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Sample records for assisted laparoscopic radical

  1. Robot-Assisted Laparoscopic Radical Prostatectomy: Four Cases

    OpenAIRE

    Lee, Yong Seong; Han, Woong Kyu; Oh, Young Taik; Choi, Young Deuk; Yang, Seung Choul; Rha, Koon Ho

    2007-01-01

    The role of the da Vinci™ robot is being defined in minimally invasive urologic surgery. Robot-assisted laparoscopic radical prostatectomy (rLRP) has emerged as a feasible treatment option for patients with organ-confined prostate cancer. We performed the first four rLRPs on four prostate cancer patients in the Republic of Korea. This is a report of its techniques and outcomes. In all four cases, the surgery was successfully completed with a mean operative time of 392.5 minutes. The mean esti...

  2. 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...

  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. Laparoscopic radical and partial cystectomy

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    Challacombe Ben

    2005-01-01

    Full Text Available Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy.

  5. Laparoscopic-assisted nephroureterectomy after radical cystectomy for transitional cell carcinoma

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    Frederico R. Romero

    2006-12-01

    Full Text Available OBJECTIVE: To report our experience with laparoscopic-assisted nephroureterectomy for upper tract transitional cell carcinomas after radical cystectomy and urinary diversion. MATERIALS AND METHODS: Seven patients (53-72 years-old underwent laparoscopic-assisted nephroureterectomy 10 to 53 months after radical cystectomy for transitional cell carcinoma at our institution. Surgical technique, operative results, tumor features, and outcomes of all patients were retrospectively reviewed. RESULTS: Mean operative time was 305 minutes with a significant amount of time spent on the excision of the ureter from the urinary diversion. Estimate blood loss and length of hospital stay averaged 180 mL and 10.8 days, respectively. Intraoperative and postoperative complications occurred in two patients each. There was one conversion to open surgery. Pathology confirmed upper-tract transitional cell carcinoma in all cases. Metastatic disease occurred in two patients after a mean follow-up of 14.6 months. CONCLUSIONS: Nephrouretectomy following cystectomy is a complex procedure due to the altered anatomy and the presence of many adhesions. A laparoscopic-assisted approach can be performed safely in properly selected cases but does not yield the usual benefits seen with other laparoscopic renal procedures.

  6. Robotic-Assisted Laparoscopic Radical Prostatectomy: A Review of the Current State

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    Patel VR

    2008-01-01

    Full Text Available Cancer of the prostate is the most common malignancy diagnosed in the male genitourinary tract. Although a number of treatment options are available for early prostate cancer, the gold standard of treatment remains retropubic radical prostatectomy (RRP. However, robotic-assisted laparoscopic radical prostatectomy (RALP has become a forerunner in treatment options, yielding comparable medium-term perioperative and functional outcomes. For this our team utilized MEDLINE searching for publications on perioperative and functional outcomes related to robotic prostatectomy. Robotic-assisted prostatectomy has allowed urologists to enter the realm of minimally invasive surgery by incorporating open surgery manoeuvres to a laparoscopic environment. To date RALP perioperative and functional outcomes are comparable to the gold standard. Collection of long-term data is needed in order to establish its true efficacy.

  7. Laparoscopic radical cystectomy

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    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...

  8. Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy

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    Joo, Eun-Young; Moon, Yeon-Jin; Yoon, Syn-Hae; Chin, Ji-Hyun; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-01-01

    Abstract Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion. The objective of this study was to compare the incidence of postoperative AKI between RRP and RALP. We included 1340 patients who underwent RRP (n = 370) or RALP (n = 970) between 2013 and 2014. Demographics, cancer-related data, and perioperative laboratory data were evaluated. Postoperative AKI was determined according to the Kidney Disease: Improving Global Outcomes criteria. Operation and anesthesia time, estimated blood loss, amounts of administered fluids and transfused packed red blood cells, and the lengths of the postoperative intensive care unit and hospital stays were evaluated. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences between the RRP and RALP groups. After performing 1:1 propensity score matching, the RRP and RALP groups included 307 patients, respectively. The operation time and anesthesia time in RALP were significantly longer than in the RRP group (both P < 0.001). However, the estimated blood loss and amount of administered fluids in RALP were significantly lower than in RRP (both P < 0.001). Also, RALP demonstrated a significantly lower incidence of transfusion and smaller amount of transfused packed red blood cells than RRP (both P < 0.001). Importantly, the incidence of AKI in RALP

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

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    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

  10. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

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    Tobias-Machado, Marcos; Mitre, Anuar Ibrahim; Rubinstein, Mauricio; da Costa, Eduardo Fernandes; Hidaka, Alexandre Kyoshi

    2016-01-01

    ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP. PMID:27136471

  11. 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.

  12. 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

  13. 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...

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

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    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.

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

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    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.

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

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    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 obtained. The medical history including hypertension, diabetes mellitus, liver and kidney diseases were collected and International Index of Erectile Function questionnaire (IIEF-5) were applied to the patients .All patients undergoing RP have an MRI to obtain an accurate local staging of the disease. Snap-gauge was used to define the hardness of erection. Duplex sonography evaluation was performed with a color Doppler ultrasound machine and peak systolic (PS), end-diastolic velocities (EDV), and resistance index (RI) were measured and recorded at 5-minute intervals. Standard nerve-sparing procedures of LRP and RALP were performed. The ventral prostatic surface is completely cleaned to put in evidence the pubovesical ligaments and the reflection of the endopelvic fascia. We subsequently perform intrafascial release of the NVB. The plane of dissection were close to the prostate capsule throughout its path, leaving lateral the prostatic fascia at the anterolateral and posterolateral aspect of the prostate and remaining anterior to the posterior prostatic fascia–seminal vesicles fascia network, following the principles of energy-free dissection. Hem-O-Lock clips are used to control bleeding. Postoperative erectile function of patients underwent LPR or RALP was reevaluated according to the same preoperative procedures 12 mo after surgery .The incidence of complication, such as incontinence, blood loss and PSMs were also collected. Results The IIEF-5 results before surgery showed

  17. Pathologic outcomes during the learning curve for robotic-assisted laparoscopic radical prostatectomy

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    Amul Shah

    2008-03-01

    Full Text Available OBJECTIVE: We report our initial experience with 62 patients undergoing robotic-assisted laparoscopic prostatectomy (RALP, focusing on the primary parameter of positive surgical margins. The authors demonstrate that excellent oncologic outcomes can be attained with a less steep learning curve than previously hypothesized. MATERIALS AND METHODS: The first 62 patients undergoing RALP by a single physician (DPD at our institution between November 2005 and August 2007 were retrospectively assessed. Surgical pathology records were reviewed for Gleason score, pathologic tumor stage, nodal status, location of prostate cancer within the specimen, extracapsular extension, surgical margin status, presence of perineural invasion, tumor volume, and weight of the surgical specimen. Margin status was determined using surgical specimens only, and not intraoperative frozen sections. All cases in this series were completed using the four-arm da Vinci Robotic System (Intuitive Surgical, Sunnyvale, California. RESULTS: Sixty-one patients had prostate cancer on their final surgical pathology specimens. Pathologic stage T2 and stage T3 patients were 88.7% and 9.7% of all cases, respectively. The pathologic Gleason score was 7 or greater in 62.3%. Our overall positive surgical margin rate was 3.3%. Patients with pathologic T2 and T3 disease had a positive surgical margin rate of 1.8% and 16.7%, respectively. CONCLUSIONS: Our study suggests that RALP can have equal if not better pathologic outcomes compared to open radical prostatectomy even during the initial series of cases. We argue that the learning curve for RALP is shorter than previously thought with respect to oncologic outcomes, and concerns asserting that lack of tactile feedback leads to poor oncologic outcomes are unfounded.

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

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    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.

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

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    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

  20. Comparison of oncological results and functional outcomes of radical prostatectomy techniques – retropubic, laparoscopic and robot-assisted

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    E. A. Prilepskaya

    2015-12-01

    Full Text Available Radical prostatectomy (RP continues to be the «gold standard» in the treatment of localized prostate cancer (PC for patients with a life expectancy of 10 years.The purpose of this article is to review pertinent literature to the several surgical approaches for PC and compare both functional outcomes and oncological results of radical retropubic prostatectomy (RRP, laparoscopic radical prostatectomy (LRP and robot-assisted radical prostatectomy (RARP. We chose and systematically reviewed 44 articles published between 1999 and 2013. Comparison analysis showed that the mean blood loss during RRP, LRP and RARP was 935, 442 and 191 ml respectively. Intraoperative transfusion required 19,9; 6,3 and 4,6 % patients respectively. We’d like to outline in our functional outcomes that within the 6-months and 12-months period of follow-up acute urinary retention experienced 89,1 and 92,7 % patients undergoing RARP.However, lack of certain data and absence of standard assessment methods made objective evaluation of erectile function quite complex. Oncologic results revealed that positive surgical margin rates were higher for RARP in comparison to patients after RRP and LRP (the difference was statistically significant.Nevertheless, the absence of randomized approach in an overwhelming majority of cases, as well as the short follow-up period are serious deterrents limiting the number of such trials. Therefore it’s still impossible today to draw certain conclusions about the superiority of any surgical approach for RP

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

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    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.

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

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    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

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

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    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.)

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

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    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.)

  5. Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy: A Propensity Score Matching Analysis.

    Science.gov (United States)

    Joo, Eun-Young; Moon, Yeon-Jin; Yoon, Syn-Hae; Chin, Ji-Hyun; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-02-01

    Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion. The objective of this study was to compare the incidence of postoperative AKI between RRP and RALP.We included 1340 patients who underwent RRP (n = 370) or RALP (n = 970) between 2013 and 2014. Demographics, cancer-related data, and perioperative laboratory data were evaluated. Postoperative AKI was determined according to the Kidney Disease: Improving Global Outcomes criteria. Operation and anesthesia time, estimated blood loss, amounts of administered fluids and transfused packed red blood cells, and the lengths of the postoperative intensive care unit and hospital stays were evaluated. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences between the RRP and RALP groups.After performing 1:1 propensity score matching, the RRP and RALP groups included 307 patients, respectively. The operation time and anesthesia time in RALP were significantly longer than in the RRP group (both P < 0.001). However, the estimated blood loss and amount of administered fluids in RALP were significantly lower than in RRP (both P < 0.001). Also, RALP demonstrated a significantly lower incidence of transfusion and smaller amount of transfused packed red blood cells than RRP (both P < 0.001). Importantly, the incidence of AKI in RALP was

  6. Radical prostatectomy - discharge

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

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

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    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

  8. Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Roh, Go Un; Kim, Won Oak; Rha, Koon Ho; Lee, Byung Ho; Jeong, Hae Won; Na, Sungwon

    2016-01-01

    Internal jugular vein (IJV) is the main pathway of cerebral venous drainage and its valves prevent regurgitation of blood to the brain. IJV valve incompetence (IJVVI) is known to be associated with cerebral dysfunctions. It occurs more often in male over 50 years old, conditions elevating intra-abdominal or intra-thoracic pressure. In robot-assisted laparoscopic radical prostatectomy (RALRP), elderly male undergoes surgery in Trendelenburg position with pneumoperitoneum applied. Therefore, we assessed the IJVVI during RALRP and its influence on postoperative cognitive function. 57 patients undergoing RALRP were enrolled. Neurocognitive tests including Mini-Mental State Examination (MMSE), Auditory Verbal Learning Test, Digit Symbol Substitution Test, Color Word Stroop Test, digit span test, and grooved pegboard test were performed the day before and 2 days after surgery. During surgery, IJVVI was assessed with ultrasonography in supine position with and without pneumoperitoneum, and Trendelenburg position with pneumoperitoneum. 50 patients underwent sonographic assessment and 41 patients completed neurocognitive examination. A total of 27 patients presented IJVVI, 19 patients in supine position without pneumoperitoneum, 7 patients in supine position with pneumoperitoneum and 1 patient in Trendelenburg position with pneumoperitoneum. In neurocognitive tests, patients with IJVVI showed statistically significant decline of score in MMSE postoperatively (p<0.05). IJVVI occurred in 38% in supine position but the incidence was increased to 54% after Trendelenburg position and pneumoperitoneum. Patients with IJVVI did not show significant differences in cognitive function tests except MMSE. Clinical and neurological significance of physiologic changes associated RALRP should be studied further. PMID:26921505

  9. 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.

  10. 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

  11. 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.

  12. 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...

  13. 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

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. Laparoscopic Robot-Assisted Diaphragm Plication.

    Science.gov (United States)

    Zwischenberger, Brittany A; Kister, Nathaniel; Zwischenberger, Joseph B; Martin, Jeremiah T

    2016-01-01

    Minimally invasive approaches to diaphragm plication for eventration include thoracoscopic and laparoscopic techniques. The elevated hemidiaphragm and ribs limit thoracoscopic techniques. We report our modification of the laparoscopic approach using robotic assistance with the da Vinci Surgical System, (Intuitive Surgical Inc, Sunnyvale, CA) to avoid single-lung ventilation, facilitate exposure, and allow more precise placement of plication sutures to achieve an even tension and maximum plication. Critical steps include creation of a small defect in the diaphragm to equalize pressures between cavities and placement of multiple, pledgeted interrupted horizontal mattresses. PMID:26694286

  1. 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.

  2. 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

  3. Robot Assisted Laparoscopic Repair of Sciatic Hernia (RASH): A Case Report.

    Science.gov (United States)

    Singh, Iqbal; Hudson, Jon E; Richards, Kyle A; Hemal, Ashok K

    2011-12-01

    Sciatic hernia is a surgical rarity. One such hernia was incidentally diagnosed in a 79-year-old woman who underwent Robot assisted laparoscopic radical cystectomy for locally invasive bladder cancer. Intra-operatively, a patent hernia sac was noted in the sciatic notch. The hernia was successfully repaired during the same operation by using robot assisted laparoscopic technique. This appears to be the first robot assisted sciatic hernia repair in the world literature although it was done incidentally during another procedure. The technical descriptions of the operation are also applicable when isolated sciatic hernia repair is intended. A robot assisted laparoscopic repair is safe, feasible and well suited to the repair of sciatic hernias in women. The surgeon needs to be aware of this uncommon surgical pathology that may occur in women presenting with persistent chronic pelvic discomfort. PMID:23204714

  4. Radical cystectomy for bladder cancer: сomparison of early surgical complications during laparoscopic, open-access, and video-assisted surgery

    Directory of Open Access Journals (Sweden)

    A. K. Nosov

    2015-09-01

    Full Text Available Objectives. To evaluate peri- and postoperative morbidity and functional results of LRC in a single-site cohort of patients, comparing it with standard open approach (ORC and laparoscopic cystectomy with open urinary diversion (HALRC.Subjects and methods. A prospective analysis was performed in 51 muscle-invasive and locally advanced BCa patients who underwent RC between February 2012 and March 2014 in N. N. Petrov Research Institute of Oncology, Saint-Petersburg. The final cohort included 21 ORC, 21 LRC and 9 HALRC patients. Mean patients age was 64 (38–81 years old and did not differ in all groups. Pathological stage were similar in all groups. Multivariable logistic and median regression was performed to evaluate operating time, perioperative and postoperative complications (30-d and 90-d, readmission rates, length of stay (LOS – totally and in ICU.Results. Operating time during LRC and HALRC was longer than that of ORC (398 min vs 468 min vs 243 min, respectively. Despite that, there was no statistically significant influence of type of surgery on intraoperative complications – 14.3 % in ORC group, 11.1 % in HALRC and 4.7 % in LRC patients. Major complication rates (Clavien grade  3; 23.8 % vs 33.3 % vs 19.4 % were similar between all groups. However, LRC had 4,0 times lower rate of minor complications (Clavien grade 1–2 compared to ORC (4.7 % vs 19.0 %. LRC had a significantly shorter LOS (27.8 d vs 32.6 d vs 22.6 d in ORC, HALRC and LRC groups, respectively, but no significant differences in ICU stay existed (5.1 d vs 3.1 d vs 2.1 d. Morbidity were present by one patient in each group (medium rate 5,8 %. The common transfusion rate during and after surgical intervention was 19.6 % and was higher in ORC group (33.3 % vs 4.7 % in LRC; as well, intraoperative bleeding was lower in minimally invasive techniques – the average volume of blood loss was 285 ml in LRC and did not differ between HALRC and ORC groups – 468

  5. Robot-assisted radical prostatectomy: recent advances.

    Science.gov (United States)

    Mistretta, F A; Grasso, A A; Buffi, N; Cozzi, G; De Lorenzis, E; Fiori, C; Patel, V R; Porpiglia, F; Scarpa, R; Srinivas, S; Rocco, B

    2015-09-01

    Robot assisted radical prostatectomy (RARP) represents the leading application of robotic surgery in the urologic field and it has become the main treatment option for localized prostate cancer (PCa) in the USA In the present review we summarized and critically analyzed the literature of the past five years about this widely used robotic procedure. RARP has continuously evolved in terms of technical modifications and procedural steps. Long-term data are now available, suggesting comparable oncological outcomes to those of open and laparoscopic radical prostatectomy. Good functional outcomes have also been demonstrated. Technological innovations and the introduction of more advanced robotic platforms featuring novel arm-integrated equipment, together with a mature clinical experience with the robotic approach, are likely to lead towards optimal outcomes. Despite the expanding clinical implementation of RARP in the management of prostate cancer, some issues related to this procedure remain matter of debate, such as costs, comparative outcomes versus other approaches, and its role in high risk disease. PMID:26086533

  6. 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

  7. 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

  8. 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。

  9. 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

  10. 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

  11. 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

  12. 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.

  13. Learning curve analysis of laparoscopic radical hysterectomy for gynecologic oncologists without open counterpart experience

    OpenAIRE

    Kong, Tae-Wook; Chang, Suk-Joon; Paek, Jiheum; Park, Hyogyeong; Kang, Seong Woo; Ryu, Hee-Sug

    2015-01-01

    Objective To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwent residency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radical hysterectomy (ARH). Methods We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervical cancer who underwent LRH (Piver type III) between April 2006 and March 2014. The patients were divid...

  14. 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

  15. 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. PMID:23909823

  16. 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.

  17. How can laparoscopic management assist radiation treatment in cervix carcinoma?

    International Nuclear Information System (INIS)

    Purpose: To determine the role of laparoscopic lymphadenectomy (pelvis ± para-aortic nodes) and laparoscopic hysterectomy in cervical cancer compared to 'classic radical surgery' in patients undergoing surgery in comparison with modern imaging in patients treated with radiotherapy alone.Materials and methods: The limitations of modern imaging are presented as well as how complication rates can be increased when classic laparotomy is followed by radiation therapy.Laparoscopic procedures are described with particular emphasis on how to provide information on lymph node metastases with the risk of overlooking microscopic involvement. A number of clinical experiences are cited to illustrate this problem and show how treatment approaches can be adapted.Results: The role of laparoscopy is evaluated according to different clinical situations and treatment protocols emphasizing the possibilities offered by this method to the radiotherapist. Conclusion: When developing laparoscopic techniques for the management of cervical carcinoma, caution must be exercised to ensure that these techniques are not detrimental to the prognosis. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

  18. 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.

  19. 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...

  20. 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.

  1. Robot-assisted laparoscopic retroperitoneal lymph node dissection for stage IIIb mixed germ cell testicular cancer after chemotherapy

    OpenAIRE

    Lee, Sang Hyub; Kim, Dong Soo; CHANG, SUNG-GOO; Jeon, Seung Hyun

    2015-01-01

    Laparoscopic retroperitoneal lymph node dissection, especially when performed with the da Vinci Surgical System (Intuitive Surgical), has shown excellent cosmetic results with similar oncologic outcomes to those of open surgery. In this study, we present a case of robot-assisted retroperitoneal lymph node dissection performed in an 18-year-old man who was diagnosed with a stage IIIb mixed germ cell tumor and who was initially treated with radical orchiectomy, followed by chemotherapy. This ca...

  2. 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

  3. Perioperative Outcomes of Robotic Assisted Laparoscopic Surgery Versus Conventional Laparoscopy Surgery for Advanced-Stage Endometriosis

    OpenAIRE

    Nezhat, Farr R.; Sirota, Ido

    2014-01-01

    Background and Objectives: To determine perioperative outcome differences in patients undergoing robotic-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for advanced-stage endometriosis. Methods: This retrospective cohort study at a minimally invasive gynecologic surgery center at 2 academically affiliated, urban, nonprofit hospitals included all patients treated by either robotic-assisted or conventional laparoscopic surgery for stage III or IV endometrios...

  4. ROBOTIC ASSISTED LAPAROSCOPIC MYOMECTOMY VERSUS CLASSICAL MYOMECTOMY - A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    I. Georgescu

    2012-11-01

    Full Text Available AIM:The objective of this study was to perform a comparative analysis between robotic assisted laparoscopic and open approach, for patients with uterine leiomyoma, in terms of feasibility and quality of operation (duration of surgery, number and dimensions of extracted miomas, intraoperative blood loss. MATERIAL AND METHODS: We conducted a retrospective study on 166 patients diagnosed with uterine fibroids who have received conservative surgery – myomectomy over a period of 3 years (2008-2010. 38 cases were treated by robotic assisted laparoscopic myomectomy (RALM and 128 patients underwent open myomectomy. RESULTS: BMI was higher among patients with RALM, 27.68 vs 22.63, respectively. The average time of interventions was similar, 111.8 min for RALM. Time for myomectomy itself was 50.39 min and 22.37 min for the uterine suture. Open myomectomy took an average of 103 min, 21.05 min for myomectomies itself, and 21.05 min for the uterine suture. In RALM, a higher number of myomas were extracted, but with a smaller volume, 2.26 myomas with a volume of 57 mm3 vs 1.8 myomas with a volume of 156 mm3 for open myomectomy. Blood loss was significantly lower during robotic-assisted laparoscopic myomectomy compared to open myomectomy, 140 mL vs 267 mL. Patients treated by RALM had a shorter length of stay 2.05 versus 6 days. Postoperative complications in RALM were insignificant. In open miomectomy we noted: a case of uncontrollable intraoperative bleeding that required the use the Gelaspon, 4 cases of postoperative febrile syndrome and one case of urinary infection. CONCLUSIONS: RALM is feasible and allows superior results compared to open myomectomy, with less blood loss and shorter postoperative hospital stay.

  5. 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

  6. 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.

  7. Pure Laparoscopic Radical Heminephrectomy for a Large Renal-Cell Carcinoma in a Horseshoe Kidney

    OpenAIRE

    Rafael B Reboucas; Rodrigo C Monteiro; Thiago N Souza; Paulyana F Barbosa; George G Pereira; Cesar A Britto

    2013-01-01

    Introduction Horseshoe Kidneys are the most common renal fusion anomaly. When surgery is contemplated for renal-cell carcinoma in such kidneys, aberrant vasculature and isthmusectomy are the major issues to consider. We describe a case of a pure laparoscopic radical heminephrectomy with hand-sewn management of the isthmus for a 11 cm tumour in a horseshoe kidney. Presentation A 47-year-old man complaining of palpable left flank mass for two months. Magnetic resonance of the abdomen revealed...

  8. [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

  9. Laparoscopic resection of tumor recurrence after radical nephrectomy for localized renal cell carcinoma

    OpenAIRE

    Lessandro Curcio; Antonio Claudio Cunha; Juan Renteria; Daniel Presto

    2014-01-01

    Introduction Local recurrence of Renal Cell Carcinoma (RCC) after radical nephrectomy is a rare event. Some known risk factors are: clinical/pathological stage, locorregional disease and lyimph node positivity. Since up to 30-40% of patients can achieve a disease-free status, we show a case (video) in which we performed a laparoscopic excision of a local RCC, taking advantage of all the well-known benefits of laparoscopy.Case report A 56 years old female with a history of open radical nephrec...

  10. [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

  11. Laparoscopic Radical Nephrectomy in a Pelvic Ectopic Kidney: Keys to Success

    OpenAIRE

    Chung, Benjamin I.; Liao, Joseph C.

    2010-01-01

    Background and Objectives: Laparoscopic radical nephrectomy of a pelvic kidney for renal cell carcinoma is a procedure with little precedent, but one that offers the advantages of the minimally invasive approach. We present our experience with this unique procedure. Methods: A 64-year-old male with a history of end-stage renal disease was diagnosed with a 2.6-cm enhancing mass in a pelvic left kidney with 2 separate sources of blood supply. He was offered either an open radical nephrectomy or...

  12. 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

  13. 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.

  14. 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...

  15. 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

  16. 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

  17. Ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy.

    Science.gov (United States)

    Chen, I-Hsuan; Tsai, Jeng-Yu; Yu, Chia-Cheng; Wu, Tony; Huang, Jong-Khing; Lin, Jen-Tai

    2014-05-01

    The aim of this study was to examine the feasibility of ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy and to evaluate the effects of retrograde ureteroscopic access exerted on the sutured ureterotomy site. From January 2002 to December 2011, 30 patients with proximal ureteral stone underwent ureteroscopic double-J stenting of the ureter following retroperitoneal laparoscopic ureterolithotomy. Patient demographics and perioperative parameters, including the degree of hydronephrosis, urine leakage, and drainage time, were retrospectively reviewed. These data were compared with those of 30 consecutive patients who received open ureterolithotomy and intracorporeal ureteral double-J stenting. In addition, a PubMed search was conducted and the related literature on the placement of a ureteral stent was reviewed. Twenty-eight patients successfully underwent ureteral double-J stenting with ureteroscopic access. No malposition of the ureteral stent was identified in the ureteroscopic group, but two patients in the intracorporeal group required postoperative adjustment of the stent. Residual stone fragments were found during stent placement in three patients in the ureteroscopic group and holmium:yttrium-aluminum-garnet laser lithotripsy was immediately performed. There was no significant difference in postoperative outcomes or complication rates between the two groups. Ureteroscope-assisted ureteral double-J stenting is a simple and safe alternative allowing intraluminal navigation along the entire ureter, correct stent placement, and prompt treatment of residual stone fragments, without radiation exposure. In addition, ureteral disruption and urinary extravasation may not be concerns for ureteroscopic access with continuous normal saline irrigation. PMID:24751387

  18. Laparoscopic Assisted Vaginal Hysterectomy, Setting Up a Service at a Peripheral Teaching Hospital

    OpenAIRE

    Jim Tsaltas; Gab Kovacs; Jenny Dennis; Amanda Pratt

    1996-01-01

    The establishment of a laparoscopically assisted hysterectomy program at Box Hill Hospital is described. The first eight cases have been reviewed and recommendations are made to other gynaecology units who wish to establish a minimally invasive gynaecological surgery unit.

  19. 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.

  20. 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.

  1. 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.

  2. Laparoscopic resection of tumor recurrence after radical nephrectomy for localized renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Lessandro Curcio

    2014-06-01

    Full Text Available Introduction Local recurrence of Renal Cell Carcinoma (RCC after radical nephrectomy is a rare event. Some known risk factors are: clinical/pathological stage, locorregional disease and lyimph node positivity. Since up to 30-40% of patients can achieve a disease-free status, we show a case (video in which we performed a laparoscopic excision of a local RCC, taking advantage of all the well-known benefits of laparoscopy.Case report A 56 years old female with a history of open radical nephrectomy two years before was diagnosed with a mass at the time of surveillance CT imaging during follow-up. The suspected local recurrence was 12cm, and vascularized predominantly by tributaries originating from the iliac vessels. There was no other site of disease (i.e. brain, lung, liver, bones and laboratory tests were normal. Laparoscopic approach was approached, by inserting 4 trocars (2 of 10 and 2 of 5mm with the patient in the lateral position.Result The procedure lasted 130 minutes, with 220mL of estimated bleeding; the larger vessels were ligated with polymer clips (Hem-o-lok and the smaller handled by ultrasonic clamp. The specimen was removed by a small incision below the umbilicus in an appropriate bag. The patient was feed in the first postoperative day and discharged on the third day. Histopathology revealed sarcoma, with a high degree of mitosis, and negative surgical margins. She was referred to medical oncology for adjuvant therapy consideration.Conclusion The laparoscopic resection of recurrent tumor should be encouraged in highly selected cases. The minimally invasive method, with its known advantages, especially for more debilitated patients, can be advantageous when applied to suitable cases.

