was 100%, at 3 months 90% and at 1 month 66%. In patients with no preoperative erectile dysfunction (preoperative SHIM of 25), 79% had return of erections sufficient for intercourse by 6 months. 2 of these patients were able to have intercourse 2 weeks after surgery. These preliminary findings appear promising.

  10. Laparoscopic Radical Trachelectomy

    OpenAIRE

    Rendón, Gabriel J.; Ramirez, Pedro T.; Frumovitz, Michael; Schmeler, Kathleen M.; Pareja, Rene

    2012-01-01

    Introduction: The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. Case Description: We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old fem...

  11. Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    2009-06-01

    Full Text Available OBJECTIVE: No consensus has yet been established regarding the best minimally invasive access for radical ablation of renal tumors. Our objective was to prospectively compare the surgical results and oncologic management of two currently used endoscopic techniques. MATERIAL AND METHODS: Over a four-year period, 50 patients with renal tumors and clinical stage T1b-T2, smaller than 12 cm, underwent a radical nephrectomy at two reference institutions, 25 underwent retroperitoneoscopic radical nephrectomy (RRN and 25 a hand-assisted laparoscopic radical nephrectomy (HALRN. Mean follow-up of both cohorts was 50 months. Operative parameters and oncological management were compared. RESULTS: The mean operative time was 180 min in RRN and 108 min in HALRN (p < 0.001. The time required to access the renal pedicle in RRN was 30 min. and in HALRN 40 min., Learning curve was shorter in HALRN than RRN. Mean blood loss was 100 mL in RRN and 242 mL in HALRN. Mean incision size for specimen retrieval in RRN was 6.5 cm and in HALRN 7.5 cm. One patient with intra operative occurrence of ascites and subsequent pathological stage pT2N0M0 grade 3 operated via HALRN, had neoplasic implants in the Hand-port incision 3 months after surgery followed by death 4 months after recurrence. One patient, with pathological stage pT3N0M0 grade 3 in RRN had metastasis after 36 months. CONCLUSION: Both, RRN and HALRN techniques are accepted minimally invasive options for endoscopic radical nephrectomy with equivalent long term oncological outcome in the treatment of renal tumors.

  12. Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy.

    Directory of Open Access Journals (Sweden)

    Philip Verdonck

    Full Text Available During robot assisted laparoscopic radical prostatectomy (RALRP, a CO2 pneumoperitoneum (CO2PP is applied and the patient is placed in a head-down position. Intracranial pressure (ICP is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath diameter (ONSD measurement, may warn us that the mechanism of protective cerebrospinal fluid (CSF shifts becomes exhausted.After obtaining IRB approval and written informed consent, ONSD was measured by ocular ultrasound in 20 ASA I-II patients at various stages of the RALRP procedure: baseline awake, after induction, after applying the CO2PP, during head-down position, after resuming the supine position, in the postoperative anaesthesia care unit, and on day one postoperatively. Cerebral perfusion pressure (CPP was calculated as the mean arterial (MAP minus central venous pressure (CVP.The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5 mm Hg to 27.6(3.8 mm Hg. The CPP was decreased 70 min after assuming the head-down position until 15 min after resuming the supine position, but remained above 60 mm Hg at all times.Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position. These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small.

  13. The "halo effect" in Korea: change in practice patterns since the introduction of robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Sung, Ee-Rah; Jeong, Wooju; Park, Sung Yul; Ham, Won Sik; Choi, Young Deuk; Hong, Sung Joon; Rha, Koon Ho

    2009-03-01

    Acquisition of the da Vinci surgical system (Intuitive Surgical, Mountain View, USA) has enabled robot-assisted surgery to become an acceptable alternative to open radical prostatectomy (ORP). Implementation of robotics at a single institution in Korea induced a gradual increase in the number of performances of robot-assisted laparoscopic radical prostatectomy (RALP) to surgically treat localized prostate cancer. We analyzed the impact of robotic instrumentation on practice patterns among urologists and explain the change in value in ORP and RALP-the standard treatment and the new approach or innovation of robotic technology. The overall number of prostatectomies has increased over time because the number of RALPs has grown drastically whereas the number of OPRs did not decrease during the period of evaluation. Our experience emphasizes the potential of RALP to become the gold standard in the treatment of localized prostate cancer in various parts of the world.

  14. The new era of minimally invasive interventions for prostate cancer: robot-assisted laparoscopic radical prostatectomy and focal therapy

    Directory of Open Access Journals (Sweden)

    Schatloff O

    2011-10-01

    Full Text Available Oscar Schatloff1, Alyssa S Louis2, Uri Lindner21Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA; 2Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, CanadaAbstract: Prostate cancer remains a common but highly treatable disease. Innovations in prostate cancer treatment have allowed a transition toward minimally invasive approaches in an attempt to avoid treatment-related morbidities. In the middle of the treatment spectrum between radical open surgeries and active surveillance lies robot-assisted laparoscopic radical prostatectomy (RALP and focal therapy (FT. This review sets out the most current information on RALP and FT (including laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, and irreversible electroporation.Keywords: PCa, RALP, FT, laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, irreversible electroporation

  15. A comparison of radical perineal, radical retropubic, and robot-assisted laparoscopic prostatectomies in a single surgeon series.

    Science.gov (United States)

    Mirza, Moben; Art, Kevin; Wineland, Logan; Tawfik, Ossama; Thrasher, J Brantley

    2011-01-01

    Objective. We sought to compare positive surgical margin rates (PSM), estimated blood loss (EBL), and quality of life outcomes (QOL) among perineal (RPP), retropubic (RRP), and robot-assisted laparoscopic (RALP) prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92), RRP (180), or RALP (191) for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC) were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml) group compared to both RPP (475 ml) and RRP (999 ml) groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  16. An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite.

    Science.gov (United States)

    Canda, Abdullah Erdem; Asil, Erem; Balbay, Mevlana Derya

    2011-02-01

    A case of moving ileal Taenia saginata parasites is presented with demonstrative images. We came across the parasites surprisingly while performing robot-assisted laparoscopic radical cystoprostatectomy with intracorporeal Studer pouch urinary diversion. We recommend stool sample evaluation in the preoperative period for possible presence of intestinal parasitic diseases, particularly in patients with bladder cancer who are admitted from areas with an increased incidence of intestinal parasitic diseases, before opening the bowel segments during surgery to perform radical cystectomy and urinary diversion.

  17. Comparison of peritoneal free gastric cancer cells' detecting rates between laparoscopically assisted and open radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods:Intraoperative peritoneal lavage cytologic examination was performed in 65 patients with gastric cancer, during laparoscopic gastrectomy (n=34) and conventional surgery (n=31). Cytology was examined twice, immediately after opening the peritoneal cavity and just before closing the abdomen. Saline was poured into the peritoneal cavity, and 100 ml fluid was retrieved after irrigation. Laparoscopic instruments were lavaged after surgery with 100 ml saline. Carbon dioxide (CO2) was derived through the trocar side orifice after pneumoperitoneum during laparoscopic gastrectomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after the filtration process. Results: The incidence of positive cytology during laparoscopic surgery was 32.26% in the preoperative lavage and 22.58% in the postoperative lavage. The incidence of positive cytology during conventional surgery was 41.18% before lavage and 26.47% after lavage. Only one positive cytology was detected in the CO2 filtrate gas. The incidence of positive cytology in the lavage of the instruments during laparoscopic surgery was 6.45%. Conclusion: During gastric laparoscopic surgery, CO2 pneumoperitoneum does not affect tumor cell dissemination and seeding. In this study, laparoscopic techniques used in gastric cancer surgery were not associated with a higher risk for intraperitoneal dissemination of cancer cells than the conventional surgery.

  18. A Comparison of Radical Perineal, Radical Retropubic, and Robot-Assisted Laparoscopic Prostatectomies in a Single Surgeon Series

    Directory of Open Access Journals (Sweden)

    Moben Mirza

    2011-01-01

    Full Text Available Objective. We sought to compare positive surgical margin rates (PSM, estimated blood loss (EBL, and quality of life outcomes (QOL among perineal (RPP, retropubic (RRP, and robot-assisted laparoscopic (RALP prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92, RRP (180, or RALP (191 for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml group compared to both RPP (475 ml and RRP (999 ml groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  19. Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy.

    Science.gov (United States)

    Jacobsen, André; Berg, Kasper Drimer; Iversen, Peter; Brasso, Klaus; Røder, Martin Andreas

    2016-08-01

    Objective Anastomotic complications are well known after radical prostatectomy (RP). The vesicourethral anastomotic technique is handled differently between open and robotic RP. The aim of the study was to investigate whether the frequency of anastomotic leakages and strictures differed between patients undergoing retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) and to identify risk factors associated with these complications. Materials and methods The study included 735 consecutive patients who underwent RRP (n = 499) or RARP (236) at the Department of Urology, Rigshospitalet, Denmark, in a complete 3 year period from 2010 to 2012. Univariate and multivariate logistic regression analysis was used to analyse associations between surgical procedure (RRP vs RARP) and anastomotic complications. Analyses included age, smoking status, diabetes, hypertension, surgeon, prostate volume and anastomotic leakage as variables. Owing to a low number of events, multivariable analyses only included smoking status, diabetes and prostate volume for anastomotic leakage, and age, smoking status, prostate volume and anastomotic leakage for anastomotic strictures. Results The frequency of anastomotic leakage was 2.9%. Anastomotic stricture was seen in 4.9% of patients during follow-up. No differences were found in the frequency of anastomotic leakage (p = 0.35) or strictures (p = 0.35) between RRP and RARP. Univariate analysis demonstrated an association between surgeon and the risk of anastomotic strictures in RRP patients (p = 0.02). No other independent risk factors were identified. Conclusion Overall, the anastomotic complication rate in this cohort is similar to other published reports. No obvious risk factors for anastomotic complications could be identified, which in part was due to the low number of events. PMID:26963663

  20. Adjuvant chemoradiation after laparoscopically assisted radical vaginal hysterectomy (LARVH) in patients with cervical cancer. Oncologic outcome and morbidity

    Energy Technology Data Exchange (ETDEWEB)

    Gruen, Arne; Musik, Thabea; Stromberger, Carmen; Budach, Volker; Marnitz, Simone [Charite Univ. Medicine Berlin, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Radiooncology; Koehler, Christhardt; Schneider, Achim [Charite Univ. Medicine Berlin, Campus Mitte- und Benjamim Franklin, Berlin (Germany). Dept. of Gynaecology; Fueller, Juergen; Wendt, Thomas [Jena Univ. Hospital (Germany). Dept. of Radiooncology

    2011-06-15

    Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation. A total of 55 patients (range 28-78 years) with cervical cancer on FIGO stages IB1-IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH. At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed. With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients. (orig.)

  1. Adjuvant chemoradiation after laparoscopically assisted radical vaginal hysterectomy (LARVH) in patients with cervical cancer. Oncologic outcome and morbidity

    International Nuclear Information System (INIS)

    Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation. A total of 55 patients (range 28-78 years) with cervical cancer on FIGO stages IB1-IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH. At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed. With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients. (orig.)

  2. Robotic-assisted laparoscopic radical prostatectomy: The Ohio State University technique.

    Science.gov (United States)

    Patel, Vipul R; Shah, Ketul K; Thaly, Rahul K; Lavery, Hugh

    2007-03-01

    Robotic radical prostatectomy is a new innovation in the surgical treatment of prostate cancer. The technique is continuously evolving. In this article we demonstrate The Ohio State University technique for robotic radical prostatectomy. Robotic radical prostatectomy is performed using the da Vinci surgical system. The video demonstrates each step of the surgical procedure. Preliminary results with robotic prostatectomy demonstrate the benefits of minimally invasive surgery while also showing encouraging short-term outcomes in terms of continence, potency and cancer control. Robotic radical prostatectomy is an evolving technique that provides a minimally invasive alternative for the treatment of prostate cancer. Our experience with the procedure now stands at over 1,300 cases.

  3. Laparoscopic assisted cholecystostomy.

    Science.gov (United States)

    Grecu, F

    1999-01-01

    Laparoscopic assisted cholecystostomy (LAC) is a safe method for external biliary drainage in jaundiced patients with distal common bile duct obstruction. It consists of the retrieval of the fundus of the gallbladder through the trocar, thus through abdominal wall followed by suture to the skin. This technique could be an option for surgeons who manage a patients with jaundice by distal common bile duct obstruction.

  4. Regaining Candidacy for Heart Transplantation after Robotic Assisted Laparoscopic Radical Prostatectomy in Left Ventricular Assist Device Patient

    Directory of Open Access Journals (Sweden)

    Tariq A. Khemees

    2012-01-01

    Full Text Available Several factors may highlight the relevance of prostate cancer to the pre-heart-transplant population. First, the expansion in candidate selection criteria led to increased number of men over the age of fifty to be considered for heart transplantation. With the introduction of left ventricular assist device (LVAD therapy, waiting-list mortality has dramatically declined over the past decade. Additionally, transplant candidates are diligently screened for preexisting neoplasm while on the waiting list. Taken together, screening-detected prostate cancer may increasingly be diagnosed in patients on the waiting list. If discovered, it will pose unique challenge to clinicians as to date there has been no universally accepted management guideline. We report a case of LVAD-treated heart transplant candidate diagnosed with prostate cancer while on the waiting list. Patient screening demonstrated PSA elevation which prompted prostate biopsy. Low-risk clinically localized prostate cancer was confirmed and led to removal of patient from transplant list. When counseled regarding management of his cancer, the patient elected to undergo radical prostatectomy in a hope to regain candidacy for heart transplantation. Despite being of high surgical risk, multidisciplinary team approach led to successful management of prostate cancer and the patient eventually received heart transplant one year following prostatectomy.

  5. Hand-assisted laparoscopic surgery using Gelport

    Directory of Open Access Journals (Sweden)

    Gupta Puneet

    2005-01-01

    Full Text Available Introduction: Minimally invasive surgery has revolutionized general surgery during the past 10 years. However, for more advanced surgical procedures, the acceptance of the minimally invasive approach has been slower than expected. Advanced laparoscopic surgery is complex and time-consuming. The major drawbacks of laparoscopic surgery are two-dimensional view, lack of depth perception and loss of tactile sensation. This has led to the innovation of hand-assisted laparoscopic surgery (HALS. The objective of the present study was to determine that safety of HALS. Materials and Methods: We preformed 18 HALS procedures in our department between July 2003 and January 2005 on patients who had given their informed consent for the use of Gelport. Out of these, 15 were colectomy, 2 nephrectomy and 1 splenectomy. Out of the 18 patients, 13 were males and 5 were females with the age group ranging from 44 to 72 years. Results: Hand-assisted laparoscopic surgery could be completed in 17 patients maintaining all the oncological principals of surgery. The mean operating times were 120 min for right haemicolectomy, 135 min for left colectomy, 150 min for splenectomy, and 150 min for nephrectomy. The patient undergoing radical nephrectomy by HALS had to be converted to open surgery. As the tumour was large and adherent to the spleen and posterior peritoneal wall. Postoperative recovery was excellent with an average hospital stay of 5 days. Histopathology report showed wide clearance and till date we have a good follow up of 30-380 days. Conclusion: Hand-assisted laparoscopic surgery allows tactile sensation and depth perception thereby may simplify the complex procedures. This may result in reduction of operating time and conversion rates at the same time maintaining all the oncological principles. Hand-assisted laparoscopic surgery strikes a perfect balance between an extended open laparotomy incision and an excessively tedious laparoscopic exercise. Hand

  6. Radical prostatectomy - discharge

    Science.gov (United States)

    ... prostatectomy - discharge; Laparoscopic radical prostatectomy - discharge; LRP - discharge; Robotic-assisted laparoscopic prostatectomy - discharge ; RALP - discharge; Pelvic lymphadenectomy - ...

  7. [Robot-Assisted Laparoscopic Radical Prostatectomy for Patients with Prostatic Cancer and Factors Promoting Installation of the Robotic Surgical Equipment-Questionnaire Survey].

    Science.gov (United States)

    Tsukamoto, Taiji; Tanaka, Shigeru

    2015-08-01

    We conducted a questionnaire survey of hospitals with robot-assisted surgical equipment to study changes of the surgical case loads after its installation and the managerial strategies for its purchase. The study included 154 hospitals (as of April 2014) that were queried about their radical prostatectomy case loads from January 2009 to December 2013, strategies for installation of the equipment in their hospitals, and other topics related to the study purpose. The overall response rate of hospitals was 63%, though it marginally varied according to type and area. The annual case load was determined based on the results of the questionnaire and other modalities. It increased from 3,518 in 2009 to 6,425 in 2013. The case load seemed to be concentrated in hospitals with robot equipment since the increase of their number was very minimal over the 5 years. The hospitals with the robot treated a larger number of newly diagnosed patients with the disease than before. Most of the patients were those having localized cancer that was indicated for radical surgery, suggesting again the concentration of the surgical case loads in the hospitals with robots. While most hospitals believed that installation of a robot was necessary as an option for treatment procedures, the future strategy of the hospital, and other reasons, the action of the hospital to gain prestige may be involved in the process of purchasing the equipment. In conclusion, robot-assisted laparoscopic radical prostatectomy has become popular as a surgical procedure for prostate cancer in our society. This may lead to a concentration of the surgical case load in a limited number of hospitals with robots. We also discuss the typical action of an acute-care hospital when it purchases expensive clinical medical equipment. PMID:26411654

  8. Comparison of curative effect of totally laparoscopic and laparoscopic assisted radical gastrectomy for gastric cancer%完全腹腔镜与腹腔镜辅助胃癌根治术的疗效比较

    Institute of Scientific and Technical Information of China (English)

    赵战强; 汪海

    2015-01-01

    Objective To observe the clinical effect of totally laparoscopic and laparoscopic-as-sisted radical gastrectomy on gastric cancer,and evaluate the feasibility and safety of the two kinds of methods. Methods One hundred and twenty patients with gastric cancer from April 2012 to April 2013 were selected,they all underwent the radical gastric cancer operation. Patients were divided into the ob-servation group(65 cases)and control group(55 cases)according to the therapeutic method. The cura-tive effects of the two groups were observed and statistical analyzed. Results Compared with the control group,the amount of bleeding,use of analgesics postoperative and gastrointestinal function recovery time of the observation group had obvious advantages,the differences were statistically significant( P 0 . 05 ). Conclusions Total laparoscopic and laparoscopic assisted radical gastrectomy for gastric cancer,can complete resect of pathological tissues and relevant organizations,but totally lapa-roscopic radical gastrectomy for gastric cancer has advantages such as pain less and fast recovery,with a certain amount of surgeons can actual carry out inspection according to clinical application.%目的:观察完全腹腔镜下胃癌根治术与腹腔镜辅助下胃癌根治术的临床效果,探讨两种方法的可行性与安全性。方法收集2012年4月至2013年4月济源市中医院收治的胃癌患者120例,均采用胃癌根治术,根据选择完全腹腔镜完成手术与否分为观察组(65例)和对照组(55例),对比观察两组患者术后效果并进行统计学分析。结果与对照组相比,观察组术中出血量、术后镇痛药物应用、胃肠功能恢复时间等方面优势明显,差异有统计学意义(P0.05)。结论完全腹腔镜下缝合重建的胃癌根治术与腹腔镜辅助胃癌根治术都能很好地完成病变及相关组织的切除任务,但是完全腹腔镜胃癌根治术术后患者所承受痛苦相对

  9. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.

    Science.gov (United States)

    Davila, Hugo H; Storey, Raul E; Rose, Marc C

    2016-09-01

    Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN. PMID:27272759

  10. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.

    Science.gov (United States)

    Davila, Hugo H; Storey, Raul E; Rose, Marc C

    2016-09-01

    Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.

  11. Management of rectal injury during laparoscopic radical prostatectomy

    OpenAIRE

    Castillo, Octavio A.; Elias Bodden; Gonzalo Vitagliano

    2006-01-01

    PURPOSE: Because laparoscopic radical prostatectomy remains a challenging procedure, rectal injury is always a potential complication. We review the incidence of rectal injuries at our institution in the first 110 consecutive laparoscopic extraperitoneal radical prostatectomies. MATERIALS AND METHODS: Nine (8%) out of the first 110 laparoscopic extraperitoneal radical prostatectomies performed between December 2001 and February 2004, were complicated by rectal injury. Mean patient age was 64....

  12. Robotic assisted laparoscopic colectomy.

    LENUS (Irish Health Repository)

    Pandalai, S

    2010-06-01

    Robotic surgery has evolved over the last decade to compensate for limitations in human dexterity. It avoids the need for a trained assistant while decreasing error rates such as perforations. The nature of the robotic assistance varies from voice activated camera control to more elaborate telerobotic systems such as the Zeus and the Da Vinci where the surgeon controls the robotic arms using a console. Herein, we report the first series of robotic assisted colectomies in Ireland using a voice activated camera control system.

  13. The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy:experience of a single surgeon with 500cases in Taiwan, China

    Institute of Scientific and Technical Information of China (English)

    YenChuan Ou; ChunKuang Yang; KuanghSi Chang; John Wang; SiuWan Hung; MinChe Tung; Ashutosh K Tewari; Vipul R Patel

    2014-01-01

    To analyze the learning curve for cancer control from an initial 250cases(GroupI) and subsequent 250cases(GroupII) of robotic‑assisted laparoscopic radical prostatectomy(RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin(PSM) and biochemical recurrence(BCR) were assessed as cancer control outcomes. Patients in GroupII had signiifcantly more advanced prostate cancer than those in GroupI(22.2%vs 14.2%, respectively, with Gleason score 8–10,P=0.033; 12.8%vs 5.6%, respectively, with clinical stage T3,P=0.017). The incidence of PSM in pT3 was decreased signiifcantly from 49% in GroupI to 32.6% in GroupII. Ameaningful trend was noted for a decreasing PSM rate with each consecutive group of 50cases, including pT3 and high‑risk patients. Neurovascular bundle(NVB) preservation was signiifcantly inlfuenced by the PSM in high‑risk patients(84.1% in the preservation groupvs 43.9% in the nonpreservation group). The 3‑year, 5‑year, and 7‑year BCR‑free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased signiifcantly after 250cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50cases. NVB preservation during RALP for the high‑risk group is not suggested due to increasing PSM.

  14. The Effect of the Vesical Adaptation Response to Diuresis on Lower Urinary Tract Symptoms after Robot-Assisted Laparoscopic Radical Prostatectomy: A Pilot Proof of Concept Study

    Science.gov (United States)

    Haga, Nobuhiro; Aikawa, Ken; Hoshi, Seiji; Yabe, Michihiro; Akaihata, Hidenori; Hata, Junya; Sato, Yuichi; Ogawa, Soichiro; Ishibashi, Kei; Kojima, Yoshiyuki

    2016-01-01

    Background When urine output increases, voided volume at each voiding also increases in normal subjects. This is generally understood as a vesical adaptation response to diuresis (VARD). Because lower urinary tract symptoms (LUTS) are supposed to be improved by the change in bladder function after robot-assisted laparoscopic radical prostatectomy (RARP), the aim of the present study was to investigate whether VARD is involved in the improvement of LUTS after RARP. Methods 100 consecutive patients who underwent RARP and had the International Prostate Symptom Score (IPSS), quality of life (QOL) index, a frequency-volume chart (FVC), uroflowmetry, and post-voided residual urine (PVR) available were evaluated before and after RARP. This cohort was divided into patients with and without preoperative LUTS according to the preoperative IPSS total score. VARD was defined as the presence of a significant correlation between the urine output rate and voided volume at each voiding (R2>0.2). Results In patients with preoperative LUTS, the IPSS total, storage, and voiding symptom scores were significantly improved after RARP (all P<0.001). The QOL index was also significantly improved after RARP (P<0.05). Although VARD was not seen before RARP (R2 = 0.05), it was seen after RARP (3 months R2 = 0.22, 12 months R2 = 0.23). PVR was significantly reduced after RARP (P = 0.004). Conclusions Improvement of LUTS was seen with acquisition of VARD after RARP. As a result, urinary QOL was also improved in patients with preoperative LUTS. RARP might be an effective procedure for amelioration of LUTS by the acquisition of VARD. PMID:27447829

  15. Laparoscopic assisted radical cystoprostatectomy with Y-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples through a 5 cm Pfannensteil incision

    Directory of Open Access Journals (Sweden)

    Sidney C. Abreu

    2005-08-01

    Full Text Available INTRODUCTION: We performed a laparoscopic radical cystoprostatectomy followed by constructing a Y-shaped reservoir extra-corporeally with titanium staples through a 5-cm muscle-splitting Pfannenstiel incision. SURGICAL TECHNIQUE: Upon completion of the extirpative part of the operation, the surgical specimen was entrapped and removed intact through a 5-cm Pfannenstiel incision. Through the extraction incision, the distal ileum was identified and a 40 cm segment isolated. With the aid of the laparoscope, the ureters were brought outside the abdominal cavity and freshened and spatulated for approximately 1.5-cm. Bilateral double J ureteral stents were then inserted up to the renal pelvis and the ureters were directly anastomosed to the open ends of the limbs of the neobladder. Following this, the isolated intestinal segment was arranged in a Y shape with two central segments of 14 cm and two limbs of 6 cm. The two central segments were brought together and detubularized, with two sequential firings of 80 x 3.5 mm and 60 x 3.5 mm non-absorbable mechanical stapler (Multifire GIA - US Surgical inserted through an opening made at the lowest point of the neobladder on its anti-mesenteric border. The neobladder was reinserted inside the abdominal cavity and anastomosed to the urethra with intracorporeal laparoscopic free-hand suturing. CONCLUSION: Although this procedure is feasible and the preliminary results encouraging, continued surveillance is necessary to determine the lithiasis-inducing potential of these titanium staples within the urinary tract.

  16. 机器人辅助腹腔镜下低位直肠癌根治术的护理配合%Nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope

    Institute of Scientific and Technical Information of China (English)

    许晓晓; 张秋玲; 李凤云

    2014-01-01

    目的:探讨机器人辅助腹腔镜下低位直肠癌根治术的护理配合方法,提高护士的手术配合质量。方法对48例机器人辅助腹腔镜下低位直肠癌根治术的手术配合进行总结分析。结果48例机器人辅助腹腔镜下低位直肠癌根治术均顺利完成。结论充分的术前准备和完善的术中护理管理是保障手术顺利进行的关键。%Objective To probe into ways of nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope, thus improve the quality of nursing cooperation. Methods Summarize and analyze 48 cases of nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope. Results All the 48 cases have been performed successfully. Conclusion The full preoperative preparation and sound intraoperative nursing management are the guarantees of the smooth operation.

  17. The Incidence and Anatomy of Accessory Pudendal Arteries as Depicted on Multidetector-Row CT Angiography: Clinical Implications of Preoperative Evaluation for Laparoscopic and Robot-Assisted Radical Prostatectomy

    International Nuclear Information System (INIS)

    To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description. The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64- channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus. We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs. APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy

  18. Incidence of Benign Results After Laparoscopic Radical Nephroureterectomy

    OpenAIRE

    Hong, Sungwoo; Kwon, Taekmin; You, Dalsan; Jeong, In Gab; Hong, Bumsik; Hong, Jun Hyuk; Ahn, Hanjong; Kim, Choung-Soo

    2014-01-01

    Background and Objectives: Studies of patients with benign pathologic lesions who underwent laparoscopic radical nephroureterectomy (RNU) with preoperative suspicion of upper urinary tract urothelial carcinoma are lacking. The aim of this retrospective cross-sectional study was to evaluate the incidence of benign pathologic lesions on laparoscopic RNU for upper urinary tract tumors that are presumed to be urothelial carcinoma. The clinicopathologic characteristics of these lesions were also d...

  19. Laparoscopic radical prostatectomy: omitting a pelvic drain

    Directory of Open Access Journals (Sweden)

    David Canes

    2008-03-01

    Full Text Available PURPOSE: Our goal was to assess outcomes of a selective drain placement strategy during laparoscopic radical prostatectomy (LRP with a running urethrovesical anastomosis (RUVA using cystographic imaging in all patients. Materials and Methods: A retrospective chart review was performed for all patients undergoing LRP between January 2003 and December 2004. The anastomosis was performed using a modified van Velthoven technique. A drain was placed at the discretion of the senior surgeon when a urinary leak was demonstrated with bladder irrigation, clinical suspicion for a urinary leak was high, or a complex bladder neck reconstruction was performed. Routine postoperative cystograms were obtained. RESULTS: 208 patients underwent LRP with a RUVA. Data including cystogram was available for 206 patients. The overall rate of cystographic urine leak was 5.8%. A drain was placed in 51 patients. Of these, 8 (15.6% had a postoperative leak on cystogram. Of the 157 undrained patients, urine leak was radiographically visible in 4 (2.5%. The higher leak rate in the drained vs. undrained cohort was statistically significant (p = 0.002. Twenty-four patients underwent pelvic lymph node dissection (8 drained, 16 undrained. Three undrained patients developed lymphoceles, which presented clinically on average 3 weeks postoperatively. There were no urinomas or hematomas in either group. CONCLUSIONS: Routine placement of a pelvic drain after LRP with a RUVA is not necessary, unless the anastomotic integrity is suboptimal intraoperatively. Experienced clinical judgment is essential and accurate in identifying patients at risk for postoperative leakage. When suspicion is low, omitting a drain does not increase morbidity.

  20. The Outcomes of Laparoscopic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Muzaffer Akçay

    2010-03-01

    Full Text Available Aim: In this study, we analyzed the surgical data and indications of patients, who underwent laparoscopic radical prostatectomy (LRP with the Heilbronn technique, according to the techniques and observed complications. Methods: Between November 2006 and September 2008, 61 patients with prostate cancer underwent LRP at Haseki Training and Research Hospital, Department of Urology. The analyzed preoperative factors were mean age, body-mass index, PSA value, prostate volume measured by transrectal ultrasonography, Gleason score, and hemoglobin levels. Mean operation time, urethrovesical anastomosis time, requirement of blood transfusion and complications were investigated. The postoperative factors such as duration of hospitalization and catheterization were also analyzed. Results: The mean operating time was 257.1±64.6 (190-460 and the mean urethrovesical anastomosis time was 47.6±12.1 (29-90 minutes. Pelvic lymphadenectomy and nerve sparing surgery were performed in 62% and 32% of the patients, respectively. Blood transfusion was needed in 36% of patients in perioperative or postoperative period. The mean hospitalization time was 4.4±1.3 days. The mean urethral catheterization time was 9.3±2.9 (5-17 days. Conclusion: The data of our series, which is one of the first large series of LRP in our country, show that LRP will evolve as an important surgical procedure in our country in the future. The advance in surgical training programs and skills should have an important role to make it a commonly used technique. (The Medical Bulletin of Haseki 2010; 48: 28-33

  1. ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY: OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    S. N. Nesterov

    2014-08-01

    Full Text Available Background. Retropubic radical prostatectomy (RPE is now the gold standard of treatment for locally advanced prostate cancer (PC. However, robot-assisted RPE procedures using the da Vinci system are finding increasing acceptance.Materials and methods. The authors conducted a prospective study of 60 robot-assisted prostatectomies made at the Clinic of Urology, N.I. Pirogov National Medical Surgical Center, in the period January 2009 to December 2010.Results. The duration of an operation averaged 230 min; the average amount of blood loss was 200 ml. The mean duration of postoperative analgesia was 2,7 days. That of urinary catheterization was 8.5 days. A normal postoperative course was noted in most cases (88,4 %. Seven patients were found to have 8 (13,3 % mild and moderate complications. A pathohistological study revealed a positive surgical margin of resection in 21,7 % of the patients, extracapsular tumor growth in 21,7 %, and seminal vesicle invasion in 23,3 %. Tumor-affected regional lymph nodes were detected in 1 (1,7 % patient. In our observed series, 82 and 93 % of the subjects completely retained urine after 6 and 12 moths, respectively. Throughout the follow-up, erectile function recovered in 7 of the 15 patients undergoing a nerve-sparing surgical procedure.Conclusion. Postoperative results in our series of interventions are comparable to those obtained in the studies by Russian and foreign colleagues at the early stage of mastering this procedure. By considering a few observations, it is today difficult to say that our study is valid in the context of evidence-based medicine. Estimation of the benefits of robot-assisted laparoscopic prostatectomy calls for long-term multicenter randomized trials.

  2. ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY: OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    S. N. Nesterov

    2011-01-01

    Full Text Available Background. Retropubic radical prostatectomy (RPE is now the gold standard of treatment for locally advanced prostate cancer (PC. However, robot-assisted RPE procedures using the da Vinci system are finding increasing acceptance.Materials and methods. The authors conducted a prospective study of 60 robot-assisted prostatectomies made at the Clinic of Urology, N.I. Pirogov National Medical Surgical Center, in the period January 2009 to December 2010.Results. The duration of an operation averaged 230 min; the average amount of blood loss was 200 ml. The mean duration of postoperative analgesia was 2,7 days. That of urinary catheterization was 8.5 days. A normal postoperative course was noted in most cases (88,4 %. Seven patients were found to have 8 (13,3 % mild and moderate complications. A pathohistological study revealed a positive surgical margin of resection in 21,7 % of the patients, extracapsular tumor growth in 21,7 %, and seminal vesicle invasion in 23,3 %. Tumor-affected regional lymph nodes were detected in 1 (1,7 % patient. In our observed series, 82 and 93 % of the subjects completely retained urine after 6 and 12 moths, respectively. Throughout the follow-up, erectile function recovered in 7 of the 15 patients undergoing a nerve-sparing surgical procedure.Conclusion. Postoperative results in our series of interventions are comparable to those obtained in the studies by Russian and foreign colleagues at the early stage of mastering this procedure. By considering a few observations, it is today difficult to say that our study is valid in the context of evidence-based medicine. Estimation of the benefits of robot-assisted laparoscopic prostatectomy calls for long-term multicenter randomized trials.

  3. Single port laparoscopic assisted pyloromyotomy: our experience

    Directory of Open Access Journals (Sweden)

    Appignani Antonino

    2013-10-01

    Full Text Available Background Ramstedt pyloromyotomy is the procedure of choice for infantile hypertrophic pyloric stenosis; however, the best way to approach the pylorus is debated. Recent literature reports many comparisons between various open and laparoscopic approaches. The purpose of this experience is to show a new approach to infantile hypertrophic pyloric stenosis: single-port, laparoscopic-assisted pyloromyotomy. Methods: 31 infants underwent single-port laparoscopic-assisted pyloromyotomy. The approach to the abdominal cavity is performed through a right circumbilical incision, and then a 12-mm trocar is inserted. After the pneumoperitoneum is established, an operative telescope is introduced. Once the telescope is inserted, the pylorus is easily located, and then grasped and exteriorized via the umbilical incision. At this point, conventional Ramstedt pyloromyotomy is performed. Once the pylorus is reintroduced in the abdomen, a new pneumoperitoneum is created to control mucosal integrity and hemostasis. Results. In all 31 cases operated on, an adequate pyloromyotomy was performed in a good ranging time without any intra- or post-operative complications, achieving also excellent cosmetic results. Conclusions The feasibility of single-port laparoscopic assisted pyloromyotomy obtained in this small sample suggests that this procedure could be an excellent alternative to open or laparoscopic pyloromyotomy as long as it acts as intermediary between the two techniques.

  4. Robot assisted transperitoneal laparoscopic pyeloplasty

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Nowadays,with laparoscope techniques increasingly developed its indications are covering more complicated medical fields.Moreover,as a camera holder,the robotic system of an automated endoscopic system for optimal positioning (AESOP) can be controlled directly by the surgeon's voice.

  5. Robot-Assisted Laparoscopic Seminal Vesicle Cystadenoma Excision

    Science.gov (United States)

    Mourmouris, Panagiotis; Tufek, İlter; Saglican, Yesim; Obek, Can; Kural, Ali Riza

    2015-01-01

    Abstract Background: Cystadenoma is an extremely rare benign tumor of the seminal vesicle. Diagnosis of these tumors and differential diagnosis from malignant ones may be challenging since most of the time symptoms do not occur. Management of these tumors remains debatable due to the limited data in the literature. We present the first robot-assisted laparoscopic excision of a cystadenoma of the seminal vesicle. Case Presentation: A 48-year-old man presented with diminished ejaculate volume and a 3.5 cm right seminal vesicle mass, which increased its size at 6 cm after the 3-month period. Transrectal ultrasound-guided biopsy revealed no malignancy. Robot-assisted laparoscopic excision of the tumor was performed. Port placement was the same as robot-assisted radical prostatectomy. Operative time and estimated blood loss were 240 minutes and 200 mL, respectively. Patient was discharged on postoperative day 3 without any complications. Final histopathologic examination revealed cystadenoma of the seminal vesicle. Conclusion: Surgical intervention may be considered when a cystadenoma of the seminal vesicle is diagnosed and symptoms or tumor growth occurs. Robot-assisted laparoscopic excision is an alternative in the management of these rare tumors.

  6. Pediatric Robot-Assisted Laparoscopic Pyeloplasty

    Science.gov (United States)

    Hollis, Michael V.; Cho, Patricia S.; Yu, Richard N.

    2016-01-01

    The laparoscopic approach to the pyeloplasty procedure has proven to be safe and effective in the pediatric population. Multiple studies have revealed outcomes comparable to the open approach. However, a major drawback to laparoscopy is the technical challenge of precise suturing in the small working space in children. The advantages of robotic surgery when compared to conventional laparoscopy have been well established and include motion scaling, enhanced magnification, 3-dimensional stereoscopic vision, and improved instrument dexterity. As a result, surgeons with limited laparoscopic experience are able to more readily acquire robotic surgical skills. Limitations of the robotic platform include its high costs for acquisition and maintenance, as well as the need for additional robotic surgical training. In this article, we review the current status of the robot-assisted laparoscopic pyeloplasty, including a brief history, comparative outcomes, cost considerations, and training.

  7. 手助腹腔镜胃癌 D2根治术的团队配合%Teamwork Cooperation in Hand-assisted Laparoscopic D2 Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    周均; 曹永宽; 宋亚宁; 王永华; 张国虎; 王培红; 李旭

    2014-01-01

    目的:探讨手助腹腔镜胃癌D2根治术的团队配合技巧及重要性。方法对我中心2010年12月~2013年6月180例手助腹腔镜胃癌D2根治术的临床资料进行回顾性总结。术者及助手相对固定,只需术者及扶镜手两人相互配合,就能完成肿瘤的根治性切除及淋巴结清扫。结果180例均在手助腹腔镜下完成手术,全胃切除术84例,远端胃切除术81例,近端胃切除术15例。手术切口长度(6.9±0.5)cm;术中出血量(226.1±127.0)ml;手术时间(172.2±34.1)min;病检获淋巴结数(17.3±5.0)枚;术后住院时间(9.3±2.0) d。围手术期死亡1例,手术残端癌残留2例。手术相关并发症率6%(11/180)。术后随访1~24个月,失访12例(失访率7%),同时性肝转移4例,异时性淋巴结转移2例,局部复发1例,未发生切口和穿刺口种植。结论良好的团队配合是保证手助腹腔镜胃癌D2根治术的必备条件,对肿瘤的根治程度、手术时间及术后并发症的发生起着至关重要的作用。%Objective To discuss the importance of teamwork coorperation in hand-assisted laparoscopic D2 radical gastrectomy. Methods Clinical materials of 180 patients with gastric cancer undergoing hand-assisted laparoscopic D2 radical gastrectomy from December 2010 to June 2013 were summarized retrospectively.The lymph nodes dissection and radical tumor excision were performed by two persons of cooperation that the operator surgeon worked with camera assistant in a relatively fixed mode in the operation. Results The hand-assisted laparoscopic D2 radical gastrectomy was accomplished in all the patients.Among the 180 patients, gastrectomy was performed in 84 cases, distal gastrectomy in 81 cases, and proximal gastrectomy in 15 cases.The average length of incision was (6.9 ±0.5) cm, the blood loss was (226.1 ±127.0) ml, the operative time was (172.2 ±34.1) min, the number

  8. Management of rectal injury during laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Octavio A. Castillo

    2006-08-01

    Full Text Available PURPOSE: Because laparoscopic radical prostatectomy remains a challenging procedure, rectal injury is always a potential complication. We review the incidence of rectal injuries at our institution in the first 110 consecutive laparoscopic extraperitoneal radical prostatectomies. MATERIALS AND METHODS: Nine (8% out of the first 110 laparoscopic extraperitoneal radical prostatectomies performed between December 2001 and February 2004, were complicated by rectal injury. Mean patient age was 64.9 years (range 52 to 74 and mean prostate specific antigen was 11.45 ng/mL (range 4.8 to 37.4. Median preoperative Gleason score was 6 (range 4 to 8 and clinical stage was T1c, T2a, T2b in 6, 2 and 1 patient, respectively. Mean operative time was 228 minutes (range 150 to 300. RESULTS: From 9 injuries, 6 were diagnosed and repaired intraoperatively and 3 were diagnosed postoperatively. From the 6 cases of intraoperative diagnosis and repair, 3 patients healed primarily without colostomy and a recto-urinary fistula was evidenced by pneumaturia in the remaining three. These 3 patients were managed conservatively with urethral catheterization during 30 days. One of the patients required secondary fistula repair by anterior transphincteric, transanal surgical approach (ASTRA. Urinary fistula was diagnosed postoperatively on 3 patients. A diverting colostomy was performed on one patient with secondary fistula repair by ASTRA. Another patient required laparotomy due to peritonitis and urinary fistula was later managed with ASTRA. On the third patient conservative management with urethral catheter was successful. All fistulas repaired with ASTRA evolved uneventfully. There was no perioperative mortality. CONCLUSIONS: Rectal injury during laparoscopic radical prostatectomy can be managed intraoperatively or by a minimally invasive procedure without the need of colostomy. Laparoscopic radical prostatectomy is a challenging procedure and is associated with a very flat

  9. 超声刀结合单极电凝应用于腹腔镜胃癌根治术的评价%Ultrasonic Scalpel and Monopolar Electrocoagulation in Laparoscopic-assisted Radical Gastrectomy for Gastric Carcinoma

    Institute of Scientific and Technical Information of China (English)

    鱼国盛; 汤黎明; 钱峻; 朱杰

    2011-01-01

    Objective To evaluate the outcome of ultrasonic scalpel combined with monopolar electrocoagulation in laparoscopic-assisted radical gastrectomy for gastric carcinoma. Methods From January 2010 to March 2011, 75 patients with curable gastric carcinoma underwent laparoscopic-assisted radical gastrectomy, of which 39 patients were treated solely by ultrasonic scalpel, the other 36 patients underwent ultrasonic scalpel combined with monopolar electrocoagulation. The operation time, intraoperative blood loss, number of resected lymph nodes, and postoperative drainage volume and complications were analyzed retrospectively and compared between the two groups. Results The mean operation time and blood loss of ultrasonic scalpel group were significantly more than that in the study group [ (347 ±38) min vs. (310 ±23) min, t =5. 049, P = 0. 000, and (274 ± 122) ml vs. (186 ± 90) ml, t = 3. 530, P = 0. 000]. The number of harvested lymph nodes, postoperative drainage volume and the incidence rate of complications were comparable between the two groups ( P > 0.05). Conclusion By combining ultrasonic scalpel with monopolar electrocoagulation in laparoscopic-assisted radical gastrectomy for gastric carcinoma, the advantages of the both methods can be utilized so that to reduce operation time and blood loss,and make lymph nodes resection easier.%目的 评价腹腔镜胃癌根治术中联合应用超声刀及单极电凝的效果.方法 回顾分析2010年1月~2011年3月75例腹腔镜胃癌D2根治术的临床资料,前39例单纯使用超声刀(超声刀组),后36例联合应用超声刀与单极电凝(联合组).比较2组手术时间、术中出血量、平均清扫淋巴结个数、术后引流量及术后并发症方面的差异.结果 与超声刀组相比,联合组术中出血少[(274±122)ml vs.(186±90) ml,t=3.530,P=0.000],手术时间短[(347±38)min vs.(310±23) min,t=5.049,P=0.000],2组清扫淋巴结个数、术后引流量及并发症

  10. Comparative Study of Laparotomy and Laparoscopic-assisted Radical Distal Gastrectomy%开腹及腹腔镜辅助根治性远端胃切除的对比研究

    Institute of Scientific and Technical Information of China (English)

    高金辉; 李建国; 蔡铭智; 蔡丽生; 曾燕华

    2014-01-01

    Objective-To-explore-the-feasibility-of-laparoscopic-assisted-radical-distal-gastrectomy-.-Methods-We-retrospectively-reviewed-the-clinical-data-of-16-cases-undergoing-laparoscopic-gastrectomy-(-laparoscopic-group-)-and-16-cases-undergoing-open-gastrectomy-(-open-group-)-in-our-hospital-from-March-2011-to-June-2012.The-operation-time-,-intraoperative-blood-loss,-number-of-lymph-node-dissected-,-postoperative-anal-exhaust-time-,-time-to-liquid-diet,-and-complications-were-compared-between-the-two-groups.-Results-Compared-with-the-open-group,-the-operation-time-of-laparoscopic-gastrectomy-was-longer-[(183.4-±-20.2)-min-vs.(143.4-±21.6)-min,-t-=5.400,-P-=0.000],-but-the-hemorrhage-volume-was-less-[(157.5-±30.1)-ml-vs.-(183.1-±28.4)-ml,-t=-2.474,-P=0.010],-the-anal-exhaust-time-after-operation-was-earlier-[(2.8-±0.3)-d-vs.(3.6-±0.3)-d,-t=-7.005,-P=0.000],-and-time-to-liquid-diet-after-operation-was-earlier-[(2.9-±0.2)-d-vs.(4.0-±0.2)-d,-t=-13.421,-P=0.000].There-were-no-differences-in-number-of-lymph-nodes-removed-and-complications-between-the-two-groups-(P>0.05).In-the-laparoscopic-group-,-there-were-3-cases-of-pulmonary-infection-,-1-case-of-gastric-paralysis-,-and-1-case-of-anastomotic-bleeding-.In-the-open-group,-there-were-2-cases-of-pulmonary-infection,-2-cases-of-gastric-paralysis,-and-3-cases-of-incisional-infection-or-fat-liquefaction-.-Conclusions-Laparoscopic-gastrectomy-is-feasible-and-safe-for-patients-with-gastric-cancer-.It-can-be-performed-safely-with-comparable-early-curative-effects-to-open-gastrectomy-,-bearing-advantages-of-clear-vision-,-small-trauma-,-less-bleeding-,-and-fast-recovery.%目的:探讨腹腔镜辅助根治性远端胃切除术的可行性。方法回顾性分析我院2011年3月~2012年6月行腹腔镜辅助及开腹根治性远端胃切除术各16例的临床资料。比较2组手术时间、出血量、清扫淋巴结数、术后肛门排气时间、开始流质饮食时间及并发症。结果与开腹组相比,虽

  11. Fast access and early ligation of the renal pedicle significantly facilitates retroperitoneal laparoscopic radical nephrectomy procedures: modified laparoscopic radical nephrectomy

    Directory of Open Access Journals (Sweden)

    Yang Qing

    2013-01-01

    Full Text Available Abstract Background The objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique. Methods One hundred retroperitoneal laparoscopic nephrectomies were performed from February 2007 to October 2011. The previous technique was performed in 60 cases (Group 1. The modified technique (n = 40 included fast access to the renal pedicle according to several anatomic landmarks and early ligation of renal vessels (Group 2. The mean operation time, mean blood loss, duration of hospital stay conversion rate and complication rate were compared between the groups. Results No significant differences were detected regarding mean patient age, mean body mass index, and tumor size between the two groups (P >0.05. The mean operation time was 59.5 ± 20.0 and 39.5 ± 17.5 minutes, respectively, in Groups 1 and 2 (P P P >0.05. Conclusions Early ligature using fast access to the renal vessels during retroperitoneal laparoscopic radical nephrectomy contributed to less operation time and intraoperative blood loss compared with the previous technique. In addition, the modified technique permits the procedure to be performed following the principles of open radical nephrectomy.

  12. HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY. THE FIRST RUSSIAN EXPERIENCE

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2010-01-01

    Full Text Available The first experience of hand-assisted laparoscopic donor nephrectomy is described in the article. A new technique of the operation and it’s results are discussed in details. Advantages of this type of the operation in comparison with open and full laparoscopic techniques are presented. 

  13. Minilaparoscopy-assisted transumbilical laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    GERALDO JOSÉ DE SOUZA LIMA

    2016-06-01

    Full Text Available ABSTRACT The role of laparoscopy in the modern surgery era is well established. With the prospect of being able to improve the already privileged current situation, new alternatives have been proposed, such as natural orifice endoscopic surgery (NOTES, the method for single transumbilical access (LESS - Laparo-endoscopic single-site surgery and minilaparoscopy (MINI. The technique proposed by the authors uses a laparoscope with an operative channel like the flexible endoscope used in NOTES. All operative times are carried out through the umbilical trocar as in LESS, and assisted by a minilaparoscopy grasper. This new technic combines, and results from, the rationalization of technical particularities and synergy of these three approaches, seeking to join their advantages and minimize their disadvantages.

  14. 腹腔镜辅助结肠癌根治术32例报告%Laparoscopic assisted radical colectomy:a report of 32 cases

    Institute of Scientific and Technical Information of China (English)

    余水平; 陈胜林; 王文友; 莫伟明; 汪栋宇; 张彬

    2007-01-01

    自1991年Jcobs用腹腔镜行结肠癌根治术以来。该技术得到不断发展。使腹腔镜辅助结肠癌根治术(laparoscopie assisted colectomy LAC)成为治疗结肠癌的主要手段之一,但LAC的安全性和疗效一直存在争议。本文总结我院开展LAC的初步经验,旨在探讨LAC的可行性和临床疗效。

  15. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations.

    Science.gov (United States)

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-07-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  16. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations.

    Science.gov (United States)

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-07-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  17. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

    Science.gov (United States)

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-01-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  18. Application of right-to-lateral approach in laparoscopic-assisted radical gastrectomy%右侧入路在腹腔镜胃癌根治术中的应用

    Institute of Scientific and Technical Information of China (English)

    尤俊; 黄正接; 许林; 卢传辉; 刘凯华; 黄安乐; 李永文; 罗琪

    2014-01-01

    Objective To explore the technical feasibility,safety,and short-term clinical efficacy of right-to-lateral approach in laparoscopic-assisted radical gastrectomy.Methods Clinicopathological data of 178 gastric cancer patients undergoing laparoscopic-assisted radical gastrectomy,including 92 patients with right-to-lateral approach (R-LG group) and 86 cases with left-to-lateral approach (L-LG group),in our department from October 2010 to September 2013 were analyzed retrospectively.Short-term efficacy and complication morbidity were compared between R-LG group and L-LG group according to body mass index(BMI).Results For those patients with BMI≥24 kg/m2,the R-LG group (35 cases) had shorter mean operation time,less intraoperative blood loss,shorter painkiller used time than L-LG group(31 cases)[(227±17) min vs.(262±23) min,(73±9) ml vs.(84±8) ml and (2.1±0.1) d vs.(2.6±0.4) d,all P<0.05].The average time to ambulation and recovery time of peristalsis in the R-LG group were faster than those in L-LG group [(2.2±0.2) d vs.(2.8±0.6) d and (3.6±0.3) d vs.(4.2± 0.5) d,all P<0.05].The R-LG group had more dissected lymph nodes per patient (35±4) than the L-LG group (30±5) with significant difference (P<0.05).There were no significances in postoperative hospital stay,postoperative complication morbidity and hospitalization expenses between R-LG and L-LG group (all P>0.05).For those patients with BMI<24 kg/m2,there were no significant differences in all above parameters between R-LG group(57 cases) and L-LG group(55 cases).No mortality and recurrence was observed during follow-up of 3 to 24 months.Conclusion Right-to-lateral approach in laparoscopicassisted radical gastrectomy is a safe and feasible procedure,especially for the obesity patients,which can shorten the operation time,decrease intraoperative blood loss,lead to a faster postoperative recovery and harvest more lymph nodes as compared to L-LG procedure.%目的 探讨右侧入路应用于腹腔

  19. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions

    Science.gov (United States)

    Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

    2016-01-01

    Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen’s fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated. PMID:26877605

  20. Laparoscopic pelvic anatomy of nerve-sparing radical hysterectomy.

    Science.gov (United States)

    Park, Nae Yoon; Cho, Young Lae; Park, Il Soo; Lee, Yoon Soon

    2010-03-01

    Many reports regarding nerve-sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve-sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve-sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament. PMID:20108355

  1. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy.

    Science.gov (United States)

    Thaker, Adarsh M; Sedarat, Alireza

    2016-09-01

    There are a variety of techniques for gastrostomy tube placement. Endoscopic and radiologic approaches have almost entirely superseded surgical placement. However, an aging population and significant advancements in modern healthcare have resulted in patients with increasingly complex medical issues or postsurgical anatomy. The rising prevalence of obesity has also created technical challenges for proceduralists of many specialties. When patients with these comorbidities develop the need for long-term enteral nutrition and feeding tube placement, standard approaches such as percutaneous endoscopic gastrostomy (PEG) by endoscopists and percutaneous image-guided gastrostomy (PIG) by interventional radiologists may be technically difficult or impossible. For these challenging situations, laparoscopic-assisted PEG (LAPEG) is an alternative option. LAPEG combines the advantages of PEG with direct intraperitoneal visualization, helping ensure a safe tube placement tract free of intervening organs or structures. In this review, we highlight some of the important factors of first-line gastrostomy techniques, with an emphasis on the utility and procedural technique of LAPEG when they are not feasible. PMID:27422123

  2. Laparoscopic assisted anorectal pull through: Reformed techniques

    Directory of Open Access Journals (Sweden)

    Bhandary Karthik

    2009-01-01

    Full Text Available Aim: To assess the modifications in the technique of laparoscopic assisted anorectal pull through (LAARP practiced at our institute and analyze the post operative outcome and associated complications. Materials and Methods: A retrospective study from January 2001 to May 2009 analyzing LAARP for high anorectal malformations. Results: A total of 40 patients - 34 males and six females, in the age group of two months to six years were studied. Staged procedure was done in 39 patients; one child with recto vestibular fistula underwent single stage procedure. All the patients withstood surgery well. One patient required conversion due to problems in gaining enough length for the distal rectum in a patient with rectovesical fistula so colostomy was closed and re-located at a proximal splenic flexure. The complications were mucosal prolapse (six cases, anal stenosis (three, adhesive obstruction (two, distal rectal necrosis (one, and urethral diverticulum (one. The patients were followed up with clinical evaluation and continence scoring. The progress has been satisfactory and weight-gain is adequate. Conclusions: The advantages of the reformed techniques are as follows: Transcutaneous bladder stitch provides excellent visualization; traction over the fistula helps in dissection of the puborectalis, dividing the fistula without ligation is safe, railroading of Hegar′s dilators over the suction canula creates adequate pull through channel, saves time and makes procedure simpler with reproducible comparable reports.

  3. HAND-ASSISTED LAPAROSCOPIC NEPHROURETERECTOMY: INITIAL CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Nephroureterectomy with removal of a bladder cuff was performed successfully on a 47-year -old man for transitional cell carcinoma of the right renal pelvis using hand-assisted laparoscopy. The results showed that hand-assisted laparoscopic nephroureterectomy is an efficacious altemative to open surgery and provides the urologist new to laparoscopy a shorter learning curve compared with standard laparoscopy.

  4. Robotics and telesurgery--an update on their position in laparoscopic radical prostatectomy.

    Science.gov (United States)

    Rassweiler, J; Safi, K C; Subotic, S; Teber, D; Frede, T

    2005-01-01

    Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D-vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot-assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as six telesurgical interventions with the da Vinci-system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees ; the angles between the instrument and the working plane that should not exceed 55 degrees ; and the bi-planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 degrees to 110 degrees . 3-D-systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF). To date

  5. 机器人辅助腹腔镜下前列腺癌根治术38例临床分析%Robot assisted laparoscopic radical prostatecto my:Cli nical analysis of 38 cases

    Institute of Scientific and Technical Information of China (English)

    孙康伟; 袁建林; 杨晓剑; 王延柱; 孟平; 张龙龙; 武鹏

    2014-01-01

    To-co-mpare-the-peri-operati-ve-cli-nical-data-,co-mplicati-ons-,postoperati-ve-functi-on-recovery-after-Leonardo's-robot-assisted-laparoscopic-radical-prostatecto-my-(RALRP-)vs-.retropubic-radical-prostatecto-my-(RRP-)for-l-ocal-prostate-cancer-,and-pri-maril-y-eval-uate-the-applied-val-ue-of-RALRP-.Methods-:The-cli-nical-data-of-38-cases-of-prostate-cancer-undergoi-ng-RALRP-perfor-med-by-the-sa-me-group-of-surgeons-fro-m-Jan-.201-3-to-Nov-.-201-3-were-retrospecti-vel-y-anal-yzed-.The-operati-ng-ti-me-,bl-ood-l-oss-,bl-ood-transfusi-on-,postoperati-ve-hospital-stay-and-postoperati-ve-foll-o-w--up-uri-nary-conti-nence-were-observed-i-n-RALRP-group-,and-co-mpared-with-those-i-n-20-cases-of-RRP-at-the-sa-me-peri-od-.Results-:In-RALRP-and-RRP-group-,the-average-operati-ve-ti-me-was-4-6-h-and-3-1-5-h-,and-the-average-bl-ood-l-oss-was-50-1-50-mL-and-850-1-500-mL-(P-<005-).The-bl-ood-transfusi-on-rate-i-n-RALRP-and-RRP-groups-was-0-and-85-%respecti-vel-y-(P-<0-.05-).The-conti-nence-rate-one-month-after-operati-on-i-n-RALRP-group-and-RRP-group-was-81-.6-%-and-55-%-respecti-vel-y-(P-<005-).The-average-postoperati-ve-hostal-stay-i-n-RALRP-group-and-RRP-group-was-53-days-and-1-0-.6-days-respecti-vel-y-(P-<005-).Conclusions-:The-pri-mary-results-suggest-that-RALRP-sho-ws-the-advantages-of-reduci-ng-bl-ood-l-oss-and-bl-ood-transfusi-on-,and-advanci-ng-the-controlled-micturiti-on-over-RRP-.%目的:对比达芬奇机器人辅助腹腔镜前列腺癌根治术(RAL-RP )与耻骨后前列腺癌根治术(RRP )两种手术方式治疗局限性前列腺癌的围手术期临床资料、并发症发生率、术后功能恢复等方面指标,初步评价机器人辅助腹腔镜前列腺癌根治术的价值。方法:回顾2013年1月~2013年11月由同一组医生行 RALRP 术38例临床资料。观察手术时间、出血量、输血情况、术后住院时间、随访控尿等情况,与同期该组医生行 RRP 术20例临床资料相比较并进行统计学分析。结果:RALRP

  6. Laparoscopic repair of diaphragmatic hernia after left ventricular assist device.

    Science.gov (United States)

    Farma, Jeffrey; Leeser, David; Furukawa, Satoshi; Dempsey, Daniel T

    2003-06-01

    This case report describes a patient with a symptomatic diaphragmatic hernia that developed after orthotopic heart transplantation and explantation of a left ventricular assist device. The hernia was repaired laparoscopically, and at 6-month follow-up, she is without evidence of recurrence.

  7. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy.

    Science.gov (United States)

    Shiroki, Ryoichi; Fukami, Naohiko; Fukaya, Kosuke; Kusaka, Mamoru; Natsume, Takahiro; Ichihara, Takashi; Toyama, Hiroshi

    2016-02-01

    Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot-assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm(2) , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy

  8. Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

    Directory of Open Access Journals (Sweden)

    Carlo Camargo Passerotti

    2012-02-01

    Full Text Available CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with

  9. Cystic local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy in a hemodialysis patient.

    Science.gov (United States)

    Ito, Kazuyo; Takagi, Toshio; Kondo, Tsunenori; Yoshida, Kazuhiko; Iizuka, Junpei; Kobayashi, Hirohito; Tomita, Eri; Hashimoto, Yasunobu; Tanabe, Kazunari

    2014-03-01

    Although local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy is sometimes reported, cystic local recurrence of renal cell carcinoma has rarely been reported. We report the case of a 59-year-old man with hemodialysis who developed cystic local recurrence of renal cell carcinoma accompanied by acquired cystic disease of the kidney in the retroperitoneal space after laparoscopic radical nephrectomy. A cystic tumor of 5.1 cm in diameter occurred in the left retroperitoneal space 15 months after left laparoscopic radical nephrectomy, and enlarged to 7.2 cm in diameter with enhanced mass along the wall of the cyst 36 months after surgery. The cystic tumor was removed and showed local recurrence of renal cell carcinoma on pathological examination.

  10. Laparoscopic-Assisted Cryptorchidectomy in an Adult Reindeer (Rangifer tarandus

    Directory of Open Access Journals (Sweden)

    Romain Pizzi

    2011-01-01

    Full Text Available A successful laparoscopic-assisted cryptorchidectomy is reported in a novel species, the reindeer (Rangifer tarandus. The procedure was performed in an 8-year-old adult positioned in dorsolateral oblique recumbency, with an open approach midline subumbilical placement of the primary 10 mm optical port and carbon dioxide insufflation at 12 mmHg. Three 5 mm instrument ports were inserted under visualization in the left caudal abdomen as the retained testicle was localized to the internal inguinal ring. A 5 mm flexible organ retractor was used to assist in localizing the retained testicle. This procedure provided a less invasive alternative to open laparotomy. The authors are unaware of any published reports of laparoscopy in reindeer, or of laparoscopic assisted cryptorchidectomy in deer species.

  11. Primary Renal Lymphoma Identified in a Robot-Assisted Laparoscopic Nephroureterectomy Specimen

    Science.gov (United States)

    Jipp, Jacob; Kay, Paul; Schwartz, Bradley

    2016-01-01

    Abstract Background: Although renal involvement is often present in non-Hodgkin's lymphoma (NHL), primary renal NHL is a rare diagnosis. Case Presentation: We present a case report of a 72-year-old asymptomatic male who underwent a robot-assisted laparoscopic radical nephroureterectomy on an atrophic left kidney with evidence of an infiltrating mass. Pathology report demonstrated a grade 1 follicular lymphoma. Conclusion: Lymphoma is a differential that should be considered when evaluating a renal mass. Chemotherapy and radiation are the mainstays of treatment.

  12. Robot-assisted laparoscopic radical prostatectomy: report of 107 cases%机器人辅助腹腔镜下根治性前列腺切除术107例报告

    Institute of Scientific and Technical Information of China (English)

    高旭; 王燕; 杨波; 王海峰; 叶华茂; 王辉清; 鲁欣; 李耀明; 方梓宇

    2014-01-01

    Objective To summarize our initial experience and early postoperative follow-up results with robot assisted laparoscopic radical prostatectomy (RALP) and evaluate the efficacy and safety of this surgical method.Methods 107 patients underwent RALP in our hospital from March 2012 to November 2013.The mean age of the patients was 67 years (range,49-80 years),The mean pretreatment serum PSA level was 23.6 μg/L(range,3.6-209.0 μg/L),and mean preoperative Gleason score was 7.4 (range,5-10).Clinical stages were between T1aN0M0-T3aN0M0,which ≤< T3c in 6 cases,T2a in 10 cases,T2b in 46 patients,T2c in 39 cases,T3a in 6 cases.Under the general anesthesia,all patients received RALP.Among them,transperitoneal approach was chosen in 102 patients and extraperitoneal approach was chosen in 5 patients.The level of serum PSA and urinary continence were followed up after procedure.Results Except one patient converted to open surgery due to the serious adhesion between prostate and rectum,the remaining 106 cases are performed successfully.The mean preoperative set up time of the robot was 52 min (range,28-106 min),and mean operation time was 182 min (range,118-462 min).The perioperative blood loss averaged 232 ml (range,50~ 1 300 ml),and 5 patients required blood transfusion ; The patients were ambulant between the 2nd and 4th postoperative days.Foley catheter was successfully removed on day 7 to 14 and mean hospital stay after surgery was 11 days (range,5-20 d).Postoperative pathology was prostatic adenocarcinoma in all patients.Pathological stages were between pT2aN0M0-pT3b N1 M0.Positive margin rate was 15% (16/107).Seminal vesicle invasion was found in 7 patients and obturator lymph node metastasis was observed in 2 patients.The mean postperative Gleason score was 7.4 (range,6-10).During a median follow-up of 6 (range,1-19) months,the level of serum PSA was more than 0.2 μg/L in 9 patients 4 weeks after RALP.After 3 and 6 months,the urinary continence recovery rates

  13. Laparoscopic Assisted Transmesocolonic Percutaneous Nephrolithotripsy in Ectopic Iliac Kidney

    OpenAIRE

    N. Sohail; Albodour, A.; K. Abdelrahman

    2016-01-01

    We report a case of 15-year old female who presented with recurrent lower abdominal pain treated three times with ESWL previously. She was diagnosed as having right ectopic kidney with a 4 cm renal stone in renal pelvis and involving lower and mid calyx. She was treated successfully with laparoscopic assisted transmesocolonic percutaneous nephrolithotripsy. Procedure resulted in complete stone clearance without any perioperative or post operative complication. Patient stayed in hospital for 7...

  14. Hand-assisted laparoscopic nephrectomy in living donor

    Directory of Open Access Journals (Sweden)

    Luiz S. Santos

    2003-02-01

    Full Text Available OBJECTIVE: Report the authors’ initial experience with hand-assisted laparoscopic nephrectomy technique in renal donors for transplantation. MATERIALS AND METHODS: Twenty-seven donors submitted to hand-assisted laparoscopic nephrectomy were retrospectively analyzed from February 2001 to June 2002. Technical aspects of the donor surgery, results, and complications, are discussed, as well as recipient’s complications and outcomes. RESULTS: Among 27 hand-assisted laparoscopic nephrectomies, left kidney was withdrew in 18 donors (66.6%, and right kidney in 9 (33.3%. The operative time ranged from 55 to 210 minutes (mean 132.7 ± 37.6 min, and the time of hot ischemia ranged from 2 to 11 minutes (mean 4.7 ± 2.5 min, with an estimated mean blood loss during the intraoperative period of 133.3 mL. Conversion to open surgery was necessary for 1 (3.7% patient due to vascular lesion. In graft evaluation, immediate diuresis was observed in 26 (96.3% cases, and mean serum creatinine in PO day 7 was 1.5 ± 1.1 mg/dL. Renal vein thrombosis occurred in 1 (3.7% patient requiring graft removal. Lymphocele was observed in 3 recipients (11.1%, and urinary leakage due to ureteral necrosis in 1 case (3.7%. CONCLUSION: Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure presented low morbidity after surgery providing to the recipient a good morphological and functional quality of the graft.

  15. Hand-assisted right laparoscopic nephrectomy in living donor

    Directory of Open Access Journals (Sweden)

    Fernando Meyer

    2005-02-01

    Full Text Available OBJECTIVE: To assess results obtained with the authors' technique of right hand-assisted laparoscopic nephrectomy in living kidney donors. MATERIALS AND METHODS: We retrospectively analyzed 16 kidney donors who underwent hand-assisted right laparoscopic nephrectomy from February 2001 to July 2004. Among these patients, 7 were male and 9 were female, with mean age ranging between 22 and 58 years (mean 35.75. RESULTS: Surgical time ranged from 55 to 210 minutes (mean 127.81 min and warm ischemia time from 2 to 6 minutes (mean 3.78 min with mean intra-operative blood loss estimated at 90.62 mL. There was no need for conversion in any case. Discharge from hospital occurred between the 3rd and 6th days (mean 3.81. On the graft assessment, immediate diuresis was seen in 15 cases (93.75% and serum creatinine on the 7th post-operative day was 1.60 mg/dL on average. Renal vein thrombosis occurred in 1 patient (6.25% who required graft removal, and lymphocele was seen in 1 recipient (6.25%. CONCLUSION: Hand-assisted right laparoscopic nephrectomy in living donors is a safe and effective alternative to open nephrectomy. Despite a greater technical difficulty, the procedure presented low postoperative morbidity providing good morphological and functional quality of the graft on the recipient.

  16. Hand-assisted laparoscopic surgery of abdominal large visceral organs

    Institute of Scientific and Technical Information of China (English)

    Li-Hua Dai; Bo Xu; Guang-Hui Zhu

    2006-01-01

    AIM: To design a hand-assisted laparoscopic approach in an attempt to provide an option for laparoscopic resection of abdominal large viscera.METHODS: A 5-6 cm incision (for HandPort) and 2 trocars were employed. The main vessel of the target organ was taken as a "core", and all tissues around the core were taken as peripheral structures. The peripheral structures were dissected first, and the core vessels were treated last. Twenty-six patients underwent laparoscopic deroofing of the hepatic huge cysts, resection of the segments lying at the outer edge of the liver (segments 2 to 6), splenectomy, hemicolectomy, ileocecectomy and subtotal gastrectomy with HandPort device, harmonic scalpel, or Ligasure.RESULTS: The duration of the procedure was within 2 hours. Blood loss amounted to 8-120 mL. The conversion rate was 3.8% (1/26). All patients had uneventful postoperative courses with less pain, earlier oral intake,and faster recovery, compared with conventional surgery.CONCLUSION: This method combines the advantages of both open and laparoscopic techniques, achieving better hemostasis effect, shortening the operative time,and is beneficial to the patients.

  17. Robot-assisted laparoscopic urological surgery in children.

    Science.gov (United States)

    Sávio, Luís F; Nguyen, Hiep T

    2013-11-01

    Robot-assisted laparoscopic surgery (RALS) has been proven to be safe and effective for various urological procedures in children, including pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation. The robot system enables delicate and precise movements, which are ideal for the types of reconstructive surgeries that children with urological issues often require, overcoming many of the impediments associated with the conventional laparoscopic approach. RALS helps the relative novice to perform fine surgical techniques and is thought to reduce the learning curve associated with some surgical techniques, such as intracorporeal suturing, owing to the improved freedom of movement of the surgical instruments, the ergonomic positioning of the surgeon, and the 3D vision provided by the robotic system. Given the favourable safety profile and associated benefits of the robot system, including reductions in mean postoperative hospital stay compared with conventional procedures, RALS is becoming more widely adopted by paediatric urologists. PMID:24100517

  18. Robot-assisted laparoscopic urological surgery in children.

    Science.gov (United States)

    Sávio, Luís F; Nguyen, Hiep T

    2013-11-01

    Robot-assisted laparoscopic surgery (RALS) has been proven to be safe and effective for various urological procedures in children, including pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation. The robot system enables delicate and precise movements, which are ideal for the types of reconstructive surgeries that children with urological issues often require, overcoming many of the impediments associated with the conventional laparoscopic approach. RALS helps the relative novice to perform fine surgical techniques and is thought to reduce the learning curve associated with some surgical techniques, such as intracorporeal suturing, owing to the improved freedom of movement of the surgical instruments, the ergonomic positioning of the surgeon, and the 3D vision provided by the robotic system. Given the favourable safety profile and associated benefits of the robot system, including reductions in mean postoperative hospital stay compared with conventional procedures, RALS is becoming more widely adopted by paediatric urologists.

  19. Robot-Assisted Laparoscopic Repair of Spontaneous Appendicovesical Fistula

    Science.gov (United States)

    Kibar, Yusuf; Yalcin, Serdar; Kopru, Burak; Topuz, Bahadir; Ebiloglu, Turgay

    2016-01-01

    Abstract Background: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. Case Presentation: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. Conclusion: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option.

  20. The Essential Elements of a Robotic-Assisted Laparoscopic Hysterectomy.

    Science.gov (United States)

    Simpson, Khara M; Advincula, Arnold P

    2016-09-01

    Robotic-assisted laparoscopic hysterectomies are being performed at higher rates since the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA, USA) received US Food and Drug Administration approval in 2005 for gynecologic procedures. Despite the technological advancements over traditional laparoscopy, a discrepancy exists between what the literature states and what the benefits are as seen through the eyes of the end-user. There remains a significant learning curve in the adoption of safe and efficient robotic skills. The authors present important considerations when choosing to perform a robotic hysterectomy and a step-by-step technique. The literature on perioperative outcomes is also reviewed. PMID:27521880

  1. Salvage robot-assisted radical prostatectomy after brachytherapy: our experience

    OpenAIRE

    A. V. Govorov; A. O. Vasilyev; E. A. Prilepskaya; K. B. Kоlоntaryov; D. Yu. Pushkar

    2014-01-01

    In case of recurrence of prostate cancer after radiation therapy patient may be offered salvage radical prostatectomy (both open and laparoscopic/robotic), hormone therapy, and a number of alternative techniques such as salvage cryoablation, HIFU-therapy and brachytherapy. Results of monitoring of patients for 10 years after salvage treatment of prostate cancer are known only after salvage prostatectomy. Technically radical prostatectomy after radiation therapy is associated with a large numb...

  2. [Oncological and functional results of laparoscopic radical prostatectomy after 100 procedures: our experience].