  3. 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

  4. 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.

  5. Laparoscopic and robot-assisted surgery in the management of urinary lithiasis

    OpenAIRE

    Ganpule, Arvind P; Prashant, Jain; Desai, Mahesh R.

    2012-01-01

    Objectives To review the current role of laparoscopy and robot-assisted laparoscopy for managing urinary lithiasis. Results The contemporary indications for laparoscopic stone management are: anatomical variations in location or shape of the kidney (pelvic kidney, horseshoe kidney and malrotated kidney); coexisting pathologies, e.g. pelvi-ureteric junction obstruction; and stones in a renal unit with lower ureteric obstruction. The laparoscopic approach allows the simultaneous management of b...

  6. Comparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial Nephrectomy for Renal Masses

    OpenAIRE

    Jeon, Hwang Gyun; Choi, Kyung Hwa; Kim, Kwang Hyun; Rha, Koon Ho; Yang, Seung Choul; Han, Woong Kyu

    2011-01-01

    Purpose Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. Materials and Methods We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique....

  7. Robot-assisted radical prostatectomy is a safe procedure

    DEFF Research Database (Denmark)

    Thomsen, Frederik Birkebæk; Berg, Kasper Drimer; Hvarness, Helle; Nielsen, Jon; Iversen, Peter

    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....

  8. Effects of laparoscopic radical surgeries of gastric carcinoma on systemic inflammatory reaction and immune function and its clinical significance

    International Nuclear Information System (INIS)

    Objective: To analyze the effects of laparoscopic radical gastrectomy of gastric carcinoma on systemic inflammatory reaction and immune function and its clinical significance. Methods: The patients were divided into two groups: the laparoscopic group and the laparotomy group, 20 patients in each group. Venous blood in the empty stomach condition on the morning of the following days was drawn respectively: 1 d before surgery, 1 d, 3 d, 5 d after surgery. Detection indexes such as IL-6, TNF, CRP, CD4+/CD8+ cells, CD4+/CD8+ ratio, NK cells et al were tested and compared. Results: There was no significant difference in every, index between two groups on the 1st day before surgery, (P>0.05). On the 1st day after surgery, IL-6, TNF and CRP increased in the two groups apparently (P<0.05) and the indexes in laparoscopic group were less than those in the laparotomy group markedly (P<0.05). On the 5th day, there was no statistical significance between the two groups any more (P>0.05), but CRP decreased slowly, still showing the existence of differences to some extent (P<0.05); T-cell subgroups (CD4+/CD8+ cells, CD4+/CD8+ ratio) decreased largely (P<0.05) in the two groups on the 1st day after surgery, and laparoscopic group decreased less than in the laparotomy group markedly (P<0.05). Above indexes of patients in the laparoscopic group nearly recovered the preoperative level 3 days after surgery, but those in the laparotomy group had been keeping a low level for the first 3 days after surgery and they did not recovered fully to the preoperative level on the 5th day. Conclusion: Compared with laparotomy radical gastrectomy of gastric carcinoma, laparoscopic radical gastrectomy has the advantages in that it causes slight systemic inflammatory reaction and can protect body immune function. (authors)

  9. Robotically assisted laparoscopic tubal anastomosis in a porcine model: a pilot study.

    Science.gov (United States)

    Margossian, H; Garcia-Ruiz, A; Falcone, T; Goldberg, J M; Attaran, M; Miller, J H; Gagner, M

    1998-04-01

    As with standard microsurgical procedures performed at laparotomy, laparoscopic tubal anastomosis requires great dexterity. Handling fine suture materials under magnification to anastomose tubal segments with lumens less than 3 mm in diameter while working with your hands at a distance from the tissue makes these fine movements even more difficult. This is exacerbated by the tremor induced by the fatigue caused by a prolonged laparoscopic procedure and the need for precise control. We conducted a pilot study to evaluate the feasibility of performing laparoscopic tubal anastomosis with robotic assistance in a live porcine model. Two anastomoses were performed on one uterine horn via each of the following techniques: laparoscopy, laparoscopy with robotic assistance, and open microsurgery. Immediate necropsy demonstrated all the anastomoses to be patent. There were no intraoperative complications. Laparoscopic tubal anastomosis was associated with surgeon fatigue and neck, shoulder, and back pain. The surgeons were more comfortable performing the procedure with robotic assistance. The device functioned well and without incident. This acute animal study suggests that robotic assistance in laparoscopic tubal anastomoses is safe and feasible. It enhances surgeons' dexterity and precision while reducing fatigue. It is promising for future use in chronic experimental studies. PMID:9617965

  10. 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.

  11. 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

  12. Pure Laparoscopic Radical Heminephrectomy for a Large Renal-Cell Carcinoma in a Horseshoe Kidney

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    Rafael B Reboucas

    2013-07-01

    Full Text Available Introduction Horseshoe Kidneys are the most common renal fusion anomaly. When surgery is contemplated for renal-cell carcinoma in such kidneys, aberrant vasculature and isthmusectomy are the major issues to consider. We describe a case of a pure laparoscopic radical heminephrectomy with hand-sewn management of the isthmus for a 11 cm tumour in a horseshoe kidney. Presentation A 47-year-old man complaining of palpable left flank mass for two months. Magnetic resonance of the abdomen revealed a 11 cm renal mass arising from the left moiety of an incidentally discovered horseshoe kidney. Preoperative CT angiography revealed a dominant anterior renal artery feeding the upper and midpole, with two other arteries feeding the lower pole and isthmus. The patient was placed in a modified flank position. A four-port transperitoneal technique was used, the colon was reflected. Renal pedicle was dissected and the renal arteries and renal vein were secured with polymer clips. The kidney was fully mobilized and a Satinsky clamp was placed on the isthmus for its division. A running 2-0 vicryl hand-sewn was used for parenchyma hemostasis. The specimen was extracted intact in a plastic bag through an inguinal incision. Results The operative time was 220 minutes, and the estimated blood loss was 200 mL. There were no immediate or delayed complications. The patient resumed oral intake on postoperative day 1 and was discharged on postoperative day 2. Pathologic examination of the specimen confirmed a 11 cm organ-confined chromophobe renal-cell carcinoma, with negative margins. Discussion Laparoscopic oncologic surgery in patients with horseshoe kidneys can be technically challenging. The presence of a large cancer in a horseshoe kidney should not preclude a purely laparoscopic approach. With the aid of a Satinsky clamp, the isthmus can be sharply divided and sutured in a fashion similar to the open technique. To our knowledge, this report represents the largest

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

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    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.

  14. 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.

  15. Percutaneous and laparoscopic assisted cryoablation of small renal cell carcinomas

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Borre, Michael;

    route; n=34 (47%) and laparoscopic guided; n=39 (53%). The mean follow-up time was 18 months [1 - 56]. 18 patients were excluded from follow-up analysis (8 pt. with short observation time, 5 pt. treated despite severe co-morbidity with no planned follow-up, 3 pt. lost to follow-up, 1 pt. emigrated, 1 pt...

  16. 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 ...

  17. Laparoscopic-assisted extirpation of falciform ligament hemangiosarcoma in a dog

    OpenAIRE

    Hoddinott, Katie; Singh, Ameet; Crawford, Evan C; Guieu, Elizabeth V.; Richardson, Danielle

    2015-01-01

    An 8-year-old, spayed female, bichon frisé dog had incidental nodules within its falciform ligament identified on routine abdominal ultrasonography. A laparoscopic-assisted technique provided both a diagnostic and a therapeutic treatment option. A histopathological diagnosis of hemangiosarcoma was made. This is the second case reporting hemangiosarcoma of the falciform fat.

  18. Laparoscopic-assisted extirpation of falciform ligament hemangiosarcoma in a dog.

    Science.gov (United States)

    Hoddinott, Katie; Singh, Ameet; Crawford, Evan C; Guieu, Elizabeth V; Richardson, Danielle

    2015-04-01

    An 8-year-old, spayed female, bichon frisé dog had incidental nodules within its falciform ligament identified on routine abdominal ultrasonography. A laparoscopic-assisted technique provided both a diagnostic and a therapeutic treatment option. A histopathological diagnosis of hemangiosarcoma was made. This is the second case reporting hemangiosarcoma of the falciform fat. PMID:25829552

  19. 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

  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. Laparoscopic-assisted transanal pull-through for Hirschsprung′s disease: Comparison between partial and near total laparoscopic mobilization of rectum

    Directory of Open Access Journals (Sweden)

    Mohit Kumar Mathur

    2014-01-01

    Full Text Available Background: Transanal pull-through with laparoscopic assistance is gaining popularity. How much rectal dissection to do laparoscopically and how much transanally is not clear. Laparoscopic rectal mobilization is akin to open pelvic dissection of Swenson′s operation - the most physiological procedure. Through this comparative study, we aim to evolve a technique that maximizes the benefits of Swenson′s technique and minimizes the problems of a transanal procedure. Materials and Methods: Twenty patients (19 boys and one girl, newborn to 6 years with Hirschsprung′s disease (HD were randomized for laparoscopic-assisted transanal pull-through (LATAPT either by near complete (Group A or partial (Group B laparoscopic mobilization of rectum. Patients were followed up for at least 3 months. Demographic profile; operative details (time taken, blood loss, operative difficulty, and complications; postoperative course (duration of urinary catheter, oral feeding, and hospital stay; and follow-up stooling pattern, consistency, and continence were compared in the two groups. Results: The time taken for laparoscopic mobilization was marginally higher in group A, but the time taken for transanal dissection in this group was significantly less than in group B. All other comparisons showed no significant difference in the two groups. Stool frequency and continence improved with time in both groups. Conclusion: Extent of laparoscopic mobilization of rectum does not appear to be a factor deciding the outcomes. No recommendations could be made in view of the small number of cases. However, it shows that laparoscopic assistance can be used to maximize the benefits of Swenson type of operation and a transanal pull-through.

  3. Endoscopically assisted laparoscopic local resection of gastric tumor

    OpenAIRE

    Kosmidis, Christoforos; Efthimiadis, Christoforos; Anthimidis, Georgios; Vasileiadou, Kalliopi; Stavrakis, Thomas; Ioannidou, Georgia; Basdanis, Georgios

    2013-01-01

    Background Minimally invasive procedures have been applied in treatment of gastric submucosal tumors. Currently, combined laparoscopic - endoscopic rendezvous resection (CLERR) emerges as a new technique which further reduces operative invasiveness. Case presentation A-57-year-old female patient presented with epigastric pain. She was submitted to gastroscopy, which revealed a tumor located at the angle of His. Biopsy specimens demonstrated a leiomyoma. The patient underwent endoscopically as...

  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 laparoscopic partial nephrectomy: Current review of the technique and literature

    Directory of Open Access Journals (Sweden)

    Singh Iqbal

    2009-01-01

    Full Text Available Aim: To visit the operative technique and to review the current published English literature on the technique, and outcomes following robot-assisted laparoscopic partial nephrectomy (RPN. Materials and Methods: We searched the published English literature and the PubMed (TM for published series of ′robotic partial nephrectomy′ (RPN using the keywords; robot, robot-assisted laparoscopic partial nephrectomy, laparoscopic partial nephrectomy, partial nephrectomy and laparoscopic surgery. Results: The search yielded 15 major selected series of ′robotic partial nephrectomy′; these were reviewed, tracked and analysed in order to determine the current status and role of RPN in the management of early renal neoplasm(s, as a minimally invasive surgical alternative to open partial nephrectomy. A review of the initial peri-operative outcome of the 350 cases of select series of RPN reported in published English literature revealed a mean operating time, warm ischemia time, estimated blood loss and hospital stay, of 191 minutes, 25 minutes, 162 ml and 2.95 days, respectively. The overall computed mean complication rate of RPN in the present select series was about 7.4%. Conclusions: RPN is a safe, feasible and effective minimally invasive surgical alternative to laparoscopic partial nephrectomy for early stage (T 1 renal neoplasm(s. It has acceptable initial renal functional outcomes without the increased risk of major complications in experienced hands. Prospective randomised, controlled, comparative clinical trials with laparoscopic partial nephrectomy (LPN are the need of the day. While the initial oncological outcomes of RPN appear to be favourable, long-term data is awaited.

  6. 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.

  7. 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

  8. 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 ...

  9. 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, ...

  10. Improvement in Cormack and Lehane grading with laparoscopic assistance during tracheal intubation

    Directory of Open Access Journals (Sweden)

    Anjeleena K Gupta

    2011-01-01

    Full Text Available Background: To use laparoscope as an easily available and easy to use alternative option to videolaryngoscope. Aims: The aim of the study was to assess the improvement in the glottic view using a conventional direct laryngoscope (DL assisted by a laparoscope with its endovision system along with the time taken for tracheal intubation. Settings and Design: A prospective, double blind, randomized, controlled study was conducted in a tertiary care centre. Methods: Sixty patients with American Society of Anesthesiologists (ASA physical status I and II requiring general anaesthesia and tracheal intubation for elective surgery were included in the study. The patients were anaesthetized, paralysed, DL was performed and Cormack and Lehane grade (C and L noted, followed by the introduction of the laparoscope alongside the flange of the Macintosh laryngoscope and a further C and L grading done as seen on monitor. Demographic data, ASA physical status, airway assessment, mouth opening, modified Mallampatti class, jaw protrusion, thyromental and sternomental distances, optimal external laryngeal manipulation, time taken for intubation, pulse oximetry, blood on; tracheal tube, lip, dentition or mucosal trauma, sore throat, hoarseness of voice, excessive secretions and regurgitation were recorded. Statistical Analysis: Statistical analysis was done using statistics package for social sciences software (17.0 version. A P-value less than 0.05 was considered statistically significant. Results: Eighty-three percent of the patients showed improvement in glottic view after laparoscopic assistance. Eighty-one and 85% of the patients with C and L grade II and III respectively on DL had an improved glottic view with this technique. The mean time to intubate was 37 seconds. Conclusions: Laparoscopic assistance provided a better glottic view than DL in most patients (83%. It has a potential advantage over standard DL in difficult intubation.

  11. 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.

  12. 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.

  13. 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

    2014-07-01

    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.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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......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...... 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....

  15. 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. ...

  16. 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

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    Liu G

    2016-06-01

    Full Text Available 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 September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21, FTS + laparotomy group (Group B, n=21, conventional perioperative care (CC + laparoscopic group (Group C, n=21, and CC + laparotomy group (Group D, n=21. Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators.Results: Preoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05. There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05. Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest.Conclusion: FTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more

  19. 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

  20. Coring-type laparoscopic resection of a cavitated non-communicating rudimentary horn under hysteroscopic assistance.

    Science.gov (United States)

    Akdemir, Ali; Ergenoglu, Ahmet Mete; Yeniel, Ahmet Özgür; Sendag, Fatih; Karadadaş, Nedim

    2014-07-01

    Non-communicating accessory uterine horns with an endometrial cavity are the most common and clinically significant unicornuate subtype of Müllerian duct abnormality. They are generally associated with symptoms of dysmenorrhea, dyspareunia, infertility, endometriosis, adhesions, and life-threatening cornual pregnancy. Treatment options include surgical resection of the rudimentary horn, hysteroscopic recanalization, and endometrial ablation. Currently, laparoscopic resection is the recommended treatment choice. Dissection of the rudimentary horn from the unicornuate uterus is the most challenging part of this procedure and may compromise the remaining unicornuate uterus wall. Here we describe a case of laparoscopic coring-type resection of a non-communicating functional rudimentary horn firmly attached to the unicornuate uterus, by using hysteroscopic assistance. The use of hysteroscopy, adjunct to laparoscopy, facilitates the coring-type resection and may strengthen the remaining myometrial scar. PMID:25056476

  1. 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

  2. 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.

  3. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    OpenAIRE

    Thomas Lendvay

    2008-01-01

    Robotic-assisted laparoscopy (RAL) has become a promising means for performing correction of vesicoureteral reflux disease in children through both intravesical and extravesical techniques. We describe the importance of patient selection, intraoperative patient positioning, employing certain helpful techniques for exposure, and recognizing the limitations and potential complications of robotic reimplant surgery. As more clinicians embrace robotic surgery and more urology residents are traine...

  4. 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

  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. 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...

  7. 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.

  8. 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.

  9. Hand-assisted laparoscopic management of a midtrimester rudimentary horn pregnancy with placenta increta: a case report and literature review.

    Science.gov (United States)

    Contreras, Karenrose R; Rothenberg, Jeffrey M; Kominiarek, Michelle A; Raff, Gregory J

    2008-01-01

    Pregnancy in a rudimentary horn is an extremely rare but serious obstetric condition. It is associated with uterine rupture and increased maternal mortality. The standard treatment is excision of the pregnancy and rudimentary horn. Several case reports describe a successful laparoscopic approach for rudimentary horn pregnancies diagnosed in the first trimester. A midtrimester rudimentary horn pregnancy was managed with a hand-assisted laparoscopic technique. This patient sought prenatal care at 19 weeks without any symptoms. A routine ultrasound found an empty uterus and an abdominal pregnancy was suggested. She subsequently had a hand-assisted laparoscopic delivery of a 19-week fetus with excision of the left-sided noncommunicating rudimentary horn. Intraoperative and pathologic findings were both consistent with a noncommunicating uterine horn pregnancy with placenta increta. Midtrimester rudimentary horn pregnancy can be successfully managed via hand-assisted laparoscopy in a patient who is hemodynamically stable. PMID:18722979

  10. 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

  11. 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.

  12. Initiation of robot-assisted radical prostatectomies in Finland: Impact on centralization and quality of care.

    Science.gov (United States)

    Riikonen, Jarno; Kaipia, Antti; Petas, Anssi; Horte, Antero; Koskimäki, Juha; Kähkönen, Esa; Boström, Peter J; Paananen, Ilkka; Kuisma, Jani; Santti, Henrikki; Matikainen, Mika; Rannikko, Antti

    2016-06-01

    Objective The aim of this study was to analyze the impact of introduction of robot-assisted prostate surgery and its quality measures in Finland from 2008 to 2012. Materials and methods Registry data were collected for time trends and national distribution of prostate cancer surgery in Finland, while preoperative, operative and follow-up data were collected for quality measures. Results The number and proportion of robot-assisted laparoscopic radical prostatectomies (RALPs) increased rapidly and they accounted for 68% of all radical prostatectomies in 2012. The number of centers performing prostatectomies diminished from 25 to 20 at the expense of low-volume centers. In total, 1996 patients were operated on in the four RALP centers in 2008-2012. As anticipated, the learning curve was uniform between the centers, as were mean blood loss (212 ml), hospitalization (1.8 days) and catheterization times (10.6 days). At 3 and 12 months, 49.4% and 71.2% of patients, respectively, were totally continent (no pads). After unilateral nerve-sparing surgery, 9.9% and 5.1% had partial or normal erection at 3 months postoperatively and 14.8% and 20.4% at 12 months, respectively. If bilateral nerve sparing was done, the figures were 13.0% and 13.5% at 3 months and 14.6% and 34.9% at 12 months. Clavien-Dindo grade 3, 4 or 5 complications were seen in 0.3%, 0.3% and 0.1% of patients, respectively. Limitations of the study include non-standardized collection of outcome parameters. Conclusions This report shows that the main impact of adoption of RALP on a national level was rapid spontaneous centralization of prostate cancer surgery. The main advantages of minimally invasive prostatectomy, i.e. low blood loss and short hospitalization, are easily achieved, while continuous effort is necessary for improvements in surgical outcomes. PMID:26881411

  13. Approach to endoscopic extraperitoneal radical prostatectomy (EERPE: the impact of previous laparoscopic experience on the learning curve

    Directory of Open Access Journals (Sweden)

    Wieland Wolf F

    2007-07-01

    Full Text Available Abstract Background We report our approach regarding the technique of endoscopic extraperitoneal radical prostatectomy (EERPE and analyze the learning curve of two surgeons after thorough technical training under expert monitoring. The purpose of this study was to investigate the influence of expert monitoring on the surgical outcome and whether previous laparoscopic experience influences the surgeon's learning curve. Methods EERPE was performed on 120 consecutive patients by two surgeons with different experience in laparoscopy. An analysis and comparison of their learning curve was made. Results Median operation time: 200 (110 – 415 minutes. Complications: no conversion, blood transfusion (1.7%, rectal injury (3.3%. Median catheterisation time: 6 (5 – 45 days. Histopathological data: 55% pT2, 45% pT3 with a positive surgical margin rate of 6.1% and 46%, respectively. After 12 months, 78% of the patients were continent, 22% used 1 or more pad. Potency rate with or without PDE-5-inhibitors was 66% with bilateral and 31% with unilateral nerve-sparing, respectively. Operation time was the only parameter to differ significantly between the two surgeons. Conclusion EERPE can be learned within a short teaching phase. Previous laparoscopic experience is reflected by shorter operation times, not by lower complication rates or superior early oncological data.

  14. Robot-assisted radical prostatectomy in Brazil: preliminary results

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    Jose Roberto Colombo Junior

    2009-12-01

    Full Text Available Purpose: To report the initial experience on robot-assisted radical prostatectomy in Brazil. Methods: From March 2008 to March 2009, a hundred patients were treated with robot-assisted radical prostatectomy. Patient’s demographic data, as well as perioperative results of the procedures, are described in this study. Rresults: Patients’ mean age and mean PSA were 58 years and 7.58 ng/ml, respectively. All procedures were performed through transperitoneal approach, with a mean bleeding of 480 mL and surgical time of 298 minutes. A surgical margin affected by cancer was present in 16% of the cases. There were four complications: bleeding requiring transfusion (two cases, rectal perforation corrected on the spot and inadequate functioning of the robot. There was no conversion to another access or obit occurrences in this caseload. Cconclusions: Robot-assisted prostatectomy is a reality in Brazil and the results herein presented demonstrate that this procedure can be safely performed. Long-term follow-up is still necessary to assess the oncological and functional outcomes.

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

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    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.

  16. Advances in Robotic-Assisted Radical Prostatectomy over Time

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    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.

  17. Robot-assisted laparoscopic prostatectomy in a 68-year-old patient with previous heart transplantation and pelvic irradiation.

    Science.gov (United States)

    Axcrona, Karol; Vlatkovic, Ljiljana; Hovland, Jarl; Brennhovd, Bjørn; Kongsgaard, Ulf; Giercksky, Karl-Erik

    2012-03-01

    We report the case of a 68-year-old man who had previously undergone heart transplantation and pelvic irradiation for Hodgkin's lymphoma and who was under active surveillance for prostate cancer. In response to his increased prostate-specific antigen levels and elevated Gleason score, he was offered robot-assisted laparoscopic prostatectomy. PMID:22408687

  18. 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.

  19. AB054. An improved technique for bladder cancer: pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder using titanium staples

    Science.gov (United States)

    Wang, Shuai; Qi, Xiaolong; Liu, Feng; Zheng, Min; Zhang, Dahong

    2015-01-01

    Objective To report our experience with an improved technique of laparoscopic radical cystectomy (LRC) and orthotopic ileal neobladder reconstruction, evaluating the perioperative and pathological outcomes. Methods We retrospectively reviewed the data of 56 cases who underwent radical cystoprostatectomy followed by construction of an orthotopic U-shaped ileal neobladder between August 2010 and December 2014. These data include intraoperative data, early and long-term postoperative complications, neobladder function, urinary continence and oncologic results. Also the key innovative procedure was introduced with details. Results The median time of the overall procedure was 212 min. The median estimated blood loss was 171 mL. The median hospitalization time after the operation was 21 days. Complications included two cases of unilateral ureter-pouch anastomotic strictures, one case of bilateral ureteral stricture, three cases of vesicourethral anastomotic strictures and three cases of vesicourethral leakage. The mean maximum pouch capacity was 446±32 mL, and pouch pressure at capacity was 18.1±2.6 cmH2O. The Qmax was 14±1.2 mL/s, and the mean post-void residual was 25±10 mL. There were nine cases of night-time incontinence at 3 months post-operatively. Negative surgical margins of the bladder specimens were achieved in all patients. During a follow-up period of 3 to 44 months (average 32.6 months), local recurrence was found in two patients and distant metastasis was occurred in another three patients. Conclusions Our preliminary experience showed that pure LRC with non-absorbable titanium staples assisted orthotopic U-shape ileal neobladder reconstruction is feasible based on perioperative data and oncologic features.

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

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    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.

  1. 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.

  2. 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

  3. 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.

  4. Robot-assisted partial nephrectomy in contemporary practice

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    YoussefS.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.

  5. Feasibility of Hand-Assisted Laparoscopic Surgery as Compared to Open Surgery for Sigmoid Colon Cancer: A Case-Controlled Study

    OpenAIRE

    Nam, Sang Eun; Jung, Eun-Joo; Ryu, Chun-Geun; Paik, Jin Hee; Hwang, Dae-Yong

    2013-01-01

    Purpose The aim of this study was to evaluate short-term clinical outcomes by comparing hand-assisted laparoscopic surgery (HALS) with open surgery for sigmoid colon cancer. Methods Twenty-six patients who underwent a hand-assisted laparoscopic anterior resection (HAL-AR group) and 52 patients who underwent a conventional open anterior resection during the same period were enrolled (open group) in this study with a case-controlled design. Results Pathologic parameters were similar between the...

  6. 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

  7. Hand-assisted laparoscopic transhiatal esophagectomy with a systematic procedure for en bloc infracarinal lymph node dissection.

    Science.gov (United States)

    Fujiwara, H; Shiozaki, A; Konishi, H; Komatsu, S; Kubota, T; Ichikawa, D; Okamoto, K; Morimura, R; Murayama, Y; Kuriu, Y; Ikoma, H; Nakanishi, M; Sakakura, C; Otsuji, E

    2016-02-01

    Laparoscopic transhiatal esophagectomy is a minimally invasive approach for esophageal cancer. However, a transhiatal procedure has not yet been established for en bloc mediastinal dissection. The purpose of this study was to present our novel procedure, hand-assisted laparoscopic transhiatal esophagectomy, with a systematic procedure for en bloc mediastinal dissection. The perioperative outcomes of patients who underwent this procedure were retrospectively analyzed. Transhiatal subtotal mobilization of the thoracic esophagus with en bloc lymph node dissection distally from the carina was performed according to a standardized procedure using a hand-assisted laparoscopic technique, in which the operator used a long sealing device under appropriate expansion of the operative field by hand assistance and long retractors. The thoracoscopic procedure was performed for upper mediastinal dissection following esophageal resection and retrosternal stomach roll reconstruction, and was avoided based on the nodal status and operative risk. A total of 57 patients underwent surgery between January 2012 and June 2013, and the transthoracic procedure was performed on 34 of these patients. In groups with and without the transthoracic procedure, total operation times were 370 and 216 minutes, blood losses were 238 and 139 mL, and the numbers of retrieved nodes were 39 and 24, respectively. R0 resection rates were similar between the groups. The incidence of recurrent laryngeal nerve palsy was significantly higher in the group with the transthoracic procedure, whereas no significant differences were observed in that of pneumonia between these groups. The hand-assisted laparoscopic transhiatal method, which is characterized by a systematic procedure for en bloc mediastinal dissection supported by hand and long device use, was safe and feasible for minimally invasive esophagectomy. PMID:25487303

  8. Robotic assisted Laparoscopic partial Nephrectomy for suspected Renal Cell Carcinoma: Retrospective review of surgical outcomes of 35 Cases

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    Das Nitin

    2008-09-01

    Full Text Available Abstract Background A standard of care for the treatment of small renal masses is partial nephrectomy. The open and laparoscopic approaches have been well described in the literature. Robotic assistance may augment partial nephrectomy by aiding in dissection and renal reconstruction. In this communication we describe the surgical outcomes of 35 patients undergoing robotic partial nephrectomy. Methods Patient records and databases were reviewed for 35 consecutive patients undergoing RPN. Clinical, pathological, and radiographic data were obtained. The data was deidentified. Results Thirty five patients successfully underwent RPN. An additional 2 patients were converted to other nephron sparing procedures. Mean tumor size was 2.8 cm, and mean OR time was 142 minutes. Mean warm ischemia time was 20 minutes. All margins were negative. There were 4 complications, and no patients required reoperation. Conclusion Robotic partial nephrectomy can produce excellent initial results. Further studies should be performed to compare the outcomes to laparoscopic and open operations.