    Science.gov (United States)

    Parma, P; Dall'oglio, B; Samuelli, A; Guatelli, S; Bondavalli, C

    2009-01-01

    Laparoscopic radical prostatectomy plays an emerging role in the surgical management of prostatic tumors. We present our experience of the first 100 cases of extraperitoneal laparoscopic radical prostatectomy. Our results about continence, erectile function and surgical margins are reported. MATERIALS AND METHODS. Between January 2005 and December 2007, 100 laparoscopic radical prostatectomies were performed by one surgeon. We retrospectively reviewed margins status, operative time, blood transfusion rates, time of catheterization, length of hospital stay, continence and potency rates. RESULTS. The operative time decreased during the learning curve. The mean duration of surgery was 240 minutes (in the first 25 procedures the median time was 320 minutes, while in the last 25 cases the mean duration was 200 minutes). Five conversions to open surgery were required owing to failure to progress. The overall rate of positive surgical margins was 15% in pT2 and 35% in pT3a tumors. We had 3 minor complications (two anastomotic leakage and one hemorrhage from the anastomosis) and 2 major complications (recto-urethral fistula). The mean intraoperative blood loss was 450 ml (range 200-1500). With regard to transfusion, 25 patients (25%) received their autologous units, while 2% of the patients required homologous units. The mean duration of catheterization was 7.8 days. The continence rate at 12 months was 85%; the potency rate was 55% at 12 months. CONCLUSIONS. The results of the present study show that by using a rational approach to training, a general urologist with low experience in laparoscopy is able to safely perform laparoscopic radical prostatectomy, and with oncological and functional results comparable to those of other published series. PMID:21086314

  3. Surgical and obstetrical outcomes after laparoscopic radical trachelectomy and pelvic lymphadenectomy for early cervical cancer

    Science.gov (United States)

    Yoo, So-Eun; So, Kyeong A; Kim, Seon-Ah; Kim, Mi Kyung; Lee, Yoo Kyung; Lee, In-Ho; Kim, Tae-Jin

    2016-01-01

    Objective The aim of this study was to evaluate the surgical and obstetrical outcomes of patients with early cervical cancer who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy. Methods We analyzed data from women who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy between July 2000 and October 2014. Results Of a total of 12 patients, 91.7% were FIGO (International Federation of Gynecology and Obstetrics) stages IA2 and IB1. Seven patients (58.3%) had squamous cell carcinoma. The median tumor size was 1.87 cm (range, focal to 4.6 cm) and two patients (16.7%) had a tumor lager than 2 cm. Lymphovascular space invasion in the tumor lesion was reported in six patients (50%). The following surgical complications were observed: neurogenic bladder (one patient), hemoperitoneum (one patient), and infection (one patient). A total of 33.3% had attempted to conceive, resulting in two pregnancies and two healthy babies. All pregnancies were achieved by in vitro fertilization and embryo transfer. Each woman underwent cesarean delivery because of premature pre-labor rupture of membranes at gestational weeks 27.3 and 33.3. After a median follow-up time of 4.4 years (range, 1 to 8 years), there were no recurrences or deaths. Conclusion Laparoscopic radical trachelectomy and pelvic lymphadenectomy should be offered as an alternative treatment for women with early stage cervical cancer who want to preserve their fertility.

  4. [Laparoscopic radical cystectomy and orthotopic urinary diversion in the male patient: technique].

    Science.gov (United States)

    Nuñez-Mora, C; Cabrera, P; García-Mediero, J M; de Fata, F Ramón; González, J; Angulo, J

    2011-04-01

    Radical cystectomy with extended pelvic lymphadenectomy remains the treatment of choice for muscle invasive bladder cancer and non-metastatic chorion-invasive high grade tumors resistant to treatment with intravesical chemotherapy. During the last decade the procedure has been refined and we have acquired the skills necessary to perform it using the laparoscopic approach. In this way, the oncologic and functional outcomes obtained can be compared to those of its open counterpart. This article describes in detail the technique of radical cystoprostatectomy and urinary diversion in the male patient conducted by our group in an attempt to improve the knowledge and spread of this always difficult procedure. PMID:21487170

  5. Hand-assisted versus straight laparoscopic sigmoid colectomy on a training simulator: what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator.

    LENUS (Irish Health Repository)

    Leblanc, Fabien

    2010-12-01

    We hypothesized that simulator-generated metrics and intraoperative errors may be able to differentiate the technical differences between hand-assisted laparoscopic (HAL) and straight laparoscopic (SL) approaches.

  6. Robot-assisted laparoscopic excision of a retroperitoneal paracaval tumor.

    Science.gov (United States)

    Wei, Tzu-Chun; Chung, Hsiao-Jen; Lin, Alex T L; Chen, Kuang-Kuo

    2013-12-01

    During the past few years, robotic surgical systems have been rapidly developed. The progress and advantages of these systems include three-dimensional vision and enhanced ergonomics. These advantages have helped a new generation of minimally invasive surgery to evolve. The da Vinci Surgical System seems to greatly resolve problems (e.g., wide exposure and retraction of peritoneal organs) that are confronted by traditional laparoscopic surgeries for retroperitoneal tumors that are near great vessels. There have been few reported cases concerning laparoscopic excision of retroperitoneal tumors situated between the inferior vena cava, the right renal vessel, and the kidney. We report the use of a robotic surgical system for this type of treatment. A 54-year-old female patient had a hypoechoic lesion near the inferior vena cava and superior to the right renal vessels. It was incidentally found by ultrasound during a health check-up examination. The computed tomography (CT) scan revealed a heterogeneous contrast-enhanced retroperitoneal mass approximately 4.4 cm medial to the right kidney with the inferior vena cava slightly deviated to the left. Robot-assisted laparoscopic excision of the retroperitoneal tumor was performed on October 15, 2010 with an operation time of 135 minutes and an estimated blood loss of less than 30 mL. The J-Vac drainage tube was removed on postoperative Day 3, and the patient was discharged in a stable condition the following day. The pathology of the tumor was retroperitoneal schwannoma. A re-evaluation was arranged postoperatively for the 15-month ambulatory visit. No local recurrence or distal metastasis was present. PMID:24079977

  7. Robot-Assisted Laparoscopic Adenomyomectomy for Patients Who Want to Preserve Fertility.

    Science.gov (United States)

    Chung, Youn Jee; Kang, So Yeon; Choi, Mi Rang; Cho, Hyun Hee; Kim, Jang Heub; Kim, Mee Ran

    2016-11-01

    An adenomyomectomy is a conservative-surgical option for preserving fertility. Conventional laparoscopic adenomyomectomies present difficulties in adenomyoma removal and suturing of the remaining myometrium. Robot-assisted laparoscopic surgery could overcome the limitations of conventional laparoscopic surgery. Four patients with severe secondary dysmenorrhea and pelvic pain visited Seoul St. Mary's Hospital and were diagnosed with adenomyosis by pelvic ultrasonography and pelvic magnetic resonance imaging (MRI). The four patients were unmarried, nulliparous women, who desired a fertility-preserving treatment. We performed robot-assisted laparoscopic adenomyomectomies. The dysmenorrhea and pelvic pain of the patients nearly disappeared after surgery. No residual adenomyosis was observed on the follow-up pelvic MRI. A robot-assisted laparoscopic adenomyomectomy was feasible, and could be a minimally invasive surgical option for fertility-sparing treatment in patients with adenomyosis. PMID:27593887

  8. Salvage robot-assisted radical prostatectomy after brachytherapy: our experience

    Directory of Open Access Journals (Sweden)

    A. V. Govorov

    2014-11-01

    Full Text Available In case of recurrence of prostate cancer after radiation therapy patient may be offered salvage radical prostatectomy (both open and laparoscopic/robotic, hormone therapy, and a number of alternative techniques such as salvage cryoablation, HIFU-therapy and brachytherapy. Results of monitoring of patients for 10 years after salvage treatment of prostate cancer are known only after salvage prostatectomy. Technically radical prostatectomy after radiation therapy is associated with a large number of complications if compared with primary radical prostatectomy. The most frequent complications after salvage prostatectomy include incontinence, stricture formation of urethrovesical anastomosis, rectal injury, acute urinary retention and infectious complications.

  9. Salvage robot-assisted radical prostatectomy after brachytherapy: our experience

    Directory of Open Access Journals (Sweden)

    A. V. Govorov

    2014-01-01

    Full Text Available In case of recurrence of prostate cancer after radiation therapy patient may be offered salvage radical prostatectomy (both open and laparoscopic/robotic, hormone therapy, and a number of alternative techniques such as salvage cryoablation, HIFU-therapy and brachytherapy. Results of monitoring of patients for 10 years after salvage treatment of prostate cancer are known only after salvage prostatectomy. Technically radical prostatectomy after radiation therapy is associated with a large number of complications if compared with primary radical prostatectomy. The most frequent complications after salvage prostatectomy include incontinence, stricture formation of urethrovesical anastomosis, rectal injury, acute urinary retention and infectious complications.

  10. Hand-Assisted Laparoscopic Donor Nephrectomy in Complete Situs Inversus.

    Science.gov (United States)

    Gahagan, John V; Whealon, Matthew D; Reddy, Uttam; Foster, Clarence E; Ichii, Hirohito

    2016-01-01

    Complete situs inversus is a rare congenital anomaly characterized by transposition of organs. We report a case of renal transplantation using a kidney from a living complete situs inversus donor. The recipient was a 59-year-old female with end-stage renal disease because of type 2 diabetes mellitus. The donor was the 56-year-old sister of the recipient with complete situs inversus. CT angiogram of the abdomen and pelvis showed complete situs inversus and an otherwise normal appearance of the bilateral kidneys with patent bilateral single renal arteries and longer renal vein in the right kidney. The patient was taken to the operating room for a hand-assisted laparoscopic right donor nephrectomy. The patient tolerated the procedure well and was discharged home in good condition on postoperative day 1. The recipient experienced no episodes of acute rejection or infection, with serum creatinine levels of 0.8-1.2 mg/dL. Laparoscopic donor nephrectomy in a patient with complete situs inversus remains a technically feasible operation and the presence of situs inversus should not preclude consideration for living kidney donation. PMID:27579434

  11. Simultaneous bilateral robotic-assisted laparoscopic procedures in children.

    Science.gov (United States)

    Kapoor, Victor; Elder, Jack S

    2015-12-01

    Our main objective is to report the feasibility of performing simultaneous robotic-assisted laparoscopic (RAL) heminephrectomy with contralateral ureteroureterostomy in children with bilateral duplicated systems. Three female children with bilateral congenital renal/ureteral anomalies underwent concurrent RAL simultaneous unilateral partial nephrectomy with ureterectomy and contralateral ureteroureterostomy with redundant ureterectomy using a four/five-port approach. Mean age at repair was 32.9 months (range 7-46 months) and mean weight was 13.7 kg (range 10.4-13.6 kg). The RAL heminephroureterectomy and contralateral ureteroureterostomy were performed via a four-port approach (five ports in one patient), and the patients were repositioned and draped when moving to the other side. Mean operative time was 446 min (range 356-503 min). Mean estimated blood loss was 23.3 cc (range 10-50 cc). Postoperative length of stay for two patients was 2 days and 1 day for one patient (mean = 1.7 days). Mean length of follow-up was 18.3 months (range 7-36 months). No significant intraoperative or postoperative complications occurred for any of the three patients. Two children had no hydronephrosis on postoperative imaging in follow-up, and one child had a small stable, residual pararenal fluid collection on the side of heminephrectomy. Two patients underwent postoperative ureteral stent removal under general anesthesia. In children with bilateral duplicated urinary tract with ureterocele, ectopic ureter, and/or vesicoureteral reflux, laparoscopic repair with robotic assistance can be accomplished safely in a single operative procedure with a short hospital stay. PMID:26530838

  12. Pfannenstiel incision for intact specimen extraction in laparoscopic transperitoneal radical nephrectomy: a longitudinal prospective outcome study

    Directory of Open Access Journals (Sweden)

    Saleh Binsaleh

    2015-07-01

    Full Text Available OBJECTIVES: To evaluate the intra- and postoperative outcomes of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through a Pfannenstiel transverse suprapubic incision. METHODS: Prospective follow-up of 26 laparoscopic transperitoneal radical nephrectomies for suspected renal tumors in which the kidneys were extracted via a Pfannenstiel lower abdominal transverse incision. RESULTS: The mean operating time was 152.3 (80-255 minutes, and the mean blood loss was 90 (20-300 ml. The mean extraction time was 20.4 (12-35 minutes. The mean weight of the removed specimen was 631.5 (190-1505 grams, and the mean longest diameter of the extracted specimen was 17.4 (9-25 cm. The mean extraction incision size was 10.7 (7-16 cm. No open surgical conversions were necessary. Pain control was excellent, with minimal intravenous morphine equivalent narcotic use by patients: 15.7 (0-31 mg in the recovery room, 33.8 (0-127 mg on the first postoperative day and 8.7 (0-60 mg in the first week after discharge. The patients experienced a short duration to full ambulation and normal dietary intake. Postoperative follow-up visits were recorded for at least six months. The patients reported a high cosmetic satisfaction rate of 97.7% (60-100. No late postoperative complications were observed related to the extraction site. CONCLUSIONS: The operative specimen can be extracted via a low transverse Pfannenstiel incision during radical laparoscopic nephrectomy. This incision ensures the extraction of large specimens while preserving the aesthetic and functional advantages of laparoscopy without increasing the cancer risk. The absence of muscle cutting maintains the integrity of the abdominal wall and elicits minimal pain. No postoperative incisional hernias or keloid formations were observed.

  13. Clipless management of the renal vein during hand-assist laparoscopic donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Rosenblatt Gregory S

    2006-09-01

    Full Text Available Abstract Background Laparoscopic live donor nephrectomy has become the preferred method of donor nephrectomy at many transplant centers. The laparoscopic stapling device is commonly used for division of the renal vessels. Malfunction of the stapling device can occur, and is often due to interference from previously placed clips. We report our experience with a clipless technique in which no vascular clips are placed on tributaries of the renal vein at or near the renal hilum in order to avoid laparoscopic stapling device misfires. Methods From December 20, 2002 to April 12, 2005, 50 patients underwent hand-assisted laparoscopic left donor nephrectomy (LDN at our institution. Clipless management of the renal vein tributaries was used in all patients, and these vessels were divided using either a laparoscopic stapling device or the LigaSureTM device (Valleylab, Boulder, CO. The medical and operative records of the donors and recipients were reviewed to evaluate patient outcomes. Results The mean follow-up time was 14 months. Of the 50 LDN procedures, there were no laparoscopic stapling device malfunctions and no vascular complications. All renal allografts were functioning at the time of follow-up. Conclusion Laparoscopic stapling device failure due to deployment across previously placed surgical clips during laparoscopic live donor nephrectomy can be prevented by not placing clips on the tributaries of the renal vein. In our series, there were no vascular complications and no device misfires. We believe this clipless technique improves the safety of laparoscopic donor nephrectomy.

  14. Robot-assisted radical prostatectomy is a safe procedure

    DEFF Research Database (Denmark)

    Thomsen, Frederik Birkebæk; Berg, Kasper Drimer; Hvarness, Helle;

    2013-01-01

    We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients.......We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients....

  15. 机器人辅助腹腔镜下根治性前列腺切除术与开放手术的对照研究%Comparative study on the efficacy and safety of robot assisted laparoscopic and retropubic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    沈志远; 钱伟庆; 盛璐; 孙忠全

    2015-01-01

    目的 分析机器人辅助腹腔镜下根治性前列腺切除术(robot assisted laparoscopic radical prostatectomy,RALRP)与耻骨后根治性前列腺切除术(retropubic radical prostatectomy,RRP)治疗局限性前列腺癌的疗效和安全性.方法 回顾性分析2004年5月至2013年9月接受RALRP或RRP并获得随访的124例患者临床资料,其中RALRP组41例,RRP组83例.两组患者年龄、PSA、术前分期和Gleason评分比较差异均无统计学意义(P>0.05).比较两种术式的手术时间、术中出血量及输血比例、术后病理、术后留置导尿时间、住院天数、尿控、生化复发率等指标.结果 124例手术均获成功,RALRP组无中转开放.RALRP组与RRP组平均手术时间分别为224、165 min,平均术中出血量分别为266、659 ml,术中输血8例(20%)和71例(86%),术后住院时间分别为16.4、17.9d,切缘阳性率分别为24%与10%,组间比较差异均有统计学意义(P<0.05).RALRP组与RRP组术后留置导尿时间分别为27.2、23.5 d,组间比较差异无统计学意义(P>0.05).RALRP组术后3个月、6个月、1年、2年控尿率分别为56%、70%、80%、94%,RRP组分别为55%、70%、78%、79%;RALRP组术后6个月、1年、2年生化复发率分别为8%、21%、24%,RRP组分别为13%、16%、31%;两组间比较差异均无统计学意义(P>0.05).结论 RALRP具有出血少、恢复快的优势.由于我院RALRP尚处于学习曲线内,手术时间长于RRP,手术切缘阳性率高于RRP组,但术后短期肿瘤学效果、控尿功能方面与RRP相似.%Objective To compare the efficacy and safety of robot assisted laparoscopic radical prostatectomy (RALRP) and retropubic radical prostatectomy (RRP).Methods From May 2004 to September 2013,data from 124 prostate cancer patients were collected.Of them,41 cases underwent RALRP,and 83 cases underwent RRP.The following clinical data was reviewed and analyzed,including operation time,blood loss

  16. Comparison beetwen open and laparoscopic radical cistectomy in a latin american reference center: perioperative and oncological results

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    2015-08-01

    Full Text Available ABSTRACTObjectives:To evaluate the differences of peri-operatory and oncological outcomes between Laparoscopic Radical Cystectomy and Open Radical Cystectomy in our center.Materials and Methods:Overall, 50 patients were included in this non randomized match-pair analysis: 25 patients who had undergone Laparoscopic Radical Cystectomy for invasive bladder cancer (Group-1 and 25 patients with similar characteristics who had undergone Open Radical Cystectomy (Group-2. The patients were operated from January 2005 to December 2012 in a single Institution.Results:Mean operative time for groups 1 and 2 were 350 and 280 minutes (p=0.03 respectively. Mean blood loss was 330 mL for group 1 and 580 mL for group 2 (p=0.04. Intraoperative transfusion rate was 0% and 36% for groups 1 and 2 respectively (p=0.005. Perioperative complication rate was similar between groups. Mean time to oral intake was 2 days for group 1 and 3 days for group 2 (p=0.08. Median hospital stay was 7 days for group 1 and 13 for group 2 (p=0.04. There were no differences in positive surgical margins and overall survival, between groups.Conclusions:In a reference center with pelvic laparoscopic expertise, Laparoscopic Radical Cystectomy may be considered a safe procedure with similar complication rate of Open Radical Cystectomy. Laparoscopic Radical Cystectomy is more time consuming, with reduced bleeding and transfusion rate. Hospital stay seems to be shorter. Oncologically no difference was observed in our mid-term follow-up.

  17. Laparoscopic radical cystectomy with orthotopic ileal neobladder in the female: report of 14 cases

    Institute of Scientific and Technical Information of China (English)

    LIN Tian-xin; YIN Xin-bao; HUANG Jian; ZHANG Cai-xia; XU Ke-wei; HUANG Hai; JIANG Chun; HAN Jin-li; YAO You-sheng; GUO Zheng-hui; XIE Wen-lian

    2008-01-01

    Background Bladder carcinoma is the most common malignant urological tumor in China. We present our preliminary experience and results of laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder in female patients with bladder carcinoma.Methods From February 2003 to February 2008, 14 female patients with bladder carcinoma underwent LRC with orthotopic ileal neobladder. Nine of these patients underwent hysterectomy and ovariectomy, and the other 5 had preservation of the uterus and ovarian appendage. Standard bilateral pelvic lymphadenectomy was followed by radical cystectomy that was completed laparoscopically with hysterectomy and ovariectomy when needed. The tumor was removed by a 4-5 cm lower midline abdominal incision, followed by the construction of ileal neobladder and the extracorporeal anastomosis of ureter-neobladder. The neobladder was anastomosed to the urethral stump under a laparoscope.Results The mean operative time and blood loss in the 14 patients were 350.2 minutes and 349.8 ml, respectively.Postoperative complications included uretero-pouch anastomotic stricture in 1 patient and pouch-vaginal fistula in 1 patient. Follow-up time of all patients ranged from 3 to 60 months, and 12 patients were followed up for more than 6 months and achieved micturition in half a year. One patient had occasional day-time urinary incontinence and 2 had night-time incontinence. Two patients who had undergone hystectomy and ovariectomy had voiding difficulties after one year, which was treated by intermittent self-catheterization. The mean volume of the neobladder and the residual urine were 333.6 ml and 31.2 ml, respectively. Surgical margins were tumor free for all patients. One patient had bone metastasis and died 11 months after the operation.Conclusions LRC with orthotopic ileal neobladder in female patients is a technically feasible, safe and mini-invasive procedure with a low morbidity and acceptable neobladder function. Long-term follow-up is

  18. Long-term urodynamic evaluation of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer.

    Science.gov (United States)

    Wang, Dong; Li, Li-Jun; Liu, Jing; Qiu, Ming-Xing

    2014-09-01

    The long-term urodynamics of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer remain unclear in the clinical setting. The present prospective observational study was conducted between January 2010 and December 2012 to evaluate the 6-month and 12-month follow-up data of urodynamic changes of bladder cancer patients who were initially treated by laparoscopic radical cystectomy with orthotopic ileal neobladder. A total of 53 eligible patients were included, and all patients were followed up for at least 12 months, with a median time of 18 months. During the follow-up period, no patients reported difficulty urinating, and the daily frequency of urination and the urine output were gradually improved with time. Dynamic urodynamic examinations showed that the maximum flow rate (11.4±1.1 vs. 7.3±1.4 ml/sec; Pcompliance (26.9±13 vs. 27.4±13.1 cm H2O; P=0.848) at 12 and 6 months after initial surgical treatment. In conclusion, the urodynamics of this orthotopic ileal neobladder gradually improve, and its long-term urine storage and voiding functions are acceptable. PMID:25120652

  19. Robotic-Assisted Laparoscopic Ovarian Cystectomy during Pregnancy

    Directory of Open Access Journals (Sweden)

    Susanna Carter

    2011-09-01

    Full Text Available The use of robotic-assisted laparoscopic surgery (RALS in gynecologic oncology is rising rapidly; however, the role of this modality in obstetrics has not been widely investigated. During pregnancy, the surgical management of adnexal masses is traditionally approached via laparotomy or laparoscopy. RALS offers a minimally invasive approach secondary to improved instrument dexterity and precision, 14-fold magnification, and 3-D imaging. For the pregnant patient, this translates into minimal manipulation of the gravid uterus, quicker recovery times, and potentially decreased maternal and fetal morbidity. Here we report six cases in which the da Vinci robotic surgical system (Intuitive Surgical Incorporated, Sunnyvale, CA was used to perform an ovarian cystectomy during pregnancy. Pathology in all cases returned benign and each patient continued pregnancy without complications of surgery. In centers with the resources and adequately trained physicians, RALS offers the obstetric patient a safe and less invasive alternative to laparotomy or conventional laparoscopy. Although the advantages of robotic surgery are many, the limitations of this modality remain elevated equipment costs as well as the time investment necessary to train physicians.

  20. Robotic-Assisted Laparoscopic Ovarian Cystectomy during Pregnancy.

    Science.gov (United States)

    Carter, Susanna; Depasquale, Steven; Stallings, Shawn

    2011-09-01

    The use of robotic-assisted laparoscopic surgery (RALS) in gynecologic oncology is rising rapidly; however, the role of this modality in obstetrics has not been widely investigated. During pregnancy, the surgical management of adnexal masses is traditionally approached via laparotomy or laparoscopy. RALS offers a minimally invasive approach secondary to improved instrument dexterity and precision, 14-fold magnification, and 3-D imaging. For the pregnant patient, this translates into minimal manipulation of the gravid uterus, quicker recovery times, and potentially decreased maternal and fetal morbidity. Here we report six cases in which the da Vinci robotic surgical system (Intuitive Surgical Incorporated, Sunnyvale, CA) was used to perform an ovarian cystectomy during pregnancy. Pathology in all cases returned benign and each patient continued pregnancy without complications of surgery. In centers with the resources and adequately trained physicians, RALS offers the obstetric patient a safe and less invasive alternative to laparotomy or conventional laparoscopy. Although the advantages of robotic surgery are many, the limitations of this modality remain elevated equipment costs as well as the time investment necessary to train physicians.

  1. Laparoscopically Assisted Low Anterior Resection for Lower Rectal Endometriosis: Usefulness of Laparoscopic Surgery

    Directory of Open Access Journals (Sweden)

    Hiroki Sugishita

    2009-11-01

    Full Text Available A 34-year-old woman presented with pain during menstruation and was diagnosed with endometriosis of the lower rectum. Despite treatment with an LH-RH agonist, she was unable to become pregnant and surgical removal of her endometriosis was recommended. Preoperative magnetic resonance imaging revealed endometriosis localized between the neck of the uterus and rectum with indentation and scuffing. Laparoscopically assisted low anterior resection was performed. Exfoliation was started from the right side of the rectum to the presacral and retrorectal space, and the rectococcygeus ligament was transected. Exfoliation of the retrorectal space was continued to the levator ani muscle and mobilization of the right side of the rectum was performed. In front of the rectum, exfoliation was started posterior to the wall of the vagina, but layers became unclear near the tumor as the tissue was solid in this region. The left hypogastric nerve close to the tumor was inflamed and it was cut. The layer of the exfoliation was connected to the right side of the rectum, the tumor was isolated from the vagina, and the lower rectum was transected at a point 1 cm distal to the tumor with a 60-mm linear stapler. Reconstruction with a 31-mm circular stapler was performed using the double stapling technique. Operative time was 520 min with a blood loss of 320 ml. On the 9th post operative day, a rectovaginal fistula occurred, and ileostomy was performed. The patient was discharged from the hospital on the 25th postoperative day, and 4 months later, stoma closure was performed.

  2. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study.

    Science.gov (United States)

    Tolboom, Robert C; Draaisma, Werner A; Broeders, Ivo A M J

    2016-03-01

    Surgery for refractory gastroesophageal reflux disease (GERD) and hiatal hernia leads to recurrence or persisting dysphagia in a minority of patients. Redo antireflux surgery in GERD and hiatal hernia is known for higher morbidity and mortality. This study aims to evaluate conventional versus robot-assisted laparoscopic redo antireflux surgery, with the objective to detect possible advantages for the robot-assisted approach. A single institute cohort of 75 patients who underwent either conventional laparoscopic or robot-assisted laparoscopic redo surgery for recurrent GERD or severe dysphagia between 2008 and 2013 were included in the study. Baseline characteristics, symptoms, medical history, procedural data, hospital stay, complications and outcome were prospectively gathered. The main indications for redo surgery were dysphagia, pyrosis or a combination of both in combination with a proven anatomic abnormality. The mean time to redo surgery was 1.9 and 2.0 years after primary surgery for the conventional and robot-assisted groups, respectively. The number of conversions was lower in the robot-assisted group compared to conventional laparoscopy (1/45 vs. 5/30, p = 0.035) despite a higher proportion of patients with previous surgery by laparotomy (9/45 vs. 1/30, p = 0.038). Median hospital stay was reduced by 1 day (3 vs. 4, p = 0.042). There were no differences in mortality, complications or outcome. Robotic support, when available, can be regarded beneficial in redo surgery for GERD and hiatal hernia. Results of this observational study suggest technical feasibility for minimal-invasive robot-assisted redo surgery after open primary antireflux surgery, a reduced number of conversions and shorter hospital stay.

  3. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study.

    Science.gov (United States)

    Tolboom, Robert C; Draaisma, Werner A; Broeders, Ivo A M J

    2016-03-01

    Surgery for refractory gastroesophageal reflux disease (GERD) and hiatal hernia leads to recurrence or persisting dysphagia in a minority of patients. Redo antireflux surgery in GERD and hiatal hernia is known for higher morbidity and mortality. This study aims to evaluate conventional versus robot-assisted laparoscopic redo antireflux surgery, with the objective to detect possible advantages for the robot-assisted approach. A single institute cohort of 75 patients who underwent either conventional laparoscopic or robot-assisted laparoscopic redo surgery for recurrent GERD or severe dysphagia between 2008 and 2013 were included in the study. Baseline characteristics, symptoms, medical history, procedural data, hospital stay, complications and outcome were prospectively gathered. The main indications for redo surgery were dysphagia, pyrosis or a combination of both in combination with a proven anatomic abnormality. The mean time to redo surgery was 1.9 and 2.0 years after primary surgery for the conventional and robot-assisted groups, respectively. The number of conversions was lower in the robot-assisted group compared to conventional laparoscopy (1/45 vs. 5/30, p = 0.035) despite a higher proportion of patients with previous surgery by laparotomy (9/45 vs. 1/30, p = 0.038). Median hospital stay was reduced by 1 day (3 vs. 4, p = 0.042). There were no differences in mortality, complications or outcome. Robotic support, when available, can be regarded beneficial in redo surgery for GERD and hiatal hernia. Results of this observational study suggest technical feasibility for minimal-invasive robot-assisted redo surgery after open primary antireflux surgery, a reduced number of conversions and shorter hospital stay. PMID:26809755

  4. Hand-assisted laparoscopic colorectal surgery: Initial experience of a single surgeon

    Directory of Open Access Journals (Sweden)

    Abdul-Wahed N Meshikhes

    2011-01-01

    Full Text Available Background/Aim: As totally laparoscopic colorectal surgery is considered challenging and technically demanding with a long steep learning curve, we adopted hand-assisted laparoscopic colorectal surgery as a bridge to totally laparoscopic assisted colorectal surgery. This prospective study aims to highlight the initial experience of a single surgeon with this technique. Materials and Methods: A prospective analysis of the first 25 cases of hand-assisted laparoscopic colorectal resections which were performed by a single surgeon over a 15-month period. There were 15 males and 10 females with a mean age of 55.5 (range 20-82 years. Results: The indication in majority of cases was cancer (76%. The procedures consisted of 18 (72% various colectomies and 7 (28% anterior resections. The operative time ranged between 110-400 (mean 180 min. There was one conversion (4% and the mean operative blood loss was 80 (range 60-165 ml. The number of lymph nodes retrieved in the cancer cases was 5-31 (mean 15 nodes. The mean length of hospital stay was five (range 3-10 days. The total number of short-term complications was six (24% and there was one death due to anastomatic leak and multiorgan failure. Long-term complications after a maximum follow up of 30 months were two incisional hernias at the hand port site, but none of the patients developed adhesive small bowel obstruction or late anastomotic stricture. Currently all our colorectal procedures are conducted laparoscopically. Conclusion: Hand-assisted laparoscopic colorectal procedures are easy to learn as a good bridge to master totally laparoscopic colorectal surgery.

  5. Hand-assisted laparoscopic nephrectomy and nephroureterectomy: our experience in Hospital Universiti Kebangsaan Malaysia.

    Science.gov (United States)

    Ho, C C K; Zulkifli, M Z; Nazri, J; Sundram, M

    2008-03-01

    Hand-assisted laparoscopic nephrectomy (HAL-N) and nephroureterectomy (HAL-NU) were introduced to bridge the gap between open and laparoscopic surgery. This newer technique has the benefits of both laparoscopic and open surgical approaches but has a shorter learning curve and decreased operative time compared to laparoscopic surgery. A review of our 2-year experience showed that for the seventeen cases of HAL-N that was performed, the mean operative time was 187.8 minutes while the mean length of hospital stay was 4.1 days. For the two HAL-NU cases, the mean operative time was 415 minutes while the mean length of hospital stay was 5.5 days. Only one complication occurred and it was an incisional hernia at the hand-port site. There was no recurrence for the carcinoma cases. Our experience shows that this technique is feasible and safe. PMID:18935731

  6. Single-port laparoscopic radical prostatectomy: initial experience and technical points to reduce its difficulties

    Institute of Scientific and Technical Information of China (English)

    WEN Xing-qiao; HUANG Wen-tao; SITU Jie; HU Cheng; YE Chun-wei; GAO Xin

    2011-01-01

    Background Laparoendoscopic single-site surgery (LESS) approaches have been reported for treating various kidney and pelvic procedures,and are feasible and effective in selected patients.In this study,we aimed to present the initial experience and evaluate the efficacy of laparoscopic radical prostatectomy performed through a single incision using a multichannel port.Methods Between July 2010 and April 2011,six patients diagnosed with early stage prostate cancer underwent LESS radical prostatectomy (RP) in our institute.A multichannel port was inserted transperitoneally through a 2-cm umbilical incision.Specially articulating and flexible laparoscopic were used.Some technical tricks and points were applied during the operation to overcome the drawbacks and reduce the difficulties of this approach.Two continuous urethrovesical sutures in both sides were performed to complete both lateral aspects of anastomosis.The two ends of the suture threads were fixed by double Lapro-Clips,instead of the difficult knot-tying.Results Total operative time was (265±43) minutes.Mean blood loss was (230±65) ml.All cases were completed successfully,without conversion to open surgery or adding additional abdomen ports.No patient required a blood transfusion and no intraoperative complications occurred.The Foley catheter was removed at the 14th day (range 12th-16th) after surgery.At the 12th week of follow-up,all patients had an undetectable prostate-specific antigen level.Two patients used 2 or 1 pad for continence daily; other patients had achieved good continence.Conclusion In selected cases,LESS-RP is feasible and effective; these technic points and the flexible-articulating instruments are helpful to reduce the operation difficulties.

  7. Lessons learned from a case of calf compartment syndrome after robot-assisted laparoscopic prostatectomy.

    Science.gov (United States)

    Rosevear, Henry M; Lightfoot, Andrew J; Zahs, Marta; Waxman, Steve W; Winfield, Howard N

    2010-10-01

    Robot-assisted laparoscopic prostatectomy is rapidly gaining favor as a minimally invasive method to surgically address prostate cancer. The sophisticated equipment and unique positioning requirements of this technology require exceptional preparation and attention to detail to minimize the chance of surgical complications. We present the case of a 57-year-old man who developed left calf compartment syndrome after (robot-assisted laparoscopic prostatectomy) requiring fasciotomies. We use this example to highlight specific areas of risk unique to the da Vinci Surgical System® using intraoperative photos to show danger areas as well as review basic positioning requirements common to all prolonged pelvic surgeries performed in Trendelenburg position.

  8. Laparoscopic-assisted treatment of pyometra associated with mammary fibroadenomatous hyperplasia in a cat

    OpenAIRE

    Lucas Marques Colomé; Hiran Castagnino Kunert Filho; João Pedro Scussel Feranti; Fabiane Reginatto dos Santos; Luana Walendorff Sartori; Maurício Veloso Brun

    2014-01-01

    This paper describes a case of laparoscopic-assisted ovariohysterectomy in a female cat presenting pyometra and mammary fibroadenomatous hyperplasia. Using four portals, mesovarium were ligated by titanium ligature clips whereas the uterine vessels were occluded by video-assisted conventional ligatures. There were no postoperative complications. Video-assisted technique can be an alternative method for treatment of pyometra and cystic endometrial hyperplasia in female cats.

  9. Laparoscopic-assisted treatment of pyometra associated with mammary fibroadenomatous hyperplasia in a cat

    Directory of Open Access Journals (Sweden)

    Lucas Marques Colomé

    2014-03-01

    Full Text Available This paper describes a case of laparoscopic-assisted ovariohysterectomy in a female cat presenting pyometra and mammary fibroadenomatous hyperplasia. Using four portals, mesovarium were ligated by titanium ligature clips whereas the uterine vessels were occluded by video-assisted conventional ligatures. There were no postoperative complications. Video-assisted technique can be an alternative method for treatment of pyometra and cystic endometrial hyperplasia in female cats.

  10. Robot-assisted laparoscopic prostatectomy and previous surgical history: a multidisciplinary approach.

    Science.gov (United States)

    Bernstein, Adrien N; Lavery, Hugh J; Hobbs, Adele R; Chin, Edward; Samadi, David B

    2013-06-01

    Previous abdominal or prostate surgery can be a significant barrier to subsequent minimally invasive procedures, including radical prostatectomy (RP). This is relevant to a quarter of prostatectomy patients who have had previous surgery. The technological advances of robot-assisted laparoscopic RP (RALP) can mitigate some of these challenges. To that end, our objective was to elucidate the effect of previous surgery on RALP, and to describe a multidisciplinary approach to the previously entered abdomen. One-thousand four-hundred and fourteen RALP patients were identified from a single-surgeon database. Potentially difficult cases were discussed preoperatively and treated in a multidisciplinary fashion with a general surgeon. Operative, pathological, and functional outcomes were analyzed after stratification by previous surgical history. Four-hundred and twenty (30 %) patients underwent previous surgery at least once. Perioperative outcomes were similar among most groups. Previous major abdominal surgery was associated with increased operative time (147 vs. 119 min, p history. Major complications included two enterotomies diagnosed intraoperatively and one patient requiring reoperation. All cases were performed robotically, without conversion to open-RP. There was no difference in biochemical disease-free survival among surgical groups and continence and potency were equivalent between groups. In conclusion, previous abdominal surgery did not affect the safety or feasibility of RALP, with all patients experiencing comparable perioperative, functional, and oncologic outcomes. PMID:27000905

  11. Clinical characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy: A report of 40 cases

    Institute of Scientific and Technical Information of China (English)

    Han-Xin Zhou; Yue-Hua Guo; Xiao-Fang Yu; Shi-Yun Bao; Jia-Lin Liu; Yue Zhang; Yong-Gong Ren; Qun Zheng

    2006-01-01

    AIM: To summarize the performing essentials and analyze the characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy.METHODS: Robot-assisted laparoscopic cholecystectomy was performed in 40 patients between May 2004 and July 2005. The operating procedures and a variety of clinical parameters were recorded and analyzed.RESULTS: Forty laparoscopic cholecystectomy procedures were successfully completed with Zeus robotic system. And there were no post-operative complications. Total operating time, system setup time and performing time were 100.3±18.5 min, 27.7±8.8 min and 65.6±18.3 min, respectively. The blood loss and postoperative hospital stay were 30.6±10.2 mL and 2.8±0.8d, respectively. Camera clearing times and time used for operative field adjustment were 1.1 ± 1.0 min and 2.0± 0.8min, respectively. The operative error was 7.5%.CONCLUSION: Robot-assisted laparoscopic cholecystectomy following the principles of laparoscopic operation has specific performing essentials. It preserves the benefits of minimally invasive surgery and offers enhanced ability of controlling operation field, precise and stable operative manipulations.

  12. Natural orifice transendoluminal surgery and laparoendoscopic single-site surgery: the future of laparoscopic radical prostatectomy.

    Science.gov (United States)

    Barret, Eric; Sanchez-Salas, Rafael; Ercolani, Matthew C; Rozet, Francois; Galiano, Marc; Cathelineau, Xavier

    2011-03-01

    Techniques for minimally invasive radical prostatectomy (RP) have been carefully reviewed by surgical teams worldwide in order to identify possible weaknesses and facilitate further improvement in their overall performance. The initial plan of action has been to carefully study the best-practice techniques for open RP in order to reproduce and standardize performance from the laparoscopic perspective. Similar to open surgery, the learning curve of minimally invasive RP has been well documented in terms of objective evaluation of outcomes for cancer control and functional results. Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have recently gained momentum as feasible techniques for minimal access urological surgery. NOTES-LESS drastically limit the surgeon's ability to choose the site of entry for operative instruments; therefore, the advantages of NOTES-LESS are gained with the understanding that the surgical procedure is more technically challenging. There are several key elements in RP techniques (in particular, dorsal vein control, apex exposure and cavernosal nerve sparing) that can have significant implications on oncologic and functional results. These steps are hard to perform in a limited working field. LESS radical prostatectomy can clearly be facilitated by using robotic technology.

  13. Robot-assisted laparoscopic hiatal hernia and antireflux surgery

    NARCIS (Netherlands)

    Tolboom, R. C.; Broeders, I. A M J; Draaisma, W. A.

    2015-01-01

    Gastroesophageal reflux disease is a common disorder of the GE-junction that allows gastric acid to enter the esophagus. Surgery is indicated when the presence of the disease is objectively documented. The laparoscopic Toupet fundoplication is the preferred treatment of GERD. There is no clear advan

  14. Renal Function Recovery in Donors and Recipients after Live Donor Nephrectomy: Hand-Assisted Laparoscopic vs. Open Procedures

    OpenAIRE

    Kim, Bum Soo; Yoo, Eun Sang; Kim, Tae-Hwan; Kwon, Tae Gyun

    2010-01-01

    Purpose Laparoscopic donor nephrectomy is associated with less postoperative pain and faster recovery times in living kidney donors. However, pneumoperitoneum, which is required in laparoscopic donor nephrectomy, can result in adverse effects on renal function in donors and recipients. We compared renal function in donors and recipients after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN). Materials and Methods Between January 1997 and January 2008, 241 ...

  15. Safety and Feasibility of Laparoscopic Abdominal Surgery in Patients With Mechanical Circulatory Assist Devices.

    Science.gov (United States)

    Ashfaq, Awais; Chapital, Alyssa B; Johnson, Daniel J; Staley, Linda L; Arabia, Francisco A; Harold, Kristi L

    2016-10-01

    Objectives Increasing number of mechanical circulatory assist devices (MCADs) are being placed in heart failure patients. Morbidity from device placement is high and the outcome of patients who require noncardiac surgery after, is unclear. As laparoscopic interventions are associated with decreased morbidity, we examined the impact of such procedures in these patients. Methods A retrospective review was conducted on 302 patients who underwent MCAD placement from 2005 to 2012. All laparoscopic abdominal surgeries were included and impact on postoperative morbidity and mortality studied. Results Ten out of 16 procedures were laparoscopic with 1 conversion to open. Seven patients had a HeartMate II, 2 had Total Artificial Hearts, and 1 had CentriMag. Four patients had devices for ischemic cardiomyopathy and 6 cases were emergent. Surgeries included 6 laparoscopic cholecystectomies, 2 exploratory laparoscopies, 1 laparoscopic colostomy takedown, and 1 laparoscopic ventral hernia repair with mesh. Median age of the patients was 63 years (range, 29-79 years). Median operative time was 123 minutes (range, 30-380 minutes). Five of 10 patients were on preoperative anticoagulation with average intraoperative blood loss of 150 mL (range, 20-700 mL). There were 3 postoperative complications; acute respiratory failure, acute kidney injury and multisystem organ failure resulting in death not related to the surgical procedure. Conclusion The need for noncardiac surgery in post-MCAD patients is increasing due to limited donors and due to more durable and longer support from newer generation assist devices. While surgery should be approached with caution in this high-risk group, laparoscopic surgery appears to be a safe and successful treatment option. PMID:26839214

  16. Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial

    Directory of Open Access Journals (Sweden)

    Alwayn Ian PJ

    2010-03-01

    Full Text Available Abstract Background Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee the donor's safety, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy experienced by the donor. However, this method is characterised by higher in hospital costs, longer operating times and it requires a well-trained surgeon. The hand-assisted retroperitoneoscopic technique may be an alternative to a complete laparoscopic, transperitoneal approach. The peritoneum remains intact and the risk of visceral injuries is reduced. Hand-assistance results in a faster procedure and a significantly reduced operating time. The feasibility of this method has been demonstrated recently, but as to date there are no data available advocating the use of one technique above the other. Methods/design The HARP-trial is a multi-centre randomised controlled, single-blind trial. The study compares the hand-assisted retroperitoneoscopic approach with standard laparoscopic donor nephrectomy. The objective is to determine the best approach for live donor nephrectomy to optimise donor's safety and comfort while reducing donation related costs. Discussion This study will contribute to the evidence on any benefits of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy. Trial Registration Dutch Trial Register NTR1433

  17. Robot-Assisted Laparoscopic Hiatal Hernia Repair : Promising Anatomical and Functional Results

    NARCIS (Netherlands)

    Brenkman, Hylke J F; Parry, Kevin; Van Hillegersberg, Richard; Ruurda, Jelle P.

    2016-01-01

    Background: There is no consensus on the optimal technique for hiatal hernia (HH) repair, and considerable recurrence rates are reported. The aim of this study was to evaluate the perioperative outcomes, quality of life (QoL), and recurrence rate in patients undergoing robot-assisted laparoscopic HH

  18. Randomized controlled trial comparing hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy

    NARCIS (Netherlands)

    Dols, L.F.; Kok, N.F.; D'Ancona, F.C.H.; Klop, K.W.; Tran, T.C.K.; Langenhuijsen, J.F.; Terkivatan, T.; Dor, F.J.; Weimar, W.; Dooper, I.; Ijzermans, J.N.M.

    2014-01-01

    BACKGROUND: Laparoscopic donor nephrectomy (LDN) has become the gold standard for live-donor nephrectomy, as it results in a short convalescence time and increased quality of life. However, intraoperative safety has been debated, as severe complications occur incidentally. Hand-assisted retroperiton

  19. Cost-effectiveness of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: a randomized study

    NARCIS (Netherlands)

    Klop, K.W.; Kok, N.F.; Dols, L.F.; D'Ancona, F.C.H.; Adang, E.M.M.; Grutters, J.P.C.; Ijzermans, J.N.M.

    2013-01-01

    BACKGROUND: Live kidney donation has a clear economical benefit over dialysis and deceased-donor transplantation. Compared with mini-incision open donor nephrectomy, laparoscopic donor nephrectomy (LDN) is considered cost-effective. However, little is known on the cost-effectiveness of hand-assisted

  20. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    OpenAIRE

    Liu G; Jian F; Wang X; Chen L

    2016-01-01

    Guozheng Liu,1 Fengguo Jian,2 Xiuqin Wang,2 Lin Chen1 1Department of General Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Second Department of General Surgery, Changyi People’s Hospital, Shandong, People’s Republic of China Aim: To study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients.Methods: Eighty-four elderly patients diagnosed with GC between Se...

  1. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    OpenAIRE

    Chen, Linpayi

    2016-01-01

    Guozheng Liu,1 Fengguo Jian,2 Xiuqin Wang,2 Lin Chen1 1Department of General Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Second Department of General Surgery, Changyi People’s Hospital, Shandong, People’s Republic of China Aim: To study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients.Methods: Eighty-four elderly patients diagnosed with G...

  2. No differences in short-term morbidity and mortality after robot-assisted laparoscopic versus laparoscopic resection for colonic cancer

    DEFF Research Database (Denmark)

    Helvind, Neel Maria; Eriksen, Jens Ravn; Mogensen, Anders Skibsted;

    2013-01-01

    . There was a significantly longer setup time for RC (77.1 vs. 69.7 min, P = 0.000), but surgical time was significantly shorter for RC (165.8 vs. 183.4 min, P = 0.006) and there was no difference in the overall procedure time (254.0 vs. 243.6 min, P = 0.086). CONCLUSION: We found RC to be a safe and feasible alternative......BACKGROUND: Robot-assisted laparoscopy has been reported to be a safe and feasible alternative to traditional laparoscopy. The aim of this study was to compare short-term results in patients with colonic cancer who underwent robot-assisted laparoscopic colonic resection (RC) or laparoscopic colonic...... to LC for colonic cancer. We found that for RC surgical time was shorter and overall procedure time was comparable to that for LC; however, these results should be confirmed in future randomized clinical trials....

  3. Peri-operative comparison between daVinci-assisted radical prostatectomy and open radical prostatectomy in obese patients

    Science.gov (United States)

    Le, Carter Q.; Ho, Khai-Linh V.; Slezak, Jeffrey M.; Blute, Michael L.; Gettman, Matthew T.

    2007-02-01

    Introduction: While the effects of increasing body mass index on prostate cancer epidemiology and surgical approach have recently been studied, its effects on surgical outcomes are less clear. We studied the perioperative outcomes of obese (BMI >= 30) men treated with daVinci-assisted laparoscopic radical prostatectomy (DLP) and compared them to those treated with open radical retropubic prostatectomy (RRP) in a contemporary time frame. Method: After Institutional Review Board approval, we used the Mayo Clinic Radical Prostatectomy database to identify patients who had undergone DLP by a single surgeon and those who had undergone open RRP by a single surgeon between December 2002 and March 2005. Baseline demographics, peri- and post-operative courses, and complications were collected by retrospective chart review, and variables from the two cohorts compared using chi-square method and least-squares method of linear regression where appropriate. Results: 59 patients who had DLP and 76 undergoing RRP were available for study. Baseline demographics were not statistically different between the two cohorts. Although DLP had a significantly lower clinical stage than RRP (p=0.02), pathological stage was not statistically different (p=0.10). Transfusion rates, hospital stay, overall complications, and pathological Gleason were also not significantly different, nor were PSA progression, positive margin rate, or continence at 1 year. After bilateral nerve-sparing, erections suitable for intercourse with or without therapy at 1 year was 88.5% (23/26) for DLP and 61.2% (30/49) for RRP (p=0.01). Follow-up time was similar. Conclusion: For obese patients, DLP appears to have similar perioperative, as well as short-term oncologic and functional outcomes when compared to open RRP.

  4. First-ever Reported Obstructing Ureteral Nephrogenic Adenoma in a Child and Subsequent Robotic-assisted Laparoscopic Ileal Ureter.

    Science.gov (United States)

    Koenig, Joel F; Rensing, Adam; Austin, Paul F; Vricella, Gino

    2016-08-01

    To report the first known case of a completely intracorporeal robotic-assisted laparoscopic ileal ureter in the pediatric population, a 12-year-old boy with near-complete replacement of his right ureter with nephrogenic adenoma and resulting debilitating renal colic. Intracorporeal robotic-assisted laparoscopic ileal ureter was performed without complication. A detailed description of our surgical technique is included. The patient had improvement in hydronephrosis and complete resolution of renal colic symptoms with minimal incisional length compared to traditional laparotomy. Intracorporeal robotic-assisted laparoscopic ileal ureter provides the benefits of minimally invasive surgery when complete ureteral replacement is needed. PMID:27001506

  5. Robot-Assisted Prostatectomy

    Medline Plus

    Full Text Available ... this da Vinci assisted laparoscopic radical prostatectomy. Our scrub, which is Alex Santander, our nurse anesthetist back ... Okay, Dr. Pinon, you’re going to come scrub in? Yes, I will, yes. Dr. Pinon is ...

  6. Robot-Assisted Prostatectomy

    Medline Plus

    Full Text Available ... Robotic Surgery. My name is Dr. Andy Pinon. This is my partner, Dr. Darren Bruck. He’s going ... at the very beginning, helping us navigate through this da Vinci assisted laparoscopic radical prostatectomy. Our scrub, ...

  7. Laparoscopic Assisted Surgery for Crohn's Disease an Initial Experience and Results

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The inflammatory process associated with Crohn's disease often makes dissection difficult, even in open surgery. The aim of this study was to assess the technical feasibility, safety and indication of laparoscopic assisted procedures performed in patients with Crohn's disease. Records of patients undergoing surgical operation for Crohn's disease from 1993 to 1998 at our hospital were reviewed. Intestinal resection was performed laparoscopically in 24 patients (LAP) and by open technique in 23 patients (OPEN). No significant differences existed as to age, gender, body-mass-index and previous surgery. In the laparoscopic group, seven operations (CON) were converted to open laparotomy (29 %) because of large inflammatory mass and/or fistula. The mean intraoperative blood loss was significantly higher in CON- and OPEN-groups than in LAP-group (P<0. 01 ). Major complications occurred only in one patient who underwent laparoscopic assisted high anterior resection. Patients who underwent laparoscopic operation tolerated p.o. liquids sooner than patients who underwent open surgery (median: 2 vs. 5 day, P<0. 05). Compared with the CON- and OPEN-groups, patients in LAP-group had lower analgesic requirements (median: 3 vs. 6 and 5 day, P<0. 01). The median postoperative length of stay was significantly shorter in LAP-group than in OPEN-group (median: 11 vs. 14 day, P<0. 05). Our study showed that LAP is technically feasible for Crohn's disease. The preoperative correct diagnosis and selection of indications are very important, because the laparoscopic mobilization and resection may be difficult or impossible in patients with large fixed masses, multiple complx fistulas, or recurrent Crohn'sdisease.

  8. [Comparative research of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum].

    Science.gov (United States)

    Khitar'yan, A G; Glumov, E E; Veliev, K S

    2015-01-01

    The article made a comparative assessment of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum in lateral and spinal positions. The presented technique of hand-assisted laparoscopic colon and rectal surgery is simple. There are advantages in case of obesity presence (IMT more than 30 kg/m2), in significant shortening of the mesocolon and mesentery, high fixation of splenic flexure and intimate fixation of the spleen, in case of bad preparation of the bowels in partial intestinal obstruction or in case of emergency operation, big cancer size, expressed perifocal inflammation. A comparative analysis of dynamics of hormone stress content and metabolism (cortisol, adrenaline, thyrothrophic hormone) showed their expressed increase in blood during operation after traditional surgery. Less stressed reaction was noted after hand-assisted surgery, especially in overweight patients. An application of low invasive method allowed reduction of hemorrhage, pain syndrome, terms of patient's activation and restoration of intestinal motility after operation.

  9. [Techniques of autonomic nerve preservation in laparoscopic radical resection for rectal cancer].

    Science.gov (United States)

    Wei, Hongbo; Zheng, Zongheng

    2015-06-01

    Pelvic autonomic nerve is a three-dimensional structure surrounding the rectum. There are several key points related to nerve injury during laparoscopic radical resection for rectal cancer. Hypogastric nerve has close relation with the upper and middle part of the rectum. Combined with S2-S4 pelvic splanchnic nerve, hypogastric nerve forms pelvic plexus. Incorrect operation in pelvic parietal peritoneum during dissection of upper rectum will lead to nerve injury. When performing dissection of inferior mesenteric artery, bilateral nerve tracts should be pushed to posterior abdominal wall and anterior fascia of the abdominal aorta should be well protected to avoid nerve injury. Pelvic plexus fibers located lateral to the rectum of pelvic floor, as well as neurovascular bundle closed to Denonvillier's fascia, also have close relations with nerve injury. Dissection of either lateral or anterior wall of rectum should be performed behind the Denonvillier's fascia and in front of the proper fascia of rectum. Sharp dissection should be performed closed to the mesorectum to protect branches of pelvic plexus.

  10. Pancreas-centered Anatomy in D2 Radical Lymphadenectomy in Laparoscopic-assisted Distal Gastrectomy%“胰腺中心解剖法”在腹腔镜辅助远端胃癌D2根治术淋巴结清扫中的应用

    Institute of Scientific and Technical Information of China (English)

    肖俊峰; 暨玲; 阮小蛟; 郑晓风

    2013-01-01

    目的 探讨“胰腺中心解剖法”在腹腔镜辅助远端胃癌D2根治术淋巴结清扫中的价值.方法 回顾性分析2009年9月~ 2011年5月开展的20例以胰腺为解剖中心的腹腔镜辅助远端胃癌D2根治术病例资料(A组),并以2009年5月~8月同术者20例传统腹腔镜辅助远端胃癌D2根治术为对照(B组),比较2组一般资料、手术相关指数、切缘距肿瘤距离、术后恢复时间、术后生活质量评分、术后30天内并发症以及1、2年生存率.结果 与B组相比,A组手术时间短[(110.3-20.1)min vs.(160.0±30.4)min,t=-6.100,P=0.000],术中出血量少[(149.6±60.4)ml vs.(332.0±104.5)ml,t=-6.757,P=n.000].2组淋巴结清扫数目、切缘距肿瘤距离、肛门排气时间、进食时间、术后住院时间、生活质量评分以及术后30天内并发症发生率差异均无显著性(P>0.05),A组1、2年的生存率分别为54.30%、34.30%,B组为52.87%、34.30%,2组差异无显著性(x2=0.132,P=0.717).结论 “胰腺中心解剖法”可以缩短腹腔镜辅助远端胃癌D2根治术手术时间,减少出血.%Objective To evaluate pancreas-centered anatomy in D2 radical lymphadenectomy in laparoscopic-assisted distal gastrectomy ( LADG). Methods We reviewed the clinical data of 20 patients with distal gastric cancer, who underwent LADG with D2 lymphadenectomy by using pancreas centered anatomy in our hospital from September 2009 to May 2011 (group A). Another 20 patients with distal gastric cancer, who recieved LADG with D2 lymphadenectomy by using traditional methods from May 2009 to August 2009, were set as a control group (group B). The genera! information, operation related indexes,distance between tumor and incisional margin, and postoperative recovering time, quality of life, rate of complications within 30 days, and 1- and 2-year survival rate were compared between the two groups. Results Compared to group B, group A showed significantly shorter operation time and less

  11. Comparative study of abdominal, vaginal and laparoscopic assisted vaginal hysterectomies with special reference to immediate sequel, late sequel and complications

    Directory of Open Access Journals (Sweden)

    Pujitha Devi Suraneni

    2016-02-01

    Conclusions: Preference for laparoscopic assisted vaginal hysterectomy or vaginal hysterectomy depends on expertise of doctor and selections of patients. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 402-406

  12. Robot-Assisted Laparoscopic Hysterectomy,Gonadal Biopsy, and Orchiopexies in an Infant with Persistent Mullerian Duct Syndrome

    OpenAIRE

    Wu, Jonathan A.; Hsieh, Michael H.

    2013-01-01

    An infant born with hypospadias and no palpable gonads was diagnosed with persistent mullerian duct syndrome (PMDS) based on history, physical examination, laboratory testing, and radiologic imaging. A robot-assisted laparoscopic hysterectomy, right gonadal biopsy, and bilateral orchiopexies were performed without incident. Final pathology confirmed the diagnosis of PMDS. To our knowledge, this is only the second report of PMDS managed through a robot-assisted laparoscopic approach.

  13. Robot-assisted laparoscopic hysterectomy, gonadal biopsy, and orchiopexies in an infant with persistent mullerian duct syndrome.

    Science.gov (United States)

    Wu, Jonathan A; Hsieh, Michael H

    2014-04-01

    An infant born with hypospadias and no palpable gonads was diagnosed with persistent mullerian duct syndrome (PMDS) based on history, physical examination, laboratory testing, and radiologic imaging. A robot-assisted laparoscopic hysterectomy, right gonadal biopsy, and bilateral orchiopexies were performed without incident. Final pathology confirmed the diagnosis of PMDS. To our knowledge, this is only the second report of PMDS managed through a robot-assisted laparoscopic approach. PMID:24246315

  14. Concurrent management of bilateral ureteropelvic junction obstruction in children using robotic-assisted laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Drew A. Freilich

    2008-03-01

    Full Text Available INTRODUCTION: Bilateral ureteropelvic junction (UPJ obstruction occurs infrequently. When surgical management is deemed necessary, staged pyeloplasties traditionally have been recommended to minimize the morbidity associated with performing procedures concurrently. With the advent of robotic-assistance, concurrent surgical management can more readily be performed laparoscopically. In this report, we evaluated the safety and outcome of managing patients with bilateral UPJ obstruction with concurrent robotic-assisted laparoscopic pyeloplasty. MATERIALS AND METHODS: We performed a retrospective review of five patients with bilateral ureteropelvic junction obstruction who underwent concurrent bilateral robotic-assisted pyeloplasties at our institution between October 2003 and April 2007. Technical consideration for patient positioning, robotic set-up, port placement, and the use of a hitch stitches was assessed. The operative time, complications, analgesic needs, length of hospitalization, and overall success of the procedure were evaluated. RESULTS: Operative time ranged from 235 to 541 minutes (mean = 384. Estimated blood loss was 5-100 cc (mean = 48.0. Length of hospitalization ranged from 1.3 to 3.6 days (mean = 2.4. Ureteral stents were removed 3-8 weeks postoperatively. There were no complications. All kidneys demonstrated decreased hydronephrosis on postoperative ultrasound or improved drainage parameters on diuretic renography or IVP. CONCLUSIONS: Simultaneous bilateral robotic-assisted laparoscopic pyeloplasties utilizing 4-port access is feasible and safe. It provides an effective method of managing patients with bilateral UPJ obstruction, avoiding the burden and morbidity of performing staged surgeries.

  15. Secondary omental infarction related to open and laparoscopic-assisted distal gastrectomy: report of two cases.

    Science.gov (United States)

    Park, Kyung Eun; Chung, Dong Jin; Kim, Wook; Hahn, Seong-Tae; Lee, Jae Moon

    2011-01-01

    Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

  16. THE SAFETY AND EXPEDIENCY OF USING A TRANSPERITONEAL LAPAROSCOPIC ACCESS TO RADICAL NEPHRECTOMY FOR CLINICALLY LOCALIZED KIDNEY CANCER

    Directory of Open Access Journals (Sweden)

    V. B. Matveev

    2013-01-01

    Full Text Available Objective: to compare immediate, oncological, and functional results, as well as quality of life in patients undergoing open and laparoscopic transperitoneal radical nephrectomy (RNE for clinically localized kidney cancer (KC.Subjects and methods. Data from 426 cT1-2N0M0 KC patients after radical nephrectomy in 1991 to 2011 were retrospectively selected. Their median age was 57 years. The male/female ratio was 1.1:1. The median highest tumor diameter was 5.0±2.2 cm. RNE was carried out in all 426 patients: in 211 (49.5 % patients through open access and in 215 (50.5 % through transperitoneal laparoscopic one. The patient groups operated on via different accesses were matched for major signs; however, the laparoscopy group displayed a preponderance of cT1a tumors. The median follow-up was 50.0±12.3 months.Results. There were no significant differences in the frequency of intraoperative and postoperative complications of laparoscopic and open nephrectomies. The five-year overall, specific, and relapse-free survival rates in the patients who had undergone open nephrectomy were 95.4, 98.4, and 92.2 %, respectively; those in the patients who had laparoscopic nephrectomy were 94.5, 100.0, and 93.6 %, respectively (p > 0.05 for all. The incidence of acute renal dysfunction and its distribution according to the RIFLE classes, the rate of acute dialysis and that of a decrease and a continued reduction in glomerular filtration rate, as well as the distribution of patients according to the stages of chronic kidney disease after RNE did not depend on the surgical access (p > 0.05 for all. The QLQ-30 survey data show that the laparoscopic access versus the laparotomic one improves quality of life within 1 month after RNE.Conclusion. Laparoscopic transperitoneal RNE is a safe alternative to open surgery that can improve quality of life in the patients with clinically localized kidney cancer within one month after surgical intervention.

  17. Robot-assisted laparoscopic pyeloplasty: minimum 1-year follow-up

    Science.gov (United States)

    Patel, Vipul; Thaly, Rahul; Shah, Ketul

    2007-02-01

    Objectives: To evaluate the feasibility and efficacy of robotic-assisted laparoscopic pyeloplasty. Laparoscopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. However, the steep learning curve has hindered its acceptance into mainstream urologic practice. The introduction of robotic assistance provides advantages that have the potential to facilitate precise dissection and intracorporeal suturing. Methods: A total of 50 patients underwent robotic-assisted laparoscopic dismembered pyeloplasty. A four-trocar technique was used. Most patients were discharged home on day 1, with stent removal at 3 weeks. Patency of the ureteropelvic junction was assessed in all patients with mercaptotriglycylglycine Lasix renograms at 1, 3, 6, 9, and 12 months, then every 6 months for 1 year, and then yearly. Results: Each patient underwent a successful procedure without open conversion or transfusion. The average estimated blood loss was 40 ml. The operative time averaged 122 minutes (range 60 to 330) overall. Crossing vessels were present in 30% of the patients and were preserved in all cases. The time for the anastomosis averaged 20 minutes (range 10 to 100). Intraoperatively, no complications occurred. Postoperatively, the average hospital stay was 1.1 days. The stents were removed at an average of 20 days (range 14 to 28) postoperatively. The average follow-up was 11.7 months; at the last follow-up visit, each patient was doing well. Of the 50 patients, 48 underwent one or more renograms, demonstrating stable renal function, improved drainage, and no evidence of recurrent obstruction. Conclusions: Robotic-assisted laparoscopic pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. The procedure provides a minimally invasive alternative with good short-term results.

  18. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance

    OpenAIRE

    Tuech, Jean-Jacques; Bridoux, Valérie; Kianifard, Babak; Schwarz, Lilian; Tsilividis, Basile; Huet, Emmanuel; Michot, Francis

    2011-01-01

    Abstract Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging concept which has been recently applied to the field of rectal excision. The authors describe a case of total mesorectal excision using a transanal port and laparoscopic assistance We described a procedure performed in a A 45-year-old for a rectal adenocarcinoma (1cm wide, T1sm3) 3cm above the dentate line. The procedure is described in the text and in a didactic video. ...

  19. Laparoscopic Radical Cystectomy: a 5-year review of a single institute's operative data and complications and a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Omar M. Aboumarzouk

    2012-06-01

    Full Text Available OBJECTIVE: We aim to evaluate our experience and results with laparoscopic radical cystectomy and conduct a systematic review of studies reporting on 50 or more procedures. MATERIALS AND METHODS: Between February 2006 and March 2011, a prospective study in a single institute on patients with bladder cancer who underwent laparoscopic radical cystectomy was conducted. A search of the Cochrane Library, PubMed, Medline, and Scopus databases was conducted for studies reporting on 50 or more laparoscopic radical cystectomy procedures to compare with our results. RESULTS: Sixty men and five women underwent laparoscopic radical cystectomy during the 5-year study period. Thirty-nine patients were submitted to ileal conduits, 24 to neobladders, and two patients to ureterocutaneostomies. The mean operative time was 294 ± 27 minutes, the mean blood loss was 249.69 ± 95.59 millilitres, the mean length of hospital stay was 9.42 ± 2 days, the mean morphine requirement was 3.69 ± 0.8 days. The overall complication rate was 44.6% (29/65. However, the majority of the patients with complications (90% (26/29 had minor complications treated conservatively with no further surgical intervention needed. The literature search found seven studies, which reported on their institutions' laparoscopic radical cystectomy results of 50 or more patients. Generally, our results were similar to other reported studies of the same calibre. CONCLUSION: Laparoscopic radical cystectomy is a safe and efficient modality of treatment of bladder cancer. However, it comes with a steep learning curve, once overcome, can provide an alternative to open radical cystectomy.

  20. Transversus abdominis plane (TAP) block after robot-assisted laparoscopic hysterectomy

    DEFF Research Database (Denmark)

    Torup, H; Bøgeskov, M; Hansen, E G;

    2015-01-01

    BACKGROUND: Transversus abdominis plane (TAP) block is widely used as a part of pain management after various abdominal surgeries. We evaluated the effect of TAP block as an add-on to the routine analgesic regimen in patients undergoing robot-assisted laparoscopic hysterectomy. METHODS: In a pros...... and Nonsteroidal anti-inflammatory drugs (NSAID) treatment, had no effect on morphine consumption, VAS pain scores, or frequency of nausea and vomiting after robot-assisted laparoscopic hysterectomy compared with paracetamol and NSAID alone.......BACKGROUND: Transversus abdominis plane (TAP) block is widely used as a part of pain management after various abdominal surgeries. We evaluated the effect of TAP block as an add-on to the routine analgesic regimen in patients undergoing robot-assisted laparoscopic hysterectomy. METHODS...... on top of paracetamol and ibuprofen or diclofenac. For the first 24 post-operative hours, we monitored PCA morphine consumption and pain scores with visual analogue scale (VAS) at rest and while coughing. Post-operative nausea and number of vomits (PONV) were recorded. RESULTS: Sixty-five patients...

  1. Current status of robot-assisted laparoscopic surgery in pediatric urology.

    Science.gov (United States)

    Song, Sang Hoon; Kim, Kun Suk

    2014-08-01

    Laparoscopic procedures for urological diseases in children have been proven to be safe and effective. However, the availability of laparoscopic procedures is still partly limited to experienced, high-volume centers because the procedures are technically demanding. The da Vinci robot system is being used for an increasing variety of reconstructive procedures because of the advantages of this approach, such as motion scaling, greater optical magnification, stereoscopic vision, increased instrument tip dexterity, and tremor filtration. Particularly in pediatric urologic surgery, where the operational field is limited owing to the small abdominal cavity of children, robotic surgical technology has its own strengths. Currently, robots are used to perform most surgeries in children that can be performed laparoscopically. In this review, we aimed to provide a comprehensive overview of the current role of robot-assisted laparoscopic surgery in Pediatric Urology by analyzing the published data in this field. A growing body of evidence supports the view that robotic technology is technically feasible and safe in pediatric urological surgery. Robotic technology provides additional benefits for performing reconstructive urologic surgery, such as in pyeloplasty, ureteral reimplantation, and enterocystoplasty procedures. The main limitations to robotic surgery are its high purchase and maintenance costs and that the cost-effectiveness of this technology remains to be validated. PMID:25132942

  2. Rethinking radical politics in the context of assisted reproductive technology.

    Science.gov (United States)

    Parks, Jennifer

    2009-01-01

    Radical feminists have argued for both the radical potential of assisted reproductive technology (ART) and its oppressive and damaging effects for women. This paper will address the question of what constitutes a radical feminist position on ART; I will argue that the very debate over whether ART liberates or oppresses women is misguided, and that instead the issue should be understood dialectically. Reproductive technologies are neither inherently liberating nor entirely oppressive: we can only understand the potential and effects by considering how they are actually taken up within a culture. The internal contradictions, tensions, and inconsistencies within ART and the way it is addressed within the law points to a dialectic that resists a simple reductivist understanding. PMID:19076939

  3. Laparoscopic-assisted vaginal pull-through: A new approach for congenital adrenal hyperplasia patients with high urogenital sinus

    Directory of Open Access Journals (Sweden)

    Jacques Birraux

    2015-01-01

    Full Text Available Background: To open vaginal cavity to the pelvic floor is part of surgical treatment for urogenital sinus (UGS in girls with congenital adrenal hyperplasia (CAH. For high UGS, this operative procedure can be challenging and may jeopardise urinary continence. Combined perineal and laparoscopic approaches could be useful to minimise perineal dissection and to facilitate the vaginal lowering. Patients and Methods: We report the procedure of a laparoscopic-assisted vaginal pull-through for supra-sphincteric UGS in a 5-year-old girl with CAH. Laparoscopic dissection of the vagina from the posterior wall of the bladder and urethra, division of the confluence and vaginal pull-through to the perineum are described. Discussion: The technique is derived from laparoscopic-assisted treatment for high ano-rectal malformations. Compared with current procedures for treatment for high UGS, laparoscopic-assisted approach allows mobilising vagina with minimal dissection of perineum and complete preservation of urethra. Another major advantage is to provide a direct vision for dissection of the space between rectum and urethra prior to vaginal pull-through. Conclusion: Laparoscopic-assisted vaginal pull-through appears to be an interesting approach for high UGS in CAH patients, reducing dissection and risk of urinary incontinence. This new approach needs to be strengthened by other cases.

  4. Thoracoscopic radical esophagectomy and laparoscopic transhiatal lymph node dissection for superficial esophageal cancer associated with lymph node metastases in the dorsal area of the thoracic aorta.

    Science.gov (United States)

    Ninomiya, Itasu; Okamoto, Koichi; Tsukada, Tomoya; Saito, Hiroto; Fushida, Sachio; Ikeda, Hiroko; Ohta, Tetsuo

    2015-12-01

    Esophageal cancer invading the muscularis mucosa sometimes involves regional lymph node metastases. However, lymph node metastases are rare in the dorsal area of the thoracic aorta. We describe a patient with an intramucosal esophageal cancer invading the muscularis mucosa, accompanied by lymph node metastases in the dorsal area of the thoracic aorta. These lesions were successfully resected by hand-assisted laparoscopic surgery using a transhiatal approach. A 60-year-old man was diagnosed with superficial esophageal cancer during a routine health examination. Endoscopic examination and ultrasonography revealed a superficial cancer, of diameter 6.0 cm, invading the submucosal layer and intramural metastases caudal to the primary tumor. Enhanced computed tomography and F-deoxyglucose positron emission tomography demonstrated the two metastatic lymph nodes, one in the dorsal area of the thoracic aorta and the other near the left gastric artery. Thoracoscopic radical esophagectomy with three-field lymph node dissection was performed. The metastatic lymph node in the dorsal area of the thoracic aorta was successfully removed by hand-assisted laparoscopic surgery using a transhiatal approach. Histopathological examination showed primary cancer invading the muscularis mucosa and intramural metastases in the lamina propria mucosa and submucosal layer. The pathological diagnosis according to the Japanese classification of esophageal cancer was MtLt, 47 mm, 0-IIa + IIb, pT1a-MM, ie(+), INF-b, ly3, v0, pN4(4a), pIM1, M0, and pstage IVa. The patient underwent two courses of adjuvant chemotherapy, consisting of CDDP and 5-fluorouracil. At present, 1 year and 8 months after surgery, the patient remains alive without tumor recurrence. Although the lymph node in the dorsal area of the thoracic aorta is not recognized as regional nodes of thoracic esophageal cancer, solitary mediastinal metastases from a mucosal cancer may indicate the existence of direct lymphatic flow

  5. Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results

    Directory of Open Access Journals (Sweden)

    Tanya Nazemi

    2006-02-01

    Full Text Available PURPOSE: Radical nephrectomy can be performed using open or laparoscopic (with or without hand assistance methods, and most recently using the da Vinci Surgical Robotic System. We evaluated the perioperative outcomes using a contemporary cohort of patients undergoing radical nephrectomy by one of the above 4 methods performed by the same surgeon. MATERIALS AND METHODS: The relevant clinical information on 57 consecutive patients undergoing radical nephrectomy from September 2000 until July 2004 by a single surgeon was entered in a Microsoft Access DatabaseTM and queried. Following appropriate statistical analysis, p values < 0.05 were considered significant. RESULTS: Of 57 patients, the open, robotic, laparoscopy with or without hand assistance radical nephrectomy were performed in 18, 6, 21, and 12 patients, respectively. The age, sex, body mass index (BMI, incidence of malignancy, specimen and tumor size, tumor stage, Fuhrman grade, hospital stay, change in postoperative creatinine, drop in hemoglobin, and perioperative complications were not significantly different between the methods. While the estimated median blood loss, postoperative narcotic use for pain control, and hospital stay were significantly higher in the open surgery method (p < 0.05, the median operative time was significantly shorter compared to the robotic method (p = 0.02. Operating room costs were significantly higher in the robotic and laparoscopic groups; however, there was no significant difference in total hospital costs between the 4 groups. CONCLUSIONS: The study demonstrates that radical nephrectomy can be safely performed either by open, robotic, or laparoscopic with or without hand assistance methods without significant difference in perioperative complication rates. A larger cohort and longer follow up are needed to validate our findings and establish oncological outcomes.