  9. 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.

  10. 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.

  11. Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

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    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.

  12. Laparoscopically assisted colorectal surgery provides better short-term clinical and inflammatory outcomes compared to open colorectal surgery

    Science.gov (United States)

    Korać, Tina; Kodre, Anamarija Rebolj; Jelenc, Franc; Ihan, Alojz

    2015-01-01

    Introduction Changes in immune function after surgery may influence overall outcome, length of hospital stay, susceptibility to infection and perioperative tumour dissemination in cancer patients. Our aim was to elaborate on postoperative differences in the immune status and the intensity of the systemic inflammatory response between two groups of prospectively enrolled patients with colorectal cancer, namely patients undergoing laparoscopically assisted or open colorectal surgery. Material and methods Blood samples from 77 patients were taken before surgery and then 3 h, 24 h and 4 days after surgery. The inflammatory response was determined by leukocyte counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin levels (PCT). Immune status was determined by phenotypic analysis of lymphocyte populations and the activation of mononuclear cells. CD64 expression and cytokine expression were also determined. Results Patients undergoing laparoscopically assisted surgery had less intraoperative blood loss (p = 0.002), earlier resumption of diet (p = 0.002) and shorter hospital stay (p = 0.02). Numbers of total leukocytes (p = 0.12), CRP (p = 0.002) and PCT (p = 0.23) were remarkably higher 4 days after surgery in patients who underwent an open colorectal procedure. There was an important decrease in monocyte HLA-DR expression 3 h after surgery in patients undergoing laparoscopically assisted surgery (p = 0.03). Conclusions Our study suggests that minimally invasive surgery provides better short-term clinical outcomes for patients with resectable colorectal cancer. The acute inflammatory response is less pronounced. Post-surgical immunological disturbance in both groups is similar, but we observed a divergent effect of different surgical approaches on the expression of HLA-DR on monocytes. However, our results corroborate the results of previous studies. PMID:26788083

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

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    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.

  14. 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 (patients with a minimum follow up of 1 year (average 15.7 months) 95% have undetectable PSA (oncologic outcomes.

  15. Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion: a case control study

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    Chen Qi-Yue

    2012-11-01

    Full Text Available Abstract Background The application of laparoscopic surgery for advanced gastric cancer (AGC remains questionable on account of technical difficulty of D2 lymphadenectomy, and there has been few large-scale follow-up results regarding the oncological adequacy of laparoscopic surgery compared with that of open surgeries for AGC. The aim of this study is to evaluate technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG for advanced gastric cancer without serosal invasion. Methods From January 2008 to December 2012, 1114 patients with gastric cancer underwent D2 gastrectomy, including 336 T2 and T3 patients in term of depth of invasion. Of all 336 patients, 224 underwent LAG, while open gastrectomy (OG performed on the other 112 patients. The comparison was based on the clinicopathologic characteristics, surgical outcome, and follow-up results. Results There are not significant differences in clinicopathological characteristics between the two groups (P > 0.05. The operation time and first ambulation time was similar in the two groups. However, estimated blood loss, bowel function recovery time and duration of hospital stay were significantly less in the LAG group. No significant difference in morbidity and mortality was found between the LAG group and OG group (11.1% vs. 15.3%, P = 0.266; 0.9% vs. 1.8%, P = 0.859. The mean number of resected lymph nodes (LNS between the LAG group and OG group was similar (30.6 ± 10.1 vs. 30.3 ± 8.6, P = 0.786. Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P > 0.05. No statistical difference was seen in 1 year survival rate (91.5% vs. 89.8% P > 0.05 and the survival curve after surgery between the LAG group and OG group. Conclusion Laparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative oncological efficacy compared with

  16. 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

  17. 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. PMID:24916514

  18. Apendicectomia videoassistida por acesso único transumbilical comparada à via laparoscópica e laparotômica na apendicite aguda Transumbilical laparoscopic assisted appendectomy compared with laparoscopic and laparotomic approaches in acute appendicitis

    Directory of Open Access Journals (Sweden)

    Geraldo José de Souza Lima

    2012-03-01

    three decades comparing laparoscopic with laparotomic appendectomy, the available scientific evidence does not show consensus of opinion about the best access for the treatment of acute appendicitis. The transumbilical laparoscopic assisted appendectomy combines the advantages of laparoscopic access to the simplicity of the laparotomic technique. AIM: To compare the three technical advantages showing possible tendency to transumbilical laparoscopic assisted appendectomy. METHODS: This is a retrospective study comparing three series with 1232 patients. Variables were: operative time, hospital stay, early and late postoperative complications, postoperative pain and earlier return to daily activities. RESULTS: The averaged surgical time was 59.8 min in laparotomic appendectomy, 75.5 min in laparoscopic appendectomy and 51,7 min in transumbilical laparoscopic assisted appendectomy with significant difference. The incidence of postoperative pain, general complications and wound infection were greater in the group submitted to laparotomic appendectomy. The earlier return to daily activities and short hospital stay were observed in groups laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy. CONCLUSION: The effectiveness and safety of transumbilical laparoscopic assisted appendectomy can make this technique the preferred choice in the initial management of patients with acute appendicitis.

  19. 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...

  20. 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

  1. 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.

  2. The Experience of Robotic-Assisted Laparoscopic Hysterectomy for Women Treated for Early-Stage Endometrial Cancer

    DEFF Research Database (Denmark)

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

    2016-01-01

    -assisted laparoscopic hysterectomy. METHODS: Semistructured interviews were carried out with 12 women, and interview data were analyzed by qualitative content analysis. RESULTS: Four overarching themes emerged: "surgery was a piece of cake," "recovering physically after surgery," "going from being off guard to being on...... in the robotic technique and recovered quickly physically, they lacked information about what went on in the operation theatre and about their new anatomy. IMPLICATIONS FOR PRACTICE: Patient education about the normal postoperative course in regard to vaginal bleeding, bowel function, and level of...... physical activity is needed. Individualized information about anatomical changes after surgery is warranted, preferably using anatomical drawings. Potentially, the women could benefit from attending a nursing clinic during the first postoperative months....

  3. 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

  4. 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

  5. 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

  6. 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.

  7. 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.

  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. [Sacrocolpopexy - pro laparoscopic].

    Science.gov (United States)

    Hatzinger, M; Sohn, M

    2012-05-01

    Innovative techniques have a really magical attraction for physicians as well as for patients. The number of robotic-assisted procedures worldwide has almost tripled from 80,000 procedures in the year 2007 to 205,000 procedures in 2010. In the same time the total number of Da Vinci surgery systems sold climbed from 800 to 1,400. Advantages, such as three-dimensional visualization, a tremor-filter, an excellent instrument handling with 6 degrees of freedom and better ergonomics, together with aggressive marketing led to a veritable flood of new Da Vinci acquisitions in the whole world. Many just took the opportunity to introduce a new instrument to save a long learning curve and start immediately in the surgical master class.If Da Vinci sacrocolpopexy is compared with the conventional laparoscopic approach, robotic-assisted sacrocolpopexy shows a significantly longer duration of the procedure, a higher need for postoperative analgesics, much higher costs and an identical functional outcome without any advantage over the conventional laparoscopic approach. Although the use of robotic-assisted systems shows a significantly lower learning curve for laparoscopic beginners, it only shows minimal advantages for the experienced laparoscopic surgeon. Therefore it remains uncertain whether robotic-assisted surgery shows a significant advantage compared to the conventional laparoscopic surgery, especially with small reconstructive laparoscopic procedures such as sacrocolpopexy. PMID:22526178

  10. 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.

  11. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

    DEFF Research Database (Denmark)

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

    2016-01-01

    AND METHODS: This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare......INTRODUCTION: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. MATERIAL...... professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference...

  12. 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...

  13. Radicals

    Czech Academy of Sciences Publication Activity Database

    Jahn, Ullrich; Cornils, B.

    Weinheim: Wiley-VCH, 2013 - (Cornils, B.; Herrmann, W.; Wong, C.; Zanthoff, H.), s. 1897-1898 ISBN 978-3-527-33307-3 Institutional support: RVO:61388963 Keywords : radicals * enzymatic catalysis * coenzyme B12 * ribonucleotide reductase * mutases Subject RIV: CC - Organic Chemistry

  14. Current Status of Robot-Assisted Radical Cystectomy and Intracorporeal Urinary Diversion.

    Science.gov (United States)

    Kurpad, Raj; Woods, Michael; Pruthi, Raj

    2016-06-01

    Robot-assisted surgery has become a widely used surgical approach in the management of urologic malignancies. With its initial experience in the treatment of prostate cancer, the technology rapidly expanded to other urologic malignancies including bladder cancer. Since its introduction in 2003, robot-assisted radical cystectomy has seen refinement and increased penetration over the last decade. Furthermore, urologic surgeons have expanded its use to perform urinary diversions. The concept of intracorporeal urinary diversion is still in development but continues to see increased refinement among high volume academic centers. PMID:27021910

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. Learning Curve of Robotic Radical Prostatectomy

    OpenAIRE

    Muhammed Ersagun Arslan; Abdullah Erdem Canda; Ali Fuat Atmaca; Mevlana Derya Balbay; Ziya Akbulut; Serkan Altinova; Ahmet Tunc Ozdemir

    2015-01-01

    Introduction: Prostate cancer (PrC) is the fifth most common malignancy worldwide and the second most common malignancy in men. Currently, robotic-assisted laparoscopic radical prostatectomy (RARP) has become a popular treatment for localised PrC treatment worldwide. We aimed to assess the learning curve of RARP in our institution. Methods: A total of 391 patients who underwent RARP in our clinic between February 2009 and April 2013 were included in the study. We retrospectively evaluated ...

  20. Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis

    Science.gov (United States)

    Thomson, David; Allin, Benjamin; Long, Anna-May; Bradnock, Tim; Walker, Gregor; Knight, Marian

    2015-01-01

    Objective To compare outcomes following totally transanal endorectal pull-through (TTERPT) versus pull-through with any form of laparoscopic assistance (LAPT) for infants with uncomplicated Hirschsprung's disease. Design Systematic review and meta-analysis. Setting Five hospitals with a paediatric surgical service. Participants 405 infants with uncomplicated Hirschsprung's disease. Interventions TTERPT versus LAPT. Primary and secondary outcome measures Primary outcomes: mortality, postoperative enterocolitis, faecal incontinence, constipation, unplanned laparotomy or stoma formation, and injury to abdominal viscera. Secondary outcomes Haemorrhage requiring transfusion of blood products, abscess formation, intestinal obstruction, intestinal ischaemia, enteric fistula formation, urinary incontinence or retention, impotency and duration of procedure. Results Five eligible studies comprising 405 patients were identified from 2107 studies. All studies were retrospective case series, with variability in outcome assessment quality and length of follow-up. Operative duration was 50.29 min shorter with TTERPT (95% CI 39.83 to 60.74, pHirschsprung's disease. Trial registration number PROSPERO registry- CRD42013005698. PMID:25805527

  1. 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.

  2. 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

  3. 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

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

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    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

  5. 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

  6. 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.

  7. 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

  8. 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...

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

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    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

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

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    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.

  11. 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 ...

  12. 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

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

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    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.

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. Simultaneous robot-assisted radical cystoprostatectomy and nephroureterectomy in a patient with multifocal invasive urothelial carcinoma and previous contralateral nephroureterectomy.

    Science.gov (United States)

    Özveren, Bora; Türkeri, Levent

    2013-12-01

    We present a case of simultaneous robot-assisted radical cystoprostatectomy and nephroureterectomy with extended lymphadenectomy for multifocal invasive urothelial carcinoma in a patient with recurrent high-grade urothelial cancer and a previous right nephroureterectomy. The total urinary exenteration and extended lymphadenectomy was successfully performed with robot-assisted surgery in this unique case where the patient was rendered anephric at the end of the operation. We discuss the operative steps and the techniques performed to optimize the oncological results of robot-assisted surgery for invasive urothelial carcinoma, while attempting to preserve the renal function until the patient's urinary system was totally exenterated. PMID:27001880

  1. 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.

  2. 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。

  3. 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

  4. 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

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

    OpenAIRE

    Schatloff O; Louis AS; Lindner U

    2011-01-01

    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 ...

  6. 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.

  7. Surgical time and complications of total transvaginal (total-NOTES, single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches

    Directory of Open Access Journals (Sweden)

    M.A.M. Silva

    2015-06-01

    Full Text Available The recently developed minimally invasive techniques of ovariohysterectomy (OVH have been studied in dogs in order to optimize their benefits and decrease risks to the patients. The purpose of this study was to compare surgical time, complications and technical difficulties of transvaginal total-NOTES, single-port laparoscopic-assisted and conventional OVH in bitches. Twelve bitches were submitted to total-NOTES (NOTES group, while 13 underwent single-port laparoscopic-assisted (SPLA group and 15 were submitted to conventional OVH (OPEN group. Intra-operative period was divided into 7 stages: (1 access to abdominal cavity; (2 pneumoperitoneum; approach to the right (3 and left (4 ovarian pedicle and uterine body (5; (6 abdominal or vaginal synthesis, performed in 6 out of 12 patients of NOTES; (7 inoperative time. Overall and stages operative times, intra and postoperative complications and technical difficulties were compared among groups. Mean overall surgical time in NOTES (25.7±6.8 minutes and SPLA (23.1±4.0 minutes groups were shorter than in the OPEN group (34.0±6.4 minutes (P<0.05. The intraoperative stage that required the longest time was the approach to the uterine body in the NOTES group and abdominal and cutaneous sutures in the OPEN group. There was no difference regarding the rates of complications. Major complications included postoperative bleeding requiring reoperation in a bitch in the OPEN group, while minor complications included mild vaginal discharge in four patients in the NOTES group and seroma in three bitches in the SPLA group. In conclusion, total-NOTES and SPLA OVH were less time-consuming then conventional OVH in bitches. All techniques presented complications, which were properly managed.

  8. 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.

  9. [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

  10. 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

  11. Laparoscopic Ureterolithotomy

    OpenAIRE

    Şahin, Selçuk; Aras, Bekir; Ekşi, Mithat; Şener, Nevzat Can; Tugču, Volkan

    2016-01-01

    Background and Objective: The present study retrospectively analyzed the data of 213 patients who underwent laparoscopic ureterolithotomy. Methods: We retrospectively analyzed the data of 213 patients, in whom we performed conventional laparoscopic ureterolithotomy from April 2006 and January 2015 based on the diagnosis of an upper or middle ureteral stone. Patients with large ureteral stones (>15 mm) or a history of failed shock-wave lithotripsy or ureteroscopy were included in the study. Al...

  12. 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

  13. 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

  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. 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

  16. [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

  17. LAPAROSCOPIC GYNAEC SURGERIES – A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Hiremath

    2013-10-01

    Full Text Available ABSTRACT : BACKGROUND: There has been a rapid worldwide adoption of laparoscopic procedures across many surgical specialt ies, most notably in Gynaecology. Unfortunately, the increased adoption of laparoscopic surgery has also been accompanied by a corresponding rise in the rates and types of complications reported. AIMS : To audit the different types of laparoscopic surgerie s and their complications and comparison with other routes of surgery. METHODS & MATERIALS : We have retrospectively analysed 285 laparoscopic surgeries and 306 other routes of surgery which were done at our institute from July 2011 to April 2013.We admit t he patients 1 - 2 days prior to surgery and a complete medical work - up of the patient is done for elective laparoscopic surgery .We defer laparoscopy for malignant conditions, uterine size more than 20 weeks, cervix flushed to the vagina or with history of m ore than 2 pelvic surgeries. Sub - fertile women, after an initial workup, are subjected to diagnostic laparoscopy with chromopertubation. For laparoscopic cystectomies, patients with ultrasono graphy findings suggestive of benign tumours are selected. RESULT S : We have performed 285 laparoscopic procedures over this time period till date. Majority of these cases are Laparoscopic Assisted Vaginal Hysterectomies (LAVH [111 – 38.9%], followed by laparoscopic surgeries for various benign ovarian conditions ( BOC [62 – 21%] and Diagnostic Laparoscopies ( DL with or without laparoscopic ovarian drilling ( LOD [59 cases – 20.7%]. Out of 111 LAVH, 3 patients had bladder injury [2.7%] ; Out of 285 cases that underwent laparoscopic procedures, 5 [1.75%] required conversi on to laparotomy. Overall operative complications including major and minor, are significantly higher in the abdominal surgery group as compared to the laparoscopic group ( p value= 0.001 CONCLUSION : Laparoscopy is a safe route for conventional surgery, with lesser intraoperative, immediate post

  18. 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

  19. 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

  20. 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

  1. [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

  2. 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.

  3. Clinical utility of robot-assisted radical prostatectomy: advances and current status

    OpenAIRE

    Challacombe, Ben

    2015-01-01

    Paul Sturch, Nicholas T Raison, Ben ChallacombeUrology department, Guy’s Hospital, Guy’s and St Thomas’ Hospital Trust, London, UKAbstract: The development of robotic technology in surgery has changed the landscape of radical surgery for localized prostate cancer. Early on, urologists recognizing its advantages were quick to adopt robotic techniques, building on the experience gained from years of open prostatectomy. The 3D HD vision and the precision endowrist i...

  4. 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)

  5. 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

  6. 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

  7. 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

  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. 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

  10. 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

  11. 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

  12. Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Anil A Thomas

    2014-01-01

    Conclusions: Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3 rd round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs.

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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 ...

  20. Concomitant laparoscopic urological procedures: Does it contribute to morbidity?

    Directory of Open Access Journals (Sweden)

    Maurya Kamlesh

    2009-01-01

    Full Text Available Aim: With advancement in minimal access surgery two laparoscopic procedures can be combined together shortening the total hospital stay, decreasing morbidity and overall reduced cost. Combining two laparoscopic procedures in a single session has been reported in general surgery. Very few articles are available in literature with regard to combined urological laparoscopic surgeries. This article retrospectively analyses the outcomes of multiple laparoscopic procedures performed in a single stage at our centre. Materials and Methods: Patients undergoing simultaneous procedures from May 2003 to Jan 2009 were included in the study. Patients were categorised into three groups according to the primary urological organ involved, for better comparison with the control group. Diseases involving the adrenals gland were grouped in (group 1, kidney (group 2 and renal collecting system/ureter (group 3. All patients had one urological procedure for either of the above-mentioned organs combined with another surgical procedure. Similarly three control groups were chosen according to the primary urological organ involved (group 1c- unilateral laparoscopic adrenalectomy, group 2c- unilateral laparoscopic radical nephrectomy and group 3c- unilateral laparoscopic ureterolithotomy for comparative study. The operative details, hospital stay and complications were analysed. Results: Thirty-two patients underwent 64 laparoscopic procedures under single anaesthesia. The most common procedure in this series was laparoscopic adrenalectomy (n=34 followed by laparoscopic nephrectomy (n=13. Group 1 patients had a prolonged operative time ( P=0.012 and hospital stay ( P=0.025 when compared with group 1c. However, blood loss was comparable in both the groups. Patients in groups 2 and 3 had comparable operative times, blood loss and recovery period with respect to their controls. Intraoperatively, the end tidal carbon dioxide levels were within permissible limits. All

  1. Principles of hydrogen radical mediated peptide/protein fragmentation during matrix-assisted laser desorption/ionization mass spectrometry.

    Science.gov (United States)

    Asakawa, Daiki

    2016-07-01

    Matrix-assisted laser desorption/ionization in-source decay (MALDI-ISD) is a very easy way to obtain large sequence tags and, thereby, reliable identification of peptides and proteins. Recently discovered new matrices have enhanced the MALDI-ISD yield and opened new research avenues. The use of reducing and oxidizing matrices for MALDI-ISD of peptides and proteins favors the production of fragmentation pathways involving "hydrogen-abundant" and "hydrogen-deficient" radical precursors, respectively. Since an oxidizing matrix provides information on peptide/protein sequences complementary to that obtained with a reducing matrix, MALDI-ISD employing both reducing and oxidizing matrices is a potentially useful strategy for de novo peptide sequencing. Moreover, a pseudo-MS(3) method provides sequence information about N- and C-terminus extremities in proteins and allows N- and C-terminal side fragments to be discriminated within the complex MALDI-ISD mass spectrum. The combination of high mass resolution of a Fourier transform-ion cyclotron resonance (FTICR) analyzer and the software suitable for MALDI-ISD facilitates the interpretation of MALDI-ISD mass spectra. A deeper understanding of the MALDI-ISD process is necessary to fully exploit this method. Thus, this review focuses first on the mechanisms underlying MALDI-ISD processes, followed by a discussion of MALDI-ISD applications in the field of proteomics. © 2014 Wiley Periodicals, Inc., Mass Spec Rev 35:535-556, 2016. PMID:25286767

  2. 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.

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

    International Nuclear Information System (INIS)

    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)

  4. 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...

  5. 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.

  6. Effect of Dexmedetomidine on Heart Rate-Corrected QT and Tpeak-Tend Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study.

    Science.gov (United States)

    Kim, Na Young; Han, Dong Woo; Koh, Jae Chul; Rha, Koon Ho; Hong, Jung Hwa; Park, Jong Min; Kim, So Yeon

    2016-05-01

    Intraperitoneal insufflation of carbon dioxide may affect the sympathetic activity that leads to changes in ventricular repolarization. This in turn can result in changes of heart rate-corrected QT (QTc) interval and Tpeak-Tend (Tp-e) interval. Dexmedetomidine is a highly selective α2-receptor agonist and has potential antiarrhythmic properties. This prospective, randomized, double-blinded, controlled study evaluated the effects of dexmedetomidine administration on QTc and Tp-e intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg position.Fifty patients scheduled for robot-assisted laparoscopic prostatectomy randomly received either a continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour, from anesthetic induction until the end of the Trendelenburg position (dexmedetomidine group; n = 25), or the same volume of normal saline (control group; n = 25). Anesthesia was maintained with sevoflurane and remifentanil. The primary and secondary goals were to evaluate the effect of dexmedetomidine on the QTc and Tp-e interval changes. Mean arterial pressure, heart rate, end-tidal CO2, and end-tidal sevoflurane concentrations were assessed as well.Forty-seven patients (94%) completed the study. Dexmedetomidine significantly attenuated QTc interval prolongation and reduced the Tp-e interval, even though the baseline values of the QTc and Tp-e intervals were similar between the 2 groups (PGroup × Time = 0.001 and 0.014, respectively). Twenty-two patients (96%) in the control group and 13 (54%) in the dexmedetomidine group had QTc interval prolongation of >20 ms from the baseline value during surgery (P = 0.001). The maximum QTc interval prolongation from the baseline value during surgery was 46 ± 21 ms in the control group and 24 ± 21 ms in the dexmedetomidine group (mean ± SD, P = 0.001). Mean arterial pressure and heart rate were comparable between the groups.Continuous infusion of

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. Superoxide radical and UV irradiation in ultrasound assisted oxidative desulfurization (UAOD): A potential alternative for greener fuels

    Science.gov (United States)

    Chan, Ngo Yeung

    This study is aimed at improving the current ultrasound assisted oxidative desulfurization (UAOD) process by utilizing superoxide radical as oxidant. Research was also conducted to investigate the feasibility of ultraviolet (UV) irradiation-assisted desulfurization. These modifications can enhance the process with the following achievements: (1) Meet the upcoming sulfur standards on various fuels including diesel fuel oils and residual oils; (2) More efficient oxidant with significantly lower consumption in accordance with stoichiometry; (3) Energy saving by 90%; (4) Greater selectivity in petroleum composition. Currently, the UAOD process and subsequent modifications developed in University of Southern California by Professor Yen's research group have demonstrated high desulfurization efficiencies towards various fuels with the application of 30% wt. hydrogen peroxide as oxidant. The UAOD process has demonstrated more than 50% desulfurization of refractory organic sulfur compounds with the use of Venturella type catalysts. Application of quaternary ammonium fluoride as phase transfer catalyst has significantly improved the desulfurization efficiency to 95%. Recent modifications incorporating ionic liquids have shown that the modified UAOD process can produce ultra-low sulfur, or near-zero sulfur diesels under mild conditions with 70°C and atmospheric pressure. Nevertheless, the UAOD process is considered not to be particularly efficient with respect to oxidant and energy consumption. Batch studies have demonstrated that the UAOD process requires 100 fold more oxidant than the stoichiometic requirement to achieve high desulfurization yield. The expected high costs of purchasing, shipping and storage of the oxidant would reduce the practicability of the process. The excess use of oxidant is not economically desirable, and it also causes environmental and safety issues. Post treatments would be necessary to stabilize the unspent oxidant residual to prevent the waste

  12. 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.

  13. Ergonomics in laparoscopic surgery

    OpenAIRE

    Supe Avinash; Kulkarni Gaurav; Supe Pradnya

    2010-01-01

    Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environment are essential to improve efficiency, safety, and comfort for the operating team. Understanding ergonomics can not only make life of surgeon comf...

  14. 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.

  15. 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.

  16. Laparoscopic managment of common bile duct stones: our initial experience.

    Science.gov (United States)

    Aroori, S; Bell, J C

    2002-05-01

    The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence. PMID:12137159

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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...

  3. 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 ...

  4. 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... ...

  5. 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 ...

  6. 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.

  7. Photocatalysis assisted by peroxymonosulfate and persulfate for benzotriazole degradation: effect of pH on sulfate and hydroxyl radicals.

    Science.gov (United States)

    Ahmadi, Mehdi; Ghanbari, Farshid; Moradi, Mahsa

    2015-01-01

    Recently, notable attempts have been devoted to removing emerging pollutants from water resources. Benzotriazole (BTA) as an emerging pollutant has widely been detected in the aquatic environment and water resources. In the current work, peroxymonosulfate (PMS) and persulfate (PS) were added to a TiO2/UV system for BTA degradation, as electron acceptors to overcome recombination of hole and electron. Additions of PMS and PS to the photocatalysis process considerably increased removal efficiency. The rate constants of UV/TiO2/PMS, UV/TiO2/PS and UV/TiO2 were 0.0217 min(-1), 0.0152 min(-1) and 0.0052 min(-1) respectively. The results showed that pH significantly affected the UV/TiO2/PMS system while it marginally affected UV/TiO2/PS. Scavenging experiments using alcohols indicated that in acidic pH, the dominant oxidant was sulfate radical in both systems. The contribution of hydroxyl radical in BTA degradation was boosted at alkaline and neutral conditions especially in the UV/TiO2/PMS system. Moreover, other scavenging experiments implied that reaction of radicals occurred at both the catalyst surface and in solution. The mineralization results showed that PMS and PS significantly increased chemical oxygen demand and total organic carbon removal efficiencies. In general, presence of PMS in the photocatalysis process had a better performance compared to PS in terms of BTA removal and mineralization. PMID:26606105

  8. 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.