  6. Preliminary experience of the robot-assisted laparoscopic excision of a retroperitoneal mass: A case report.

    Science.gov (United States)

    Liu, Qin; Wang, Xinjing; Shen, Baiyong; Zhao, Liangchao; Zhan, Qian; Zhao, Shulin; Wen, Chenlei; Deng, Xiaxing; Peng, Chenghong; Li, Hongwei

    2014-12-01

    The aim of the present study was to report the initial clinical experience of adopting the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to perform a retroperitoneal tumor resection. The patient was a 56-year-old female who presented with a five-year history of hypertension. Abdominal dynamic computed tomography (CT) and positron emission tomography-CT scans revealed a mass measuring ~6 cm in diameter that was located anterior to the abdominal aorta, and between the abdominal aorta and the inferior vena cava (at the level of the third lumbar vertebra). The tumor was excised via a five-port, robot-assisted, transperitoneal laparoscopic approach. Careful dissection of the tumor away from the abdominal aorta and the inferior vena cava was accomplished without resulting in major vascular injury. There were no complications and the patient was discharged in a good condition on the eleventh postoperative day. Pathological analysis of a tumor specimen demonstrated a benign pheochromocytoma (PHEO). During the three-month follow-up, no recurrence was identified through CT scans or measurement of the patient's endocrine hormone levels. Thus, the da Vinci robot-assisted laparoscopic system may be safely employed in the treatment of extra-adrenal PHEOs that occur in difficult locations for which a laparoscopic surgical excision may be challenging. PMID:25360164

  7. 腹腔镜辅助与开腹胃癌D2根治术治疗局部进展期远端胃癌的安全性及近期疗效Meta分析%Safety and Short-term Efficacy of Laparoscopic Assisted Distal Gastrectomy versus Open Distal Gastrectomy in D2 Radical Surgeries for Locally Advanced Distal Gastric Cancer:A Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    王红岩; 赵晓丹; 李国胜; 傅元; 匡立润; 崔仕健; 刘峥嵘

    2015-01-01

    目的:运用Meta分析方法比较腹腔镜辅助与开腹胃癌D2根治术治疗局部进展期远端胃癌的安全性和近期疗效。方法收集1990年1月至2014年8月发表的有关腹腔镜辅助与开腹胃癌D2根治术治疗局部进展期远端胃癌疗效评价的文献,对纳入文献进行质量评价,利用Revman 5.2分析软件对疗效进行Meta分析。结果共纳入25篇文献,包括5044例行D2根治术治疗局部进展期远端胃癌患者。Meta分析结果显示:腹腔镜辅助与开腹胃癌D2根治术治疗局部进展期远端胃癌的淋巴结清扫数量比较,差异无统计学意义。前者在手术时间上多于后者,但在术中出血量、术后近期疗效等评价指标上均优于后者。结论治疗局部进展期远端胃癌,腹腔镜辅助胃癌D2根治术与开腹胃癌D2根治术相比,在手术时间、术后恢复时间等方面存在差异,术者在临床实践中选择术式时应予以考虑,远期疗效尚需进一步研究验证。%Objective To conduct a Meta⁃analysis to compare the safety and short⁃term efficacy of laparoscopic assisted distal gastrectomy (LADG)and open distal gastrectomy(ODG)in D2 radical surgeries for locally advanced distal gastric cancer. Methods The literatures from Janurary,1990 to August,2014 on the evaluation of safety and short⁃term efficacy of LADG versus ODG in D2 radical surgeries for locally advanced distal gastric cancer were collected. The quality of the enrolled articles was evaluated and the software Revman 5.2 was adopted to analyze the cura⁃tive effect. Results Totally 25 articles met the inclusion criteria,including 5 044 patients with treatment of D2 radical surgeries for locally advanced distal gastric cancer. There was no significant difference in the cleaning number of lymph nodes between LADG and ODG in patients undergoing D2 radical surgeries for locally advanced distal gastric cancer. The operation time was longer for LADG than ODG

  8. Exploring the potential of haptic feedback for assisting navigation of laparoscopic surgical instruments

    Directory of Open Access Journals (Sweden)

    Thomas eHoward

    2016-06-01

    Full Text Available The poor ergonomics of laparoscopic surgery are a widely recognized source of difficulty for surgeons, leading to sub-optimal surgeon performance and sometimes injury to the patient. The main causes for this are lost and distorted perception of interaction forces and instrument position. The latter, due to losses in visual and kinaesthetic depth perception and modified hand-eye coordination, can prevent precise navigation of instruments towards surgical targets or away from sensitive anatomic structures.This situation prompts us to explore methods for efficiently assisting the surgeon during instrument navigation. Here, we present experiments aimed at providing insights into the effectiveness of haptic (tactile and kinaesthetic, visual and combined feedback in assisting the navigation of a laparoscopic instrument tip towards a surgical target.Subjects placed in front of a laparoscopic trainer were tasked with following various instrument tip trajectories within a target plane while minimizing both deviations and task execution times. Feedback on the level of deviation was provided alternately through visual on-screen cues, tactile cues provided by vibration motors and / or kinaesthetic cues provided by a haptic interface co-manipulating the surgical instrument.Evaluations of these forms of feedback over two series of experiments implicating a total of 35 subjects (34 non-surgeon novices, 1 surgeon intern with experience in laparoscopy show positive impacts of providing such feedback on precision in instrument navigation.Visual, tactile and combined cues lead to increased precision in navigation (up to 25% increase in time spent on target, and 32% reduction in deviation amplitudes, but usually at the cost of reduced task execution speed. However, the use of kinaesthetic feedback through soft virtual fixtures provided in a co-manipulated robot-assisted surgery set-up both significantly improved precision (32% increase in time spent on target, and

  9. An alternative port for use in hand-assisted laparoscopic surgery: a design using a stoma ring and a glove.

    Science.gov (United States)

    Kumar, Pradeep; Kumar, Senthil

    2005-04-01

    Hand-assisted laparoscopic surgery (HALS) has widened the range of laparoscopic surgery. An appropriate port allowing the passage of the hand while maintaining pneumoperitoneum is mandatory for HALS to be performed. Commercially available ports are expensive and may not be universally available. An inexpensive 2-component port using the flange of a stoma appliance and a glove, which could be readily assembled at short notice, is described. PMID:15821629

  10. Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012-2013.

    Science.gov (United States)

    Sugihara, Toru; Yasunaga, Hideo; Horiguchi, Hiromasa; Matsui, Hiroki; Fujimura, Tetsuya; Nishimatsu, Hiroaki; Fukuhara, Hiroshi; Kume, Haruki; Changhong, Yu; Kattan, Michael W; Fushimi, Kiyohide; Homma, Yukio

    2014-11-01

    In 2012, Japanese national insurance started covering robot-assisted surgery. We carried out a population-based comparison between robot-assisted and three other types of radical prostatectomy to evaluate the safety of robot-assisted prostatectomy during its initial year. We abstracted data for 7202 open, 2483 laparoscopic, 1181 minimal incision endoscopic, and 2126 robot-assisted radical prostatectomies for oncological stage T3 or less from the Diagnosis Procedure Combination database (April 2012-March 2013). Complication rate, transfusion rate, anesthesia time, postoperative length of stay, and cost were evaluated by pairwise one-to-one propensity-score matching and multivariable analyses with covariants of age, comorbidity, oncological stage, hospital volume, and hospital academic status. The proportion of robot-assisted radical prostatectomies dramatically increased from 8.6% to 24.1% during the first year. Compared with open, laparoscopic, and minimal incision endoscopic surgery, robot-assisted surgery was generally associated with a significantly lower complication rate (odds ratios, 0.25, 0.20, 0.33, respectively), autologous transfusion rate (0.04, 0.31, 0.10), homologous transfusion rate (0.16, 0.48, 0.14), lower cost excluding operation (differences, -5.1%, -1.8% [not significant], -10.8%) and shorter postoperative length of stay (-9.1%, +0.9% [not significant], -18.5%, respectively). However, robot-assisted surgery also resulted in a + 42.6% increase in anesthesia time and +52.4% increase in total cost compared with open surgery (all P robotic surgery led to a dynamic change in prostate cancer surgery. Even in its initial year, robot-assisted radical prostatectomy was carried out with several favorable safety aspects compared to the conventional surgeries despite its having the longest anesthesia time and the highest cost.

  11. Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

    Directory of Open Access Journals (Sweden)

    Carmine Noviello

    2015-01-01

    Full Text Available Transumbilical laparoscopic-assisted appendectomy (TULAA is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA. All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years. Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results.

  12. Early Experiences of Robotic-assisted Laparoscopic Liver Resection

    OpenAIRE

    Choi, Sae Byeol; Park, Joon Seong; Kim, Jae Keun; Hyung, Woo Jin; Kim, Kyung Sik; Yoon, Dong Sup; Lee, Woo Jung; Kim, Byong Ro

    2008-01-01

    Purpose The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentations. Robotic surgery for hepatic resection has not yet been extensively reported. Patients and Methods Between March and May 2007, we performed 3 robot-assisted left lateral sectionectomies of the liver. Case 1 had a hepatocellular carcinoma (HCC), case 2 had colon cancer with liver metastasis, and case 3 had intrahepatic duct stones. Results All patients had s...

  13. Comparative evaluation of two reconstructive methods following laparoscopic assisted subtotal gastrectomy in dogs

    Directory of Open Access Journals (Sweden)

    Bakhtiari Jalal

    2012-12-01

    Full Text Available Abstract Background Laparoscopic gastrectomy is a new and technically challenging surgical procedure with potential benefit. The objective of this study was to investigate clinical and para-clinical consequences following Roux-en-Y and Jejunal Loop interposition reconstructive techniques for subtotal gastrectomy using laparoscopic assisted surgery. Results Following resection of the stomach attachments through a laparoscopic approach, stomach was removed and reconstruction was performed with either standard Roux-en-Y (n = 5 or Jejunal Loop interposition (n = 5 methods. Weight changes were monitored on a daily basis and blood samples were collected on Days 0, 7 and 21 post surgery. A fecal sample was collected on Day 28 after surgery to evaluate fat content. One month post surgery, positive contrast radiography was conducted at 5, 10, 20, 40, 60 and 90 minutes after oral administration of barium sulfate, to evaluate the postoperative complications. There was a gradual decline in body weight in both experimental groups after surgery (P  0.05. Fecal fat content increased in the Roux-en-Y compared to the Jejunal loop interposition technique (P  0.05. Conclusion Roux-en-Y and Jejunal loop interposition techniques might be considered as suitable approaches for reconstructing gastro-intestinal tract following gastrectomy in dogs. The results of this study warrant further investigation with a larger number of animals.

  14. Current surgical treatment option, utilizing robot-assisted laparoscopic surgery in obese women with endometrial cancer: Farghalys technique

    International Nuclear Information System (INIS)

    Background: Endometrial cancer is the most prevalent cancer of the female genital tract in North America. Minimally invasive laparoscopic-assisted surgery and panniculectomy in obese women with endometrial cancer are associated with an improved lymph node count, and lower rate of incisional complications than laparotomy. Methods: Technique for robot-assisted laparoscopic surgery for obese women with endometrial cancer is detailed. Results: Robot-assisted laparoscopic surgical staging, pelvic and para-aortic lymphadenectomy and panniculectomy allow us to avoid the use of postoperative pelvic radiation which is recommended in women with histopathology high-risk findings: deep myometrial invasion or high grade histology. The procedure has the advantage of three-dimensional vision, ergonomic, intuitive control, and wristed instrument that approximate the motion of the human hand. Conclusion: Robot-assisted laparoscopic surgical staging, and panniculectomy in these patients are a safe, and effective alternative to laparoscopic, and laparotomy surgery. It is an ideal tool for performing the complex oncologic procedures encountered in endometrial cancer staging that requires delicate retroperitoneal, pelvic and para-aortic lymph node dissection, while maintaining the principles of oncologic surgery but in a minimally invasive fashion.

  15. Robot-Assisted Laparoscopic Nephroureterectomy for Transitional Cell Carcinoma of a Right Pelvic Kidney

    Science.gov (United States)

    Rezaee, Michael E.; Shetty, Zubin; Pridmore, David; Dave, Chirag N.

    2016-01-01

    Abstract Background: Nephroureterectomy is the standard of care for transitional cell carcinoma (TCC) involving the upper urinary tract. However, few published case reports exist describing the surgical treatment of ectopic kidneys with TCC. Surgical removal of a pelvic kidney can be complicated by aberrant vasculature supply, a tortuous ureter and abutting anatomical structures. Thus, it is necessary to determine the most appropriate surgical technique for treatment of pelvic kidneys with suspected malignancy. Case Presentation: A 65-year-old female who presented with hematuria and lower abdominal pain was found to have a right pelvic kidney with a heterogeneous mass on computed tomography (CT) urogram. A robot-assisted laparoscopic nephroureterectomy of the right pelvic kidney was performed. Histopathological analysis revealed high-grade TCC with microscopic extension through the muscularis propria of the renal pelvis and superficially into the renal parenchyma. Conclusion: This case demonstrates the successful use of robot-assisted laparoscopic nephroureterectomy in the treatment of a pelvic kidney with TCC. Preoperative CT angiography is critical to define vascular anatomy and to prevent significant blood loss and damage to surrounding structures during surgery. This case was presented because TCC of a pelvic kidney is a rare occurrence and the use of robot-assisted nephroureterectomy for treatment of this disease is novel. PMID:27579441

  16. Robotic-assisted laparoscopic excision of gossypiboma simulating bladder wall mass after 35 years of appendectomy

    Directory of Open Access Journals (Sweden)

    Emad Sabri Rajih

    2014-01-01

    Full Text Available Gossypiboma or textiloma are terms commonly used to describe a retained sponge in the body that is composed of sponge invested within a layer of foreign body reaction in the form of an abscess or an aseptic fibrotic reaction. These cases are rarely reported despite an incidence of 1:1,000-1,500 of abdominal or pelvic surgery. We report a patient who presented with an incidental supravesical mass discovered upon work up for frequency and suprapubic pain. He had appendectomy 35 years ago. The mass was excised by robotic-assisted laparoscopic technique. The pathologic evaluation came as gossypiboma.

  17. Advances in Robotic-Assisted Radical Prostatectomy over Time

    Directory of Open Access Journals (Sweden)

    Emma F. P. Jacobs

    2013-01-01

    Full Text Available Since the introduction of robot-assisted radical prostatectomy (RALP, robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize recent advances in perioperative management and surgical technique for RALP.

  18. Use of a novel multi-purpose sponge for laparoscopic surgery: Does it have special relevance to robotically-assisted laparoscopic surgery?

    Science.gov (United States)

    Morelli, Luca; Guadagni, Simone; Troia, Elena; Di Franco, Gregorio; Palmeri, Matteo; Caprili, Giovanni; D’Isidoro, Cristiano; Moglia, Andrea; Pisano, Roberta; Pietrabissa, Andrea; Cuschieri, Alfred; Mosca, Franco

    2016-01-01

    BACKGROUND: The STAR System (Ekymed SpA) is a novel multipurpose sponge developed for conventional manual laparoscopic surgery. MATERIALS AND METHODS: Between December 2012 and December 2014, we successfully used the sponge in ten robot-assisted and ten direct manual laparoscopic operations to achieve haemostasis, for blunt dissections, for atraumatic lifting of solid organs, to check for bile leaks, for cleaning the surgical field thus avoiding frequent use of suction or the application of haemostatic agents. The reason of the insertion (RI), the main use (MU) and any further use (FU), once inserted, were registered for each operation and compared between the two groups. RESULTS: The principal RI was haemostasis for minor bleeding, without differences between the two groups (P = not significant). Regard to MU, in the robotic group cleaning the surgical field was utilised more than laparoscopic group (100% vs. 60%; P = 0.03). About FU, atraumatic solid organs lifting was more frequent during robotically assisted surgery than with laparoscopy (50% vs. 0%; P = 0.01). A statistically more frequent use of the sponge was registered during standard laparoscopy for the blunt dissection (30% vs. 80%; P = 0.03). CONCLUSIONS: The STAR System was beneficial in both approaches, but it imparts added benefit during robotically-assisted laparoscopic surgery organs because of the lack of tactile feedback and because the operating surgeon is remote from the patient, and has to rely on the assisting surgeon in the sterile field for dealing with bleeding episodes, cleansing/mopping the operative field when necessary, who may not be experienced or completely proficient. PMID:27251845

  19. The current status of robot-assisted radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Prokar Dasgupta; Roger S.Kirby

    2009-01-01

    Robot-assisted radical prostatectomy (RARP) is a rapidly evolving technique for the treatment of localized prostate cancer.In the United States,over 65% of radical prostatectomies are robot-assisted,although the acceptance of this technology in Europe and the rest of the world has been somewhat slower.This article reviews the current literature on RARP with regard to oncological,continence and potency outcomes-the so-called 'trifecta'.Preliminary data appear to show an advantage of RARP over open prostatectomy,with reduced blood loss,decreased pain,early mobilization,shorter hospital stay and lower margin rates.Most studies show good postoperative continence and potency with RARP;however,this needs to be viewed in the context of the paucity of randomized data available in the literature.There is no definitive evidence to show an advantage over standard laparoscopy,but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging.Finally,evolving techniques of single-port robotic prostatectomy,laserguided robotics,catheter-free prostatectomy and image-guided robotics are discussed.

  20. Does robot-assisted laparoscopic radical prostatectomy enable to obtain adequate oncological and functional outcomes during the learning curve? From the Korean experience%在学习曲线中观察机器人辅助腹腔镜前列腺根除术能否得到充分的肿瘤学和功能性结果?来自韩国的经验

    Institute of Scientific and Technical Information of China (English)

    Young Hwii Ko; Jeong Hyeon Ban; Seok Ho Kang; Hong Seok Park; Jeong Gu Lee; Duck Ki Yoon; Je Jong Kim; Jun Cheon; Vipul R. Patei

    2009-01-01

    To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy (RALRP) during the learning curve, in terms of surgical, oncologicai and functional outcomes, we conducted a prospective survey on RALRP. From July 2007, a single surgeon performed 63 robotic prostatectomies using the same operative technique. Perioperative data, including pathological and early functional results of the patient, were collected prospectively and analyzed. Along with the accumulation of the cases, the total operative time, setup time, console time and blood loss were significantly decreased. No major complication was present in any patient. Transfusion was needed in six patients; all of them were within the initial 15 cases. The positive surgical margin rate was 9.8% (5/51) in pT2 disease. The most frequent location of positive margin in this stage was the lateral aspect (60%), but in pT3 disease multiple margins were the most frequent (41.7%). Overall, 53 (84.1%) patients had totally continent status and the median time to continence was 6.56 weeks. Among 17 patients who maintained preoperative sexual activity (Sexual Health Inventory for Men ≥ 17), stage below pT2, followed up for > 6 months with minimally one side of neurovascular bundle preservation procedure, 12 (70.6%) were capable of intercourse postoperatively, and the mean time for sexual intercourse after operation was 5.7 months. In this series, robotic prostatectomy was a feasible and reproducible technique, with a short learning curve and low perioperative complication rate. Even during the initial phase of the learning curve, satisfactory results were obtained with regard to functional and oncological outcome.%为了评价学习曲线中机器人辅助腹腔镜检查根治前列腺切除术(robot-assisted laparoscopic radical prostatectomy,RALRP)的短期结果,即外科、肿瘤学和功能性结果,我们进行了一个关于RALRP的前瞻性调查.从2007年7月开始,一名外科医生运用

  1. Successful pregnancy outcome after laparoscopic-assisted excision of a bizarre leiomyoma: a case report

    Directory of Open Access Journals (Sweden)

    Mori Masahiko

    2011-08-01

    Full Text Available Abstract Introduction Bizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation. Especially when diagnosed in a younger woman, this tumor leads to challenging treatment issues involving fertility preservation. Owing to the low incidence of bizarre leiomyoma, there is insufficient evidence to support myomectomy alone as an appropriate management option. Also, the impact of bizarre leiomyoma on fertility is not well known. Case presentation A 30-year-old Japanese woman who had never given birth was referred to us because of a uterine tumor with an unusual diagnostic image and was treated by a gasless laparoscopic-assisted excision with a wound retractor. Owing to an unclear margin between her uterine tumor and myometrium, a concomitant excision of adjacent myometrial tissue was required to achieve the maximum resection of her tumor. The histopathological diagnosis was bizarre leiomyoma. Seven months later, she conceived spontaneously and her pregnancy course was uneventful. At 37 weeks of gestation, an elective cesarean section was performed. Although a slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted. Conclusions A laparoscopic-assisted excision of bizarre leiomyoma is a feasible and minimally invasive conservative measure for a woman who wishes to preserve fertility.

  2. Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy.

    Science.gov (United States)

    Matsuda, Takeru; Iwasaki, Takeshi; Mitsutsuji, Masaaki; Hirata, Kenro; Maekawa, Yoko; Tanaka, Tomoko; Shimada, Etsuji; Kakeji, Yoshihiro

    2015-04-01

    Complete mesocolic excision with central vascular ligation is considered to contribute to superior oncological outcomes after colon cancer surgery [1]. For advanced right-sided colon cancer, this surgery sometimes requires lymph node (LN) dissection along the superior mesenteric vein (SMV), with division of the middle colic vessels, or their right branches, at origin [2]. Here, we present cranially approached radical LN dissection along the surgical trunk during laparoscopic right hemicolectomy. The omental bursa is first opened wide, and the gastrocolic trunk of Henle is exposed, using the right gastroepiploic vessels and the accessory right colic vein (ARCV) as landmarks. After division of ARCV, SMV and middle colic vein (MCV) are identified. After dividing MCV at its root, LN dissection along SMV is conducted in a cranial-to-caudal manner. Concurrently, the middle colic artery, or its right branch, is exposed and divided at origin. The transverse colon is then raised ventrally, and LN dissection along SMV using a cranial-to-caudal approach is again performed. The ileocolic and right colic vessels are divided at origin. The ascending and transverse mesocolon, including the pedicles, are then separated from the retroperitoneal tissues, pancreatic head, and duodenum, using a medial approach. The key characteristics in this procedure consist of easy access to pancreas, early division of ARCV and middle colic vessels at origin, and easy dissection along SMV. We performed a laparoscopic colectomy using this approach for 18 patients with right-sided colon cancer. The mean operative time and blood loss were 288 min and 83 ml, respectively. The mean number of harvested LNs was 24. There were 6 cases with positive LN metastasis. There were no recurrent cases at a median follow-up period of 24 months. We consider this approach to be safe and useful for radical LN dissection along SMV for right-sided colon cancers.

  3. Laparoscopic assisted ventriculoperitoneal shunt revisions as an option for pediatric patients with previous intraabdominal complications

    Directory of Open Access Journals (Sweden)

    Fernanda O. de Carvalho

    2014-04-01

    Full Text Available Multiple shunt failure is a challenge in pediatric neurosurgery practice and one of the most feared complications of hydrocephalus. Objective: To demonstrate that laparoscopic procedures for distal ventriculoperitoneal shunt failure may be an effective option for patients who underwent multiple revisions due to repetitive manipulation of the peritoneal cavity, abdominal pseudocyst, peritonitis or other situations leading to a “non reliable” peritoneum. Method: From March 2012 to February 2013, the authors reviewed retrospectively the charts of six patients born and followed up at our institution, which presented with previous intra-peritoneal complications and underwent ventriculoperitoneal shunt revision assisted by video laparoscopy. Results: After a mean follow-up period of nine months, all patients are well and no further shunt failure was identified so far. Conclusion: Laparoscopy assisted shunt revision in children may be, in selected cases, an effective option for patients with multiple peritoneal complications due to ventriculo-peritoneal shunting.

  4. Port-site metastasis following robotic-assisted radical hysterectomy for squamous cell cervical cancer

    OpenAIRE

    Bolles, Olivia; Borowsky, Mark

    2011-01-01

    ► Port-site metastases can occur following treatment for cervical cancer. ► Port-site metastases can occur following robotic assisted laparoscopic surgery. ► The pathogenesis of port-site metastases is poorly understood.

  5. Place of Schauta's radical vaginal hysterectomy.

    Science.gov (United States)

    Roy, Michel; Plante, Marie

    2011-04-01

    Women affected by early stage invasive cancer of the cervix are usually treated by surgery. Radical abdominal hysterectomy with pelvic lymphadenectomy is the most widely used technique. Because the morbidity of the abdominal approach can be important, the radical vaginal hysterectomy has gained acceptance in gynaecologic oncology. New instrumentation in laparoscopy also opens the possibility of treating cervical cancer by laparoscopically assisted vaginal radical hysterectomy and also total laparoscopic radical hysterectomy. Before these techniques become widely accepted, it has to be shown that safety and efficacy are comparable with the 'standard' abdominal approach. In this chapter, we review the technique of radical vaginal hysterectomy with pelvic lymphadenectomy and evaluate results of published studies, comparing the abdominal, vaginal and laparoscopic approaches.

  6. Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection

    Directory of Open Access Journals (Sweden)

    Anita Joselyn

    2015-01-01

    Full Text Available Purpose: One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection. Materials and Methods: With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure. Results: This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024. Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS. No difference was noted in the postoperative pain scores. Conclusion: Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

  7. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy

    DEFF Research Database (Denmark)

    Novara, Giacomo; Catto, James W F; Wilson, Timothy;

    2015-01-01

    and complications of RARC in comparison with ORC and LRC. EVIDENCE ACQUISITION: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies...

  8. Combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy for synchronous double cancer of the rectum and the prostate.

    Science.gov (United States)

    Kamiyama, Hirohiko; Sakamoto, Kazuhiro; China, Toshiyuki; Aoki, Jun; Niwa, Koichiro; Ishiyama, Shun; Takahashi, Makoto; Kojima, Yutaka; Goto, Michitoshi; Tomiki, Yuichi; Horie, Shigeo

    2016-05-01

    Here we report a combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy. A 74-year-old man was diagnosed with T4b low rectal and prostate cancer. The operation was performed after neoadjuvant chemotherapy for the rectal cancer. The procedure used eight ports in total, five for laparoscopic abdominoperineal resection and six for robotic-assisted prostatectomy. First, laparoscopic total mesorectal excision including division of the inferior mesenteric artery was performed, and then, robotic dissection of the prostate was performed. The en bloc specimen was removed through the perineal wound. Then, robotic urethrovesical anastomosis was performed. An extraperitoneal end colostomy was created to finish the operation. The operating time was 545 min, and blood loss was 170 mL. The postoperative course was uneventful, and the patient discharged on postoperative day 17. The combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy were performed safely without any additional technical difficulty, as both procedures shared port settings and patient positions. PMID:27117964

  9. Laparoscopic D2 radical gastrectomy plus complete mesogastrium excision with membrane anatomy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:By employing video laparoscopy, we further demonstrated that mesogastrium, covered by Proper Fascia with anterior surface (A) and posterior surface (P) extends towards and fuses with the “mesogastrium bed”. Therefore, D2 lymphadenectomy plus complete mesogastrium excision (CME) is proposed as a novel approach to en bloc for advanced gastric cancer.Methods: This study was approved by the Tongji Hospital Ethics Committee.Results:A total of 54 patients underwent laparoscopic D2+CME with membrane anatomy. hTe mean number of retrieved regional lymph nodes was 35.04±10.70 (range, 14-55 lymph nodes). The mean volume of blood loss was 12.44±22.89 mL. No operative complication was observed during hospitalization.Conclusion:We believe that the laparoscopic D2 plus CME can minimize the differences in the number of lymph nodes harvested, and substantially reduce the intraoperative blood losses and surgery-related injuries in advanced gastric cancer patients.

  10. Robot-assisted partial nephrectomy in contemporary practice

    Directory of Open Access Journals (Sweden)

    Youssef S. Tanagho

    2013-01-01

    Full Text Available Laparoscopic renal surgery is associated with reduced blood loss, shorter hospital stay, enhanced cosmesis, and more rapid convalescence relative to open renal surgery. Laparoscopic partial nephrectomy is a minimally invasive, nephron-sparing alternative to laparoscopic radical nephrectomy for the management of small renal masses. While offering similar oncological outcomes to laparoscopic radical nephrectomy, the technical challenges and prolonged learning curve associated with laparoscopic partial nephrectomy limit its wider dissemination. Robot-assisted partial nephrectomy, although still an evolving procedure with no long-term data, has emerged as a viable alternative to laparoscopic partial nephrectomy, with favorable preliminary outcomes. This article provides an overview of the role of robot-assisted partial nephrectomy in the management of renal cell carcinoma. The clinical indications and principles of surgical technique for this procedure are discussed. The oncological, renal functional, and perioperative outcomes of robot-assisted partial nephrectomy are also evaluated, as are complication rates.

  11. Robotic-assisted laparoscopic hysterectomy seems safe in women with early-stage endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Havemann, Maria Cecilie; Palle, Connie;

    2015-01-01

    INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine...... the incidence of complications according to the Clavien-Dindo scale after robotic-assisted laparoscopic hysterectomy (RALH) for early-stage endometrial cancer and atypical complex hyperplasia. The Clavien-Dindo scale grades the severity of complications. METHODS: This was a retrospective, descriptive cohort...... study of 235 women with endometrial cancer or atypical complex hyperplasia who had RALH. Surgeries were stratified into two groups: with or without pelvic lymphadenectomy. RESULTS: A total of 6% developed a grade 3 or higher complication with no significant difference (p = 0.24) between the groups...

  12. A surgical glove port technique for laparoscopic-assisted ovariohysterectomy for pyometra in the bitch.

    Science.gov (United States)

    Becher-Deichsel, Anja; Aurich, Jörg E; Schrammel, Nadine; Dupré, Gilles

    2016-07-15

    The objective of the study was to describe the feasibility of a glove port technique for laparoscopic-assisted surgical treatment of canine pyometra. In this retrospective case series, a total of 10 female dogs (median age 7 years, range 5.5-10.5 years; median weight 37.0 kg, range 12.9-64.0 kg) with pyometra were included. A multiaccess port was created from a surgical glove attached to an Alexis wound retractor and placed in the ventral midline between the middle and caudal third of the distance between umbilicus and pubic rim. A vessel sealing device was used for transection of the ovarian pedicle. The port size was selected on the basis of maximum uterine diameter determined by ultrasound. Median incision length was 5.0 cm (range 3.1-7.7 cm) for a maximum uterine diameter of 4.0 cm (range 2.0-7.0 cm). Median surgical time was 57 minutes (range 48-65 minutes). No case had to be converted to open celiotomy. Complications included one case of minor, self-limiting splenic trauma by the endoscope. In eight dogs, the distended uterine horns endangered safe access to the ovarian pedicle, and the vessel sealing device was inserted through a second cannula placed periumbilically. Extension of the original incision was necessary to exteriorize organs in two dogs. All dogs recovered quickly and were discharged either on the day of surgery or 1 day thereafter. In conclusion, a surgical glove port technique in combination with an Alexis wound retractor is feasible for surgical laparoscopic treatment of canine pyometra up to a diameter of 7 cm. PMID:27039076

  13. Standardized technique for single-incision laparoscopic-assisted stoma creation.

    Science.gov (United States)

    Miyoshi, Norikatsu; Fujino, Shiki; Ohue, Masayuki; Yasui, Masayoshi; Noura, Shingo; Wada, Yuma; Kimura, Ryuichiro; Sugimura, Keijiro; Tomokuni, Akira; Akita, Hirofumi; Kobayashi, Shogo; Takahashi, Hidenori; Omori, Takeshi; Fujiwara, Yoshiyuki; Yano, Masahiko

    2016-08-10

    To describe the procedure, efficacy, and utility of single-incision laparoscopic-assisted stoma creation (SILStoma) for transverse colostomy. Using single-incision laparoscopic surgery, we developed a standardized technique for SILStoma. Twelve consecutive patients underwent SILStoma for transverse colostomy at Osaka Medical Center for Cancer and Cardiovascular Diseases from April 2013 to March 2016. A single, intended stoma site was created with a 2.5-3.5 cm skin incision for primary access to the intra-abdominal space, and it functioned as the main port through which multi-trocars were placed. Clinical and operative factors and postoperative outcomes were evaluated. Patient demographics, including age, gender, body mass index, and surgical indications for intestinal diversion were evaluated. SILStoma was performed in nine cases without the requirement of additional ports. In the remaining three cases, 1-2 additional 5-mm ports were required for mobilization of the transverse colon and safe dissection of abdominal adhesions. No cases required conversion to open surgery. In all cases, SILStoma was completed at the initial stoma site marked preoperatively. No intraoperative or postoperative complications greater than Grade II (the Clavien-Dindo classification) were reported in the complication survey. Surgical site infection at stoma sites was observed in four cases; however, surgical interventions were not required and all infections were cured completely. In all cases, the resumption of bowel movements was observed between postoperative days 1 and 2. SILStoma for transverse loop colostomy represents a feasible surgical procedure that allows the creation of a stoma at the preoperatively marked site without any additional large skin incisions. PMID:27606046

  14. Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

    Directory of Open Access Journals (Sweden)

    Tiberio M. Siqueira Jr.

    2010-08-01

    Full Text Available Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP and with the extraperitoneal LRP (ELRP during the learning curve (LC. Materials and Methods: Data of the initial 40 TLRP (Group 1 were retrospectively compared with the initial 40 ELRP (Group 2. Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001 and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001 were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5% represented by one case of bleeding and one case of rectal injury, whereas four complications (10% were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675. Open conversion occurred once in each Group (2.5%. Overall postoperative complications were similar (52.5% x 35%; p = 0.365. Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary, leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.

  15. LAPAROSCOPIC-ASSISTED OVARIOHYSTERECTOMY IN A BITCH WITH HEMATOMETRA OVÁRIO-HISTERECTOMIA VIDEOASSISTIDA EM UMA CADELA COM HEMATOMETRA

    OpenAIRE

    Carlos Eduardo Bortolini; Bianca Bertoletti; Natasha Frezza Oliveira; Paula Cristina Basso; Maurício Veloso Brun; Anelise Bonilla Trindade; Emerson Antônio Contesini

    2010-01-01

    The canine pyometritis is an adult bitch illness characterized by the inflammation of the uterus with secretion accumulation. Hematometra is a consequence of the piometritis, however it is characterized for diapese of erythrocytes for the uterus, which changes the coloration of the secretion. The treatment ought to be immediate and aggressive, and the advised treatment is ovariohysterectomy for seriously ill animals. This report describes the laparoscopic-assisted ovariohysterctomy as a surgi...

  16. Athermal bladder neck dissection during robot-assisted radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Fabrizio Dal Moro

    2014-06-01

    Full Text Available Introduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontinence remains a frustrating side-effect. Anatomically, bladder neck (BN serves as an internal sphincter. The longitudinal fibres of BN may be identified and isolated with a meticulous dissection at the prostato-vesical junction, contributing to earlier return of urinary continence. The purpose of this video is to show an anatomical athermal dissection of BN during RARP.Materials and Methods After incision of endopelvic fascia and anterior defatting, the morphology of prostate not only laterally, but also at the level of bladder-prostatic junction is well visualized. With an athermal dissection of the plane between prostate and bladder we can minimize the traumatic effects on the longitudinal fibres of BN. A cold section of the preserved BN permits the complete preservation of integrity of this sphincteric structure.Results With this technique we preserve the longitudinal fibres of BN, allowing the sparing of the sphincteric mechanism of BN. The finding of a difficult athermal dissection of these plans may make you suspect the presence of an infiltration, suggesting to sacrifice BN in order to avoid a positive surgical margin. In our series no increase of PSM has been recorded using this technique.Conclusions This surgical technique preserving the natural BN mechanism appears to improve urinary continence, allowing at the same time an easy identification of a neoplastic infiltration.

  17. Donor Complications Following Laparoscopic Compared to Hand-Assisted Living Donor Nephrectomy: An Analysis of the Literature

    Directory of Open Access Journals (Sweden)

    Whitney R. Halgrimson

    2010-01-01

    Full Text Available There are two approaches to laparoscopic donor nephrectomy: standard laparoscopic donor nephrectomy (LDN and hand-assisted laparoscopic donor nephrectomy (HALDN. In this study we report the operative statistics and donor complications associated with LDN and HALDN from large-center peer-reviewed publications. Methods. We conducted PubMed and Ovid searches to identify LDN and HALDN outcome studies that were published after 2004. Results. There were 37 peer-reviewed studies, each with more than 150 patients. Cumulatively, over 9000 patients were included in this study. LDN donors experienced a higher rate of intraoperative complications than HALDN donors (5.2% versus. 2.0%, <.001. Investigators did not report a significant difference in the rate of major postoperative complications between the two groups (LDN 0.5% versus HALDN 0.7%, =.111. However, conversion to open procedures from vascular injury was reported more frequently in LDN procedures (0.8% versus 0.4%, =.047. Conclusion. At present there is no evidence to support the use of one laparoscopic approach in preference to the other. There are trends in the data suggesting that intraoperative injuries are more common in LDN while minor postoperative complications are more common in HALDN.

  18. Effect of Trapping Agent and Polystyrene Chain End Functionality on Radical Trap-Assisted Atom Transfer Radical Coupling

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Carnicom

    2014-10-01

    Full Text Available Coupling reactions were performed to gauge the effect of the inclusion of a radical trap on the success of coupling reactions of monohalogenated polystyrene (PSX chains in atom transfer radical coupling (ATRC type reactions. The effect of both the specific radical trap chosen and the structure of the polymer chain end were evaluated by the extent of dimerization observed in a series of analogous coupling reactions. The commonly used radical trap 2-methyl-2-nitrosopropane (MNP showed the highest amounts of dimerization for PSX (X = Br, Cl compared to coupling reactions performed in its absence or with a different radical trap. A dinitroxide coupling agent was also studied with the extent of coupling nearly matching the effectiveness of MNP in RTA (Radical trap-assisted-ATRC reactions, while N-nitroso and electron rich nitroso coupling agents were the least effective. (2,2,6,6-Tetramethyl-piperin-l-yloxyl-capped PS (PS-TEMPO, prepared by NMP, was subjected to a coupling sequence conceptually similar to RTA-ATRC, but dimerization was not observed regardless of the choice of radical trap. Kinetic experiments were performed to observe rate changes on the coupling reaction of PSBr as a result of the inclusion of MNP, with substantial rate enhancements found in the RTA-ATRC coupling sequence compared to traditional ATRC.

  19. Radical prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Sønksen, Jens; Jakobsen, Henrik

    2014-01-01

    OBJECTIVE: The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. MATERIAL AND METHODS: Patient and tumour...... surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood...... loss and functional outcomes were compared between groups. RESULTS: Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins (p = 0.96) or potency at 12 months (p = 0.7). Patients who had undergone...

  20. Robot-assisted radical prostatectomy: histopathologic and biochemical recurrence data at one-year follow-up

    Science.gov (United States)

    Patel, Vipul; Thaly, Rahul; Shah, Ketul

    2007-02-01

    Introduction: Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and short term PSA outcomes of 500 robotic prostatectomies. Materials and Methods: Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM Stage, Gleason's grade, tumor location, volume, specimen weight, seminal vesicle involvement and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data was collected every three months for the first year, then every six months for a year, then yearly. Results: Average pre-operative PSA was 6.9 (1-90) with Gleason's score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), 9(2%). Post operatively histopathologic analysis showed Gleason's 6 (44%), 7(42%), 8(10%), 9(4%). 10%, 5%, 63%, 15%, 5% and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b and T4 respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1-100), 8% (101-200), 13% (201-300), 5% (301-400) and 8% (401-500). By stage it was 2%, 4%, 2.5% for T2a, T2b, T2c tumors, 23% (T3a), 46% (T3b) and 53% (T4a). For organ confined disease (T2) the margin rate was 2.5% and 31% for non organ confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle and 11 (23%) multifocally. Ninety five percent of patients (n=500) have undetectable PSA (<0.1) at average follow up of 9.7 months. Recurrence has only been seen with non organ confined tumors. Those patients with a minimum follow up of 1 year (average 15.7 months) 95% have undetectable PSA (<.1). Conclusion: Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall margin positive rate

  1. Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Avinash Chennamsetty

    2015-01-01

    Full Text Available Introduction. To explore the long term incidence and predictors of incisional hernia in patients that had RARP. Methods. All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair. Results. Of 577 patients, 48 (8.3% had a hernia at an incisional site (35 men had umbilical, diagnosed at (median 1.2 years after RARP (mean follow-up of 5.05 years. No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams; P=0.001 and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48 versus 4.6% (22/480; P=0.033. Overall, 4% (23/577 of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias. Conclusion. Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.

  2. Vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy for enlarged myomatous uterus: a randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    Fan Rong; Zhu Lan; Lang Jing-he; Shi Hong-hui; Gong Xiao-ming

    2011-01-01

    Objective:To compare the intraoperative condition and short-term outcomes of vaginal hysterectomy (VH) and laparoscopic assisted vaginal hysterectomy (LAVH) for enlarged myomatous uterus.Methods:Fifty patients from Peking Union Medical College Hospital (PUMCH) were randomly assigned to two treatment groups:VH (n=23) and LAVH (n=27).All procedures were performed by a single senior surgeon to maintain homogeneity.Results:The baseline characteristics of the two groups were comparable.The operative time for LAVH was significantly longer than for VH (76.7±23.2 vs.57.6±23.5 min,P<0.05),and LAVH costs more money than VH (6,923.07±622.96 vs.5,974.46±1,408.08 RMB,P<0.05).Major complications,uterine weight and the length of hospital stay were comparable between VH and LAVH group.One case of VH was converted to LAVH due to adhesion.Conclusions:Compared with LAVH,VH is a time- and cost-saving operative technique for enlarged myomatous uterus.VH should be the primary method for uterine removal,but LAVH may have advantages when adhesion is present.

  3. 腹腔镜前列腺癌根治术的围手术期护理%The perioperative nursing of laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    程范华; 郑红娟; 潘翠青

    2013-01-01

    目的 探讨腹腔镜前列腺癌根治术治疗前列腺癌患者的临床疗效及围手术期的护理要点.方法 对10例前列腺癌患者采用腹腔镜前列腺癌根治术切除前列腺及行膀胱颈尿道吻合,并通过改进围手术期的护理方法,有效地促进患者恢复.结果 所有患者手术均获成功并痊愈出院.结论 腹腔镜前列腺癌根治术治疗前列腺癌,手术成功率高;加强围手术期的护理,尤其是重视术前心理疏导、术中配合及术后妥善处理好各种引流管等,有助于减少前列腺癌患者围手术期并发症的发生.%Objectives This pedicled investigates the therapeutic effects of which laparoscopic radical prostatectomy for treatment of prostate cancer patients and perioperative care elements.Methods 10 cases of prostate cancer patients,with introduction of laparoscopic radical prostatectomy for prostate,bladder neck-urethral anastomosis and through improving the perioperative nursing,promoting fistula healing and increasing the cure rate.Results ALL the operations were successfully completed fully recouered.Conclusions The laparoscopic radical prostatectomy for treatment of prostate cancer,which can improve the success rate of operation.Intensive perioperative care,with particular attention to psychological intervention,intraoperative cooperation and properly handle the various drainage tubes,etc,which are help to reduce perioperative complications.

  4. 腹腔镜根治性前列腺切除术预见性护理%Predictive nursing for the patients with laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    郑红娟

    2012-01-01

    OBJECTIVE To investigate the predictive nursing for the patients with laparoscopic radical prostatectomy. METHODS 11 cases of laparoscopic radical prostatectomy were predictively nursed. Hypercapnia, anastomotic leakage of bladder and urethra, venous thrombosis of lower limbs, anastomotic stricture of bladder and urethra, urinary incontinence, sexual dysfunction and other complications were observed and analyzed. RESULTS The predictive nursing can significantly reduce the hypercapnia, anastomotic leakage of bladder and urethra, venous thrombosis of lower limbs, urinary incontinence, anastomotic stenosis of bladder and urethra and sexual dysfunction. CONCLUSION Scientific predictive nurses can make the patients with laparoscopic radical prostatectomy recover quickly with little trauma, less bleeding and systemic responses.%目的 探讨腹腔镜根治性前列腺切除术预见性护理.方法 对某院11例腹腔镜根治性前列腺切除术实施预见性护理,观察其术后高碳酸血症、尿道膀胱吻合口漏、下肢静脉血栓形成、尿道膀胱吻合口狭窄、尿失禁、性功能障碍等并发症的情况.结果 预见性护理能明显减少高碳酸血症、尿道膀胱吻合口漏、下肢静脉血栓形成、尿失禁、尿道膀胱吻合口狭窄、性功能障碍等并发症的发生.结论 腹腔镜根治性前列腺切除术创伤小、出血少、全身反应轻,配合科学的预见性护理,可以使患者迅速康复.

  5. [A technic for laparoscopic gastrostomy].

    Science.gov (United States)

    Kala, Z; Vomela, J; Hanke, I

    1995-08-01

    The authors describe the technique of laparoscopic gastrostomy and laparoscopic assisted gastrostomy. It is an alternative method for patients, when PEG (percutaneous endoscopic gastronomy) or other more physiologic way of food administration is not possible to perform.

  6. Transperitoneal mini-laparoscopic pyeloplasty and concomitant ureteroscopy-assisted pyelolithotomy for ureteropelvic junction obstruction complicated by renal caliceal stones.

    Directory of Open Access Journals (Sweden)

    Zhi Chen

    Full Text Available OBJECTIVE: To present our experience of combining transperitoneal mini-laparoscopic pyeloplasty (mini-LP and concomitant ureteroscopy-assisted pyelolithotomy (U-P for ureteropelvic junction obstruction (UPJO complicated by renal caliceal stones in the same session. METHODS: Between May 2007 and December 2011, mini-LP and concomitant U-P was performed in nine patients with UPJO and ipsilateral renal caliceal stones. Stone location and burden were preoperatively assessed. After pyelotomy with appropriate length (about 4 mm, a 16-Fr catheter sheath replaced the uppermost or lowermost laparoscopic trocar and was introduced directly into the renal pelvis under the guidance of a guide wire and laparoscopic vision. A 7.5F rigid ureteroscopy passed through the catheter sheath into the plevis. Intracorporeal lithotripsy and/or pressure irrigation via a pump was used for caliceal stone removal. Subsequently, laparoscopic pyeloplasty was performed in a standard fashion. Postoperative imaging was assessed. RESULTS: The calculi sizes ranged from 2 to 11 mm (mean, 7.1 mm and an average of 3 stones per patient was removed (range, 1 to 6 stones. Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 210 minutes, and estimated blood loss was 20 mL. Mean hospital stay was 5 days (4-7. Stent was removed after 4-8 weeks. No intraoperative or postoperative complications were noted during a mean follow-up of 18.5 months (range, 6 to 24 months. CONCLUSIONS: Mini-LP and concomitant U-P are simple and effective alternatives for the simultaneous management of UPJO complicated by coexisting ipsilateral renal caliceal stones.

  7. Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer

    Science.gov (United States)

    Hao, Yingxue; Yu, Peiwu; Qian, Feng; Zhao, Yongliang; Shi, Yan; Tang, Bo; Zeng, Dongzhu; Zhang, Chao

    2016-01-01

    Abstract Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79

  8. Perioperative differences in open radical prostatectomy versus laparoscopic radical prostatectomy%开放和经腹腔镜前列腺癌根治术围手术期的临床差异分析

    Institute of Scientific and Technical Information of China (English)

    李雪梅; 季惠翔; 潘进洪; 方强; 周占松; 陈志文

    2013-01-01

    目的 探讨经腹腔镜前列腺癌根治术较开放性前列腺癌根治术围手术期的优点.方法 回顾分析2006年1月至2012年2月我科收治的75例前列腺癌患者的临床资料,对比开放性前列腺癌根治术与经腹腔镜前列腺癌根治术两组患者围术期的临床特征及并发症等.结果 经腹腔镜前列腺癌根治术组的患者术中出血量和总输血量以及住院时间显著低于开放性前列腺癌根治术组(P<0.05).开放性前列腺癌根治术组与经腹腔镜前列腺癌根治术组的总并发症分别为38.7%和18.2% (P <0.05),其中重度并发症分别为6.5%和4.5%(P>0.05).结论 经腹腔镜前列腺癌根治术因创伤小,术中出血量和围手术期输血量显著减少,总并发症率显著减少,最终可能节约了医疗资源.%Objective To determine the perioperative advantages in laparoscopic radical prostatectomy compared with open radical prostatectomy.Methods The perioperative clinical characteristics in both groups of laparoscopic radical prostatectomy and open radical prostatectomy were reviewed and statistically investigated.The complications related to operations were recorded and graded according to the severity grading system of surgical complications.Results The blood loss,transfusion and days of hospital stay were significantly less in the group of laparoscopic radical prostatectomy than in the group of open radical prostatectomy.The incidences of total complications were 38.7% vs 18.2%,and the incidences of severe complications were 6.5% vs 4.5% in the groups of open radical prostatectomy and laparoscopic radical prostatectomy,respectively.Conclusion The blood loss,transfusion,complications and days of hospital stay are decreased significantly in minimally invasive prostate cancer surgery.Thus the medical resource is saved eventually.

  9. Transvaginal repair of recurrent rectovaginal fistula with laparoscopic-assisted rectovaginal mobilization.

    Science.gov (United States)

    Pelosi, M A; Pelosi, M A

    1997-12-01

    This study examines the use of laparoscopic upper rectovaginal mobilization to facilitate the transvaginal repair of recurrent rectovaginal fistulas. A 39-year-old female presented with fecal and gas incontinence consequent to an obstetrically related rectovaginal fistula with five unsuccessful transvaginal repairs over a 5-year period. Her condition was successfully treated by a transphincteric approach that combined an extensive laparoscopic dissection of the rectovaginal space from above with transvaginal dissection of the rectovaginal space from below to create complete mobilization between the two organs and to permit an excellent, tension-free closure of the rectal defect. Successful fistula closure and restoration of anal continence were achieved. The patient remains cured 18 months postsurgery. Laparoscopic mobilization of the upper rectovaginal septum followed by transvaginal division of the lower septum permits a more extensive mobilization and release of tension for fistula repair than that typically noted by the vaginal route alone. PMID:9449089

  10. Robotic-assisted laparoscopic resection of ectopic pancreas in the posterior wall of gastric high body: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Sheng-Der Hsu; Hurng-Sheng Wu; Chien-Long Kuo; Yueh-Tsung Lee

    2005-01-01

    Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors of the stomach can be resected using laparoscopic techniques. We report here a case of ectopic pancreas tissue in the gastric wall that was removed using robotic-assisted laparoscopic resection. The patient was a 15-year-old female who presented with abdominal discomfort and tarry stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the posterior wall of the gastric high body. Intraoperative upper endoscopy clearly located the lesion. A robotic-assisted laparoscopic wedge resection of the putative gastric submucosal tumor was performed. The pathology results showed an ectopic pancreas. The patient had an uneventful recovery and we believe that this is a valid treatment option for this benign condition.

  11. Outcomes of gynecologic oncology patients undergoing robotic-assisted laparoscopic procedures in a university setting.

    Science.gov (United States)

    Walters Haygood, Christen L; Fauci, Janelle M; Huddleston-Colburn, Mary Katherine; Huh, Warner K; Straughn, J Michael

    2014-09-01

    This study evaluated intraoperative complications and postoperative outcomes of gynecologic oncology patients undergoing robotic-assisted (RA) laparoscopic procedures in a university setting. A retrospective chart review evaluated all gynecologic oncology patients at the University of Alabama at Birmingham who underwent attempted RA procedures between August 2006 and October 2011. Patient demographics, medical/surgical history, intraoperative complications, postoperative outcomes, conversion rates, readmission rates, and length of stay were examined. Total complication rates were assessed over time for each surgeon. 681 patients underwent planned RA procedures by seven gynecologic oncologists. The mean body mass index was 33.5 kg/m(2) (range 16.6-71.0 kg/m(2)). 61.4 % were diagnosed with malignancy. The most common procedure was RA hysterectomy with unilateral/bilateral salpingo-oophorectomy (37.2 %). Robotic staging was performed in 291 patients (45.1 %). Mean estimated blood loss was 75 ml (range 5-700 ml). 36 patients (5.3 %) were converted to laparotomy. The most common reason for conversion was adhesions (30.1 %), followed by uterine size (22.2 %). In 107 cases, a surgical modification was required for specimen removal including mini-laparotomy (24), extension of accessory port (36), morcellation (9), and difficult vaginal delivery (38). 3.7 % had intraoperative complications; 6 patients had a cystotomy and 5 had a vascular injury. Postoperatively, 20 patients had a febrile episode, 9 had wound complications, and 3 had a vaginal cuff dehiscence. 27 (4.2 %) patients were readmitted within 30 days. Complication rates and conversion rates were similar per surgeon. Total complication rates for evaluable surgeons were similar between the first 10 cases and subsequent 50 cases. Although patients undergoing RA procedures in a university setting are high risk, the conversion rate to laparotomy is low and intraoperative and postoperative complications are

  12. Comparative study of laparoscope and laparotomy D2 radical gastrectomy in the treatment of distal gastric cancer%腹腔镜与开腹远端胃癌D2根治术的对比研究

    Institute of Scientific and Technical Information of China (English)

    何洪生; 曾文龙; 朱柏炼; 杜永御; 赖扬城

    2014-01-01

    目的:通过对比腹腔镜与开腹远端胃癌D2根治术的疗效及安全性,探讨腹腔镜辅助远端胃癌D2根治术的临床价值。方法221例行远端胃癌D2根治术患者,分为两组。其中腹腔镜组115例,开腹组106例,对两组手术时间、术中出血量、术后排气时间、首次进流质时间、淋巴结清扫数目、术后住院天数、并发症进行比较。结果腹腔镜组手术时间、淋巴结清扫数与开腹组差异无统计学意义(P>0.05),而腹腔镜组术中出血量少,术后肛门排气时间早,首次进流质时间早,术后住院时间短,并发症发生率低(P0.05). However, the laparoscope group had fewer intraoperative bleeding volumes, earlier postoperative anal exhaust time, earlier first time of liquid diet, shorter postoperative hospital stays and lower incidence of complications (P<0.05). Conclusion Laparoscope assisted D2 radical gastrectomy in the treatment of distal gastric cancer has small trauma, few bleeding, quick recovery and less complications. The recent curative effect is similar as that of laparotomy, and the treatment is safe and feasible, and worthy of clinical promotion.

  13. 腹腔镜和手辅助腹腔镜活体供肾切取术%Laparoscopic and Hand-assisted Laparoscopic Live Donor Nephrectomy

    Institute of Scientific and Technical Information of China (English)

    孙立安; 朱同玉; 王国民

    2005-01-01

    肾移植是终末期肾病(end-stage renal disease,ES—DR)的理想治疗手段。由于尸肾来源匮乏,活体供肾移植的比例逐年增加。与尸肾移植相比,活体供肾移植的植肾功能和存活率均优于尸肾移植,人/肾存活率高,对病人和移植物长期存活有利。活体供肾切取术方式主要有3种,传统开放手术活体供肾切取术(open donor nephreetomy,ODN),经典腹腔镜活体供肾切取术(1aparoscopic live donor nephreetomy,LDN),手辅助腹腔镜活体供肾切取术(hand-assisted laparoscopic live donornephreetomy,HLDN)。美国大多数肾移植中心已将U)N作为首选的供肾切取方法,活体供肾比例大幅度提高。现对LDN、HLDN的适应证、手术方法、结果作一综述。

  14. Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques.

    Science.gov (United States)

    Dion, Joanna M; McKee, Chris; Tobias, Joseph D; Herz, Daniel; Sohner, Paul; Teich, Steven; Michalsky, Marc

    2015-02-01

    Various factors including severe obesity or increases in intra-abdominal pressure during laparoscopy can lead to inaccuracies in end-tidal carbon dioxide (PETCO2) monitoring. The current study prospectively compares ET and transcutaneous (TC) CO2 monitoring in severely obese adolescents and young adults during laparoscopic-assisted bariatric surgery. Carbon dioxide was measured with both ET and TC devices during insufflation and laparoscopic bariatric surgery. The differences between each measure (PETCO2 and TC-CO2) and the PaCO2 were compared using a non-paired t test, Fisher's exact test, and a Bland-Altman analysis. The study cohort included 25 adolescents with a mean body mass index of 50.2 kg/m2 undergoing laparoscopic bariatric surgery. There was no difference in the absolute difference between the TC-CO2 and PaCO2 (3.2±3.0 mmHg) and the absolute difference between the PETCO2 and PaCO2 (3.7±2.5 mmHg). The bias and precision were 0.3 and 4.3 mmHg for TC monitoring versus PaCO2 and 3.2 and 3.2 mmHg for ET monitoring versus PaCO2. In the young severely obese population both TC and PETCO2 monitoring can be used to effectively estimate PaCO2. The correlation of PaCO2 to TC-CO2 is good, and similar to the correlation of PaCO2 to PETCO2. In this population, both of these non-invasive measures of PaCO2 can be used to monitor ventilation and minimize arterial blood gas sampling.

  15. A comparison of the robotic-assisted versus retropubic radical prostatectomy.

    Science.gov (United States)

    Laviana, A A; Hu, J C

    2013-09-01

    After Walsh's detailed anatomic description of pelvic anatomy in 1979, the retropubic radical prostatectomy (RRP) was the predominant surgical treatment for prostate cancer for more than twenty-five years. Over the past decade, however, the robotic-assisted radical prostatectomy (RARP) has grown increasingly popular and now is the most used surgical modality. Willingness to adopt this approach has been confounded by the novelty of technology and widespread marketing campaigns. In this article, we performed a literature search comparing radical retropubic prostatectomy to robotic-assisted radical prostetectomy with regard to perioperative, oncologic, and quality-of-life outcomes. We performed a PubMed literature search for a review of articles published between 2000 and 2013. Relevant articles were highlighted using the following keywords: robot or robotic prostatectomy, open or retropubic prostatectomy. Perioperative outcomes including decreased blood loss, fewer blood transfusions, and decreased length of hospital stay tend to favor RARP, while perioperative mortality is near negligible in both. Short-term positive surgical margins, prostate-specific antigen recurrence free survival, and need for salvage therapy following RARP are similar to RRP, though data at greater than ten years is limited. Preservation of urinary and sexual function and quality of life favored RARP, though this is dependent on surgeon technique. Finally, cost, though evolving, favors RRP. In our current state, most prostatectomies will continue to be perfromed robotically. Though there is evidence the robotic-assisted radical prostatectomy offers shorter lengths of stay, decreased intraoperative blood loss, faster return of sexual function and continence, there is a paucity on long-term oncologic outcomes. Rigorous, prospective randomized-controlled trials need to be performed to determine the long-term success of the robotic-assisted radical prostatectomy and whether it is cost

  16. The analysis of laparoscopic-assisted and open abdominal right hemi-colectomy:a report of 192 cases%腹腔镜辅助与开腹右半结肠癌根治术192例临床分析

    Institute of Scientific and Technical Information of China (English)

    王俊江; 林锋; 李勇; 姚学清; 吴伍林; 蔡观福; 陈仕荣; 余清华; 吴德庆; 陈志京; 曾穗德

    2011-01-01

    Objective:To explore the method, the feasibility, safety and curative of radical laparoscopic-assisted right hemi-colectomy for colon cancer by comparing laparoscopic-assisted and open abdominal right hemi-colectomy. Methods; Analyze 57 lapaioscopic-assisted right hemi-colectomy (laparoscopic-assisted group) and 135 traditional abdominal radical hemi-colectomy (open abdominal group) in the corresponding period, compare the operative time, blood loss, postoperative anus exhaust time, postoperative hospital time, postoperative complication and number of dissected lymph nodes in two groups. Results:There were no significant difference between two groups in postoperative complication and number of dissected lymph nodes. The blood loss in laparoscopic-assisted group was less than open abdominal group(P =0.040). The postoperative anus exhaust time and the postoperative hospital time in laparoscopic-assisted group were also less than open abdominal group ( P = 0.000, 0.008) , and the operation time in laparoscopic-assisted group was longer than open abdominal group(P = 0.000). Conclusions:The radical laparoscopic-assisted right hemi-colectomy was safe and feasible, and can meet the requirement of radical resection.%目的:对比2006年11’月至2009年7月我院腹腔镜辅助与开腹右半结肠癌根治术的临床资料,探讨腹腔镜辅助右半结肠癌根治术的可行性、安全性及根治性.方法:分析同期57例腹腔镜辅助右半结肠癌根治术(腔镜组)与135例传统开腹右半结肠癌根治术(开腹组)的临床资料,比较两组病例的手术时间、术中出血量、术后肛门排气时间、术后住院时间、术后并发症及淋巴结清扫个数等指标.结果:两组术后并发症(出血、吻合口漏、肠梗阻、肺部感染、泌尿系感染、切口感染)及淋巴结清扫个数差异无统计学意义.腔镜组手术时间较开腹组延长(205.9±63.7) minvs(168.9±57.9)min,(t=3.931,P=0.000);腔镜组出血量(157.5

  17. ROBOT-ASSISTED RADICAL PROSTATECTOMY: ANALYSIS OF THE FIRST 80 CASES

    Directory of Open Access Journals (Sweden)

    D. Yu. Pushkar

    2010-01-01

    Full Text Available Background. As a common disease, prostate cancer (PC has taken now first place among all malignancies in many countries of the world.The authors have analyzed the results of their series of robot-assisted radical laparoscopic prostatectomy (RALP in patients with PC. They also present a number of surgical techniques that may be useful for novice surgeons. Materials and methods. In November 2008 to November 2009, the Department of Urology, Moscow State University of Medicine and Dentistry, performed 80 RALPs using the da Vinci S surgical robotic system. The patients’ mean age was 63.7 (49–71 years; the mean blood level of total prostate-specific antigen was 6.1 (2.1–20.84 ng/ml; the mean prostate volume was 44 (18–94 cm3, as evidenced by transrectal ultrasound study. The authors analyzed the following indicators: operating time, degree of blood loss, conversion of surgical intervention,degrees of intra- and postoperative complications, and oncological and functional results. Results. In our series, RALP was performed without preserving neurovascular bundles or by using a nerve-sparing procedure in 66 (82.5% and 14 (17.5%, respectively; 22 (27.5% patients underwent lymphadenectomy. The average length of hospital stay was 7 (4–21 days; the mean time of urethral catheter removal was 10 (6–21 days postoperatively. The mean time of surgical intervention was 174 (121–276 min. Mean blood loss was 248 (35–1950 ml. Postmortem study revealed a positive surgical margin in 19 (24% cases and tumor invasion into the seminal vesicles in 5 (6% patients. Stages pT2 and pT3 were found in 56 (70% and 24 (30%, respectively; total Gleason scores were 6 (3+3, 7 (3+4, 7 (4+3, 8 (4+4 in 38 (47.5%, 35 (43.75%, 5 (6.25%, and 2 (2.5% patients, respectively. Among 34 patients examined 3 months after RALP, 28 (82.4% patients completely retained urine; 5 (14.7% applied not more than a pad a day. In patients with preserved erectile function, the

  18. ROBOT-ASSISTED RADICAL PROSTATECTOMY: ANALYSIS OF THE FIRST 80 CASES

    Directory of Open Access Journals (Sweden)

    D. Yu. Pushkar

    2014-07-01

    Full Text Available Background. As a common disease, prostate cancer (PC has taken now first place among all malignancies in many countries of the world.The authors have analyzed the results of their series of robot-assisted radical laparoscopic prostatectomy (RALP in patients with PC. They also present a number of surgical techniques that may be useful for novice surgeons. Materials and methods. In November 2008 to November 2009, the Department of Urology, Moscow State University of Medicine and Dentistry, performed 80 RALPs using the da Vinci S surgical robotic system. The patients’ mean age was 63.7 (49–71 years; the mean blood level of total prostate-specific antigen was 6.1 (2.1–20.84 ng/ml; the mean prostate volume was 44 (18–94 cm3, as evidenced by transrectal ultrasound study. The authors analyzed the following indicators: operating time, degree of blood loss, conversion of surgical intervention,degrees of intra- and postoperative complications, and oncological and functional results. Results. In our series, RALP was performed without preserving neurovascular bundles or by using a nerve-sparing procedure in 66 (82.5% and 14 (17.5%, respectively; 22 (27.5% patients underwent lymphadenectomy. The average length of hospital stay was 7 (4–21 days; the mean time of urethral catheter removal was 10 (6–21 days postoperatively. The mean time of surgical intervention was 174 (121–276 min. Mean blood loss was 248 (35–1950 ml. Postmortem study revealed a positive surgical margin in 19 (24% cases and tumor invasion into the seminal vesicles in 5 (6% patients. Stages pT2 and pT3 were found in 56 (70% and 24 (30%, respectively; total Gleason scores were 6 (3+3, 7 (3+4, 7 (4+3, 8 (4+4 in 38 (47.5%, 35 (43.75%, 5 (6.25%, and 2 (2.5% patients, respectively. Among 34 patients examined 3 months after RALP, 28 (82.4% patients completely retained urine; 5 (14.7% applied not more than a pad a day. In patients with preserved erectile function, the

  19. Chemotherapy with laparoscope-assisted continuous circulatory hyperthermic intraperitoneal perfusion for malignant ascites

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritoneal carcinomatosis from gastric cancers. METHODS: From August 2006 to March 2008, the laparoscopic approach was used to perform CHIPC on 16 patients with malignant ascites induced by gastric cancer or postoperative intraperitoneal seeding. Each patient underwent CHIPC three times after laparosco...

  20. Laparoscopic Distal Pancreatectomy: Feasibility Study of Radiofrequency-Assisted Transection in a Porcine Model

    OpenAIRE

    Dorcaratto, Dimitri; Burdio Pinilla, Fernando; Fondevila, Dolors; Andaluz, Anna; Poves, Ignasi; Martínez, María Ángeles; Quesada, Rita; Berjano Zanón, Enrique; Grande, Luis

    2012-01-01

    This is a copy of an article published in the Journal of Laparoendoscopic and Advanced Surgical Techniques © 2012 [copyright Mary Ann Liebert, Inc.]; Journal of Laparoendoscopic and Advanced Surgical Techniques is available online at: http://online.liebertpub.com. Background and Aim: Despite technological improvements in pancreatic surgery, the incidence and morbidity of pancreatic leak after resection of distal pancreas are persistently high in most series. Laparoscopic distal pancreatec...

  1. The Initial Case Report: Salvage Robotic Assisted Radical Prostatectomy After Heavy Ion Radiotherapy

    Directory of Open Access Journals (Sweden)

    Choichiro Ozu

    2016-07-01

    Full Text Available Salvage radical prostatectomy is one of treatments after radiation therapy to patients with prostate cancer. To date, no case of the salvage robotic assisted radical prostatectomy (RARP following heavy ion radiotherapy (HIRT has been published. We report on a 70-year-old man with a history of HIRT for prostate cancer in 2011. For 3 years after. HIRT, his serum PSA levels were permissible range. However, his PSA levels were increased. We had diagnosis localized prostate cancer after HIRT. We had carried out salvage RARP. Until 10 months after salvage RARP, his PSA level was not detectable.

  2. Radical Cystectomy with Ileal Conduit Urinary Diversion in a Patient with a Left Ventricular Assist Device

    Directory of Open Access Journals (Sweden)

    Joseph J. Pariser

    2015-01-01

    Full Text Available Left ventricular assist device (LVAD is an option for the surgical management of severe heart failure, and radical cystectomy remains the standard of care for muscle-invasive bladder cancer. Given a complicated population in terms of comorbidities and management for patients with an LVAD, there is little experience with major urologic procedures, which require balancing the benefits of surgery with considerable perioperative risks. We report our experience performing the first radical cystectomy with ileal conduit in a patient with an LVAD and muscle-invasive bladder cancer.

  3. Comparing Prognosis Situation of Radical Resection of Laparoscopic Rectal Cancer and Open Radical Operation%直肠癌根治术在腹腔镜与开腹预后情况的比较

    Institute of Scientific and Technical Information of China (English)

    徐立伟

    2015-01-01

    Objective:To compare the prognosis situation of radical resection of laparoscopic rectal cancer and open radical operation. Method:100 cases of cancer patients were selected in our hospital from August 2012 to May 2013. According to the different treatment methods,they were divided into the observation group and control group,50 cases in each group. The observation group was performed laparoscopic resection,the control group with traditional open operation treatment,clinical parameters,resection of the recurrence after operation,postoperative complications and survival rate were compared.Result:In the observation group,the amount of bleeding during the operation,incision size,intestinal function recovery time,hospitalization time and other clinical parameters were significantly better than the control group, the differences were statistically significant(P0.05);the postoperative complication rates between observation group and control group were respectively 6% and 16%,the observation group was significantly better than the control group,the difference was statistically significant(P0.05). Conclusion:Survival rate and recurrence rate of rectal cancer by laparoscopic and open radical resection of rectal cancer are not significant difference,but the laparoscopic radical resection of rectal cancer with rapid recovery of disease,height of minimally invasive and reliable safety,the preferred solution can be used as the surgical treatment of rectal cancer,it is worth the clinical promotion.%目的:探析直肠癌根治术在腹腔镜与开腹预后情况的比较。方法:选取本院2012年8月-2013年5月直肠癌患者100例,按治疗方式的不同分为观察组与对照组,每组各50例。观察组进行腹腔镜切除术,对照组经传统开腹手术疗法,比较手术的临床各项参数指标、术后复发情况、术后并发症情况及存活率。结果:观察组的术中出血量、切口大小、肠功能恢复时间、

  4. Clinical experience of laparoscopic radical resection of colorectal cancer%腹腔镜结直肠癌根治术的临床体会

    Institute of Scientific and Technical Information of China (English)

    侯森

    2012-01-01

    目的:探讨腹腔镜结直肠癌根治术的临床效果.方法:回顾分析2011年3月至10月为26例结直肠癌患者行腹腔镜结直肠癌根治术的临床资料,并总结手术方式及随访结果.结果:手术时间105 ~315 min,平均185 min;术中出血量100~320 ml,平均175 ml;术后胃肠功能恢复时间1~4d,平均1.8d;标本切缘均阴性,清扫淋巴结总数10~ 22枚,平均15枚.术后未发生腹腔出血、吻合口漏及狭窄等并发症;术后住院7~10 d,平均8d.随访3~10个月,平均8个月,均无转移、复发及切口种植.结论:腹腔镜结直肠癌根治术安全可行,具有微创、安全、术后康复快、肿瘤根治彻底等优点,在肿瘤根治性、手术时间、近期疗效等方面与传统开腹手术相当,值得推广应用.%Objective;To investigate the clinical efficacy of laparoscopic radical resection of colorectal cancer. Methods: Lapa-roscopic radical resection of colon and rectal cancer was applied to 26 cases with colorectal cancer from Mar. to Oct. 201 i. The clinical data,operation methods and the follow-up outcome were summarized. Results: In the 26 cases, the time of the operation was 105-315 min,the average was 185 min.the amount of bleeding was 100-320 ml, the average was 175 ml;the recovery time of the gastrointestinal function was 1-4 d,the average was 1. 8 d. There were no positive surgery margins,the complications such as abdominal bleeding, anas-tomotic leak and stenosis did not occur. The number of harvested lymph node was 10-22,the average number was 15. The time in the hospital after the operations was 7-10 d.the average time was 8 d. The time of the follow-up visit was 3-10 months,the average time was 8 months,in the follow-up period no metastasis,recurrence or incision implantation was found. Conclusions:Laparoscopic radical resection of colon and rectal cancer is safe and feasible, has the advantages of small damage,safety,fast postoperative recovery and radical cure

  5. Health-related quality of life after robotic-assisted laparoscopic hysterectomy for women with endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Møller, Ann M; Palle, Connie;

    2016-01-01

    OBJECTIVE: The aim of this prospective cohort study using patient-reported outcome measures (PROMs) was to detect short term changes in functioning, symptoms and health-related quality of life (HRQoL) after robotic-assisted laparoscopic hysterectomy (RALH) for endometrial cancer or atypical complex...... postoperatively, but back to baseline level at 5 weeks. Ability to perform work or hobbies and change of taste were still affected at 5 weeks. CONCLUSIONS: HRQoL and postoperative symptoms were overall back to the preoperative level 5 weeks after RALH. These findings indicate fatigue, pain, constipation......, gastrointestinal symptoms, appetite, ability to perform work and hobbies, change of taste and sexually related problems should be addressed in future research and in the pre- and postoperative care for women undergoing RALH....

  6. Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation in Children: Top-Down Suturing Technique Without Stent Placement.

    Science.gov (United States)

    Silay, Mesrur Selcuk; Baek, Minki; Koh, Chester J

    2015-08-01

    Extravesical robotic-assisted laparoscopic ureteral reimplantation in children is a challenging procedure. Our top-down suturing technique facilitates this reconstructive surgery. After mobilization of the ureter without the use of ureteral stent placement, the detrusor muscle is divided. Once adequate muscle flaps are raised, the ureter is placed into its new muscle tunnel. Unlike previously described techniques, the top-down suturing approach involves placement of the first detrusor stitch at the superior aspect. This allows the ureter to be elevated out of harm's way and in a tension-free manner. The rest of the detrusor reapproximation is performed in a top-down approach with interrupted sutures without the need for ureteral elevation or manipulation. This technique facilitates the suturing process and decreases trauma to the ureter with less instrument contact. This helps to prevent potential complications and improve success rates associated with this procedure. PMID:25674670

  7. Single port-assisted fully laparoscopic abdominoperineal resection (APR) with immediate V-RAM flap reconstruction of the perineal defect.

    LENUS (Irish Health Repository)

    Ali, Sayid

    2012-09-01

    Abdominoperineal resection (APR) of anorectal cancers after neoadjuvant chemoradiotherapy may incur significant perineal morbidity. While vertical rectus abdominis muscle (V-RAM) flaps can fill the pelvic resection space with health tissue, their use has previously been described predominantly in association with laparotomy. Here, we describe a means of combination laparoscopic APR with V-RAM flap reconstruction that allows structural preservation of the entire abdominal wall throughout the oncological resection and of the deep parietal layers after V-RAM donation. Furthermore, a single port access device used at the end colostomy site allows a second senior surgeon assist with an additional two working instruments for the purpose of improved pelvic tissue retraction, especially useful in obese patients.

  8. A comparative study of complications and outcomes associated with radical retropubic prostatectomy and robot assisted radical prostatectomy

    Science.gov (United States)

    Gettman, Matthew T.

    2008-02-01

    Purpose: To evaluate outcomes among a matched cohort of prostate cancer patients treated with radical retropubic prostatectomy (RRP) and robot assisted radical prostatectomy (RARP). Materials and methods: Between 2002 and 2005, 294 patients underwent RARP at our institution. Comparison RRP patients were matched 2:1 for surgical year, age, PSA, clinical stage, and biopsy grade (n=588). Outcomes among groups were compared. From an oncologic standpoint, pathologic features among groups were assessed and Kaplan-Meier estimates of PSA recurrence free survival were compared. Results: Overall margin positivity was not significantly different between groups (RARP, 15.6%, RRP, 17%), yet risk of apical margin was significantly less with RARP. RARP was associated with significantly shorter hospitalization (ppatients (p=0.02). At a median followup of 1.3 years, PSA recurrence free estimates were not significantly different (92% vs 92%, p=0.69). Conclusions: Early complications were higher in this RARP group, but this experience includes cases performed in the learning curve. Oncologic, quality of life, and functional data in this study revealed encouraging results for RARP when compared to RRP.

  9. Novel technique to enhance bladder neck dissection with traction of Foley catheter during extraperitoneal laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Henry Y. Lin

    2015-03-01

    Conclusion: Improved bladder neck enhancement provides a clearer vision during bladder neck dissection. Similar functional results and cancer control rates were also encountered during modified extraperitoneal radical prostatectomy. This novel technique is a feasible method for performing endoscopic radical prostatectomy using four ports instead of five.

  10. Transperitoneal Robot-Assisted Radical Prostatectomy Should Be Considered in Prostate Cancer Patients with Pelvic Kidneys

    Science.gov (United States)

    Plagakis, Sophie; Foreman, Darren; Sutherland, Peter

    2016-01-01

    Abstract We highlight two cases of transperitoneal robot-assisted radical prostatectomy (RARP) in patients with pelvic kidneys because of congenital development and renal transplant. These uncommon cases present a challenge to the surgeon contemplating surgery because of access and anomalous vascular and ureteral anatomy. We describe the technical considerations that are paramount in effectively completing transperitoneal RARP, and believe it should be considered as a treatment option in men with pelvic kidneys. PMID:27579412

  11. Transperitoneal Robot-Assisted Radical Prostatectomy Should Be Considered in Prostate Cancer Patients with Pelvic Kidneys.

    Science.gov (United States)

    Plagakis, Sophie; Foreman, Darren; Sutherland, Peter; Fuller, Andrew

    2016-01-01

    We highlight two cases of transperitoneal robot-assisted radical prostatectomy (RARP) in patients with pelvic kidneys because of congenital development and renal transplant. These uncommon cases present a challenge to the surgeon contemplating surgery because of access and anomalous vascular and ureteral anatomy. We describe the technical considerations that are paramount in effectively completing transperitoneal RARP, and believe it should be considered as a treatment option in men with pelvic kidneys. PMID:27579412

  12. PERIOPERATIVE NURSING FOR PROSTATE CANCER PATIENTS WITH EXTRAPERITONEAL LAPAROSCOPIC RADICAL PROSTATECTOMY%经腹膜外腹腔镜前列腺癌根治术围手术期的护理

    Institute of Scientific and Technical Information of China (English)

    孔春霞

    2012-01-01

    [目的]探讨腹腔镜前列腺癌根治术围手术期的护理要点.[方法]2010年11月~2011年8月,某科共行9例经腹腔镜前列腺癌根治术,总结围手术期护理要点.[结果]经过系统的术前护理和细致的术后观察,采取相应的护理措施,患者均安全地渡过了围手术期.[结论]系统术后护理,保持各引流管通畅是腹腔镜前列腺癌根治术围手术期的护理关键.%[Objective] To investigate the nursing highlight for prostate cancer patients treated by laparoscopic radical prostatectomy. [Methods] From November 2010 to August 2011, 9 consecutives laparoscopic radical prostatectomies were performed in our institution, nursing main points were summarized. [Results] All patients had securely passed through preop-eralive period with systemic preoperative care and rnicromesh postoperative observation. [Conclusion] Key points of Periopera-tive nursing were systemic postoperative care and maintaining drainage tube unblocked for prostate cancer patients were treated by laparoscopic radical prostatectomy.

  13. Comparison of short-term outcomes between laparoscopically-assisted vs. transverse-incision open right hemicolectomy for right-sided colon cancer: a retrospective study

    OpenAIRE

    Akaraviputh Thawatchai; Chinswangwatanakul Vitoon; Lohsiriwat Darin; Lohsiriwat Varut; Lert-akyamanee Narong

    2007-01-01

    Abstract Background Laparoscopically-assisted right hemicolectomy (LRH) is an acceptable alternative to open surgery for right-sided colon cancer which offers patients less pain and faster recovery. However, special equipment and substantial surgical experience are required. The aim of the study is to compare the short-term surgical outcomes of LRH and open right hemicolectomy through right transverse skin crease incision (ORHT) for right-sided colon cancer. Patients and methods This retrospe...

  14. Laparoscopic-Assisted Tension-free Vaginal Mesh: An Innovative Approach to Placing Synthetic Mesh Transvaginally for Surgical Correction of Pelvic Organ Prolapse

    Directory of Open Access Journals (Sweden)

    Watanabe,Toyohiko

    2012-02-01

    Full Text Available Polypropylene mesh implants for the correction of pelvic organ prolapse (POP are now available in Japan. We developed an innovative approach for correcting POP by placing polypropylene mesh transvaginally with laparoscopic assistance. From June 2007 through March 2010, sixteen consecutive patients with symptomatic stage 2 or 3 pelvic organ prolapse underwent the laparoscopic-assisted tension-free vaginal mesh procedure at Okayama University Hospital. All patients were evaluated before and at 1, 3, 6, and 12 months after surgery. Female sexual function was also evaluated with the Female Sexual Function Index (FSFI. The procedure was performed successfully without significant complications. Fifteen of 16 patients were considered anatomically cured (93.8% at 12 months postoperatively. One patient with a recurrent stage 3 vaginal vault prolapse required sacral colpopexy six months postoperatively. Total FSFI scores improved significantly from 10.3±1.3 at baseline to 18.0±1.2 at 12 months after surgery. The laparoscopic-assisted trans-vaginal mesh is a safe, effective, and simple procedure for POP repairs. The procedure not only restores anatomic relationships but also improves sexual function.

  15. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  16. Robot assisted radical prostatectomy: how I do it. Part II: Surgical technique.

    Science.gov (United States)

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-12-01

    The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes. PMID:24331353

  17. [Current status and future prospect of robot-assisted radical prostatectomy].

    Science.gov (United States)

    Miyake, Hideaki; Fujisawa, Masato

    2016-01-01

    Although radical retropubic prostatectomy had long been the mainstay as the surgical treatment for patients with localized prostate cancer, robot-assisted radical prostatectomy (RARP) has recently been achieving increasing acceptance, resulting in the leading option for treating such patients in the United States, and it has been progressively expanding in other countries, including Japan. To date, however, there have been limited data concerning prospective studies or randomized trials showing the superiority of RARP over other surgical approaches. In this review, we attempted to summarize the current status of RARP based on available evidence as well as the experience at our institution, and to discuss the future prospect of this novel system as a major surgical technique for localized prostate cancer.

  18. Nosocomial infection after laparoscopic radical resection of rectal cancer and related nursing strategies%腹腔镜下直肠癌根治术后医院感染的临床分析及护理对策

    Institute of Scientific and Technical Information of China (English)

    刘圣芳; 刘新国

    2014-01-01

    Objective To analyze the factors causing nosocomial infection after laparoscopic radical resection of rectal caner ,and to summarize relevant nursing strategies .Methods A total of 152 patients with nosocomial infection after laparoscopic radical resection of rectal caner (observation group) and 150 patients without nosocomial infection after laparoscopic radical resection of rectal caner (control group) were enrolled and the related clinical data were ret-rospectively analyzed .Results The main factors causing nosocomial infection after laparoscopic radical resection of rectal caner included age (more than 60 years old ,accounting for 88 .2% ) ,primary disease (accounting for 69 .1% ) and surgery time (more than 3 h ,accounting for 71 .1% ) .Conclusion Advanced age ,primary disease and surgery time could be main factors causing nosocomial infection after laparoscopic radical resection of rectal caner ,and targe-ted treatment and care should be taken to reduce the incidence rate of nosocomial infection .%目的:观察分析腹腔镜下直肠癌根治术后医院感染情况及感染因素,总结相关护理对策。方法选取奉节县人民医院直肠癌医院感染患者152例为观察组。选择同期没有并发医院感染的150例腹腔镜直肠癌根治术手术患者作为对照组,比较两组患者临床资料。结果导致腹腔直肠癌根治术后医院感染的高危因素包括:年龄大于60岁占88.2%,具有基础疾病占69.1%,手术时间超过3 h占71.1%。结论高龄、具有基础疾病、住院时间长、手术时间长等是导致腹腔镜直肠癌根治术患者发生医院感染的高危因素,临床治疗中应针对上述高危因素采取针对性治疗护理措施,以期降低医院感染率。

  19. 腹膜外入路腹腔镜下前列腺癌根治术41例%Extraperitoneal laparoscopic radical prostectomy of 41 cases

    Institute of Scientific and Technical Information of China (English)

    粱朝朝; 周骏; 叶元平; 刘明; 张贤生; 郝宗耀; 方卫华; 施浩强; 王克孝

    2012-01-01

    目的 熟悉腹膜外入路腹腔镜下前列腺癌根治术的手术方法,降低前列腺癌根治术的手术并发症的发生率.方法 对2005年11月至2012年6月的41例腹腔镜下前列腺癌根治术患者的临床资料进行回顾性分析,患者年龄65 ~ 78岁,平均72岁,所有患者术前均获确诊,前列腺特异性抗原3.4~45.6 ng/ml,<4.0 ng/ml 3例,4~ 20 ng/ml 30例,>20 ng/ml 8例.结果 除1例中转开腹手术,其余均由腹腔镜完成,手术时间65~240 min,平均125 min,术中出血量80 ~700 ml,平均120 ml.术后轻度尿失禁6例,通过尿道括约肌锻炼后1~3个月后可满意控尿,术中保留性神经26例,其中19例术后勃起功能恢复,可以完成性交.术后病理均证实为前列腺癌,Gleason评分4~9分,切缘阳性1例,术后加用内分泌治疗.术后随访2个月~6年,生化复发9例,予内分泌治疗后控制满意,1例因其他疾病死亡.结论 腹膜外入路腹腔镜前列腺癌根治术是治疗前列腺癌的重要方法,把握好关键步骤,仔细操作,可以达到安全、有效、创伤小的目的.%Objective To learn the procedure of extraperitoneal laparoscopic radical prostectomy and to limit the complications of radical prostectomy.Methods We performed the retrospective study among 41 patients (from Nov.2005 to June 2012) undergoing the laparoscopic radical prostectomy.The mean age is 72 (from 65 to 78),and all those were diagnosed with prostate cancer.The PSA was 3.4-45.6 ng/ml.<4.0 ng/ml,4-20 ng/ml and >20 ng/ml was 3,30 and 8,respectively.Results We transferred 1 case from laparoscopy to opening surgery,and others were performed with laparoscopic procedure.The mean operation duration was 125 min (from 65 to 240 min),mean bleeding was 120 ml (from 80 to 700 ml),and there were 6 cases with little uroclepsia,satisfactory with urination after contract urethral sphincter for 3 months.We retained the neurovascular bundle in 26 cases,and the erectile function can

  20. Effect of the transvaginal total laparoscopic rectal cancer radical resection on female sexual dysfunction%经阴道完全腹腔镜直肠癌根治术对女性性功能障碍的影响

    Institute of Scientific and Technical Information of China (English)

    朱畅; 潘凯; 谢海慧; 夏利刚

    2015-01-01

    目的::探讨经阴道腹腔镜直肠癌根治术对女性性功能的影响。方法:选取64例女性直肠癌患者,观察组31例经阴道完全腹腔镜直肠癌根治术,对照组33例常规腹腔镜直肠癌根治术,分别于术后6、12个月进行问卷调查或电话随访,记录患者术后的性功能变化情况,比较2种手术方式对女性患者性功能的影响。结果:术后6个月观察组患者阴道湿润度、性交痛和性生活满意度均差于对照组(P0.05)。结论:阴道完全腹腔镜直肠癌根治术后由于阴道干燥,短期内会对女性性功能造成一定影响,但随时间推移可恢复到与行常规腹腔镜手术相同的水平。%Objective:To explore the effects of the transvaginal total laparoscopic rectal cancer radical resection on female sexual dysfunction. Methods:Sixty-four female rectal cancer patients were randomly divided into the experimental group(31 cases) and control group(33 cases). The experimental group and control group were treated with the transvaginal total laparoscopic and conventional laparoscopic rectal cancer radical resection,respectively. All patients were followed up using questionnaire survey or call after 6 and 12 months of operation,the sexual function of patients was recorded. The effects of two kinds of operation methods on sexual function were compared. Results:The vaginal moisture,pain during sex and sexual satisfaction in experimental group were worse than those in control group after 6 months of operation(P 0. 05). Conclusions:Because of the vaginal dryness,the transvaginal total laparoscopic rectal cancer radical resection has certain effects on female sexual function. With the time over,the female sexual function can recover the level of the patients treated with conventional laparoscopic rectal cancer radical resection.

  1. LAPAROSCOPIC-ASSISTED OVARIOHYSTERECTOMY IN A BITCH WITH HEMATOMETRA OVÁRIO-HISTERECTOMIA VIDEOASSISTIDA EM UMA CADELA COM HEMATOMETRA

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Bortolini

    2010-04-01

    Full Text Available The canine pyometritis is an adult bitch illness characterized by the inflammation of the uterus with secretion accumulation. Hematometra is a consequence of the piometritis, however it is characterized for diapese of erythrocytes for the uterus, which changes the coloration of the secretion. The treatment ought to be immediate and aggressive, and the advised treatment is ovariohysterectomy for seriously ill animals. This report describes the laparoscopic-assisted ovariohysterctomy as a surgical treatment of hematometra in a bitch akita, six years-old with 34kg. The laparoscopic was the occlusion of ovarian vessels and mesovarium attachment using three portals technique. The uterine vessels and uterus were managed through a small pre-pubic celiotomy. No complications or reincidence of the disease were noticed, showing the effectiveness of the procedure in dogs. Seven month adequate postoperative evolution reassured the surgical conduct performed.

    KEY WORDS: Bitches, surgery, laparoscopy, pyometritis, treatment.

    A piometrite canina é uma enfermidade da cadela adulta, caracterizada por inflamação do útero com acúmulo de exsudatos. A hematometra é uma consequência da piometrite, porém caracteriza-se por diapese de eritrócitos para a luz uterina, modificando a coloração da secreção.   A terapia deve ser imediata e agressiva. Ovário-histerectomia é o tratamento de escolha para animais gravemente acometidos. O presente trabalho descreve a ovário-histerectomia videoassistida no tratamento de hematometra em uma cadela da raça Akita, com seis anos de idade e 34 kg de massa corporal. Utilizou-se o acesso com três portais, os quais permitiram a ligadura dos vasos ovarianos e a secção do mesométrio. Já  o útero e os vasos uterinos foram manipulados por meio de miniceliotomia pré-púbica. Não se constataram complicações transoperatórias ou recidiva da doença, o que demonstra a eficácia do procedimento

  2. Robotic-assisted laparoscopic partial nephrectomy: A single centre Indian experience

    Directory of Open Access Journals (Sweden)

    Arvind P Ganpule

    2015-01-01

    Full Text Available Background: We summarise our experience with RPN emphasising on learning curve, techniques and outcomes. Patients and Methods: A retrospective chart review of 57 patients was done. The preoperative workup included a triple phase CT angiography. The parameters analyzed were demographics, tumor characteristics, operative details, postoperative outcome, histopathology and follow-up. The data were compared with historical cohort of the laparoscopic partial nephrectomy (LPN. Results: 58 renal units in 57 patients (45 males and 12 females underwent RPN. The mean age was 53.08 ± 13.6 (30-71 years. The mean tumor size was 4.96 ± 2.33 (2-15.5 cm. Average operative time was 129.4 ± 29.9 (70-200 min.; mean warm ischemia time was 20.9 ± 7.34 (9-39 min. 8 renal units in 7 patients were operated with the zero ischemia technique. The average follow-up was 5.15 months (1-18. There was no recurrence. 15 patients underwent LPN. The mean tumor size was 4.3 ± 1.6 (1.6-8 cm. operative time was 230.7 ± 114.8 (150-300 min.; mean warm ischemia time was 31.8 ± 9 min. The nephromerty score in the LPN group was 7.1 ± 0.89, in the RPN group was 8.75 ± 1.21. Conclusion: Our results suggest that prior experience of LPN shortens the learning curve for RPN as seen by shorter warm ischemia time and operative time in our series. The nephrometry score in RPN were higher suggesting that complex tumour can be managed with robotic approach.

  3. Robot assisted radical prostatectomy: how I do it. Part I: Patient preparation and positioning.

    Science.gov (United States)

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-10-01

    Radical prostatectomy remains the standard treatment for long term cure of clinically localized prostate cancer, offering excellent oncologic outcomes, with cancer-specific survival approaching 95% at 15 years after surgery. The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been another important step toward a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the surgeon and patient. In this first part of a two article series, we describe preoperative patient preparation and positioning protocols for robot assisted radical prostatectomy (RARP) that are currently used in our institution (University of Montreal Hospital Center (CHUM)-Hopital St-Luc). We use the four-arm da Vinci Si Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes. PMID:24128839

  4. Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery

    NARCIS (Netherlands)

    Olivier, R. H. van der Schatte; van't Hullenaar, C. D. P.; Ruurda, J. P.; Broeders, I. A. M. J.

    2009-01-01

    Robot-assisted surgical systems have been introduced to improve the outcome of minimally invasive surgery. These systems also have the potential to improve ergonomics for the surgeon during endoscopic surgery. This study aimed to compare the user's mental and physical comfort in performing standard

  5. Re: Long-Term Analysis of Oncological Outcomes after Laparoscopic Radical Cystectomy in Europe: Results from a Multicentre Study by the European Association of Urology (EAU Section of Uro-Technology

    Directory of Open Access Journals (Sweden)

    Simone Albisinni

    2015-06-01

    Full Text Available Open radical cystectomy (ORC is the gold standard treatment option for muscle-invasive urothelial carcinoma. However, evolution is still going on. Nowadays, there is a growing interest for laparoscopic (LRC and robotic-assisted radical cystectomy (RARC as well as in kidney and prostate procedures. In the European Urology Association (EAU guidelines, LRC or RARC are still accepted as investigational options. This remarkable study presented long-term oncological results after LRC. In this multicentric study, 503 patients were included with a mean age of 68 years and median follow-up of 50 months. In previous studies with LRC, patients were younger and with lower stage of disease which was accepted as a bias in reviews. Pathological stage distribution was about 1/3 for groups except pT4 (9%. Median number of retrieved lymph nodes was 14. Although extent of lymphadenectomy in this study was not same between centers and it should be a limitation; median number of nodes was acceptable according to the EAU guidelines (<10. Bricker technique was the most urinary diversion type in this study (69%. The most interesting part in this study was elevated complications. 60 patients (12% were re-operated within first 30 days. Minor complication rate was 36% (Clavien 1+2. Major complication rate was similar with ORC studies. Conversion rate was 3.4%. Overall positive surgical margin rate was 5.8% (29 patients while it was a little bit high in pT2b disease (3 of 29. This result should be questioned. It might be explained by ‘learning curve’. Techniques were not standardized between centers although experienced surgeons were in the study. This was one of the limitations of this study. Global recurrence-free survival (RFS, cancer-specific survival (CSS and overall survival (OS9 rates at five years were 66%, 75% and 62%, respectively. These results were comparable with open series in the literature. Lack of randomization is another limitation. All patients had a

  6. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial

    Directory of Open Access Journals (Sweden)

    van der Sluis Pieter C

    2012-11-01

    Full Text Available Abstract Background For esophageal cancer patients, radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent. Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes. However, the percentage of cardiopulmonary complications associated with the transthoracic approach is high (50 to 70%. Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RATE is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes. RATE was accompanied with reduced blood loss, shorter ICU stay and improved lymph node retrieval compared with open esophagectomy, and the pulmonary complication rate, hospital stay and perioperative mortality were comparable. The objective is to evaluate the efficacy, risks, quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer. Methods/design This is an investigator-initiated and investigator-driven monocenter randomized controlled parallel-group, superiority trial. All adult patients (age ≥18 and ≤80 years with histologically proven, surgically resectable (cT1-4a, N0-3, M0 esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 112 with resectable esophageal cancer are randomized in the outpatient department to either RATE (n = 56 or open three-stage transthoracic esophageal resection (n = 56. The primary outcome of this study is the percentage of overall complications (grade 2 and higher as stated by the modified Clavien–Dindo classification of surgical complications. Discussion This is the first randomized controlled trial designed to compare RATE with

  7. Robot-assisted laparoscopic resection of a huge pelvic tumor: A case report.

    Science.gov (United States)

    Jia, Zhuomin; Lyu, Xiangjun; Xu, Yong; Leonardi, Rosario; Zhang, Xu

    2016-01-01

    The traditional open surgery, for the treatment of huge tumor in the narrow space of pelvic cavity and in close proximity to pelvic organs and neurovascular structures, is very difficult and challenging. We report a case of huge neurilemmoma operated using the robot-assisted laparoscopy. We used interventional pre-operation embolization to control blood supply of tumor because MRI showed the tumor had a sufficient blood supply. PMID:27377092

  8. Comparison of short-term outcomes between laparoscopically-assisted vs. transverse-incision open right hemicolectomy for right-sided colon cancer: a retrospective study

    Directory of Open Access Journals (Sweden)

    Akaraviputh Thawatchai

    2007-05-01

    Full Text Available Abstract Background Laparoscopically-assisted right hemicolectomy (LRH is an acceptable alternative to open surgery for right-sided colon cancer which offers patients less pain and faster recovery. However, special equipment and substantial surgical experience are required. The aim of the study is to compare the short-term surgical outcomes of LRH and open right hemicolectomy through right transverse skin crease incision (ORHT for right-sided colon cancer. Patients and methods This retrospective study included 33 patients with right-sided colon cancer who underwent elective right hemicolectomy by laparoscopic or open approaches through right transverse skin crease incision between March 2004 and September 2006 at the Department of Surgery, Faculty of Medicine Siriraj Hospital. Operative details, postoperative requirement of narcotics, recovery of bowel function, and oncological parameters were analyzed. Results Thirteen patients underwent LRH and 20 patients underwent ORHT. Both approaches achieved adequate oncological resection of the tumor. The laparoscopic group were characterized by shorter average incision lengths (7.7 vs 10.3 cm; p Conclusion LRH and ORHT for right-sided colon cancer resulted in the same short-term surgical outcomes including postoperative bowel function, narcotics consumption and length of hospital stay. However, LRH required a significantly longer operating time.

  9. Electrical impedance map (EIM) for margin assessment during robot-assisted laparoscopic prostatectomy (RALP) using a microendoscopic probe

    Science.gov (United States)

    Mahara, Aditya; Khan, Shadab; Schned, Alan R.; Hyams, Elias S.; Halter, Ryan J.

    2015-03-01

    Positive surgical margins (PSMs) found following prostate cancer surgery are a significant risk factor for post-operative disease recurrence. Noxious adjuvant radiation and chemical-based therapies are typically offered to men with PSMs. Unfortunately, no real-time intraoperative technology is currently available to guide surgeons to regions of suspicion during the initial prostatectomy where immediate surgical excisions could be used to reduce the chance of PSMs. A microendoscopic electrical impedance sensing probe was developed with the intention of providing real-time feedback regarding margin status to surgeons during robot-assisted laparoscopic prostatectomy (RALP) procedures. A radially configured 17-electrode microendoscopic probe was designed, constructed, and initially evaluated through use of gelatin-based phantoms and an ex vivo human prostate specimen. Impedance measurements are recorded at 10 frequencies (10 kHz - 100 kHz) using a high-speed FPGA-based electrical impedance tomography (EIT) system. Tetrapolar impedances are recorded from a number of different electrode configurations strategically chosen to sense tissue in a pre-defined sector underlying the probe face. A circular electrical impedance map (EIM) with several color-coded pie-shaped sectors is created to represent the impedance values of the probed tissue. Gelatin phantom experiments show an obvious distinction in the impedance maps between high and low impedance regions. Similarly, the EIM generated from the ex vivo prostate case shows distinguishing features between cancerous and benign regions. Based on successful development of this probe and these promising initial results, EIMs of additional prostate specimens are being collected to further evaluate this approach for intraoperative surgical margin assessment during RALP procedures.

  10. Nursing Cooperation in Robot-assisted Laparoscopic Partial Nephrectomy%机器人辅助腹腔镜肾部分切除术的护理配合

    Institute of Scientific and Technical Information of China (English)

    吴小凤; 盛夏; 吴震杰; 吕晨; 杨波

    2016-01-01

    目的:探讨机器人辅助腹腔镜肾部分切除术护理配合的要点。方法回顾性分析2012年3月至2014年10月在第二军医大学长海医院泌尿外科中心行机器人辅助腹腔镜肾部分切除术的151例肾脏肿瘤患者的临床资料,总结其护理要点。结果150例患者顺利完成手术,1例患者中转开腹行肾部分切除术。结论机器人辅助腹腔镜肾部分切除术是一种安全有效的治疗局限性肾肿瘤的微创手术方法,器械设备管理以及手术前后护理配合是保证手术顺利实施的重要环节。%Objective To summarize the key point of nursing cooperation in robot-assisted laparoscopic partial nephrectomy.Methods Clinical data of 15 1 cases were analyzed retrospectively,and the key nursing points were concluded.Results There were 150 patients underwent successful robot-assisted laparoscopic partial nephrectomy,1 case was transferred to opening partial nephrectomy.Conclusion Robot-assisted laparoscopic partial nephrectomy is a safe and effective minimally invasive treatment for localized renal cell carcinoma.The equipment management and preoperative and postoperative nursing cooperation is the key link to gurantee the successful implementation of the surgery.

  11. Prostatectomía radical laparoscópica: primeros dos casos realizados por urólogos costarricenses Laparoscopic Radical Prostatectomy: First Two Cases Performed by Costa Rican Urologists

    Directory of Open Access Journals (Sweden)

    Roy López-Arias

    2010-12-01

    Full Text Available Se reportan los primeros dos casos de prostatectomía radical laparoscópica (PRL realizada por urólogos costarricenses. La PRL se realizó con colocación de 4 trócares luego de poner la cámara en cicatriz umbilical. El tiempo operatorio total fue de 240 y 205 minutos, la pérdida de sangre estimada fue de 150 y 100 ml respectivamente. Se extrajeron las próstatas con vesículas seminales por una incisión umbilical de 3 cm. Un dreno cerrado con succión se externalizó por una de las incisiones de los trócares de 5mm. No hubo complicaciones trans ni post operatorias. La estadia hospitalaria post operatoria fue de 3 y 2 días, el dreno se retiró al tercer y segundo día post operado y las sondas Foley se retiraron a los 14 días. Las próstatas pesaron 27 y 23 gramos, los puntajes Gleason fueron de (3+4 y (3+3 ambos tuvieron márgenes negativos, sin infiltración vascular ni nerviosa. La PRL es un procedimiento mínimamente invasivo para hombres con cáncer de próstata órgano confinado realizable, seguro y reproducible. Con mejor resultado cosmético y menor dolor posoperatorio.We herein report the first two cases of laparoscopic radical prostatectomy (LRP performed by Costarican Urologists. Two 50 and 64-year-old patients respectively, with an adenocarcinoma of the prostate with Gleason scores (3+ 3 6, diagnosed trough transrectal ultrasonografic guided biopsies, indicated by an elevation of the prostate specific antigen (PSA or abnormal rectal digital examination (DRE. The LRP was performed transperitonealy with Montsouris technique using standard laparoscopy instruments and high definition laparoscopic video tower. After placing a 10mm camera port through the umbilicus, the procedure was accomplished with 4 trocars. The entire operative time was 240 and 205 minutes, whereas the blood loss was 150 and 100 ml respectively. The extraction of the specimens with seminal vesicles was through a 3 cm. umbilical incision. A closed drainage

  12. Complications and oncologic outcomes following robot-assisted radical cystectomy: What is the real benefit?

    Science.gov (United States)

    Bak, Dong Jae; Lee, You Jin; Woo, Myeong Jin; Chung, Jae-Wook; Ha, Yun-Sok; Kim, Hyun Tae; Kim, Tae-Hwan; Yoo, Eun Sang; Kim, Bup Wan

    2016-01-01

    Purpose The aim of this study was to assess the advantages of robotic surgery, comparing perioperative and oncological outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). Materials and Methods Between August 2008 and May 2014, 112 radical cystectomies (42 RARCs and 70 ORCs) were performed at a single academic institution following Institutional Review Board approval. Patient demographics, perioperative variables (e.g., complications), and oncologic outcomes including metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) were reported using the Kaplan-Meier analyses. Results The median follow-up period was 40 months (range, 0–70 months) vs. 42 months (range, 0–74 months) in RARC and ORC, respectively. Baseline characteristics of both groups were balanced. Blood loss (median, [range]; 300 mL [125–925 mL] vs. 598 mL [150–2,000 mL], p=0.001) and perioperative transfusion rates (23.8% vs. 45.7%, p=0.020) were significantly lower in the RARC group than in the ORC group. The overall complication rates were greater in the ORC group, but this was not statistically significant (65.7% vs. 64.3%, p=0.878). However, there were significantly higher major complication rates in the ORC group (45.7% vs. 26.2%, p=0.040). No significant differences were found with regards to MFS, CSS, and OS. Conclusions While histopathological findings, overall complications, and survival rates do not reveal definite differences, RARC has more advantages compared to ORC in terms of estimated blood loss, perioperative transfusion rates and fewer perioperative major complications. We propose that RARC is a safer treatment modality with equivalent oncological outcomes compared to ORC. PMID:27437535

  13. Contemporary evidence for robot-assisted radical cystectomy for treating bladder cancer.

    Science.gov (United States)

    Satkunasivam, Raj; Wallis, Christopher J D; Nam, Robert K; Desai, Mihir; Gill, Inderbir S

    2016-09-01

    Robot-assisted radical cystectomy (RARC) is an evolving technique for the treatment of muscle-invasive bladder cancer (MIBC); however, its effectiveness compared with open radical cystectomy (ORC) - the established modality - is debated. Six specific areas of evidence are critically important for supporting the continuing use of RARC for MIBC, including technical aspects of surgery, perioperative outcomes, complications, oncological outcomes, functional outcomes, and financial costs. Considerable progress has been made regarding these aspects and data show that RARC replicates the technical benchmarks of ORC in terms of success of cystectomy, lymph node dissection, and urinary diversion, and could offer advantages over the more-established technique. Despite some clear benefits of RARC (such as reduced blood loss) other perioperative outcomes, including duration of inpatient stay and 30-90 day complication rates, seem to be similar to those of ORC. Current data on oncological and functional outcomes are promising, but robust data from prospective studies will help determine the indications for use of RARC for treating MIBC in the future. PMID:27502548

  14. Current status of various neurovascular bundle-sparing techniques in robot-assisted radical prostatectomy.

    Science.gov (United States)

    Kumar, Anup; Tandon, Sarvesh; Samavedi, Srinivas; Mouraviev, Vladimir; Bates, Anthony S; Patel, Vipul R

    2016-09-01

    Nerve-sparing procedures during robot-assisted radical prostatectomy (RARP) have demonstrated improved postoperative functional outcomes. This article provides an overview of clinically applied prostatic neuro-anatomy, various techniques of nerve sparing (NS), and recent innovations in NS and potency outcomes of NS RARP. We retrieved and reviewed all listed publications within PubMed using keywords: nerve sparing, robotic radical prostatectomy, prostate cancer, outcomes, pelvic neuroanatomy and potency. Studies reporting potency outcomes of NS RARP (comparative and non-comparative) were analysed using the Delphi method with an expert panel of urological robotic surgeons. Herein, we outline the published techniques of NS during RARP. Potency and continence outcomes of individual series are discussed in light of the evidence provided by case series and published trials. The potency outcomes of various comparative and non-comparative series of NS RARP have also been mentioned. There are numerous NS techniques reported for RARP. Each method is complimented with benefits and constrained by idiosyncratic caveats, and thus, careful patient selection, a wise intraoperative clinical judgment and tailored approach for each patient is required, when decision for nerve sparing is made. Further large prospective multi-institutional randomized controlled trials are required to evaluate potency and continence outcomes of these techniques, using a rigid standard patient selection criteria and definition of potency are warranted in the new era of functional outcome-driven research. PMID:27251473

  15. Laparoscopic surgery for colon cancer

    OpenAIRE

    Millo, Paolo; Rispoli, Corrado; Rocco, Nicola; Contul, Riccardo Brachet; Fabozzi, Massimiliano; Grivon, Manuela; Nardi, Mario Junior; Allieta, Rosaldo

    2013-01-01

    Colon cancer is a major problem in Western countries and complete surgical resection is the main treatment. Since its introduction the laparoscopic approach has been used to achieve bowel resection with a better postoperative course and better aesthetic outcomes. Initial concerns about the radicality of the resection and the oncologic outcomes have been overcome in the last decade. All over the world large trials have been conducted to compare the laparoscopic approach and the traditional lap...

  16. One-stage laparoscopic-assisted resection of gastrojejunocolic fistula after gastrojejunostomy for duodenal ulcer: a case report

    Directory of Open Access Journals (Sweden)

    Takemura Masashi

    2011-11-01

    Full Text Available Abstract Introduction Gastrojejunocolic fistula is a rare condition after gastrojejunostomy. It was thought to be a late complication related to stomal ulcers as a result of inadequate gastrectomy or incomplete vagotomy. We report a case of gastrojejunocolic fistula after gastrojejunostomy for peptic ulcer treated with one-stage laparoscopic resection. Case presentation A 41-year-old Japanese man complained of diarrhea for 10 months, as well as severe weight loss and weakness. After admission, we immediately started intravenous hyperalimentation. On performing colonoscopy and barium swallow, gastrojejunocolic fistula was observed close to the gastrojejunostomy site leading to the transverse colon. After our patient's nutritional status had improved, one-stage surgical intervention was performed laparoscopically. After the operation, our patient recovered uneventfully and his body weight increased by 5 kg within three months. Conclusions Modern management of gastrojejunocolic fistula is a one-stage resection because of the possibility of early recovery from malnutrition using parenteral nutritional methods. Today, laparoscopic one-stage en bloc resection may be feasible for patients with gastrojejunocolic fistula due to the development of laparoscopic instruments and procedures. We describe the first case of gastrojejunocolic fistula treated laparoscopically by one-stage resection and review the literature.

  17. [Radical prostatectomy - pro robotic].

    Science.gov (United States)

    Gillitzer, R

    2012-05-01

    Anatomical radical prostatectomy was introduced in the early 1980s by Walsh and Donker. Elucidation of key anatomical structures led to a significant reduction in the morbidity of this procedure. The strive to achieve similar oncological and functional results to this gold standard open procedure but with further reduction of morbidity through a minimally invasive access led to the establishment of laparoscopic prostatectomy. However, this procedure is complex and difficult and is associated with a long learning curve. The technical advantages of robotically assisted surgery coupled with the intuitive handling of the device led to increased precision and shortening of the learning curve. These main advantages, together with a massive internet presence and aggressive marketing, have resulted in a rapid dissemination of robotic radical prostatectomy and an increasing patient demand. However, superiority of robotic radical prostatectomy in comparison to the other surgical therapeutic options has not yet been proven on a scientific basis. Currently robotic-assisted surgery is an established technique and future technical improvements will certainly further define its role in urological surgery. In the end this technical innovation will have to be balanced against the very high purchase and running costs, which remain the main limitation of this technology.

  18. First Clinical Experience in Urologic Surgery with a Novel Robotic Lightweight Laparoscope Holder

    CERN Document Server

    Long, Jean-Alexandre; Lanchon, Cecilia; Voros, Sandrine; Medici, Maud; Descotes, Jean-Luc; Troccaz, Jocelyne; Cinquin, Philippe; Rambeaud, Jean-Jacques; Moreau-Gaudry, Alexandre

    2012-01-01

    Purpose: To report the feasibility and the safety of a surgeon-controlled robotic endoscope holder in laparoscopic surgery. Materials and methods: From March 2010 to September 2010, 20 patients were enrolled prospectively to undergo a laparoscopic surgery using an innovative robotic endoscope holder. Two surgeons performed 6 adrenalectomies, 4 sacrocolpopexies, 5 pyeloplasties, 4 radical prostatectomies and 1 radical nephrectomy. Demographic data, overall set-up time, operative time, number of assistants needed were reviewed. Surgeon's satisfaction regarding the ergonomics was assessed using a ten point scale. Postoperative clinical outcomes were reviewed at day 1 and 1 month postoperatively. Results: The per-protocol analysis was performed on 17 patients for whom the robot was effectively used for surgery. Median age was 63 years, 10 patients were female (59%). Median BMI was 26.8. Surgical procedures were completed with the robot in 12 cases (71 %). Median number of surgical assistant was 0. Overall set-up ...

  19. Robot-assisted versus conventional laparoscopic surgery for endometrial cancer staging: A meta-analysis.

    Science.gov (United States)

    Chen, Shao-Hui; Li, Zhao-Ai; Huang, Rui; Xue, Hui-Qin

    2016-08-01

    This meta-analysis broadly compared the safety and efficacy of robot-assisted laparoscopy (RAL) with that of conventional laparoscopy (CL) for endometrial cancer staging. The advantages of RAL were evaluated through the outcomes in terms of conversion rates, complications, length of operation, blood loss, number of lymph nodes harvested, and length of hospitalization. Three electronic databases (PubMed, MEDLINE, and EmBASE) were searched to identify eligible studies. We selected all retrospective studies documenting a comparison between RAL and CL for endometrial cancer staging between 2005 and 2015, and tallied with meta-analyses criteria. Only studies published in English were included in this analysis. The outcomes of the extracted data were pooled and estimated by the Review Manager version 5.1 software. Seventeen studies met the eligibility criteria. Among the 2105 patients reported, 912 underwent RAL and the other 1193 underwent CL for endometrial cancer staging. Compared with CL, RAL had lower conversion rates [risk ratio, 0.4; 95% confidence interval (CI), 0.25-0.64; p = 0.0002]. Its complications were also less than that of CL (risk ratio, 0.72; 95% CI, 0.56-0.94; p = 0.02). RAL was associated with significantly less intraoperative blood loss (weighted mean difference, -79.2 mL; 95% CI, from -103.43 to -54.97; p < 0.00001) and a shorter length of hospitalization (weighted mean difference, -0.37 days; 95% CI, from -0.57 to -0.17; p = 0.0003). We found no significant differences in the length of operation and number of lymph nodes harvested between the two groups. From our meta-analysis results, RAL is a safe and effective alternative to CL for endometrial cancer staging. Further studies are required to determine potential advantages or disadvantages of RAL. PMID:27590368

  20. Initial experience of a novel ergonomic surgical chair for laparoscopic pelvic surgery

    Directory of Open Access Journals (Sweden)

    Fernando J. Kim

    2011-08-01

    Full Text Available INTRODUCTION: We present the initial experience of a novel surgical chair for laparoscopic pelvic surgery, the ETHOS TM (Bridge City Surgical, Portland, OR. MATERIALS AND METHODS: The ETHOS chair has an adjustable saddle height that ranges from 0.89 to 1.22 m high, an overall width of 0.89 m, and a depth of 0.97 m. The open straddle is 0.53 m and fits most OR tables. We performed 7 pelvic laparoscopy cases with the 1st generation ETHOS TM platform including 2 laparoscopic ureteral reimplantations, 5 laparoscopic pelvic lymphadenectomies for staging prostate cancer in which one case involved a laparoscopic radical retropubic prostatectomy, performed by 2 different surgeons. RESULTS: All 7 pelvic laparoscopic procedures were successful with the ETHOS TM chair. No conversion to open surgery was necessary. Survey done by surgeons after the procedures revealed minimal stress on back or upper extremities by the surgeons from these operations even when surgery was longer than 120 minutes. Conversely, the surgical assistants still had issues with their positions since they were on either sides of the patient stressing their positions during the procedure. CONCLUSION:The ETHOS chair system allows the surgeon to operate seated in comfortable position with ergonomic chest, arms, and back supports. These supports minimize surgeon fatigue and discomfort during pelvic laparoscopic procedures even when these procedures are longer than 120 minutes without consequence to the patient safety or detrimental effects to the surgical team.

  1. Training mode of surgeons for laparoscopy-assisted radical resection of rectal cancer%外科医师腹腔镜辅助直肠癌根治术培训模式探讨

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

      目的提高外科医师腹腔镜手术技能,普及腹腔镜技术。方法采取在腹腔镜辅助直肠癌根治术手术教学中引入手术模拟系统,结合手术室实地参观答疑的方法,探讨外科医师腹腔镜辅助直肠癌根治术的培训模式。结果104名普通外科高级职称医师参加培训,全部随访,随访率为100%,随访结果:99位学员(95%)反馈更加熟悉腹腔镜操作技巧,手术时间比培训前平均缩短45 min。结论通过本培训模式训练可有效提高外科医师对腹腔镜辅助直肠癌根治术手术操作流程的认识及局部解剖的技巧,提高操作手术效率、提升手术效果。%Objective To popularize the laparoscopic techniques in surgeons by improving their laparoscopy-assisted surgical skills. Methods The training model of surgeons for laparoscopy-assisted radical resection of rectal cancer was studied by introducing the surgery simulation system into teaching of laparoscopy-assisted radical resection of rectal cancer in combination with questions-answering in operation room. Results A total of 104 surgeons with a senior professional title from departments of general surgery were trained and followed up (with a follow-up rate of 100%), during which 99 surgeons (95%) reported that they were more skillful in laparoscopy-assisted radical resection of rectal cancer with the mean operation time shortened to 45 minutes after training as compared to that before training. Conclusion The training model of surgeons for laparoscopy-assisted radical resection of rectal cancer can effectively improve their laparoscopy-assisted surgical skills and local anatomy knowledge.

  2. Rapid rehabilitation in elderly patients after laparoscopic colonic resection

    DEFF Research Database (Denmark)

    Bardram, Linda; Funch-Jensen, P; Kehlet, H

    2000-01-01

    invasive procedure. In the present study the laparoscopic approach was combined with a perioperative multimodal rehabilitation protocol. METHODS: After laparoscopically assisted colonic resection, patients were treated with epidural local anaesthesia for 2 days, early mobilization and enteral nutrition...

  3. 腹腔镜根治性前列腺切除术后控尿功能的影响因素%Factors influencing urinary continence after laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    黄建林; 邱敏; 马潞林

    2013-01-01

    Radical prostatectomy is one of the most effective treatments for men with clinically localized prostate cancer.Though technical innovations,especially laparoscopic techniques,have developed rapidly for the last decade,urinary incontinence remains one of the most troubling side effects of the operation.While the injury of urethral sphincter and its innervations was considered as the most important reason for incontinence,factors influencing postoperative continence that have been considered include clinical features of patients,such as the patient' s age,size of the prostate,prior prostatic surgery and features of the surgical technique itself,such as preservation of full functional-length urethra,preservation of the neurovascular bundles,bladder neck preservation or reconstruction and pelvic floor muscle training during the early phase after the surgery.Nonetheless,many factors above have not been clearly established,and controversy goes on among different studies.This article reviews factors that may influence urinary continence after laparoscopic radical prostatectomy.

  4. Telerobotic-assisted laparoscopic abdominoperineal resection for low rectal cancer: Report of the first case in Hong Kong and China with an updated literature review

    Institute of Scientific and Technical Information of China (English)

    Simon Siu-Man Ng; Janet Fung-Yee Lee; Raymond Ying-Chang Yiu; Jimmy Chak-Man Li; Sophie Sok-Fei Hon

    2007-01-01

    Telerobotic surgery is the most advanced development in the field of minimally invasive surgery. The da Vinci surgical system, which is currently the most widely used telerobotic device, was approved by the Food and Drug Administration of the United States of America for clinical use in all abdominal operations in July 2000. The first da Vinci surgical system in China was installed in November 2005 at our institution. We herein report the first telerobotic-assisted laparoscopic abdominoperineal resection using the 3-arm da Vinci surgical system for low rectal cancer in Hong Kong and China, which was performed in August 2006. The operative time and blood loss were 240 min and 200 mL, respectively. There was no complication, and the patient was discharged on postoperative day five. An updated review of published literature on telerobotic-assisted colorectal surgery is included in this report, with special emphasis on its advantages and limitations.

  5. Difference between actual vs. pathology prostate weight in TURP and radical robotic-assisted prostatectomy specimen

    Directory of Open Access Journals (Sweden)

    Szilveszter Lukacs

    2014-12-01

    Full Text Available Introduction To investigate and highlight the effect of formaldehyde induced weight reduction in transurethral resection of prostate (TURP and radical robotically-assisted prostatectomy (RALP specimen as a result of standard chemical fixation. Materials and Methods 51 patients were recruited from January 2013 to June 2013 who either underwent a TURP (n=26 or RALP (n=25. Data was collected prospectively by the operating surgeon who measured the native, unfixed histology specimen directly after operation. The specimens were fixed in 10% Formaldehyde Solution BP and sent to the pathology laboratory where after sufficient fixation period was re-weighed. Results Overall mean age 64.78 years, TURP mean age 68.31 years RALP mean age 61.12years. We found that the overall prostatic specimen (n=51 weight loss after fixation was a mean of 11.20% (3.78 grams (p≤0.0001. Subgroup analysis of the native TURP chips mean weight was 16.15 grams and formalin treated mean weight was 14.00 grams (p≤0.0001. Therefore, TURP chips had a mean of 13.32 % (2.15 grams weight loss during chemical fixation. RALP subgroup unfixed specimen mean weight was 52.08 grams and formalin treated mean weight was 42.60 grams (p≤0.0001, a 19.32 % (9.48grams mean weight reduction. Conclusion It has not been known that prostatic chips and whole human radical prostatectomy specimen undergo a significant weight reduction. The practical significance of the accurate prostate weight in patient management may be limited, however, it is agreed that this should be recorded correctly, as data is potential interest for research purposes and vital for precise documentation.

  6. Curative effect observation for advanced gastric cancer by laparoscopic-assisted surgery%腹腔镜辅助下近端胃癌D2根治术的近期疗效分析

    Institute of Scientific and Technical Information of China (English)

    延学军

    2015-01-01

    Objective To explore the curative effect for advanced gastric cancer of laparoscopic-assisted surgery. Methods All 66 patients with advanced gastric cancer were retrospectively analyzed from January 2014 to March 2015 as the research object.According to the different methods of operation, they were divided into observation group and control group, the observation group (36 cases) had cure by laparoscopic-assisted surgery, the control group (30 cases) were by radical open surgery. Related indicators of two groups were compared. Results Operation time, intraoperative blood loss, time of the liquid diets, ambulation time, incision length, cleaning the number of lymph nodes, and hospital-ization days of two groups were compared, in addition to cleaning the number of lymph nodes, the difference was statis-tically significant (P<0.05);the incidence of complications of anastomotic leakage, anastomotic bleeding, abdominal cav-ity infection, pleural effusion, and lymph leakage, pulmonary infection, infection of incision liquefaction, and gastric paralysis of two groups have a comparison, the incidence of postoperative complications of the observation group was 11.11% (4/36), the control group was 33.33% (10/30), the difference was statistically significant (P<0.05). Conclusion Advanced gastric cancer by laparoscopic-assisted surgery have obvious advantages,it is expected to become the stan-dard operation for advanced gastric cancer.%目的:探讨腹腔镜辅助下近端进展期胃癌D2根治术的近期疗效。方法回顾性分析我院2014年1月~2015年3月间行手术治疗的66例进展期近端胃癌患者的临床资料,根据手术方式的不同分为观察组和对照组,观察组(36例)采用腹腔镜辅助下胃癌根治术,对照组(30例)采用经腹近端胃癌根治术,对两组患者手术相关指标及术后并发症等进行比较。结果两组患者手术时间、术中出血量、进流食时间、下床活动时间、切口长度、清

  7. Laparoscopic pyelolithotomy.

    Science.gov (United States)

    Jordan, G H; McCammon, K A; Robey, E L

    1997-01-01

    Laparoscopic surgery has been applied to virtually every aspect of urinary tract disease. Presented is a case of laparoscopic-extended pyelolithotomy accomplished in a 16-month-old child with a large cystine stone that occupied the child's entire renal pelvis. Although not the first pyelolithotomy accomplished laparoscopically, we believe this to be the first extended laparoscopic pyelolithotomy and also believe this is the youngest patient in whom laparoscopic pyelolithotomy has been done. Extracorporeal shock wave lithotripsy and percutaneous and endoscopic stone techniques have drastically modified the management of urolithiasis. However, select cases in which these techniques may not be applicable (such as this toddler with bulky cystine lithiasis) may require open surgery. The laparoscopic approach represents an excellent, yet less-invasive option. PMID:9000203

  8. 腹腔镜宫颈癌根治术中腹膜阴道延长术的应用%The application of vaginal extension with peritoneum in the laparoscopic radical hysterectomy

    Institute of Scientific and Technical Information of China (English)

    杨尚武; 王小婕; 梦灵; 仲勇; 李莉芳; 黄浩

    2013-01-01

    Objective To explore the value of vaginal extension with peritoneum in the laparoscopic radical hysterectomy with the preservation of pelvic autonomic nerve .Methods Seven cases with cervical carcinoma at the stage of the Ⅰb-Ⅱa had the laparoscopic radical hysterectomy with the preservation of pelvic autonomic nerve and the operation of vaginal extension with peritoneum at the same time.Post-operative vaginal length and sexual life status of the patients were studied .Results The length of vagina 3 months after the operation was 8 to 11cm, with the average length of 8.8 ±2.2cm.No obvious side effect on sex life was found after the surgery . Conclusion It is feasible and advisable that the patients with cervical carcinoma have vaginal extension with peritoneum to ensure their life quality while they have laparoscopic radical hysterectomy with the preservation of the pelvic autonomic nerve .%目的探讨腹膜阴道延长术在腹腔镜下保留盆腔自主神经广泛子宫切除术中的价值。方法对7例Ⅰb~Ⅱa宫颈癌患者在行保留盆腔自主神经广泛性子宫切除术的同时行腹膜阴道延长术,研究患者术后阴道长度、性生活的情况。结果术后3个月测量阴道长度为8~11cm,平均长度为8.8±2.2cm。性生活质量术后与术前相比无明显影响。结论宫颈癌患者在行腹腔镜下保留盆腔自主神经的同时,采用腹膜进行阴道延长是可行的,保证了患者术后的生活质量,值得推广。

  9. Port-site metastasis as a primary complication following retroperitoneal laparoscopic radical resection of renal pelvis carcinoma or nephron-sparing surgery: A report of three cases and review of the literature

    Science.gov (United States)

    WANG, NING; WANG, KAI; ZHONG, DACHUAN; LIU, XIA; SUN, JI; LIN, LIANXIANG; GE, LINNA; YANG, BO

    2016-01-01

    The present study reports the clinical data of two patients with renal pelvis carcinoma and one patient with renal carcinoma who developed port-site metastasis following retroperitoneal laparoscopic surgery. The current study aimed to identify the cause and prognosis of the occurrence of port-site metastasis subsequent to laparoscopic radical resection of renal pelvis carcinoma and nephron-sparing surgery. Post-operative pathology confirmed the presence of high-grade urothelial cell carcinoma in two patients and Fuhrman grade 3 renal clear cell carcinoma in one patient. Port-site metastasis was initially detected 1–7 months post-surgery. The two patients with renal pelvis carcinoma succumbed to the disease 2 and 4 months following the identification of the port-site metastasis, respectively, whereas the patient with renal carcinoma survived with no disease progression during the targeted therapy period. The occurrence of port-site metastasis may be attributed to systemic and local factors. Measures to reduce the development of this complication include strict compliance with the operating guidelines for tumor surgery, avoidance of air leakage at the port-site, complete removal of the specimen with an impermeable bag, irrigation of the laparoscopic instruments and incisional wound with povidone-iodine when necessary, and enhancement of the body's immunity. Close post-operative follow-up observation for signs of recurrence or metastasis is essential, and systemic chemotherapy may be required in patients with high-grade renal pelvis carcinoma and renal carcinoma in order to prolong life expectancy. PMID:27313720

  10. Surgical Treatment of Diverticulitis: Hand-Assisted Laparoscopic Resection Is Predominantly Used for Complex Cases and Is Associated With Increased Postoperative Complications and Prolonged Hospitalization.

    Science.gov (United States)

    Miyagaki, Hiromichi; Rhee, Rebecca; Shantha Kumara, H M C; Yan, Xiaohong; Njoh, Linda; Cekic, Vesna; Whelan, Richard L

    2016-06-01

    Introduction Laparoscopic (LAP) colectomy is now the "gold" standard for diverticulitis; the role of hand-assisted LAP (HAL) and Open methods today is unclear. This study assessed the elective use of these methods for diverticulitis. Methods A retrospective review of demographic, comorbidity (Carlson Comorbidity Index [CCI]), resection type, and short-term outcomes was carried out. Results There were 125 (44.5%) LAP, 125 (44.5%) HAL, and 31 (11%) Open cases (overall N = 281). The mean age, body mass index, and percentage of high-risk patients (CCI score >2) of the HAL group were greater (P 2 was greater when compared with the LAP group (P bowel movement was not different; however, there was a stepwise increase in median length of stay (LOS; days) from the LAP (5 days) to HAL (6 days) to Open group (7 days) (P surgery utilization rate (89%). PMID:26611789

  11. Improving time to continence after robot-assisted laparoscopic prostatectomy: augmentation of the total anatomic reconstruction technique by adding dynamic detrusor cuff trigonoplasty and suprapubic tube placement.

    Science.gov (United States)

    Tewari, Ashutosh K; Ali, Adnan; Ghareeb, George; Ludwig, Wesley; Metgud, Sheela; Theckumparampil, Nithin; Takenaka, Atsushi; Chugtai, Bilal; Shrivastava, Abhishek; Kaplan, Steve A; Leung, Robert; Paryani, Rahul; Grushow, Siobhan; Durand, Matthieu; Peyser, Alexandra; Chopra, Sameer; Harneja, Niyati; Lee, Richard K; Herman, Michael; Robinson, Brian; Shevchuck, Maria M

    2012-12-01

    After robot-assisted laparoscopic prostatectomy, total anatomic reconstruction (TR) with the additions of a circumapical urethral dissection, a dynamic detrusor cuff trigonoplasty, and placement of a suprapubic catheter was performed in 49 patients from June to July 2012. Continence at 6 weeks after catheter removal was assessed for an initial group of 23 patients, and also at 2 weeks in an additional 26 patients who most recently had undergone surgery. Follow-up appointments and telephone interviews were used to assess pad use and continence. Of the initial 23 patients receiving the modified TR, 60.9% had 0 pad use at 6 weeks. By 2 weeks, 65.4% of the most recent 26 patients operated on achieved continence with 0-1 pad use. Preservation and reconstruction of the pelvic floor and supporting bladder structures leads to an earlier return of continence. These key steps need to be validated and confirmed in larger and randomized trials. PMID:23230868

  12. A comparative study of erectile function and use of erectile aids in high-risk prostate cancer patients after robot-assisted laparoscopic prostatectomy

    DEFF Research Database (Denmark)

    Østby-Deglum, Marie; Brennhovd, B.; Axcrona, K.;

    2015-01-01

    Objective. Erectile function with and without use of erectile aids was compared in high-, intermediate- and low-risk prostate cancer patients at a mean of 3 years after robot-assisted laparoscopic prostatectomy (RALP). Materials and methods. A sample of 982 men who underwent RALP at Oslo University...... according to the preoperative D'Amico classification. Based on questionnaire data, two primary outcomes were defined: ability to have intercourse (sufficient erection), and use and effect of erectile aids. Results. Sufficient erection with or without erectile aids was reported by 19% of the high-, 30......% of the intermediate- and 19% of the low-risk group (not significant). Erectile aids were used by 48% of the sample, of whom 18% of the high-, 21% of the intermediate- and 14% of the low-risk group reported sufficient erection (not significant). Papaverine injections were used by 21% and phosphodiesterase-5 inhibitors...

  13. Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer?

    Science.gov (United States)

    Nosnik, Israel P; Gan, Tong J; Moul, Judd W

    2007-09-01

    The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.

  14. Selective indication for check cystogram before catheter removal following robot assisted radical prostatectomy

    Science.gov (United States)

    Yadav, Rajiv; Bansal, Somendra; Gupta, Narmada P.

    2016-01-01

    Introduction: With the improvement in anastomotic technique, it is rare to find anastomotic site leak after robot-assisted radical prostatectomy (RARP). It may not always be necessary to do regular check cystogram before catheter removal. We evaluated our 230 consecutive RARP patients and their cystograms to determine the indications for selective use of cystogram before catheter removal. Materials and Methods: We reviewed our prospectively collected RARP database of 230 consecutive patients. Cystography was performed at low pressure by gravity instillation of diluted contrast through the catheter. Patients were observed under fluoroscopy in lateral oblique position for any contrast leak at the site of anastomosis. All patients were followed for a minimum of 6 months, and the longest follow-up was 5 years. Results: A total of 207 patients (90%) underwent catheter removal on postoperative day 7. Nine patients (3.9%) had extravasation on initial cystogram. Two patients with leak had a history of transurethral resection of prostate (TURP) and seven other had bladder neck reconstruction for wide bladder neck. Three patients with minimal leak did not require catheter replacement. In rest of the 6 patient with leak, continued catheter drainage was done. No significant difference in the intraoperative variables, blood loss, duration of drain, length of hospital stay, and continence outcomes was noted between the patients with leak compared to rest of the patients. None of the patient needed any procedure/intervention related to the surgery and none developed bladder neck stenosis. Conclusion: In usual circumstances, catheter removal can be done safely on a postoperative day 7 without routine cystography. Selective use of check cystogram can be done in the case where bladder neck reconstruction is performed or those had a prior TURP and a wide bladder neck. PMID:27127354

  15. The Nursing Points of Laparoscope-assisted Rectum Resection%腔镜下直肠癌切除术的手术护理

    Institute of Scientific and Technical Information of China (English)

    黄丽慧; 李秋菊

    2011-01-01

    Objective: To investigate the nursing points of peroperative period of laparoscope- assisted rectum resection. Method: We observed and recorded the nursing of 25 cases of laparoscope- assisted rectum resection during preoperative and postoperative. Result: All of the 25 cases were operated successfully,the average time of staying in hospital was 14 days, there had no postoperative complications such as hemorrhage, anastomotic stoma stenosis or fistula except one ankylenteron, there was no death, and the living quality was good. Conclusion: The specialized nursing during the celioscope operation caused to improve the success in operation, reduce distress after operation, promote the function of the intestinal to recover.%目的:探讨腔镜下行直肠癌切除术中围手术期护理方法.方法:观察并记录25例行直肠癌根治术患者术前以及术后护理情况.结果:25例手术患者均顺利完成手术,平均住院时间为14d,除1例发生肠粘连外,其余均未发生出血、吻合口瘘及吻合口狭窄等术后并发症,无死亡病例,患者生活质量好.结论:围手术期的护理可以帮助患者顺利完成手术,在减轻患者痛苦、促进术后肠道功能的恢复等方面起到了重要的作用.

  16. A comparative study of clinical effect on the Da Vinci surgical robot-assisted and laparoscopic-assisted distal subtotal gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:To evaluate the feasibility, safety and the clinical outcomes of the robotic distal gastrectomy for gastric cancer.Methods: We retrospectively analyzed the clinical and follow-up data of 113 cases underwent robotic distal gastrectomy from March 2010 to July 2013.Results:Compared with laparoscopic group, the robotic group had less intraoperative blood loss, more lymph nodes dissection (P<0.05). hTere was no signiifcant difference in the incidence of postoperative complications and neutrophil-lymphocyte ratio between the two groups. hTe follow-up data showed that the 1-, 2- and 3-year survival rates were 91.7%, 77.4% and 72.9% in robotic group while they were 91.2%, 76.2% and 70.4% in laparoscopic group ,and the difference was not significant. Conclusion:Robotic distal gastrectomy for gastric cancer is safe and effective, and it has less harm to the patients, with less intraoperative blood loss, more lymph nodes dissection and quicker postoperative recover than laparoscopic surgery, so it is worthy of popularization and application.

  17. A Novel Technique of Uterine Manipulation in Laparoscopic Pelvic Oncosurgical Procedures: “The Uterine Hitch Technique”

    Directory of Open Access Journals (Sweden)

    S. P. Puntambekar

    2010-01-01

    Full Text Available Aim. To describe a new technique of uterine manipulation in laparoscopic management of pelvic cancers. Material and Methods. We used a novel uterine hitch technique in 23 patients from May 2008 to October 2008. These patients underwent pelvic oncologic surgery including laparoscopic radical hysterectomy (n=7, laparoscopic anterior resection (n=4, laparoscopic abdominoperineal resection (n=3, laparoscopic posterior exenteration (n=4, or laparoscopic anterior exenteration (n=5. The uterus was hitched to the anterior abdominal.wall by either a single suture in the fundus or by sutures through the round ligaments. Results. The uterine hitch technique was successfully accomplished in all procedures. It was performed in less than 5 minutes in all cases. It obviated the need for vaginal manipulation. An extra port for retraction could be avoided. There were no intraoperative complications. Conclusion. A practical, cheap and reproducible method for uterine manipulation, during pelvic oncologic surgery is described. It improves the stability of the uterus and also obviates the need for keeping an additional assistant for vaginal manipulation in any of the procedures.

  18. Classification and valuation of postoperative complications after laparoscopic and open radical resection for colorectal cancer%开腹与腹腔镜结直肠癌根治术后并发症的分级与评估

    Institute of Scientific and Technical Information of China (English)

    季新威; 张建立; 孙振青; 王政坤; 邱志刚

    2012-01-01

    目的:探讨开腹手术与腹腔镜结直肠癌根治术后并发症的分级及评估.方法:2009年6月至2011年8月前瞻性地连续纳入158例腹腔镜结直肠癌根治术患者(腹腔镜组)及158例开腹结直肠癌根治术患者(开腹组),对比两组患者术后4周内并发症发生情况.分三步评价并发症的严重性.首先,将术后所有并发症根据Clavien分级进行分类.第二步,5位研究员分别独自应用直观叙述问卷模式对并发症的严重程度进行分级,0表示无术后并发症,100表示术后死亡.第三步,分别用中位数、最低及最高值对两组患者术后并发症进行评价.结果:开腹组术后并发症发生率显著高于腹腔镜组(23.4% vs.13.9%,P<0.05),术后并发症严重程度高于腹腔镜组.在敏感性比较中,中位数、最高值及最低值取得了类似结果.结论:开腹结直肠癌根治术术后并发症发生率显著高于腹腔镜手术,术后并发症严重程度亦高于腹腔镜手术.应用此分级评估法可对开腹与腹腔镜结直肠癌根治术术后并发症的发生做出直接评价.%Objective :To explore classification and valuation of postoperative complications afler laparoscopic and open radical resection for coloreclal cancer. Methods; From Jun. 2009 to Aug. 2011,316 patients with colorectal cancer were divided into two groups (laparoseopie versus open,both n - 158) prospectively and consecutively. The primary outeome was complications at four weeks,and they were compared between the two groups. A three-step methodology was used to assign severity weights to complications. Firstly,each complication was graded using the Clavien classification. Secondly,five reviewers were asked to independently and directly evaluate their perception of the severity of each class using a non-categorized visual analog scale. Zero represented an uneventful postoperative course, but 100 represented postoperative death. Thirdly, the median, lowest, and highest

  19. 腹腔镜下宫颈癌根治术32例临床分析%Clinical Analysis of 32 Cases of Laparoscopic Radical Hysterectomy for Cervical Cancer

    Institute of Scientific and Technical Information of China (English)

    倪琴; 米鑫; 张风格

    2015-01-01

    Objective:To explore the clinical efficacy of laparoscopic radical hysterectomy in the treatment of cervical cancer.Method:A retrospective chart review identified stageⅠa2 toⅡa cervical cancer patients who underwent laparoscopic radical hysterectomy and pelvic lymph node dissection and abdominal aorta lymph node dissection from January 2011 to November 2014,the treatment effect was observed.Result:All the 32 cases were successfully treated by laparoscopic surgery,no one turned to undergo laparotomy.The mean operative time was (240.06±31.99)min.The average intraoperative blood loss was (245.31±102.45)ml.The average pelvic lymph node resected and abdominal aorta lymph node resected were (23.41±1.72) and (4.13±0.94).Postoperative anal exhaust time was (42.63±5.98)h,and bladder function recovery time was (16.78±4.72)d.One case complicated with external iliac vein injury.All cases of vaginal stump and cutting edge were negative.Seven cases received supplementary postoperative radiotherapy and chemotherapy.32 cases followed up 1 to 48 months postoperatively no recurrence.Conclusion:Laparoscopic radical hysterectomy for cervical cancer is safe and feasible,and has satisfactory result,but the surgeon must have skilled operation technique and treatment experience of operation complication.%目的:探讨腹腔镜下宫颈癌根治术的临床疗效。方法:回顾性分析笔者所在医院32例Ⅰa2~Ⅱa期宫颈癌患者腹腔镜下广泛子宫切除术及盆腔淋巴结和腹主动脉旁淋巴结清扫术的临床资料,观察腹腔镜手术治疗效果。结果:32例患者手术均成功,无一例中转开腹。手术时间(240.06±31.99)min,术中出血量(245.31±102.45)ml,切除盆腔淋巴结(23.41±1.72)枚,切除腹主动脉旁淋巴结(4.13±0.94)枚,术后肛门排气时间(42.63±5.98)h,膀胱功能恢复时间(16.78±4.72)d;1例髂外静脉损伤;所有病例断端及阴道切缘均阴性,术后7例补充放疗、化疗。32

  20. The application of laparoscopic gastric cancer radical disease-free technology%腹腔镜胃癌根治术无瘤技术的应用研究

    Institute of Scientific and Technical Information of China (English)

    韩晓鹏; 许威; 于建平; 刘宏斌; 苏琳

    2015-01-01

    目的:探讨应用无瘤技术后腹腔镜下胃癌根治术对肿瘤脱落细胞的影响,评价其安全性及可行性。方法:收集65例行腹腔镜胃癌手术患者切除前后腹腔冲洗液,细胞学检测腹腔游离癌细胞,并以流式细胞学(FCM)方法检测腹腔冲洗液癌胚抗原(CEA)及基质金属蛋白酶-7(MMP-7),对比术前、术后检出率。结果:65例规范无瘤操作的腹腔镜胃癌根治术患者腹腔游离癌细胞术前、术后检出率分别为6.15%(4/65)和9.23%(6/65),CEA检测阳性率术前、术后分别为46.2%(30/65)和52.3%(34/65),MMP-7检测阳性率术前、术后分别为56.9%(37/65)和64.6%(42/65),术后较手术前高,但两者差异无统计学意义( P﹥0.05)。结论:严格遵守无瘤操作规程的腹腔镜胃癌根治术,不增加癌细胞的脱落,也不增加腹腔种植转移几率,是安全可行的。%Objective:To explore the application of laparoscopic gastric cancer after radical disease-free technol-ogy,evaluate the safety and feasibility. Methods:Collect 65 patients with gastric cancer underwent laparoscopic surgi-cal resection in before and after abdominal rinses,cytological examination intraperitoneal free cancer cells,fluid cytol-ogy(FCM)method in detecting celiac rinses carcinoembryonic antigen(CEA)and matrix metalloproteinases -7 (MMP-7),compare the preoperative and postoperative detection rate. Results:In 65 cases of specification disease-free laparoscopic operation intraperitoneal free cancer cells in patients with preoperative and postoperative gastric cancer radical detection rate was 6. 15%(4/65)and 9. 23%(6/65),CEA detection rate of preoperative and postop-erative were 46. 2%(30/65)and 52. 3%(34/65),MMP-7 detection rate of preoperative and postoperative were 56. 9%(37/65)and 64. 6%(42/65),higher than before the operation,but there was no statistically significant difference between the two(P ﹥0. 05). Conclusion

  1. [Laparoscopic myomectomy].