  9. 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...

  10. Laparoscopic pancreatic surgery for benign and malignant disease.

    Science.gov (United States)

    de Rooij, Thijs; Klompmaker, Sjors; Abu Hilal, Mohammad; Kendrick, Michael L; Busch, Olivier R; Besselink, Marc G

    2016-04-01

    Laparoscopic surgery for benign and malignant pancreatic lesions has slowly been gaining acceptance over the past decade and is being introduced in many centres. Some studies suggest that this approach is equivalent to or better than open surgery, but randomized data are needed to assess outcomes. In this Review, we aim to provide a comprehensive overview of the state of the art in laparoscopic pancreatic surgery by aggregating high-quality published evidence. Various aspects, including the benefits, limitations, oncological efficacy, learning curve and latest innovations, are discussed. The focus is on laparoscopic Whipple procedure and laparoscopic distal pancreatectomy for both benign and malignant disease, but robot-assisted surgery is also addressed. Surgical and oncological outcomes are discussed as well as quality of life parameters and the cost efficiency of laparoscopic pancreatic surgery. We have also included decision-aid algorithms based on the literature and our own expertise; these algorithms can assist in the decision to perform a laparoscopic or open procedure. PMID:26882881

  11. 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.

  12. Laparoscopic Surgery - What Is It?

    Science.gov (United States)

    ... Surgery - What is it? Laparoscopic Surgery - What is it? Laparoscopic Surgery - What is it? | ASCRS Alternate Titles: Trocar Used in Surgery WHAT ... addressed by the topics covered in these brochures. It should be recognized that these brochures should not ...

  13. 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

  14. 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.

  15. Review of laparoscopic partial nephrectomy in the treatment of renal tumors, T1 stadium in adults

    International Nuclear Information System (INIS)

    The T1 renal cancer in adults is made known; incidence, characteristics and management. Renal cell carcinoma has been the most common malignancy of the kidney, percentage is close to three percent of solid tumors of adults. The treatments for this tumor are analyzed: open radical nephrectomy, laparoscopic radical nephrectomy, open partial nephrectomy and laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy has represented an alternative option acceptable, safely and with good oncological and surgical outcomes for patients, as it is used to conserve nephrons and simultaneously to resect the tumor of a complete form promoting in the future the patient present a good renal function. Additionally, a adequate oncological control has reduced the risk of submit postoperative renal failure. An evolution of laparoscopic partial nephrectomy is presented determining the procedure for renal tumors in state T1 in the adults

  16. Urological laparoscopic surgery: Our experience of first 100 cases in Dicle University

    OpenAIRE

    Ahmet Ali Sancaktutar; Yaşar Bozkurt; Murat Atar; Haluk Söylemez; Necmettin Penbegül; Namık Kemal Hatipoğlu; Mehmet Nuri Bodakçi

    2012-01-01

    Objectives: In this study the experience and results of first100 laparoscopic surgery is presented.Materials and methods: The laparoscopic surgical operationswere reviewed between July 2010 and October 2011,retrospectively.Results: During a year period we performed of 100 laparoscopicinterventions. The ratio of male to female and themean age was 57/43 and 48,65±8,94 years respectively.The kind of operation and total numbers were like this: simplenephrectomy 34, radical nephrektomy 22, renal c...

  17. 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.

  18. 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

  19. Comparison of the Efficacy and Safety of a Pharmacokinetic Model-Based Dosing Scheme Versus a Conventional Fentanyl Dosing Regimen For Patient-Controlled Analgesia Immediately Following Robot-Assisted Laparoscopic Prostatectomy: A Randomized Clinical Trial.

    Science.gov (United States)

    Jin, Seok-Joon; Lim, Hyeong-Seok; Kwon, Youn-Ju; Park, Se-Ung; Yi, Jung-Min; Chin, Ji-Hyun; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-01-01

    Conventional, intravenous, patient-controlled analgesia, which is only administered by demand bolus without basal continuous infusion, is closely associated with inappropriate analgesia. Pharmacokinetic model-based dosing schemes can quantitatively describe the time course of drug effects and achieve optimal drug therapy. We compared the efficacy and safety of a conventional dosing regimen for intravenous patient-controlled analgesia that was administered by demand bolus without basal continuous infusion (group A) versus a pharmacokinetic model-based dosing scheme performed by decreasing the dosage of basal continuous infusion according to the model-based simulation used to achieve a targeted concentration (group B) following robot-assisted laparoscopic prostatectomy.In total, 70 patients were analyzed: 34 patients in group A and 36 patients in group B. The postoperative opioid requirements, pain scores assessed by the visual analog scale, and adverse events (eg, nausea, vomiting, pruritis, respiratory depression, desaturation, sedation, confusion, and urinary retention) were compared on admission to the postanesthesia care unit and at 0.5, 1, 4, 24, and 48 h after surgery between the 2 groups. All patients were kept for close observation in the postanesthesia care unit for 1 h, and then transferred to the general ward.The fentanyl requirements in the postanesthesia care unit for groups A and B were 110.0 ± 46.4 μg and 77.5 ± 35.3 μg, respectively. The pain scores assessed by visual analog scale at 0.5, 1, 4, and 24 h after surgery in group B were significantly lower than in group A (all P comparison with conventional dosing regimen. PMID:26765479

  20. 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.

  1. 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.

  2. Analysis of outcome following robotic assisted radical prostatectomy for patients with high risk prostate cancer as per D’Amico classification

    Science.gov (United States)

    Gupta, Narmada Prasad; Murugesan, Anandan; Kumar, Anand; Yadav, Rajiv

    2016-01-01

    Introduction: Prognosis of prostate cancer depends on the risk stratification. D’Amico classification, the most commonly used risk stratification method is based on three factors, i.e., prostate specific antigen (PSA), Gleason grade and clinical stage. The impact of presence of multiple risk factors on prognosis after radical prostatectomy has not been studied in Indian patients. We analyzed the outcome of patients with high-risk disease undergoing robotic-assisted radical prostatectomy (RARP), as per D’Amico classification. Materials and Methods: Our study is a review of the data of all patients with high-risk prostate cancer who underwent RARP between July 2010 and January 2015. Preoperative, perioperative and outcome data were analyzed for patients with high-risk disease as per D’Amico classification. Results: Of 227 patients who underwent RARP, 90 (39.6%) were in the high-risk group. PSA > 20 ng/ml was the most common risk factor, present in 50 (55.6%) patients. All three risk factors were present in 3 patients, and single risk factor was present in 65 patients. Nine (10%) patients had lymphnode involvement, 18 (20%) had positive margin, and 38 (41.1%) had extraprostatic extension (EPE). Among these adverse outcomes, only EPE showed significant association with multiplicity of risk factors. At 12 months, 27.8% had biochemical recurrence (BCR). 92% of patients were continent at 12 months. Conclusion: About 92% of patients with high-risk disease were continent at 12 months, whereas less than one-third of the patients had BCR. EPE was the only outcome associated with multiplicity of risk factors. Adjuvant treatment is not required in two-thirds of patients.

  3. 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.

  4. Linfadenectomía lumboaórtica asistida por robot en tumor residual postquimioterapia en cáncer testicular Robotic-assisted laparoscopic retroperitoneal lymph node dissection in post chemotherapy residual mass in testis cancer

    Directory of Open Access Journals (Sweden)

    OCTAVIO A CASTILLO C

    2011-10-01

    comparable to open surgery in terms of perioperative complications and oncological results, but its application in the post chemotherapy scenario is still matter of study. The development of robotic surgery and its advantages over laparoscopic surgery, make this an attractive option for complex procedures. We report our initial experience with robotic-assisted retroperitoneal lymph node dissection (R-RPLND. Methods: We describe the cases of two patients who underwent R-RPLND due to a Post Chemotherapy residual mass of a non-seminomatous testicular cancer. Results: Two patients, 27 and 30 years old, presented with retroperitoneal residual mass after 4 and 6 cycles of Bleomicin, Etoposide and Cis-Platinum. The first patient had a 4.3 cm left para-aortic mass and the other had a 6 cm mass behind the third portion of the duodenum. The mean surgical time was 255 minutes (210-300, with an estimated mean blood loss of 450 cc (100-800 and a mean hospital stay of 60 hours (72-48. The pathologic result was Teratoma in both cases. There was no periopera-tive morbidity. Conclusions: We believe that R-RPLND is a feasible and safe alternative in selected patients. However still needs more experience and longer follow up to asess its oncological outcome.

  5. Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

    OpenAIRE

    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 o...

  6. 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

  7. Laparoscopic management of ovarian cysts: an endocrinologist view.

    OpenAIRE

    Thornton, K. L.; DeCherney, A H

    1991-01-01

    The management of certain ovarian cysts has evolved from the traditional and often quite radical surgical approach to a more conservative approach. Much of this change can be attributed to the improvement in laparoscopic surgical technique. After a brief discussion of the differential diagnosis and clinical presentation of ovarian cysts, ultrasonographic features of certain ovarian cysts will be reviewed. Certainly the ability to characterize cysts ultrasonographically has facilitated gynecol...

  8. Evidence supporting laparoscopic major hepatectomy.

    Science.gov (United States)

    Cheek, Susannah M; Sucandy, Iswanto; Tsung, Allan; Marsh, J Wallis; Geller, David A

    2016-05-01

    Laparoscopic liver resection (LLR) has been increasing in frequency with over 9,000 cases done worldwide. Benefits of laparoscopic resection include less blood loss, smaller incisions, decreased postoperative morbidity, and shorter length of stay compared to open liver resection. With increased experience, several centers have reported series of laparoscopic major hepatectomy, although this represents only about 25% of total LLR performed. Evidence is accumulating to support laparoscopic major hepatectomy with the understanding that there is a steep learning curve, and surgeons should begin with minor LLR before moving on to laparoscopic major hepatectomy. Controversy still remains concerning indications, techniques, learning curve, risks, and long-term cancer outcomes with laparoscopic major hepatectomy. PMID:27040039

  9. 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

  10. 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

  11. 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......OBJECTIVE: Laparoscopic surgery may offer advantages compared to open surgery, such as earlier mobilization, less pain and lower post-surgical morbidity. Surgical stress is thought to be associated with the postoperative immunological changes in the body as an impaired immune function, which may...... 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...

  12. 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.

  13. 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

  14. Laparoscopic Ovariohysterectomy in Dogs

    OpenAIRE

    Muneer S. Al-Badrany,; Myeasr G. Thanoon; Mae T. Al-Anaaz

    2012-01-01

    The purpose of this study was to evaluate the surgical technique of Laparoscopic ovariohysterectomy (LOVH) in dogs. LOVH was evaluated in eight healthy intact bitches. The surgical procedure was applied under xylazine- ketamine anesthesia; insufflation was performed by CO2 at the pressure of 12 mm Hg. Monopolar electrocautery and titanium clips were used for haemostasis. LOVH was performed successfully in all bitches. No surgical complications were obs...

  15. 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...

  16. 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...

  17. 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.

  18. 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.

  19. 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.

  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...

  1. 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 in a...

  2. 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.

  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. 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

  5. Controle dos vasos renais usando clips vasculares e fio cirúrgico em nefrectomias vídeo-assistidas de doadores vivos Control of renal vessels using titanium clips and cotton suture in hand-assisted laparoscopic live donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Alcides José Branco Filho

    2005-02-01

    Full Text Available OBJETIVO: A nefrectomia laparoscópica em doadores vivos para transplante renal vem assumindo um papel importante na era das cirurgias minimamente invasivas, acarretando menor morbidade aos doadores, e resultados semelhantes à técnica aberta no que se refere ao enxerto renal. O objetivo do presente artigo é relatar a experiência do nosso serviço utilizando a técnica de controle dos vasos renais usando fio cirúrgico e clips vasculares. MÉTODO: Foram realizadas 45 nefrectomias utilizando a técnica vídeo-assistida, com ligadura dos vasos renais com clips de titânio (LT-300 e fio cirúrgico. As variáveis analisadas foram tempo cirúrgico, perda sangüínea, tempo de isquemia quente, permanência hospitalar, necessidade de conversão e complicações. RESULTADOS: O procedimento foi realizado com sucesso em todos os casos. O tempo cirúrgico médio foi de 118 minutos, com perda sangüínea estimada em 84ml e tempo de isquemia quente de 4,3 minutos. Dois casos de íleo prolongado, uma lesão de veia gonadal, um escape de artéria renal e uma necrose de ureter foram observados. A permanência hospitalar média foi de 3,7 dias. O uso de clips vasculares e fio cirúrgico reduziu a perda de tecido venoso comparado à técnica com staplers e gerou redução de custos. CONCLUSÕES: A nefrectomia vídeo-assistida com a técnica descrita é factível e mostrou ser efetiva na contenção de gastos e na redução de tecido venoso perdido.BACKGROUND: Laparoscopic live donor nephrectomy has acquired an important role in the minimally invasive surgery era, decreasing morbidity to kidney donors, with an equivalent renal graft outcome compared with open surgery. The aim of this article is report our experience using the technique of renal vessels control with metallic clips and cotton suture. METHODS: Fourty-five nephrectomies were performed following the hand-assisted technique and using titanium clips (LT-300 and cotton suture for renal vessels

  6. SILC for SILC: Single Institution Learning Curve for Single-Incision Laparoscopic Cholecystectomy

    OpenAIRE

    Chee Wei Tay; Liang Shen; Mikael Hartman; Shridhar Ganpathi Iyer; Krishnakumar Madhavan; Stephen Kin Yong Chang

    2013-01-01

    Objectives. We report the single-incision laparoscopic cholecystectomy (SILC) learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC) were analysed. CUSUM analysis is used to identify learning curve...

  7. 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

  8. 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

  9. LAPAROSCOPIC REPAIR OF PERFORATED PEPTIC ULCER

    OpenAIRE

    S. Lunca; N.S. Romedea; C. Moroşanu

    2007-01-01

    Since 1990 when Mouret reported the first laparoscopic sutureless repair for a perforated duodenal ulcer and Nathanson the first successful laparoscopic suture repair for perforated peptic ulcer, laparoscopic approach became a widespread procedure. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late eventration. Laparoscopic approach is indicated in any case of suspected ga...

  10. 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.

  11. Laparoscopy-Assisted Total Gastrectomy with D2 Lymphadenectomy and Roux-En-Y Reconstruction - Case Report

    Directory of Open Access Journals (Sweden)

    Papaj Piotr

    2015-03-01

    Full Text Available We report a case of patient with stage IIIb gastric cancer qualified for laparoscopy - assisted gastrectomy and our first impressions about this procedure. Total gastrectomy with complete omentectomy and extended lymphadenectomy (D2 was performed laparoscopically. The intestinal continuity was restored in a Roux-en-Y mode extracorporeally through the abdominal access system. The orogastric tube with anvil of the circular stapler was transorally introduced into the esophagus. Subsequently, intracorporeal stapling esophagojejunostomy was performed. There were no complications after the operation and the patient was discharged in good shape. Oncological radicality was sufficient and patient has undergone chemotherapy treatment.

  12. 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.

  13. 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 ...

  14. 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 ...

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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.

  20. Laparoscopic colonic resection for rectosigmoid colonic tumours: a retrospective analysis and comparison with open resection.

    Science.gov (United States)

    Prakash, Kurumboor; Varma, Deepak; Rajan, Mahendra; Kamlesh, Naduthottam Palanisamy; Zacharias, Prakash; Ganesh Narayanan, Ramesh; Philip, Mathew

    2010-08-01

    Laparoscopic approach for treatment of colorectal malignancy is gaining acceptance gradually; however the benefits of laparoscopic surgery in colonic and rectal tumours is still open to debate. This study aims at a retrospective analysis of operative and short term outcome of patients with rectosigmoid tumours. A retrospective analysis of operative, postoperative and short-term outcome of 62 patients who underwent laparoscopic colorectal resection for cancer of rectosigmoid region were compared with a same number of parameters-matched patients who underwent open colorectal resection. Blood transfusion requirement was significantly more in the open group compared to the laparoscopy group (38.7% versus 6.4%, p = 0.001). ICU stay was less in the laparoscopy group (p = <0.05) and they were started on oral liquid diet earlier (p = 0.013). The number of the lymph nodes retrieved, positive distal margin and radial involvement were similar in both groups. The hospital stay was significantly shorter in laparoscopy group (8.4 versus 13.8 days, p < 0.05). Radical operation for rectosigmoid tumors is technically feasible with laparoscopic surgery. Laparoscopic approach is associated with less blood loss, transfusion and significantly less ICU stay. Laparoscopic group recovers early and needs less hospital stay. PMID:21938195

  1. 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....

  2. 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.

  3. 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.

  4. 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.

  5. Sleep after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Skarbye, M; Wildschiødtz, G;

    1996-01-01

    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 of...... opioids. There were no significant changes in the total time awake or the number of arousals on the postoperative night compared with the night before operation. During the postoperative night, we found a decrease (P = 0.02) in slow wave sleep (SWS) with a corresponding increase in stage 2 sleep (P = 0.......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...

  6. [Robotics and laparoscopic surgery].

    Science.gov (United States)

    Martínez Ramos, Carlos

    2006-10-01

    Laparoscopic surgery has completely revolutionized modern surgery. In addition to its advantages, however, this approach also presents significant limitations. The most important are loss of the sense of depth, tactile sensation and resistance, as well as loss of natural hand-eye coordination and manual dexterity. The main motivation for the development of surgical robots is the possibility of eliminating all these limitations. Robots have acquired great potential to improve the operative possibilities of surgeons. Given the continual increase in the use of surgical robots, in the near future the structure and appearance of current operating rooms will change. The present article analyzes the origin and development of robotic systems, as well as the characteristics of the latest generation of robots. Because of the strong interest in robotic surgery and its future prospects, surgeons should be familiar with these emerging and innovative techniques. PMID:17040667

  7. Morgagni hernia - laparoscopic approach

    Directory of Open Access Journals (Sweden)

    Şt.O. Georgescu

    2013-09-01

    Full Text Available INTRODUCTION: Morgagni hernia is due to a diaphragmatic defect, retrosternal congenital hernia being a rare form of hernie. The diagnosis is usually in childhood but there are cases that are found in adult or as a intraoperative surprise. The condition is asymptomatic or has nonspecific clinical manifestations or clinical dressing of often occlusive complications. The diagnosis is established by Rx thoracic imaging, barium enema or computed tomography (CT eso-gastro-duodenal passage. Treatment consists of reducing the hernia with or without dissection and resection of the hernia sac and diaphragmatic defect closure by suture the fascia endotoracica retrosternal and retrocostala or rectus abdominis sheath or plastic bag. CASE PRESENTATION: We present a case of a 49 years old woman admitted in our department for an insidious onset, several months ago, with postprandial upper abdominal pain, flatulence and nausea. CT scan revealed a mass of 95 / 130 / 80 mm, narrowly defined with homogeneous structure and negative densities (fat in the lower and middle mediastinum, outlining opacity described in cardiofrenic sinus radiography. The aspect was characteristic for a Morgagni hiatus hernia. Exploratory laparoscopy was performed using a 30º laparoscope inserted through a 10 mm supraombilical trocar; it revealed the parietal defect (Morgagni hernia and the herniation of greater omentum. Two additional 5 mm trocars are then inserted; the escaped great omentum was reintegrated and the parietal defect was laparoscopically sutured. To note, the peritoneal hernia sac was abandoned. Postoperative course was uneventful. A review of the literature data was also performed. CONCLUSION: Minimally invasive surgery is feasible, safe and tends to become “gold standard” therapeutic approach for the treatment of Morgagni hernia.

  8. 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 ...

  9. 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.

  10. Single-Port Access Laparoscopy-Assisted Vaginal Hysterectomy: Our Initial Experiences with 100 Cases

    OpenAIRE

    Yun-Sang Oh; Ji-No Park; Jin Choi; Kwang-Sik Shin; Young-Sam Choi; Tae-Eel Rhee

    2012-01-01

    Objectives. To present our initial experiences with laparoscopically assisted vaginal hysterectomy performed using homemade transumbilical single-port system. Materials and Methods. We reviewed the medical records of one hundred patients who underwent single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH). SPA-LAVH was performed with homemade single port system and conventional rigid laparoscopic instruments. Results. All procedures were successfully completed through th...

  11. Laparoscopy-Assisted Cystectomy: Management of a Large Ovarian Cyst with Torsion

    OpenAIRE

    Emin Üstunyurt

    2013-01-01

    Ovarian cysts are the most common cause of pelvic masses in women. Although laparoscopic surgery is considered the gold standard treatment for ovarian cysts, most of the large ovarian cysts continue to be treated by laparotomy due to technical difficulties. Laparoscopic-assisted cystectomy is an alternative operation type for managing such cases. A case of large ovarian cyst with adnexal torsion in a 21-year-old virgin patient is presented in this report. In this case laparoscopic-assisted cy...

  12. 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

  13. 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

  14. Error analysis in laparoscopic surgery

    Science.gov (United States)

    Gantert, Walter A.; Tendick, Frank; Bhoyrul, Sunil; Tyrrell, Dana; Fujino, Yukio; Rangel, Shawn; Patti, Marco G.; Way, Lawrence W.

    1998-06-01

    Iatrogenic complications in laparoscopic surgery, as in any field, stem from human error. In recent years, cognitive psychologists have developed theories for understanding and analyzing human error, and the application of these principles has decreased error rates in the aviation and nuclear power industries. The purpose of this study was to apply error analysis to laparoscopic surgery and evaluate its potential for preventing complications. Our approach is based on James Reason's framework using a classification of errors according to three performance levels: at the skill- based performance level, slips are caused by attention failures, and lapses result form memory failures. Rule-based mistakes constitute the second level. Knowledge-based mistakes occur at the highest performance level and are caused by shortcomings in conscious processing. These errors committed by the performer 'at the sharp end' occur in typical situations which often times are brought about by already built-in latent system failures. We present a series of case studies in laparoscopic surgery in which errors are classified and the influence of intrinsic failures and extrinsic system flaws are evaluated. Most serious technical errors in lap surgery stem from a rule-based or knowledge- based mistake triggered by cognitive underspecification due to incomplete or illusory visual input information. Error analysis in laparoscopic surgery should be able to improve human performance, and it should detect and help eliminate system flaws. Complication rates in laparoscopic surgery due to technical errors can thus be considerably reduced.

  15. [Advantages and disadvantages of three-dimensional technique in laparoscopic gastrectomy for gastric cancer].

    Science.gov (United States)

    Huang, Changming; Lin, Jianxian

    2016-02-25

    Recently, the technological advancements have led to the introduction of new three-dimension (3D) laparoscopic system. 3D technique in laparoscopic radical gastrectomy provides an abdominal strong stereoscopic depth and accurate operative field, and can be helpful for the beginner to shorten the learning curve. Moreover, spatial orientation becomes more accurate with 3D technique. 3D technique also has the advantages of clearer anatomical level, better vessel exposure, lymph node dissection and digestive tract reconstruction. However, there are still some defects of 3D laparoscopic system. For example, the surgeon may not adapt to 3D vision at the beginning, and special equipment is required to display the data. PMID:26831878

  16. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

    Svenningsen, Peter Olsen; Bulut, Orhan; Jess, Per

    2010-01-01

    INTRODUCTION: 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. MATERIAL AND METHODS: The medical records of...... all patients who underwent reversal of a colostomy after a primary Hartmann's procedure during the period May 2005 to December 2008 were reviewed retrospectively in a case-control study. RESULTS: A total of 43 patients were included. Twenty-one had a laparoscopic and 22 an open procedure. The two...... groups matched with regard to age, sex, American Society of Anestheologists (ASA) score, body mass index and indication for Hartmann's operation. A significantly longer operation time was found for laparoscopic than for open surgery (median 285 versus 158 minutes, p < 0.001), but with less blood loss...

  17. 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)

  18. 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

  19. Single Incision Laparoscopic Splenectomy: Our First Experiences

    Directory of Open Access Journals (Sweden)

    Umut Barbaros

    2011-06-01

    Full Text Available Objective: Most laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using less and smaller trocars. Single incision laparoscopic splenectomy is a new laparoscopic procedure. Herein we would like to present our experiences.Material and Methods: Between January 2009 and June 2009, data of the 7 patients who underwent single incision laparoscopic splenectomy were evaluated retrospectively.Results: There were 7 patients (5 females and 2 males with a mean age of 29.9 years. The most common splenectomy indication was idiopathic thrombocytopenic purpura. Single incision laparoscopic splenectomy was performed successfully in 6 patients. In one patient the operation was converted to an open procedure.Conclusion: With surgeons experienced in minimally invasive surgery, single incision laparoscopic splenectomy could be performed successfully. However, in order to demonstrate the differneces between standard laparoscopic splenectomy and SILS splenetomy, prospective randomized comparative studies are required.

  20. LAPAROSCOPIC REPAIR OF PERFORATED PEPTIC ULCER

    Directory of Open Access Journals (Sweden)

    S. Lunca

    2007-04-01

    Full Text Available Since 1990 when Mouret reported the first laparoscopic sutureless repair for a perforated duodenal ulcer and Nathanson the first successful laparoscopic suture repair for perforated peptic ulcer, laparoscopic approach became a widespread procedure. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late eventration. Laparoscopic approach is indicated in any case of suspected gastroduodenal perforation and seems to offer the same advantages as for the vast majority of laparoscopic procedures. Nowadays laparoscopic repair of duodenal perforation seems to be a useful method for reducing hospital stay, complications and return to normal activity if carried on in proper manner. With better training in minimal access surgery and better ergonomics now available the time has arrived for it to take its place in the surgeon’s repertoire.

  1. 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.

  2. Differences in early outcomes after open or laparoscopic surgery: what is the evidence?

    Science.gov (United States)

    Papagrigoriadis, Savvas

    2012-01-01

    Laparoscopic surgery has been widely studied in colorectal cancer and its feasibility and safety have been proven to the extent that in the UK a national laparoscopic colorectal surgery programme has been established. The advantages of laparoscopic surgery have been studied less systematically in diverticular disease. Several prospective uncontrolled studies have demonstrated that laparoscopic surgery for diverticular disease is feasible with low morbidity and mortality rates. A large population study in the USA has demonstrated elective laparoscopic surgery for diverticular disease to have reduced hospital stay by 1 day, and a lower rate of intra-operative and post-operative complications over open surgery. Some of the reported differences may be attributable to selection bias of more complex cases to open surgery. A Cochrane systematic review examining 11 non-randomized and 1 randomized study showed laparoscopic surgery to be feasible in diverticular disease, although there might be a higher minor complications rate in laparoscopic resections. Attention has been focused on surgical techniques as means to reduce complications. There is a belief that preservation of the inferior mesenteric and superior rectal artery protects from anastomotic leak, but a study from the USA looking into that point did not find a difference. The application of hand-assisted laparoscopy seems to help cope with complex diverticular masses and colovesical fistulas. New hybrid techniques incorporating specimen extraction via rectum may reduce complications further. Single incision laparoscopic surgery has recently been shown to be feasible. Although minimally invasive techniques appear superior in terms of early outcomes than open surgery the choice of minimally invasive technique seems to be less relevant to outcomes if accompanied by an appropriate level of surgical experience and expertise. Patient-related factors such as comorbidities or degree of disease complexity are more likely to

  3. 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.

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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.