    Science.gov (United States)

    Kolmorgen, K

    1995-01-01

    This retrospective study reviews the indications, surgical techniques and complications in 212 laparoscopic myomectomies performed on 150 patients. The indications for laparoscopic myomectomy include myoma with symptoms, irregular menstruation, rapid growth or sterility and pediculate myoma or identified secondary changes without symptoms. Laparoscopy is contraindicated in patients with fibroids larger than 10 cm and extreme localizations such as prevesicular, parametrial and deep intramural myoma in patients desirous of children. Pediculate myomas were resectioned after coagulation or ligation (22.6%), whereas other myomas were enucleated by various other techniques (77.4%). The small intestine of one patient was damaged by alligator forceps. The lesion was noticed the next day as intestinal contents emerged from the Robinson drain. In three other patients, the laparoscopic operation was completed by laparotomy. Laparoscopic myomectomy, the main advantage of which lies in the avoidance of hysterectomy, is recommended, provided the various surgical suturing and morcellation skills are available and the indications and contraindications are observed. PMID:8585361

  2. 腹腔镜前列腺癌根治术开展初期术中并发症分析%Intraoperative complications of laparoscopic radical prostatectomy during initial stage application

    Institute of Scientific and Technical Information of China (English)

    杨波; 王辉清; 过菲; 宋瑞祥; 许传亮; 高旭; 侯建国; 王林辉; 孙颖浩

    2013-01-01

    目的 回顾腹腔镜前列腺癌根治术(LRP)开展初期阶段术中并发症的发生情况,分析原因并总结经验.方法 通过视频回顾的方法统计2010年1月至2012年11月3名泌尿外科医生在独立开展前20例LRP时出现的术中并发症,并收集患者一般资料、肿瘤分期等相关因素,分析发生术中并发症的原因.结果 60例LRP中共出现并发症23例(38.3%),其中导尿管被误缝7例,术中出血而中转开放5例,前列腺组织残留5例,二次吻合4例,直肠损伤1例,标本遗失1例.所有并发症均在术中得到处理.发生并发症的原因包括解剖层次不清、解剖标记不明、助手配合不默契、手术细节考虑不周全等,其中部分病例肿瘤分期偏晚、手术难度较大.结论 LRP在开展初期应尽量选择难度较低的病例,形成相对固定的手术团队,通过观摩手术,对器械选择、手术步骤、解剖标记、操作手法形成相对完善的套路,并在实践中逐步摸索和改进.%Objective To retrospectively analyze the intraoperative complications of laparoscopic radical prostatectomy (LRP) during the initial application,so as to analyze the reasons and summarize the experience.Methods The videos of the 60 patients undergoing LRP for prostate cancer in our hospital between January 2010 and November 2012 were reviewed to analyze the intraoperative complications.The patients were the first 20 cases done by 3 surgeons independently.The clinical data,tumor staging,and other related factors were collected for analyzing the reasons for complications of LRP.Results Complications were observed intraoperatively in the 23 patients.The most frequent complications included mistaken suture of bladder catheter (7 cases),open conversion due to intraoperative bleeding (5 cases),residual prostate tissue (5 cases),secondary anastomosis (4 cases),rectal injury (1 case),and specimen missing (1 case).All the events were managed during the operation.The reasons

  3. Clinical analysis on laparoscopic nerve sparing radical hysterectomy in malignant uterine cancer%腹腔镜保留盆腔神经的广泛子宫切除治疗子宫肿瘤

    Institute of Scientific and Technical Information of China (English)

    王文翔; 海静; 高玉霞; 段树锋; 杨静; 马瑞霞; 陈彩霞; 董学彩

    2016-01-01

    目的:回顾性分析腹腔镜下保留盆腔自主神经的广泛子宫切除术在子宫肿瘤患者治疗中的可行性。方法选择2013年8月至2015年6月在新乡市中心医院接受手术治疗的早期宫颈癌及Ⅱ期子宫内膜癌患者95例,其中43例患者接受腹腔镜保留盆腔神经的广泛子宫切除术+盆腔淋巴结清扫术( A组),52例患者行经腹广泛子宫切除+盆腔淋巴结清扫术( B组)。总结两组的手术时间、术中出血量、切除宫旁组织及阴道长度、淋巴结数量,以及术后膀胱、直肠及性功能恢复情况。结果两组的手术时间、切除范围及淋巴结数量差异无统计学意义(P>0.05);两组的术中出血量,以及术后膀胱、直肠及性功能评估治疗比较[(180±55)ml vs (340±75)ml,(51.2±10.3)h vs (74.9±12.8) h,(11.6±2.1) d vs (18.3±2.9) d,19.9分 vs 23.4分],差异有统计学意义(P<0.05)。结论腹腔镜下保留盆腔神经的广泛子宫切除术在子宫肿瘤中是安全可行的,与传统术式相比更有利于膀胱直肠功能恢复,提高生命质量。%Objective To explore the efficacy of laparoscopic nerve sparing radical hysterectomy for malignant uterine cancer. Methods Nighty-five patients with early cervical cancer and endometrial cancer received surgery from Aug. 2013 to Jun. 2015 in Central Hospital of Xinxiang, 43 cases underwent laparo-scopic nerve sparing radical hysterectomy pelvic lymphadenectomy, 52 cases underwent radical hysterectomy combined pelvic lymphadenectomy. The data of operating time, blood loss, excision extent, numbers of lymph node, the postoperative function of bladder, rectal and sexual were assessed. Results There were not remarkable difference in terms of operating time, excision extent, number of lymph node, duration of hospital stays. The data of blood loss, the postoperative function of bladder, rectal and sexual reached statis-tical difference [(180±55)ml vs (340±75)ml, (51. 2±10. 3)h vs (74. 9±12. 8

  4. 腹腔镜直肠癌根治术对病人生活质量影响的分析%Quality-of-life analyses for patients with rectal cancer underwent radical laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    许菡; 胡艳艳; 金艳; 奚蓓华; 施晓群; 吴蓓雯

    2012-01-01

    目的:比较腹腔镜直肠癌根治术与传统开腹手术对病人术后生活质量(quality of life,QOL)的影响.方法:对照研究25例腹腔镜直肠癌根治术(腹腔镜组)和29例开腹直肠癌根治术(开腹组),采用欧洲癌症研究与治疗组织的癌症病人QOL评价量表QLQ-C30,评价和比较手术前后QOL的变化特征.结果:两组病人在年龄、性别、肿瘤与肛缘距离、TNM分期方面差异均无统计学意义.两组病人术后早期除情绪功能和认知功能以外的QOL总体评价较术前均明显下降,术后3~6个月,各项功能分值呈逐渐恢复趋势,腹腔镜组恢复显著早于开腹组(P<0.05).总体健康状况量表的评价结果显示,腹腔镜组病人QOL恢复到中等以上水平的时间也显著早于开腹组.结论:腹腔镜直肠癌根治术不但创伤小、痛苦少、恢复快,且病人术后QOL恢复较开腹手术佳.%Objective To compare the impacts of radical laparoscopic surgery and conventional laparotomy on the quality of life (QOL) in patients with rectal cancer. Methods Quality of life questionnaire module, European Organisation for Research and Treatment of Cancer QLQ-C30, was used to evaluate the quality of life for all enrolled rectal cancer patients peri-operatively. Results No significant difference was observed in terms of age, gender, tumor location, as well as TNM staging between the groups. Overall QOL early after operation decreased significantly in both groups of patients comparing with preoperative data, except for emotional function and cognitive function. The trend of QOL recovery was observed in both groups 3—6 months after operation. Furthermore, the QOL recovery was earlier in laparoscopic group than in open group (P<0.05). Overall rating scales of health condition showed that recovery was earlier for patients underwent laparoscopic surgery than for patients underwent conventional open laparotomy. Conclusions Laparoscopic rectal surgery is safe

  5. Limited Evidence for Robot-assisted Surgery

    DEFF Research Database (Denmark)

    Broholm, Malene; Onsberg Hansen, Iben; Rosenberg, Jacob

    2016-01-01

    PURPOSE: To evaluate available evidence on robot-assisted surgery compared with open and laparoscopic surgery. METHOD: The databases Medline, Embase, and Cochrane Library were systematically searched for randomized controlled trials comparing robot-assisted surgery with open and laparoscopic...

  6. EMR Study and DFT-Assisted Identification of Transient Radicals in X-Irradiated Crystalline Sucrose.

    Science.gov (United States)

    Kusakovskij, Jevgenij; Callens, Freddy; Vrielinck, Henk

    2015-06-01

    Solid-state sucrose is a well-known dosimetric system, which is capable of reliable dose estimates only at a considerable time after exposure. Immediately after irradiation at room temperature, its electron paramagnetic resonance (EPR) spectrum is dominated by contributions from unstable radicals, which are studied here using continuous-wave EPR and electron-nuclear double resonance (ENDOR) spectroscopy. Four hyperfine tensors of proton couplings were determined, associated with two radical species, and subsequently compared to density functional theory calculation results, which led to the identification of the species with lower abundance (U2) as a radical formed by a H abstraction from C4. The more abundant center (U1) has not been definitively identified yet, but we present compelling evidence that it should be a C6 centered radical. Comparison of the simulated EPR spectra with all available data to the experimental ones suggests that the EPR spectrum of X-irradiated sucrose immediately after irradiation can now be almost entirely understood. PMID:25973579

  7. Ultrasound elastography: enabling technology for image guided laparoscopic prostatectomy

    Science.gov (United States)

    Fleming, Ioana N.; Rivaz, Hassan; Macura, Katarzyna; Su, Li-Ming; Hamper, Ulrike; Lagoda, Gwen A.; Burnett, Arthur L., II; Lotan, Tamara; Taylor, Russell H.; Hager, Gregory D.; Boctor, Emad M.

    2009-02-01

    Radical prostatectomy using the laparoscopic and robot-assisted approach lacks tactile feedback. Without palpation, the surgeon needs an affordable imaging technology which can be easily incorporated into the laparoscopic surgical procedure, allowing for precise real time intraoperative tumor localization that will guide the extent of surgical resection. Ultrasound elastography (USE) is a novel ultrasound imaging technology that can detect differences in tissue density or stiffness based on tissue deformation. USE was evaluated here as an enabling technology for image guided laparoscopic prostatectomy. USE using a 2D Dynamic Programming (DP) algorithm was applied on data from ex vivo human prostate specimens. It proved consistent in identification of lesions; hard and soft, malignant and benign, located in the prostate's central gland or in the peripheral zone. We noticed the 2D DP method was able to generate low-noise elastograms using two frames belonging to the same compression or relaxation part of the palpation excitation, even at compression rates up to 10%. Good preliminary results were validated by pathology findings, and also by in vivo and ex vivo MR imaging. We also evaluated the use of ultrasound elastography for imaging cavernous nerves; here we present data from animal model experiments.

  8. 腹腔镜残胃癌根治术空肠R型代胃食管-空肠三角吻合技术的应用研究%Application of R-type jejunal interposition and esophagojejunosto-my by delta-shaped anastomosis after totally laparoscopic radical gastrectomy for gastric stump carcinoma

    Institute of Scientific and Technical Information of China (English)

    刘宏斌; 于建平; 许威; 韩晓鹏; 苏琳; 李洪涛; 景化忠; 曹廷宝; 魏登文

    2015-01-01

    August 2014. All the patients received R-type jejunal interposi-tion and esophagojejunostomy by delta-shaped anastomosis after totally laparoscopic radical gastrectomy for gastric stump carcinoma (laparoscope group) in the Lanzhou General Hospital of the Lanzhou Military Area. Laparotomy was performed on 18 cases that com-prised the control group (laparotomy group). The intraoperative and postoperative indicators between these two groups were then com-pared. All the patients were followed-up from 14 to 21 months after the operations. Results:The operations were successfully carried out in all 10 patients (laparoscope group), without performing open operation. The mean operative times, volumes of the intraoperative blood loss, numbers of dissected lymph nodes, frequencies of leaving the bed, days marking the first liquid diet intake, days marking the recovery of gastrointestinal function, and days of hospitalization of the laparoscope group and the laparotomy group were (210.0 ± 30.9) min and (283.9 ± 50.9) min, (90.0 ± 26.7) mL and (277.8 ± 79.1) mL, (19.0 ± 3.6) and (18.8 ± 3.7), (17.3 ± 3.6) h and (75.8 ± 15.7) h, (1.6 ± 0.4) d and (5.7 ± 1.3) d, (3.0 ± 0.8) d and (7.2 ± 1.3) d, and (7.6 ± 1.2) d and (20.8 ± 3.9) d, respectively. Anastomotic stricture, reflux esophagitis, bleeding, leakage, dumping syndrome, or intestinal obstruction was not detected in the laparoscope group. There was no perioperative death. All of the cases exhibited good nutrition situation, and no choking or esophagus burning was reported. Conclusion:R-type jejunal interposition and esophagojejunostomy by delta-shaped anastomosis after totally laparoscopic radical gastrectomy is safe and feasible. The operation can improve the quality of life of patients and induce positive short-term therapeutic effects. Laparo-scopic-assisted radical gastrectomy for gastric stump cancer has the same effect as laparotomy.

  9. [Laparoscopic rectal resection technique].

    Science.gov (United States)

    Anthuber, M; Kriening, B; Schrempf, M; Geißler, B; Märkl, B; Rüth, S

    2016-07-01

    The quality of radical oncological operations for patients with rectal cancer determines the rate of local recurrence and long-term survival. Neoadjuvant chemoradiotherapy for locally advanced tumors, a standardized surgical procedure for rectal tumors less than 12 cm from the anus with total mesorectal excision (TME) and preservation of the autonomous nerve system for sexual and bladder function have significantly improved the oncological results and quality of life of patients. The TME procedure for rectal resection has been performed laparoscopically in Germany for almost 20 years; however, no reliable data are available on the frequency of laparoscopic procedures in rectal cancer patients in Germany. The rate of minimally invasive procedures is estimated to be less than 20 %. A prerequisite for using the laparoscopic approach is implicit adherence to the described standards of open surgery. Available data from prospective randomized trials, systematic reviews and meta-analyses indicate that in the early postoperative phase the generally well-known positive effects of the minimally invasive approach to the benefit of patients can be realized without any long-term negative impact on the oncological results; however, the results of many of these studies are difficult to interpret because it could not be confirmed whether the hospitals and surgeons involved had successfully completed the learning curve. In this article we would like to present our technique, which we have developed over the past 17 years in more than 1000 patients. Based on our experiences the laparoscopic approach can be highly recommended as a suitable alternative to the open procedure. PMID:27277556

  10. Internal Hernia Underneath an Elongated External Iliac Artery: A Complication After Extended Pelvic Lymphadenectomy and Robotic-assisted Laparoscopic Prostatectomy.

    Science.gov (United States)

    Viktorin-Baier, Pascal; Randazzo, Marco; Medugno, Cristoforo; John, Hubert

    2016-09-01

    Small bowel herniation underneath the iliac vessel after transperitoneal pelvic lymphadenectomy is a rare complication. This report describes the first case of bowel incarceration behind the external iliac artery after transperitoneal robotic-assisted radical prostatectomy with extended lymph node dissection in a patient with prostate cancer 1 year after surgery. After diagnosis on CT scan, an open resection of the ischemic bowel was performed. Because of thrombosis, the external iliac artery was opened, the clot was removed and the elongated artery was resected with end-to-end anastomosis. In case of a meandering iliac artery, a retroperitonealization after pelvic lymphadenectomy might be discussed. PMID:27313985

  11. Nursing coordination measures exploration in laparoscopic radical resection of rectal cancer%腹腔镜下直肠癌根治术中的护理配合措施探究

    Institute of Scientific and Technical Information of China (English)

    周荣杰

    2016-01-01

    Objective:To explore the nursing coordination measures exploration in laparoscopic radical resection of rectal cancer. Methods:80 cases of rectal cancer patients were selected.They were randomly divided into the control group and the observation group.The control group used the conventional nursing measures,and the observation group was given the whole course nursing coordination measures,then we observed the anxiety and nursing satisfaction of two groups were before and after the operation. Results:After the operation,the anxiety,depression and nursing satisfaction if the observation group were significantly better than those of the control group(P<0.05).Conclusion:The implementation of whole course nursing care in the laparoscopic radical operation of rectal cancer has significant clinical significance,which can relieve patients with anxiety and depression effectively, and improve patients' satisfaction.%目的:探讨腹腔镜下直肠癌根治术中的护理配合措施。方法:收治直肠癌患者80例,随机分为对照组与观察组,对照组采用常规护理措施,观察组采用全程护理配合措施,观察两组患者术前术后焦虑情况及护理满意度。结果:观察组患者术后焦虑、抑郁及护理满意度明显优于对照组(P<0.05)。结论:实施全程护理配合措施在腹腔镜下直肠癌根治手术中具有显著的临床意义,能够有效地缓解患者的焦虑、抑郁等不良情绪,提高患者的护理满意度。

  12. Laparoscopic-assisted gastrectomy versus open gastrectomy for T4a gastric cancer in short-term and long-term outcomes.

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:To study thesafety of oncologic short-term and long-term outcomes of laparoscopic-assisted gastrectomy (LAG) performed for T4a stage gastric cancer. Methods: Between January 2009 and December 2014, 86 patients with American Joint Committee on Cancer (AJCC) stage T4a gastric cancer underwent LAG or conventional open gastrectomy (OG). Of these patients, 43 patients underwent LAG and they were compared with patients who underwent OG regarding short-term and long-term outcome. Results:The N stage (P=0.685) did not differ between the LAG and OG groups. Postoperative morbidity occurred in 6 (14.0%) OG and 8 (9.3%) LAG cases and postoperative mortality occurred 2 (4.0%) and 0 (0.0%) cases of OG and LAG, respectively. Recurrence occurred in 6 (14.0%) cases and 4 (9.3%) case in the OG and LAG group, respectively (P=0.077). hTe mean survival time in the OG group was 53.86 m)and in the LAG was 53.97 m with no signiifcant difference (P=0.295).Conclusion:The LAG is a feasible and safe procedure, and has several advantages over conventional OG.

  13. Optimized magnetic resonance sequences and parameters with operative assisted images for radical prostatectomy at 3 tesla-magnetic resonance image

    International Nuclear Information System (INIS)

    The objective of our study was to optimize magnetic resonance image (MRI) sequences and parameters using operative assisted images (three-dimensional images) for radical prostatectomy at 3 tesla (T) MRI. Five healthy volunteers underwent MRI on the 3.0 T scanner. Various sequences and parameters [Cube (echo time/repetition time (TE/TR)=18, 50, 90 ms/2000 ms), fast imaging employing steady state acquisition (FIESTA) (TE/TR/FA=2.4 ms/5 ms/40deg, 90deg), fast spoiled gradient recalled acquisition in the steady state (fSPGR) (TE/TR/FA=2.3 ms/11.2 ms/20deg), slice thickness=1.2 mm, matrix=192 x 160] were respectively compared. Several structures of the pelvis (the central zones and transition zones of the prostate, the peripheral zones of the prostate, seminal vesicles, rectum wall, bladder, muscle and fat) were determined. The signal intensities of these structures were measured on reformatted axial images and compared against several structures of the pelvis. Correlation with various sequences and parameters was based on the signal-to-noise ratio (SNR), the contrast ratio (CR) and the presence of artifacts. Student's t-test was used for statistical analysis. With Cube (TE/TR=50 ms/2000 ms), the average value of visual evaluation with artifacts was high, and SNR and CR were higher than for other sequence and parameters. Optimized MRI sequences and parameters were Cube (TE/TR=50 ms/2000 ms) which provides improved SNR and CR and the presence of artifacts with operative assisted images for radical prostatectomy. These operative assisted images obtained from Cube (TE/TR=50 ms/2000 ms) are likely to be useful for surgery. (author)

  14. Laparoscopic pyelolithotomy: optimizing surgical technique.

    Science.gov (United States)

    Salvadó, José A; Guzmán, Sergio; Trucco, Cristian A; Parra, Claudio A

    2009-04-01

    The classic approach to renal stone disease includes shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotripsy, and, in some cases, a combination of both. The usefulness of laparoscopy in this regard remains debated. In this report and video, we present our technique of laparoscopic pyelolithotomy assisted by flexible instrumentation to achieve maximal stone clearance in a selected group of patients. PMID:19358685

  15. Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer: A retrospective study in a single minimally invasive surgery center.

    Science.gov (United States)

    Hao, Yingxue; Yu, Peiwu; Qian, Feng; Zhao, Yongliang; Shi, Yan; Tang, Bo; Zeng, Dongzhu; Zhang, Chao

    2016-06-01

    Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79.70%, 57

  16. Laparoscopic donor nephrectomy.

    Science.gov (United States)

    Deger, S; Giessing, M; Roigas, J; Wille, A H; Lein, M; Schönberger, B; Loening, S A

    2005-01-01

    Laparoscopic live donor nephrectomy (LDN) has removed disincentives of potential donors and may bear the potential to increase kidney donation. Multiple modifications have been made to abbreviate the learning curve while at the same time guarantee the highest possible level of medical quality for donor and recipient. We reviewed the literature for the evolution of the different LDN techniques and their impact on donor, graft and operating surgeon, including the subtleties of different surgical accesses, vessel handling and organ extraction. We performed a literature search (PubMed, DIMDI, medline) to evaluate the development of the LDN techniques from 1995 to 2003. Today more than 200 centres worldwide perform LDN. Hand-assistance has led to a spread of LDN. Studies comparing open and hand-assisted LDN show a reduction of operating and warm ischaemia times for the hand-assisted LDN. Different surgical access sites (trans- or retroperitoneal), different vessel dissection approaches, donor organ delivery techniques, delivery sites and variations of hand-assistance techniques reflect the evolution of LDN. Proper techniques and their combination for the consecutive surgical steps minimize both warm ischaemia time and operating time while offering the donor a safe minimally invasive laparoscopic procedure. LDN has breathed new life into the moribund field of living kidney donation. Within a few years LDN could become the standard approach in living kidney donation. Surgeons working in this field must be trained thoroughly and well acquainted with the subtleties of the different LDN techniques and their respective advantages and disadvantages. PMID:16754618

  17. Intraoperative nursing cooperation for robotic-assisted laparoscopic precise liver resection%机器人辅助腹腔镜精准肝切除的手术配合

    Institute of Scientific and Technical Information of China (English)

    许晓晓; 武伟; 李凤云; 孙建荷

    2011-01-01

    Objective To investigate intraoperative nursing cooperation for robotic-assisted laparoscopic precise liver resection. Methods Between April and July 2009, 13 consecutive patients underwent roboticassisted laparoscopic anatomic hepatectomy for benign and malignant hepatic diseases. The clinical data of preoperative preparation, intraoperative cooperation and management of emergency were analyzed retrospectively and summarized gradually. Results All 13 robotic-assisted laparoscopic precise liver resections were performed successfully in the manner of pure laparoscopic resection. The nursing protocol was formulated to improve the preoperative preparation, intraoperative cooperation, management of emergency and postoperative summary. The nursing outcome was satisfactory due to effective nursing strategy. Conclusions Robotic surgery has been expanded into multi-disciplinary field, therefore preparation, communication, discreet placement and protection are important guarantees in its development.%目的 探讨机器人辅助腹腔镜精准肝切除手术的护理配合。方法 回顾性分析13例机器人辅助腹腔镜精准肝切除手术资料,对本组手术的术前准备、术中配合及紧急情况的处理进行总结。结果 13例患者均成功接受了机器人辅助腹腔镜精准肝切除术,术前准备、术中配合、特殊情况应对及术后整理均不断改进,取得满意的护理效果。结论 机器人手术方式扩展到多专科多种术式,准备与沟通、谨慎的安置与保护,是手术护理伴随手术技术发展呈现专科护士作用的重要保障。

  18. LAPAROSCOPIC HERNIOPLASTY

    Institute of Scientific and Technical Information of China (English)

    Bittner R; Leibl BJ; Kraft K; Schmedt CG

    2003-01-01

    @@ The first steps in laparoscopic hemioplastic surgery were performed by gynaecologists in the 1980′s[ 1, 2]. However the essentials of transabdominal technique with preperitoneal placement of polypropylene mesh (TAPP) and totally extraperitoneal (TEP) repair were first described in the beginning of the 1990′s by Arregui[3] and Mc Keman respectively[4].

  19. Laparoscopic partial nephrectomy: state of the art review

    Directory of Open Access Journals (Sweden)

    Faiena I

    2014-05-01

    Full Text Available Izak Faiena, Christopher Sejong Han, Ephrem O Olweny Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA Introduction: The surgical management of small renal masses (<4 cm has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods: We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms “laparoscopic partial nephrectomy”, “robot-assisted partial nephrectomy”, “robotic partial nephrectomy”, and “laparoscopic partial nephrectomy oncologic and functional outcomes”. Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN. Keywords: nephrectomy, robotics, kidney

  20. Neoadjuvant hormone therapy following treatment with robotic-assisted radical prostatectomy achieved favorable in high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Hou CP

    2014-12-01

    Full Text Available Cheng-Pang Hou,1,2,* Wei-Chang Lee,1,2,* Yu-Hsiang Lin,1,2 Shao-Ming Chen,3 Chien-Lun Chen,1,2 Phei-Lang Chang,1,2,4 Horng-Heng Juang,4,5 Ke-Hung Tsui1,2,4 1Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China; 2School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China; 3Hou-Pin Taipei Hospital, 4Bioinformation Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China; 5Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China *These authors contributed equally to this work Purpose: Patients with a high risk of prostate carcinoma typically have higher rates of positive surgical margins and biochemical failure following radical prostatectomy and adjuvant hormone therapy. In this study, we assessed the effects of neoadjuvant hormone therapy (NHT on prostate carcinoma in high-risk patients following robotic-assisted radical prostatectomy (RARP. Methods: This retrospective study investigated the medical records of 28 patients who underwent RARP between January 2009 and October 2013. Twenty-two patients underwent NHT prior to RARP. Furthermore, six patients did not undergo NHT prior to RARP. Parameters including age, operating time, blood loss, blood transfusion status, and cancer stage were checked against anatomical correlations. Potential predictors of prolonged operating time and prolonged surgical procedures were assessed using multiple logistic regressions. Results: NHT was shown to be an independent predictor of prolonged total operating time. Tumor stage alterations did not appear to be associated with NHT followed by RARP. The patients who underwent NHT were not more likely to have positive surgical margins, and an increase in patients requiring blood transfusion was not seen. Conclusion: NHT appears to increase

  1. 后腹腔镜与开放式肾癌根治术的临床疗效比较%Compare the clinical efficacy of retroperitoneal laparoscopic versus open radical nephrectomy

    Institute of Scientific and Technical Information of China (English)

    庞松强; 范治璐; 孙卫兵; 杨玻; 刘志宇

    2008-01-01

    目的 比较后腹腔镜与开放式肾癌根治术的临床疗效.方法 2003年10月至2006年10月,对临床分期为T1N0M0或T2N0M0期90例患者,施行后腹腔镜肾癌根治术49例(A组),开放式肾癌根治术41例(B组),对两组的临床疗效进行回顾性分析.结果 A组46例手术成功.4例(8.7%)出现主要并发症,随访(21.9±6.1)个月.B组手术均成功,1例因术后脑出血死亡.9例(22.5%)出现主要并发症,随访(24.9±7.8)个月.病理证实均为肾恶性肿瘤.两组病例在肿瘤大小、手术时间、随访时间比较差异无统计学意义(P>0.05),而术中出血量、术后引流时间、术后下床活动时间、肠功能恢复时间、术后住院时间、术后镇痛剂使用、输血等方面比较,差异有统计学意义(P>0.01).结论 与开放式肾癌根治术相比,后腹腔镜肾癌根治术具有微创、痛苦小、恢复快、并发症少等优点,而对T1N0M0或T2N0M0期肿瘤控制,临床疗效相同.%Objective To evaluate the clinical efficacy and complication rate by open or retroperitoneal laparoscopic radical nephrectomy for renal tumor with stages T1N0M0 or T2N0M0.Methods Between October 2003 and October 2006,90 patients with renal cell carcinoma,which were clinically localized stages T1N0M0 or T2NOM0 Based on the patients' options to undergo retroperitoneal laparoscopic radical nephrectomy (group A,49 patients)and open radical nephrectomy(group B,41 patients).The clinical efficacy were compared between group A and group B,retrospectively.Results In group A,the operations of 46 patients were successful,4 cases occurred major complications(8.7%)during the follow-up visit which lasted for (21.9±6.1)months.The operations in group B were all successful.9 cases occurred major complications (22.5%)during the follow-up visit which lasted for(24.9±7.8)months.All cases were renal malignant tumors with pathologically confirmed stages T1N0M0 or T2N0M0 and there were no renal pedical lymph node

  2. Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer - complications, women´s experiences, quality of life and a health economic evaluation.

    Science.gov (United States)

    Herling, Suzanne Forsyth

    2016-07-01

    This thesis contains four studies all focusing on women with endometrial cancer undergoing robotic-assisted laparoscopic hysterectomy (RALH). Women with endometrial cancer are typically elderly with co-morbidities. RALH is a relatively new treatment option which has been introduced and adopted over the last decade without randomised controlled trials (RCTs) to prove superiority over other surgical alternatives. The purpose of the thesis was to explore and describe patient and health economic outcomes of RALH for women with endometrial cancer using different research approaches. The first study was a retrospective descriptive cohort study with 235 women. The aim was to explore types and incidence of post-operative complications within 12 months after RALH reported with the Clavien-Dindo scale. We found that 6% had severe complications and that women with lymphadenectomy did not have an increased rate of complications. Urinary tract and port site infections were the most frequent complications. The second study was a qualitative interview study where we explored the experience of undergoing RALH. Using content analysis, we analysed semi-structured interviews with 12 women who had undergone RALH on average 12 weeks earlier. The women were positive towards the robotic approach and felt recovered shortly after. They expressed uncertainty with the normal course of bleeding and bowel movement post-operatively as well as with the new anatomy. The third study was an economic evaluation; an activity-based costing study including 360 women comparing total abdominal hysterectomy (TAH) to RALH. This study showed that for women with endometrial cancer, RALH was cheaper compared to TAH, mainly due to fewer complications and shorter length of stay (LOS) that counterbalanced the higher robotic expenses. When including all cost drivers the analysis showed that the RALH procedure was more than 9.000 Danish kroner (DKK) cheaper than the TAH. Increased age and Type 2 diabetes appeared

  3. Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer - complications, women´s experiences, quality of life and a health economic evaluation.

    Science.gov (United States)

    Herling, Suzanne Forsyth

    2016-07-01

    This thesis contains four studies all focusing on women with endometrial cancer undergoing robotic-assisted laparoscopic hysterectomy (RALH). Women with endometrial cancer are typically elderly with co-morbidities. RALH is a relatively new treatment option which has been introduced and adopted over the last decade without randomised controlled trials (RCTs) to prove superiority over other surgical alternatives. The purpose of the thesis was to explore and describe patient and health economic outcomes of RALH for women with endometrial cancer using different research approaches. The first study was a retrospective descriptive cohort study with 235 women. The aim was to explore types and incidence of post-operative complications within 12 months after RALH reported with the Clavien-Dindo scale. We found that 6% had severe complications and that women with lymphadenectomy did not have an increased rate of complications. Urinary tract and port site infections were the most frequent complications. The second study was a qualitative interview study where we explored the experience of undergoing RALH. Using content analysis, we analysed semi-structured interviews with 12 women who had undergone RALH on average 12 weeks earlier. The women were positive towards the robotic approach and felt recovered shortly after. They expressed uncertainty with the normal course of bleeding and bowel movement post-operatively as well as with the new anatomy. The third study was an economic evaluation; an activity-based costing study including 360 women comparing total abdominal hysterectomy (TAH) to RALH. This study showed that for women with endometrial cancer, RALH was cheaper compared to TAH, mainly due to fewer complications and shorter length of stay (LOS) that counterbalanced the higher robotic expenses. When including all cost drivers the analysis showed that the RALH procedure was more than 9.000 Danish kroner (DKK) cheaper than the TAH. Increased age and Type 2 diabetes appeared

  4. [Laparoscopic rectopexy].

    Science.gov (United States)

    Herold, A; Bruch, H P

    1997-01-01

    Within 4 years 66 laparoscopic rectopexies were performed. The indications were: rectal prolapse, morphologic outlet-constipation and a combination of both. Using a modified suture rectopexy (according to Sudeck), we did not take any foreign material and resected the sigmoid in 35 patients. Conversion rate was 2%, complications that needed reoperation occurred in 9%. In the follow up period of 24.1 months in the mean (max. 50) no recurrent prolapse occurred. Incontinence was abolished or improved in 64%, outlet-constipation was improved in 85%. Especially in rectopexy the laparoscopic technique seems to be of benefit for the patient: quicker convalescence, less pain, small scars, a.o. But all these potential advantages have to be proven in prospective-if possible randomised-studies. PMID:9340966

  5. [Laparoscopic pyelolithotomy].

    Science.gov (United States)

    Chiva Robles, Vicente; Escalera Almendros, Carlos; Pascual Mateo, Carlos; Rodríguez García, Nuria; García Tello, Ana; Berenguer Sánchez, Antonio

    2006-03-01

    The application of laparoscopy as a surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The treatment of urinary lithiasis localized in the renal pelvis is one of them. We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. The objective of this article is to show the technique, presenting it as an alternative option. PMID:16649523

  6. [Laparoscopic choledochoduodenostomy].

    Science.gov (United States)

    Baĭramov, N Iu; Zeĭnalov, N A; Pashadze, V A

    2013-01-01

    The article presents the results of laparoscopic choledoch-duodenostomy (CDS) applied to 23 patients with benign strictures of distal part of common bile duct (CBD). 21 patients had cholelithiasis in combination with the CBD stricture. The rest 2 patients had acalculous postcholecystectomy stricture. The laparoscopic CDS was executed by 5 trocars: 4 were placed in standard cholecystectomy positions and the 5th was placed by the right pararectal line at the umbilicus level and was used for traction of duodenum and continuous aspiration. 2 sm long side-to-side CDS was performed with interrupted sutures. The mean operative time was 128±36 (90-205) min. There was no conversion. The mean hospital stay was 4.5 (3-9) days. There was no mortality. 2 patients developed an anastomosis bile leakage: one received the relaparoscopy and T-draining of the CDS, in another patient the leakage seased spontaneously. 82.7% of patients showed excellent and good long term results. 3 patients reported bad outcome and very bad result was registered in 1 patient. In conclusion, the laparoscopic CDS gives good outcomes in experienced hands and could be considered as an alternative to endoscopic sphincterotomy in patients with distal CBD stenosis.

  7. Laparoscopic pyeloplasty.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-01-01

    We report our results and short term follow up of transperitoneal laparoscopic pyeloplasty for pelvi-ureteric junction (PUJ) obstruction. We have prospectively maintained a database to document our initial experience of 54 laparoscopic pyeloplasty. All procedures were carried out by one surgeon through a transperitoneal approach. The data extends from April 2005 to September 2008 and reports operative time, blood loss, complications, hospital stay, short term follow-up on symptomatic and radiological outcome. Fifty-four procedures were performed during the study period. Mean patient age was 29 years. Mean operating time was 133 minutes (range 65-300 minutes), and mean blood loss was 45 ml (range 20-300 ml). No intra operative complication occurred. Neither blood transfusion nor conversion to open surgery was required. Postoperative mean hospital stay was 3.4 days (range 3-14 days). There were 3 anastomotic leakages; 2 in the immediate postoperative period and 1 following removal of stent. They all required percutaneous drainage and prolonged stenting. Overall 47 (87%) patients have symptomatic relief and resolution of obstruction on renogram. Four (7%) patients developed recurrence. Three (5.5%) patients had symptomatic relief but have a persistent obstructive renogram. Laparoscopic pyeloplasty is an effective alternative treatment for symptomatic pelvi-ureteric junction obstruction. The results appear comparable to open pyeloplasty with decreased postoperative morbidity.

  8. 腹腔镜与开腹胃癌根治术的疗效及对患者免疫功能的影响%Laparoscopic versus open gastric radical gastrectomy: the efficacy and impact on immune function

    Institute of Scientific and Technical Information of China (English)

    夏亚斌; 郑成竹

    2013-01-01

    Objective:To compare the efficacies between laparoscopic and open radical gastrectomy and their impacts on immune function of patients.Methods:The clinical data of 114 gastric cancer patients admitted over the past 3 years were retrospectively analyzed.Of the patients,55 cases underwent laparoscopic gastrectomy (laparoscopy group) while 59 cases were subjected to open gastrectomy (laparotomy group).The postoperative immune function alterations,and intra-and postoperative conditions between the two groups of patients were compared.Results:The determination results for immune function parameters at 24 and 72 h after operation showed the levels of IL-2 and IL-6 in both groups were increased significantly compared with those before operation (all P<0.01),but the increasing degrees of both factors in laparotomy group were greater than those in laparoscopy group (all P<0.05); the peripheral blood levels of CD3+,CD4+,and CD8+ cells in laparotomy group were decreased significantly versus those before operation (all P<0.05),while no significant changes in above T cell subsets were noted in laparoscopy group (all P>0.05).Compared with laparotomy group,the intraoperative blood loss,frequency in analgesic use and postoperative complications in laparoscopy group were significantly reduced,and times to first flatus passage,liquid diet and ambulation as well as length of postoperative hospital stay were significantly shortened (all P<0.05).Conclusion:The efficacy of laparoscopic gastrectomy is better than that of open surgery,because it exerts less impact on immune function and with little systemic damage on the patients.%目的:比较腹腔镜与开腹胃癌根治术的疗效及对患者免疫功能的影响.方法:回顾性分析3年内收治的1 14例胃癌患者临床资料,其中55例行腹腔镜胃癌根治术(腹腔镜组)和59例行开腹胃癌根治术(开腹组),比较两组术后免疫功能的变化,以及术中、术后情况.结果:术后24,72 h免疫指

  9. A prospective study of comparison between Open Gastrojejunostomy and Laparoscopic Assisted Gastrojejunostomy in patients of post corrosive ingestion pyloric stenosis.

    Directory of Open Access Journals (Sweden)

    Samir shah

    2016-03-01

    Results: We observed that benign etiology was more common for GOO (58% compared to malignant cause (42% and post corrosive ingestion pyloric stenosis was most common benign cause(42% of GOO, Pancreatic cancer was most common malignant cause(18.5% of GOO. Corrosive ingestion was more common in younger age group (66% in 15 -30 yr age and female gender(63.34% and mostly as a suicidal attempt(86.66% and most common corrosive agent was sanitary cleansing agent(hydrochloric acid (70%.Postprandial nonbillious vomiting and weight loss were consistent symptom and appeared after 6-8 week of corrosive ingestion and 50% of patient of post corrosive ingestion pyloric stenosis had concomitant esophageal stricture. In present study those patient operated with Lap Assisted Gastrojejunostomy had smaller size of incision, reduce intra operative need of blood transfusion, less post-operative pain and less chance of wound infection, early drain and suture removal and early discharged from hospital with minimal post-operative morbidity and without significant increase in total duration and cost of operation. Conclusion : As compared to Open Gastrojejunostomy, Lap Assisted Gastrojejunostomy is better alternative operative method for pyloric stenosis. [Natl J Med Res 2016; 6(1.000: 48-50

  10. Infected Urachal Cyst in an Adult: A Laparoscopic Approach

    Science.gov (United States)

    Kwok, Ching-Ming

    2016-01-01

    Urachal cysts occur infrequently in adults and are rarely reported in the literature. Laparoscopic excision or robot-assisted laparoscopic excision of urachal cysts has widely been applied in recent years. We present a case of urachal cyst infection treated with antibiotics and two-staged operation. The laparoscopic procedure was performed without any complications. Strong suspicion is the key for early diagnosis. PMID:27462196

  11. Laparoscopic Techniques: What is the Role in Inflammatory Bowel Disease?

    Directory of Open Access Journals (Sweden)

    Tracy L Hull

    1995-01-01

    Full Text Available Laparoscopic cholecystectomy has quickly become the preferred technique for removing the gallbladder. Real advantages in the area of laparoscopic gallbladder removal have spurred interest towards other areas of laparoscopic surgery. There has been interest in laparoscopic bowel surgery but this approach has not gained popularity as quickly as gallbladder surgery. Reasons surround the fact that the bowel is a continuous organ (versus an end organ like the gallbladder laden with bacteria and it has a rich blood supply. These differences make laparoscopic bowel surgery more difficult and challenging. If inflammatory bowel disease (IBD is considered, the indications to approach surgery laparoscopically fall into two categories: current and future indications. The current indications are diagnostic laparoscopy, fecal diversion, limited bowel resections with extracorporeal anastomosis and stoma closures. Future indications include laparoscopic subtotal colectomy and laparoscopic assisted pelvic pouch procedures. As experience is gained and laparoscopic instruments are modified and refined for bowel surgery, intracorporeal anastomosis and more extensive bowel resections will be feasible. Currently laparoscopic bowel surgery can be done in select circumstances for problems associated with IBD. It has yet to be proven if doing the surgery laparoscopically provides advantages for bowel surgery as has been demonstrated with gallbladder surgery. Prospective studies are underway to answer these questions.

  12. 机器人辅助腹腔镜子宫全切术41例报告%Robotic-assisted Laparoscopic Hysterectomy: Report of 41 Cases

    Institute of Scientific and Technical Information of China (English)

    何晓琴; Mukesh Parekh

    2011-01-01

    Objective To investigate the techniques of robotic-assisted laparoscopic hysterectomy. Methods With the patients at dorsal lithotomy position, under general anesthesia, we placed a colpotomy ring and uterine manipulator to delineate the vaginal fornices, and then inserted a colpo-pneumo occluder. With an digital video system prepared, we determined one port for camera, and two ports for instrument arms, and one port for assistant trocars. A patient cart was positioned between the patient' s legs and locked, the camera arm and remained instrument arms were then docked, HotShears (Monopolar Curved Scissors) and PK Dissect Forceps were fixed at each side. When suturing, needle drivers was used at the both sides. Assistant trocar was used to help exposing surgical field and suction. By controlling the robotic arms, we completed the operation. Results The mean operation time was (82.5 ± 9.5) minutes [ console time (61.9 ± 7.9) minutes, docking time (7.0 ± 1.5 ) minutes ]; and intraoperative blood loss was (55.0 ± 12.8) ml. No intraoperative complications occurred. Two patients developed postoperative complications: hypertension in one and urological infection at 3 days postoperation in the other. Both cases were cured by conservative therapies. Follow-up was available in 41 cases for 42 days, during which no vaginal bleeding or abdominal pain was complained. Conclusions Robot-assisted hysterectomy is safe and reliable with few complications and quick recovery.%目的 探讨机器人辅助腹腔镜子宫全切术的临床应用.方法 全麻后取截石位,放置阴道环切环、子宫操纵器及阴道封堵球囊,准备数字电视摄像系统,确定一个内镜端口、2个器械端口及一个助手端口的位置并置入套管,自动操作仪器置于患者两腿间,对接自动操作仪器和内镜摄像臂,一侧端口安装双极电凝钳,一侧端口安装单极电剪.缝合时两侧端口均安装针持器.助手端口置入普通腔镜器械,由手术

  13. Clinical Value of Laparoscopic Radical Parametrectomy in the Treatment of Unexpected Cervical Cancer%腹腔镜广泛宫旁切除术治疗意外发现宫颈癌

    Institute of Scientific and Technical Information of China (English)

    赵佳佳; 王武亮; 王晨阳

    2016-01-01

    Objective To investigate the safety and clinical effect of laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer . Methods A retrospective analysis was made on clinical characteristics of 15 patients who were diagnosed as unexpected cervical cancer from January 2008 to December 2014.The age of the patients was between 29 and 67 years old, with an average of 43.9 years old.The indications for hysterectomy were cervical intraepithelial neoplasia (CIN) grade 2-3 in 7 cases, uterine myoma in 3 cases, dysfunctional uterine bleeding in 2 cases, uterine prolapse in 2 cases and adenomyosis in 1 case. Pathological results after the hysterectomy included 13 cases of cervical squamous carcinoma and 2 cases of adenocarcinoma .The lesions were all confined to the cervix , with 4 cases of stage ⅠA2 disease and 11 cases of stage ⅠB1 .The lymph-vascular space invasion was found in 4 cases.The operation interval between the two operations was 3-7 d (mean, 4.6 d).They were all given laparoscopic radical parametrectomy . Results The operation time was 212-285 min (mean, 249.6 min), and the blood loss was 250-500 ml ( mean, 376 ml) .Postoperative pathological findings showed no residual disease .Only one patient had left pelvic lymph node mestastasis .Two patients had intraoperative complications , including 1 bladder injury and 1 ureteral injury .There were 3 cases of postoperative complications , including 2 cases of uroschesis and 1 case of lymphocyst .The follow-up time was 6-84 months ( median, 48 months).No recurrence was seen.The 1-, 3-, 5-year survival rates were 100%, 93.3%, 86.7%, respectively. Conclusions Laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer is difficult to perform and has more complications . This surgical method is applicable to those who refused postoperation radiotherapy or required retaining ovarian function .%目的:探讨腹腔镜广泛宫旁切除术

  14. 手术频率对腹腔镜胃癌根治术学习曲线的影响%The influence of surgical frequency on laparoscopic radical gastrectomy learning curve

    Institute of Scientific and Technical Information of China (English)

    耿良元; 白剑峰; 孙跃明; 陆文熊; 傅赞

    2012-01-01

    目的:探讨手术频率对于腹腔镜胃癌根治术学习曲线的影响.方法:回顾性分析由同一组甲医师(n=100例,月平均手术3.33例)、乙医师(n=90例,月平均手术2.50例)分别在2008年1月~2010年6月和2008年1月~2011年1月完成的腹腔镜胃癌根治手术.按照手术先后顺序,将甲医师组分为4阶段(A、B、C、D),每阶段25例,乙医师组分为6阶段(E、F、G、H、I、J),每阶段15例.分别比较甲、乙医师组内各阶段及甲乙医师两组的手术时间、术中出血量、术后住院天数、并发症、中转开腹数、淋巴结清扫数.结果:所有分组比较的手术患者年龄、性别、病理分期、手术方式上均具有可比性.甲医师组C、D阶段手术时间及出血量显著少于A、B阶段,乙医师组I、J阶段手术时间及出血量显著少于E、F、G、H阶段,各阶段间淋巴结清扫数、并发症、术后住院天数及中转开腹率差异无统计学意义.甲医师组手术时间显著少于乙医师组手术时间,甲医师组术中出血量显著少于乙医师组术中出血量,两者差异具有统计学意义,两医师组间淋巴结清扫数、中转开腹率、手术并发症差异无统计学意义.结论:当适当增加手术频率时,可以在较短的学习曲线下,更好地掌握腹腔镜胃癌根治术.%Objective;To investigate effects of surgery frequency on the laparoscopic radical gastrectomy learning curve. Methods; A retrospective analysis of the laparoscopic radical gastrectomy by the same physician group Ⅰ and Ⅱ , respectively, from January 2008 to June 2010 (n = 100) and from January 2008 to January 2011 (n = 90) ,the average monthly surgery rate was 3.33 and 2.50. I group was divided into four phases (A,B,C,D),each phase of 25 cases, Ⅱ group divided into six phases (E, F, G, H, I, J) , each phase of 15 cases. Operative time,blood loss,postoperative hospital stay,complications,laparotomy number,number of lymph node dissection were

  15. 筋膜内与筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术%Fascia between fascia and nerves reservations extraperitoneal laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    黎志钦; 吴爱明

    2016-01-01

    Objective To analyze and compare the extraperitoneal laparoscopic fascia between reservations and radical prostatectomy nerve. Methods The patients from our hospital between January 2013 and November 2014 were treated. Total 189 cases with localized prostate cancer were included into the present study. All patients underwent fascial fascia extraperitoneal laparoscopic radical prostatectomy. According to surgical methods fascia,these patients were divided into fascia group 63 cases,126 cases among the fascia group. Comparative analysis was per-formed. Follow-up time was 12 months. The age,BMI,serum PSA,Gleason score,operative time,intraoperative blood loss,positive margin rate,indwelling catheter time and pathological staging,control urinary function,erectile function of two groups patients were compared. Results The age,BMI,serum PSA,Gleason score,surgical time,intraoperative blood loss,positive margin rate,indwelling catheter time,pathological stage,between groups after 12 months of urinary and erectile function of two groups patients did not show the difference,no statistically significant difference( P ﹥0. 05). And after 3 and 6 months,the urinary recovery after 6 months and the recovery of erectile function of two groups had the difference,and the difference was statistically significant( P ﹤0. 05). Conclusion For patients with localized prostate cancer,inline fascia ex-traperitoneal laparoscopic nerve-sparing radical prostatectomy,postoperative urinary continence and erectile function recovery was significantly better than the fascia group. The short-term clinical results more stable,but far clinical effects still need to extend the period of follow-up time and increase the sample size to be confirmed.%目的:将筋膜内与筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术进行对比分析。方法选取2013年1月至2014年11月收治的189例局限性前列腺癌患者为研究对象,且均行筋膜间或筋膜内腹膜外腹腔镜

  16. Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases.

    Science.gov (United States)

    Yang, Yun Seok; Kim, Seung Hyun; Jin, Chan Hee; Oh, Kwoan Young; Hur, Myung Haeng; Kim, Soo Young; Yim, Hyun Soon

    2014-01-01

    The objective of this study was to present the initial operative experience of solo surgeon single-port laparoscopic surgery (SPLS) in the laparoscopic treatment of benign gynecologic diseases and to investigate its feasibility and surgical outcomes. Using a novel homemade laparoscope-anchored instrument system that consisted of a laparoscopic instrument attached to a laparoscope and a glove-wound retractor umbilical port, we performed solo surgeon SPLS in 13 patients between March 2011 and June 2012. Intraoperative complications and postoperative surgical outcomes were determined. The primary operative procedures performed were unilateral salpingo-oophorectomy (n = 5), unilateral salpingectomy (n = 2), adhesiolysis (n = 1), and laparoscopically assisted vaginal hysterectomy (n = 5). Additional surgical procedures included additional adhesiolysis (n = 4) and ovarian drilling (n = 1).The primary indications for surgery were benign ovarian tumors (n = 5), ectopic pregnancy (n = 2), pelvic adhesion (infertility) (n = 1), and benign uterine tumors (n = 5). Solo surgeon SPLS was successfully accomplished in all procedures without a laparoscopic assistant. There were no intraoperative or postoperative complications. Our laparoscope-anchored instrument system obviates the need for an additional laparoscopic assistant and enables SPLS to be performed by a solo surgeon. The findings show that with our system, solo surgeon SPLS is a feasible and safe alternative technique for the treatment of benign gynecologic diseases in properly selected patients. PMID:24509292

  17. Management of Duodenal Stump under Laparoscope Combined Assisted Incision in Laparoscopic Gastric Operation%腹腔镜胃手术结合辅助切口十二指肠残端处理方法改进的临床研究

    Institute of Scientific and Technical Information of China (English)

    田夫; 肖宝来; 蒋雪峰; 邓清; 龙琦; 岳信; 张绪良

    2012-01-01

    Objective To explore the clinical effect of management of duodenal stump under laparoscope combined assisted incision in laparoscopic-assisted gastric operation. Methods The clinical data of 68 cases treated by laparoscopic-assisted gastric operation were analyzed retrospectively. Among them, 24 cases (group A) were performed duodenal stump management by laparoscope, 44 cases (group B) were performed duodenal stump management by laparoscope combined assisted incision. Results Laparoscopic-assisted gastric operation was performed successfully in all 68 patients. Both operative duration and intraoperative blood loss of group A was higher than those of group B (P 0.05). Postoperative infection and anastomotic stoma bleeding was found in 1 patient respectively in group A, and in 2 and 1 case respectively in group B, and no difference in the rate of postoperative complication between two groups(P>0.05). No operative death, stomal leak and duodenal stump leakage occurred in all the 68 cases. The cost of duodenal stump management was 8 660.50 in group A, and was obviously higher than 120 in group B (P > 0. 05). Conclusion The management of duodenal stump by laparoscope combined assisted incision is safe and effective for laparoscopic-assisted gastric operation with advantages as short operation duration, less blood loss, easy exposure for adjacent pylorus lesion, low difficulty degree and operative risk, less complication and decreasing surgery cost, but the long-term outcome needs to be observed.%目的 探讨腹腔镜胃手术结合辅助切口十二指肠残端处理方法改进的临床应用效果.方法 回顾分析68例腹腔镜胃手术患者的临床资料,其中腹腔镜下十二指肠残端处理24例(A组),结合辅助切口十二指肠残端处理44例(B组). 结果 68例患者均顺利完成手术.A组较B组手术时间长、出血量多(P<0.05);两组切口长度、远/近切缘及淋巴结清扫数目比较均无统计学差异(P>0.05);两组患者

  18. Surface-Enhanced Raman Spectroscopy Assisted by Radical Capturer for Tracking of Plasmon-Driven Redox Reaction

    Science.gov (United States)

    Yan, Xuefeng; Wang, Lingzhi; Tan, Xianjun; Tian, Baozhu; Zhang, Jinlong

    2016-07-01

    The deep understanding about the photocatalytic reaction induced by the surface plasmon resonance (SPR) effect is desirable but remains a considerable challenge due to the ultrafast relaxation of hole-electron exciton from SPR process and a lack of an efficient monitoring system. Here, using the p-aminothiophenol (PATP) oxidation SPR-catalyzed by Ag nanoparticle as a model reaction, a radical-capturer-assisted surface-enhanced Raman spectroscopy (SERS) has been used as an in-situ tracking technique to explore the primary active species determining the reaction path. Hole is revealed to be directly responsible for the oxidation of PATP to p, p‧-dimercaptoazobenzene (4, 4‧-DMAB) and O2 functions as an electron capturer to form isolated hole. The oxidation degree of PATP can be further enhanced through a joint utilization of electron capturers of AgNO3 and atmospheric O2, producing p-nitrothiophenol (PNTP) within 10 s due to the improved hole-electron separation efficiency.

  19. Large-Scale Domain Motions and Pyridoxal-5'-Phosphate Assisted Radical Catalysis in Coenzyme B12-Dependent Aminomutases

    Directory of Open Access Journals (Sweden)

    Amarendra Nath Maity

    2014-02-01

    Full Text Available Lysine 5,6-aminomutase (5,6-LAM and ornithine 4,5-aminomutase (4,5-OAM are two of the rare enzymes that use assistance of two vitamins as cofactors. These enzymes employ radical generating capability of coenzyme B12 (5'-deoxyadenosylcobalamin, dAdoCbl and ability of pyridoxal-5'-phosphate (PLP, vitamin B6 to stabilize high-energy intermediates for performing challenging 1,2-amino rearrangements between adjacent carbons. A large-scale domain movement is required for interconversion between the catalytically inactive open form and the catalytically active closed form. In spite of all the similarities, these enzymes differ in substrate specificities. 4,5-OAM is highly specific for D-ornithine as a substrate while 5,6-LAM can accept D-lysine and L-β-lysine. This review focuses on recent computational, spectroscopic and structural studies of these enzymes and their implications on the related enzymes. Additionally, we also discuss the potential biosynthetic application of 5,6-LAM.

  20. Model of diffusion-assisted direct laser writing by means of nanopolymerization in the presence of radical quencher

    Directory of Open Access Journals (Sweden)

    Alexander Pikulin

    2015-12-01

    Full Text Available Diffusion-assisted direct laser writing (DA-DLW by multiphoton polymerization has been recently shown to be one of the most promising methods for the high-resolution 3D nanofabrication [I. Sakellari, et al., ACS Nano 6, 2302 (2012]. The improvement of the writing spatial resolution has been observed under certain conditions when the mobile radical quencher (polymerization inhibitor is added to the photosensitive composition. In this work, we present a theoretical study of this method, focusing on the resolution capabilities and optimal writing parameters. The laser beam absorption in the polymerizable composition causes the localized depletion of the quencher molecules. If the quencher depletion is balanced by its diffusion from the outside of the focal volume, the quasi-stationary non-equillibrium concentration spatial profile with zero minimum can be obtained. The polymer is then effectively formed only in the domain where the quencher is depleted. The spatially-distributed quencher, in this case, has the effect similar to that of the vortex beam in STimulated Emission Microscopy (STED.

  1. 腹腔镜辅助下阴式全子宫切除术的应用分析%Clinical analysis of laparoscopic assisted vaginal hysterectomy

    Institute of Scientific and Technical Information of China (English)

    关冰

    2012-01-01

    目的 探讨腹腔镜辅助下阴式全子宫切除术(LAVH)的疗效.方法 回顾性分析148例行经腹全子宫切除术(TAH)、69例阴式全子宫切除术(VH)、81 LAVH患者的临床资料,比较分析3组患者的手术时间、术中出血量、术后肛门排气时间、住院费用、住院时间及并发症发生情况.结果 LAVH的术中出血量为(122.0±40.2) mL,少于TAH(P<0.05);术后肛门排气时间和住院时间分别为(21.6±3.8)h、(5.5±1.9)d,短于TAH(P <0.05).LAVH的中转开腹率为0%,低于VH (P<0.05).结论 LAVH集合了TAH和VH的优点,是一种有效的子宫切除术,值得临床推广应用.%Objective To investigate the clinical effectiveness of laparoscopically assisted vaginal hysterectomy ( LAVH). Methods The clinical data of 148 cases of total abdominal hysterectomy (TAH) , 69 cases of vaginal hysterectomy (VH) , 81 cases of LAVH were analyzed retrospectively. The operation time, blood loss, postoperative anus exhaust recover)' time, medical costs, length of stay and incidence of complication were compared in this observation. Results The blood loss, postoperative anus exhaust recovery time, length of stay of LAVH were ( 122. 0 ±40. 2) mL, (21. 6 ±3. 8) h, (5. 5 ± 1. 9) d, and were lower than those of TAH (P < 0. 05). The rate of converted -to -laparoto-my of LAVH was 0% , and was lower than that of VH (P < 0. 05). Conclusions LAVH has the advantages of TAH and VH, is effective hysterectomy.

  2. 完全腹腔镜下上尿路尿路上皮癌根治术12例分析%12 cases of reports on totally laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma

    Institute of Scientific and Technical Information of China (English)

    陈志军; 李庆文; 汪盛; 张家俊; 杨小淮; 韩锋; 杨帅; 伍宏亮; 代昌远

    2015-01-01

    目的:探讨完全腹腔镜肾、输尿管全长切除+膀胱部分切除术治疗上尿路尿路上皮癌的疗效及临床价值。方法12例上尿路尿路上皮癌患者在我院接受完全腹腔镜下肾盂、输尿管癌根治术,肾盂癌8例,输尿管癌4例,其中2例输尿管癌突入膀胱内。术中采用70°健侧卧位,建立人工气腹,置5枚套管,首先在肾周筋膜外行患侧肾切除,再游离输尿管至膀胱,其中肾盂癌或输尿管癌未侵入膀胱病例切开部分逼尿肌,将输尿管开口及部分膀胱黏膜拉出膀胱壁外,Hem-o-lock夹毕切断;输尿管癌侵入膀胱病例术前膀胱内保留灌注100 mL稀释后的50 mg羟基喜树碱,切开膀胱前将灌注液自导尿管放出,沿输尿管膀胱入口处周围2 cm环形切除膀胱壁及输尿管开口处肿瘤,2-0可吸收线缝合膀胱。结果该组病例均成功完成手术,无中转开放手术。手术时间150~200 min,平均170 min;术中出血80~150 mL,平均95 mL;无严重围手术期并发症。术后住院时间6~9 d,平均7 d,术后病理均为尿路上皮癌。8例患者术后辅以4次GC方案全身化疗。术后随访2~30个月,1例术后7个月因膀胱内肿瘤复发行经尿道膀胱肿瘤电切术,其余患者未见肿瘤复发、转移。结论完全腹腔镜下上尿路尿路上皮癌根治术临床疗效满意,同时具有创伤小、不需要术中更换体位、术后恢复快等优点,值得临床推广应用。%Objective To explore the efficacy and clinical value of totally laparoscopic radical resection of the kidney and ureter and partial resection of the bladder in the treatment of upper urinary tract urothelial carcinoma. Methods A total of 12 patients underwent totally laparoscopic radical resection of the renal pelvis and ureter in our hospital, including eight cases of renal pelvis cancer and four cases of ureter cancer, in which two cases of ureteral cancer were immersed into the bladder. The patients were in the

  3. LAPAROSCOPIC MYOMECTOMY

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective. To investigate the indications, surgical techniques and complications of laparoscopic myomectomy. Materials and methods. A retrospective study was carried out in 74 patients with fibroids >3cm from March, 1995 until May,2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids( 20 cases) , mainly pain or urine frequency ; progressively increasing fibroid size (7 cases); coexistent adnexal pathology( 26 cases) and infertility( 21 cases) . Results. The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7% ).The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3~ 8 cm (mean 4.8 cm). In 19 cases (25.6% ),the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids≥ 4cm than those with fibroids <4cm. The difference was statistically significant (P< 0.05). Mean postoperative hospital stay was 3.2 days and overall complication rate was 1.4% . The average postoperative follow-up period was 22 months (1~ 62 months). All the patients with symptoms showed remission of their complaints at 2-month follow-up. Recurrence of fibroid occurred in 1 case 1 year after initial operation and second laparoscopic myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients. Conclusions. Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and

  4. Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE): technique and outcome

    Institute of Scientific and Technical Information of China (English)

    Jens-Uwe Stolzenburg; Odysseas Andrikopoulos; Panagiotis Kallidonis; Iason Kyriazis; Minh Do; Evangelos Liatsikos

    2012-01-01

    Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established and standardized technique for treating patients with localized prostate cancer.Nevertheless,the procedure is continuously being refined with the expansion of anatomical knowledge.The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure's established benefits in terms of potency,continence and oncological management.In this study,the technique and its evolution are presented in detail,along with an analysis of its clinical efficacy.We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy,and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.

  5. Laparoscopic Inguinal Hernia Repair

    Science.gov (United States)

    ... wall to weaken or separate. What are the Advantages of Laparoscopic Inguinal Hernia Repair? Laparoscopic Hernia Repair ... underlying medical conditions. What Preparation is Required? Keep reading... Page 1 of 2 1 2 » Brought to ...

  6. Surgeon perception is not a good predictor of peri-operative outcomes in robot-assisted radical prostatectomy.

    Science.gov (United States)

    Stern, Joshua; Sharma, Saurabh; Mendoza, Pierre; Walicki, Mary; Hastings, Rachel; Monahan, Kelly; Sheikh, Baber; Wedmid, Alexei; Lee, David I

    2011-12-01

    Surgeons have always used their cognitive intuition for the execution of skilled tasks and real-time perception of intra-operative outcomes. We attempted to measure the overall accuracy of intra-operative surgeon perception on the functional outcome of early continence after robot-assisted radical prostatectomy (RARP). A single experienced surgeon (D.I.L.) used a scoring sheet to prospectively capture his subjective opinion of how well a particular portion of the RARP procedure was completed. Surgeon perception of factors affecting post-operative continence such as quality of bladder neck preservation, nerve sparing, urethral length, anastomosis, striated sphincter thickness, quality of Rocco repair and bladder neck plication suture (total 7 variables) were graded as "poor", "average" or "good". Urinary continence was graded as either total continence [0 pads per day (PPD) or social continence (security pad or one PPD)]. A total of 273 (39 patients × 7 variables) responses were recorded: 58.6% were rated as "good", 32.2% as "average" and 8.4% as "poor". A log-rank test for all perception variables showed no significant differences in subsequent achievement of continence (either 0 or 1 PPD) (P > 0.05) at both the 1- and 3-month time points. In the case of some perception variables, patients with "bad" scores gained continence a median of 3 weeks sooner than patients with "good" scores. Surgeon perception of intra-operative performance during RARP is a poor predictive indicator of subsequent functional outcome in terms of urinary continence. Inter-surgeon variability of perception may vary and needs further investigation. PMID:27628118

  7. A novel method of bladder neck imbrication to improve early urinary continence following robotic-assisted radical prostatectomy.

    Science.gov (United States)

    Beattie, K; Symons, J; Chopra, S; Yuen, C; Savdie, R; Thanigasalam, R; Haynes, A M; Matthews, J; Brenner, P C; Rasiah, K; Sutherland, R L; Stricker, P D

    2013-06-01

    Early return of continence forms an important component of quality of life for patients after robotic-assisted radical prostatectomy (RALP). Here we describe the steps of bladder neck imbrication and vesico-urethral anastomosis improving early continence after RALP. Between April 2008 and July 2009, 202 consecutive patients underwent RALP for clinically localised prostate cancer in a tertiary referral centre by a single surgeon. One hundred and thirty-two (65 %) of these patients agreed to participate in the study. Prior to November 2008, 51 patients underwent standard RALP as described by Patel et al. From November 2008, 81 patients underwent a novel method of bladder neck imbrication. The robotic urethro-vesical anastomosis commences on the posterior wall of the urethra and proceeds anteriorly. In our technique the anastomosis is halted with the suture arms fixed to the anterior abdominal wall. A new suture is used to perform a two-layer repair, anchoring proximally then continuing anteriorly to the level of the urethral stump, where it returns upon itself. The aim is to narrow the urethra to 16 Fr and tighten the second layer to create an imbrication effect. Posterior reconstruction was performed in all patients. Outcome measures were recorded prospectively using the Expanded Prostate Cancer Index Composite tool. Our technique shows significant improvement at all stages of follow-up in urinary summary and incontinence scores. Absolute continence rates increased from 8.2 to 20.5 %, 26.7 to 44.3 %, and 47.7 to 62.3 % at 1.5, 3 and 6 months, respectively. These results support the use of our technique in patients undergoing RALP. PMID:27000912

  8. Robotic assisted radical prostatectomy in morbidly obese patients: how to create a cost-effective adequate optical trocar.

    Science.gov (United States)

    Cestari, Andrea; Sangalli, Mattia; Buffi, Nicolò Maria; Lazzeri, Massimo; Larcher, Alessandro; Scapaticci, Emanuele; Lughezzani, Giovanni; Fabbri, Fabio; Rigatti, Patrizio; Guazzoni, Giorgio

    2013-03-01

    Obesity is a major health issue in modern society, and with the progressive widespread employment of robotic assisted radical prostatectomy (RALP), the urologist-robotic surgeon is increasingly involved in the treatment of obese patients. However, the vast majority of urological departments are not equipped with a complete set of bariatric instruments. One of the potential difficulties of robotic surgery on the morbidly obese patient is the relatively short length of the optical trocar sheath, as the optical robotic arm requires some very valuable centimeters of the sheath to hang onto. This condition may make it impossible to properly reach the peritoneal cavity with the optical trocar during the RALP procedure. We present a series of four morbidly obese patients (BMI ranging from 42.1 to 46.2) with localized prostate cancer treated with RALP. We have developed an effective and "easy-to-implement" solution to the problem of properly elongating the sheath of the optical trocar which involves the use of the plastic cylindrical transparent protective tube of a disposable 26-Ch Amplatz sheath. The Amplatz sheath, with an internal diameter of 13 mm and length of 25 cm, perfectly fits outside of the 13-mm trocar usually employed for the optical trocar. Additionally, the cylindrical tube perfectly fits and hangs onto the robotic optical arm system. Mean operative time was 202.5 min (range 185-220 min). Mean blood loss was 284 mL (range 185-380 mL). Catheterization time and hospital stay were 5 and 6 days, respectively, in all patients. All procedures were safely completed, and no minor or major complications were reported. The optical trocar lengthening technique allowed us to properly perform RALP procedures even in severely morbidly obese patients in an urological setting not equipped for bariatric minimally invasive surgery. PMID:27000892

  9. Application of Transanal Anastomosis with Stapler in Laparoscopic Radical Resection for Rectal Cancer%经肛门拖出吻合器吻合法在腹腔镜直肠癌根治术中的应用

    Institute of Scientific and Technical Information of China (English)

    陈金水; 张少炎; 张罕松; 湛继久; 王铁虎; 胡旭辉; 蔡晓棠

    2014-01-01

    目的:探讨经肛门拖出吻合器吻合在腹腔镜直肠癌根治术中应用的可行性及临床疗效。方法2010年6月~2013年1月,采用腹腔镜辅助经肛门拖出吻合器吻合法治疗30例中低位直肠癌。22例≤T2期,8例T3期,均为N0,M0。电子结肠镜检查显示肿瘤下缘距肛缘的距离4.0~10.0 cm,(7.6±1.5) cm;肿瘤直径2~6 cm,(3.8±1.3) cm。先在腹腔镜下进行直肠全系膜切除,于耻骨联合上做下腹部正中辅助切口,直视下切断近端结肠,经肛门拖出切除直肠标本,应用双荷包、单吻合器技术,以国产管型消化道吻合器(31.5 mm或28.5 mm)行结-直肠端端吻合。结果30例手术均顺利完成。手术时间170~280 min,(216.3±25.9) min。术中出血量50~700 ml,(273.3±160.1) ml。术后肛门排气时间1~4 d,(2.5±0.8) d。术后住院时间8~30 d,(12.2±4.2) d。肠管远端切缘距肿瘤的距离2.0~6.0 cm,(3.9±0.9) cm。远近切缘均未见癌残留。术后发生吻合口漏1例(3.3%),腹腔积液并感染1例(3.3%),均经非手术治疗治愈,无腹腔内出血、肠梗阻、吻合口出血等并发症。随访6~24个月,(11.8±3.9)月,术后3个月大便次数1~5次/d;1例吻合口瘢痕收缩狭窄,排便困难,予以扩肛等处理后好转;1例术后16个月局部肿瘤复发,行腹-会阴联合直肠癌根治术( Miles手术)。结论经肛门拖出吻合器吻合联合腹腔镜手术治疗中低位直肠癌安全可行,值得推广应用。%Objective To investigate the feasibility and clinical effect of transanal anastomosis with stapler in laparoscopic radical resection for rectal cancer . Methods The clinical data of 30 patients undergoing transanal anastomosis with stapler during laparoscopic radical resection for middle-low rectal cancer from June 2010 to January 2013 in our

  10. 非离断式Roux-en-Y吻合在腹腔镜远端胃癌根治性切除术中的应用%Application of uncut Roux-en-Y anastomosis in laparoscopic distal radical gastrectomy of gastric cancer

    Institute of Scientific and Technical Information of China (English)

    黄玉琴; 王森; 汤东; 蒋学通; 王杰; 王道荣

    2016-01-01

    Objective To investigate the application and clinical effect of uncut Roux-en-Y (uncut RY) anastomosis in laparoscopic distal radical gastrectomy of gastric cancer.Methods The retrospective crosssectional study was adopted.The clinical data of 23 patients with gastric cancer who were admitted to the Northern Jiangsu People's Hospital from December 2014 to July 2015 were collected.All the 23 patients underwent laparoscopy-assisted distal gastrectomy (LADG) and total laparoscopic distal gastrectomy (TLDG) according to the individual situations.The indexes of observation were collected,including (1) intraoperative indexes:operation time,uncut RY anastomosis time and volume of inraoperative blood loss,(2) postoperative indexes:time to anal exsufflation,time for initial water intake,time for semi-fluid diet intake,time for out-off-bed activity,duration of hospital stay,occurrence of complications and results of pathological examination,(3) results of follow-up.The follow-up was performed by outpatient examination and telephone interview up to November 2015,including postoperative discomfort after diet intake,barium meal examination of gastrointestinal tract at postoperative month 1 (anas-tomotic stenosis,recanalization and dehiscence of occlusion),detecting situations of gastric remnant and anas-tomotic stoma at postoperative month 3 by gastroscopy and occurrence of gastrointestinal obstruction.Measurement data with normal distribution were presented as x ± s.Results (1) Intraoperative situations:all the 23 patients underwent successful uncut RY anastomosis,including 18 receiving LADG and 5 receiving TLDG.The operation time,uncut RY anastomosis time and volume of intraoperative blood loss were (165.9 ± 11.6) minutes,(18.2 ± 2.2) minutes,(48 ± 6) mL in all the 23 patients and (172.0 ± 8.5) minutes,(26.6 ± 1.5) minutes,(46 ± 4) mL in 5 patients with TLDG,respectively.Two patients received hemostatic treatment using suture and hemostatic forceps due to anastomotic

  11. Transvaginal Route for Kidney Extraction in Laparoscopic Donor Nephrectomy

    OpenAIRE

    Gurluler, Ercument; Berber, Ibrahim; Cakir, Ulkem; Gurkan, Alihan

    2014-01-01

    Background and Objectives: The aim of this retrospective study was to compare conventional laparoscopic living-donor nephrectomy with transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy in terms of feasibility and reproducibility. Methods: A total of 115 consecutive female patients who underwent laparoscopic living-donor nephrectomy (n = 70) or transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy (n = 45) wer...

  12. Role of laparoscopic surgery in treatment of infertility

    Directory of Open Access Journals (Sweden)

    Ivanka Šijanović

    2012-02-01

    Full Text Available The role of laparoscopy in assisted reproduction is disputed by many. A rising problem of infertility is battled by an increasingnumber of centres for reproductive medicine in the region. Nevertheless,there is a large number of indications and conditionswhere laparoscopic surgery should not be avoided as a therapeuticchoice or an aid in assisted reproductive techniques (ART.The number of centres where laparoscopic surgery is performed is significantly higher than the number of reproductive centres; anumber of gynaecologists educated in laparoscopic gynaecologyis growing, making it more available for patients.