  9. Laparoscopic reversal of Hartmann procedure

    Directory of Open Access Journals (Sweden)

    Golash Vishwanath

    2006-01-01

    Full Text Available Background: The Hartmann procedure is a standard life-saving operation for acute left colonic complications. It is usually performed as a temporary procedure with the intent to reverse it later on. This reversal is associated with considerable morbidity and mortality by open method. The laparoscopic reestablishment of intestinal continuity after Hartmann procedure has shown better results in terms of decrease in morbidity and mortality. Materials and Methods: The laparoscopic technique was used consecutively in 12 patients for the reversal of Hartmann procedure in the last 3 years. The adhesiolysis and mobilization of the colon was done under laparoscopic guidance. The colostomy was mobilized and returned to abdominal cavity after tying the anvil in the proximal end. An end-to-end intracorporeal anastomosis was performed between the proximal colon and the rectum using the circular stapler. Results: Mean age of the patients was 40 years and the mean time of restoration of intestinal continuity was 130 days. Two patients were converted to open. The mean time of operation was 90 min. There were no postoperative complications and mortality. The mean hospital stay was 5 days. Conclusion: Laparoscopic reversal of Hartmann is technically safe and feasible.

  10. 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

  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. PMID:26024818

  12. 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

  13. Robotic Compartment-Based Radical Surgery in Early-Stage Cervical Cancer

    Science.gov (United States)

    Toptas, Tayfun; Uysal, Aysel; Ureyen, Isin; Erol, Onur; Simsek, Tayup

    2016-01-01

    A radical hysterectomy with pelvic lymphadenectomy is the recommended treatment option in patients with early-stage cervical cancer. Although various classifications were developed in order to define the resection margins of this operation, no clear standardization could be achieved both in the nomenclature and in the extent of the surgery. Total mesometrial resection (TMMR) is a novel procedure which aims to remove all components of the compartment formed by Müllerian duct in which female reproductive organs develop. TMMR differs from the conventional radical hysterectomy techniques in that its surgical philosophy, terminology, and partly resection borders are different. In this paper, a TMMR with therapeutic pelvic lymphadenectomy operation that we performed for the first time with robot-assisted laparoscopic (robotic) approach in an early-stage cervical cancer patient was presented. This procedure has already been described in open surgery by Michael Höckel and translated to the robotic surgery by Rainer Kimmig. Our report is the second paper, to our knowledge, to present the initial experience regarding robotic TMMR in the English literature. PMID:27195167

  14. Laparoscopic Adrenalectomy for Large Adrenal Metastasis From Contralateral Renal Cell Carcinoma

    OpenAIRE

    Zografos, G. N.; Farfaras, A.; Aggeli, C; Kontogeorgos, G.; Pagoni, M.; Vogiati, S.; Vasiliadis, G.; Papastratis, G.

    2007-01-01

    We present herein the case of a patient with solitary metachronous contralateral adrenal metastasis from renal cell cancer. The patient had undergone left radical nephrectomy and adrenalectomy for localized renal cancer 7 years previously. Laparoscopic transperitoneal right adrenalectomy was performed. The postoperative period was uneventful. Histology showed right adrenal metastasis from renal cancer. At 6-month follow-up, there was no evidence of recurrence.

  15. Radical Geography

    Directory of Open Access Journals (Sweden)

    H. Hataminezhad

    2012-07-01

    Full Text Available Interdisciplinary sciences emerging and specialization were result of historical conditions. Lack of common and grand theories have caused social sciences such as Geography disintegrated to many courses. The Geography science has been divided two main courses, Physical and Human through the time. Every one used another similar science in theoretical principles and methodologies for their domain development and strengthening of their bases. The Human Geography was influenced by Anthropology during nineteenth century and was affected by nineteenth century and dawn twentieth century by Sociology and from mid twentieth century until present time by Biological sciences, Psychology, Political economics and social theories. Radical Geography was one of the Human Geography branches that was influenced by Political economics and left ideology. Radical Geography emphasizes on investigation about quality of life in different spaces and attempts to change socio-economic and spatial relationships, therefore critical Geography is one of its similar approaches.

  16. Speech recognition for embedded automatic positioner for laparoscope

    Science.gov (United States)

    Chen, Xiaodong; Yin, Qingyun; Wang, Yi; Yu, Daoyin

    2014-07-01

    In this paper a novel speech recognition methodology based on Hidden Markov Model (HMM) is proposed for embedded Automatic Positioner for Laparoscope (APL), which includes a fixed point ARM processor as the core. The APL system is designed to assist the doctor in laparoscopic surgery, by implementing the specific doctor's vocal control to the laparoscope. Real-time respond to the voice commands asks for more efficient speech recognition algorithm for the APL. In order to reduce computation cost without significant loss in recognition accuracy, both arithmetic and algorithmic optimizations are applied in the method presented. First, depending on arithmetic optimizations most, a fixed point frontend for speech feature analysis is built according to the ARM processor's character. Then the fast likelihood computation algorithm is used to reduce computational complexity of the HMM-based recognition algorithm. The experimental results show that, the method shortens the recognition time within 0.5s, while the accuracy higher than 99%, demonstrating its ability to achieve real-time vocal control to the APL.

  17. 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.

  18. 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....

  19. 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...

  20. 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 ...

  1. 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.

  2. 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...

  3. 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 ...

  4. 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.

  5. 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

  6. 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 ...

  7. 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...

  8. 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.

  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. 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

  11. 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)

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

    OpenAIRE

    Marcel Autran Cesar MACHADO; Rodrigo Canada Trofo SURJAN; Goldman, Suzan Menasce; Jose Celso ARDENGH; Fabio Ferrari MAKDISSI

    2013-01-01

    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 2...

  13. 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.

  14. Laparoscopic partial nephrectomy for endophytic hilar tumors

    DEFF Research Database (Denmark)

    Di Pierro, G B; Tartaglia, N; Aresu, L; Polara, A; Cielo, A; Cristini, C; Grande, P; Gentile, V; Grosso, G

    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....

  15. Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

    OpenAIRE

    Ahmed Al-Sayyad

    2012-01-01

    Objectives: To evaluate the efficacy and safety of laparoscopic transperitoneal ureterolithotomy for management of large proximal ureteric stones. Materials and Methods: Medical records of patients who underwent laparoscopic transperitoneal ureterolithotomy for proximal ureteral stones ≥2 cm were reviewed retrospectively. Patients′ characteristics, stone characteristics, perioperative and follow-up data were studied. Patients with stones

  16. 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.

  17. Cholecystoenteric Fistule and Laparoscopic Repair

    Directory of Open Access Journals (Sweden)

    Temel Bulut

    2014-03-01

    Full Text Available Gallbladder stones are an endemic disease of hepatobiliary system.Whereas, cholecystoenteric fistules which develop by depending on gallbladder stone are rarely seen complications. A diagnosis is usually established during an operation. As is seen in our case too, in view of acute-stoned cholecystitis, laparoscopy has been carried out and a diagnosis of cholecystoduodenal fistule has been established during laparoscopy. Our case to whom laparoscopic duodenography and cholecystectomy has been applied is a rarely seen disease in literature. So, we aimed at sharing this information.

  18. Ontology-based prediction of surgical events in laparoscopic surgery

    Science.gov (United States)

    Katić, Darko; Wekerle, Anna-Laura; Gärtner, Fabian; Kenngott, Hannes; Müller-Stich, Beat Peter; Dillmann, Rüdiger; Speidel, Stefanie

    2013-03-01

    Context-aware technologies have great potential to help surgeons during laparoscopic interventions. Their underlying idea is to create systems which can adapt their assistance functions automatically to the situation in the OR, thus relieving surgeons from the burden of managing computer assisted surgery devices manually. To this purpose, a certain kind of understanding of the current situation in the OR is essential. Beyond that, anticipatory knowledge of incoming events is beneficial, e.g. for early warnings of imminent risk situations. To achieve the goal of predicting surgical events based on previously observed ones, we developed a language to describe surgeries and surgical events using Description Logics and integrated it with methods from computational linguistics. Using n-Grams to compute probabilities of followup events, we are able to make sensible predictions of upcoming events in real-time. The system was evaluated on professionally recorded and labeled surgeries and showed an average prediction rate of 80%.

  19. Safe laparoscopic clearance of the common bile duct in emergently admitted patients with choledocholithiasis and cholangitis

    Science.gov (United States)

    Plaudis, Haralds; Fokins, Vladimirs; Mukans, Maksims; Pupelis, Guntars

    2016-01-01

    Backgrounds/Aims Laparoscopic treatment of patients with choledocholithiasis and cholangitis is challenging due to mandatory recovery of the biliary drainage and clearance of the common bile duct (CBD). The aim of our study was to assess postoperative course of cholangitis and biliary sepsis after laparoscopic clearance of the CBD in emergently admitted patients with choledocholithiasis and cholangitis. Methods Emergently admitted patients who underwent laparoscopic clearance of the CBD were included prospectively and stratified in 2 groups i.e., cholangitis positive (CH+) or negative (CH-) group. Patient demographics, comorbidities, preoperative imaging data, inflammatory response, surgical intervention, complication rate and outcomes were compared between groups. Results Ninety-nine of a total 320 patients underwent laparoscopic clearance of the CBD, of which, 60 belonged to the acute cholangitis group (CH+) and 39 to the cholangitis negative group (CH-). Interventions were done on average 4 days after admission, operation duration was 95-105 min, and the conversion rate was 3-7% without differences in the groups. Preoperative inflammatory response was markedly higher in the CH+ group. Inflammation signs on intraoperative choledochoscopy were more evident in patients with cholangitis. Postoperative inflammatory response did not differ between the groups. The overall complication rate was 8.3% and 5.1%, respectively. Laparoscopic clearance of the CBD resulted in 1 lethal case (CH+ group), resulting in 1% mortality rate and a similar 12-month readmission rate. Conclusions Single-stage laparoscopic intraoperative US and choledochoscopy-assisted clearance of the CBD is feasible in emergently admitted patients with choledocholithiasis and cholangitis. PMID:27212991

  20. Laparoscopic repair of postoperative perineal hernia.

    LENUS (Irish Health Repository)

    Ryan, Stephen

    2010-01-01

    Perineal hernias are infrequent complications following abdominoperineal operations. Various approaches have been described for repair of perineal hernias including open transabdominal, transperineal or combined abdominoperineal repairs. The use of laparoscopic transabdominal repair of perineal hernias is not well-described. We present a case report demonstrating the benefits of laparoscopic repair of perineal hernia following previous laparoscopic abdominoperineal resection (APR) using a nonabsorbable mesh to repair the defect. We have demonstrated that the use of laparoscopy with repair of the pelvic floor defect using a non absorbable synthetic mesh offers an excellent alternative with many potential advantages over open transabdominal and transperineal repairs.

  1. Emergency and elective laparoscopic repair of spigelian hernias: two case reports and a review of the literature.

    Science.gov (United States)

    Leff, Daniel Richard; Hassell, Jane; Sufi, Pratik; Heath, Dugal

    2009-08-01

    Diagnosing spigelian hernias through physical examination can be particularly challenging. Increasingly, laparoscopy is being used to both confirm the diagnosis and carry out therapeutic repair. Here, we describe 2 cases of successful laparoscopic repair of spigelian hernias using an Endocatch assisted sutured technique. A review of the literature describing the role of laparoscopy in the management of spigelian hernia is also provided. PMID:19692870

  2. 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.

  3. Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013).

    Science.gov (United States)

    Stiles, Mandy; Case, J Brad; Coisman, James

    2016-08-01

    OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted. PMID:27439347

  4. Radiologic investigation after laparoscopic inguinal hernia repair

    International Nuclear Information System (INIS)

    Laparoscopic instead of open surgical repair of inguinal hernias is becoming more frequent. Radiologists may expect different postoperative findings depending on the technique used. We studied how radiology had been used postoperatively and what findings were encountered after laparoscopic herniorraphy. Postoperative radiologic examinations related to hernia repair of all consecutive patients that had had laparoscopic herniorraphy in Malmoe University hospital between 1992 and 1998 were retrospectively evaluated. A total of 538 groins were included, 3.9% (n=21) of these were postoperatively examined with ultrasound (n=10), herniography (n=7), plain abdominal films (n=2), CT (n=1), or fistulography (n=1). Significant findings were found in five groins, namely, one sinus tract, two hematomas, one small bowel obstruction, and one recurrence of hernia. Four insignificant seromas were found. The characteristics of the findings and pitfalls are described. Symptoms resulting in radiologic examination are rare after laparoscopic herniorraphy. The radiologist must be familiar with the spectrum of such findings. (orig.)

  5. An overview of laparoscopic colorectal surgery

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Laparoscopic skills has been widely applied in colorectal surgery. The definition, indications and contraindications, the oncologic principles, port side recurrence, and the newer advances are reported in this article .

  6. Acceptable outcome after laparoscopic appendectomy in children

    DEFF Research Database (Denmark)

    Stilling, Nicolaj M; Fristrup, Claus; Gabers, Torben;

    2013-01-01

    An increasing proportion of childhood -appendicitis is being treated with laparoscopic appendectomy (LA). We wanted to elucidate the outcome of childhood appendicitis treated primarily by residents in a university hospital....

  7. Laparoscopic extirpation of giant adrenal ganglioneuroma

    Directory of Open Access Journals (Sweden)

    George P Abraham

    2014-01-01

    Full Text Available Laparoscopic adrenalectomy is the standard of care for management of adrenal neoplasms. However, large sized adrenal lesions are considered as relative contraindication for laparoscopic extirpation. We report laparoscopic excision of giant ganglioneuroma of adrenal gland in a 33-year-old female patient. Patient was presented with left loin pain of 2 months duration. Computed tomography (CT scan was suggestive of non-enhancing left suprarenal mass measuring 17 × 10 cm. Preoperative endocrine evaluation ruled out functional adrenal tumor. Patient underwent transperitoneal excision of suprarenal mass. The lesion could be completely extirpated laparoscopically. Duration of surgery was 250 minutes. Estimated blood loss was 230 milliliters. Specimen was extracted through pfannenstiel incision. No significant intraoperative or postoperative happenings were recorded. Microscopic features were suggestive of ganglioneuroma of adrenal gland.

  8. Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

    Directory of Open Access Journals (Sweden)

    Ahmed Al-Sayyad

    2012-01-01

    Conclusion: Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.

  9. Laparoscopic Fertility Sparing Management of Cervical Cancer

    OpenAIRE

    Chiara Facchini; Giuseppina Rapacchia; Giulia Montanari; Paolo Casadio; Gianluigi Pilu; Renato Seracchioli

    2014-01-01

    Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery ...

  10. A Comparison of Laparoscopic and Open Appendectomy

    OpenAIRE

    Tarnoff, Michael; Atabek, Umur; Goodman, Martin; Alexander, James B.; Chrzanowski, Francis; Mortman, Keith; Camishon, Rudolph; Pello, Mark

    1998-01-01

    Background and Objectives: To compare laparoscopic appendectomy with traditional open appendectomy. Methods: Seventy-one patients requiring operative intervention for suspected acute appendicitis were prospectively compared. Thirty-seven patients underwent laparoscopic appendectomy, and 34 had open appendectomy through a right lower quadrant incision. Length of surgery, postoperative morbidity and length of postoperative stay (LOS) were recorded. Both groups were similar with regard to age, g...

  11. LAPAROSCOPIC ANATOMY OF THE EXTRAHEPATIC BILIARY TRACT

    Directory of Open Access Journals (Sweden)

    E. Târcoveanu

    2005-01-01

    Full Text Available Development of mini-invasive surgery determinates a rapid improvement in laparoscopic regional anatomy. As laparoscopy is becoming common in most surgical departments, basic laparoscopic anatomy is mandatory for all residents in general surgery. Successful general surgery starts in the anatomy laboratory. Successfully minim invasive surgery starts in the operative theatre with laparoscopic exploration. The initial laparoscopic view of the right upper quadrant demonstrates primarily the subphrenic spaces, abdominal surface of the diaphragm and diaphragmatic surface of the liver. The falciform ligament is a prominent dividing point between the left subphrenic space and the right subphrenic space. The ligamentum teres hepatis is seen in the free edge of the falciform. Upward traction on the gallbladder exposes the structures of Calot’s triangle and the hepatoduodenal ligament. The liver is divided into anatomic segments based on internal anatomy that is invisible to the laparoscopist. Surface landmarks include the falciform ligament and the gallbladder fossa. The surgical procedures performed laparoscopically currently include liver biopsy, wedge resection, fenestration of hepatic cysts, laparoscopic approach of the hidatid hepatic cyst, and atypical hepatectomy. We present the laparoscopic anatomy of extrahepatic biliary tract. Once the gallbladder is elevated, inspection reveals Hartmann’s pouch and the cystic duct. The typical angular junction of the cystic duct on the common duct actually occurs in a minority of patients and the length and course of the cystic duct are highly variable. The boundaries of Calot’s triangle are often not well seen. The cystic artery is often visible under the peritoneum as it runs along the surface of the gallbladder. The variations of the structures of the hepatoduodenal ligament may occur to injuries during laparoscopic cholecystectomy. Cholangiography increases the safety of dissection of biliary tract by

  12. Therapeutic advances: Single incision laparoscopic hepatopancreatobiliary surgery

    OpenAIRE

    Chang, Stephen Kin Yong; Lee, Kai Yin

    2014-01-01

    Single-port laparoscopic surgery (SPLS) is proposed to be a step towards minimizing the invasiveness of surgery, and has since gained popularity in several surgical sub-specialties including hepatopancreatobiliary surgery. SPLS has since been applied to cholecystectomy, liver resection as well as pancreatectomy for a multitude of pathologies. Benefits of SPLS over conventional multi-incision laparoscopic surgery include improved cosmesis and potentially post-operative pain at specific time pe...

  13. Laparoscopic cholecystectomy perioperative management: an update

    OpenAIRE

    Jakobsson, Jan

    2015-01-01

    Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no fir...

  14. Our Initial Experiences with Laparoscopic Urologic Surgery

    OpenAIRE

    Selçuk Altın; Ramazan Topaktaş2; Ali Akkoç; Cemil Aydın; Reha Girgin; Zeynep Banu Aydın; Kadir Yıldırım

    2016-01-01

    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 postoper...

  15. Current Trends in Laparoscopic Ventral Hernia Repair

    OpenAIRE

    Misiakos, Evangelos P.; Patapis, Paul; Zavras, Nick; Tzanetis, Panagiotis; Machairas, Anastasios

    2015-01-01

    Background and Objectives: The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature. Database: A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair. Conclusions: LVHR is a safe alternative to the open met...

  16. Factors determining convalescence after uncomplicated laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, T; Klarskov, B; Rosenberg, J; Kehlet, H

    2001-01-01

    HYPOTHESIS: Detailed information on duration and limiting factors for convalescence after uncomplicated laparoscopic cholecystectomy is lacking. Duration of convalescence may be associated with patients' expectations, given recommendations, and postoperative complaints such as pain and fatigue....... DESIGN: Prospective, descriptive study. SETTING: A university hospital. PATIENTS: Two hundred consecutive patients who underwent uncomplicated elective laparoscopic cholecystectomy. INTERVENTION: For sedentary, light, or moderate workload or main recreational activity, we recommended 2 days of...

  17. Totally Laparoscopic Gastrectomy for Gastric Cancer

    OpenAIRE

    Theodorous, Arianne N.; Train, William W.; Goldfarb, Michael A.; Borao, Frank J.

    2013-01-01

    Background and Objectives: Recent studies have supported minimally invasive techniques as a viable alternative to open surgery in the treatment of gastric cancer. The goal of this study is to review our institution's experience with totally laparoscopic gastrectomy for the treatment of both early- and advanced-stage gastric cancer. Methods: A retrospective study was conducted to examine the short-term outcomes of laparoscopic gastrectomy performed at Monmouth Medical Center between May 2003 a...

  18. Massive right hemothorax as the source of hemorrhagic shock after laparoscopic cholecystectomy - case report of a rare intraoperative complication

    Directory of Open Access Journals (Sweden)

    Federico Biolchini

    2011-05-01

    Full Text Available Abstract A 62-year old man was referred to our institution in hemorrhagic shock after a laparoscopic cholecystectomy for acute cholecystitis, performed at an outside hospital. A chest X-ray revealed a right-sided massive pleural effusion. Urgent surgical exploration was performed through a video-assisted mini-thoracotomy which revealed active bleeding from a pleural adherence. Successful hemostasis was achieved intraoperatively and the patient had an uneventful recovery. In absence of intra-abdominal hemorrhage, a hemothorax should be considered as a potential source of major bleeding in patients who develop symptoms of hypovolemia after laparoscopic surgery.

  19. Dynamics of Radical-Mediated Enzyme Catalyses

    Science.gov (United States)

    Warncke, Kurt

    1997-11-01

    An emergent class of enzymes harnesses the extreme reactivity of electron-deficient free radical species to perform some of the most difficult reactions in biology. The regio- and stereo-selectivity achieved by these enzymes defies long-held ideas that radical reactions are non-specific. The common primary step in these catalyses is metal- or metallocenter-assisted generation of an electron-deficient organic "initiator radical". The initiator radical abstracts a hydrogen atom from the substrate, opening a new reaction channel for rearrangement to the product. Our aim is to elucidate the detailed molecular mechanisms of the radical pair separation and radical rearrangement steps. Radical pair separation and substrate radical rearrangement are tracked by using time-resolved (10-7 to 10-3 s) techniques of pulsed-electron paramagnetic resonance spectroscopy (FT-EPR, ESEEM). Synchronous time-evolution of the reactions is attained by triggering with a visible laser pulse. Transient non-Boltzmann population of the states of the spin-coupled systems, and resultant electron spin polarization, facilitates study at or near room temperature under conditions where the enzymes are operative. The systems examined include ethanolamine deaminase, a vitamin B12 coenzyme-dependent enzyme, ribonucleotide reductase and photosynthetic reaction centers. The electronic and nuclear structural and kinetic information obtained from the pulsed-EPR studies is used to address how the initiator radicals are stabilized against deleterious recombination with the metal, and to distinguish the participation of concerted versus sequential rearrangement pathways.

  20. Hepatectomia direita por videolaparoscopia Laparoscopic right hepatectomy

    Directory of Open Access Journals (Sweden)

    Marcel Autran C. Machado

    2007-06-01

    Full Text Available The first application of laparoscopic liver surgery consisted of wedge liver biopsies or resection of peripheral lesions, mostly benign. More recently, reports of anatomic left and right hepatectomy have been seen in the literature. Expertise in some centers has evolved to such an extent that even living related donor hepatectomy has been performed. The aim of this paper is to report a laparoscopic right hepatectomy and describe in detail the surgical technique employed. To our knowledge this is the first case performed in Brazil totally laparoscopically. The surgery followed four distinct phases: complete mobilization of the liver; hilum dissection with encircling of right portal vein and right hepatic artery, caval dissection using linear vascular stapler to divide right hepatic vein and parenchymal transection with harmonic shears and firings of linear staplers are used to divide segmental 5 and 8 branches of middle hepatic vein. The liver specimen was removed by Pfannenstiel incision. Intraoperative blood loss was estimated in 120 ml with no need for blood transfusion. Hospital stay was 5 days. Laparoscopic right hepatectomy is feasible, technically demanding but can be safely accomplished by surgeons who have experience in advanced laparoscopic procedures and open hepatic surgery. In Brazil laparoscopic liver surgery is still in its first years and there is a lack of technical description of this complex procedure.

  1. Training techniques in laparoscopic donor nephrectomy: a systematic review.

    Science.gov (United States)

    Raque, Jessica; Billeter, Adrian T; Lucich, Elizabeth; Marvin, Michael M; Sutton, Erica

    2015-10-01

    The learning curve to achieve competency in laparoscopic donor nephrectomy (LDN) is poorly outlined. Online databases were searched for training in LDN. Abstracts and manuscripts were excluded if they did not address introduction of a laparoscopic technique for donor nephrectomy. Relevant manuscripts were reviewed for surgical technique, use of animal models, co-surgeons, surgeon specialty and training, institution type/volume, and assessment of training method. Forty-four met inclusion criteria, with 75% describing the evolution from open to LDN. Eighty-two percent were from academic centers, and 36% were from centers performing learning curve, defined by decreased operating time, averaged 35 cases. Improved intra-operative, patient, and recipient outcomes were observed for centers performing ≥50 LDNs annually. The United Network of Organ Sharing requires 15 cases as surgeon or assistant to be certified as the primary LDN surgeon. This falls below the described learning curve for LDN. The assessment of training and competency for LDN is heterogeneous, and objective learner-based metrics could help surgeons and institutions reach a quality standard for performing this operation. PMID:26179472

  2. Laparoscopic Management of Perforated Meckel's Diverticulum in Adults

    Directory of Open Access Journals (Sweden)

    Yinlu Ding, Yong Zhou, Zhipeng Ji, Jianliang Zhang, Qisan Wang

    2012-01-01

    Full Text Available Objective: To determine the role of laparoscopy in diagnosis and surgical treatment of perforated Meckel's diverticulum (MD in adults.Methods: Between July 2003 and July 2011, fifteen patients were seen with perforated MD. Eleven were male and four were female. The median age was 38 years (range, 21-68. All patients presented with a sudden onset of pain. Among them 9 had a past medical history of bloody stools and /or chronic recurrent abdominal pain. 2 were preoperatively diagnosed with perforated MD confirmly and 4 suspiciously, 9 with perforated acute appendicitis. All 15 patients underwent exploratory laparoscopy.Results: 4 patients with broad-base(≧ 2 cm and 2 patients with narrow-base(<2 cm whose perforative site was near the base underwent laparoscopically assisted extracorporal bowel segment resection, the other 9 patients with narrow-base(<2 cm underwent laparoscopically intraabdominal wedge resection of the MD. No intraoperative or postoperative complications occurred. The median hospital stay was 4 days (range, 2-7days. The histopathologic studies showed heterotopic gastric mucosa (HGM in 10 cases (66.7%. All patients recovered uneventfully.Conclusion: To patients with sudden abdomen pain mimic acute appendicitis accompanied by a past medical history of bloody stools and/or chronic recurrent abdominal pain, proferated MD should be kept in mind as a differential diagnosis. Laparoscopy is a safe and effective surgical modality for diagnosis of proferated MD and has a therapeutic role that results in an excellent cosmetic result.

  3. Section 17. Laparoscopic and minimal incisional donor hepatectomy.

    Science.gov (United States)

    Choi, YoungRok; Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk

    2014-04-27

    Living donor hepatectomy is now a well-established surgical procedure. However, a large abdominal incision is still required, which results in a large permanent scar, especially for a right liver graft. This report reviews our techniques of minimally invasive or minimal incisional donor hepatectomy using a transverse incision.Twenty-five living donors underwent right hepatectomy with a transverse incision and 484 donors with a conventional incision between April 2007 and December 2012. Among the donors with a transverse incision, two cases were totally laparoscopic procedures using a hand-port device; 11 cases were laparoscopic-assisted hepatectomy (hybrid technique), and 14 cases were open procedures using a transverse incision without the aid of the laparoscopic technique. Currently, a hybrid method has been exclusively used because of the long operation time and surgical difficulty in totally laparoscopic hepatectomy and the exposure problems for the liver cephalic portion during the open technique using a transverse incision.All donors with a transverse incision were women except for one. Twenty-four of the grafts were right livers without middle hepatic vein (MHV) and one with MHV. The donors' mean BMI was 21.1 kg/m. The median operation time was 355 minutes, and the mean estimated blood loss was 346.1±247.3 mL (range, 70-1200). There was no intraoperative transfusion. These donors had 29 cases of grade I [14 pleural effusions (56%), 11 abdominal fluid collections (44%), 3 atelectasis (12%), 1bile leak (4%)], 1 case of grade II (1 pneumothorax) and two cases of grade III complications; two interventions were needed because of abdominal fluid collections by Clavien-Dindo classification. Meanwhile, donors with a conventional big incision, which included the Mercedes-Benz incision or an inverted L-shaped incision, had 433 cases of grade I, 19 cases of grade II and 18 cases of grade III complications. However, the liver enzymes and total bilirubin of all donors

  4. Laparoscopic splenectomy using conventional instruments

    Directory of Open Access Journals (Sweden)

    Dalvi A

    2005-01-01

    Full Text Available INTRODUCTION : Laparoscopic splenectomy (LS is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4, 197-200 (2004], trauma [Ren et al., Surg Endosc 15(3, 324 (2001; Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4, 283-286 (2002], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45, 847-852 (2002]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported. MATERIALS AND METHODS : Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision. RESULTS : A total of 26 patients underwent LS. Twenty-two (85% of patients had spleen size more than 500 g (average weight being 942.55 g. Mean operative time was 214 min (45-390 min. The conversion rate was 11.5% ( n = 3. Average duration of stay was 5.65 days (3-30 days. Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease. CONCLUSION : Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS.

  5. Laparoscopic morcellator-related complications.

    Science.gov (United States)

    Milad, Magdy P; Milad, Elizabeth A

    2014-01-01

    Morcellation at laparoscopy is a commonly used minimally invasive method to extract bulky tissue from the abdomen without extending abdominal incisions. Despite widespread use of morcellation, complications still remain underreported and poorly understood. We performed a systematic review of surgical centers in the United States to identify, collate and update the morcellator-related injuries and near misses associated with powered tissue removal. We searched articles on morcellator-related injuries published from 1993 through June 2013. In addition, all cases reported to MedSun and the FDA device database (MAUDE) were evaluated for inclusion. We used the search terms "morcellation," "morcellator," "parasitic," and "retained" and model name keywords "Morcellex," "MOREsolution," "PlasmaSORD," "Powerplus," "Rotocut," "SAWALHE," "Steiner," and "X-Tract." During the past 15 years, 55 complications were identified. Injuries involved the small and large bowels (n = 31), vascular system (n = 27), kidney (n = 3), ureter (n = 3), bladder (n = 1), and diaphragm (n = 1). Of these injuries, 11 involved more than 1 organ. Complications were identified intraoperatively in most patients (n = 37 [66%]); however, the remainder were not identified until up to 10 days postoperatively. Surgeon inexperience was a contributing factor in most cases in which a cause was ascribed. Six deaths were attributed to morcellator-related complications. Nearly all major complications were identified from the FDA device database and not from the published literature. The laparoscopic morcellator has substantially expanded our ability to complete procedures using minimally invasive techniques. Associated with this opportunity have been increasing reports of major and minor intraoperative complications. These complications are largely unreported, likely because of publication bias associated with catastrophic events. Surgeon experience likely confers some protection against these injuries

  6. Single-port laparoscopic surgery.

    Science.gov (United States)

    Tsai, Anthony Y; Selzer, Don J

    2010-01-01

    Laparoscopic surgery performed through a single-incision is gaining popularity. The demand from the public for even less invasive procedures will motivate surgeons, industry, and academic centers to explore the possibilities and refine the technology. Although the idea seems quite attractive, there are several technological obstacles that are yet to be conquered by improved technology or additional training. The question of safety has yet to be answered and will require well-designed randomized control trials. Opponents to the approach argue that the size of the single incision (see Table 1) is frequently larger than all the standard laparoscopy incisions combined. On the other hand, proponents remember a similar argument from traditional open surgeons during the initial development of laparoscopy. That argument was quickly discredited when the immediate benefits oflaparoscopy were compared with patients undergoing surgery with small laparotomy incisions. During the development of a new technique, the learning curve exposes patients to risk and society to expense. LESS pioneers appear to have reached a level of comfort with technology and techniques that paves the way for scientific scrutiny. Perhaps, the surgical community will capitalize on this situation with randomized, controlled studies and sound evidence to support or refute the benefits of LESS. If we do not seize this opportunity, patient demand and industry's dual edge message of financial success versus fear of losing referrals will lead to a scenario similar to the development of laparoscopic cholecystectomy in the 1990s. Regardless of its future, the surgical community will still benefit from a renewed excitement as surgeons aim to continually reduce the amount of pain and trauma our patients must endure. In addition, technological advances on instrumentation will benefit the field of laparoscopy and improve patient care. PMID:20919511

  7. Preliminary results after single-port laparoscopic colonic surgery

    DEFF Research Database (Denmark)

    Mynster, Tommie; Hammer, Janne; Wille-Jørgensen, Peer

    2012-01-01

    Single incision laparoscopic surgery (SILS) may be even less invasive to patients than conventional laparoscopic surgery (CLS). The present study investigates the applicability of the procedure and we report the first year of experiences and operative quality....

  8. Quantification of a radical beam source for methyl radicals

    International Nuclear Information System (INIS)

    A radical beam source for methyl radicals (CH3) was characterized applying ionization-threshold mass spectrometry. The beam source is based on thermal dissociation of methane (CH4) or azomethane (N2(CH3)2) in a heated tungsten capillary. A flux of (3±1)x1013 cm-2 s-1 CH3 radicals is produced using methane as precursor gas and a capillary temperature of 1650 K. Alternatively, a flux of (3±1)x1014 cm-2 s-1 CH3 is produced using azomethane as precursor gas and a capillary temperature of 1150 K. The dominant production of methyl from the precursor methane occurs due to reaction 2 CH4+M→2 CH3+H2+M at the hot tungsten surface. The dominant production of methyl from azomethane occurs due to the reaction N2(CH3)2→2 CH3+N2. Besides methyl radicals, only stable molecules contribute to the emitted flux; within the detection limit, no atomic hydrogen is observed. From the comparison of ionization-threshold mass spectrometry and standard mass spectrometry, it is concluded that the cracking pattern of methane varies with the methane gas temperature. This is explained by the vibrational assisted dissociation of methane

  9. Evaluation of Efficacy of Four Laparoscopic Needle Drivers

    OpenAIRE

    Ramani, Anup P.; Braasch, Matthew; Botnaru, Andrei; Lavers, Ann; Herrera, Shannon; Pedro, Renato Nardi; Monga, Manoj

    2008-01-01

    Introduction: To evaluate the impact of needle driver design on laparoscopic suturing skills by experts and novices. Methods: Three experienced laparoscopic surgeons and 3 novice junior residents were asked to perform a fixed set of suturing tasks in a laparoscopic pelvic-trainer. The laparoscopic needle drivers compared were (1) the Ethicon driver (E 705R), (2) Karl Storz (KS) pistol grip (26173 KC), (3) KS finger grip (26167 SK), and (4) KS palm grip (26173 ML). Times were recorded for each...

  10. Current Status of Laparoscopic Liver Resection in Korea

    OpenAIRE

    Park, Joon Seong; Han, Ho-Seong; Hwang, Dae Wook; Yoon, Yoo-Seok; Cho, Jai Young; Koh, Yang-Seok; Kwon, Choon Hyuck David; Kim, Kyung Sik; Kim, Sang Bum; Kim, Young Hoon; Kim, Hyung Chul; Chu, Chong Woo; Lee, Dong Shik; Kim, Hong-Jin; Park, Sang Jae

    2012-01-01

    Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure...

  11. Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer

    OpenAIRE

    Lee, Jeong-Eun; Joh, Yong-Geul; Yoo, Sang-hwa; Jeong, Geu-Young; Kim, Sung-Han; Chung, Choon-Sik; Lee, Dong-Gun; Kim, Seon Hahn

    2011-01-01

    Purpose The long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. We investigated the long-term outcomes, including the five-year overall survival, disease-free survival and recurrence rate, after a laparoscopic resection for colorectal cancer. Methods Using prospectively collected data on 303 patients with colorectal cancer who underwent a laparoscopic resect...

  12. 5-Millimeter Trocar-Site Bowel Herniation Following Laparoscopic Surgery

    OpenAIRE

    Khurshid, Nauman; Chung, Maurice; Horrigan, Terrence; Manahan, Kelly; Geisler, John P.

    2012-01-01

    Background and Objectives: This is a case report of a 5-mm trocar-site large bowel herniation following laparoscopic tubal sterilization. During laparoscopic sterilization, the 5-mm port site was closed initially. Large bowel herniation was recognized at the end of the case and managed immediately by laparoscopically reducing the hernia and closing the port site without any short- or long-term complications. Trocar-site bowel hernia is a rare complication after laparoscopic surgery. It is usu...

  13. Laparoscopic versus open surgery for rectal cancer (COLOR II)

    DEFF Research Database (Denmark)

    van der Pas, Martijn Hgm; Haglind, Eva; Cuesta, Miguel A;

    2013-01-01

    Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the COlorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer....

  14. Laparoscopic pull through for Hirschsprung′s disease in infants

    Directory of Open Access Journals (Sweden)

    Jona Juda

    2005-01-01

    Full Text Available Purpose: To report personal experience with Primary Laparoscopic Pullthrough Procedure (PLPP in infants with Hirschsprung′s Disease (H.D.. Materials and Methods: Sixty four PLPP were performed by the author. In addition, 17 assisted LPP were done but not reported herein. The patients′ personal and anatomic data were typical for babies with H.D. Results: Average age at operation was seven weeks (range 1-28 weeks. Operative time for PLPP averaged 140 minutes. Two babies required conversion to a standard laparotomy for anatomic reasons (long segment. Average blood loss was Conclusion: PLPP is an effective, problem free approach for treating neonatal H.D. It has replaced the standard two stage open procedure in babies with uncomplicated presentation.

  15. Laparoscopic repair of an incarcerated femoral hernia

    Science.gov (United States)

    Pillay, Yagan

    2015-01-01

    Introduction A femoral hernia is a rare, acquired condition, which has been reported in less than 5% of all abdominal wall hernias, with a female to male ratio of 4:1. Presentation of case We report a case in a female patient who had a previous open inguinal herniorrhaphy three years previously. She presented with right sided groin pain of one month duration. Ultrasound gave a differential diagnosis of a recurrent inguinal hernia or a femoral hernia. A transabdominal preperitoneal repair was performed and the patient made an uneventful recovery. Discussion Laparoscopic repair of a femoral hernia is still in its infancy and even though the outcomes are superior to an open repair, open surgery remains the standard of care. The decision to perform a laparoscopic trans abdominal preperitoneal (TAPP) repair was facilitated by the patient having previous open hernia surgery. The learning curve for laparoscopic femoral hernia repair is steep and requires great commitment from the surgeon. Once the learning curve has been breached this is a feasible method of surgical repair. This is demonstrated by the fact that this case report is from a rural hospital in Canada. Conclusion Laparoscopic femoral hernia repair involves more time and specialized laparoscopic skills. The advantages are a lower recurrence rate and lower incidence of inguinodynia. PMID:26581083

  16. Total laparoscopic liver resection in 78 patients

    Directory of Open Access Journals (Sweden)

    Lei Zhang, Ya-Jin Chen, Chang-Zhen Shang, Hong-Wei Zhang, Ze-Jian Huang

    2009-12-01

    Full Text Available AIM: To summarize the clinical experience of laparoscopic hepatectomy at a single center.METHODS: Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma (n = 39, metastatic liver carcinoma (n = 10, and benign liver neoplasms (n = 29 underwent laparoscopic hepatectomy in our unit. A retrospective analysis was done on the clinical outcomes of the 78 patients.RESULTS: The lesions were located in segments I (n = 3, II (n = 16, III (n = 24, IV (n = 11, V (n = 11, VI (n = 9, and VIII (n = 4. The lesion sizes ranged from 0.8 to 15 cm. The number of lesions was three (n = 4, two (n = 8 and one (n = 66 in the study cohort. The surgical procedures included left hemi-hepatectomy (n = 7, left lateral lobectomy (n = 14, segmentectomy (n = 11, local resection (n = 39, and resection of metastatic liver lesions during laparoscopic surgery for rectal cancer (n = 7. Laparoscopic liver resection was successful in all patients, with no conversion to open procedures. Only four patients received blood transfusion (400-800 mL. There were no perioperative complications, such as bleeding and biliary leakage. The liver function of all patients recovered within 1 wk, and no liver failure occurred.CONCLUSION: Laparoscopic hepatectomy is a safe and feasible operation with minimal surgical trauma. It should be performed by a surgeon with sufficient experience in open hepatic resection and who is proficient in laparoscopy.

  17. Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.

    LENUS (Irish Health Repository)

    Joyce, M

    2012-02-01

    BACKGROUND: Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS: Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS: All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION: Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.

  18. Pseudoaneur ysm following laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Mansoor Ahmed Madanur; Narendra Battula; Harsheet Sethi; Rahul Deshpande; Nigel Heaton; Mohamed Rela

    2007-01-01

    BACKGROUND: Laparoscopic cholecystectomy (LC) is the operation of choice for removal of the gallbladder. Unrecognized bile duct injuries present with biliary peritonitis and systemic sepsis. Bile has been shown to cause damage to the vascular wall and therefore delay the healing of injured arteries leading to pseudoaneurysm formation. Failure to deal with bile leak and secondary infection may result in pseudoaneurysm formation. This study was to report the incidence and outcomes of pseudoaneurysm in patients with bile leak following LC referred to our hospital. METHODS:A retrospective analysis of our prospectively maintained liver database using key words pseudoaneurysm, bile leak and bile duct injury following laparoscopic cholecystectomy from January 2000 to December 2005 was performed. RESULTS:A total of 86 cases were referred with bile duct injury and bile leak following LC and of these, 4 patients (4.5%) developed hepatic artery pseudoaneurysm (HAP) presenting with haemobilia in 3 and massive intra-abdominal bleed in 1. Selective visceral angiography conifrmed pseudoaneurysm of the right hepatic artery in 2 cases, cystic artery stump in one and an intact but ectatic hepatic artery with surgical clips closely applied to the right hepatic artery at the origin of the cystic artery in the fourth case. Effective hemostasis was achieved in 3 patients with coil embolization and the fourth patient required emergency laparotomy for severe bleeding and hemodynamic instability due to a ruptured right hepatic artery. Of the 3 patients treated with coil embolization, 2 developed late strictures of the common hepatic duct (CHD) requiring hepatico-jejunostomy and one developed a stricture of left hepatic duct. All the 4 patients are alive at a median follow up of 17 months (range 1 to 65) with normal liver function tests. CONCLUSIONS:HAP is a rare and potentially life-threatening complication of LC. Biloma and subsequent infection are reported to be associated with

  19. Laparoscopic ovarian drilling by diathermy for ovulation induction in infertile women with polycystic ovarian syndrome

    International Nuclear Information System (INIS)

    Background: Polycystic ovarian syndrome (PCOS) is the commonest cause of secondary infertility. Laparoscopic ovarian drilling has widely been used for induction of ovulation in polycystic ovarian syndrome patients resistant to clomiphene citrate. 80% patients ovulated after treatment and 60% patient conceived either spontaneously or after treatment with medication to which they are previously resistant. Purpose: The aim of the present study was to see the effectiveness of laparoscopic ovarian drilling (LOD) with monopolar diathermy on pregnancy outcome in infertile women with polycystic ovarian syndrome (PCOS). Design: Descriptive cross sectional study. Intervention: Laparoscopic ovarian drilling. Main Outcome Measures: Pregnancy, ovulation rate. Material and Methods: This study was carried out in the department of Gynae and Obstetrics in Sharif Medical City Hospital from January, 2007 to January, 2009. The inclusion criteria for laparoscopy ovarian drilling (LOD) were those infertile women between the age group of 25 - 38 years who meet the criteria for PCOS and who are resistant to clomiphene citrate and injectable gonadotrophins. A total of 30 women were booked for laparoscopic ovarian drilling after having informed consent for procedure. Response to therapy was assessed in term of pregnancy outcome and ovulation rate for 1 year after therapy. Results: A total of 30 patients were booked for laparoscopic ovarian drilling from January, 2007 to January, 2009. The mean age of study group was 30 years +- SD 4.7791. Cumulative ovulation rate was observed in 22 patients (73%), out of which spontaneous ovulation occurred in 18 patients (80%), and after ovulation induction therapy in 4 patients (18%). Eleven patients (37%) conceived in two year duration. Spontaneous conception without any treatment was observed in 7 patients (63%); however 4 patients (37%) require further assistance with combined therapy of clomiphene citrate and injectable gonadotrophins after failure

  20. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

    Directory of Open Access Journals (Sweden)

    Jennings Jason

    2010-01-01

    Full Text Available Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP approach using Polypropylene Mesh (Mesh and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

  1. Case selection and outcome of radical perineal prostatectomy in localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Jeffrey M Holzbeierlein

    2003-08-01

    Full Text Available Radical prostatectomy continues to play a central role in the management of localized prostate cancer. The majority of patients diagnosed with prostate cancer will undergo radical prostatectomy. A decrease in the morbidity of this surgical procedure has been accomplished through an improved understanding of pelvic anatomy and a greater understanding of the natural history of prostate cancer. Recently, minimally invasive techniques have been applied to radical prostatectomy (laparoscopic prostatectomy in order to further decrease the morbidity of this operation. What remains to be determined is whether this approach confers the same long term surgical outcomes as the open approach. One method which offers known long term outcomes coupled with decreased morbidity is the radical perineal prostatectomy. The purpose of this paper is to review the criteria for patient selection as well as outcomes of the radical perineal prostatectomy.

  2. Effects of modified chest-up Trendelenburg position on cerebral oxygen metabolism and early postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of the colorectal carcinoma%改良抬胸Trendelenburg位对腹腔镜结直肠癌根治术老年患者脑氧代谢和早期术后认知功能的影响

    Institute of Scientific and Technical Information of China (English)

    施锋; 李金宝; 邓小明; 许波

    2016-01-01

    Objective To study the effects of modified chest-up Trendelenburg position on cerebral oxygen metabolism and early postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of colorectal carcinoma.Methods Eighty ASA Ⅰ or Ⅱ patients,60-82 years old,weighing 44-69 kg,scheduled for elective laparoscopic radical resection of colorectal carcinoma,were randomly divided into 2 groups (n=40):group M,patients in chest-up position using custom-made posture cushions,group T,patients in conventional Trendelenburg position.Blood samples were simultaneously taken from radial artery and jugular bulb at 5 min after regular general anesthesia induction in supine position (T1),immediately after pneumoperitoneum in modified Trendelenburg position or Trendelenburg position(T2),at 30 min (T3),60 min(T4),90 min(T5) after pneumoperitoneum,and at 15 min after deflation in horizon position (T6).The values of blood gas,blood glucose,lactate,and MAP were recorded.he differences of arteriovenous O2 content (Ca-jvDO2) and glucose content (Da-jvglu) were calculated.Cognitive function was assessed by mini-mental state examination at 24 h before anesthesia and at 6,24,48 h and 72 h after anesthesia.Results Compared with T1,arterial partial pressure carbon dioxide(PaCO2) at T3-6,jugular venous partial pressure oxygen(PjvO2) at T3-5 and jugular venous oxygen saturation(SjvO2) at T4-5 were significantly increased in both groups,MAP at T2 were significantly decreased in both groups,MAP at T4-6 were significantly increased in group M,MAP at T3-6,SjvO2 [(75±9)%] at T6 and jugular venous lactate (Lacjv)[(2.0±0.5) mmol/L] at T5 were significantly increased and Ca-jvDO2[(5.2±1.5)%] at T5 were significantly decreased in group T(P<0.05).Compared with group T,CajvDO2[(5.9±1.6)%] at T5 was not significantly decreased,MAP at T4-6,SjvO2[(75±9)%] and Lacjv[(1.5±0.5) mmol/L] at T5 were not significantly increased,Da-jvglu before and after pneumoperitoneum

  3. LAPAROSCOPIC HELLER MIOTOMY USING ENDOSCOPIC GUIDANCE

    Directory of Open Access Journals (Sweden)

    E. Târcoveanu

    2008-10-01

    Full Text Available Heller miotomy is the procedure of choice for the treatment of esophageal achalasia. The paper present our laparoscopic technique using endoscopic guidance for a better visualization of the eso-gastric region and for minimal eso-gastric dissection. We also discussed the advantages of laparoscopic miotomy versus endoscopic dilatation and botulinum toxine injection. The use of associated Dor procedure is also discussed. Conclusions: Laparoscopic esocardiomiotomy is the gold standard treatment for esophageal achalasia with good short and long-term results. The associated Dor operation is useful to avoid the gastroesophageal reflux and esophagitis and to protect the miotomy. Endoscopic guidance is useful for esophageal dissection, during the miotomy and to for the airtight checking of the mucosa.

  4. Procedural specificity in laparoscopic simulator training

    DEFF Research Database (Denmark)

    Bjerrum, Flemming; Sørensen, Jette Led; Konge, Lars;

    2014-01-01

    functional resemblance, such as whole procedural modules. In contrast to basic skills training, procedural training involves several cognitive skills such as elements of planning, movement integration, and how to avoid adverse events. The objective of this trial is to investigate the specificity of......BACKGROUND: The use of structured curricula for minimally invasive surgery training is becoming increasingly popular. However, many laparoscopic training programs still use basic skills and isolated task training, despite increasing evidence to support the use of training models with higher...... procedural practice in laparoscopic simulator training. METHODS/DESIGN: A randomised single-centre educational superiority trial. Participants are 96 surgical novices (medical students) without prior laparoscopic experience. Participants start by practicing a series of basic skills tasks to a predefined...

  5. Laparoscopic Repair for Perforated Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    A. Cotirleţ

    2015-01-01

    Full Text Available Perforated peptic ulcer (PPU, despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

  6. Single-incision total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Sinha Rakesh

    2011-01-01

    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  7. Free radical inactivation of trypsin

    International Nuclear Information System (INIS)

    Reactivities of free radical oxidants, radical OH, Br2-anion radical and Cl3COO radical and a reductant, CO2-anion radical, with trypsin and reactive protein components were determined by pulse radiolysis of aqueous solutions at pH 7, 200C. Highly reactive free radicals, radical OH, Br2-anion radical and CO2-anion radical, react with trypsin at diffusion controlled rates. Moderately reactive trichloroperoxy radical, k(Cl3COO radical + trypsin) preferentially oxidizes histidine residues. The efficiency of inactivation of trypsin by free radicals is inversely proportional to their reactivity. The yields of inactivation of trypsin by radical OH, Br2-anion radical and CO2-anion radical are low, G(inactivation) = 0.6-0.8, which corresponds to ∼ 10% of the initially produced radicals. In contrast, Cl3COO radical inactivates trypsin with ∼ 50% efficiency, i.e. G(inactivation) = 3.2. (author)

  8. Laparoscopic restorative proctocolectomy ileal pouch anal anastomosis: How I do it?

    Directory of Open Access Journals (Sweden)

    Manish A Madnani

    2015-01-01

    Full Text Available Surgery for ulcerative colitis is a major and complex colorectal surgery. Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients. For surgeons, it is a better tool for improving vision and magnification in deep cavities. This is not the simple extension of the laparoscopy training. Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery. There are also many variations in steps of laparoscopic surgery. It involves left colon, right colon and rectal mobilisation, low division of rectum, pouch creation and anastomosis of pouch to rectum. Over many years after standardisation of this technique, it takes same operative time as open surgery at our centre. So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA.

  9. Laparoscopic restorative proctocolectomy ileal pouch anal anastomosis: How I do it?

    Science.gov (United States)

    Madnani, Manish A; Mistry, Jitendra H; Soni, Harshad N; Shah, Atul J; Patel, Kantilal S; Haribhakti, Sanjiv P

    2015-01-01

    Surgery for ulcerative colitis is a major and complex colorectal surgery. Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients. For surgeons, it is a better tool for improving vision and magnification in deep cavities. This is not the simple extension of the laparoscopy training. Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery. There are also many variations in steps of laparoscopic surgery. It involves left colon, right colon and rectal mobilisation, low division of rectum, pouch creation and anastomosis of pouch to rectum. Over many years after standardisation of this technique, it takes same operative time as open surgery at our centre. So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA). PMID:26195886

  10. [LAPAROSCOPIC APPROACH AND SURGICAL CONSIDERATIONS IN RESECTION OF A LARGE EPIPHRENIC ESOPHAGEAL DIVERTICULUM].

    Science.gov (United States)

    Rudnicki, Yaron; Inbar, Roy; Barkay, Olga; Shpitz, Baruch; Ghinea, Ronen; Avital, Shmuel

    2015-08-01

    Epiphrenic diverticulum of the esophagus is an uncommon finding. Small diverticula are usually asymptomatic in nature. Large diverticula may present with dysphagia, chest or upper abdominal discomfort, vomiting, irritating cough or halitosis. There are a few different surgical approaches to epiphrenic diverticulum resection. It can be performed with an abdominal or a thoracic approach and in an open or a laparoscopic manner. In this case report we present a 70 years old male patient with a giant epiphrenic diverticulum and dysphagia. The patient was operated upon via a laparoscopic abdominal approach with intra-operative endoscopic assistance and underwent a diverticulum resection. We present a review of the different kinds of esophageal diverticula, the mechanism of their formation, and the surgical considerations associated with choosing the appropriate surgical approach. PMID:26480613

  11. Successful laparoscopic management for cholecystoenteric fistula

    Institute of Scientific and Technical Information of China (English)

    Wen-Ke Wang; Chun-Nan Yeh; Yi-Yin Jan

    2006-01-01

    AIM: Since 1987, laparoscopic cholecystectomy (LC)has been widely used as the favored treatment for gallbladder lesions. Cholecystoenteric fistula (CF) is an uncommon complication of the gallbladder disease, which has been one of the reasons for the conversion from LC to open cholecystectomy. Here, we have reported four cases of CF managed successfully by laparoscopic approach without conversion to open cholecystectomy.METHODS: During the 4-year period from 2000 to 2004, the medical records of the four patients with CF treated successfully with laparoscopic management at the Chang Gung Memorial Hospital-Taipei were retrospectively reviewed.RESULTS: The study comprised two male and two female patients with ages ranging from 36 to 74 years (median: 53.5 years). All the four patients had right upper quadrant pain. Two of the four patients were detected with pneumobilia by abdominal ultrasonography.One patient was diagnosed with cholecystocolic fistula preoperatively correctly by endoscopic retrograde cholangiopancreatography and the other one was diagnosed as cholecystoduodenal fistula by magnetic resonance cholangiopancreatography. Correct preoperative diagnosis of CF was made in two of the four patients with 50% preoperative diagnostic rate. All the four patients underwent LC and closure of the fistula was carried out by using Endo-GIA successfully with uneventful postoperative courses. The hospital stay of the four patients ranged from 7 to 10 d (median, 8 d).CONCLUSION: CF is a known complication of chronic gallbladder disease that is traditionally considered as a contraindication to LC. Correct preoperative diagnosis of CF demands high index of suspicion and determines the success of laparoscopic management for the subset of patients. The difficult laparoscopic repair is safe and effective in the experienced hands of laparoscopic surgeons.

  12. Hydroxyl-radical-induced oxidation of cyclic dipeptides: Reactions of free peptide radicals and their peroxyl radicals

    International Nuclear Information System (INIS)

    In the course of this study investigations were carried out into the reactions of hydroxyl radicals and hydrogen atoms with cyclic dipeptides as well as the subsequent reactions of peptide radicals and their peroxyl radicals in aqueous solution. The radiolysis products formed in the absence and presence of oxygen or transient metal complexes were characterized and determined on a quantitative basis. The linking of information from product analyses to the kinetic data for transient species obtained by time-resolving UV/VIS and conductivity measurements (pulse radiolysis) as well as computer-assisted simulations of individual events during the reaction permitted an evaluation of the mechanisms underlying the various processes and an identification of interim products with short life-times, which did or did not belong to the group of radicals. Through the characterization of key reactions of radicals and peroxyl radicals of this substance class a major advance has been made towards a better understanding of the role of radicals in the peptide compound and the mechanisms involved in indirect radiation effects on long-chain peptides and proteins. (orig.)