  13. 筋膜内切除法在腹腔镜下前列腺癌根治性切除术中的应用%The application of intrafascial laparoscopic extraperitoneal radical prostatectomy in prostate cancer patients

    Institute of Scientific and Technical Information of China (English)

    干思舜; 徐丹枫; 高轶; 崔心刚; 王军凯

    2012-01-01

    To discuss the application of intrafascial laparoscopic extraperitoneal radical prostatectomy in prostate cancer patients. Method:The operation was performed in 19 prostate cancer patients from 2009. 09 - 2010. 11 in our hospital. The age was 51-72(61. 0 ± 9. 2)years old. Preoperative prostate specific antigen(PSA) level was 4. 1-13.2(8.6 ± 4. l)μg/L, T, clinical stage in 12 patients, T2 clinical stage in 7 patients,and patients distribution as Gleason Score 5 in 2 cases, Gleason Score 6 in 10 cases and Gleason Score 7 in 7 cases. Sixteen patients had preoperativepotency. The technique was to keep the endopelvic fascia intact. The prostatic fascia was incised at 1 and 11 o'clock points. And the dissection plane was directly on the prostatic capsule. The bilateral and apex prostate fascia were stripped though this plane without injure the neurovascular bundle and external sphincter. Result: The oprative time was 55-115(85. 0 ± 28. 6) min. Hemorrhage was 30-200(120. 0 ± 56. 4) ml. No transfusion. Catheterization time was 8-14(11. 0 ± 2. 8) d. All the 19 patients were followed up for 12 months. 89. 5% of patients were continent(no need for pads), 10. 5% had minimal stressincontinence (1-2 pads). 87. 5% of 16 cases who had potency preoperative kept erections sufficient forintercourse. During the follow up period, 1 (5. 3%) had biochemical recurrence. Conclusion:The neurovascular bundles and the external sphincter are less injured by intrafascial laparoscopic extraperitoneal radical prostatectomy. Urinary incontinence and erectile dysfunction were low. The operation should be promoted.%目的:探讨筋膜内切除法在腹腔镜下前列腺癌根治性切除术中的应用.方法:自2009年9月~2010年11月采用筋膜内切除法在腹腔镜下行前列腺癌根治性切除术治疗前列腺癌患者19例,年龄51~72岁,平均(61.0±9.2)岁.术前血PSA为4.1~13.2 μg/L,平均(8.6±4.1)μg/L.临床分期T112例,T27例;活检组织Gleason评分:5分2例,6

  14. Analysis of a Standardized Technique for Laparoscopic Cuff Closure following 1924 Total Laparoscopic Hysterectomies.

    Science.gov (United States)

    O'Hanlan, Katherine A; Emeney, Pamela L; Peters, Alfred; Sten, Margaret S; McCutcheon, Stacey P; Struck, Danielle M; Hoang, Joseph K

    2016-01-01

    Objective. To review the vaginal cuff complications from a large series of total laparoscopic hysterectomies in which the laparoscopic culdotomy closure was highly standardized. Methods. Retrospective cohort study (Canadian Task Force Classification II-3) of consecutive total and radical laparoscopic hysterectomy patients with all culdotomy closures performed laparoscopically was conducted using three guidelines: placement of all sutures 5 mm deep from the vaginal edge with a 5 mm interval, incorporation of the uterosacral ligaments with the pubocervical fascia at each angle, and, whenever possible, suturing the bladder peritoneum over the vaginal cuff edge utilizing two suture types of comparable tensile strength. Four outcomes are reviewed: dehiscence, bleeding, infection, and adhesions. Results. Of 1924 patients undergoing total laparoscopic hysterectomy, 44 patients (2.29%) experienced a vaginal cuff complication, with 19 (0.99%) requiring reoperation. Five patients (0.26%) had dehiscence after sexual penetration on days 30-83, with 3 requiring reoperation. Thirteen patients (0.68%) developed bleeding, with 9 (0.47%) requiring reoperation. Twenty-three (1.20%) patients developed infections, with 4 (0.21%) requiring reoperation. Three patients (0.16%) developed obstructive small bowel adhesions to the cuff requiring laparoscopic lysis. Conclusion. A running 5 mm deep × 5 mm apart culdotomy closure that incorporates the uterosacral ligaments with the pubocervical fascia, with reperitonealization when possible, appears to be associated with few postoperative vaginal cuff complications. PMID:27579179

  15. Comparison of incidence of shunt system failure between neuroendoscope-laparoscope assisted and non-endoscope-assisted ventricular-peritoneal shunt for hydrocephalus%神经内镜加腹腔镜辅助与常规的脑室腹腔分流术后分流系统失效率比较

    Institute of Scientific and Technical Information of China (English)

    林发牧; 许小兵

    2014-01-01

    Objective To compare the incidence of shunt system failure between neuroendoscope-laparoscope assisted and non-endoscope-assisted ventricular-peritoneal shunt (VPS) for hydrocephalus.Methods A retrospective analysis was performed in the incidence of shunt system failure of 141 hydrocephalus patients accepted neuroendoscope-laparoscope assisted VPS,admitted to our hospital from January 2007 to August 2012,and 167 hydrocephalus patients with non-endoscope assisted VPS,admitted to our hospital from January 2001 to December 2006.All these patients were followed up for 1 to 72 months and the incidence rate of shunt system failure was compared between the two groups.Results Five patients failed in follow-up in patients accepted neuroendoscope-laparoscope assisted VPS; the incidence rate of shunt system failure in neuroendoscope-laparoscope assisted VPS was 5.1%,including 3 in ventricular end blockage and 4 in intraperitoneal end blockage; shunt valve was not noted.Twelve patients failed in follow-up in patients accepted neuroendoscope-laparoscope assisted VPS; the incidence rate of shunt system failure in neuroendoscope-laparoscope assisted VPS was 30.3%,including 31 in ventricular end blockage and 15 in intraperitoneal end blockage; shunt valve was noted in one patient.The incidence rate of shunt system failure in neuroendoscope-laparoscope assisted VPS was significantly lower than that in non-endoscope assisted group (x2=30.379,P=0.000).Conclusion In contrast to the non-endoscope assisted VPS surgery,the incidence of shunt system failure has been reduced significantly by neuroendoscope plus laparoscope assisted VPS surgery.%目的 探讨神经内镜加腹腔镜综合辅助脑室腹腔分流术在降低术后分流系统失效率中的应用价值. 方法 对佛山市顺德区第一人民医院神经外科自2007年1月至2012年8月进行的141例神经内镜加腹腔镜综合辅助脑室腹腔分流术(内镜辅助组)以及自2001年1月至2006年12

  16. Single incision laparoscopic colorectal resection: Our experience

    Directory of Open Access Journals (Sweden)

    Chinnusamy Palanivelu

    2012-01-01

    Full Text Available Background: A prospective case series of single incision multiport laparoscopic colorectal resections for malignancy using conventional laparoscopic trocars and instruments is described. Materials and Methods: Eleven patients (seven men and four women with colonic or rectal pathology underwent single incision multiport laparoscopic colectomy/rectal resection from July till December 2010. Four trocars were placed in a single transumblical incision. The bowel was mobilized laparoscopically and vessels controlled intracorporeally with either intra or extracorporeal anastomosis. Results: Three patients had carcinoma in the caecum, one in the hepatic flexure, two in the rectosigmoid, one in the descending colon, two in the rectum and two had ulcerative pancolitis (one with high grade dysplasia and another with carcinoma rectum. There was no conversion to standard multiport laparoscopy or open surgery. The median age was 52 years (range 24-78 years. The average operating time was 130 min (range 90-210 min. The average incision length was 3.2 cm (2.5-4.0 cm. There were no postoperative complications. The average length of stay was 4.5 days (range 3-8 days. Histopathology showed adequate proximal and distal resection margins with an average lymph node yield of 25 nodes (range 16-30 nodes. Conclusion: Single incision multiport laparoscopic colorectal surgery for malignancy is feasible without extra cost or specialized ports/instrumentation. It does not compromise the oncological radicality of resection. Short-term results are encouraging. Long-term results are awaited.

  17. Biochemical outcomes after robot-assisted radical prostatectomy in patients with follow-up more than5-years

    Institute of Scientific and Technical Information of China (English)

    Kwang Hyun Kim; Sey Kiat Lim; Tae-Young Shin; Byung Ha Chung; Sung Joon Hong; Koon Ho Rha

    2013-01-01

    In this study,we assessed biochemical outcomes after robot-assisted radical prostatectomy (RARP).Between July 2005 and November 2007,one hundred and seventy-six consecutive patients treated by RARP without neoadjuvant treatment were included in this study.All procedures were performed by a single surgeon and the median follow-up period was 60 months (interquartile range (IQR):59-69).The median prostate specific antigen was 7.50 ng ml-1 (IQR:5.14-11.45) and 39.2% of the patients were classified as intermediate risk and 15.3% were classified as high risk; on final pathological examination,35.2% of the patients had non-organ confined disease and 37.5%and 14.2% had Gleason scores of 7 and 8-10,respectively.The biochemical recurrence (BCR)-free survival rates at 3 and 5 years were 85.6% and 81.2%,respectively.The 5-year BCR-free survival rates stratified by pathologic Gleason scores were 93.1% in Gleason scores of 6 or less,74.5% in a Gleason score of 7,and 58.1% in Gleason scores of 8 or greater,respectively (P<0.001).When stratified by pathologic stage,the BCR-free survival rates were 89.8% in pT2 patients,66.2% in pT3a patients,and 39.3% in pT3b patients at 5 years following RARP,respectively (P<0.001).Preoperative prostate-specific antigen (PSA),pathologic stage,postoperative Gleason score and surgical margin status were independently associated with BCR in multivariate analysis.In this study,we report biochemical outcomes after RARP with the longest follow-up periods to date in Asian men.We found that robotic surgery provided satisfactory biochemical outcomes,and that RARP is a safe and effective procedure in terms of oncologic outcomes.

  18. 全机器人辅助低温灌注下肾部分切除术的护理配合%Nursing cooperation of cold intravascular perfusion during Robot-assisted laparoscopic partial nephrectomy

    Institute of Scientific and Technical Information of China (English)

    王涛; 李丽霞; 董薪; 蔡康灵

    2014-01-01

    目的:探讨全机器人辅助低温灌注下肾部分切除术下的护理配合流程,提高护士的手术配合质量。方法通过配合10例全机器人辅助低温灌注下肾部分切除手术,对术前物品准备、手术间布局,术中体位摆放及手术精准配合进行总结。结果10例手术顺利完成,无中转开腹,手术配合满意。结论准备好特殊手术物品,熟练的手术操作步骤,与手术医生积极沟通,掌握机器人各系统的使用情况是确保手术成功的关键。%Objective To explore the nursing cooperation during cold intravascular perfusion during robot-assisted laparoscopic partial nephrectomy. Methods Ten patients with renal cancer underwent robot-assisted laparoscopic partial nephrectomy using renal arterial perfusion with cold,the experience including preoperative preparation,intraoperative positioning and cooperation, and perioperative management of devices were drawn. Results All operative procedures were successfully performed. Conclusion Preoperative preparation,intraoperative communication and the skillful use of robotˊs system play critical roles on the success of the procedure.

  19. 氟比洛芬酯超前镇痛对腹腔镜下直肠癌根治术患者术后镇痛的影响%Effect of analges ic of flurbiprofen axetil pre-emptive analgesia in laparocsopic assisted radical resection for rectal cancer

    Institute of Scientific and Technical Information of China (English)

    李秋宏; 刘志群; 吴论; 彭学强

    2015-01-01

    Objective To study effect of analgesic of flurbiprofen axetil pre-emptive analgesia in laparoscopic assisted radical resection for rectal cancer .Methods Sixty patients undergoing laparoscopic radical resection for rectal cancer were divided into two groups ( n=30 each) .The observation group before anesthesia induction received an injection flurbiprofen axetil 100 mg and the con-trol group was given postoperatively injection flurbiprofen axetil 100 mg.VAS score,BCS scores,inflammatory cytokine levels and ad-verse reaction between the two groups were observed and compared .Rseult VAS score,IL-2,IL-6,TNF alpha level of the observation group at postoperative 4th and 8th h were lower than that of the control group ( P 0.05).Conclusion Flurbiprofen axetil pre-emptive analgesia can obviously improve analgesia effect of laparoscopic assisted radical resection for rectal cancer and improve degree of comfort and reduce inflammatory reaction of the patients .%目的:探讨氟比洛芬酯超前镇痛对腹腔镜下直肠癌根治术患者术后镇痛效果的影响。方法将60例拟行腹腔镜下直肠癌根治术患者随机分为两组,各30例。观察组麻醉诱导前给予氟比洛芬酯100 mg,静脉注射;对照组术后给予氟比洛芬酯100 mg,静脉注射。观察两组患者术后不同时间段疼痛视觉模拟评分( VAS)、舒适度评分( BCS)及术后炎症细胞因子水平变化和不良反应情况。结果观察组术后4 h、8 h时VAS评分均低于对照组( P <0.01);观察组术后2 h、4 h、8 h时BCS评分均高于对照组( P <0.01);观察组术后白细胞介素-2( IL-2)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)水平均低于对照组( P <0.01);两组术后不良反应发生率差异无统计学意义( P >0.05)。结论氟比洛芬酯超前镇痛对腹腔镜下直肠癌根治术患者术后镇痛效果显著,可提高患者舒适度,减轻术后炎性反应。

  20. Pure Laparoscopic Augmentation Ileocystoplasty

    Directory of Open Access Journals (Sweden)

    Rafael B. Rebouças

    2014-12-01

    or worsening of renal function. We did not experience any complication related to the intestinal anastomosis fully prepared intracorporeally. Conclusions Albeit technically challenging, pure laparoscopic enterocystoplasty was feasible and safe. Preparing the enteral anastomosis and the pouch intracoporeally may prolong surgical time and contribute to postoperative ileus. Surgical staplers can assist in the procedure, however they are not essential.

  1. 腹腔镜下与开放式根治性膀胱切除术临床疗效及安全性的荟萃分析%Laparoscopic radical cystectomy versus open radical cystectomy for the treatment of muscle invasive bladder cancer:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    曾庆松; 肖亚军

    2015-01-01

    目的:荟萃分析腹腔镜下根治性膀胱切除术( laparoscopic radical cystectomy ,LRC)及开放式根治性膀胱切除术(open radical cystectomy,ORC)治疗肌层浸润性膀胱肿瘤的疗效及安全性。方法计算机检索Cochrane Library、PubMed、EMbase、SCI、Ovid、中国生物医学文献数据库、万方、维普和中国知网数据库,收集LRC与ORC治疗肌层浸润性膀胱癌的随机或非随机同期对照试验,检索时限截至2013年5月。由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.2.6软件进行荟萃分析。结果纳入13个非随机对照试验,共783例患者。 Meta分析结果显示:LRC较ORC术中出血量少[MD=-466.85,95%CI(-603.33,-330.37), P<0.001)],输血率低[OR =0.27,95%CI(0.18,0.41),P <0.001],术后住院时间短[MD =-3.46,95%CI (-5.98,-0.94), P=0.007],术后恢复进食时间早[MD=-1.16,95%CI(-1.41,-0.90),P<0.001],术后轻微并发症少[OR=0.52,95%CI(0.30,0.89),P=0.020],手术切缘的阳性率低[OR=0.25,95%CI(0.10,0.58), P=0.001],淋巴结阳性率低[OR=0.61,95%CI(0.40,0.92),P=0.020],但手术时间比开放手术长[MD=52.44,95%CI(36.67,68.21),P<0.001]。腹腔镜手术与开放手术在淋巴结清扫数目、肿瘤局部复发及远处转移方面比较差异无统计学意义( P>0.05)。结论在严格掌握LRC治疗肌层浸润性膀胱癌适应证的前提下,采用LRC治疗肌层浸润性膀胱癌是安全可行的。由于纳入研究数量和质量存在局限性,仍需大样本、高质量的临床对照研究进一步验证。%Objective To systematically evaluate the effectiveness and safety of laparoscopic radical cystectomy (LRC) versus open radical cystectomy (ORC).Methods The

  2. 早期康复训炼治疗腹腔镜前列腺癌根治术后尿失禁的疗效观察%Efficacy of Early Rehabilitation Workout Laparoscopic Treatment of Urinary Incontinence after Radical Prostatectomy

    Institute of Scientific and Technical Information of China (English)

    陈涵凯; 王明

    2014-01-01

    目的:探讨术后早期康复训练对经腹腔镜前列腺癌根治术后尿失禁的影响。方法将41例经腹腔镜前列腺癌根治术后尿失禁的患者随即分为常规护理组(对照组)和综合护理组(观察组),观察组在常规护理基础上进行盆底肌功能训练、膀胱肌训练治疗,比较两组在拔除导尿管后1个月、3个月、6个月尿失禁改善情况。结果观察组拔除尿管后1个月、3个月、6个月尿失禁改善情况均优于对照组。结论对腹腔镜下前列腺癌根治术后尿失禁的患者进行早期系统的康复训练,可改善患者尿失禁状况,使患者早日恢复控尿功能。%Objective:To investigate the occurrence of urinary incontinence after laparoscopic radical prostatectomy, and evaluate the ef ect of early rehabilitation on urinary incontinence. Method:41 patients with urinary incontinence after laparoscopic radical prostaectomy were divided randomly into control group and observation group.On the basis of conventional nursing,the patients in the observation group received a series of nursing intervention measures,including pelvic muscles training and bladder function training. The recovery condition of urinary incontinence in the two groups was observed in 1 month,3 months and 6 months after the removal of the catheters. Results: Urinary incontinence after the early rehabilitation was significantly lower than before training. Patients with urinary incontinence in the observation group had a bet er improvement than the control group. Conclusion: For the patients with urinary incontinence after laparoscopic radical prostatectomy,early systematic rehabilitation training can significantly improve the urinary incontinence status.

  3. Laparoscopic repair of high rectovaginal fistula: Is it technically feasible?

    Directory of Open Access Journals (Sweden)

    Parthasarathi Ramakrishnan

    2005-10-01

    Full Text Available Abstract Background Rectovaginal fistula (RVF is an epithelium-lined communication between the rectum and vagina. Most RVFs are acquired, the most common cause being obstetric trauma. Most of the high RVFs are repaired by conventional open surgery. Laparoscopic repair of RVF is rare and so far only one report is available in the literature. Methods We present a case of high RVF repaired by laparoscopy. 56-year-old female who had a high RVF following laparoscopic assisted vaginal hysterectomy was successfully operated laparoscopically. Here we describe the operative technique and briefly review the literature. Results The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found. Conclusion Laparoscopic repair of high RVF is feasible in selected patients but would require proper identification of tissue planes and good laparoscopic suturing technique.

  4. 腹腔镜保留盆腔自主神经的直肠癌根治术技术要领%Techniques of autonomic nerve preservation in laparoscopic radical resection for rectal cancer

    Institute of Scientific and Technical Information of China (English)

    卫洪波; 郑宗珩

    2015-01-01

    Pelvic autonomic nerve is a three-dimensional structure surrounding the rectum. There are several key points related to nerve injury during laparoscopic radical resection for rectal cancer. Hypogastric nerve has close relation with the upper and middle part of the rectum. Combined with S2-S4 pelvic splanchnic nerve, hypogastric nerve forms pelvic plexus. Incorrect operation in pelvic parietal peritoneum during dissection of upper rectum will lead to nerve injury. When performing dissection of inferior mesenteric artery, bilateral nerve tracts should be pushed to posterior abdominal wall and anterior fascia of the abdominal aorta should be well protected to avoid nerve injury. Pelvic plexus fibers located lateral to the rectum of pelvic floor, as well as neurovascular bundle closed to Denonvillier′s fascia, also have close relations with nerve injury. Dissection of either lateral or anterior wall of rectum should be performed behind the Denonvillier′s fascia and in front of the proper fascia of rectum. Sharp dissection should be performed closed to the mesorectum to protect branches of pelvic plexus.%盆腔自主神经丛是一个立体的结构,包裹于直肠周围。在腹腔镜直肠癌手术中,有多个容易造成神经损伤的关键点。腹下神经与直肠中上段关系密切,来自骶2至骶4的盆内脏神经与腹下神经共同组成盆腔神经丛;游离直肠上段时,如错误进入盆筋膜壁层之后,则可能会将神经层掀起,造成神经损伤或离断。游离肠系膜下动脉时,应将动脉双侧可见的神经束尽量推向后腹壁,注意避免切开腹主动脉前筋膜,以免损伤神经。盆底深部直肠侧方的盆腔神经丛纤维和靠近Denonvilliers筋膜的血管神经束这两个部位也是容易受损伤的关键点,在游离直肠侧壁及前壁时,可在Denonvilliers筋膜后方、直肠固有筋膜前方进行,紧贴直肠系膜锐性离断,保护由盆腔神经丛发出的支配其他器官的分支。

  5. Living donor renal transplantation : Hand-assisted laparoscopic donor nephrectomy is superior to laparoscopic donor nephrectomy%活体供肾移植:手助腹腔镜供肾切除优于常规腹腔镜供肾切除

    Institute of Scientific and Technical Information of China (English)

    MichelGagner; PaoloGentileschi; JohndeCsepel; SubhashKini; DanielH

    2003-01-01

    目的比较活体供肾移植中手助腹腔镜供肾切除(Hand-assisted laparoscopic donor nephrectomy,HALDN)和完全腹腔镜活体供肾切除(Laparoscopic donor nephrectomy,LDN)以及对供肾者和接受肾移植者的影响. 方法回顾总结1996年10月~2001年2月Mount Sinai医学中心所有LDN和HALDN的病例资料.1996年10月开始行LDN手术,1999年6月转而行HALDN手术. 结果与LDN组相比,HALDN组手术时间明显缩短((211±7)min vs (257±5)min, P<0.05),术中出血量明显减少((122±17)ml vs (286±33)ml, P<0.05),肾脏热缺血时间明显缩短((106±6)s vs (257±8)s,P<0.05),术后淋巴漏和血栓形成发生率(0%vs 13.7%(16例);2.5%(2例)vs 6.8%(8例),P<0.05)明显下降. 结论在活体供肾移植中,HALDN似乎优于LDN,但尚需要前瞻性对照研究予以进一步证实.

  6. Analysis of the clinical effect of 42 cases of laparoscopy-assisted radical gastrectomy%腹腔镜辅助胃癌根治术42例临床效果分析

    Institute of Scientific and Technical Information of China (English)

    黎堃

    2014-01-01

    目的:分析腹腔镜辅助胃癌根治术的临床效果及可行性。方法:收集2010年1月-2012年3月在我院手术的82例胃癌患者资料,分为治疗组42例和对照组40例,其中治疗组患者接受腹腔镜手术、对照组患者接受开腹手术,比较两组患者的治疗效果。结果:治疗组患者的术中出血量、肠道功能恢复时间和住院时间均显著少于对照组(P均<0.05),而淋巴结清扫数和后期并发症则与对照组无显著差异。两组患者均无术中死亡病例。随访54个月,治疗组患者死亡4例、带瘤生存6例,对照组患者死亡5例、带瘤生存4例,也都无显著差异。结论:与开腹手术相比,腹腔镜辅助胃癌根治术的临床效果相似,但具有创伤较少、并发症较少、安全等优点,患者痊愈速度更快,可明显提高患者的生存质量以及预后,值得临床推广。%To further study the clinical effects and the feasibility of laparoscopy-assisted radical gastrectomy. Methods:The data on 82 cases of patients with gastric cancer, who received surgical operation from January 2010 to March 2012 in our hospital, were selected and divided into a treatment group with 42 cases and a control group with 40 cases. The patients received a laparoscopic surgery in the treatment group or laparotomy in the control group. The clinical effects were compare between two groups. Results:The intraoperative blood loss, the times for the intestinal function recovery and the hospital stay were signiifcantly less in the treatment group than in the control group (P<0.05) while the number of lymph node cleaning and late complications had no signiifcant difference between two groups. There was no intraoperative death case in two groups. There were 4 cases of death, 6 cases of survival with tumor in the treatment group while 5 and 4 in the control group during 54 months follow-up, which was also no signiifcant difference. Conclusion

  7. 经阴道NOTES辅助腹腔镜肾切除术猪动物模型的构建%Transvaginal NOTES-assisted laparoscopic nephrectomy in a porcine model

    Institute of Scientific and Technical Information of China (English)

    张国玺; 邹晓峰; 张旭; 马鑫; 徐辉; 朱刚; 林天歆; 牛远杰; 单戈

    2012-01-01

    Objective; To introduce our experience in transvaginal NOTES-assisted laparoscopic nephrectomy in a porcine model and access its value. Method:Six female pigs underwent transvaginal NOTES-assisted laparoscopic nephrectomy (3 right, 3 left). A 5 and 10 mm trocar were placed at the right and left margin of umbilicus. The vaginal mucosa in the posterior vaginal fornix was opened by a chiastic 0. 5 cm incision, and a 5 mm trocar was inserted into the abdominal cavity under the direct vision from a 5 mm flexible-tip 0° laparoscope inserted through the 5 mm trocar at the margin of umbilicus. Dissection was performed using operating apparatus placed in the abdominal trocars, under direct vision a-chieved by the 5 mm flexible-tip 0° laparoscope placed through the vaginal trocar. The renal artery, vein, and ureter were blocked by Hem-o-lock and titanium clips. The specimen was placed inside a homemade bag and removed via the incision of posterior vaginal fornix under direct vision with an optic in the abdominal trocar. The vaginal wound was closed using a running 2-0 absorbable suture. Result: A total of 6 transvaginal NOTES-assisted laparoscopic nephrectomies were successfully performed in this series. The median operative time was 100(range 70 to 150)min. The median estimated blood loss was 30(range 20 to 40) ml. On necropsy, no intraabdominal injuries were noted. Condnsion:Transvaginal NOTES-assisted laparoscopic riephrectomy in a porcine model appears to be feasible, which is suitable to NOTES training for beginners and the development of special instruments.%目的:介绍构建经阴道NOTES辅助腹腔镜肾切除术猪动物模型的经验和体会,并评价其应用价值.方法:本组选择6头健康雌性小型猪,中位重量46(42~48)kg.全麻,取70°侧卧位,双后肢外展.于脐两侧缘分别置入-5mm和10 mm trocar.自阴道后穹窿置入-5 mm trocar.自阴道trocar置入腹腔镜,脐缘两trocar置入操作器械.用电凝钩和吸引器锐性和钝

  8. Single incision laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    Arun; Prasad

    2010-01-01

    As a complement to standard laparoscopic surgery and a safe alternative to natural orifice transluminal endoscopic surgery,single incision laparoscopic surgery is gaining popularity.There are expensive ports,disposable hand instruments and flexible endoscopes that have been suggested to do this surgery and would increase the cost of operation.For a simple surgery like laparoscopic cholecystectomy,these extras are not needed and the surgery can be performed using standard ports,instruments and telescopes.Tri...

  9. Pilot study on laparoscopic surgery in Port-Harcourt, Nigeria

    Directory of Open Access Journals (Sweden)

    E Ray-Offor

    2014-01-01

    Full Text Available Background: Video-laparoscopic surgery has long been practiced in western countries; however documented practice of this minimal access surgical technique are recently emanating from Nigeria. To the best of our knowledge, this is the first documented study on laparoscopic surgery from the Niger Delta region. Aim: To evaluate the feasibility of laparoscopy as a useful tool for management of common surgical abdominal conditions in our environment. Patients and Methods: This was a prospective outcome study of all consecutive surgical patients who had laparoscopic procedures in general and pediatric surgery units of our institution from August 2011 to December 2012. Data on patient′s age, gender, indication for surgery, duration of hospital stay and outcome of surgery were collected and analyzed. Results: A total of 15 laparoscopic procedures were performed during this study period with age range of 2-65 years; mean: 32.27 ± 17.86 years. There were 11 males and four females. Six laparoscopic appendicectomies, one laparoscopy-assisted orchidopexy, five diagnostic laparoscopy ± biopsy, one laparoscopic trans-abdominal pre-peritoneal herniorrhaphy for bilateral indirect inguinal hernia and two laparoscopic adhesiolysis for small bowel obstruction were performed. All were successfully completed except one conversion (6.7% for uncontrollable bleeding in an intra-abdominal tumor. Conclusion: The practice of laparoscopic surgery in our environment is feasible and safe despite the numerous, but surmountable challenges. There is the need for adequate training of the support staff and a dedicated theatre suite.

  10. A non-acid-assisted and non-hydroxyl-radical-related catalytic ozonation with ceria supported copper oxide in efficient oxalate degradation in water

    KAUST Repository

    Zhang, Tao

    2012-06-01

    Oxalate is usually used as a refractory model compound that cannot be effectively removed by ozone and hydroxyl radical oxidation in water. In this study, we found that ceria supported CuO significantly improved oxalate degradation in reaction with ozone. The optimum CuO loading amount was 12%. The molar ratio of oxalate removed/ozone consumption reached 0.84. The catalytic ozonation was most effective in a neutral pH range (6.7-7.9) and became ineffective when the water solution was acidic or alkaline. Moreover, bicarbonate, a ubiquitous hydroxyl radical scavenger in natural waters, significantly improved the catalytic degradation of oxalate. Therefore, the degradation relies on neither hydroxyl radical oxidation nor acid assistance, two pathways usually proposed for catalytic ozonation. These special characters of the catalyst make it suitable to be potentially used for practical degradation of refractory hydrophilic organic matter and compounds in water and wastewater. With in situ characterization, the new surface Cu(II) formed from ozone oxidation of the trace Cu(I) of the catalyst was found to be an active site in coordination with oxalate forming multi-dentate surface complex. It is proposed that the complex can be further oxidized by molecular ozone and then decomposes through intra-molecular electron transfer. The ceria support enhanced the activity of the surface Cu(I)/Cu(II) in this process. © 2012 Elsevier B.V.

  11. Simultaneous laparoscopic nephroureterectomy and cystectomy: a preliminary report

    Directory of Open Access Journals (Sweden)

    Rodrigo Barros

    2008-08-01

    Full Text Available PURPOSE: Patients with muscle-invasive bladder cancer and concomitant upper urinary tract tumors may be candidates for simultaneous cystectomy and nephroureterectomy. Other clinical conditions such as dialysis-dependent end-stage renal disease and non-functioning kidney are also indications for simultaneous removal of the bladder and kidney. In the present study, we report our laparoscopic experience with simultaneous laparoscopic radical cystectomy (LRC and nephroureterectomy. MATERIALS AND METHODS: Between August 2000 and June 2007, 8 patients underwent simultaneous laparoscopic radical nephroureterectomy (LNU (unilateral-6, bilateral-2 and radical cystectomy at our institution. Demographic data, pathologic features, surgical technique and outcomes were retrospectively analyzed. RESULTS: The laparoscopic approach was technically successful in all 8 cases (7 males and 1 female without the need for open conversion. Median total operative time, including LNU, LRC, pelvic lymphadenectomy and urinary diversion, was 9 hours (range 8-12. Median estimated blood loss and hospital stay were 755 mL (range 300-2000 and 7.5 days (range 4-90, respectively. There were no intraoperative complications but only 1 major and 2 minor postoperative complications. The overall and cancer specific survival rates were 37.5% and 87.5% respectively at a median follow-up of 9 months (range 1-45. CONCLUSIONS: Laparoscopic nephroureterectomy with concomitant cystectomy is technically feasible. Greater number of patients with a longer follow-up is required to confirm our results.

  12. 达芬奇机器人手术系统在结直肠癌根治术的应用进展%Updates of Da Vinci robot assisted surgical system in radical resection of colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    李太原; 江群广

    2016-01-01

    手术微创化一直是外科医师追求的目标之一.达芬奇机器人手术系统以其3D高清影像、灵活的高自由度机械臂、动作校正及颤抖过滤等腹腔镜所不具备的优势在结直肠手术中得到广泛应用.然而目前达芬奇机器人手术系统与传统腹腔镜手术比较的优势与不足,仍是目前争议和研究的焦点.笔者将全面阐述达芬奇机器人手术系统在结直肠癌手术的应用进展.%Minimally invasive has surgery become the target of the surgeons,Da Vinci robot assisted surgical system has been used generally for colorectal cancer,with the advantages of three-dimensional high-definition imaging,flexible and high degree of freedom robotic arms,functions of action correction and shake filtration compared with laparoscopic surgery.However,advantages and disadvantages between Da Vinci robot assisted surgical system and traditional laparoscopic surgery are still controversial.In this paper,the present situation and prospect of Da Vinci robot assisted surgical system for colorectal cancer surgery are explored.

  13. Inguinal hernia developed after radical retropubic surgery for prostate cancer

    OpenAIRE

    Chung, Choon Sik; Jeong, Gyu Young; Kim, Seung Han; Lee, Dong Keun

    2013-01-01

    Purpose In this retrospective study, we aimed to compare the clinical characteristics of inguinal hernia developed after radical retropubic surgery for prostate cancer to the hernia without previous radical prostatectomy. Methods Twenty-three patients (group A) who had radical retropubic surgery for prostate cancer underwent laparoscopic or open tension-free inguinal hernia repair from March 2007 to February 2011. Nine hundred and forty patients (group B) without previous radical retropubic s...

  14. 机器人辅助腹腔镜下前列腺癌根治术护理团队的建设和培训%Construction and Training of Robot-assisted Laparoscopic Prostatectomy Nursing Team

    Institute of Scientific and Technical Information of China (English)

    沈群; 杨波; 王燕; 过菲; 高旭; 盛夏

    2014-01-01

    Objective To discuss the progressive construction and training of robot‐assisted laparoscopic prostatectomy (RALP) nursing team .Methods Our accumulated experience in nursing team‐building for the RALP from March 2012 until now was retrospectively summarized .The whole training system include four stages:theoretical study ,simulation operation ,scene teaching and concentrate training .Results Over the study period ,100 consecutive cases of RALP were carried out in our hospital .Through this series ,the member of nurses mastered in surgical cooperation were increased from the initial 2 to the current 10 ,and a specialized step‐by‐step training system was establish with a series of improvement measures .With this training program ,the preoperative preparation time of the Da Vinci robot was significantly decreased .Con‐clusion RALP nursing team construction and training have significant improvement to surgical effective‐ness ,which is worthwhile for clinical trial .%目的:总结机器人辅助腹腔镜下前列腺癌根治术(robot‐assisted laparoscopic prostatectomy ,RALP)护理团队渐进式建设和培训的经验。方法回顾性分析并总结2012年3月至今第二军医大学长海医院开展RA L P护理团队的建设经验,整个培训体系包括4个阶段:理论学习,模拟操作,现场带教和集中强化。结果2012年3月至2013年10月,第二军医大学长海医院共开展RALP手术100例,熟练掌握手术配合的护士由最初的2人增加到目前的10人,建立了一个成熟的护理团队,形成了一套“阶梯式”的培训体系,摸索了一系列改进措施,机器人的术前准备时间明显缩短。结论 RALP护理团队的建设与培训对手术的进一步开展和提高手术效率具有积极意义,值得在临床推广应用。

  15. LAPAROSCOPIC SURGERY IN THE MANAGEMENT OF EARLY GASTRIC CANCER

    Directory of Open Access Journals (Sweden)

    Abhijit

    2016-02-01

    Full Text Available INTRODUCTION This study was performed to check Laparoscopic Surgery in the management of early Gastric Cancer. For that we choose laparoscopic and laparoscopic Assisted Gastrectomies for 119 cases. It was performed during the period from June 1996 to February 2002 in Kameda Medical Center, Kamogawa, Japan. Male and female ratio was 2.78:1. The age range was 48-88 years (65.5. MATERIALS AND METHODS 1. Laparoscopic Intragastric Mucosal Resection (LIMR. 2. Local Resection by Lesion Lifting Method (LLM. 3. Laparoscopy-Assisted Distal Gastrectomy (LADG. 4. Intragastric Mucosal Resection through laparotomy. RESULTS OF THIS STUDY AFTER USING SURGICAL TECHNIQUES ARE AS FOLLOWS- 1. The tear was successfully closed by intragastric hand suturing technique. 2. All the planned laparoscopic procedures were completed in all the cases and the operation was finished after the confirmation of tumor free margins on frozen section biopsy specimen. 3. All resected specimen underwent detailed histopathologic examination. Subsequent diagnosis includes stomach cancer in 106 cases, duodenal cancer in 1 case and stomach adenoma in 5 cases. 8cases of stromal tumors were resected laparoscopically. 4. We have not lost even a single patient in follow up or due to mortality. Five year follow up is present in the first year group. 5. 06 patients who were diagnosed with EGC have been successfully treated with 4 laparoscopic techniques at our institute from June 1996 to February 2002. CONCLUSION We, in our study had no mortality or local recurrence to date but our follow up is obviously too short to draw any conclusions. If patients are selected properly, we on the basis of our study propose that laparoscopic procedures are curative.1,2 When performed by a skilled surgeon, laparoscopic resection is a safe and useful technique in the management of Early Gastric Cancer.

  16. LAPAROSCOPIC PANCREATIC RESECTION. FROM ENUCLEATION TO PANCREATODUODENECTOMY. 11-YEAR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Marcel Autran Cesar MACHADO

    2013-09-01

    Full Text Available Context Our experience with laparoscopic pancreatic resection began in 2001. During initial experience, laparoscopy was reserved for selected cases. With increasing experience more complex laparoscopic procedures such as central pancreatectomy and pancreatoduodenectomies were performed. Objectives The aim of this paper is to review our personal experience with laparoscopic pancreatic resection over 11-year period. Methods All patients who underwent laparoscopic pancreatic resection from 2001 through 2012 were reviewed. Preoperative data included age, gender, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Diagnosis, tumor size, margin status were determined from final pathology reports. Results Since 2001, 96 patients underwent laparoscopic pancreatectomy. Median age was 55 years old. 60 patients were female and 36 male. Of these, 88 (91.6% were performed totally laparoscopic; 4 (4.2% needed hand-assistance, 1 robotic assistance. Three patients were converted. Four patients needed blood transfusion. Operative time varied according type of operation. Mortality was nil but morbidity was high, mainly due to pancreatic fistula (28.1%. Sixty-one patients underwent distal pancreatectomy, 18 underwent pancreatic enucleation, 7 pylorus-preserving pancreatoduodenectomies, 5 uncinate process resection, 3 central and 2 total pancreatectomies. Conclusions Laparoscopic resection of the pancreas is a reality. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency that could be detrimental to the patient's quality of life. Laparoscopic pancreatoduodenectomy is a safe operation but should be performed in specialized centers by highly skilled laparoscopic surgeons.

  17. Core value of laparoscopic colorectal surgery

    Institute of Scientific and Technical Information of China (English)

    Xin-Xiang; Li; Ren-Jie; Wang

    2015-01-01

    Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor’s radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future.

  18. Laparoscopic-assisted versus open distal gastrectomy with D2 lymph node resection for advanced gastric cancer: effect of learning curve on short-term outcomes. a meta-analysis.

    Science.gov (United States)

    Zhou, Di; Quan, Zhiwei; Wang, Jiandong; Zhao, Mingning; Yang, Yong

    2014-03-01

    Laparoscopic-assisted distal gastrectomy (LADG) with D2 resection is gradually being performed for treating advanced gastric cancer. This meta-analysis aims to compare the clinical outcomes between LADG and open distal gastrectomy (ODG) when considering the impact of the learning curve. The PubMed, Embase, and ISI databases and the Cochrane Library were electronically searched. Randomized controlled trails and retrospective comparative studies published between 1994 and 2013 were collected. We divided the included studies into two subgroups according to whether the authors had experience of at least or fewer than 40 cases of LADG with D2 resection and then compared the operative time, intraoperative bleeding, the amount of resected lymph nodes, short-term recovery parameters, and complications between LADG and ODG groups. Ten comparative studies including 1100 patients were selected. Meta-analysis showed that when LADG was compared with ODG, surgeons with experience of at least 40 cases could achieve more resected lymph nodes (P=.002), reduced time to flatus (Pdiet (P<.00001), and lower complication rates (P=.02). However, the above advantages of LADG faded in the subgroup of surgeons with experience of fewer than 40 cases. Our meta-analysis suggested that the learning curve has significant effects on most of the important surgical and short-term recovery outcome parameters. Accomplishment of 40 cases of LADG with D2 lymphadenectomy is required to achieve optimum proficiency.

  19. 内镜辅助腹腔镜治疗胃肠道间质瘤20例%Endoscopy-assisted laparoscopic management of gastrointestinal stromal tumors: An analysis of 20 cases

    Institute of Scientific and Technical Information of China (English)

    王小冬; 汪宝林; 褚朝顺; 王翔; 赵庆洪; 李昌阳

    2013-01-01

    AIM: To explore the safety and feasibility of endoscopy-assisted laparoscopic resection of gastrointestinal stromal tumors. METHODS: The clinical data for 95 patients who underwent resection of gastrointestinal stromal tumors by endoscopy-assisted laparoscopic technique, pure laparoscopic technique or traditional open surgery in the Digestive Medical Center of the Second Affiliated Hospital of Nanjing Medical University from 2008 to 2012 were analyzed retrospectively. The operative time, blood loss, time to postoperative recovery of gastrointestinal function, time to ambulation and postoperative length of hospital stay were compared between different groups. RESULTS: All surgeries were completed successfully without death or postoperative complications. None of recurrence or metastasis was found. The operative time was 63.0 min ± 7.8 min, 81.6 min ± 6.0 min and 134.9 min ± 12.9 min in the endoscopy-assisted laparoscopy group, pure laparoscopy group and open surgery group, respectively; the blood loss was 24.5 mL ± 4.6 mL, 27.1 mL ± 7.1 mL and 112.4 mL ± 22.5 mL; the time to recovery of gastrointestinal function was 33.4 h ± 2.7 h, 34.6 h ± 5.2 h and 36.9 h ± 3.2 h; the time to ambulation was 37.1 h ± 4.8 h, 38.0 h ± 3.7 h and 48.6 h ± 4.0 h; and the postoperative length of hospital stay was 7.8 d ± 1.4 d, 8.1 d ± 1.2 d and 9.4 d ± 1.8 d. The operative time was significantly lower in the endoscopy-assisted laparoscopy group than in the pure laparoscopy group (P = 0.000). The operative time, blood loss, time to recovery of gastrointestinal function, time to ambulation and postoperative length of hospital stay were significantly lower in the endoscopy-assisted laparoscopy group than in the open surgery group (all P < 0.05). CONCLUSION: Endoscopy-assisted laparoscopy is a safe and feasible technique for treating gastrointestinal stromal tumors. It has the advantages of minimal invasiveness, accurate positioning, and rapid postoperative recovery. The

  20. Pancreatic Surgery in the Laparoscopic Era

    Directory of Open Access Journals (Sweden)

    Ammori BJ

    2003-11-01

    subtotal pancreatectomy with or without preservation of the splenic vessels and spleen for neuroendocrine and cystic tumours, and in some patients with chronic pancreatitis is feasible and safe. In experienced hands, this minimally invasive approach reduces postoperative hospital stay and expedites recovery. However, the incidence of pancreatic fistula following distal resection is not any less than that of open surgery. Although the previous limited experience with laparoscopic pancreaticoduodenectomy was discouraging, the recent experience with the hand-assisted approach is quite favourable and is likely to expand.

  1. Ressecção hepática robótica. Relato de experiência pioneira na América Latina First robotic-assisted laparoscopic liver resection in Latin America

    Directory of Open Access Journals (Sweden)

    Marcel Autran C. Machado

    2009-03-01

    Full Text Available Graças ao melhor conhecimento da anatomia segmentar do fígado e desenvolvimento de novas técnicas, houve aumento no número de indicações de hepatectomias. O desenvolvimento da cirurgia minimamente invasiva ocorreu paralelamente e o aumento da experiência, aliado ao desenvolvimento de novos instrumentais, resultaram no crescimento exponencial das ressecções hepáticas videolaparoscópicas. A abordagem laparoscópica pode tornar viável a ressecção hepática em pacientes cirróticos com hipertensão portal que não tolerariam este mesmo procedimento por via laparotômica. A cirurgia robótica surgiu nos últimos anos como a última fronteira de desenvolvimento técnico aplicado à videocirurgia. O presente trabalho descreve a experiência pioneira de ressecção hepática totalmente com o uso de robótica na América Latina, em paciente com carcinoma hepatocelular e cirrose hepática. A hepatectomia laparoscópica com o uso do sistema robótico Da Vinci permite refinamentos técnicos graças à visualização tridimensional do campo cirúrgico e utilização de instrumentais precisos e com grande amplitude de movimentação que simulam os movimentos da mão humana.The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentations. Robotic surgery for hepatic resection has not yet been extensively reported. The aim of this paper is to report the first known case of liver resection with use of a computer-assisted, or robotic, surgical device in Latin America. A 72-year-old male with cryptogenic liver cirrhosis and hepatocellular carcinoma was referred for surgical treatment. Preoperative clinical evaluation and laboratory data disclosed a Child-Pugh class A patient. Magnetic resonance imaging showed a 2.2 cm tumor in segment 5. Liver size was decreased and there were signs of portal hypertension, such as splenomegaly and enlarged portal vein collaterals. Preoperative upper

  2. Laparoscopic Colon Resection

    Science.gov (United States)

    ... inches to complete the procedure. What are the Advantages of Laparoscopic Colon Resection? Results may vary depending ... type of procedure and patient’s overall condition. Common advantages are: Less postoperative pain May shorten hospital stay ...

  3. Laparoscopic Spine Surgery

    Science.gov (United States)

    ... to pressure on the nerve. Are There Other Advantages to the Anterior Approach? Inter-vertebral disc height ( ... require removal of any bone. What are the Advantages of the Laparoscopic (Minimally Invasive) Approach? Keep reading... ...

  4. Laparoscopic Adrenal Gland Removal

    Science.gov (United States)

    ... adrenal tumors that appear malignant. What are the Advantages of Laparoscopic Adrenal Gland Removal? In the past, ... of procedure and the patients overall condition. Common advantages are: Less postoperative pain Shorter hospital stay Quicker ...

  5. Retroperitoneal laparoscopic pyelolithotomy.

    Science.gov (United States)

    Gaur, D D; Agarwal, D K; Purohit, K C; Darshane, A S

    1994-04-01

    Retroperitoneal laparoscopic pyelolithotomy was successful in 5 of 8 patients using the recently described balloon technique of retroperitoneal laparoscopy. All patients were considered for this new minimally invasive procedure only on economic grounds. However, with improved technique and instrumentation, the retroperitoneal laparoscopic approach could become a practical alternative for the management of patients with medium sized pelvic stones not amenable to extracorporeal shock wave lithotripsy nor ideally suitable for percutaneous nephrolithotomy, or when both of these facilities are not available. PMID:8126827

  6. MODIFIED LAPAROSCOPIC CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    To furtherly reduce the subxiphoid port site pain,improve the cosmetic result and patient satisfaction,and increase the safety for patients underwent laparoscopic cholecystectomy by advanced laparoscopic knotting skill.Methods:Among our 1500 patients underwent laparoscopic cholecystectomy since 1991,120 cases of modified laparoscopic cholecystectomy (MLC) were performed with three 5-mm ports and one 10-mm port(for laparoscope and sepcien withdrawn).There were 25 male and 95 female patients with an average age of 55 years (24~77years).The indications for MLC included polypoid lesions of gallbladder (21),simple cholecystitis(3),cholecystolithiasisi with chronic cholecystitis(84),with acute suppurative cholecystitis(7),with atrophic cholecystitis(5).Results:There were 5 patients underwent combined laparoscopic appendectomy(3),fenestration of hepatic cyst(1),and drainge for liver abscess(1).The average operative time for MLC was 55 minutes(30~150min),blood loss was 10ml(3~50ml),and postoperative stay was 3 days(1~5days).There were no conversion from MLC to either LC or open surgery,without mortality.Complications were limited to two patients(1.7%).One was retained common bile duct stone and another was port site bleeding after operation.They were treated by transduodenal endoscopic stone retrieval and simple suture ligation,respecrtively.Conclusions:The advantages of MLC conducted mainly by advanced laparoscopic knotting techniques were no more laparoscope (either 2-mm or 5-mm)needed,no sacrifice of good illumination and laproscopic image.Most of all,its costeffective and operative safety were all improved furtherly.

  7. Laparoscopic management of gossypiboma

    OpenAIRE

    Çetin, Orkun; Çim, Numan; Alkış, İsmet; Kolusarı, Ali; GÜL, Abdülaziz

    2015-01-01

    Introduction:Gossypiboma is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. We report the laparoscopic management of gossybiboma after caserean section for placenta previa.Case:A 29 year- old women presented with a history of emergency cesarean section for placenta previa, performed seven days ago. Abdominal computerized tomography scan showed a heterogeneous and low dansity mass, with peripheral calcifications. The patient was submitted to laparoscopic su...

  8. Laparoscopic Nephroureterectomy: Oncologic Outcomes and Management of Distal Ureter; Review of the Literature

    Directory of Open Access Journals (Sweden)

    Andre Berger

    2009-01-01

    Full Text Available Introduction. Laparoscopic radical nephroureterectomy (LNU is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter. Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC. Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU or hand-assisted (HALNU. The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU. Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.

  9. Laparoscopic Radical Cyctectomy and Rectum Pouch for Urinary Diversion (Report of 37 Cases)%腹腔镜根治性膀胱切除术及直肠代膀胱术的临床疗效分析(附37例报告)

    Institute of Scientific and Technical Information of China (English)

    李超; 金讯波; 赵勇; 崔子连; 宋伟; 王慕文

    2014-01-01

    Objective To evaluate the surgical technique and clinical efficacy of laparoscopic radical cystec-tomy and rectum pouch for urinary diversion. Methods From October 2011 to June 2014,37 patients with inva-sive bladder cancer were treated with laparoscopic radical cystectomy and rectum pouch for urinary diversion. The operation time,the blood loss,the intestine function recovery time and the complication were observed. Re-sults All operations were successful,with the operation time being (230 ± 55)minutes,the blood loss (320 ± 110)ml. Recovery of bowel movement occurred (4 ± 2)days after surgery and the postoperative hospital stay was (18 ± 3)days. No severe intraoperative and postoperative complications,such as intestinal fistula and hem-orrhage,occurred,except that one patient suffered adhesive intestinal obstruction. After 2~36 months of follow-up,there was no case of recurrence and metastasis,except 1 case died of primary disease metastasis. All pa-tients urinated normally and the function of rectum pouch was regular. Conclusions Laparoscopic radical cyctec-tomy and rectum pouch for urinary diversion is a safe,effective and feasible but technically challenging alterna-tive for invasive bladder cancer.%目的:探讨腹腔镜根治性膀胱切除术及直肠代膀胱术的手术方法和临床疗效。方法收集本单位2011年10月至2014年6月采用腹腔镜根治性膀胱切除术及直肠代膀胱术的37例膀胱癌患者的临床资料,观察手术时间、术中出血量、术后肠道功能恢复、住院时间、术后并发症及手术效果,并进行统计分析。结果37例患者的手术均成功完成。手术时间(230±55)分钟,术中出血量(320±110)ml,术后肠蠕动恢复时间为(4±2)天,术后拔除引流管时间为(7±2)天,术后拔除输尿管支架管时间为(13±3)天,术后住院天数为(18±3)天。1例患者术后2月出现粘连性肠梗阻,其余均未出现感染、肠瘘和

  10. 腔镜乙状结肠癌直肠癌根治术中护理关键点质控的效果评价%Effects of Quality Control of Nursing Key Points in Laparoscopic Radical Resection of Sigmoid Colon, Rectal Cancer

    Institute of Scientific and Technical Information of China (English)

    朱琳; 彭顺秀; 黄俊平; 梁绍基; 陶云燕

    2014-01-01

    目的:评价腔镜乙状结肠癌、直肠癌根治术中护理关键点质控的效果。方法回顾分析46例腔镜乙状结肠癌、直肠癌根治术患者(对照组)的术中护理质量缺陷点,包括低体温、压疮、器械管理及配合不佳;对进行相同手术的58例患者(观察组)的术中护理进行改进。比较两组患者的手术时间、体温降低、压疮、下肢深静脉血栓发生率及患者和手术医生的满意率。结果观察组较对照组手术时间明显缩短(P<0.01)、体温更为平稳(P<0.01),无压疮(P<0.01)和深静脉血栓(P<0.05),观察组的患者和手术医生的满意率均明显高于对照组(P<0.01)。结论对腔镜乙状结肠癌、直肠癌根治术中进行护理关键点的质量控制,可缩短手术时间,减少低体温、压疮及深静脉血栓的发生率,提高手术护理的质量。%Objective To study the effects of quality control of nursing key points in laparoscopic radical resection of sigmoid colon, rectal cancer. Methods A retrospective analysis of intraoperative nursing quality defects was conducted in 46 cases of patients with laparoscopic radical resection of sigmoid colon, rectal cancer (control groups). The quality defects included low temperature, pressure sores, equipment management and poor cooperation. The pertinence nursing improvement was performed for 58 cases of patients with the same operation (observation group). The operation time, incidence of low temperature, pressure sores and DVT in two groups were compared and the satisfaction of patients and doctors with the operation were investigated. Results The operation time in observation group was significantly shorter than that in control group (P<0.01) and the temperature in observation group was more stable than that in control group (P<0.01). There were no pressure sores and DVT in observation group. The satisfaction rates of the patients and doctors in observation

  11. The clinical analysis of 10 cases of postoperative gastroparesis after laparoscopic -assisted rectal cancer%腹腔镜辅助直肠癌术后并发胃瘫10例临床分析

    Institute of Scientific and Technical Information of China (English)

    孔凡东; 何永忠; 杜汉朋; 聂向阳; 龚独辉

    2014-01-01

    Objective To investigate the possible causes and comprehensive treatment measures of postoperative complication of gastroparesis after paroscopic -assisted rectal cancer. Methods A retrospective analysis on clinical data and comprehensive treatments of 10 patients of our hospital in recent years, which suffer from gastroparesis after the laparoscopic-assisted rectal cancer surgery. Results When eating liquid diet after surgery and 4~5 days anus exhaust, 10 patients (3 men and 7 females) appeared the phenomenon of epigastric fullness, nausea and vomiting with containing bile juice. Indwelling gastrointestinal decompression tube, it could be sucked out of more than 800ml bilious gastric juice every day. Gastric angiography(76% diatrizoate) showed four cases in which the stomach is without peristalsis, and six cases in which the stomach is significantly weakened, and after 5 ~6 h observation, contrast agents stranded in the stomach. With continuous decompression, and parenteral nutrient support therapy, as well as non-surgical treatments including gastrointestinal motility drugs and acupuncture treatment, all patients with gastroparesis restore gastric motility after 7 ~15 (average 12.3) days. Conclusions The occurrence of gastroparesis after laparoscopic-assisted rectal, was a transient change in gastric function, due to a variety of causes. It may be associated with the anesthesia and patients’ mental factors, and could be cured by non-surgical treatment.%目的:探讨腹腔镜辅助直肠癌术后并发胃瘫的可能病因及综合治疗措施。方法回顾性分析我院近年来腹腔镜辅助直肠癌术后发生胃瘫的10例患者的临床资料及综合治疗效果。结果10例患者,男性3例,女性7例。在手术后4~5 d 肛门排气后进食流质饮食出现上腹饱胀、恶心呕吐,呕吐物含有胆汁样胃液。给予留置胃肠减压管,每天可吸出800 ml 以上胆汁样胃液。经胃管行胃造影显示胃无蠕动4

  12. Laparoscopic Distal Pancreatectomy

    Directory of Open Access Journals (Sweden)

    Misato Maeno

    2015-07-01

    Full Text Available Laparoscopy became a major part of the surgical armamentarium in 1989, after the initial introduction of laparoscopic cholecystectomy in 1987. Following the incredibly rapid adoption of this approach to abdominal surgery, surgeons applied the techniques to an ever-widening variety of procedures. Notably lacking throughout this period were controlled trials to demonstrate at least equal outcomes with traditional approaches to surgery. Market forces and improvements in instruments and imaging technology were powerful drivers for laparoscopic surgery. Within a short time, surgeons had shown that all organs in the abdomen and retroperitoneum could be approached laparoscopically. To many, it seemed to be only a matter of “Can we do this laparoscopically?” and rarely a question of “Will our patient benefit from a laparoscopic procedure?”. Of course, the word “benefit” has many meanings. Surgical resections of the liver, spleen, stomach, colon, kidney, and small bowel are now commonly performed in addition to the routine resections of the gallbladder and appendix. When one considers the use of laparoscopic resection in the treatment of malignancies, a multitude of new issues arise.

  13. Laparoscopic repair of left lumbar hernia after laparoscopic left nephrectomy.

    Science.gov (United States)

    Gagner, Michel; Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.

  14. Three-dimensional surgical navigation model with TilePro display during robot-assisted radical prostatectomy.

    Science.gov (United States)

    Ukimura, Osamu; Aron, Monish; Nakamoto, Masahiko; Shoji, Sunao; Abreu, Andre Luis de Castro; Matsugasumi, Toru; Berger, Andre; Desai, Mihir; Gill, Inderbir S

    2014-06-01

    Abstract To facilitate robotic nerve-sparing radical prostatectomy, we developed a novel three-dimensional (3D) surgical navigation model that is displayed on the TilePro function of the da Vinci® surgeon console. Based on 3D transrectal ultrasonography (TRUS)-guided prostate biopsies, we reconstructed a 3D model of the TRUS-visible, histologically confirmed "index" cancer lesion in 10 consecutive patients. Five key anatomic structures (prostate, image-visible biopsy-proven "index" cancer lesion, neurovascular bundles, urethra, and recorded biopsy trajectories) were image-fused and displayed onto the TilePro function of the robotic console. The 3D model facilitated careful surgical dissection in the vicinity of the biopsy-proven index lesion. Geographic location of the index lesion on the final histology report correlated with the software-created 3D model. Negative surgical margins were achieved in 90%, except for one case with extensive extra-prostate extension. At postoperative 3 months, prostate-specific antigen levels were undetectable (navigation model is presented.

  15. The impact of retractor SPONGE-assisted laparoscopic surgery on duration of hospital stay and postoperative complications in patients with colorectal cancer (SPONGE trial) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Couwenberg, Alice M; Burbach, Maarten J P; Smits, Anke B; Van Vulpen, Marco; van Grevenstein, Wilhemina M U; Noordzij, Peter G; Verkooijen, Helena M

    2016-01-01

    BACKGROUND: To achieve an adequate visual working field during laparoscopic colorectal surgery without disturbance of the small intestine, patients are positioned in the Trendelenburg position. This position results in hemodynamic changes that may increase the risk of cardiopulmonary complications a

  16. Laparoscopic reintervention in colorectal surgery.

    NARCIS (Netherlands)

    Broek, RP Ten; Goor, H. van

    2008-01-01

    Laparoscopic colorectal surgery has developed in the 1990's and beginning of 2000. The favourable results and great progress in the development of laparoscopic techniques have expanded the indications of laparoscopic colorectal surgery. More and more complicated colorectal cases are treated laparosc

  17. 机器人辅助腹腔镜手术治疗复杂性肾结石的临床研究%Clinical study of robot-assisted laparoscopic surgery for the treatment of complex nephrolithiasis

    Institute of Scientific and Technical Information of China (English)

    张祥; 许天源; 王晓晶; 夏磊磊; 秦亮; 王先进; 邵远; 沈周俊

    2015-01-01

    石等复杂性肾结石患者较优的可选手术方式.%Objective To investigate the clinical efficacy and safety of robot-assisted laparoscopic surgery for the treatment of complex nephrolithiasis.Methods The retrospective analysis of 31 cases of robot-assisted laparoscopic surgery for the treatment of complex nephrolithiasis was carried out.20 of these patients were male,while the others were female.The average age of these patients was 47 years, ranged from 26-73.Sixteen patients had calculi located both in subrenal calyx and ureter, 7 cases of them had ureteropelvic junction obstruction while the subrenal calyx calculus were far away from ureteropelvic junction.Out of the total 31 cases, 9 were multiple renal calculi, 3 were staghorn calculi, 3 were congenital renal malformation with staghorn calculi.The average diameter of calculi was 33 mm, ranged from 15 to 78.19 cases had obvious pelvic separation presented by pre-operative ultrasonography, average 33 mm, ranged from 12 to 62 mm.All the cases were performed by robot-assisted laparoscopic surgery transperitoneally.Results All operations were successful without converting to laparoscopy or open surgery.The average operative time (robotic console time) was 64 min, ranged from 45 to 128 min.The average estimated blood loss during operation was 80 ml, ranged from 10-400 ml.The length of post-operative hospital stay were 4-11 days, average 6 days.The average removal time of drainage was 4 days, ranged from 2 to 7 days.There was no severe complications after operation.The diuretic renogram showed that the obstruction in patients with UPJO was cured or significantly improved.The average follow-up time was 7 months (ranged from 2 to 27 months).Post-operative KUB X-ray showed no residual calculi in 29 patients.The average value of serum creatinine (Cr) was 96.5 μmol/L (ranged from 88.4 to 126.5 μmol/L) in one month post-operative follow-up.The glomerular filtration rates of affected side recovered to 36.5-45.7 ml

  18. Advancements in Laparoscopic Partial Nephrectomy: Expanding the Feasibility of Nephron-Sparing

    Directory of Open Access Journals (Sweden)

    Eugene J. Pietzak

    2012-01-01

    Full Text Available Partial nephrectomy (PN offers equivalent oncologic outcomes to radical nephrectomy (RN but has greater preservation of renal function and less risk of chronic kidney disease and cardiovascular disease. Laparoscopic PN remains underutilized likely because it is a technically challenging operation with higher rates of perioperative complications compared to open PN and laparoscopic RN. A review of the latest PN literature demonstrates that recent advancements in laparoscopic approaches, imaging modalities, ischemic mitigating strategies, renorrhaphy techniques, and hemostatic agents will likely allow greater utilization of LPN and expand its usage to increasingly more complex tumors.

  19. The Role of Laparoscopic Nephrectomy in Pediatric Xanthogranulomatous Pyelonephritis: A Case Report

    Directory of Open Access Journals (Sweden)

    James F. Brown

    2013-01-01

    Full Text Available Xanthogranulomatous pyelonephritis (XGP is a rare chronic renal infection characterized by the destruction of renal parenchyma. Traditional treatment involves open radical nephrectomy, which is challenging due to the inflammatory process associated with XGP. More recently, laparoscopic nephrectomy has been employed successfully in adult XGP. We present a case of a six-year-old female child with XGP who was successfully treated by laparoscopic nephrectomy with minor complications. Our case demonstrates the safety and feasibility of laparoscopic nephrectomy for childhood XGP, indicating that it should be considered a management option in such cases.

  20. A new surgical approach for da Vinci robot-assisted laparoscopic partial nephrectomy%达芬奇机器人辅助腹腔镜下肾部分切除术手术入路的新选择

    Institute of Scientific and Technical Information of China (English)

    梁朝朝; 周骏; 邰胜; 王建忠; 杨诚; 徐汉江; 徐凌凡; 施浩强; 郝宗耀

    2016-01-01

    目的 总结经腰腹联合入路机器人辅助腹腔镜下肾部分切除术的手术方法,探讨机器人辅助腹腔镜下肾部分切除术手术入路的新选择.方法 回顾性分析2015年6月至2016年1月收治的13例行经腰腹联合入路机器人辅助腹腔镜下肾部分切除术患者的临床资料,男7例,女6例.年龄26 ~ 74岁,平均48岁.肿瘤位于左肾8例,右肾5例.肿瘤直径2.5 ~4.5 cm,平均3.5 cm.其中1例患者左肾有2枚肿瘤,直径分别为1.5 cm和3.0cm.所有患者术前均行CT检查,考虑为肾细胞癌,其中3例行双肾血管三维成像.术前行胸部X线片检查排除远处转移.13例术前血肌酐均在正常范围,2例伴2型糖尿病,2例伴高血压病.13例均行经腰腹入路腹腔镜下肾部分切除术.结果 本组13例手术均顺利完成.手术时间80~140 min,平均100 min.术中热缺血时间15~28 min,平均22 min.术中出血40 ~120 ml,平均60 ml,无术中输血病例.术后病理诊断为肾透明细胞癌12例,肾血管平滑肌脂肪瘤1例,无切缘阳性病例.术后随访1~7个月,术后1、3个月复查肾功能均在正常范围,复查B超未见肿瘤残留和复发.结论 经腰腹联合入路腹腔镜下肾部分切除术有效地将经腹膜外与经腹途径结合起来,既发挥了经腹膜外手术处理血管的优势,又满足了机器人手术对空间的要求,使其优势得以充分发挥.%Objective To investigate the advantages of combination of retroperitoneal and peritoneal approach for robotic-assisted laparoscopic partial nephrectomy.Methods 7 male patients and 6 female patients,aging between 26-74,underwent robotic-assisted laparoscopic partial nephrectomy via combination of retroperitoneal and peritoneal approach between July 2015 and January 2016.Before surgery,8 cases were found the lesions on the left side and the other 5 cases were found the lesions on the right side.The mean diameter of tumor was 3.5cm (ranging from 2.5 to 4.5cm).Among them

  1. Inflammatory response in laparoscopic vs. open surgery for gastric cancer

    DEFF Research Database (Denmark)

    Okholm, Cecilie; Goetze, Jens Peter; Svendsen, Lars Bo;

    2014-01-01

    lead to an increased susceptibility to complications and morbidity. The aim of this review was to investigate if laparoscopic surgery reduces the immunological response compared to open surgery in gastric cancer. METHODS: We conducted a literature search identifying relevant studies comparing...... laparoscopy or laparoscopic-assisted surgery with open gastric surgery. The main outcome was postoperative immunological status defined as surgical stress parameters, including inflammatory cytokines and blood parameters. RESULTS: We identified seven studies that addressed the immunological status in patients...... laparotomy. Finally, most studies reported lower levels of white blood cell count in laparoscopic patients, although this result did not reach statistical significance in a small number of studies. CONCLUSIONS: Laparoscopy-assisted gastric surgery seems to attenuate the immune response compared to open...

  2. 单孔机器人或腹腔镜手术在膀胱疾病治疗中的应用现状%Application of laparoscopic or robotic-assisted single-site surgery in the treatment of bladder diseases

    Institute of Scientific and Technical Information of China (English)

    祝强; 符伟军; 张旭

    2015-01-01

    Laparoscopic or robotic-assisted single-site surgery has been widely used in all kinds of operations in department of urology.The latest information on laparoscopic or robotic-assisted single-site surgery was summarized and analyzed to evaluate its application and development direction in the treatment of bladder diseases.A detailed re-view from electronic databases Medline was done.Analysis showed that the laparoscopic or robotic-assisted single-site surgery for bladder diseases has the advantages of minimal invasion and postoperative quick recovery.Improve-ment of surgical instruments and application of robot technology may be expected to further clarify the application and extension of single-site technology in minimally invasive urologic surgery.%单孔机器人或腹腔镜手术已广泛应用于泌尿外科各类手术。现应用 Medline 查询并总结相关文献用于系统性回顾,概述并分析最新资料,以评价现有的单孔机器人或腹腔镜手术在膀胱疾病治疗中的应用及发展方向。分析表明单孔机器人或腹腔镜手术治疗膀胱疾病具有创伤小、术后恢复快等益处。手术器械的改进和机器人技术的应用,有望进一步明确单孔技术在微创泌尿外科手术中的作用及推广应用。

  3. 精准-间隙解剖技术在腹腔镜广泛性子宫切除术+腹腔镜下盆腔淋巴结切除术中预防并发症的临床价值%Clinical value of precise-fascia space dissection technique in prevention of complications in laparoscopic radical hysterectomy combined with laparoscopic pelvic lymphadenectomy

    Institute of Scientific and Technical Information of China (English)

    李平军; 嵇振岭; 孟惠吉; 朱委巧; 李霞; 崔晓勇; 李丹; 张新梅; 刘嵩颖

    2014-01-01

    Objective To research the clinical value of precise-fascia space dissection technique in laparoscopic radical hysterectomy (LRH) combined with laparoscopic pelvic lymphadenectomy (LPL).Methods A retrospective analysis for 30 cases with early uterine malignancy operated by LRH + LPL were conducted,each patient was used for precise-fascia space dissection technique.Results All cases were successfully performed LRH + LPL under laparoscopy.The operative time was (253.2 ± 30.5) min,the blood loss in operation was (180.3 ± 83.2) ml,the amount of the excised lymph nodes was (13.2 ± 4.0) pieces,the time of gastrointestinal tract functional rehabilitation was (2.5 ± 0.9) d,the time of keeping urinary catheter was (13 ± 5) d.Three cases occurred lymphatic leakage and recovered after fasting and intravenous nutrition.None occurred ureter,bladder and vascular injury.Followed up for 6-72 months,none occurred recurrence or death.Conclusion LRH + LPL using precise-fascia space dissection technique can avoid ureter,bladder and vascular injury.%目的 探讨精准-间隙解剖技术在腹腔镜广泛性子宫切除术(LRH)+腹腔镜下盆腔淋巴结切除术(LPL)中预防并发症的临床价值.方法 回顾性分析采用精准-间隙解剖技术施行LRH+ LPL治疗的30例早期子宫恶性肿瘤患者的临床资料.结果 30例患者全部成功施行LRH+ LPL,手术时间(253.2±30.5) min,术中出血量(180.3±83.2) ml,切除盆腔淋巴结(13.2士4.0)枚,术后肠功能恢复时间(2.5±0.9)d,术后留置尿管时间(13±5)d;术后发生淋巴漏3例,经禁食和静脉营养治疗痊愈;无输尿管、膀胱及大血管损伤.30例术后随访6 ~ 72个月,未发现复发患者.结论 采用精准-间隙解剖技术施行LRH+ LPL,按层次解剖、间隙分离,可避免输尿管、膀胱及大血管损伤等严重并发症.

  4. Our Initial Experiences with Laparoscopic Urologic Surgery

    Directory of Open Access Journals (Sweden)

    Selçuk Altın

    2016-03-01

    Full Text Available Objective: Retrospectively, to evaluate outcomes and complications of urological laparoscopic surgery cases performed in our clinic. Methods: A total of 115 patients who received laparo­scopic surgery between January 2012 and January 2015 were retrospectively evaluated. Included patients were assessed in terms of demographic characteristics, pre­operative diagnosis, type of laparoscopic approach, dura­tion of surgery and hospitalization, complications before and after surgery, and postoperative requirement for open surgery. Results: 61 of included patients were women, 54 were male, and the mean age was 52.4±11.7 years. Sixty-eight patients underwent transperitoneal and 47 patients re­ceived retroperitoneal procedures. While 29 patients re­ceived renal cyst excision, 25 had simple nephrectomy, 22 had ureterolithotomy, 19 had radical nephrectomy, 15 had pyelolithotomy and 5 had pyeloplasty. Four (3,4% of the 115 patients required converting to open surgery. Except these patients, no major complication or mortal­ity was encountered. The mean duration of surgery for the most commonly applied procedures were as follows: renal cyst excision 62 (50-110 min, simple nephrectomy 125 (95-140 min, ureterolithotomy 108 (90-130 min, rad­ical nephrectomy 141 (105-175 min, pyelolithotomy 116 (95-140 min, and pyeloplasty 166 (150-190 min. The mean hospital stay was 3.7±2.8 (2-11 days. Conclusion: The success and complication rates of the laparoscopic surgeries performed in our clinic were con­sistent with those reported in the literature. In the light of technological advances and increasing experience, as well as based on the higher tolerance exhibited by pa­tients, we believe that laparoscopic surgery is a minimally invasive method that is a safe alternative to open surgery.

  5. Investigating Urinary Conditions Prior to Robot-assisted Radical Prostatectomy in Search of a Desirable Method for Evaluating Post-prostatectomy Incontinence.

    Science.gov (United States)

    Kadono, Yoshifumi; Nohara, Takahiro; Kadomoto, Suguru; Nakashima, Kazufumi; Iijima, Masashi; Shigehara, Kazuyoshi; Narimoto, Kazutaka; Izumi, Kouji; Mizokami, Atsushi

    2016-08-01

    The aims of the study were to investigate desirable evaluation methods for post-prostatectomy incontinence (PPI) by analyzing the urinary status before robot-assisted radical prostatectomy (RARP).Questionnaires were evaluated from 155 patients prior to operation. The 24-h pad test before RARP revealed a weight of 1.1 g. The mean scores were as follows: total International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, 1.2; total International Prostate Symptom Score (IPSS), 10.0; IPSS quality of life, 2.7; Overactive Bladder Symptom Score (OABSS), 2.9; and Expanded Prostate Cancer Index Composite urinary summary, 92.8. The abdominal leak point pressure test in 111 patients before RARP was negative in all cases. Desirable evaluation methods for PPI should be based on a combination of subjective and objective evaluations and comparisons between pre- and post-RP. ICIQ-SF is considerably convenient for evaluating incontinence, and the 24-h pad test enables evaluation of the incontinence volume in a highly objective manner. PMID:27466547

  6. Eighty-six cases of laparoscopic vaginoplasty using an ileal segment

    Institute of Scientific and Technical Information of China (English)

    WU Ji-xiang; LI Bin; LIU Tao; LI Wen-zhi; JIANG Yong-guang; LIANG Jie-xiong; WEI Chang-sheng; HU Hai-ou; ZHONG Chen-xi

    2009-01-01

    Background The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge.As the laparoscopy has been an important tool for the treatment of uterovaginal anomalies,we evaluated the feasibility of laparoscopic vaginoplasty using an ileal segment retrospectively.Methods Totally 86 patients who underwent laparoscopic vaginoplasty using an ileal segment in Beijing Anzhen Hospital during February 2004 to July 2007 were enrolled in this study.Of the 86 patients,70 (81.4%) underwent primary operations and 16 (18.6%) secondary operations.Nineteen (22.1%) patients underwent total laparoscopic vaginoplasty and 67 (77.9%) patients underwent laparoscope-assisted vaginoplasty.The operation time,cost of hospitalization,and hospital duration were compared between the two laparoscopic groups.The Student's t test and the Mann-Whitney test were used to examine the differences.Results All the surgeries were successfully completed with no any intraoperative complication.There were three major surgical complications in the postoperative period:one case of intra-abdominal hemorrhage,one case of meatal stenosis,and one case of intestinal obstruction.The mean follow-up period of this series was 18 months.Seventy-eight patients were satisfied with their sexual lives after the surgeries except 5 women complaining of vaginal stenosis and 3 with no sexual partner during the follow-up.Significant differences were obtained between total laparoscopic and laparoscope-assisted vaginoplasty groups,such as the operation time,cost of hospitalization,and hospital duration (P<0.01).There were no significant differences in sexual function between the two groups.Conclusions The laparoscopic vaginoplasty using an ileal segment is satisfactory for cosmetic,functional,and anatomic results.Vaginoplasty with an ileal segment,performed by either total laparoscopic or laparoscope-assisted techniques,has a high success rate for a functional vagina.

  7. SIMULATION and ANALYSIS of PARALLEL MANIPULATOR for MANOEUVRING LAPAROSCOPIC CAMERA - CAD BASED APPROACH

    Directory of Open Access Journals (Sweden)

    K. Kishore Kumar

    2015-02-01

    Full Text Available The inconvenience of laparoscopic operations lies mainly in the difficulties in mutual understanding between the surgeon and the camera assistant that manoeuvres the laparoscope camera according to the surgeon’s instructions .Another problem arises when the operation had to be performed for many hours.[1] In these cases the camera image tends to become unsteady due to fatigue of the camera assistant. The self-camera control, give more stability of the laparoscopic image, A robotic camera Assistant(parallel manipulator directly under surgeon’s control can help the surgeon control the view better.In this paper a parallel robot is simulated for the manipulation of laparoscopic camera and Two dimentional workspace generated is indicated and velocity ,acceleration ,displacement graphs are shown and analysis is done using ANSYS.