  13. Spermaturia after Radical Prostatectomy: Is Surgical Preservation of Fertility Possible?

    Directory of Open Access Journals (Sweden)

    Chad Reichard

    2013-01-01

    case of a patient with postejaculatory spermaturia following robotic assisted radical prostatectomy. We hypothesize that this is due to fistula formation between the vas deferens and the urinary tract.

  14. Presacral schwannoma: laparoscopic resection, a viable option

    Science.gov (United States)

    Jatal, Sudhir; Pai, Vishwas D.; Rakhi, Bharat

    2016-01-01

    Schwannomas are benign nerve sheath tumours arising from Schwann cells. Presacral schwannomas are rare with only case report and short case series being reported in literature. Complete surgical resection is the treatment of choice for these rare tumours. Approach to surgical resection depends on the type of the tumour. Type 3 tumours have conventionally been treated with open intra or extra peritoneal approach. With improvement in the laparoscopic surgical skills, more and more complex surgical procedures have been attempted via this approach. We are presenting a case of presacral schwannoma in an overweight lady treated by laparoscopic resection. PMID:27275489

  15. Laparoscopic Fertility Sparing Management of Cervical Cancer

    Directory of Open Access Journals (Sweden)

    Chiara Facchini

    2014-03-01

    Full Text Available Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.

  16. Laparoscopic fertility sparing management of cervical cancer.

    Science.gov (United States)

    Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato

    2014-04-01

    Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women. PMID:24696772

  17. LAPAROSCOPIC SURGICAL TRAINING. A THREE STAGES MODE

    Directory of Open Access Journals (Sweden)

    R. Moldovanu

    2013-03-01

    Full Text Available The classic “Halstedian” apprenticeship model for surgical training takes place into the operating theater under the strict coordination of a senior surgeon. The development of minimally invasive surgery (MIS rapidly revealed that this apprenticeship model is insufficient to successful fulfill the well known three stages of training of Rasmussen model – skill-based behavior (SBB, rule-based behavior (RBB and knowledge-based behavior (KBB – due to ethical, medico-legal and economic considerations and a specific training using different methods (theoretical and hands-on courses using simulators, animal models and web resources is mandatory. However it isn’t a worldwide accepted laparoscopic training curriculum. We present our experience with different types of teaching methods; in this way we retrospectively reviewed our experience in laparoscopic education, presenting data using Rasmussen model, as a dynamic three stages model: 1 first stage (the beginning, from 1993 until 1995, our staff acquired SBB, RBB and KBB for basic MIS procedures: cholecystectomy, appendectomy, surgical ablation of ovarian cysts; 2 the second stage, from 1996 until 1999, characterized by continuous training of our surgical staff until the achievement of the KBB level for basic MIS procedures and training for other operations (laparoscopic treatment of the groin hernias, eso-gastric and bariatric surgery and the teaching of the residents and the surgeons from Moldova region to achieve SBB and RBB for basic MIS procedures; 3 the third stage, from 2000 until present characterized by a continuous improvement of the surgical teams’ laparoscopic skills for different procedures, and developing a modern curricula for laparoscopic education. CONCLUSIONS: There is no universal method for laparoscopic training. Our experience demonstrates good results using a combination of training methods which allowed acquiring: SBB (Basic skills using virtual reality (VR simulators

  18. Laparoscopic Resection of Unruptured Rudimentary Horn Pregnancy.

    Science.gov (United States)

    Sharma, Deepti; Usha, M G; Gaikwad, Ramesh; Sudha, S

    2011-01-01

    A non-communicating rudimentary horn is an uncommon site for ectopic pregnancy. Rudimentary horn pregnancy (RHP) is a rare entity but associated with grave clinical consequences. Majority of these cases if not detected timely end up in uterine rupture and present as an obstetrical emergency. We present this case of a 32-year-old, third gravida with a 12 weeks live gestation in the right rudimentary horn, which was successfully managed with laparoscopic resection. Early diagnosis is the key stone in the management of such cases. Laparoscopic resection is a safe and viable option in the surgical management of unruptured RHP. PMID:26085754

  19. Laparoscopic management of difficult recurrent choledocholithiasis.

    Science.gov (United States)

    Dixit, Anupam; Wynne, Kamal S; Harris, Adrian M

    2007-01-01

    The management of common bile duct stones has traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology in the latter half of the last century, endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration has become the mainstream treatment for common bile duct stones in most medical centers around the world. However, in some patients, endoscopic retrograde cholangiopancreatography is difficult and laparoscopy is challenging because of previous surgery. These facts are highlighted in this report. PMID:17651582

  20. User involvement competence for radical innovation

    DEFF Research Database (Denmark)

    Lettl, Christopher

    One important market related capability for firms which seek to develop radical innovations is the competence to involve the 'right' users at the 'right' time in the 'right' form. While former studies have identified a rather passive role of users in the radical innovation process, this paper...... focuses on the involvement of such users that are in the position to play an active role as inventors and (co)-developers. A multiple case study analysis was conducted in the field of medical technology. Five radical innovation projects within four firms were selected including medical robots and computer......-assisted navigation systems. The case study analysis reveals that firms who closely interact with specific users benefit significantly for their radical innovation work. These users have a high motivation toward new solutions, are open to new technologies, possess diverse competencies, and are embedded into a very...

  1. Radical theory of rings

    CERN Document Server

    Gardner, JW

    2003-01-01

    Radical Theory of Rings distills the most noteworthy present-day theoretical topics, gives a unified account of the classical structure theorems for rings, and deepens understanding of key aspects of ring theory via ring and radical constructions. Assimilating radical theory's evolution in the decades since the last major work on rings and radicals was published, the authors deal with some distinctive features of the radical theory of nonassociative rings, associative rings with involution, and near-rings. Written in clear algebraic terms by globally acknowledged authorities, the presentation

  2. D2 dissection in laparoscopic and open gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Ming Cui; Jia-Di Xing; Wei Yang; Yi-Yuan Ma; Zhen-Dan Yao; Nan Zhang; Xiang-Qian Su

    2012-01-01

    AIM:To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer.METHODS:Clinicopathological data from 209 patients with gastric cancer,who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011,were analyzed retrospectively.Among these patients,131 patients underwent laparoscopyassisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG).The parameters analyzed included operative time,blood loss,blood transfusion,morbidity,mortality,the number of harvested lymph nodes (HLNs),and pathological stage.RESULTS:There were no significant differences in sex,age,types of radical resection [radical proximal gastrectomy (PG + D2),radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)],and stages between the LAG and OG groups (P > 0.05).Among the two groups,127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs,respectively.The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P =0.233).In the same type of radical resection,there were no significant differences in the number of HLNs between the two groups (PG + D2:21.7 ± 7.5 vs 22.4 4-9.3;DG + D2:25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2:30.9 ± 13.4 vs 29.3 ± 10.4; P > 0.05 for all comparisons).Tumor free margins were obtained in all cases.Compared with OG group,the LAG group had significantly less blood loss,but a longer operation time (P < 0.001).The morbidity of the LAG group was 9.9%,which was not significantly different from the OG group (7.7%) (P=0.587).The mortality was zero in both groups.CONCLUSION:Laparoscopic D2 dissection is equivalent to OG in the number of HLNs,regardless of tumor location.Thus,this procedure can achieve the same radicalness as OG.

  3. Development of a standardized laparoscopic caecum resection model to simulate laparoscopic appendectomy in rats

    OpenAIRE

    Lingohr, Philipp; Dohmen, Jonas; Matthaei, Hanno; Schwandt, Timo; Hong, Gun-Soo; Konieczny, Nils; Bölke, Edwin; Wehner, Sven; Kalff, Jörg C

    2014-01-01

    Background Laparoscopic appendectomy (LA) has become one of the most common surgical procedures to date. To improve and standardize this technique further, cost-effective and reliable animal models are needed. Methods In a pilot study, 30 Wistar rats underwent laparoscopic caecum resection (as rats do not have an appendix vermiformis), to optimize the instrumental and surgical parameters. A subsequent test study was performed in another 30 rats to compare three different techniques for caecum...

  4. Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis

    Institute of Scientific and Technical Information of China (English)

    ZHONG Chen-xi; WU Ji-xiang; LIANG Jie-xiong; WU Qing-hua

    2012-01-01

    Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome).Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.

  5. A case series of laparoscopic components separation and rectus medialization with laparoscopic ventral hernia repair.

    Science.gov (United States)

    Malik, Kashif; Bowers, Steven P; Smith, C Daniel; Asbun, Horacio; Preissler, Susanne

    2009-10-01

    Laparoscopic ventral hernia repair has been shown to offer improved patient recovery, when compared to open repair. It has also been shown to offer a lower complication rate. However, in patients with high body-mass index and large defects, the intraperitoneal on-lay technique of laparoscopic repair is criticized for an increased incidence of failure. In 1990, a study introduced the technique of open-component separation, hence enabling the medialization of the rectus muscle and decreasing the incidence of recurrence associated with primary repair. Open-component separation is associated with increased wound problems due to extensive dissection. Different laparoscopic and endoscopic modifications to the open-component-separation technique have been tried to minimize wound problems. In this article, we present our case series of 4 patients involving the laparoscopic component-separation technique of rectus medialization and, laparoscopic ventral hernia combined. This is one of the first series ever reported to involve both modalities of hernia repair in using an exclusive laparoscopic technique. PMID:19694565

  6. Laparoscopically assisted liver biopsy with a hemostatic plug

    NARCIS (Netherlands)

    Karpelowsky, J. S.; Numanoglu, A.; Bax, N. M. A.; Rode, H.

    2006-01-01

    Background: Percutaneous and open liver biopsies are routine procedures for diagnosing liver pathology. However, the procedure can carry significant morbidity and even mortality, especially in the event of an un-correctable coagulopathy or a highly vascular tumor. Methods: A technique described for

  7. Hand-Assisted Laparoscopic Surgery for a Mesenteric Teratoma

    OpenAIRE

    Tanaka, Yusuke; Koyama, Shinsuke; Shiki, Yasuhiko

    2014-01-01

    Mature cystic teratomas are benign neoplasms of germ cell tumors that occur most frequently in gonadal sites. The tumors usually contain 2 or 3 well-differentiated elements of endodermal, ectodermal, and mesodermal origin. Although relatively uncommon, teratomas can be composed of mature tissue originating from only 1 germ cell layer. This is known as a monodermal teratoma. Extragonadal teratomas, especially mesenteric teratomas, are extremely rare. Currently, only 21 cases of mesenteric tera...

  8. Urological laparoscopic surgery: Our experience of first 100 cases in Dicle University

    Directory of Open Access Journals (Sweden)

    Ahmet Ali Sancaktutar

    2012-03-01

    Full Text Available Objectives: In this study the experience and results of first100 laparoscopic surgery is presented.Materials and methods: The laparoscopic surgical operationswere reviewed between July 2010 and October 2011,retrospectively.Results: During a year period we performed of 100 laparoscopicinterventions. The ratio of male to female and themean age was 57/43 and 48,65±8,94 years respectively.The kind of operation and total numbers were like this: simplenephrectomy 34, radical nephrektomy 22, renal cyst excision21, orchiectomy 7, ureterolitotomy 4, adrenalectomy 4,orchiopexy 3, pyeloplasti 2, nefroureterectomy+cystectomy1, nefroureterectomy+partial cystectomy 1 nefroureterectomy1 patient.Transperitoneal approach was used for 91 patients whileretroperitoneal approach was used to 9 patients. The operationwas completed by open surgical interventions foronly 6 of 100 patients. The reason for open proceduresduring laparoscopy was not reaching to renal pedicles forthree patients, adhesions to pararenal tissue and colonfor 2 patients and splenic artery injury for 1 patient. Threepatients needed blood transfusions. Except these patientsthere wasn’t any complications and mortalities. When performingright nephrectomy and adrenalectomy the fourthport was used to ecartate liver. Except these cases in alloperations 3 ports was used. The mean hospitalizationstay was 1,7(1-8 days. The operation times of mostlyperformed operations were like these minute (interval:simple nephrectomy 95 (70-135, radical nephrectomy 148(125-190, renal cyst excision 45 (20-80, orchiectomy 41(30-45, ureterolithotomy 104 (95-135, orchiopexy 85 (80-100, adrenalectomy 148 (110-180, pyeloplasty 170 (160-180 nefroureterectomy 150 minutes.Conclusions: The results, success and complication ratesof laparoscopic operations which are performed in our clinicswere found as similar to literature. The laparoscopicsurgery is alternative to open surgery that it can be usedsafely and effectively. J Clin

  9. Laparoscopic nephrectomy in live donor

    Directory of Open Access Journals (Sweden)

    Anuar I. Mitre

    2004-02-01

    Full Text Available OBJECTIVE: To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS: In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56% and 22 female (44%. Mean age was 37.2 years, and the mean body mass index (BMI was 27.1 kg/m². RESULTS: Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%, the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2% its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS: The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.

  10. Laparoscopic nephrectomy in live donor

    Directory of Open Access Journals (Sweden)

    Mitre Anuar I.

    2004-01-01

    Full Text Available OBJECTIVE: To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS: In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56% and 22 female (44%. Mean age was 37.2 years, and the mean body mass index (BMI was 27.1 kg/m². RESULTS: Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%, the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2% its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS: The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.

  11. Multimodal hybrid imaging agents for sentinel node mapping as a means to (re)connect nuclear medicine to advances made in robot-assisted surgery

    Energy Technology Data Exchange (ETDEWEB)

    KleinJan, Gijs H. [Leiden University Medical Hospital, Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden (Netherlands); The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Berg, Nynke S. van den [Leiden University Medical Hospital, Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden (Netherlands); The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Urology, Amsterdam (Netherlands); Jong, Jeroen de [The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Pathology, Amsterdam (Netherlands); Wit, Esther M.; Poel, Henk G. van der [The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Urology, Amsterdam (Netherlands); Thygessen, Helene [The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Biostatistics, Amsterdam (Netherlands); Vegt, Erik [The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Leeuwen, Fijs W.B. van [Leiden University Medical Hospital, Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden (Netherlands); The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Urology, Amsterdam (Netherlands); The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Head and Neck Surgery and Oncology, Amsterdam (Netherlands)

    2016-07-15

    Radical prostatectomy and complementary extended pelvic lymph node dissection (ePLND) of sentinel lymph nodes (SNs) and non-sentinel lymph nodes (LNs) at risk of containing metastases are increasingly being performed using high-tech robot-assisted approaches. Although this technological evolution has clear advantages, the physical nature of robotic systems limits the integrated use of routine radioguided surgery technologies. Hence, engineering effort in robotics are focused on the integration of fluorescence guidance technologies. Using the hybrid SN tracer indocyanine green-{sup 99m}Tc-nanocolloid (radioactive and fluorescent), for the first time in combination with a robot-integrated laparoscope, we investigated whether the robot-assisted approach affects the accuracy of fluorescence detection of SNs identified preoperatively using nuclear medicine. The study included 55 patients (Briganti nomogram-based risk >5 % on LN metastases) scheduled for robot-assisted radical prostatectomy, SN biopsy and ePLND. Following indocyanine green-{sup 99m}Tc-nanocolloid injection, preoperative nuclear imaging (lymphoscintigraphy and SPECT/CT) was used to locate the SN(s). The fluorescence laparoscope was used intraoperatively to identify the SN(s) with standard fluorescence settings (in 50 patients) and with customized settings (in 5 patients). The number and location of the SNs, the radioactive, fluorescence (both in vivo and ex vivo) and tumour status of the resected SNs/LNs, and postoperative complications were recorded and analysed. Combined, preoperative lymphoscintigraphy and SPECT/CT imaging identified 212 SNs (median 4 per patient). Intraoperative fluorescence imaging using standard fluorescence settings visualized 80.4 % (148/184 SNs; 50 patients; ex vivo 97.8 %). This increased to 85.7 % (12/14 SNs; 5 patients; ex vivo 100 %) with customized fluorescence settings. SPECT/CT images provided guidance towards the residual SNs. Ex vivo all removed SNs were radioactive. SNs

  12. Multimodal hybrid imaging agents for sentinel node mapping as a means to (re)connect nuclear medicine to advances made in robot-assisted surgery

    International Nuclear Information System (INIS)

    Radical prostatectomy and complementary extended pelvic lymph node dissection (ePLND) of sentinel lymph nodes (SNs) and non-sentinel lymph nodes (LNs) at risk of containing metastases are increasingly being performed using high-tech robot-assisted approaches. Although this technological evolution has clear advantages, the physical nature of robotic systems limits the integrated use of routine radioguided surgery technologies. Hence, engineering effort in robotics are focused on the integration of fluorescence guidance technologies. Using the hybrid SN tracer indocyanine green-99mTc-nanocolloid (radioactive and fluorescent), for the first time in combination with a robot-integrated laparoscope, we investigated whether the robot-assisted approach affects the accuracy of fluorescence detection of SNs identified preoperatively using nuclear medicine. The study included 55 patients (Briganti nomogram-based risk >5 % on LN metastases) scheduled for robot-assisted radical prostatectomy, SN biopsy and ePLND. Following indocyanine green-99mTc-nanocolloid injection, preoperative nuclear imaging (lymphoscintigraphy and SPECT/CT) was used to locate the SN(s). The fluorescence laparoscope was used intraoperatively to identify the SN(s) with standard fluorescence settings (in 50 patients) and with customized settings (in 5 patients). The number and location of the SNs, the radioactive, fluorescence (both in vivo and ex vivo) and tumour status of the resected SNs/LNs, and postoperative complications were recorded and analysed. Combined, preoperative lymphoscintigraphy and SPECT/CT imaging identified 212 SNs (median 4 per patient). Intraoperative fluorescence imaging using standard fluorescence settings visualized 80.4 % (148/184 SNs; 50 patients; ex vivo 97.8 %). This increased to 85.7 % (12/14 SNs; 5 patients; ex vivo 100 %) with customized fluorescence settings. SPECT/CT images provided guidance towards the residual SNs. Ex vivo all removed SNs were radioactive. SNs were tumour

  13. The laparoscopic approach toward hyperinsulinism in children.

    Science.gov (United States)

    Bax, Klaas N M A; van der Zee, D C

    2007-11-01

    Hyperinsulinemic hypoglycemia (HH) in children requiring surgery is rare. Early HH can be the result of focal or diffuse pancreatic pathology. A number of genetic abnormalities in early HH have been identified, but in the majority of patients no abnormality is found. The sporadic focal and diffuse forms as well the autosomal recessive form are particularly therapy-resistant and demand for early surgery. Preoperative discrimination between focal and diffuse disease in early HH is difficult. 18 F DOPA PET in combination with CT is promising as is laparoscopic exploration of the pancreas. Frozen section biopsy analysis has not been uniformly beneficial. If macroscopically no focal lesion is found, limited laparoscopic distal pancreatectomy provides tissue for definitive pathologic examination. Subsequent near total laparoscopic spleen-saving pancreatectomy surgery is not particularly difficult. Later HH may occur in the context of the MEN-1 syndrome and is then multifocal in nature. In MEN-1 patients, a distal spleen-saving pancreatectomy with enucleation of lesions in the head seems justified. Insulin-producing lesions in non-MEN-1 patients should be enucleated. There should always be a suspicion of malignancy. Also, in older children, surgery for hyperinsulinism should be performed laparoscopically. PMID:17933666

  14. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-02-01

    Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

  15. Laparoscopic Radiofrequency Thermal Ablation for Uterine Adenomyosis

    OpenAIRE

    Scarperi, Stefano; Pontrelli, Giovanni; Campana, Colette; Steinkasserer, Martin; Ercoli, Alfredo; Minelli, Luca; Bergamini, Valentino; Ceccaroni, Marcello

    2015-01-01

    Background and Objectives: Symptomatic uterine adenomyosis, unresponsive to medical therapy, is a challenging condition for patients who desire to preserve their uterus. This study was an evaluation of the feasibility and efficacy of laparoscopic radiofrequency thermal ablation of symptomatic nodular uterine adenomyosis. Methods: Fifteen women with symptomatic nodular adenomyosis, who had no plans for pregnancy but declined hysterectomy, underwent radiofrequency thermal ablation. Ultrasonogra...

  16. Laparoscopic Management of Appendicular Abscess (Clinical Observation

    Directory of Open Access Journals (Sweden)

    Tutchenko Mykola

    2014-05-01

    Full Text Available This article presents the diagnostics and laparoscopic management of appendicular abscess of 66 y.o. woman operated 3 weeks after the disease onset. The patient underwent surgery successfully. Purulent septic post-operative complications were not demonstrated. That confirms the benefits of minimally invasive surgery

  17. Laparoscopic Ovarian Surgery in Children and Adolescents

    OpenAIRE

    Kim, Hong-Bae; Cho, Hye-Yon; Park, Sung-Ho; Park, Sung-Taek

    2015-01-01

    Background and Objectives: Although laparoscopy is widely used in gynecologic surgery in adults, few studies have been undertaken to examine its use in young and adolescent patients. This study was conducted to investigate the safety and feasibility of laparoscopic surgery for the treatment of benign ovarian disease in children and adolescents. Methods: A retrospective chart review was conducted on 106 patients (age,

  18. Pneumodilation versus laparoscopic Heller's myotomy for achalasia

    LENUS (Irish Health Repository)

    Slattery, E

    2011-08-04

    Boeckxstaens et al. (May 12 issue)1 compare single laparoscopic myotomy with a series of pneumodilation procedures for patients with achalasia. They found no significant difference in outcomes between the two groups, although perforation occurred in 4% of patients in the pneumodilation group and often required emergency treatment. No significant clinical adverse outcomes occurred in the surgical group.\\r\

  19. Neuromuscular blockade during laparoscopic ventral herniotomy

    DEFF Research Database (Denmark)

    Medici, Roar; Madsen, Matias V; Asadzadeh, Sami;

    2015-01-01

    would provide a better surgical workspace. METHODS: This was an investigator-initiated, assessor- and patient-blinded randomised cross-over study. A total of 34 patients with planned laparoscopic umbilical, incisional and linea alba herniotomy were studied. Patients would be randomised to receive deep...

  20. Safe laparoscopic colorectal surgery performed by trainees

    DEFF Research Database (Denmark)

    Langhoff, Peter Koch; Schultz, Martin; Harvald, Thomas;

    2013-01-01

    Laparoscopic surgery for colorectal cancer is safe, but there have been hesitations to implement the technique in all departments. One of the reasons for this may be suboptimal learning possibilities since supervised trainees have not been allowed to do the operations to an adequate extent for the...

  1. Laparoscopic right hemicolectomy for intestinal intussuception.

    LENUS (Irish Health Repository)

    Kiernan, F

    2012-09-01

    Adult intussusception is rare and usually associated with carcinoma in 50% of the cases. These have traditionally been managed using an open technique. We herein describe a laparoscopic extended right hemicolectomy in a 62-year-old lady with an intussuception secondary to a transverse colonic tumor.

  2. Laparoscopic cholecystectomy in adult cystic fibrosis.

    LENUS (Irish Health Repository)

    McGrath, D S

    2012-02-03

    Two female patients with Cystic Fibrosis, attending the Adult Regional Cystic Fibrosis centre at the Cork University Hospital, were investigated for upper abdominal pain and found to have gallstones at ultrasonography. Laparoscopic cholecystectomy was performed successfully and, without complication, in both patients.

  3. Laparoscopic Operations; a Six Year Experience

    Directory of Open Access Journals (Sweden)

    Ahmet Karataş

    2015-11-01

    Full Text Available Objective: Laparoscopy has begun to perform in most of the cases previously operated with laparotomy in last two decade. Clinics are carrying out different kinds of operations varying from diagnostic to oncological procedures according to their experience. We decided to present the laparoscopic operations and findings performed for diagnostic and operative reason in gynecology clinic at last six year. Material and Methods: The laparoscopic operations which performed between January 2006 and December 2011 were retrospectively evaluated. A totally 229 cases in which the laparoscopy was done for diagnostic and operative purpose was included into study. Results: The mean age, gravida, parity and living child numbers of cases were 34.5±9.0 years, 2.0±1.6, 1.9±1.6 and 1.8±1.4, respectively. The 30 of 33 cases evaluated as endometriosis intraoperative were verified as pathologically. The complication rates were 0.9% in cases with diagnostic and minor laparoscopy and 12.5% in 16 cases operated with laparoscopic hysterectomy. Conclusions: Although, the laparoscopic surgery is performed as safely and effectively in thousands of cases all over the world, the complication developing risk should be considered. The advanced operations should be carried out by experienced surgeons. We thought that the specimens should be obtained for the pathological evaluation in all cases.

  4. Perioperative nursing for laparoscopic liver resection

    Institute of Scientific and Technical Information of China (English)

    CHEN Li-jia; WEN Guo-fen

    2005-01-01

    Sir Run Run Shaw Hospital (SRRSH) has developed a form of laparoscopic hepatectomy, resecting by curettage and suction. Such resection has been carried out successfully in 6 patients who had liver tumors. The results are satisfactory. And after the operation, there is a very effective perioperative nursing ensuring the patient's recovery.

  5. Zero ischemia laparoscopic partial thulium laser nephrectomy.

    LENUS (Irish Health Repository)

    Thomas, Arun Z

    2013-11-01

    Laser technology presents a promising alternative to achieve tumor excision and renal hemostasis with or without hilar occlusion, yet its use in partial nephrectomy has not been significantly evaluated. We prospectively evaluated the thulium:yttrium-aluminum-garnet laser in laparoscopic partial nephrectomy (LPN) in our institution over a 1-year period.

  6. Laparoscopic nephrectomy: analysis of 34 patients

    Directory of Open Access Journals (Sweden)

    Domingos André Luís Alonso

    2003-01-01

    Full Text Available OBJECTIVE: To analyze the clinical experience of laparoscopic nephrectomy for benign and malignant diseases at a university hospital. METHODS: From February 2000 to March 2003, 34 patients (14 men and 20 women underwent transperitoneal laparoscopic total nephrectomy at the Hospital das Clinicas - FMRP-USP: 28 (82.3% patients had benign diseases and 6 (17.7% malignant neoplasias. Benign diseases were represented by: urinary stones (N-9, 32.1%, chronic pyelonephritis (N-8, 28.6%, vesicoureteral reflux (N-4, 14.3%, ureteropelvic obstruction (N-3, 10.7%, multicystic kidney (N-2, 7.1% and pyonephrosis (N-2, 7.1%. Patients age range was 2-79 years (mean - 35,1 years. RESULTS: In 32/34 patients the procedures were accomplished successfully. In 2 (5.8% cases of pyonephrosis, open conversion was necessary due to perinephric abscess and difficulties in dissection of renal hilum. Two patients had intraoperative complications (1 duodenum serous laceration an 1 vascular lesion of renal hilum, but both were managed laparoscopically. Two (5.8% post operative complications (1 delayed bleeding and 1 pancreatic fistula required open surgical exploration. The mean time of hospital stay was 58h (18 to 240h. CONCLUSION: Laparoscopic nephrectomy proved to be a method safe and associated with a low rate of morbidity, shorter hospital stay and no casualties.

  7. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2012-02-01

    Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

  8. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Amir Abu Zikry

    2011-01-01

    Full Text Available Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO 2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO 2 and SaO 2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication.