  8. COMPARATIVE ANALYSIS OF DONOR NEPHRECTOMY PERFORMED BY OPEN AND VARIOUS MODIFICATIONS OF LAPAROSCOPIC ACCESS

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2011-01-01

    Full Text Available The aim of this study was to evaluate our experience on laparoscopic living donor nephrectomy (LDN. During the last 1,5 years we have gradually expanded the use of minimally invasive LDN with various techniques: strictly laparoscopic and hand-assisted laparoscopic. This comparative study is based on 250 conventional open LDN and 61 laparoscopic LDN. Minimally invasive hand-assisted technique was shown to be associated with a significantly lower risk of major complications and intraoperative incidents, as well as reduced warm ische- mia and operative time. There was no negative impact on recipient’s results. In our opinion, the introduction of hand-assisted technique is probably the most significant single factor for improved results, although accumulated experience and developments in equipment will contribute. Improvements in surgical outcomes following donor nephrectomy may enhance living donor programmes. 

  9. Physiology of free radicals

    Directory of Open Access Journals (Sweden)

    Stevanović Jelka

    2011-01-01

    Full Text Available Free radicals imply that every atom, molecule, ion, group of atoms, or molecules with one or several non-paired electrons in outer orbital. Among these are: nitrogenoxide (NO•, superoxide-anion-radical (O2•-, hydroxyl radical (OH•, peroxyl radical (ROO•, alcoxyl radical (RO• and hydroperoxyl radical (HO2•. However, reactive oxygen species also include components without non-paired electrons in outer orbital (so-called reactive non-radical agents, such as: singlet oxygen (1O2, peroxynitrite (ONOO-, hydrogen-peroxide (H2O2, hypochloric acid (eg. HOCl and ozone (O3. High concentrations of free radicals lead to the development of oxidative stress which is a precondition for numerous pathological effects. However, low and moderate concentrations of these matter, which occur quite normally during cell metabolic activity, play multiple significant roles in many reactions. Some of these are: regulation of signal pathways within the cell and between cells, the role of chemoattractors and leukocyte activators, the role in phagocytosis, participation in maintaining, changes in the position and shape of the cell, assisting the cell during adaption and recovery from damage (e.g.caused by physical effort, the role in normal cell growth, programmed cell death (apoptosis and cell ageing, in the synthesis of essential biological compounds and energy production, as well as the contribution to the regulation of the vascular tone, actually, tissue vascularization.

  10. The safety and short-term therapeutic effect of transumbilical single-incision laparoscopic radical resection for sigmoid colon cancer%经脐单孔腹腔镜乙状结肠癌根治术安全性及近期疗效分析

    Institute of Scientific and Technical Information of China (English)

    梁辉; 管蔚; 陈国玉

    2012-01-01

    Objective.-To evaluate the feasibility and safety of transumbilical single-incision laparoscopic radical resection for sigmoid colon cancer. Methods: Clinical data of 24 patients from Mar. 2010 to Jul. 2010 were analyzed retrospectively. Seven patients underwent single-incision laparoscopic radical resection for sigmoid colon cancer, and 17 patients received conventional laparoscopic surgery. The operative safety,postoperative recovery,complications and postoperative short-term follow-up outcome of the 2 groups were comparatively analyzed. Results: Seven patients were treated successfully without open conversion. Mean operation time was (64.2 ± 26.3) min. Mean blood loss was (20.1 ±3.4) ml. Mean length of incision was (2.2 ± 1.3) cm. Number of resected lymph nodes was (13.2 ± 3.3). Patients did not request postoperative analgesia. Postoperative exhaust time was (1.2 ± 0.6) d. Mean ambulation time was (1.5 ± 0.4) d. Mean postoperative hospital stay was (5.8 ±3.2) d. One patient suffered wound infection on postoperative day 4 which was cured by dressing change. Postoperative follow-up time was 7-12 months with a mean of 8.8 months. No tumor recurrence and metastasis was identified. Compared with conventional laparoscopic surgery, single-incision surgery had smaller incisions and longer operation time ( P < 0.05). There was no significant difference between the two groups on other aspects. Conclusions: Transumbilical single-incision multi-channel laparpscopic radical resection for sigmoid colon cancer is feasible and safe. It is associated with less trauma and better cosmetic performance,but it consumes more operation time and requires higher technique level.%目的:评价经脐单孔腹腔镜乙状结肠癌根治术的可行性及安全性.方法:回顾分析2010年3月至2010年7月7例经脐单切口腹腔镜乙状结肠癌根治术与17例常规腹腔镜根治术的临床资料,对比分析两组患者手术安全性、术后恢复情况、并发症及

  11. 腹腔镜Trocar辅助电切镜尿道会师手术治疗老年患者后尿道复杂性损伤的体会%The experience of laparoscopic Trocar assisted resectoscopic urethral reunion operation to treat complicated posterior urethral injury of aged patients

    Institute of Scientific and Technical Information of China (English)

    谢满平

    2011-01-01

    Objective:To discuss the application value of laparoscopic Trocar assisted resectoscopic urethral reunion operation to treat complicated posterior urethral injury of aged patients. Methods: The clinical data of 6 elderly patients with complicated posterior urethral injury who underwent laparoscopic Trocar assisted resectoscopic urethral reunion operation emergently from Apr. 2009 to Aug. 2010 were analyzed retrospectively. Results: Three-cavity catheters of 22-24 were inserted into all 6 patients without cystostomy or drainage,and were removed 4 weeks after the operation. No scar was found in the abdominal wall. All the patients had fluent urination, no urethral stricture was detected and no urethral dilation was needed. Conclusions: Laparoscopic Trocar assisted resectoscopic urethral reunion operation to treat complicated posterior urethral injury of aged patients have advantages of mini-invasion,easier operation,more safety, efficacy, shorter operating time and less complications. It is superior to laparoscopic urethral reunion operation and avoids cystostomy or second-stage sugery.%目的:探讨腹腔镜Trocar辅助电切镜尿道会师手术治疗老年患者后尿道复杂性损伤的应用价值.方法:回顾分析2009年4月至2011年8月为6例后尿道复杂性损伤老年患者急诊行腹腔镜Trocar辅助电切镜尿道会师手术的临床资料.结果:6例均顺利置入F22-24三腔导尿管,未放置膀胱造瘘管及引流管,术后腹壁无切口瘢痕,4周后拔除导尿管,排尿通畅,无狭窄,均未行尿道扩张术.结论:腹腔镜Trocar辅助电切镜尿道会师手术治疗老年患者后尿道复杂性损伤具有患者创伤小、操作简单、安全、有效、手术时间短、并发症少等优点,明显优于单纯腔镜尿道会师手术,避免了膀胱造瘘或二期手术.

  12. Study for comfortable supine for patients with partial nephrectomy by robot-assisted laparoscopic nephron-sparing surgery%机器人辅助腹腔镜肾部分切除患者术后舒适卧位探讨

    Institute of Scientific and Technical Information of China (English)

    胡英娜; 周秀彬

    2014-01-01

    目的:探讨机器人辅助腹腔镜肾部分切除手术后患者最舒适的卧位。方法抽取80例行机器人腹腔镜肾部分切除手术后的患者,随机分为观察组和对照组,观察组患者手术后经医生允许采用早期舒适卧位,即颈部垫软枕、腰部垫20 cm ×20 cm硬枕仰卧位;对照组患者术后按传统方法采用平卧位。术后前2 d进行观察比较,找出患者最舒适卧位。结果观察组患者睡眠、情绪稳定及腰肌酸痛情况明显优于对照组( P<0.05)。结论机器人辅助腹腔镜肾部分切除手术后卧床期间采取颈部垫软枕、腰部垫20 cm ×20 cm硬枕的仰卧位方式,患者最舒适。%Objective To study the most comfortable lying position for post-operative patients with robot assisted laparoscopic partial nephrectomy .Method 80 post-operative patients with robot assisted laparoscopic partial nephrec-tomy surgery were randomly divided into observation group and the control group ,patients observed by doctors after surgery to allow the use of early comfort lying ,that is ,a soft pillow neck cushion ,waist cushion 20 cm × 20 cm hard pillow supine position ,tupatients in control group by traditional methods in supine position ,after 2 days of ob-servation and comparison ,to find the most comfortable lying position .Result The sleep ,comfort and lumbar pain in observation group was obviously better than that of control group (P<0 .05) .Conclusion Robot assisted laparoscop-ic partial nephrectomy surgery took the neck cushion soft pillow ,lumbar pillow pad 20 cm × 20 cm hard way the su-pine position ,the patient feels most comfortable .

  13. Training in laparoscopic urology

    NARCIS (Netherlands)

    M.P. Laguna; T.M. Reijke; H. Wijkstra; J.J.M.C.H. de la Rosette

    2006-01-01

    Purpose of review Training in laparoscopy has become an important issue in the current surgical scenario. In this overview we aim to update the current knowledge in the field of laparoscopic urological training and to highlight the potential dangers of using simulation for accreditation and selectio

  14. Laparoscopic lumbar hernia repair.

    Science.gov (United States)

    Madan, Atul K; Ternovits, Craig A; Speck, Karen E; Pritchard, F Elizabeth; Tichansky, David S

    2006-04-01

    Lumbar hernias are rare clinical entities that often pose a challenge for repair. Because of the surrounding anatomy, adequate surgical herniorraphy is often difficult. Minimally invasive surgery has become an option for these hernias. Herein, we describe two patients with lumbar hernias (one with a recurrent traumatic hernia and one with an incisional hernia). Both of these hernias were successfully repaired laparoscopically.

  15. 腹腔镜辅助腰椎前路椎间融合术治疗腰椎退变性疾病%Clinical application of anterior lumbar interbody fusion assisted with laparoscopic

    Institute of Scientific and Technical Information of China (English)

    王文军; 贺更生; 晏怡果; 姚女兆; 王麓山; 王程; 韩东

    2011-01-01

    目的 探讨腹腔镜辅助腰椎前路椎间融合术治疗腰椎退变性疾病的疗效.方法 2006年1月至2009年6月腰椎退变性疾病患者37例行腹腔镜辅助腰椎前路椎间融合,男22例,女15例;年龄16~55岁,平均43.7岁.全部病例行血管造影三维CT检查、17例行椎间盘造影检查,确定责任椎间盘为L5S121例,L4-5 11例,L3-4 2例,L2-3 2例,L1-2 1例.29例经腹腔人路、8例经腹膜后入路行椎间盘切除及椎间融合器融合,3例以骨盆重建钛板固定.术后3、6、12个月通过X线或CT观察植骨融合情况,3个月时采用中华医学会骨科学分会脊柱学组腰背痛手术评分评价疗效.结果 手术时间60~140 min,平均100 min;术中出血50~300 ml,平均120 ml;住院时间7~12d,平均8d.2例经腹腔入路患者出现麻痹性肠梗阻.全部病例随访6~35个月,平均18.7个月.疗效为优23例、良11例、差3例,优良率91.9%(34/37).23例于术后3个月、12例于术后6个月植骨融合;2例术后6个月时椎间前缘高度丢失1.3mm和1.9 mm,无明显不适症状,术后12个月植骨融合.无内植物松动、脱落等并发症.结论 腹腔镜辅助腰椎前路椎间融合术创伤小、卧床时间短、并发症少.经腹腔入路术后肠梗阻相对多见.在选择手术入路时应考虑术者经验和下腰椎前方大血管的解剖位置.%Objective To evaluate the clinical outcomes of anterior lumbar discectomy and interbody fusion with cage under laparoscopic assistant.Methods From January 2006 to June 2009,37 cases with degenerative low back pain were entered the study,including 22 males and 15 females with an average age of 43.7 years (range,16-55).The responsible discs were determined according to the three dimensional computed tomography of artery and vein angiography of anterior lumbosacral spine and discography,including L5S1 in 21 cases,L4-5 in 11,L3-4 in 2,L2-3 in 2,and L1-2 in 1.All cases underwent anterior lumbar discectomy and interbody

  16. Significance of erection hardness score as a diagnostic tool to assess erectile function recovery in Japanese men after robot-assisted radical prostatectomy.

    Science.gov (United States)

    Miyake, Hideaki; Miyazaki, Akira; Yao, Akihisa; Hinata, Nobuyuki; Fujisawa, Masato

    2016-09-01

    The objective of this study was to characterize time-dependent recovery of erectile function in Japanese patients following robot-assisted radical prostatectomy (RARP) using the erection hardness score (EHS). This study prospectively included 170 Japanese patients with localized prostate cancer (PC) undergoing RARP without neoadjuvant hormonal therapy. The erectile function of each patient was assessed based on the International Index of Erectile Function-5 (IIEF-5) and EHS at the baseline and on every visit to an outpatient clinic after RARP. In this series, potency was defined as the ability to have an erection sufficient for intercourse, corresponding to EHS ≥3, while patients with EHS ≥2 were regarded as those with erectile function. Of these 170 patients, 20 and 75 underwent bilateral and unilateral nerve-sparing procedures, respectively; however, non-nerve-sparing procedures were performed in the remaining 75. A proportional increase in the IIEF-5 score according to EHS was noted at 24 months after RARP. At 6, 12 and 24 months after RARP, the recovery rates of erectile function were 11.9, 21.7 and 35.8 %, respectively, while those of potency were 3.8, 9.8 and 13.7 %, respectively. Of several factors examined, the age, preoperative IIEF-5 score and nerve-sparing procedure were identified as independent predictors of erectile function recovery. These findings suggest that favorable erectile function recovery could not be achieved in Japanese PC patients even after the introduction of RARP; therefore, it might be preferable for such a cohort to use EHS rather than IIEF-5 as an assessment tool for the postoperative recovery of erectile function. PMID:26994775

  17. Prospective assessment of time-dependent changes in quality of life of Japanese patients with prostate cancer following robot-assisted radical prostatectomy.

    Science.gov (United States)

    Miyake, Hideaki; Miyazaki, Akira; Furukawa, Junya; Hinata, Nobuyuki; Fujisawa, Masato

    2016-09-01

    The objective of this study was to characterize changes in the quality of life (QOL) of Japanese patients following robot-assisted radical prostatectomy (RARP). This study included 298 consecutive localized prostate cancer (PC) patients undergoing RARP. The health-related QOL and disease-specific QOL were assessed using The Medical Outcomes Study 8-Item Short Form (SF-8) and The Extended Prostate Cancer Index Composite (EPIC), respectively, before and 1, 3, 6, 12 and 24 months after RARP. At 1 month after RARP, four (physical function, role limitations because of physical health problems, social function and role limitations because of emotional problems) of the eight scores in SF-8 were significantly impaired compared with those of baseline scores. However, all eight scores on all postoperative assessments, except for at 1 month after RARP, showed no significant differences from baseline scores. Although there were no significant differences in the bowel function, bowel bother, sexual bother, hormonal function or hormonal bother between baseline and postoperative assessments of EPIC at all time points, the urinary function, urinary incontinence and sexual function scores at 1, 3 and 6 months after RARP were significantly inferior to those of baseline scores, and urinary bother and urinary irritation/obstruction scores at 1 month after RARP were significantly impaired compared with those of baseline scores. These findings suggest that the health-related QOL of Japanese PC patients undergoing RARP may not be markedly deteriorated following RARP; however, as for the disease-specific QOL, urinary and sexual functions, particularly those early after RARP, appeared to be significantly impaired. PMID:26885662

  18. 腹腔镜腹膜代阴道成形术24例临床分析%Laparoscopically assisted peritoneum vaginoplasty:the report of 24 cases

    Institute of Scientific and Technical Information of China (English)

    周健; 方媛媛; 李桂林; 梁丽

    2013-01-01

    目的 探讨腹腔镜下腹膜代阴道成形术治疗先天性无阴道手术方法及治疗效果.方法回顾性分析24 例腹腔镜下腹膜代阴道成形术患者的临床资料,观察手术操作时间、术中出血量、术后阴道生长情况及女性性功能指数(FSFI),评价手术效果.结果 24例患者手术均成功,手术时间( 62.40±11.45) min,术中出血量(64.25±14.75)ml.随访2~17个月,1例术后1个月未行模具扩张,致阴道瘢痕挛缩变浅变硬,1例阴道肉芽肿,同房少许出血,予LEEP息肉切除治愈.22例患者人工阴道均能容纳窥阴器,深度( 8.70±1.50) cm,人工阴道黏膜光滑、红润,柔软度及弹性符合解剖结构及生理要求;有同房史者述性生活正常,FSFI评分与年龄匹配的正常女性差异无统计学意义.结论 腹腔镜下腹膜代阴道成形术安全性高,创伤小,效果满意.%Objective To investigate the technique and therapeutic effect of laparoscopy-assisted peritoneum vagi-noplasty in the treatment of congenital absence of vagina . Methods A total of 24 cases of congenital absence of vagina received laparoscopic peritoneal vaginoplasty in our hospital . All cases were treated with laparoscopy-assisted peritoneum vaginoplasty. Results The operation were performed successfully in all the 24 cases. The operative time was (62.40 ± 11.45)min. The volume of blood loss during operation was (64. 25 ± 14. 75 ) ml. Patients were followed up for 2-17 months,the cicatricle and contracture were found in 1 case and vaginal granuloma was found in another case . The vaginal length was (8.70 ± 1. 50) cm in 22 cases. The surface of reconstructed vagina was smooth,ruddy and flexible,with satisfactory anatomical and functional results. Normal sexual activity was achieved in 16 cases. The FSFI sex factors score of these patients was 25. 85 ±3. 82,and the contrast score was 26. 20 ±3. 62,no significant difference existed between the two scores. Conclusion laparoscopy-assisted

  19. 达芬奇机器人手术系统与腹腔镜胃癌根治术近期疗效的Meta分析%Short-term efficacy of da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer: a Meta analysis

    Institute of Scientific and Technical Information of China (English)

    李政焰; 石彦; 余佩武

    2015-01-01

    目的 系统评价达芬奇机器人手术系统与腹腔镜胃癌根治术的近期疗效.方法 以gastric cancer、gastrectomy、da Vinci surgical system、laparoscopic、laparoscopy、胃癌、胃切除术、达芬奇机器人手术系统、腹腔镜为检索词,检索PubMed、EMBASE、Cochrane Library、Medline、中国期刊全文数据库、万方数据库、维普数据库及中国生物医学期刊文献数据库.检索时间为2002年5月至2014年3月.纳入研究达芬奇机器人手术系统与腹腔镜胃癌根治术的临床疗效的相关对照试验,由2名研究者独立筛选文献和提取数据,并进行文献质量评价.行达芬奇机器人手术系统胃癌根治术患者为机器人组,行腹腔镜胃癌根治术患者为腹腔镜组.应用RevMan 5.2统计软件进行Meta分析.计数资料采用相对危险度(RR)及95%可信区间(95% CI)表示,计量资料采用加权均数差(WMD)及95% CI表示.采用I2对异质性进行分析.结果 最终纳入符合标准的相关研究共11篇,累计样本量3 698例,其中机器人组953例,腹腔镜组2 745例.Meta分析结果显示:与腹腔镜组比较,机器人组胃癌患者手术时间显著延长,术中出血量显著减少,术后肛门排气时间、术后经口进食时间及术后住院时间显著缩短,差异有统计学意义(WMD=51.23,-36.96,-0.24,-0.26,-1.11,95%CI:28.01 ~ 74.46,-61.28~-12.65,-0.42 ~-0.06,-0.39~-0.14,-1.92~-0.29,P<0.05);淋巴结检出数目,远、近切缘距肿瘤距离及术后并发症发生率两组比较,差异无统计学意义(WMD=1.63,0.21,0.06,RR=1.11,95%CI:-0.49 ~ 3.76,-0.65~1.06,-0.13~0.25,0.90 ~1.37,P>0.05).结论 达芬奇机器人手术系统与腹腔镜胃癌根治术同样安全可行,且前者手术创伤更小,术后恢复更快,患者能在近期疗效上获益.%Objective To compare the short-term efficacy between da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer.Methods Database including

  20. Sex differences in laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Thesbjerg, Simon E; Harboe, Kirstine Moll; Bardram, Linda;

    2010-01-01

    Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relations...... the relationship of gender to conversion rate and length of hospital stay after laparoscopic cholecystectomy in a national cohort of patients....

  1. The EndoHand: comparison with standard laparoscopic instrumentation.

    Science.gov (United States)

    Jackman, S V; Jarzemski, P A; Listopadzki, S M; Lee, B R; Stoianovici, D; Demaree, R; Jarrett, T W; Kavoussi, L R

    1999-06-01

    Laparoscopic instrumentation is constantly being refined in an attempt to achieve the proficiency, flexibility, and tactile feedback that would be available if the human hand were small enough to be used in laparoscopic surgery. The EndoHand (DAUM GmbH, Schwerin, Germany) is a novel laparoscopic three-fingered hand developed as an advancement over standard laparoscopic tools. Grasping and manipulation ability, dexterity, and tactile feedback were compared with those of current laparoscopic instrumentation. Experiments included measurement of achievable angles of approach to a fixed point behind a 2-cm-tall obstruction, completion time and error rates during a pelvic trainer dexterity task, and tactile feedback using a device invented to simulate tissue resistance. Subjectively, the EndoHand was able to pick up a range of objects similar to those graspable by a Babcock clamp. More complex types of manipulation were possible with the EndoHand because of its wrist joint. The range of approach angles to the fixed point was 35 degrees to 90 degrees with the EndoHand and 70 degrees to 90 degrees with the straight instruments. The dexterity of the EndoHand was significantly less than that of the other two instruments, as measured by time (P = 0.0002) and errors (P = 0.02). Standard instruments were also more accurate in the tactile feedback trials (P = 0.02). The EndoHand is a prototype of a unique new generation of laparoscopic instruments. Although it falls short in both dexterity and tactile feedback, significant promise is shown in its ability to perform sophisticated manipulation of objects and its flexibility to work at a larger range of angles to the target tissue. The EndoHand may be most useful on the nondominant hand of the surgeon to assist with positioning and holding tissue in a specific orientation. Clinical trials will determine its eventual role in laparoscopic surgery.

  2. A single institution experience using the LigaSure vessel sealing system in laparoscopic nephrectomy

    Institute of Scientific and Technical Information of China (English)

    PING Hao; XING Nian-zeng; ZHANG Jun-hui; NIU Yi-nong; ZHANG Jian-zhong; WANG Jian-wen

    2011-01-01

    Background Vascular control and tissue dissection are crucial steps in successful laparoscopic surgery. Recently, a new commercially available vessel sealing technology, the LigaSure vessel sealing system (Valleylab, Boulder, USA),has been introduced. The aim of the present study was to evaluate the benefits of the LigaSure in laparoscopic nephrectomy.Methods From January 2005 to March 2010, 170 laparoscopic nephrectomies were performed with the LigaSure vessel sealing system, including simple and radical nephrectomy and nephroureterectomy. In a retrospective study, the laparoscopic operating time, estimated intraoperative blood loss, duration of postoperative drainage, total amount of postoperative drainage, as well as postoperative hospital stay, were recorded and studied.Results All 170 laparoscopic nephrectomies using LigaSure were accomplished successfully without conversion to open surgery. There was no severe vascular complication or other serious complications. The mean laparoscopic operating time was 124.2 minutes (range, 14-230 minutes); mean blood loss was 148.6 ml (range, 20-540 ml); mean time for postoperative drainage was 3.1 days (range, 1-7 days); mean amount of postoperative drainage was 206.5 ml (range, 27-435 ml) and mean postoperative hospital stay was 6.9 days (range, 3-18 days).Conclusions Laparoscopic nephrectomy using LigaSure appears technically feasible and easy, and produces satisfactory results. The LigaSure provides a safe and fast way to seal vessels and tissue bundles during nephrectomy.

  3. 机器人辅助腹腔镜保留肾单位肾部分切除术(附6例报告)%Robot-assisted Laparoscopic Partial Nephrectomy (Report of 6 Cases)

    Institute of Scientific and Technical Information of China (English)

    徐阿祥; 张旭; 周秀彬; 高江平; 王威; 朱捷; 崔亮; 董隽; 陈文政; 卢锦山

    2009-01-01

    Objective:To summarize our clinical experience of robot-assisted laparoscopic partial nephrectomy (RALPN), and to discuss its efficacy and safety. Methods:Between December 2007 and October 2008, 6 patients with small exophytie renal masses underwent intraperitoneal robotic partial nephrectomy utilizing the Da Vinci sur-gical system. The perioperative data were collected, and were compared with those performed the same operation in abroad and those performed laparoseopic partial nephrectomy(LPN) with the same team in internal. Results: All the operations were accomplished successfully except the one which required conversion to open nephron-sparing surgery (NSS) due to bleeding occured after the renal artery had been clamped. The mean lesion diameter was 3.2 (2.2-3.6)cm; the mean operative time (not including preoperative set-up time of the Da Vinci surgical system) was 130 (110-160) minutes; the mean warm ischemia time were 40(33-50)minutes; the mean estimated blood loss was 188 (100-380) ml. The patients were ambulant in the 7th postoperative days, and tubes were removaled in 3 days, and mean hospital stay was 9 (8-12)days. Renal function of all patients was in the normal range. Pathology revealed renal cell carcinoma in five, papillary renal cell carcinoma in one. All resection margins were negative. Follow-up ranged from 4 to t5 months, no local residual lesions, local recurrence, incision implantation and dis-tant metastasis were found in all patients. Conclusions.. Robot-assisted laparoscopic partial nephrectomy can be safe-ly performed in selected patients, and it is a feasible approach and a minimally invasive operation for small renal tumors.%目的:总结我院机器人辅助腹腔镜保留肾单位肾部分切除术的手术经验,探讨此术式疗效及安全性.方法:2007年12月~2008年10月,对6例肾肿瘤患者行达·芬奇机器人(Da Vinci机器人手术系统)辅助腹腔镜保留肾单位肾部分切除术,将相关资料与国外此手术

  4. Research on modified loop ileostomy with single incision in low rectal cancer patients with laparoscopic radical resection of anus preservation%低位直肠癌腹腔镜下根治保肛术中改良襻式单一切口末端回肠造口定位的研究

    Institute of Scientific and Technical Information of China (English)

    方方; 王晓岚; 徐亚香

    2015-01-01

    Objective To investigate the influence of preoperative location of modified loop ileostomy with single incision on the complications and nursing of low rectal cancer patients with la-paroscopic radical resection of anus preservation.Methods The location of 78 patients with modi-fied preventive ileostomy with single incision was 2~3 cm above the McBurney point with 15~20° angular inside.Results There was one case with stoma hernias,three cases with stoma dermati-tis,four cases with stoma infection,more than 80% of the patients had no discomfort or had mild discomfort.Conclusion Correct preoperative location before stoma is easy to nurse and could re-duce the occurrence of stoma complications.%目的:观察直肠癌根治术单一切口预防性回肠造口术术前定位对患者术后造口并发症及护理的影响。方法对78例直肠癌根治术单一切口预防性回肠造口术患者进行术前于麦氏点上方2~3 cm,向内侧成15~20°角定位。结果本组发生造口旁疝1例,造口周围皮肤炎3例,造口感染4例,80%以上患者无不适或有轻度不适。结论造瘘口术前正确定位便于护理,可减少造口并发症的发生。

  5. 低位直肠癌腹腔镜下根治保肛术中改良襻式单一切口末端回肠造口定位的研究%Research on modified loop ileostomy with single incision in low rectal cancer patients with laparoscopic radical resection of anus preservation

    Institute of Scientific and Technical Information of China (English)

    方方; 王晓岚; 徐亚香

    2015-01-01

    目的:观察直肠癌根治术单一切口预防性回肠造口术术前定位对患者术后造口并发症及护理的影响。方法对78例直肠癌根治术单一切口预防性回肠造口术患者进行术前于麦氏点上方2~3 cm,向内侧成15~20°角定位。结果本组发生造口旁疝1例,造口周围皮肤炎3例,造口感染4例,80%以上患者无不适或有轻度不适。结论造瘘口术前正确定位便于护理,可减少造口并发症的发生。%Objective To investigate the influence of preoperative location of modified loop ileostomy with single incision on the complications and nursing of low rectal cancer patients with la-paroscopic radical resection of anus preservation.Methods The location of 78 patients with modi-fied preventive ileostomy with single incision was 2~3 cm above the McBurney point with 15~20° angular inside.Results There was one case with stoma hernias,three cases with stoma dermati-tis,four cases with stoma infection,more than 80% of the patients had no discomfort or had mild discomfort.Conclusion Correct preoperative location before stoma is easy to nurse and could re-duce the occurrence of stoma complications.

  6. LARVH与RAH治疗妇科恶性肿瘤临床疗效的Meta分析%Clinical Efficacy Comparison of Lapararoscopic Assisted Radical Vaginal Hysterectomy and Radical Abdominal Hysterectomy for the Treatment of Gynecologic Malignancies: a Meta-Analysis

    Institute of Scientific and Technical Information of China (English)

    徐玮; 滕银成

    2013-01-01

    目的:通过Meta分析综合评价腹腔镜辅助阴式根治性子宫切除术(LARVH)与经腹根治性子宫切除术(RAH)治疗妇科恶性肿瘤的临床疗效.方法:电子检索Cochrane Library、PubMed、Ovid、EMBASE、中国知网数据库(CNKI)、万方全文数据库、维普中文科技期刊数据库、中国生物医学文献数据库,并辅以手工检索.检索时间截至2012年6月,收集LARVH与RAH临床疗效比较的随机对照试验(RCT)或设计良好的回顾性临床对照试验(CCT).由两名研究者按Cochrane系统评价方法提取有效数据进行Meta分析.结果:共纳入7篇RCT,11篇CCT,共计4046例患者,其中LARVH组2280例,RAH组1766例.结果显示:LARVH与RAH相比,其术中失血量少(MD=-186.00,95% CI-292.48~-79.52,P=0.0006)、住院天数短(MD=-3.37,95% CI-4.23~-2.50,P=0.0000)、术后并发症发生率低(RR =0.60,95%CI0.46—0.79,P=0.0003),但术中并发症发生率高(RR =1.45,95%CI 1.15 ~ 1.82,P=0.0010);而在手术时间、淋巴结活检数、术后总体复发率方面比较,差异均无统计学意义(P>0.01).结论:运用LARVH治疗妇科恶性肿瘤在减少住院时间、降低手术失血量和术后并发症方面比RAH具有一定优势,但应注意降低术中并发症的发生.%Objective:To compare the clinical efficacy of lapararoscopic assisted radical vaginal hysterectomy ( LARVH) and radical abdominal hysterectomy( RAH) for the treatment of gynecologic malignancies by meta-analysis. Methods:Electronic searches of the Cochrane Libaray,PubMed, Ovid, EMBASE.CNKI, Wan-fang Databases,VIP Full-text Databases and CBMdisc Databases,supplemented by manual searches. Retrieval time as of June 2012,the studies included in the references of eligible studies were additionally searched randomized controlled trials (RCTs) or well-designed retrospective controlled clinical trails (CCTs) with the clinical efficacy of LARVH and RAH. All the data were extracted in the same way as Cochrane system

  7. The effect of esmolol on immune function and inflammatory response in patients undergoing laparoscopic radical resec-tion of rectal carcinoma%艾司洛尔对腹腔镜直肠癌根治术患者的免疫功能的影响

    Institute of Scientific and Technical Information of China (English)

    周志东; 王琳; 裴向东; 徐国海

    2014-01-01

    Objective To evaluate the effect of esmolol on immune function and inflammatory response in patients undergoing laparoscopic radical resection of rectal carcinoma. Methods 40 patients undergoing laparoscopic radical resection of rectal carci-noma were enrolled,all genders,age 40-70,ASAⅠ-Ⅱ,using random number table,patients were randomly divided into two groups (n=20):esmolol group (E group) and saline control group (group C). Immediately after induction of anaesthesia ,the patients in the esmolol group (n=20) were infused with a 0.3mg·kg-1 loading dose of esmolol followed by an infusion of 30μg·kg-1·min-1, whereas the patients in the saline group(n=20) were infused with 0.9%saline solution of the same volume. Peripheral venous blood samples were collected before induction of anesthesia (T0),at 2h after surgery began(T1) and at 2h after surgery(T2). The concentra-tions of IFN-γ,IL-4 and IL-6 were measured by ELISA,and determinate of CRP levels and WBC count,record the number of patients with WBC raised in the postoperative 1d (T4). Results Compared with T0,group C was associated with IFN-γand IFN-γ/IL-4 lower,IL-4 and IL-6 raised at T1,T2 (P0.05). Compared with group C,group E was associated with IFN-γand IFN-γ/IL-4 raised,IL-4 and IL-6 lower,CRP levels was decreased at T4(P0.05). Conclusion Esmolol played an immunomodulatory role and mitigated the postoperative inflammatory response in patients undergoing laparoscopic radical resection of rectal carcinoma.%目的:评价艾司洛尔对腹腔镜直肠癌根治术患者免疫功能及炎性反应的影响。方法择期在全麻下行腹腔镜直肠癌根治术患者40例,性别不限,年龄40-70岁,ASA分级Ⅰ-Ⅱ级,采用随机数字表法,将患者随机分为2组(n=20):艾司洛尔组(E组)和生理盐水对照组(C组)。 E组于气管插管即刻静脉注射艾司洛尔0.3mg/kg,随后以30μg/(kg·min)速度输注60min,C组以同样方法静脉输注等容量生理

  8. Superpixel-based structure classification for laparoscopic surgery

    Science.gov (United States)

    Bodenstedt, Sebastian; Görtler, Jochen; Wagner, Martin; Kenngott, Hannes; Müller-Stich, Beat Peter; Dillmann, Rüdiger; Speidel, Stefanie

    2016-03-01

    Minimally-invasive interventions offers multiple benefits for patients, but also entails drawbacks for the surgeon. The goal of context-aware assistance systems is to alleviate some of these difficulties. Localizing and identifying anatomical structures, maligned tissue and surgical instruments through endoscopic image analysis is paramount for an assistance system, making online measurements and augmented reality visualizations possible. Furthermore, such information can be used to assess the progress of an intervention, hereby allowing for a context-aware assistance. In this work, we present an approach for such an analysis. First, a given laparoscopic image is divided into groups of connected pixels, so-called superpixels, using the SEEDS algorithm. The content of a given superpixel is then described using information regarding its color and texture. Using a Random Forest classifier, we determine the class label of each superpixel. We evaluated our approach on a publicly available dataset for laparoscopic instrument detection and achieved a DICE score of 0.69.

  9. 进展期胃癌腹腔镜辅助与开放 D2根治术围手术期临床效果比较%Comparison of the perioperative clinical results of laparoscopy -assisted and open radi-cal D2 gastrectomy in advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    王进; 郭绍春; 樊林; 王海江; 周力波; 贾宗良; 车向明

    2016-01-01

    目的:比较腹腔镜辅助与开放 D2胃癌根治术手术、病理与术后恢复情况。方法:回顾性分析我科收治的202例胃癌患者。查阅电子病历系统,收集腹腔镜与开放胃癌根治术患者的病历资料,比较腹腔镜组和开放组手术时间、术中出血量、淋巴结清扫数目、术后并发症与术后恢复等相关指标。结果:与开放组相比,腹腔镜组术中出血量少[(90.63±78.66)vs (154.15±151.65)ml,P <0.001],淋巴结清扫数目相当[(21.4±10.5)vs (21.7±11.4)个,P =0.810],术后伤口脂肪液化发生少,术后通气时间早[(3.0±0.8)vs (3.5±1.0)天,P <0.001],术后进半流食时间早[(6.2±1.5)vs (6.8±2.3)天,P =0.028],术后住院时间短[(9.4±2.3)vs (11.3±3.0)天,P =0.022],仅手术时间稍长[(222±36)vs(205±62)min,P =0.021]。结论:在进展期胃癌 D2根治术中,虽然腹腔镜手术时间略长于开放组,总体而言,腹腔镜组能达到与开放手术相同的淋巴结清扫数目,且具有术中出血量少,术后恢复快的优势。%Objective:To compare the character of pathology,and postoperative between laparoscopic assisted D2 gastric cancer radical surgery and open D2 gastric cancer radical surgery for advanced gastric cancer.Methods:To choose 202 patients in our department from April 2014 to April 2015.Clinical dara of all 202 patients were studied retrospectively.The operation time,intraoperative blood loss,number of retrieved lymph node,time to first flatus,time to liquid diet,postoperative hospital stay,postoperative complications were compared between the two groups.Results:As compared with the open group,the bleeding amount of LAG group was significantly less[(90.63 ±78.66)vs (154.15 ±151.65)ml,P <0.001 ],no significantly diffrence was found in the number of rerieved lymph node [(21.4 ±10.5)vs (21

  10. Renal artery injury during robot-assisted renal surgery.

    Science.gov (United States)

    Lee, Jae Won; Yoon, Young Eun; Kim, Dae Keun; Park, Sung Yul; Moon, Hong Sang; Lee, Tchun Yong

    2010-07-01

    Laparoscopic partial nephrectomy (LPN) is becoming the standard of care for incidentally diagnosed, small renal tumors. With its seven degrees of freedom and three-dimensional vision, the DaVinci robotic surgical system has been used to assist in LPNs. The main disadvantage of robot-assisted surgery, however, is the lack of tactile feedback. We present a case of renal artery injury during robot-assisted renal surgery. Robot-assisted partial nephrectomy (RPN) was planned for 47-year-old man with a 3.5-cm right renal mass. After standard bowel mobilization, renal hilar dissection was performed. In the attempt to complete the dissection posteriorly, however, there was sudden profuse bleeding. The intraperitoneal pressure immediately increased to 20 mm Hg, and an additional suction device was inserted through the 5-mm liver retractor port. On inspection, there was an injury at the takeoff of the posterior segmental artery. A decision was made to convert to robot-assisted laparoscopic radical nephrectomy. The main renal artery and renal vein were controlled with Hem-o-Lok clips. The estimated blood loss was 2,000 mL. Four units of packed red blood cells were transfused intraoperatively. The post-transfusion hemoglobin level was 12.6 g/dL. There were no other perioperative complications. The surgeon should keep in mind that the robotic arms are very powerful and can easily injure major vessels because of lack of tactile feedback. A competent and experienced tableside surgeon is very important in robot-assisted surgery because the unsterile console surgeon cannot immediately react to intraoperative complications.

  11. Peritonitis: laparoscopic approach

    Directory of Open Access Journals (Sweden)

    Agresta Ferdinando

    2006-03-01

    Full Text Available Abstract Background Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment – exploration to identify the causative pathology and performance of an appropriate operation – can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution. Methods From January 1992 and January 2002 a total of 935 patients (mean age 42.3 ± 17.2 years underwent emergent and/or urgent surgery. Among them, 602 (64.3% were operated on laparoscopically (of whom 112 -18.7% – with peritonitis, according to the presence of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than two previous major abdominal surgeries or massive bowel distension were not treated Laparoscopically. Peritonitis was not considered contraindication to Laparoscopy. Results The conversion rate was 23.2% in patients with peritonitis and was mainly due to the presence of dense intra-abdominal adhesions. Major complications ranged as high as 5.3% with a postoperative mortality of 1.7%. A definitive diagnosis was accomplished in 85.7% (96 pat. of cases, and 90.6% (87 of these patients were treated successfully by Laparoscopy. Conclusion Even if limited by its retrospective feature, the present experience let us to consider the Laparoscopic approach to abdominal peritonitis emergencies a safe and effective as conventional surgery, with a higher diagnostic yield and allows for lesser trauma and a more rapid postoperative recovery. Such features make Laparoscopy a challenging alternative to open surgery in the management algorithm for abdominal

  12. Laparoscopic Distal Pancreatectomy

    OpenAIRE

    Misato Maeno; Alan Kawarai Lefor

    2015-01-01

    Laparoscopy became a major part of the surgical armamentarium in 1989, after the initial introduction of laparoscopic cholecystectomy in 1987. Following the incredibly rapid adoption of this approach to abdominal surgery, surgeons applied the techniques to an ever-widening variety of procedures. Notably lacking throughout this period were controlled trials to demonstrate at least equal outcomes with traditional approaches to surgery. Market forces and improvements in instruments and imaging t...

  13. Laparoscopic lumbar spine surgery

    OpenAIRE

    O’Dowd, J. K.

    2000-01-01

    The use of transperitoneal endoscopic approaches to the distal segments of the lumbar spine has recently been described. This has been the catalyst for the development of other minimally invasive anterior ¶approaches to the spine. This review looks at the published results so ¶far, and highlights the principles, techniques and complications. The limitations of laparoscopic approaches have meant that surgeons are moving on to endoscopic extraperitoneal and mini-open approaches, but important l...

  14. Laparoscopic donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Gupta Nitin

    2005-01-01

    Full Text Available Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN, by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.

  15. Robot-Assisted Gynecologic Oncology Surgery

    Medline Plus

    Full Text Available ... seeing a robotic-assisted laparoscopic gynecological case live. This very progressive and minimally invasive approach will be ... and the lymph nodes in the pelvis. And this has been the mainstay treatment for uterine cancer ...

  16. Robot-Assisted Gynecologic Oncology Surgery

    Medline Plus

    Full Text Available ... Florida. You're just minutes away from seeing a robotic-assisted laparoscopic gynecological case live. This very ... will be performed by Dr. Kelly L. Molpus, a gynecological oncologist at Halifax Health and moderated by ...

  17. Sex differences in laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Thesbjerg, Simon E; Harboe, Kirstine Moll; Bardram, Linda;

    2010-01-01

    Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relations...

  18. Laparoscopic hernioplasty of hiatal hernia

    Science.gov (United States)

    Yang, Xuefei; Hua, Rong; He, Kai; Shen, Qiwei

    2016-01-01

    Laparoscopic surgery is a good choice for surgical treatment of hiatal hernia because of its mini-invasive nature and intraperitoneal view and operating angle. This article will talk about the surgical procedures, technical details, precautions and complications about laparoscopic hernioplasty of hiatal hernia. PMID:27761447

  19. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

    Svenningsen, Peter Olsen; Bulut, Orhan; Jess, Per

    2010-01-01

    of Hartmann's procedure as safely as in open surgery and with a faster recovery, shorter hospital stay and less blood loss despite a longer knife time. It therefore seems reasonable to offer patients a laparoscopic procedure at departments which are skilled in laparoscopic surgery and use it for standard...

  20. Laparoscopic colopexy in a horse

    OpenAIRE

    Butt, Troy D.; Wilson, David G.

    2003-01-01

    An 11-year-old Trakehner gelding required 2 ventral midline celiotomies for correction of a large colon volvulus and a large colon displacement, respectively. Laparoscopic colopexy was performed 50 days following the 2nd celiotomy. Delayed laparoscopic colopexy is minimally invasive and does not disrupt the ventral midline incision following abdominal exploration.

  1. Visual enhancement of laparoscopic nephrectomies using the 3-CCD camera

    Science.gov (United States)

    Crane, Nicole J.; Kansal, Neil S.; Dhanani, Nadeem; Alemozaffar, Mehrdad; Kirk, Allan D.; Pinto, Peter A.; Elster, Eric A.; Huffman, Scott W.; Levin, Ira W.

    2006-02-01

    Many surgical techniques are currently shifting from the more conventional, open approach towards minimally invasive laparoscopic procedures. Laparoscopy results in smaller incisions, potentially leading to less postoperative pain and more rapid recoveries . One key disadvantage of laparoscopic surgery is the loss of three-dimensional assessment of organs and tissue perfusion. Advances in laparoscopic technology include high-definition monitors for improved visualization and upgraded single charge coupled device (CCD) detectors to 3-CCD cameras, to provide a larger, more sensitive color palette to increase the perception of detail. In this discussion, we further advance existing laparoscopic technology to create greater enhancement of images obtained during radical and partial nephrectomies in which the assessment of tissue perfusion is crucial but limited with current 3-CCD cameras. By separating the signals received by each CCD in the 3-CCD camera and by introducing a straight forward algorithm, rapid differentiation of renal vessels and perfusion is accomplished and could be performed real time. The newly acquired images are overlaid onto conventional images for reference and comparison. This affords the surgeon the ability to accurately detect changes in tissue oxygenation despite inherent limitations of the visible light image. Such additional capability should impact procedures in which visual assessment of organ vitality is critical.

  2. Laparoscopic Pancreas-Sparing Subtotal Duodenectomy

    Directory of Open Access Journals (Sweden)

    Ignasi Poves

    2011-01-01

    Full Text Available Context Primary adenocarcinoma of the duodenum is a rare digestive malignancy which is commonly treated by radical surgical resection, pancreaticoduodenectomy being the technique of choice. Complete tumor resection obtaining free margins should be the standard of treatment for primary adenocarcinoma of the duodenum. Segmental duodenal resection is an appropriate operation for selected cases of primary adenocarcinoma of the duodenum of the 3rd and 4th portions of the duodenum. Case report We present the case of a 67-year-old woman suffering from an infra-ampullary large villous polypoid mass affecting the 3rd portion of the duodenum. Multiple endoscopic biopsies did not disclose any malignancy, and abdominal CT and endoscopic ultrasound found no extraduodenal involvement. A 3rd and 4th portion pancreas-sparing duodenectomy was carried out using a totally laparoscopic approach. Intra-operatory duodenoscopy was done to safeguard the papilla of Vater. Recovery was uneventful and the patient was discharged on the 7th postoperative day. The final diagnosis was primary adenocarcinoma of the duodenum (free resection margins. After forty-five months of follow-up, the patient is free of disease. Conclusions We recommend this procedure for treatment of an infra-ampullary benign and pre-malignant duodenal pathology; it can also be a treatment option and an alternative to a pancreaticoduodenectomy in very selected cases of tumors confined to the duodenum. Expertise in both pancreatic surgery and laparoscopic techniques is required.

  3. 性活跃男性患者膀胱癌根治+回肠膀胱术后25例勃起功能现状调查%A survey on erectile function of 25 sexually active male patients receiving laparoscopic radical cystectomy and urete roileal urinary divertion

    Institute of Scientific and Technical Information of China (English)

    刘玖玲; 陈力; 曾光; 田斌群

    2014-01-01

    Objective To evaluate the erectile function in sexually active male patients receiving laparoscopic radical cystectomy (LRC) and ureteroileal urinary divertion to provide an additional reference for medical intervention .Methods From August 2010 to March 2012, 25 cases of bladder cancer patients who were married men underwent laparoscopic radical+ileal neobladder, all patients with the normal pre-operative sexual function , defined as sexually active males , 10 cases re-ceived neurological reservations bladder cancer radical +ileal neobladder and 15 patients received non-reserved neurological bladder cancer cure +ileal neobladder.Before surgery, assessed these 25 patients erectile function by using the International Index of Erectile Function Questionnaire (IIEF-5), after surgery combined with IIEF-5 with reference to male sexual function questionnaire (O’Leary 1995), self-designed questionnaire for post -operative erectile function and related survey were carried out.Results Compared with pre-operative, after 12 months, post-operative 25 cases were unable to achieve an erection can be inserted into the vagina.IIEF-5 total: Reserved neurological group of 10 patients from preoperative (20.60 ±2.22) points to postoperative (1.90 ±1.73) points, the non-reserved neurological group of 15 patients from preoperative (18.73 ±3.83) points to postoperative (3.20 ±4.87) points, there were significantly different between the two groups before and after surgery ( P 0.05).Conclusion There are higher incidence of erectile dysfunction after radical cystectomy and ureteroileal u -rinary divertion.%目的:调查性活跃男性患者行腹腔镜膀胱癌根治+回肠膀胱术后勃起功能的现状,为进一步采取医疗干预措施提供参考和依据。方法2010年8月-2012年3月接受腹腔镜膀胱癌根治+回肠膀胱术的25例已婚男性患者,术前性功能全部正常,定义其为性活跃男性,其中10例接受保留性神经膀胱

  4. Laparoscopic nephrectomy in a hemophilia B patient

    Science.gov (United States)

    Szopiński, Tomasz; Szczepanik, Andrzej B.; Sosnowski, Roman; Szczepanik, Anna M.

    2016-01-01

    Surgery in patients with hemophilia is a serious challenge. It requires a comprehensive approach, as well as careful postoperative monitoring. We present here the first case of a transperitoneal laparoscopic radical nephrectomy (TLRN) for renal cell carcinoma, of the clear-cell type, performed in a hemophilia B patient. The level of factor IX clotting activity before surgery and on postoperative days 1–6 was maintained at 65–130% and at 30–40% on subsequent days until healing of the post-operative wound was achieved. The intraoperative and postoperative courses were uneventful. TLRN can therefore be considered safe and effective for renal cell carcinoma. In hemophilia patients, the TLRN procedure requires proper preparation, as well as adequate substitution therapy for the deficient coagulation factor provided by a multidisciplinary team in a comprehensive center. PMID:27729993

  5. Comparison of Clinical Effects Between Vaginal Hysterectomy and Laparoscopically Assisted Vaginal Hysterectomy%阴式子宫切除术与腹腔镜辅助阴式子宫切除术的术式比较

    Institute of Scientific and Technical Information of China (English)

    鲁春雁

    2011-01-01

    Objective To evaluate clinical effects between vaginal hysterectomy (TVH) and laparoscopic assisted vaginal hysterectomy (LAVH). Methods From January to December 2010, a total of 86 patients with TVH (TVH group) and 92 patients with LAVH (LAVH group) were recruited into this study. Their clinical data before and after the operation were statistically analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Luoyang No. 3 People s Hospital. Informed consent was obtained from all participants. There were no statistical difference on pelvic operation history, gravidity, parity, anemia during pregnancy, and hysterauxesis (P^>0. 05). Results The operation time, blood loss volume and operation cost of TVH group was shorter, less, and lower than those of LAVH group (P 0. 05). None of serious complication was occurred. Conclusion Compared with LAVH, TVH has the advantage of shorter operative time, less blood loss and lower cost, but it is more adapted to whom the uterus is in 4-month pregnancy and without pelvic adhesions. LAVH expanded TVH s adaptation. We should choose appropriate way according to different clinical conditions for the best therapeutic effects.%目的 探讨阴式子宫切除术(TVH)和腹腔镜辅助阴式子宫切除术(LAVH)的临床效果及应用价值.方法 回顾性分析2007年1月至2010年12月在本院行TVH的86例患者(TVH组)与同期行LAVH的92例患者(LAVH组)的临床资料,对两组患者术中、术后情况进行统计学分析(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并与其签署临床研究知情同意书).两组患者既往盆腔手术史、孕次、产次,合并贫血及子宫增大(相应孕周)情况比较,差异无统计学意义(P>0.05).结果 TVH组患者手术时间、术中出血量及手术费用均较LAVH组短、少和低,两组比较,差异有统计学意义(P0.05).所有患者无一例中转开腹及

  6. Influences of curette assisted laparoscopic sacrocolpopexy on quality of life and sexual function of patients with pelvic organ prolapse%举宫杯辅助下腹腔镜骶骨阴道固定术对盆腔器官脱垂患者生活质量和性功能的影响

    Institute of Scientific and Technical Information of China (English)

    李顺双; 纪妹

    2015-01-01

    目的:探讨举宫杯辅助下腹腔镜骶骨阴道固定术(curette assisted laparoscopic sacrocolpopexy,CALS)对盆腔器官脱垂患者症状、生活质量和性功能的影响。方法选取郑州大学第一附属医院2010年1月至2013年5月收治的盆腔器官脱垂患者,其中59例行 CALS 治疗,62例行阴式辅助下腹腔镜骶骨阴道固定术(vaginally assisted laparoscopic sacro-colpopexy,VALS)治疗。采用盆底功能障碍问卷(Pelvic Floor Distress Inventory -short form 20,PFDI -20)、盆底障碍影响问卷(Pelvic Floor Impact Questionnaire -short form 7,PFIQ -7)、盆腔器官脱垂尿失禁性功能问卷(Pelvic organ prolapse u-rinary Incontinence Sexual Questionnaire -short form 12,PISQ -12)分别对患者症状、生活质量和性功能进行评分。术后随访1 a。结果两组患者术后1 a 的 PFDI -20总评分、PFIQ -7评分和 PISQ -12总评分较术前均有改善,差异有统计学意义(P <0.05),但组间差异无统计学意义(P >0.05)。结论举宫杯辅助下腹腔镜骶骨阴道固定术可改善盆腔器官脱垂患者的症状、生活质量和性功能,值得临床推广。%and sexual function of patients with pelvic organ prolapse.Methods Patients with pelvic organ prolapse treated with curette assis-ted laparoscopic sacrocolpopexy (CALS,59 cases)and vaginally assisted laparoscopic sacrocolpopexy (VALS,62 cases)in the First Affiliated Hospital of Zhengzhou University from January of 2010 to May of 2013 were selected.Validated questionnaire were used to evaluate symptoms(PFDI -20)、HRQL(PFIQ -7)and sexual function(PISQ -12).The follow -up period was 1 year.Re-sults There was a significant improve in PFDI -20 total scores,PFIQ -7 scores and PISQ -12 total scores in both groups (P 0.05).Conclusion CALS had a positive impact on the symptoms,quality of life and sexual function of patients with pelvic organ prolapse.It deserves the

  7. Laparoscopic Heller's cardiomyotomy.

    LENUS (Irish Health Repository)

    Doodnath, R

    2012-02-01

    Achalasia is a rare motility disorder which causes failure of relaxation of the lower oesophageal sphincter (LES) and is thought to affect 0.31\\/100,000 children per year in Ireland. The classic presentation is difficulty swallowing and vomiting undigested food, and children can often present with chest pain. In some instances, these symptoms can lead to considerable weight loss. In this report, we present 2 cases of patients with achalasia who have also been the first 2 cases of laparoscopic Heller\\'s cardiomyotomy performed in children in the Republic of Ireland.

  8. Laparoscopic trans-peritoneal pyelolithotomy in a pelvic kidney

    Directory of Open Access Journals (Sweden)

    Shahnawaz Ahangar

    2012-01-01

    Full Text Available Urinary lithiasis is one of the most common and the oldest known afflictions of the urinary tract. The management of renal stones has undergone radical changes in recent years, the latest being the minimally invasive procedures like extra-corporeal shock wave lithotripsy and percutaneous nephrolithotomy, making the open surgical procedures relatively obsolete. However, there are situations where the above-mentioned minimally invasive procedures prove to be lacking in achieving the cure; laparoscopic pyelolithotomy caters to such group of patients, e.g. the presence of calculi in malrotated or malpositioned kidneys. Herein, we report a case of pelvic kidney with a large calculus managed by laparoscopic trans-peritoneal pyelolithotomy.

  9. Laparoscopic trans-peritoneal pyelolithotomy in a pelvic kidney.

    Science.gov (United States)

    Ahangar, Shahnawaz; Durrani, Abdul Munnon; Qadri, Syed Javid; Patloo, Asim Mushtaq; Ganaie, Rouf Gul; Khan, Muneer

    2012-11-01

    Urinary lithiasis is one of the most common and the oldest known afflictions of the urinary tract. The management of renal stones has undergone radical changes in recent years, the latest being the minimally invasive procedures like extra-corporeal shock wave lithotripsy and percutaneous nephrolithotomy, making the open surgical procedures relatively obsolete. However, there are situations where the above-mentioned minimally invasive procedures prove to be lacking in achieving the cure; laparoscopic pyelolithotomy caters to such group of patients, e.g. the presence of calculi in malrotated or malpositioned kidneys. Herein, we report a case of pelvic kidney with a large calculus managed by laparoscopic trans-peritoneal pyelolithotomy. PMID:23168860

  10. Robotic versus laparoscopic surgery in gynecology: which should we use?

    Science.gov (United States)

    Fanfani, Francesco; Restaino, Stefano; Ercoli, Alfredo; Chiantera, Vito; Fagotti, Anna; Gallotta, Valerio; Monterossi, Giorgia; Cappuccio, Serena; Scambia, Giovanni

    2016-08-01

    This review of the literature aims at assessing the safety and effectiveness of robotic versus laparoscopic surgery in benign and malignant gynecological diseases. Robotic-assisted laparoscopy is already widely used in the United States and Europe for the main gynecological procedure - hysterectomy - and has proved feasible and comfortable for other benign and malignant gynecological procedures. However, the clinical effectiveness and safety of robotic surgery compared with standard laparoscopy have not been undoubtedly established. We reviewed the literature by searching in the Ovid/MEDLINE, PubMed, Cochrane Library, and Google Scholar databases for all the articles published from January 1995 to September 2015. More rigorous experimental studies are needed, that compare robotic-assisted surgery and laparoscopic surgery for gynecological diseases. However, current data seem to encourage the use of minimally-invasive surgery to treat benign and malignant gynecological diseases. PMID:26633042

  11. Experimental laparoscopic aortobifemoral bypass.

    Science.gov (United States)

    Dion, Y M; Chin, A K; Thompson, T A

    1995-08-01

    The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass. Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor. Using this approach, we performed four aorto-bifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.

  12. Electrochemically assisted Fenton reaction : reaction of hydroxyl radicals with xenobiotics followed by on-line analysis with high-performance liquid chromatography/tandem mass spectrometry

    NARCIS (Netherlands)

    Jurva, U; Wikstrom, HV; Bruins, AP

    2002-01-01

    Oxygen radicals are generated in vivo by various processes, often as toxic intermediates in different metabolic transformations, and have been shown to play an important role for a large number of diseases. In this article we introduce an electrochemical flow-through system that allows generation of

  13. Mini-laparoscopic versus laparoscopic approach to appendectomy

    Directory of Open Access Journals (Sweden)

    Kercher Kent W

    2001-10-01

    Full Text Available Abstract Background The purpose of this clinical study is to evaluate the feasibility of using 2-mm laparoscopic instruments to perform an appendectomy in patients with clinically suspected acute appendicitis and compare the outcome of this mini-laparoscopic or "needlescopic" approach to the conventional laparoscopic appendectomy. Methods Two groups of patients undergoing appendectomy over 24 months were studied. In the first group, needlescopic appendectomy was performed in 15 patients by surgeons specializing in advanced laparoscopy. These patients were compared with the second or control group that included 21 consecutive patients who underwent laparoscopic appendectomy. We compared the patients' demographic data, operative findings, complications, postoperative pain medicine requirements, length of hospital stay, and recovery variables. Differences were considered statistically significant at a p-value Results Patient demographics, history of previous abdominal surgery, and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. No postoperative morbidity or mortality occurred in either group. The needlescopic group had a significantly shorter mean operative time (p = 0.02, reduced postoperative narcotics requirements (p = 0.05, shorter hospital stay (p = 0.04, and quicker return to work (p = 0.03 when compared with the laparoscopic group. Conclusions We conclude that the needlescopic technique is a safe and effective approach to appendectomy. When performed by experienced laparoscopic surgeons, the needlescopic technique results in significantly shorter postoperative convalescence and a prompt recovery.

  14. LAPAROSCOPIC RESECTION IN COLORECTAL CANCER

    Institute of Scientific and Technical Information of China (English)

    Reinhard Bittner

    2005-01-01

    @@ 1 Introduction The feasibility of colon resection using the laparoscope was demonstrated as early as 1991[1~3]. It was shown one year later that it is also possible to use the laparoscope in abdominoperineal resection of the rectum for rectal carcinoma[4, 5]. One year after this, the first study was reported in which the results of anterior resection with the laparoscope were compared with the conventional operation in a small number of patients with carcinoma of the rectum[6]. The first reports on the feasibility of total excision of the mesorectum in patients with carcinoma of the middle or lower third of the rectum were first published at the start of this century[7~9]. It can be stated in summary that resection of the colon or rectum using the laparoscope is not of disadvantage to the patient, given that the surgeon has appropriate experience and the patient has been properly selected.

  15. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

    Svenningsen, Peter Olsen; Bulut, Orhan; Jess, Per

    2010-01-01

    A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients.......A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients....

  16. Report of an unusual renal mass:Primary renal lympho-ma---Difficult procedure for laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    Seyedeh Atefeh Emadi; Marzieh Akbarpour; Shahram Azhdari

    2008-01-01

    Lymphomas form a heterogenous group of clonal(neoplastic)diseases.Primary renal lymphoma(PRL)is rare. Diagnosis of primary renal lymphoma is important for the patients to receive appropriate therapy.Laparoscopic nephrectomy should be the standard procedure in most cases of both malignant and benign,renal tumors with the possible exception of tumor >10cm.Probably this case report of laparoscopic surgery of primary renal lym-phoma is the first report of this kind and may be useful for the other laparoscopic surgeons.A 53 years-old man with unilateral primary renal lymphoma who had a history of renal colic and ESWL(Extracorporeal Shock Wave Lithotripsy)of the left kidney stone 3 years ago,he underwent laparoscopic radical left nephrectomy and chem-otherapy.The patient was monitored for follow up for 4 months and had a significant improvement.Although treatment of lymphoma is now guided by phenotype of tumor,we found that appropriate treatment is possible af-ter radical nephrectomy and assessment of pathology.Renal lesions may compeletly regress by appropriate treatment.There was not any report of laparoscopic surgery of PRL in our literature.We are reporting the first case of successful laparoscopic surgery of PRL successfully.

  17. Pancreatic insulinomas:laparoscopic management

    Institute of Scientific and Technical Information of China (English)

    Pantelis; T; Antonakis; Hutan; Ashrafian; Alberto; Martinez-Isla

    2015-01-01

    Insulinomas are rare pancreatic neuroendocrine tumors that are most commonly benign,solitary,and intrapancreatic. Uncontrolled insulin overproduction from the tumor produces neurological and adrenergic symptoms of hypoglycemia. Biochemical diagnosis is confirmed by the presence of Whipple’s triad,along with corroborating measurements of blood glucose,insulin,proinsulin,C-peptide,β-hydroxybutyrate,and negative tests for hypoglycemic agents during a supervised fasting period. This is accompanied by accurate preoperative localization using both invasive and non-invasive imaging modalities. Following this,careful preoperative planning is required,with the ensuing procedure being preferably carried out laparoscopically. An integral part of the laparoscopic approach is the application of laparoscopic intraoperative ultrasound,which is indispensable for accurate intraoperative localization of the lesion in the pancreatic region. The extent of laparoscopic resection is dependent on preoperative and intraoperative findings,but most commonly involves tumor enucleation or distal pancreatectomy. When performed in an experienced surgical unit,laparoscopic resection is associated with minimal mortality and excellent long-term cure rates. Furthermore,this approach confers equivalent safety and efficacy rates to open resection,while improving cosmesis and reducing hospital stay. As such,laparoscopic resection should be considered in all cases of benign insulinoma where adequate surgical expertise is available.

  18. Laparoscopic Drainage of Pancreatic Pseudocysts

    Directory of Open Access Journals (Sweden)

    Filip Eugen Târcoveanu

    2015-09-01

    Full Text Available Pancreatic pseudocyst is a complication of acute or chronic pancreatitis. The invasive treatment (surgical or endoscopic is recommended if the pseudocyst persisted for more than 6 weeks after the diagnosis and if the size is larger than 6 cm and is symptomatic. The laparoscopic techniques have been developed to provide the patient with the benefits of a minimal access alternative. The aim of this article is to analyze the postoperative results of the pancreatic pseudocyst laparoscopic surgery. We have accomplished a restrospective study using clinical and para-clinical test results and postoperative results from the patients who have been treated with laparoscopic drainage. We reported a case of a large symptomatic pseudocyst after an attack of gallstone pancreatitis. Laparoscopic cholecystectomy and extern drainage have been performed at the same time with good postoperative results. Starting with year 2000 until year 2015, 85 patients, diagnosed with pancreatic pseudocyst, have been treated in the First Surgical Clinic, University Hospital Saint Spiridon Iasi. From which only 8 have been treated with laparoscopic drainage, encountering no mortality and morbidity. Postoperative hospital stay was 9,41 days. The postoperative drainage duration was between 5 and 21 days with a mean of 7 days. Late postoperative results were good in 6 patients and mediocre in the 2 patients. Conclusion: The laparoscopic technique has all the benefits of the minimal invasive approach. Better postoperative results were seen in cysto-digestive anastomosis using a Endo GIA stapler.

  19. [Laparoscopic surgery for esophageal achalasia].

    Science.gov (United States)

    Ozawa, S; Ando, N; Ohgami, M; Kitagawa, Y; Kitajima, M

    2000-04-01

    Laparoscopic surgery for esophageal achalasia was first reported by Shimi et al. in 1991. Subsequently the procedure has been performed all over the world and laparoscopic Heller myotomy and Dor fundoplication (Heller and Dor operation) is now thought to be the operation of first choice. It is indicated for patients who are resistant to medical therapy (calcium blocker etc.) or have pneumatic dilatation and those with frequent aspiration at night. As Csendes et al. reported that surgical treatment was better than pneumatic dilatation and as laparoscopic surgery is less invasive, the indications for the laparoscopic Heller and Dor operation can include all achalasia patients except those who respond to medical therapy, do not accept surgery, or cannot tolerate surgery. We successfully performed the laparoscopic Heller and Dor operation on 22 patients, all of whom had an uneventful postoperative course. Manometric evaluation, endoscopic examination, and 24-hour pH monitoring showed good results. There are six important technical points: 1) flexible laparoscopy; 2) pneumoperitoneum; 3) gauze in the abdominal cavity to absorb blood; 4) laparosonic coagulating shears; 5) extracorporeal knot-tying technique; and 6) intracorporeal knot-tying technique. If an experienced surgeon is in charge, the laparoscopic Heller and Dor operation is an ideal, minimally invasive treatment for esophageal achalasia.

  20. Laparoscopic adrenalectomy: Single centre experience.

    LENUS (Irish Health Repository)

    O'Farrell, N J

    2012-02-01

    BACKGROUND: Laparoscopic adrenalectomy is an attractive alternative to the traditional open approach in the surgical excision of an adrenal gland. It has replaced open adrenalectomy in our institution and we review our experience to date. METHODS: All cases of laparoscopic adrenalectomies in our hospital over eight years (from 2001 to May 2009) were retrospectively reviewed. Patient demographics, diagnosis, length of hospital stay, histology and all operative and post-operative details were evaluated. RESULTS: Fifty-five laparoscopic adrenalectomies (LA) were performed on 51 patients over eight years. The mean age was 48 years (Range 16-86 years) with the male: female ratio 1:2. Twenty-three cases had a right adrenalectomy, 24 had a left adrenalectomy and the remaining four patients had bilateral adrenalectomies. 91% were successfully completed laparoscopically with five converted to an open approach. Adenomas (functional and non functional) were the leading indication for LA, followed by phaeochromocytomas. Other indications for LA included Cushing\\'s disease, adrenal malignancies and rarer pathologies. There was one mortality from necrotising pancreatitis following a left adrenalectomy for severe Cushing\\'s disease, with subsequent death 10 days later. CONCLUSION: Laparoscopic adrenalectomy is effective for the treatment of adrenal tumours, fulfilling the criteria for the ideal minimally invasive procedure. It has replaced the traditional open approach in our centre and is a safe and effective alternative. However, in the case of severe Cushing\\'s disease, laparoscopic adrenalectomy has the potential for significant adverse outcomes and mortality.

  1. Nursing matching of robot-assisted radical cystectomy and ileum neobladder%全机器人辅助膀胱根治性切除原位回肠新膀胱术的护理配合

    Institute of Scientific and Technical Information of China (English)

    王涛; 吕娜; 李凤云

    2013-01-01

    Objective To explore the nursing process of robot-assisted radical cystectomy and ileum neobladder so as to improve the quality of nursing matching.Methods Preoperative preparation,intra-operative positioning and cooperation,and peri-operative management of devices were managed by cooperating with six cases of robot-assisted radical cystectomy and ileum neobladder.Results All six operative procedures were successfully performed with no conversion to open surgery and high satisfaction of cooperation.Conclusions Preoperative preparation,reasonable layouts in the operation room,practiced operative procedures and close cooperation are the keys of the success of robot-assisted operations.%目的 探讨全机器人辅助下膀胱根治性切除原位回肠新膀胱手术的护理配合流程,提高护士的手术配合质量.方法 通过配合6例行全机器人辅助下膀胱根治性切除原位回肠新膀胱手术,对术前物品准备、术中体位摆放和手术配合及围手术期器械进行护理管理.结果 6例手术顺利完成,无中转开腹,手术配合满意.结论 充分的术前准备,合理的手术间布局,熟练的手术操作步骤,密切的术中配合是确保全机器人辅助手术成功的关键.

  2. Sleep after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Skarbye, M; Wildschiødtz, G;

    1996-01-01

    .01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative...... compared with the preoperative night. Comparison of our results with previous studies on SWS and REM sleep disturbances after open laparotomy, suggests that the magnitude of surgery or administration of opioids, or both, may be important factors in the development of postoperative sleep disturbances.......The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration...

  3. Pain characteristics after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette A; Strandfelt, Pernille; Rosenberg, Jacob;

    2011-01-01

    Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study...

  4. Laparoscopic Anti-Reflux (GERD) Surgery

    Science.gov (United States)

    ... Exhibit Opportunities Sponsorship Opportunities Login Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Print PDF Find ... to have laparoscopic anti-reflux surgery What is Gastroesophageal Reflux Disease (GERD)? Although “heartburn” is often used to ...

  5. 腹腔镜辅助根治长段型巨结肠远期疗效观察%Long-term outcomes of laparoscopic-assisted endorectal pull-through for long-segment Hirschsprung's disease

    Institute of Scientific and Technical Information of China (English)

    郑百俊; 王怀杰; 高亚; 黄强; 潘伟康; 段怡涛; 李鹏; 郭正团; 郭新奎

    2015-01-01

    目的 评价腹腔镜辅助治疗小儿长段型巨结肠的远期疗效.方法 对2001年9月至2009年12月在本院行腹腔镜治疗的长段型巨结肠患儿的临床资料进行回顾性分析,包括一般资料、手术方式、术后并发症、后续治疗及随访结果.随访内容包括排便控制、便秘和小肠结肠炎的发病情况等.结果 8年间共治疗长段型巨结肠患儿65例,男48例,女17例,一期手术26例(一期手术组),二期手术39例(二期手术组).术后早期严重并发症包括吻合口漏1例,拖出肠管扭转1例.主要中期并发症为便秘5例(IND4例,获得性巨结肠1例).术后小肠结肠炎发生率两组相近(一期手术组15.4%,二期手术组10.3%).一期手术组再手术率26.9%,再拖出手术率19.2%,二期组再手术率7.7%,再拖出手术率2.6%.术后随访5年以上病例51例(一期手术组19例,二期手术组32例).大多数患儿排便3d1次至4次/d,污粪3例(5.9%),无大便失禁.便秘2例(3.9%).两组远期排便功能Reding评分相近(优:一期手术组73.7%,二期手术组75.0%;良:一期手术组26.3%,二期手术组25.0%).29例来院复查钡灌肠及肛门直肠测压检查,均未引出肛门直肠抑制反射,2例便秘患儿(合并IND)回盲部扩张明显,3例污粪患儿钡灌肠造影及肛门直肠测压过程中可见钡剂和灌注液外溢,此5例患儿(便秘2例,污粪3例)肛管静息压低于其他患儿.结论 腹腔镜手术辅助根治长段型巨结肠术后可获得较好的排便控制功能,对新生儿、婴儿长段型HD推荐二期手术.%Objective To evaluate the long-term outcomes of laparoscopic-assisted endorectal pull-through (LAPT) for long-segment type Hirschsprung' s disease (HD).Methods From September 2001 to December 2009, a total of 65 patients with long-segment HD undergoing LAPT were recruited.There were 48 males and 17 females.And major postoperative complications, subsequent treatment, present bowel function

  6. 腹腔镜辅助与开腹远端胃癌根治术对比研究的荟萃分析%Meta-analysis of laparoscopic-assisted versus open distal gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    徐晓武; 陈钶; 张人超; 王捷; 牟一平

    2013-01-01

    Objective To evaluate the safety and cfficacy of laparoscopic-assisted distal gastrectomy (LADG) for gastric cancer through a meta-analysis of LADG versus open distal gastrectomy (ODG).Methods Comparative studies of LADG and ODG wer collected from Pubmed,Cochrane library,Web of Science and Biosis Previews Databases between January 1995 and October 2012.The data of operative duration,blood loss volume,number of harvested lymph node,proximal and distal resection margins,time to flatus,time to first oral intake,postoperative hospital stay,postoperative morbidity and 5-year survival rate were analyzed.And statistical analysis was performed with RevMan 5.1 software.Results A total of 16 articles were analyzed.There were 4 randomized controlled trials and 12 retrospective observational reports.Among a total of 2854 patients with gastric cancer,1441 LADG and 1413 ODG subjects wereincluded.Compared with ODG,LADG resulted in significantly prolonged operative duration (weighted mean difference (WMD) =49.09 min,P < 0.01),less blood loss volume (WMD =-118.99 ml,P < 0.01),less time to flatus (WMD =-0.58 d,P < 0.01) and oral intake (WMD =-0.61 d,P < 0.01),shortened postoperative hospital stay (WMD =-2.48 d,P < 0.01) and less postoperative morbidity (relative risk (RR) =0.62,P < 0.01).Distal resection margin did not differ significantly between LADG and ODG (WMD =-0.01 cm,P =0.94) while proximal resection margin was significantly shorter in the LADG group (WMD =-0.83 cm,P < 0.01).The number of harvested lymph node was significantly lesser in the LADG group than that in ODG group (WMD =-2.17,P =0.05).However,no significant difference existed when only analyzing the papers published over the last 5 years or having over 50 LADG cases (all P > 0.05).Furthermore,the 5-year survival rate did not differ significantly between two groups (RR =1.02,P =0.52).Conclusion As a safe and practical procedure with less blood loss volume,fewer overall complications and a quicker

  7. Radical Evil

    Directory of Open Access Journals (Sweden)

    Carlos Manrique

    2007-12-01

    Full Text Available There is an aporia in Kant’s analysis of evil: he defines radical evilas an invisible disposition of the will, but he also demands an inferential connection between visible evil actions and this invisible disposition. This inference,however, undermines the radical invisibility of radical evil according to Kant’s own definition of the latter. Noting how this invisibility of moral worth is a distinctive feature of Kant’s approach to the moral problem, the paper then asks why, in the Groundwork, he nonetheless forecloses a question about evil that seems to be consistent with this approach. It is argued that to account for this aporia and this foreclosure, one has to interrogate the way in which the category of religion orients Kant’s incipient philosophy of history in Die Religion.