  9. SILC for SILC: Single Institution Learning Curve for Single-Incision Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Chee Wei Tay

    2013-01-01

    Full Text Available Objectives. We report the single-incision laparoscopic cholecystectomy (SILC learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC were analysed. CUSUM analysis is used to identify learning curve. Results. Hundred and nineteen SILC cases were performed by Surgeons A and B, respectively. Eight cases required additional port. In CUSUM analysis, most conversion occurred during the first 19 cases. Operating time was significantly lower (62.5 versus 90.6 min, P = 0.04 after the learning curve has been overcome. Operating time decreases as the experience increases, especially Surgeon B. Most conversions are due to adhesion at Calot’s triangle. Acute cholecystitis, patients’ BMI, and previous surgery do not seem to influence conversion rate. Mean operating times of cases assisted by first assistant with and without LC experience were 48 and 74 minutes, respectively (P = 0.004. Conclusion. Nineteen cases are needed to overcome the learning curve of SILC. Team work, assistant with CLC experience, and appropriate equipment and technique are the important factors in performing SILC.

  10. Pedicle omental graft created by laparoscopic surgery for filling a radiation-induced ulcer in a woman with breast cancer

    International Nuclear Information System (INIS)

    In patients with advanced or recurrent breast cancer, it is difficult to reconstruct chest wall ulcers due to postoperative irradiation, which is often infected. We present a laparoscopic technique for creating and mobilizing an omental flap. A 63-year-old woman diagnosed with parasternal lymph node metastases from left breast cancer 11 months after standard radical mastectomy underwent lymph node resection with radiation therapy. She developed ulceration of the irradiated chest wall 3 years and 10 months later. An omental flap obtained by laparoscopy was used to fill the space after the radiation-induced ulcer was resected and covered with a free skin graft. The skin graft adapted to the omentum. This laparoscopic procedure is more cosmetrically acceptable and less invasive than laparotomy in obtaining the omentum while yielding equivalent results in chest wall reconstruction. (author)

  11. Radiofrequency ablation-assisted laparoscopic partial nephrectomy without renal hilar vessel clamping: a report of 14 cases%射频消融辅助下不阻断肾蒂血管行腹腔镜肾部分切除术

    Institute of Scientific and Technical Information of China (English)

    李笑弓; 连惠波; 郭宏骞; 张古田; 张士伟; 屈峰; 姚林方; 杨荣; 汪维

    2011-01-01

    目的 探讨射频消融辅助下不阻断肾蒂血管行腹腔镜肾部分切除术( RF-LCPN)的可行性及临床疗效。方法 2009年1月至2010年6月采用RF-LCPN治疗肾肿瘤14例,共14个肿瘤。肿瘤直径平均3.1(2.2 ~4.0) cm。临床分期均为T1aN0M0。术前常规查血肌酐(SCr)(87±36)μmol/L、患肾肾小球滤过率(GFR) (45±11) ml/min。结果 14例患者手术均成功,平均手术时间( 152±46) min,平均出血量(89±52)rnl,术中快速病理提示标本切缘均阴性。术后出现短暂漏尿1例,通过放置输尿管双J管及留置导尿后治愈。术后平均住院(5±2)d。术后SCr(90±38)μmoI/L,患肾GFR(41±12) ml/min,与术前比较差异无统计学意义(P>0.05)。14例平均随访17(6 ~25)个月。无局部复发或远处转移病例。结论 RF-LCPN安全有效,并能减少肾脏热缺血时间,但远期疗效尚需进一步观察后明确。%ObjectiveTo evaluate the clinical feasibility of radiofrequency ablation-assisted laparoscopic partial nephrectomy(RF-LCPN) without renal hilar vessel clamping. MethodsFrom January 2009 to June 2010, 14 cases with renal tumors were treated with RF-LCPN. The mean tumor size was 3. 1 cm (range: 2. 2-4. 0 cm). All cases were staged at T1a N0M0. The preoperative serum creatinine (SCr)was (87 ± 36) μmol/L and glomerular filtration rate (GFR) (45 ± 11 ) ml/min. ResultsRF-LCPN was technically successful in all patients (14 tumors). The mean operative time was (152 ±4.6) min and the mean blood loss (89 ± 52) ml. All tumor margins were negative. One patient with a brief period of urine leakage from lower pole calix was managed successfully by ureteral stenting and Foley catheter drainage of bladder. The postoperative hospital stay was (5 ± 2 ) days. The postoperative SCr was (90 ± 38 ) μmol/L and GFR (41 ± 12) ml/min. There was no statistic post-operative change of SCr and GFR (P > 0. 05). All patients completed a minimum follow-up of 6 months

  12. Laparoscopic Cholecystectomy by Sectorisation of Port Sites

    International Nuclear Information System (INIS)

    Objectives: To evaluate the results of 160 consecutive laparoscopic cholecystectomy using sectorisation based port site selection to improve ergonomics for surgeons. Design: Descriptive study. Place and Duration of study: PNS Shifa Karachi, Pakistan from Feb 2011 to Feb 2012. Patients and Methods: In this prospective study, 160 consecutive patients had undergone laparoscopic cholecystectomy in a tertiary care hospital using sectorisation for trocar placement. All patients with symptomatic gallstones, acute calculous cholecystitis and empyema gallbladder were included. Patients with choledocholithiasis were excluded from the study. The collected data included age, sex, diagnosis, history of previous surgery, conversion to open surgery and its reasons, operative time, post-operative hospital stay, complications and laparoscopy related complications to the surgeon such as shoulder pain, wrist stress and pain, finger joint pain and stress exhaustion. Result: One hundred and sixty patients underwent laparoscopic cholecystectomy with mean age 45 +- 12.9 years. Female to male ratio was 7.8:1. A total of 110 patients had chronic cholecystitis / biliary colic, 34 patients were with acute cholecystitis and 16 patients had diagnosis of empyema gallbladder. The mean operative time was 35.3+-14.6 min. Conversion rate to open surgery was 1.2%. Complications included bleeding from cystic artery (n=1) and injury to common hepatic duct (CHD) (n=1). One patient developed port site hernia post operatively. There was no incidence of laparoscopy related complications in surgeon such as pain shoulder, strains on the wrist joint, stress exhaustion and hand-finger joint pain. Conclusion: Sectorisation technique can be used in laparoscopic cholecystectomy in order to avoid the physical constraints of laparoscopic shoulder, hand finger joint pain, tenosynovitis, stress exhaustion, and hand muscle injury without increasing any morbidity to the patients. (author)

  13. Computed Tomography Perfusion, Magnetic Resonance Imaging, and Histopathological Findings After Laparoscopic Renal Cryoablation: An In Vivo Pig Model

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Graumann, Ole;

    2016-01-01

    The present study investigates how computed tomography perfusion scans and magnetic resonance imaging correlates with the histopathological alterations in renal tissue after cryoablation. A total of 15 pigs were subjected to laparoscopic-assisted cryoablation on both kidneys. After intervention......, each animal was randomized to a postoperative follow-up period of 1, 2, or 4 weeks, after which computed tomography perfusion and magnetic resonance imaging scans were performed. Immediately after imaging, open bilateral nephrectomy was performed allowing for histopathological examination of the...... cryolesions. On computed tomography perfusion and magnetic resonance imaging examinations, rim enhancement was observed in the transition zone of the cryolesion 1week after laparoscopic-assisted cryoablation. This rim enhancement was found to subside after 2 and 4 weeks of follow-up, which was consistent with...

  14. ANATOMICAL LANDMARKS FOR ROBOTIC NERVE SPARING RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    T. N. Moiseenko

    2013-01-01

    Full Text Available A detailed anatomical study of the prostate and pelvic organs has been recently relevant. Their anatomical knowledge is directly associated with the improved procedure of nerve-sparing robot-assisted radical prostatectomy, which contributes to the preservation of the anatomical structures responsible for postsurgical erection and urinary continence. The main tasks of radical prostatectomy are effective cancer control, early recovery of urinary continence, and recovery of erectile function.The literature on the anatomy of the prostate and its adjacent structures is analyzed in the context of nerve-sparing robot-assisted radical prostatectomy.

  15. Laparoscopic hysterectomy in the treatment of endometrial cancer: NCI experience

    International Nuclear Information System (INIS)

    The standard treatment for women with endometrial cancer is total abdominal hysterectomy and pelvic lymphadenectomy for surgical staging. Total laparoscopic radical hysterectomy (TLH) is an alternative approach providing surgical and patient related advantages to laparoscopy. Methods: Twenty female patients with early stage endometrial cancer were operated upon by TLH and pelvic lymphadenectomy, aiming to assess the safety and efficacy of TLH. Results: The mean operative time was 296.8 min conversion to laparotomy was done in one patient due to bleeding from the uterine vessels. The mean blood loss was 517.5 cc. The uterus was removed transvaginally in 18 patients (90%) and via a small Pfannenstiel incision in two patients (10%). The mean number of pelvic lymph nodes retrieval was 21.2. Postoperative bleeding occurred in one patient (5%) which necessitated exploration. One patient (5%) suffered a pulmonary embolism. Four patients (20%) developed pyrexia, and one patient (5%) suffered from a chest infection. One patient (5%) had wound infection. The mean hospital stay was 4.5 days (range 3-10). Conclusion: TLH with pelvic lymphadenectomy is a safe and effective approach in the treatment of early endometrial carcinoma.

  16. Laparoscopic evaluation of female infertility

    International Nuclear Information System (INIS)

    (20%) had irregular cycles. The commonest cause observed in patients with primary infertility was endometriosis spots which accounted for 11 (55%). In secondary infertility tubal occlusion was more common which accounted for 3 (30%). Conclusion: Laparoscopic procedures are less invasive, more convenient and more precise for diagnosis of sub-fertility in women. (author)

  17. Critical appraisal of laparoscopic vs open rectal cancer surgery

    Science.gov (United States)

    Tan, Winson Jianhong; Chew, Min Hoe; Dharmawan, Angela Renayanti; Singh, Manraj; Acharyya, Sanchalika; Loi, Carol Tien Tau; Tang, Choong Leong

    2016-01-01

    AIM: To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer. METHODS: An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared. RESULTS: Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin oncologic outcomes when compared to OP. Laparoscopic conversion does not confer a worse prognosis. PMID:27358678

  18. Laparoscopic management of ovarian dermoid cysts: a review of 47 cases

    International Nuclear Information System (INIS)

    Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary in the recent years, transvaginal sonographic diagnosis of ovarian dermoid cysts together with the laparascopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts. The preoperative findings, operative techniques, and postoperative complications were retrospectively reviewed in the women who underwent lpaparoscopic surgey for dermoid cysts, between January 2001 and May 2003. In 47 women aged 21 to 53 years (median, 38.8 years), 93.6% had a unilateral cyst with a diameter of 17 to 108 mm (median 51 mm). Clinical presentations were pain (62%), abnormal vaginal bleeding (21%) and ovarian torsion (2%), while 17%were diagnosed incidently during routine examination. Surgery included cystectomy (57%), total (36%) or partial oophorectomy (6.4%) and laparoscopic assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (2%). During the cyst extraction, minimal spillage occured in 42.5% of the casesand none developed chemical peritonitis. In 2 patients, conversion to laparotomy (4.3%) was required, one for sigmoid colon, injury and one for malignent ovarian tumor detected via frozen section. The median operating time was 80 minutes (range, 35-180 minutes). Using strict afherence to guidelines for preoperative clinical assessment and intraoperative management, laparoscopic treatment of dermoid cysts appers to be a safe procedure. (author)

  19. Resonance ionization detection of combustion radicals

    Energy Technology Data Exchange (ETDEWEB)

    Cool, T.A. [Cornell Univ., Ithaca, NY (United States)

    1993-12-01

    Fundamental research on the combustion of halogenated organic compounds with emphasis on reaction pathways leading to the formation of chlorinated aromatic compounds and the development of continuous emission monitoring methods will assist in DOE efforts in the management and disposal of hazardous chemical wastes. Selective laser ionization techniques are used in this laboratory for the measurement of concentration profiles of radical intermediates in the combustion of chlorinated hydrocarbon flames. A new ultrasensitive detection technique, made possible with the advent of tunable VUV laser sources, enables the selective near-threshold photoionization of all radical intermediates in premixed hydrocarbon and chlorinated hydrocarbon flames.

  20. Changes in Coagulation Profile During Planned Laparoscopic Operations

    OpenAIRE

    Gudz, I. M.; Tkachuk-Grigorchuk, O. O.; Tkachuk, O. L.

    2015-01-01

    Pneumoperitoneum may be a risk factor for venous thromboembolism. However, nowadays there is no reasonable algorithm for the prevention of thrombotic complications of laparoscopic interventions.The objective of the research was to assess the impact of laparoscopic surgery on coagulation parameters considering the number of other risk factors. The parameters of blood coagulation and thromboelastography in patients during laparoscopic cholecystectomy were investigated.Results. Blood coagulation...

  1. Elective laparoscopic splenectomy for giant hemangioma: a case report

    OpenAIRE

    Kosmidis, Christophoros; Efthimiadis, Christopher; Anthimidis, Georgios; Grigoriou, Marios; Vasiliadou, Kalliopi; Sfikakis, Petros; Tziris, Nikolaos; Fahantidis, Epaminondas

    2009-01-01

    Although unusual, hemangioma is the most common primary splenic neoplasm. Splenectomy is indicated when the tumor is large, with increased risk of hemorrhage. The laparoscopic approach is preferred for most elective splenectomies. Although technically feasible, laparoscopic splenectomy can be a challenge in the patient with splenomegaly. We present herein a case of an 18-year-old male asymptomatic patient who underwent laparoscopic splenectomy for the incidental finding of splenomegaly caused...

  2. Laparoscopic Versus Open Nissen Fundoplication in Infants After Neonatal Laparotomy

    OpenAIRE

    Barsness, Katherine A.; Feliz, Alexander; Potoka, Douglas A.; Gaines, Barbara A.; Upperman, Jeffery S.; Kane, Timothy D.

    2007-01-01

    Background: Nissen fundoplication is an effective treatment of gastroesophageal reflux in infants. Laparoscopic procedures after previous laparotomy are technically more challenging. The role of laparoscopic Nissen fundoplication after neonatal laparotomy for diseases unrelated to reflux is poorly described. Methods: This was a retrospective review of open vs laparoscopic Nissen fundoplication in infants after neonatal laparotomy. Of 32 infants who underwent neonatal laparotomy, 26 required a...

  3. Single-Incision Laparoscopic Ladd's Procedure for Intestinal Malrotation

    OpenAIRE

    Vassaur, John; Vassaur, Hannah; Buckley, F. Paul

    2014-01-01

    Introduction: The potential of single-incision laparoscopic surgery (SILS) as a less invasive and more cosmetically appealing technique has prompted the expansion of its adoption. SILS has been shown to be a safe and feasible alternative to traditional multiport cholecystectomy, appendectomy, colectomy, and many other laparoscopic procedures. The objective of this study is to provide an initial report of the feasibility of correcting intestinal malrotation via a single-incision laparoscopic t...

  4. Laparoscopic Surgery for Anorectal Malignancies Other than Carcinoma

    OpenAIRE

    Agachan, Feran; Iroatulam, Augustine; Wexner, Steven D.

    1998-01-01

    Objective: Numerous concerns have been raised relative to the appropriateness of laparoscopic surgery for cure of rectal adenocarcinomas. However, because of their rarity, little information exists about the role of laparoscopy for other anorectal malignancies. We report the outcome of five patients who underwent laparoscopic surgery for other anorectal malignancies. Methods: All patients who underwent laparoscopic surgery for treatment of non-carcinomatous anorectal malignancy were assessed ...

  5. Paediatric laparoscopic orchidopexy as a novel mentorship: Training model

    OpenAIRE

    Vipul Gupta; Sunil Kumar Yadav; Elterman Dean; Pradip Vincent; Farhat Walid; Abdulnaser Al Said

    2013-01-01

    Background: Although Laparoscopy is becoming a standard procedure in management of pediatric urology disorders, but its widespread use still limited. This can be attributed mainly to difficulty in acquiring such specialized technique, especially by post graduate practicing urologist. Thus, we herein evaluate the impact of condensed laparoscopic training programme in children hospital with the aim to analyze the feasibility and safety of laparoscopic orchidopexy in training basic laparoscopic ...

  6. Laparoscopic Lavage for Perforated Diverticulitis With Purulent Peritonitis

    DEFF Research Database (Denmark)

    Thornell, Anders; Angenete, Eva; Bisgaard, Thue;

    2016-01-01

    BACKGROUND: Perforated diverticulitis with purulent peritonitis has traditionally been treated with open colon resection and stoma formation with risk for reoperations, morbidity, and mortality. Laparoscopic lavage alone has been suggested as definitive treatment. OBJECTIVE: To compare laparoscopic...... 11 in the Hartmann group had a stoma. LIMITATION: Not all patients presenting with suspected diverticulitis were enrolled. CONCLUSION: Laparoscopic lavage reduced the need for reoperations, had a similar safety profile to the Hartmann procedure, and may be an appropriate treatment of choice for acute...

  7. Large Subcapsular Liver Hematoma Following Single-Incision Laparoscopic Cholecystectomy

    OpenAIRE

    Hansen, Adam J.; Augenstein, Julie; Ong, Evan S

    2011-01-01

    Background and Objectives: Many laparoscopic surgeons are now transitioning from standard multiple-port laparoscopic cholecystectomy to single-incision laparoscopic surgery (SILS) in an attempt to improve cosmetic outcomes and decrease postoperative morbidity. However, little has been published regarding the potential complications of SILS operations. Methods: We report the case of a patient undergoing SILS cholecystectomy who developed the complication of a large hepatic hematoma, resulting ...

  8. Influencing factors on postoperative hospital stay after laparoscopic cholecystectomy

    OpenAIRE

    Chong, Jae Uk; Lee, Jin Ho; Yoon, Young Chul; Kwon, Kuk Hwan; Cho, Jai Young; Kim, Say-Jun; Kim, Jae Keun; Kim, Sung Hoon; Choi, Sae Byeol; Kim, Kyung Sik

    2016-01-01

    Backgrounds/Aims Laparoscopic cholecystectomy can reduce postoperative pain and recovery time. However, some patients experience prolonged postoperative hospital stay. We aimed to identify factors influencing the postoperative hospital stay after laparoscopic cholecystectomy. Methods Patients (n=336) undergoing laparoscopic cholecystectomy for gallbladder pathology at 8 hospitals were enrolled and divided into 2 groups: 2 or less and more than 2 days postoperative stay. Perioperative factors ...

  9. Transumbilical pure single-port laparoscopic donor nephrectomy

    OpenAIRE

    Kim, Joo Mee; Jeong, Won Jun; Choi, Byung Jo; Yuk, Seung Mo; Hwang, Jeong Kye; Lee, Sang Chul

    2015-01-01

    Transumbilical single-port laparoscopic donor nephrectomy (SPLDN) is a novel, rapidly evolving, minimally invasive treatment modality for kidney transplantation. This method causes minimal parietal injury, has cosmetic advantages, and allows rapid recovery because of low postoperative pain and short hospital stay. Like other abdominal surgeries, when conducted by experienced laparoscopic surgeons, it can meet the same graft requirements as conventional laparoscopic surgery. Here, we report th...

  10. Laparoscopic rectal cancer surgery: Where do we stand?

    OpenAIRE

    Krane, Mukta K; Fichera, Alessandro

    2012-01-01

    Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer. In contrast, laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm. While it is likely that patients wi...

  11. Inflammatory and Tumor Stimulating Responses after Laparoscopic Sigmoidectomy

    OpenAIRE

    Kim, Jin Soo; Hur, Hyuk; Min, Byung Soh; Lee, Kang Young; Chung, Hyun Cheol; Kim, Nam Kyu

    2011-01-01

    Purpose Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation. Materials and Methods A total of 57 patients who were diagnosed with sigmoid col...

  12. A COMPARATIVE STUDY OF LAPAROSCOPIC VERSUS OPEN CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Gopal Rao

    2015-09-01

    Full Text Available The model era of Laparoscopic Surgery has evoked remarkable changes in approaches to surgical diseases. The trend toward minimal access surgery (MAS has prompted General surgeons to scrutinize nearly all operations for possible convention to Laparoscopic techniques. AIM OF THE STUDY : Our aim of the study is to compare Laparoscopic Cholecystectomy with that of open cholecystectomy. MATERIALS AND METHODS : In our Mahatma Gandhi Memorial Hospital we are doing both Open and Laparoscopic cholecystectomy, this is done between October 2011 – October 2013. In this period we have done 146 cholecystectomy, out of which 96 are Laparoscopic Cholecystectomy to compare with 50 cases of Open cholecystectomy. RESULTS : Conversation rate Laparoscopic to Open is 8%. Duration of Surgery : Open (90Min, Lap (120Min. Average post of antibiotics : Open (7 days, Laparoscopic ( 4 days. Average post - op resumption of normal diet Open (5 days, lap (3 days. Average post of hospital stay : Open (10days, Lap (5days. CONCLUSION : In our study the Laparoscopic cholecystectomy surpasses the open cholecystectomy. The only disadvantage is the prolonged operative time, which can be minimized in due course of time as the learning curve progresses. We have also found that the conversion to open cholecystectomy should be done in proper time without any hesitation in case of complications that could not be managed laparoscopic surgery and conversion in such case reflects sound judgment and should not be considered as a complication.

  13. Laparoscopic redo fundoplication for intrathoracic migration of wrap

    Directory of Open Access Journals (Sweden)

    Maheshkumar G

    2007-01-01

    Full Text Available Laparoscopic fundoplication is fast emerging as the treatment of choice of gastro-esophageal reflux disease. However, a complication peculiar to laparoscopic surgery for this disease is the intrathoracic migration of the wrap. This article describes a case of a male patient who developed this particular complication after laparoscopic total fundoplication. Following a trauma, wrap migration occurred. The typical history and symptomatology is described. The classical Barium swallow picture is enclosed. Laparoscopic redo fundoplication was carried out. The difficulties encountered are described. Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology. Confirmation is by a Barium swallow. Treatment is by redo surgery.

  14. A user-friendly automated port placement planning system for laparoscopic robotic surgery

    Science.gov (United States)

    Torres, Luis G.; Azimian, Hamidreza; Enquobahrie, Andinet

    2014-03-01

    Laparoscopic surgery is a minimally invasive surgical approach in which surgical instruments are passed through ports placed at small incisions. This approach can benefit patients by reducing recovery times and scars. Surgeons have gained greater dexterity, accuracy, and vision through adoption of robotic surgical systems. However, in some cases a preselected set of ports cannot be accommodated by the robot; the robot's arms may cause collisions during the procedure, or the surgical targets may not be reachable through the selected ports. In this case, the surgeon must either make more incisions for more ports, or even abandon the laparoscopic approach entirely. To assist in this, we are building an easytouse system which, given a surgical task and preoperative medical images of the patient, will recommend a suitable port placement plan for the robotic surgery. This work bears two main contributions: 1) a high level user interface that assists the surgeon in operating the complicated underlying planning algorithm; and 2) an interface to assist the surgical team in implementation of the recommended plan in the operating room. We believe that such an automated port placement system would reduce setup time for robotic surgery and reduce the morbidity to patients caused by unsuitable surgical port placement.

  15. Free radical reactions with subtilisin Carlsberg

    International Nuclear Information System (INIS)

    Pulse radiolysis has been used to study the mechanisms of radiation-induced inactivation of enzymes. However, interpretation of the results is often complicated by the fact that the G values for enzyme inactivation are usually much smaller than the G values for the radicals formed from water radiolysis. Where inactivation by oxidative free radical attack is concerned, the problem can often be greatly simplified by the use of the free radical probe technique. These free radicals, which include the halide-type radicals Cl2-, Br2-,I2- and (CNS)2-, react much more selectively than OH radicals with amino acids. They can be used to demonstrate that selective oxidation of certain amino acid residues can lead to enzyme inactivation. The technique assists, therefore, in determining whether such sensitive amino acids are present in the active centre and are crucial to the activity of the protein. A number of enzymes have been studied by this method and the amino acid residues found to be necessary for enzymic activitya are in agreement with those identified by conventional biochemical techniques. In these enzymes, free radical attack by the halide radicals leads to inactivation by damage to a single type of amino acid residue which is involved either in catalysis or binding of the substrate. Subtilisin Carlsberg is a serine protease consisting of a poly-peptide chain lacking both cysteine and cystine residues. This paper indicates the use of the selective probe technique in demonstrating that damage to one or more histidine residues leads to inactivation of the enzyme. (author)

  16. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction

    DEFF Research Database (Denmark)

    Broholm Andersen, Malene; Pommergaard, H-C; Gögenür, I

    2015-01-01

    AIM: Robot-assisted surgery for rectal cancer may result in lower rates of urogenital dysfunction compared with laparoscopic surgery. A systematic review was conducted of studies reporting urogenital dysfunction after robot-assisted rectal cancer surgery. METHOD: PubMed, Embase and the Cochrane...... months' follow-up [MD -2.59 (-4.25, -0.94),] P = 0.002] and 6 months' follow-up [MD -3.06 (-4.53, -1.59), P = 0.0001] were better after robot-assisted than laparoscopic surgery. CONCLUSION: Although there were few data and no randomized controlled trials the results of the review suggested that robot...

  17. Sepsis from dropped clips at laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    We report seven patients in whom five dropped surgical clips and two gallstones were visualized in the peritoneal cavity, on radiological studies. In two, subphrenic abscesses and empyemas developed as a result of dropped clips into the peritoneal cavity during or following laparoscopic cholecystectomy. In one of these two, a clip was removed surgically from the site of an abscess. In two other patients dropped gallstones, and in three, dropped clips led to no complications. These were seen incidentally on studies done for other indications. Abdominal abscess secondary to dropped gallstones is a well-recognized complication of laparoscopic cholecystectomy (LC). We conclude that even though dropped surgical clips usually do not cause problems, they should be considered as a risk additional to other well-known causes of post-LC abdominal sepsis

  18. Successful laparoscopic transabdominal cerclage in uterus didelphys.

    Science.gov (United States)

    Ades, Alex; Hong, Phoebe

    2015-01-01

    The incidence of uterus didelphys is around 3/10,000 women. It is a class III Müllerian duct anomaly resulting from a complete non-fusion of the paired Müllerian ducts between the 12th and 16th weeks of gestation. Although the prevalence of cervical insufficiency in women with uterus didelphys is unknown, the incidence of cervical insufficiency in women with Müllerian anomalies has been reported as high as 30%. We present a case of successful pregnancy outcome following a laparoscopic transabdominal cerclage in a woman with uterus didelphys and cervical insufficiency. The case demonstrates that laparoscopic transabdominal cerclage can be performed successfully in women with uterus didelphys and a satisfactory obstetric outcome can be achieved. PMID:26578507

  19. Laparoscopic cholecystectomy: Rate and predictors for conversion

    Directory of Open Access Journals (Sweden)

    Merdad Adnan

    1999-01-01

    Full Text Available Laparoscopic cholecystectomy (LC was attempted in 847 patients, 823 (97.2% were completed laparoscopically and 24 (2.8% had to be converted to open cholecystectomy (OC. Acute cholecystitis was the commonest reason for conversion (13 out of 24 patients. Patients who had acute cholecystitis are five times at risk for conversion to open than other patients with non-acute cholecystitis (p< 0.00I . Age and sex were not statistically significant predictors for conversion. There were no mortalities and no major bile duct injuries in our series. These data confirms the safety of LC, identify factors which predicts conversion to OC and may be helpful in selecting patients for day care ambulatory LC.

  20. Traumatic Gallbladder Rupture Treated by Laparoscopic Cholecystectomy

    Science.gov (United States)

    Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu

    2016-01-01

    Abstract Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188