  8. Cirugía laparoscópica en las enfermedades colorrectales Laparoscopic surgery in colorectal diseases

    Directory of Open Access Journals (Sweden)

    E. Balén

    2005-01-01

    Full Text Available Se presenta el estado actual de la cirugía laparoscópica en las enfermedades colorrectales, que muestra resultados superiores a la cirugía abierta en estancia hospitalaria, infección de herida y calidad de vida en el primer mes postoperatorio. Las indicaciones son cualquier enfermedad colorrectal. Todas las técnicas de resección colorrectal son técnicamente realizables con cirugía laparoscópica asistida. Las contraindicaciones son dependientes sobre todo del estado del paciente y de su enfermedad: la laparoscopia urgente de colon y recto apenas tiene sitio en el armamentario terapéutico. Sin embargo, la cirugía programada aporta una gran cantidad de casos, incluyendo también el cáncer de colon, cuyo abordaje laparoscópico se contraindica sólo si hay afectación de órganos vecinos o si la cirugía por laparoscopia no es radical y oncológica, por razones del caso o de falta de técnica del equipo quirúrgico, dado que los resultados de curación de cáncer son idénticos a la cirugía abierta, con nivel I de evidencia científica. Están en estudio los resultados de curación y supervivencia de la cirugía laparoscópica del cáncer de recto. Se describen los detalles de técnica quirúrgica de las colectomías derecha e izquierda, de las resecciones laparoscópicas del recto y de la colectomía total.The present state of laparoscopic surgery in colorectal diseases is presented, showing results that are superior to open surgery during the hospital stay, infection of the wound and quality of life in the first postoperative month. It is technically possible to carry out all of the techniques of colorectal resection with assisted laparoscopic surgery. The counter-indications depend above all on the state of the patient and his disease: emergency laparoscopy of the colon and rectum barely have a place in the therapeutic arsenal. However, elective surgery contributes a great number of cases, as well as colon cancer, whose laparoscopic

  9. Retroperitoneoscopic laparo-endoscopic single-site radical nephrectomy (RLESS-RN): initial experience with a homemade port

    Science.gov (United States)

    2011-01-01

    We successfully performed 6 LESS radical nephrectomy via the retroperitoneal approach (RLESS) using the Alexis wound retractor as a single access with conventional laparoscopic instruments. The results demonstrated that our RLESS technique of radical nephrectomy is a safe and feasible procedure for management of localized renal cancer. PMID:22035163

  10. Retroperitoneoscopic laparo-endoscopic single-site radical nephrectomy (RLESS-RN: initial experience with a homemade port

    Directory of Open Access Journals (Sweden)

    Chung Shiu-Dong

    2011-10-01

    Full Text Available Abstract We successfully performed 6 LESS radical nephrectomy via the retroperitoneal approach (RLESS using the Alexis wound retractor as a single access with conventional laparoscopic instruments. The results demonstrated that our RLESS technique of radical nephrectomy is a safe and feasible procedure for management of localized renal cancer.

  11. Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Arshad Rashid

    2015-01-01

    Full Text Available Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47% patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot’s triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

  12. Computer-based endoscopic image-processing technology for endourology and laparoscopic surgery

    International Nuclear Information System (INIS)

    Endourology and laparoscopic surgery are evolving in accordance with developments in instrumentation and progress in surgical technique. Recent advances in computer and image-processing technology have enabled novel images to be created from conventional endoscopic and laparoscopic video images. Such technology harbors the potential to advance endourology and laparoscopic surgery by adding new value and function to the endoscope. The panoramic and three-dimensional images created by computer processing are two outstanding features that can address the shortcomings of conventional endoscopy and laparoscopy, such as narrow field of view, lack of depth cue, and discontinuous information. The wide panoramic images show an anatomical map' of the abdominal cavity and hollow organs with high brightness and resolution, as the images are collected from video images taken in a close-up manner. To assist in laparoscopic surgery, especially in suturing, a three-dimensional movie can be obtained by enhancing movement parallax using a conventional monocular laparoscope. In tubular organs such as the prostatic urethra, reconstruction of three-dimensional structure can be achieved, implying the possibility of a liquid dynamic model for assessing local urethral resistance in urination. Computer-based processing of endoscopic images will establish new tools for endourology and laparoscopic surgery in the near future. (author)

  13. Microwave-Assisted Improved Regioselective Synthesis of 12H-Benzopyrano[3,2-c][1]benzopyran-5-ones by Radical Cyclisation

    Directory of Open Access Journals (Sweden)

    Pradipta Kumar Basu

    2011-01-01

    Full Text Available Two new effective methodologies have been adopted for the preparation of 4-(2′-bromobenzyloxybenzopyran-7-ones 3(a–h. In the first methodology, 4-hydroxy[1]benzopyran-2-ones 1(a–d was alkylated with 2-bromobenzyl bromide 2a or 2-bromo-5-methoxy benzyl bromide 2b under phase transfer catalysis condition using lithium hydroxide/tetrabutyl ammonium bromide in N,N-dimethylformamide at 40–50°C and in the second method the microwave irradiation protocol has been exploited by simply mixing of 4-hydroxy[1]benzopyran-2-ones 1(a–d with 25% excess of 2-bromobenzyl bromide 2a or 2-bromo-5-methoxy benzyl bromide 2b. A catalytic amount of TBAB and potassium carbonate were added and irradiated in an open Erlenmeyer flask in a microwave oven for 4–10 min. The tributyltin-hydride-mediated radical cyclisation of 3(a–h was carried out under microwave irradiation to generate 12H-benzopyrano[3,2-c][1]benzopyran-5-ones 4(a–h in 78–88% yield and in this technique yields were significantly improved and reaction time was shortened compared to the previously reported conventional radical cyclisation method.

  14. Laparoscopic nephrectomy in children: Initial experience

    Directory of Open Access Journals (Sweden)

    Shankar Gowri

    2006-01-01

    Full Text Available Aims: Our objective was to evaluate the feasibility and efficacy of laparoscopic nephrectomy in infants and children. Materials and Methods: From 2000 to 2005, 28 children, aged 3 months to 14 years underwent laparoscopic nephrectomy, laparoscopic nephroureterectomy and heminephrectomy. Medical records were reviewed retrospectively for clinically relevant data. Results: There were no conversions. Mean operating time was 75 minutes and there were no intraoperative complications in our series. Cosmetic results were excellent in all cases. Average hospital stay was 4 days. Conclusions: Laparoscopic nephrectomy, laparoscopic nephroureterectomy and heminephrectomy may be safely performed in infants and children with minimal morbidity, post-operative discomfort and improved cosmesis.

  15. Hemodynamic changes during robotic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Vanlal Darlong

    2012-01-01

    Full Text Available Background: Effect on hemodynamic changes and experience of robot-assisted laparoscopic radical prostatectomy (RALRP in steep Trendelenburg position (45° with high-pressure CO 2 pneumoperitoneum is very limited. Therefore, we planned this prospective clinical trial to study the effect of steep Tredelenburg position with high-pressure CO 2 pneumoperitoneum on hemodynamic parameters in a patient undergoing RALRP using FloTrac/Vigileo™1.10. Methods: After ethical approval and informed consent, 15 patients scheduled for RALRP were included in the study. In the operation room, after attaching standard monitors, the radial artery was cannulated. Anesthesia was induced with fentanyl (2 μg/kg and thiopentone (4-7 mg/kg, and tracheal intubation was facilitated by vecuronium bromide (0.1 mg/kg. The patient′s right internal jugular vein was cannulated and the Pre Sep™ central venous oximetry catheter was connected to it. Anesthesia was maintained with isoflurane in oxygen and nitrous oxide and intermittent boluses of vecuronium. Intermittent positive-pressure ventilation was provided to maintain normocapnea. After CO 2 pneumoperitoneum, position of the patient was gradually changed to 45° Trendelenburg over 5 min. The robot was then docked and the robot-assisted surgery started. Intraoperative monitoring included central venous pressure (CVP, stroke volume (SV, stroke volume variation (SVV, cardiac output (CO, cardiac index (CI and central venous oxygen saturation (ScvO 2 . Results: After induction of anesthesia, heart rate (HR, SV, CO and CI were decreased significantly from the baseline value (P>0.05. SV, CO and CI further decreased significantly after creating pneumoperitoneum (P>0.05. At the 45° Trendelenburg position, HR, SV, CO and CI were significantly decreased compared with baseline. Thereafter, CO and CI were persistently low throughout the 45° Trendelenburg position (P=0.001. HR at 20 min and 1 h, SV and mean arterial blood pressure

  16. Radical nephroureterectomy and cystectomy for ureteral tumor and bladder mixed tumor by laparoscopic combined open surgery%腹腔镜及开放根治性肾输尿管膀胱切除术治疗输尿管癌合并膀胱混合癌1例报告及文献回顾分析

    Institute of Scientific and Technical Information of China (English)

    李国成; 屈卫星; 程永毅; 季晶; 刘全海

    2012-01-01

    Objective;To evaluate the safety and availability of laparoscopic and open radical nephroureterocystec-tomy to the patients with tumors of ureteral tumor complicating with bladder cancer. Methods: Followed up 1 patient who had been performed radical nephroureterocytectomy due to the tumors of unilateral ureteral tumor complicating with invasive bladder cancer. Results; The patient was diagnosed as tumor of unilateral ureter complicating with inva-sive bladder cancer by cystoscope, ureteroscope, ultrasound, intraveneous pyelography and CT. The patient with left ureteral cancer complicating with bladder cancer was performed the operation of laparoscopy radical nephroureterocys-tectomy and open urethral resection and ureterostomy. The total operation time was 480min and bleeding volume was 560 ml without blood transfusion. The recovery time of alimentary tract and the time of free activity were 3 days and 4 days. No obvious complications were observed. Postoperative pathological results showed that the slide were urothe-lial tumors with tumor stage of ureteral cancer T2N0M0 and tumor stage of bladder cancer T2N0M0 complicated by squamous cell carcinoma. The time of follow - up was 10 months without recurrence. Conclusion; Nephroureterocys-tectomy is available to tumor of unilateral ureteral tumor complicating with bladder mixed cancer. The operation under laparoscopy is available and safe, with less trauma and bleeding and faster recovery. Early diagnosis of bladder mixed tumor is difficult. For early diagnosis and treatment of bladder cancer and improve patient survival rates, multiple sites should be drawn when we perform cystoscopy.%目的:探讨腹腔镜和开放根治性肾输尿管膀胱切除术治疗输尿管癌合并膀胱混合癌患者的可行性和安全性.方法:回顾分析1例单侧输尿管癌并浸润性膀胱混合癌,腹腔镜下行根治性肾输尿管膀胱切除术及开放尿流改道手术患者的临床资料并进行随访分析.结果:术

  17. 保留血管神经束的腹腔镜下腹膜外前列腺癌根治术对尿控及性功能影响的手术技巧%The surgical technique of extraperitoneal laparoscopic radical prostatectomy with neurovascular bundle preservation and its effect on micturition control and sexual function in patients with prostate cancer

    Institute of Scientific and Technical Information of China (English)

    谭剑敏; 徐丹枫; 高赟; 高轶; 周伟民; 张涛亮; 许嘉骏; 朱晓明; 付鑫华

    2009-01-01

    Objective To analyze the surgical technique of extraperitoneal laparoseopic radical prostatectomy with neurovascular bundle preservation and its effect on micturition control and sexual function in patients with prostate cancer. Methods Twenty-two patients with a median age of 66. 9 years underwent extraperitoneal laparoscopic radical prostatectomy with neurovascular bundle preservation from October 2005 to March 2009 in our hospital and Shanghai Changzheng hospital. All patients had no erectile dysfunction. According to the pathology, there were 2 cases of PIN high grade, 4 cases of Tla-b, 9 cases of Tlc, 4 cases of T2a-b, 2 cases of T2e and 1 case of T3a. Results All operation were successful and no case was conversed to open surgery. The average operation time was 225 min and the mean blood loss was 850ml. The amount of blood loss in 1 case was 1200 ml because of injuring deep dorsal vein of penis. 4 cases received blood transfusion, gatheters of all patients were removed 2 weeks after operation, and three cases with mild incontinence regained continence of urine after 6 months follow-up. No patient occurred postoperative vesicourethral anastomotic leakage of urine. The surgical margin of 1 case was positive. No biochemical index of prostatl cancer recurred during postoperative follow-up of 10-24 months (with an average of 16 months). 20 cases had sexual function recovery after operation. Conclusions The extraperitoneal laparoscopie radical prostatectomy with neurovascular bundle preservation for prostate cancer is a safe and effective treatment method with less bleeding, small damage and less complications. It can guarantee the maximum of micturition control and sexual function, which is worthy to be popularized in the clinic.%目的 分析总结保留血管神经束的腹腔镜下腹膜外前列腺癌根治术对尿控及性功能影响的手术技巧. 方法 对22例前列腺癌患者施行保留血管神经束的腹腔镜下腹膜外前

  18. Dysphagia after laparoscopic Nissen fundoplication

    DEFF Research Database (Denmark)

    Funch-Jensen, Peter; Jacobsen, Bo

    2007-01-01

    OBJECTIVE: To investigate the frequency and severity of dysphagia during the first 8 weeks after laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. So far, there have been no studies reporting data on day-to-day occurrence of dysphagia after laparoscopic fundoplication...... was considered bothersome. RESULTS: Thirty-seven patients (93%) experienced some degree of dysphagia during the observation period. Sixteen patients (44%) had at least one day with annoying dysphagia. The dysphagia started 1-2 days after surgery, was most prominent during the first few weeks, and subsided...... in nearly all cases after 5-6 weeks. Two patients with persistent dysphagia were treated once with balloon dilatation. None of the patients in the control group had dysphagia. CONCLUSIONS: Nearly all patients experience some degree of dysphagia after laparoscopic Nissen fundoplication, and in nearly half...

  19. 三孔法与四孔法经腹膜外途径腹腔镜下根治性前列腺切除术的比较%Extraperitoneal laparoscopic radical prostatectomy: comparison of three-port versus four-port surgeries

    Institute of Scientific and Technical Information of China (English)

    刘茁; 孟一森; 虞巍; 金杰; 张骞

    2015-01-01

    Objective To compare the perioperative outcomes and short-term efficacy of three-port extraperitoneal laparoscopic radical prostatectomy (ELRP) and four-port ELRP.Methods Two hundred patients who had undergone ELRP for prostate cancer by a single surgeon from November 2010 to October 2014 were retrospectively analyzed.Among them,95 cases underwent three-port ELRP and 105 cases underwent four-port ELRP.On the basis of traditional four-port ELRP,three-port ELRP was characterized by the omission of the trocar on the inner side of right anterior superior iliac spine.The mean age was 66.8 ± 15.5 years,and mean total prostate specific antigen (tPSA) was 15.3 ± 12.4 μg/L.There were no significant differences including age,body mass index,tPSA,clinical stages,acceptance of neoadjuvant hormone therapy,history of transurethral resection of the prostate,history of diabetes mellitus between the 2 groups (P > 0.05).Patients in three-port ELRP group had significantly smaller prostate volume than fourport group (35.6 ± 16.7 ml versus 42.2 ± 24.7 ml,P < 0.05).The clinical factors as operative time,estimated blood loss,hospital stay,drainage tube keeping days,pathological Gleason scores,pathological stages,positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates were compared between the 2 groups.Results The three-port group had significantly shorter operative time than the four-port group (81.0 ± 18.6 min versus 103.6 ±34.6 min),less estimated blood loss (102.6 ±75.8 ml versus 217.5 ± 182.9 ml),less positive surgical margin rates (13.7% versus 27.6%).There were 9 patients having Gleason scores more than 7 in the three-port ELRP group and 29 patients in four-port ELRP group (P < 0.05).There were no significant differences of hospital stay,drainage tube keeping days,pathological stages between the 2 groups (P > 0.05).Eighty-three cases in the three-port ELRP group (87.4%) were followed up for 5-19 months with the median time

  20. Effect of flurbiprofen axetil on postoperative inflammatory factors and stress hormonein patients undergoing laparoscopic radical rectectomy for rectal cancer%氟比洛芬酯镇痛对腹腔镜直肠癌根治术后患者炎性因子的影响

    Institute of Scientific and Technical Information of China (English)

    陈秋芬; 贾东林

    2014-01-01

    Objective To investigate the effects of flurbiprofen axetil analgesia on inflammatory factors and postoperative analgesia in patients undergoing laparoscopic radical rectectomy for rectal cancer.Methods Eighty patients undergoing laparoscopic radical rectectomy for rectal cancer were randomly divided into 2 groups (n =40 in each),flurbiprofen axetil group received intravenous flurbiprofen axetil 50mg/5 ml 30 minutes before anesthesia induction,and control group received normal saline 5 ml instead.Venous blood samples were obtained at 10 minutes before flurbiprofen axetil or normal saline was injected,mimediately when surgery was finished,12 hours,and 24 hour safter the surgery w as finished,to determine the plasma levels of substance P and IL-6.At the same time,visual analogue scale(VAS) scores were recorded at 2,6,12 and 24 hours after the surgery.Results Compared to the control group,the plasma levels of substance P decreased in the flurbiprofen axetil group at immediately when surgery was finished and 12 hours [mimediately when surgery was finished:(105 ± 13)ng/L vs (155 ±24) ng/L,12 hours:(111 ± 12) ng/L vs(155 ± 31) ng/L,10 minutes:(92 ± 10) ng/L vs(90 ± 8) ng/L,P <0.05].The plasma levels of IL-6 decreased in the flurbiprofen axetil group at immediately when surgery was finished to 24 hours [mimediately when surgery was finished:(32 ± 8) ng/L vs (73 ± 15) ng/L,12 hours:(26 ±8) ng/L vs (85 ± 17) ng/L,24 hours:(20±8) ng/L vs (73 ±8)ng/L,10 minutes:(15 ±6)ng/L vs (15 ±5)ng/L,P <0.05].VAS status had significant difference at 2,6 and 12 hours postoperatively in the flurbiprofen axetil group compared to the control group [(2.1 ± 0.6) scores vs (5.6 ± 0.5) scores,(2.4 ± 0.5) scores vs (2.2 ±0.4) scores,(1.9 ± 0.9) scores vs (4.7 ± 0.5) scores,P < 0.05].Conclusion flurbiprofen axetil can reduce the production of in flammatory factors and produce better analgesia effect.%目的 观察氟比洛芬酯镇痛对腹腔镜直肠癌根治术患者

  1. Laparoscopic live donor nephrectomy.

    Science.gov (United States)

    Hasan, Waleed A; Al-Akraa, Mahmoud M

    2005-07-01

    With the number of patients presently awaiting renal transplantation exceeding the number of cadaveric organs available, there is an increasing reliance on live renal donation. Of the 11,869 renal transplants performed in 2002 in the US, 52.6% were living donors from the United Network for Organ Sharing Registry. Renal allografts from living donors provide: superior immediate long-term function; require less waiting time and are more cost-effective than those from cadaveric donors. However, anticipation of postoperative pain and temporary occupational disability may dissuade many potential donors. Additionally, some recipients hesitate to accept a living donor kidney due to suffering that would be endured by the donor. It is a unique medical situation when a young, completely healthy donor undergoes a major surgical procedure to provide an organ for transplantation. It is mandatory to offer a surgical technique, which is safe and with minimal complications. It is also obvious for any organ transplantation, that the integrity of the organ remain intact, thus, enabling its successful transplantation into the recipient. An acceptably short ischemia time and adequate lengths of ureter and renal vasculature are favored. Many centers are performing laparoscopic live donor nephrectomy in an effort to ease convalescence of renal donors. This may encourage the consideration of live donation by recipients and potential donors. PMID:16047050

  2. Laparoscopic telesurgical workstation

    Science.gov (United States)

    Cavusoglu, Murat C.; Cohn, Michael B.; Tendick, Frank; Sastry, S. Shankar

    1998-06-01

    Robotic telesurgery is a promising application of robotics to medicine, aiming to enhance the dexterity and sensation of minimally invasive surgery through millimeter-scale manipulators under control of the surgeon. With appropriate communication links, it would also be possible to perform remote surgery for care in rural areas where specialty care is unavailable, or to provide emergency care en route to a hospital. The UC Berkeley/Endorobotics/UCSF Telesurgical Workstation is a master-slave telerobotic system, with two 6 degree of freedom (DOF) robotic manipulators, designed for laparoscopic surgery. The slave robotic has a 2 DOF wrist inside the body to allow high dexterity manipulation in addition to the 4 DOF of motion possible through the entry port, which are actuated by an external gross motion platform. The kinematics and the controller of the system are designed to accommodate the force and movement requirements of complex tasks, including suturing and knot tying. The system has force feedback in 4 axes to improve the sensation of telesurgery. In this paper, the telesurgical system will be introduced with discussion of kinematic and control issues and presentation of in vitro test results.

  3. A multimodal imaging framework for enhanced robot-assisted partial nephrectomy guidance

    Science.gov (United States)

    Halter, Ryan J.; Wu, Xiaotian; Hartov, Alex; Seigne, John; Khan, Shadab

    2015-03-01

    Robot-assisted laparoscopic partial nephrectomies (RALPN) are performed to treat patients with locally confined renal carcinoma. There are well-documented benefits to performing partial (opposed to radical) kidney resections and to using robot-assisted laparoscopic (opposed to open) approaches. However, there are challenges in identifying tumor margins and critical benign structures including blood vessels and collecting systems during current RALPN procedures. The primary objective of this effort is to couple multiple image and data streams together to augment visual information currently provided to surgeons performing RALPN and ultimately ensure complete tumor resection and minimal damage to functional structures (i.e. renal vasculature and collecting systems). To meet this challenge we have developed a framework and performed initial feasibility experiments to couple pre-operative high-resolution anatomic images with intraoperative MRI, ultrasound (US) and optical-based surface mapping and kidney tracking. With these registered images and data streams, we aim to overlay the high-resolution contrast-enhanced anatomic (CT or MR) images onto the surgeon's view screen for enhanced guidance. To date we have integrated the following components of our framework: 1) a method for tracking an intraoperative US probe to extract the kidney surface and a set of embedded kidney markers, 2) a method for co-registering intraoperative US scans with pre-operative MR scans, and 3) a method for deforming pre-op scans to match intraoperative scans. These components have been evaluated through phantom studies to demonstrate protocol feasibility.

  4. Early results after robot-assisted colorectal surgery

    DEFF Research Database (Denmark)

    Eriksen, Jens Ravn; Helvind, Neel Maria; Jakobsen, Henrik Loft;

    2013-01-01

    Implementation of robotic technology in surgery is challenging in many ways. The aim of this study was to present the implementation process and results of the first two years of consecutive robot-assisted laparoscopic (RAL) colorectal procedures.......Implementation of robotic technology in surgery is challenging in many ways. The aim of this study was to present the implementation process and results of the first two years of consecutive robot-assisted laparoscopic (RAL) colorectal procedures....

  5. Laparoscopic surgery for renal stones: is it indicated in the modern endourology era?

    Directory of Open Access Journals (Sweden)

    Andrei Nadu

    2009-02-01

    Full Text Available Purpose: To report the outcomes of laparoscopic surgery combined with endourological assistance for the treatment of renal stones in patients with associated anomalies of the urinary tract. To discuss the role of laparoscopy in kidney stone disease. Materials and Methods: Thirteen patients with renal stones and concomitant urinary anomalies underwent laparoscopic stone surgery combined with ancillary endourological assistance as needed. Their data were analyzed retrospectively including stone burden, associated malformations, perioperative complications and outcomes. Results: Encountered anomalies included ureteropelvic junction obstruction, horseshoe kidney, ectopic pelvic kidney, fussed-crossed ectopic kidney, and double collecting system. Treatment included laparoscopic pyeloplasty, pyelolithotomy, and nephrolithotomy combined with flexible nephroscopy and stone retrieval. Intraoperative complications were lost stones in the abdomen diagnosed in two patients during follow up. Mean number of stones removed was 12 (range 3 to 214. Stone free status was 77% (10/13 and 100% after one ancillary treatment in the remaining patients. One patient had a postoperative urinary leak managed conservatively. Laparoscopic pyeloplasty was successful in all patients according to clinical and dynamic renal scan parameters. Conclusions: In carefully selected patients, laparoscopic and endourological techniques can be successfully combined in a one procedure solution that deals with complex stone disease and repairs underlying urinary anomalies.

  6. Laparoscopic Partial Hepatectomy: Animal Experiments

    Directory of Open Access Journals (Sweden)

    Haruhiro Inoue

    1995-01-01

    Full Text Available As a first step in firmly establishing laparoscopic hepatectomy, we introduce a porcine model of laparoscopic partial hepatectomy. This procedure has been successfully performed under the normal-pressure or low-pressure pneumoperitoneum condition supported by the full-thickness abdominal wall lifting technique. An ultrasonic dissector combined with electrocautery, newly developed by Olympus Optical Corporation (Japan was effectively utilized in facilitating safe and smooth incisions into the liver parenchyma. Although indications for this procedure seem to be limited only to peripheral lesions and not to central lesions, clinical application of this method may be useful for some patients in the near future.

  7. Robot-Assisted Gynecologic Oncology Surgery

    Medline Plus

    Full Text Available ROBOTIC-ASSISTED GYNECOLOGIC ONCOLOGY PROCEDURE HALIFAX HEALTH DAYTONA BEACH, FLORIDA April 24, 2008 00:00:11 KELLY ... You're just minutes away from seeing a robotic-assisted laparoscopic gynecological case live. This very progressive ...

  8. Laparoscopic and thoracoscopic gastric pull-up for pure esophageal atresia in early infancy

    Directory of Open Access Journals (Sweden)

    D K Kandpal

    2013-01-01

    Full Text Available In the developing countries, the babies with pure esophageal atresia undergo an esophagostomy and feeding gastrostomy at birth. It assists in early discharge from hospital. Esophageal substitution in these babies around six months is recommended. We report the first laparoscopic and thoracoscopic gastric pull up in early infancy from India.

  9. Assessment of the Ergonomically Optimal Operating Surface Height for Laparoscopic Surgery

    NARCIS (Netherlands)

    Van Veelen, M.A.; Kazemier, G.; Koopman, J.; Goossens, R.H.M.; Meijer, D.W.

    2002-01-01

    Purpose: The aim of this study was to find the ergonomically optimal operating surface height for laparoscopic surgery in order to reduce discomfort in the upper extremities of the operators and the assistants. The operating surface height was defined as the level of the abdominal wall of a patient

  10. 机器人辅助腹腔镜行卵巢癌手术13例分析%Analysis of 13 cases of ovarian cancer with robot assisted laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    叶明侠; 李立安; 李利; 范文生; 黄柯; 李亚里; 孟元光

    2015-01-01

    目的:探讨机器人系统在卵巢癌手术中的应用价值。方法回顾性分析2014年11月至2015年5月期间收治的卵巢癌手术患者46例。其中机器人辅助腹腔镜手术(机器人手术组)14例(其中1例机器人探查后中转开腹手术),同期经腹手术(开腹手术组)25例,经腹腔镜手术(腹腔镜手术组)7例。所有患者统计年龄、术前新辅助化疗次数、手术时间、手术方式、术中出血量、术中并发症、术后并发症、病理类型、清扫淋巴结数、术后排气时间、术后住院时间,对相应数据进行分析。结果机器人系统完成手术共13例,其中Ⅰ-Ⅱ期手术7例,Ⅲ期手术4例,复发癌手术2例。腹腔镜手术组中1例腹腔镜探查后中转开腹手术。机器人手术组与腹腔镜手术组相比,术中出血量、清扫淋巴结数及术后排气时间均无明显差异。结论机器人手术组在卵巢癌分期手术中安全、可靠,手术效果同腹腔镜手术组类似。对于晚期或复发性卵巢癌等复杂的手术,机器人系统更有优势。%Objectives To explore the application of robot system in the operation of ovarian cancer .Methods A total of 46 patients with ovarian cancer were retrospectively analyzed from Nov .2014 to May 2015 . 14 cases of the patients were performed by the robot . 25 cases were completed by laparotomyduring the same period .7 cases were performed by laparoscopic surgery .All the statistics were analized including the age , frequency of preoperative neoadjuvantchemotherapy , operation time, operationmethods, intraoperative blood loss , intraoperative and postoperative complications , pathological type, number of lymph nodes, postoperative exhaust time,time of anal exsufflation and hospitalization after operation.Results 13 cases of the pations with ovarian cancer were performed by robot to complete the operation, including 7 cases in stageⅠ-Ⅱ, 4 cases in stage Ⅲand 2

  11. Pico Lantern: Surface reconstruction and augmented reality in laparoscopic surgery using a pick-up laser projector.

    Science.gov (United States)

    Edgcumbe, Philip; Pratt, Philip; Yang, Guang-Zhong; Nguan, Christopher; Rohling, Robert

    2015-10-01

    The Pico Lantern is a miniature projector developed for structured light surface reconstruction, augmented reality and guidance in laparoscopic surgery. During surgery it will be dropped into the patient and picked up by a laparoscopic tool. While inside the patient it projects a known coded pattern and images onto the surface of the tissue. The Pico Lantern is visually tracked in the laparoscope's field of view for the purpose of stereo triangulation between it and the laparoscope. In this paper, the first application is surface reconstruction. Using a stereo laparoscope and an untracked Pico Lantern, the absolute error for surface reconstruction for a plane, cylinder and ex vivo kidney, is 2.0 mm, 3.0 mm and 5.6 mm, respectively. Using a mono laparoscope and a tracked Pico Lantern for the same plane, cylinder and kidney the absolute error is 1.4 mm, 1.5 mm and 1.5 mm, respectively. These results confirm the benefit of the wider baseline produced by tracking the Pico Lantern. Virtual viewpoint images are generated from the kidney surface data and an in vivo proof-of-concept porcine trial is reported. Surface reconstruction of the neck of a volunteer shows that the pulsatile motion of the tissue overlying a major blood vessel can be detected and displayed in vivo. Future work will integrate the Pico Lantern into standard and robot-assisted laparoscopic surgery.

  12. Pico Lantern: Surface reconstruction and augmented reality in laparoscopic surgery using a pick-up laser projector.

    Science.gov (United States)

    Edgcumbe, Philip; Pratt, Philip; Yang, Guang-Zhong; Nguan, Christopher; Rohling, Robert

    2015-10-01

    The Pico Lantern is a miniature projector developed for structured light surface reconstruction, augmented reality and guidance in laparoscopic surgery. During surgery it will be dropped into the patient and picked up by a laparoscopic tool. While inside the patient it projects a known coded pattern and images onto the surface of the tissue. The Pico Lantern is visually tracked in the laparoscope's field of view for the purpose of stereo triangulation between it and the laparoscope. In this paper, the first application is surface reconstruction. Using a stereo laparoscope and an untracked Pico Lantern, the absolute error for surface reconstruction for a plane, cylinder and ex vivo kidney, is 2.0 mm, 3.0 mm and 5.6 mm, respectively. Using a mono laparoscope and a tracked Pico Lantern for the same plane, cylinder and kidney the absolute error is 1.4 mm, 1.5 mm and 1.5 mm, respectively. These results confirm the benefit of the wider baseline produced by tracking the Pico Lantern. Virtual viewpoint images are generated from the kidney surface data and an in vivo proof-of-concept porcine trial is reported. Surface reconstruction of the neck of a volunteer shows that the pulsatile motion of the tissue overlying a major blood vessel can be detected and displayed in vivo. Future work will integrate the Pico Lantern into standard and robot-assisted laparoscopic surgery. PMID:26024818

  13. Robotically assisted gynaecological surgery.

    Science.gov (United States)

    Falcone, Tommaso; Steiner, Charles P

    2002-05-01

    Industry has used robots successfully for fine, delicate, repetitive tasks for decades. Recently, robots have been introduced into clinical medicine and specifically into the surgical suite. Voice algorithms have been developed that allow voice activation of some types of equipment in the operating room, such as the laparoscope or the light source. Advances in computer software have allowed a computer controller to translate a surgeon's movements from the handles located in a console to the robotic arms that hold the surgical instruments. This console is placed away from the surgical table. Clinical experience is limited and there are few published clinical trials. The initial trials have focused on laparoscopic microsuturing such as that performed during coronary bypass surgery or tubal anastomosis. Preliminary results have demonstrated that laparoscopic coronary bypass surgery with the internal mammary artery can be achieved. In gynaecological surgery, laparoscopic tubal reanastomosis can be performed using the same technique that has been used traditionally at laparotomy. Future clinical trials will assess whether other gynaecological procedures can be performed with robotic assistance. PMID:12082211

  14. 腹腔镜根治性膀胱切除加原位膀胱重建术治疗肌层浸润性膀胱癌的疗效观察(附26例报告)%Laparoscopic radical cystectomy and construction of orthotopic neobladder for muscle invasive bladder cancer

    Institute of Scientific and Technical Information of China (English)

    牛亦农; 李长岭; 金木兰; 张军晖; 田溪泉; 王建文; 郭应禄; 邢念增

    2012-01-01

    目的:总结26例腹腔镜根治性膀胱切除、标准淋巴结清扫加尿流改道术的临床经验,评价此术式肿瘤学结果与功能性结果.方法:2005年8月~2011年5月对26例肌层浸润性膀胱肿瘤患者实施腹腔镜根治性膀胱切除、标准淋巴结清扫加原位膀胱重建术,包括13例T型原位回肠膀胱、11例Studer原位回肠膀胱与2例乙状结肠原位回肠膀胱,对手术时间、清扫淋巴结数量、围手术期并发症、术中出血量、输血量、上尿路形态与功能、术后原位膀胱控尿情况进行分析.结果:平均手术时间为6.24(4~8)h,平均出血量为397(100~800)ml,平均输血量为109(0~800)ml,平均清扫淋巴结数15(5~30)个,1例淋巴结阳性,无围手术期死亡.围手术期并发症发生率为16.7% (4/26),其中1例术后血肌酐上升至214.9 μmol/L,6天后下降至正常范围;2例新膀胱尿道吻合口漏,经引流治愈;1例输尿管新膀胱吻合口漏行手术修补.随访19.9(1~67)个月,生存率为92.3%(24/26);1例鳞癌死于广泛转移,1例于术后55个月因急性心肌梗塞死亡.原位膀胱重建患者日间完全控尿率达88%(22/25);夜间完全控尿率60%(15/25),小于1块尿垫24%(8/25).上尿路检查提示19.2%(5/26)术后45天内出现双侧肾盂及输尿管轻度暂时性扩张,其中2例有暂时性血肌酐升高,但均在3个月之内恢复到正常范围.结论:腹腔镜根治性膀胱切除、标准淋巴结清扫加下腹壁小切口行尿流改道术取得了满意的肿瘤学与功能性结果;其长期疗效需要进一步随访.%Objective: To introduce the initial experience of 26 cases of laparoscopic radical cystectomy(LRC), standard lymphadenectomy and construction of orthotopic neobladder, and the oncological and functional results of this procedure. Methods:26 cases of muscle-invasive bladder cancer underwent LRC. And standard lymphadenectomy was followed by reconstruction of orthotopic

  15. Roaming Radicals

    Science.gov (United States)

    Bowman, Joel M.; Shepler, Benjamin C.

    2011-05-01

    Roaming is a recently verified unusual pathway to molecular products from unimolecular dissociation of an energized molecule. Here we present the evidence for this pathway for H2CO and CH3CHO. Theoretical analysis shows that this path visits the plateau region of the potential energy surface near dissociation to radical products. It is not clear whether roaming is a distinct isolated pathway, in addition to the conventional one via the well-known molecular saddle-point transition state. Evidence is presented to suggest that the two pathways may originate from a single, but highly complicated, dividing surface. Other examples of unusual reaction dynamics are also reviewed.

  16. Poly (N-vinyl-2-pyrrolidone-co-acrylic acid): Comparing of Traditional Heating and Microwave-Assisted Free Radical Polymerization

    International Nuclear Information System (INIS)

    In organic chemistry microwave irradiation has become a common heat source and the use of microwave irradiation is also increasingly studied for polymerization reactions. Polymers have been synthesized at long reaction times by classical thermal methods. In contrast, microwave-assisted polymer synthesis is a well-known and most useful method, which is requiring shorter reaction times. In this study, our aims are to compare THPS and MAPS methods between themselves, and investigate the effect of temperature in MAPS method at different parameters such as reaction times, weight average molecular weight (Mw), polydispersity index (PDI), hydrodynamic radius (Rh), intrinsic and Mark Houwink equation constant (a) of copolymers, viscosity Firstly we synthesized N-vinyl-2-pyrrolidone-acrylic acid copolymers (P(VP-co-AA)) both with traditional heating polymer synthesis (THPS) and microwave-assisted polymer synthesis (MAPS) method comparatively in this study. Secondly, to research temperature effect on MAPS method in addition to microwave irradiation power, polymer synthesis at 40 degree C, 50 degree C and 80 degree C were tried. For analyzing of copolymers Fourier Transform Infrared (FT-IR) spectroscopy and Gel Permeation Chromatography (GPC) system with four detectors were used. (author)

  17. Laparoscopic repair for vesicouterine fistulae

    Directory of Open Access Journals (Sweden)

    Rafael A. Maioli

    2015-10-01

    Full Text Available ABSTRACT Objective: The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a cesarean delivery. The obstetric team implemented conservative management, including Foley catheter insertion, for 2 weeks. She subsequently developed intermittent hematuria and cystitis. The urology team was consulted 15 days after cesarean delivery. Cystoscopy indicated an ulcerated lesion in the bladder dome of approximately 1.0cm in size. Hysterosalpingography and a pelvic computed tomography scan indicated a fistula. Materials and Methods: Laparoscopic repair was performed 30 days after the cesarean delivery. The patient was placed in the lithotomy position while also in an extreme Trendelenburg position. Pneumoperitoneum was established using a Veress needle in the midline infra-umbilical region, and a primary 11-mm port was inserted. Another 11-mm port was inserted exactly between the left superior iliac spine and the umbilicus. Two other 5-mm ports were established under laparoscopic guidance in the iliac fossa on both sides. The omental adhesions in the pelvis were carefully released and the peritoneum between the bladder and uterus was incised via cautery. Limited cystotomy was performed, and the specific sites of the fistula and the ureteral meatus were identified; thereafter, the posterior bladder wall was adequately mobilized away from the uterus. The uterine rent was then closed using single 3/0Vicryl sutures and two-layer watertight closure of the urinary bladder was achieved by using 3/0Vicryl sutures. An omental flap was mobilized and inserted between the uterus and the urinary bladder, and was fixed using two 3/0Vicryl sutures, followed by tube drain insertion. Results: The operative time was 140 min, whereas the blood loss was 100ml. The patient was discharged 3 days after surgery, and the catheter was removed 12 days after surgery

  18. Technical and instrumental prerequisites for single-port laparoscopic solo surgery: State of art

    OpenAIRE

    Kim, Say-June; Lee, Sang Chul

    2015-01-01

    With the aid of advanced surgical techniques and instruments, single-port laparoscopic surgery (SPLS) can be accomplished with just two surgical members: an operator and a camera assistant. Under these circumstances, the reasonable replacement of a human camera assistant by a mechanical camera holder has resulted in a new surgical procedure termed single-port solo surgery (SPSS). In SPSS, the fixation and coordinated movement of a camera held by mechanical devices provides fixed and stable op...

  19. Laparoscopic retrograde (fundus first cholecystectomy

    Directory of Open Access Journals (Sweden)

    Kelly Michael D

    2009-12-01

    Full Text Available Abstract Background Retrograde ("fundus first" dissection is frequently used in open cholecystectomy and although feasible in laparoscopic cholecystectomy (LC it has not been widely practiced. LC is most simply carried out using antegrade dissection with a grasper to provide cephalad fundic traction. A series is presented to investigate the place of retrograde dissection in the hands of an experienced laparoscopic surgeon using modern instrumentation. Methods A prospective record of all LCs carried out by an experienced laparoscopic surgeon following his appointment in Bristol in 2004 was examined. Retrograde dissection was resorted to when difficulties were encountered with exposure and/or dissection of Calot's triangle. Results 1041 LCs were carried out including 148 (14% emergency operations and 131 (13% associated bile duct explorations. There were no bile duct injuries although conversion to open operation was required in six patients (0.6%. Retrograde LC was attempted successfully in 11 patients (1.1%. The age ranged from 28 to 80 years (mean 61 and there were 7 males. Indications were; fibrous, contracted gallbladder 7, Mirizzi syndrome 2 and severe kyphosis 2. Operative photographs are included to show the type of case where it was needed and the technique used. Postoperative stay was 1/2 to 5 days (mean 2.2 with no delayed sequelae on followup. Histopathology showed; chronic cholecystitis 7, xanthogranulomatous cholecystitis 3 and acute necrotising cholecystitis 1. Conclusions In this series, retrograde laparoscopic dissection was necessary in 1.1% of LCs and a liver retractor was needed in 9 of the 11 cases. This technique does have a place and should be in the armamentarium of the laparoscopic surgeon.

  20. Laparoscopic bilateral nephroureterectomy and bladder cuff excision for native renal pelvic and ureteral transitional cell carcinoma after renal transplantation.

    Directory of Open Access Journals (Sweden)

    Chen C

    2003-01-01

    Full Text Available A 37-years-old female who was suffering from end-stage renal disease for about 6 years received allograft renal transplantation 4 years ago. She has been receiving 50mg of Cyclosporin A orally daily for immuno-suppression since then. Gross haematuria was noted and computerised tomography showed native left renal pelvic and ureteral multi-focal transitional cell carcinoma with severe hydronephrosis. Laparoscopic bilateral nephroureterectomy and bladder cuff excision were performed. In the past, history of previous operation was considered a relative contraindication for laparoscopic surgery. To our knowledge, we present the first case of laparoscopic treatment for native renal pelvic and ureteral transitional cell carcinoma after renal allograft transplantation without a hand-assisted device. This case shows the feasibility of laparoscopic bilateral nephroureterectomy in patients with transplanted kidneys.

  1. Laparoscopic Appendicectomy in all Trimesters of Pregnancy

    OpenAIRE

    Machado, Norman Oneil; Grant, Christopher S.

    2009-01-01

    Background: The laparoscopic approach for appendicectomy in pregnancy was not considered the preferred procedure until recently. The aim of this study was to examine our experience with laparoscopic appendicectomy in pregnancy and review the scientific evidence available in the medical literature. Method: The clinical data of all patients who underwent laparoscopic appendicectomy during pregnancy at our hospital between 1999 and 2007 were collected and retrospectively analyzed. A Medline lite...

  2. Music Experience Influences Laparoscopic Skills Performance

    OpenAIRE

    Boyd, Tanner; Jung, Inkyung; Van Sickle, Kent; Schwesinger, Wayne; Michalek, Joel; Bingener, Juliane

    2008-01-01

    Background: Music education affects the mathematical and visuo-spatial skills of school-age children. Visuo-spatial abilities have a significant effect on laparoscopic suturing performance. We hypothesize that prior music experience influences the performance of laparoscopic suturing tasks. Methods: Thirty novices observed a laparoscopic suturing task video. Each performed 3 timed suturing task trials. Demographics were recorded. A repeated measures linear mixed model was used to examine the ...

  3. Learning curve and perioperative outcomes analysis in three-port extraperitoneal laparoscopic radical prostatectomy : initial experience in 95 cases in single center%单中心95例三孔法经腹膜外途径腹腔镜下根治性前列腺切除术的学习曲线结果分析

    Institute of Scientific and Technical Information of China (English)

    刘茁; 孟一森; 虞巍; 金杰; 张骞

    2015-01-01

    目的 分析三孔法经腹膜外途径腹腔镜下根治性前列腺切除术(extraperitoneal laparoscopic radical prostatectomy,ELRP)的学习曲线,探讨如何缩短三孔法ELRP的手术时间,减少术中出血.方法 回顾性分析2013年8月至2014年10月收治时间连续的95例前列腺癌患者的临床资料.平均年龄(65.9±7.7)岁,平均总前列腺特异抗原(15.4±12.7) μg/L,平均体质指数(24.8±3.2) kg/m2.本组95例均由同一术者行三孔法ELRP,根据手术顺序分为3组:A组32例(第1~32例),B组32例(第33 ~64例),C组31例(第65 ~ 95例).3组的年龄、体质指数、术前总前列腺特异性抗原、前列腺体积、临床分期、术前是否行新辅助内分泌治疗、经尿道前列腺切除手术史等比较差异均无统计学意义(P>0.05).分析手术例数与手术时间、术中出血量、术后住院天数、术后腹腔引流管留置时间、手术切缘情况、术后生化复发,以及术后3、6、12个月尿失禁发生率等围术期参数的相关性.分别比较A组与B、C组,以及A、B组与C组在围术期参数方面的差异.结果 本组95例平均手术时间(81.0±18.6) min.随着手术总例数增加,手术时间显著缩短(|r |=0.612,P<0.01).A、B、C各组内随着手术例数增加,手术时间无明显变化(P>0.05).A组手术时间为(96.4±11.3) min,显著长于B、C组平均手术时间(73.2±16.7) min,差异有统计学意义(P<0.01).A、B组平均手术时间为(87.6±17.2) min,显著长于C组的(67.5±13.8) min,差异有统计学意义(P<0.01).95例的平均术中出血量(102.6±75.8) ml,随着手术例数增加,术中出血量显著减少(|rs| =0.677,P<0.01).A组内随着手术例数增加,术中出血量显著减少(|rs | =0.619,P<0.01).在B、C组内,手术例数的增加与术中出血量的变化均无明显相关性(P>0.05).A组术中出血量为(158.7±81.3) ml,显著多于B、C组平均出血量(74.1 ±54.4) ml,差异有统计学意义(P<0

  4. [Organisation and early outcome after radical prostatectomy in Denmark 2004-2007

    DEFF Research Database (Denmark)

    Borre, M.; Iversen, P.; Bendixen, A.;

    2008-01-01

    .2%. CONCLUSION: There is an increasing rate of radical prostatectomies in Denmark. It is proposed that a national database be established to monitor early and long-term outcomes, including the role of surgical technique (nerve sparing, laparoscopic/robotic surgery, etc.) in order to ensure optimal organisation...

  5. Implementation and usefulness of single access laparoscopic segmental and total colectomy.

    LENUS (Irish Health Repository)

    Baig, Muhammad N

    2012-02-06

    Aim:  Single access laparoscopic surgery is a recent vogue in the field of minimally invasive colorectal surgery. While selected series have indicated feasibility, we prospectively examined its usefulness for resectional surgery in routine practice. Method:  All patients undergoing laparoscopic colorectal resection over a twelve month period were considered for a single access approach by a single surgical team in a university hospital. This utilised a \\'Glove\\' port via a 3-5 cm periumbilical or stomal site incision with standard rigid laparoscopic instruments then being used. Results:  Of 74 planned laparoscopic colorectal resections, 35 (47%) were performed by this single incision laparoscopic modality without disruption of theatre list efficiency or surgical training obligations. The mean (range) age and BMI of these 25 consecutive right sided resections, 8 total colectomies (7 urgent operations) and 2 anterior resections was 58 (22-82) years and 23.9 (18.6-36.2) kg\\/m(2) respectively. The modal postoperative day of discharge was 4. For right sided resections, the mean (range) post-op stay in those undergoing surgery for benign disease was 4, while for those undergoing operation for neoplasia (n=18, mean age 71 years) it was 5.8 days and the average lymph node harvest was 13. Use of the glove port reduced trocar cost by 58% (€60\\/£53) by allowing use of trocar sleeves alone without obturators. Conclusion:  Single incision laparoscopic surgery is an effective option for abdominal surgery and seems especially suited for laparoscopic-assisted right sided colonic resections. The Glove port technique facilitates procedural frequency and familiarity and proves economically favourable.

  6. Visual tracking of da Vinci instruments for laparoscopic surgery

    Science.gov (United States)

    Speidel, S.; Kuhn, E.; Bodenstedt, S.; Röhl, S.; Kenngott, H.; Müller-Stich, B.; Dillmann, R.

    2014-03-01

    Intraoperative tracking of laparoscopic instruments is a prerequisite to realize further assistance functions. Since endoscopic images are always available, this sensor input can be used to localize the instruments without special devices or robot kinematics. In this paper, we present an image-based markerless 3D tracking of different da Vinci instruments in near real-time without an explicit model. The method is based on different visual cues to segment the instrument tip, calculates a tip point and uses a multiple object particle filter for tracking. The accuracy and robustness is evaluated with in vivo data.

  7. 胆道镜辅助腹腔镜治疗高龄肝胆管结石患者的临床疗效%Clinical curative effect of choledochoscope assisted laparoscope in the treatment of hepatic calculus in elderly patients

    Institute of Scientific and Technical Information of China (English)

    贾廷印

    2016-01-01

    目的:探讨胆道镜联合腹腔镜治疗高龄胆管结石患者的临床疗效。方法:113例高龄胆总管结石患者给予胆道镜辅助腹腔镜治疗,回顾性分析其临床资料。年龄≥70岁41例(高龄组),<70岁72例(非高龄组),对两组患者的中转开腹率、手术时间、术中失血量、胃肠道功能恢复时间、住院时间、术后胆道残留结石率等指标进行分析。结果:高龄组顺利完成手术37例,中转开腹4例(10.8%);非高龄组顺利完成手术66例,中转开腹6例(8.3%);两组其他指标比较,差异均无统计学意义(P>0.05)。结论:腹腔镜联合胆道镜治疗胆管结石具有安全、有效、损伤小、恢复快等优点,适合高龄患者,术者需要熟练的操作技能。%Objective:To explore the clinical curative effect of choledochoscope combined with laparoscope in the treatment of hepatic calculus in elderly patients.Methods:113 patients with hepatic calculus were given choledochoscope assisted laparoscope treatment.The clinical data were retrospectively analyzed.The age was more than or equal 70 years old in 41 cases(the elderly group);the age was less than 70 years old in 72 cases(the non elderly group).The transfer laparotomy rate,operation time,intraoperative blood loss,gastrointestinal function recovery time,hospitalization time,postoperative biliary residual stone rate of patients were analyzed.Results:37 cases were successfully completed surgery in the elderly group;4 cases(10.8%) were transfer laparotomy.66 cases were successfully completed surgery in the non elderly group;6 cases(8.3%) were transfer laparotomy.The other indexes of two groups were compared,and the differences were not statistically significant(P > 0.05).Conclusion:Laparoscope combined with choledochoscope in treatment of hepatic calculus has the advantages of safe and effective,less damage and fast recovery.It is suitable for elderly patients and the operator need skilled

  8. 腹腔镜下乙状结肠代阴道和腹膜代阴道成形术治疗Ⅱ型阴道闭锁%Laparoscopic-assisted vaginoplasty by using sigmoid colon and peritoneum for congenital complete colpatresia

    Institute of Scientific and Technical Information of China (English)

    包碧惠; 徐忠兰; 宋娟; 刘春桃; 陈勇; 徐惠成; 梁志清; 唐帅

    2016-01-01

    Objective To study the desired therapeutic effect of vaginoplasty using sigmoid colon or peritoneum for entire vaginal atre-sia.Methods From May 2015 to October 2015,8 patients with complete vaginal atresia in our hospital performed vaginoplasty using sigmoid colon or peritoneum successfully.The operation methods,prognosis and therapeutic effect and quality of sexual life of two groups were com-pared and analyzed to investigate a perfect operative method and ideal nursing.Results Laparoscopic vaginoplasty using the peritoneum compared with that using sigmoid colon has advantages of shorter time of operation,less bleeding,less trauma and quicker recovery.However, artificial vagina using sigmoid colon was much more similar to a natural vagina in morphological and physiological characteristics,merely ac-companied by excessive mucus discharge during the postoperative period.At lower risk of vaginal adhesion and stenosis,laparoscopically as-sisted vaginoplasty using sigmoid colon graft also puts high technical requirements.Two patients normally developed uterus menstruate regular-ly.Four patients without uterus and 2 patients with rudimentary uterus experienced good sexual intercourse after vaginoplasty.Conclusion Patients with complete colpatresia who have normal womb should creat a patent and functional vagina until adolescence to restore its physio-logical and reproductive function.Anatomical reconstructive treatment of vaginal agenesis for patients with absent or hypoplastic uterus can be postponed till the late teens or in the adult.Both laparoscopic sigmoid vaginoplasty and peritoneal vaginoplasty achieve a minimal-invasive, cosmetic,natural lubricous, smooth artificial vagina for patient’ s sex life satisfactory.%目的:探讨腹腔镜下乙状结肠代阴道和腹膜代阴道成形术治疗Ⅱ型阴道闭锁的效果。方法我院2015年5月至2015年10月收治8例先天性阴道完全闭锁(Ⅱ型阴道闭锁)患者,均顺利实施腹腔镜下乙

  9. Outcomes of Laparoscopic Treatment Modalities for Unilateral Non-Palpable Testes

    Directory of Open Access Journals (Sweden)

    Nurullah eHamidi

    2016-03-01

    Full Text Available Purpose: To date, laparoscopy has gradually become the gold standard for treatment of NPT with different success and complication rates. In this study, we aimed to evaluate outcomes of laparoscopic approaches for NPT.Materials and Methods: We reviewed data of 82 consecutive patients who underwent laparoscopic treatment for unilateral NPT at two institutions by two high volume surgeons from 2004 January to 2014 December. Laparoscopic-assisted orchidopexy(LAO and two stage Fowler-Stephens technique(FST was performed for 45 and 37 patients, respectively. Age(at surgery, follow-up time, laterality of testes and post-operative complications were analyzed. Modified Clavien classification system(MCCS was used for evaluating complications.Results: The median age (at surgery and median follow-up time were 18(range: 6-56 and 60(range: 9-130 months, respectively. Overall success rate for two laparoscopy techniques was 87.8 % during the maximal follow-up time. We observed wound infection in 2, hematoma in one, testicular atrophy in 5, testicular re-ascending in 2 patients at follow-up period. There was no statistical difference between two laparoscopic techniques for grade 1(5 vs. 2 patients, p=0.14 and grade IIIb MCCS complications(1 vs. 2 patients, p=0.44.Conclusions: Our results have shown that two laparoscopic approaches have low complication rates.

  10. Comparative study and systematic review of laparoscopic liver resection for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Wei; Qi; Leong; Iyer; Shridhar; Ganpathi; Alfred; Wei; Chieh; Kow; Krishnakumar; Madhavan; Stephen; Kin; Yong; Chang

    2015-01-01

    AIM: To compare the surgical outcomes between laparoscopic liver resection(LLR) and open liver resection(OLR) as a curative treatment in patients with hepatocellular carcinoma(HCC). METHODS: A Pub Med database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as "laparoscopy", "hepatectomy", and "hepatocellular carcinoma". A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection. RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival(OS) rates, but disease-free survival(DFS) rates were higher in the laparoscopic arm. CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.

  11. Analysis the related risk factors of incisional hernia after hand-assisted laparoscopic surgery for colorectal cancer%手辅助腹腔镜结直肠癌术后切口疝的发生危险因素分析

    Institute of Scientific and Technical Information of China (English)

    王松松; 苏艳华; 谭晓杰; 张建立

    2013-01-01

    Objective;The aim of this study is to identify the predictive risk factors related to incisional hernia after hand-assisted laparoscopic surgery (HALS) for colorectal cancer. Additionally, this analysis has provided the necessary basis for the prevention of incisional hernia. Methods; The clinical data of 142 patients with colorectal cancer treated with HALS were analyzed retrospectively during a period from Aug. 2009 to Aug. 2012. Patients were divided into two groups according to whether a hernia developed at the hand-assist port site. Risk factors such as age,gender,body mass index (BMI) ,tobacco abuse,concomitant diseases,position and length of the incisions, wound infection were analyzed. Results;A total of 142 eligible patients were followed up?13 patients developed an incisional hernia for an incidence of 9. 2 percent. The incisional hernia incidence of patients with diabetes mellitus were significantly higher in the hernia-forming group than the non-hernia group (P<0. 01). Mean BMI and tobacco use were also higher in the heraia-forming group. A low transverse incision was associated with the lower rate of incisional hernia compared with midline vertical incision. Conclusions : Diabetes mellitus, BMI, tobacco use and position of the incision are closely related risk factors of hernia development. Adequate perioperative preparation can effectively reduce the incidence of incisional hernia.%目的:探讨手辅助腹腔镜(hand-assisted laparoscopic surgery,HALS)结直肠癌术后切口疝发生的相关危险因素,为预防术后切口疝的发生提供证据.方法:回顾分析2009年8月至2012年8月为142例患者行HALS结直肠癌切除术的临床资料,至随访结束时,根据手辅助口位置是否发生切口疝将患者分为切口疝组及无切口疝组,分析两组患者年龄、性别、体质指数(body mass index,BMI)、吸烟、伴随疾病、辅助切口位置、切口长度、是否感染等与切口疝发生相关

  12. A methylene blue-assisted technique for harvesting lymph nodes after radical surgery for gastric cancer: a prospective, randomized, controlled study.

    Science.gov (United States)

    Aoyama, Toru; Fujikawa, Hirohito; Cho, Haruhiko; Ogata, Takashi; Shirai, Junya; Hayashi, Tsutomu; Rino, Yasushi; Masuda, Munetaka; Oba, Mari S; Morita, Satoshi; Yoshikawa, Takaki

    2015-02-01

    Harvesting lymph nodes (LNs) after gastrectomy is essential for accurate staging. This trial evaluated the efficiency and quality of a conventional method and a methylene blue-assisted method in a randomized manner. The key eligibility criteria were as follows: (i) histologically proven adenocarcinoma of the stomach; (ii) clinical stage I-III; (iii) R0 resection planned by gastrectomy with D1+ or D2 lymphadenectomy. The primary endpoint was the ratio of the pathologic number of harvested LNs per time (minutes) as an efficacy measure. The secondary endpoint was the number of harvested LNs, as a quality measure. Between August 2012 and December 2012, 60 patients were assigned to undergo treatment using the conventional method (n=29) and the methylene blue dye method (n=31). The baseline demographics were mostly well balanced between the 2 groups. The number of harvested LNs (mean±SD) was 33.6±11.9 in the conventional arm and 43.4±13.9 in the methylene blue arm (P=0.005). The ratio of the number of the harvested LNs per time was 1.12±0.46 LNs/min in the conventional arm and 1.49±0.59 LNs/min in the methylene blue arm (P=0.010). In the subgroup analyses, the quality and efficacy were both superior for the methylene blue dye method compared with the conventional method. The methylene blue technique is recommended for harvesting LNs during gastric cancer surgery on the basis of both the quality and efficacy.

  13. Laparoscopic approach to retrorectal cyst

    Institute of Scientific and Technical Information of China (English)

    Petra Gunkova; Lubomir Martinek; Jan Dostalik; Igor Gunka; Petr Vavra; Miloslav Mazur

    2008-01-01

    Retrorectal cysts are rare benign lesions in the presacral space which are frequently diagnosed in middle-aged females. We report here our experience with two symptomatic female patients who were diagnosed as having a retrorectal cyst and managed using a laparoscopic approach. The two patients were misdiagnosed as having an ovarian cystic lesion after abdominal ultrasonography. Computer tomograghy (CT) scan was mandatory to establish the diagnosis. The trocar port site was the same in both patients. An additional left oophorectomy was done for a coexisting ovarian cystic lesion in one patient in the same setting. There was no postoperative morbidity or mortality and the two patients were discharged on the 5th and 6th post operative days, respectively. Our cases show that laparoscopic management of retrorectal cysts is a safe approach. It reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space.

  14. Suprapubic approach for laparoscopic appendectomy

    OpenAIRE

    Singh, Manish K.; Kumar, Mani K.; Mohan, Lalit

    2013-01-01

    Objective: To evaluate the results of laparoscopic appendectomy using two suprapubic port incisions placed below the pubic hair line. Design: Prospective hospital based descriptive study. Settings: Department of surgery of a tertiary care teaching hospital located in Rohtas district of Bihar. The study was carried out over a period of 11months during November 2011 to September 2012. Participants: Seventy five patients with a diagnosis of acute appendicitis. Materials and Methods: All patients...

  15. Granulomatous Peritonitis After Laparoscopic Cholecystectomy

    OpenAIRE

    Famularo, Giuseppe; Remotti, Daniele; Galluzzo, Michele; Gasbarrone, Laura

    2012-01-01

    Background: Granulomatous peritonitis may indicate a number of infectious, malignant, and idiopathic inflammatory conditions. It is a very rare postoperative complication, which is thought to reflect a delayed cell-mediated response to cornstarch from surgical glove powder in susceptible individuals. This mechanism, however, is much more likely to occur with open abdominal surgery when compared with the laparoscopic technique. Methods: We report a case of sterile granulomatous peritonitis in ...

  16. Ignorance Radicalized

    Directory of Open Access Journals (Sweden)

    Gergo Somodi

    2009-12-01

    Full Text Available The aim of this paper is twofold. I criticize Michael Devitt's linguistic---as opposed to Chomsky's psychological---conception of linguistics on the one hand, and I modify his related view on linguistic intuitions on the other. I argue that Devitt's argument for the linguistic conception is in conflict with one of the main theses of that very conception, according to which linguistics should be about physical sentence tokens of a given language rather than about the psychologically real competence of native speakers. The basis of this conflict is that Devitt's view on language, as I will show, inherits too much from the criticized Chomskian view. This is also the basis of Devitt's strange claim that it is the linguist, and not the ordinary speaker, whose linguistic intuition should have an evidential role in linguistics. I will argue for the opposite by sketching a view on language that is more appropriate to the linguistic conception. That is, in criticizing Devitt, I am not defending the Chomskian approach. My aim is to radicalize Devitt's claims.

  17. A case of laparoscopic cystogastrostomy for pancreatic abscess

    Institute of Scientific and Technical Information of China (English)

    FAN Hua; ZHANG Dong; ZHAO Xin; PAN Fei; JIN Zhong-kui

    2012-01-01

    To the Editor:Open surgery is considered the gold standard for pancreatic abscess.1 With the development of laparoscopic ultrasound and laparoscopic skills,laparoscopic internal drainage for pancreatic abscess becomes feasible.We report a successful application of the laparoscopic cystogastrostomy for pancreatic abscess in a patient.

  18. Force feedback and basic laparoscopic skills

    NARCIS (Netherlands)

    Chmarra, M.K.; Dankelman, J.; Van den Dobbelsteen, J.J.; Jansen, F.W.

    2008-01-01

    Background - Not much is known about the exact role offorce feedback in laparoscopy. This study aimed to determine whether force feedback influences movements of instruments during training in laparoscopic tasks and whether force feedback is required for training in basic laparoscopic force applicat

  19. Laparoscopic partial nephrectomy for endophytic hilar tumors

    DEFF Research Database (Denmark)

    Di Pierro, G B; Tartaglia, N; Aresu, L;

    2014-01-01

    To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients.......To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients....

  20. Day-case laparoscopic Nissen fundoplication.

    LENUS (Irish Health Repository)

    Khan, S A

    2012-01-01

    For day-case laparoscopic surgery to be successful, patient selection is of the utmost importance. This study aimed to assess the feasibility of day-case laparoscopic Nissen fundoplication and to identify factors that may lead to readmission and overstay.

  1. TOTAL LAPAROSCOPIC HYSTERECTOMY VERSUS TOTAL ABDOMINAL HYSTERECTOMY: A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Virupaksha

    2015-10-01

    Full Text Available BACKGROUND: Hysterectomy is a common gynaecological surgery which can be done by abdominal, vaginal or laparoscopic routes or with robotic assistance. Although there were concerns regarding the safety of laparoscopic surgery, a newer technique when compared with abdominal hysterectomy, it is now being reco gnized as a safe procedure in the hands of an experienced surgeon. AIMS: This study was done to compare the intra - operative and post - operative parameters of abdominal and laparoscopic hysterectomy. SETTINGS AND DESIGN: This study was done at JSS Hospital, Mysore between June 2013 and September 2014. It is a retrospective study . MATERIALS AND METHOD S: Patients admitted in the Department of Obstetrics and Gynaecology at JSS Hospital, JSS University, Mysore, with an indication for total abdominal hysterectomy( TAH or total laparoscopic hysterectomy(TLH for benign pathology from June 2013 to September 2014 were included in the study. Exclusion criteria were suspicion of malignancy, vaginal prolapse higher than first degree and those undergoing laparoscopic assi sted vaginal hysterectomy. Baseline characteristics, intraoperative and postoperative parameters were compared between the two groups. STATISTICAL ANALYSIS : The data were analyzed using independent T test, Chi square test and Mann Whitney test. A p value o f <0 . 05 was accepted as significant. RESULTS: The mean time taken to perform TLH was significantly longer, i.e. 113.46 minutes compared with TAH, i.e. 70.44 minutes, with the p value being <0.0001. But the duration of stay in the hospital was shorter for t he women undergoing TLH, mean duration being 3.74 days as opposed to 7.65 days in women undergoing TAH. This difference was also statistically significant with p value being <0.0001. Also, women undergoing TAH required more analgesic doses (mean 3.29 than those undergoing TLH (mean 1.36 and this difference was also statistically significant. CONCLUSION: Although TLH took a

  2. Laparoscopic right-sided colonic resection with transluminal colonoscopic specimen extraction

    Institute of Scientific and Technical Information of China (English)

    Cuneyt; Kayaalp; Koray; Kutluturk; Mehmet; Ali; Yagci; Mustafa; Ates

    2015-01-01

    AIM: To study the transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance at laparoscopic colonic surgery. METHODS: The diagnoses of our patients were Crohn’s disease, carcinoid of appendix and adenocarcinoma of cecum. We preferred laparoscopic total mesocolic resections. Colon and terminal ileum were divided with endoscopic staplers. A colonoscope was placed per anal and moved proximally in the colon till to reach the colonic closed end under the laparoscopic guidance. The stump of the colon was opened with laparoscopic scissors. A snare of colonoscope was released and the intraperitoneal complete free colonic specimen was grasped. Specimen was moved in to the colon with the help of the laparoscopic graspers and pulled gently through the large bowel and extracted through the anus. The open end of the colon was closed again and the ileal limb and the colon were anastomosed intracorporeally with a 60-mm laparoscopic stapler. The common enterotomy orifice was closed in two layers with a running intracorporeal suture.RESULTS: There were three patients with laparoscopic right-sided colonic resections and their specimens were intended to remove through the remnant colon by colonoscopy but the procedure failed in one patient(adenocarcinoma) due to a bulky mass and the specimen extraction was converted to transvaginal route. All the patients had prior abdominal surgeries and had related adhesions. The operating times were 210, 300 and 500 min. The lengths of the specimenswere 13, 17 and 27 cm. In our cases, there were no superficial or deep surgical site infections or any other complications. The patients were discharged uneventfully within 4-5 d and they were asymptomatic after a mean 7.6 mo follow-up(ranged 4-12). As far as we know, there were only 12 cases reported yet on transcolonic extraction of the proximal colonic specimens by colonoscopic assistance after laparoscopic resections. With our cases, success rate of the

  3. Impact of transvaginal natural orifice transluminal endoscopic surgery-assisted laparoscopic nephrec-tomy on female sexual function and quality of life%经阴道自然腔道内镜手术辅助腹腔镜下肾切除术对女性性功能及生活质量影响的前瞻性研究

    Institute of Scientific and Technical Information of China (English)

    邹晓峰; 龙大治; 徐辉; 杨军; 钟辛; 刘全亮; 吴玉婷; 张国玺; 袁源湖; 肖日海; 薛义军; 刘佛林; 伍耿青; 王晓宁

    2014-01-01

    Objective To investigate the impact of transvaginal natural orifice transluminal endo-scopic surgery(NOTES)-assisted laparoscopic nephrectomy on female sexual function and quality of life . Methods This was a prospective study on the change of female sexual function and quality of life of female patients who underwent transvaginal NOTES-assisted laparoscopic nephrectomy from May .2011 to Nov. 2012.A total of 42 cases were included in this study (28 of them with severe hydronephrosis , non-functio-ning kidney , 11 with pyelonephrosis , 1 with renal tuberculosis , 1 with duplex kidney complicated with hy-dronephrosis, and 1 with renal angiomyolipoma ).The mean age was 36.9±5.3 (26-45) years, and the mean body mass index was 21.7±2.6 (14.7 to 27.1) kg/m2.Twenty-four cases were operated on the left side, 18 cases on the right .The female sexual function and quality of life were assessed before and 4 months, 7 months and 1 year after surgery using the Female Sexual Function Index (FSFI) questionnaire and the MOS 36-item Short-Form Health Survey (SF-36), respectively. Results The mean FSFI of 42 cases preoperatively and 4 months, 7 months and 1 yr postoperatively were 27.74 ±4.34, 27.19 ±4.49, 28.54±4.23, and 28.68 ±4.19, respectively.There was no statistically significant difference among them (F=1.111, P=0.346).Compared with that of preoperation , the physical function, vitality, metal health, body pain, and general health of the patients were improved , but the role-physical, role-emotion and social function were not improved at postoperative month 4 and month 7 (P<0.05).Each item of SF-36 was im-proved after postoperative 1 year ( P<0.05) . Conclusions Transvaginal NOTES-assisted laparoscopic ne-phrectomy does not cause negative effect on the female sexual function .The quality of life can be improved after operation .The physical function is improved at early stage , and the psychological function as well .%目的:探讨经阴

  4. Transanal vs laparoscopic total mesorectal excision for rectal cancer

    DEFF Research Database (Denmark)

    Perdawood, Sharaf; Al Khefagie, Ghalib Ali Abod

    2016-01-01

    BACKGROUND: Laparoscopic total mesorectal excision (LaTME) has improved short-term outcomes of rectal cancer surgery with comparable oncological results to open approach. LaTME can be difficult in the lower most part of the rectum, leading potentially to higher rates of complications, conversion...... to open surgery and probably suboptimal oncological quality. Transanal TME (TaTME) can potentially solve these problems. The aim of this study was to compare the short-term results after TaTME with those after LaTME. METHODS: A prospectively collected database of consecutive patients who underwent Ta......TME was maintained. Results were compared with those underwent LaTME in the preceding period. Patients who underwent low anterior resection or intersphincteric abdominoperineal excision (APE) were included. Primary end-points were radical resection and specimen quality. Secondary end-points were complications, rates...

  5. Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado

    2005-06-01

    Full Text Available OBJECTIVE: To describe surgical and functional results with extraperitoneal laparoscopic radical prostatectomy with duplication of the open technique, from the experience obtained in the treatment of 28 initial cases. MATERIALS AND METHODS: In a 36-month period, we prospectively analyzed 28 patients diagnosed with localized prostate cancer undergoing extraperitoneal laparoscopic radical prostatectomy. RESULTS: Mean surgical time was 280 min, with mean blood loss of 320 mL. As intraoperative complications, there were 2 rectal lesions repaired with laparoscopic suture in 2 planes. There was no conversion to open surgery. Median hospital stay was 3 days, with return to oral diet in the first post-operative day in patients. As post-operative complications, there were 3 cases of extraperitoneal urinary fistula. Two of these cases were resolved by maintaining a Foley catheter for 21 days, and the other one by late endoscopic reintervention for repositioning the catheter. Five out of 18 previously potent patients evolved with erectile dysfunction. The diagnosis of prostate cancer was confirmed in all patients, with focal positive margin occurring in 3 cases. During a mean follow-up of 18 months, 2 patients presented increased PSA, with no clinical evidence of disease. CONCLUSION: Laparoscopic radical prostatectomy is a laborious and difficult procedure, with a long learning curve. Extraperitoneal access is feasible, and it is possible to practically duplicate the principles of open surgery. The present technique can possibly offer advantages in terms of decreased blood loss, preservation of erectile function and prevention of positive margins.

  6. Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes.

    Directory of Open Access Journals (Sweden)

    Jia-Yu Zhou

    Full Text Available To compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP and laparoscopic distal pancreatectomy (LDP.A literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale.Seven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RAD