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Sample records for assisted laparoscopic radical

  1. Outcomes after robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  2. Laparoscopic Radical Prostatectomy in the ERA of Robot-Assisted Technology

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    Iason Kyriazis

    2014-05-01

    Full Text Available In this work the outcomes of laparoscopic radical prostatectomy (LRP with regard to perioperative morbidity, oncological effectiveness, as well as postoperative continence and potency preservation are being reviewed and compared with the gold standard open radical prostatectomy. In addition, the limitations of LRP are being presented in contrast to the advancement offered by the emerging robotic assisted radical prostatectomy in an attempt to reveal whether laparoscopic approach still has a role in the era of robot-assisted technology.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  4. 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.

  5. Management of pelvic lymphoceles following robot-assisted laparoscopic radical prostatectomy

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    Omer A Raheem

    2012-01-01

    Full Text Available Pelvic lymphocele is a potential complication of radical prostatectomy. Although lymphoceles often regress spontaneously, many may progress, precipitate clinical symptoms, and ultimately require intervention. To date, the best treatment of pelvic lymphoceles has not yet been fully defined. However, laparoscopic marsupialization is a definitive and efficacious surgical alternative to percutaneous drainage. It is effective, results in minimal patient morbidity, and allows for rapid recovery. We report our experience with management of clinically symptomatic pelvic lymphoceles following robotic-assisted prostatectomy using laparoscopic marsupialization.

  6. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center.

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    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J

    2012-02-01

    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  7. Intra-operative prostate motion tracking using surface markers for robot-assisted laparoscopic radical prostatectomy

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    Esteghamatian, Mehdi; Sarkar, Kripasindhu; Pautler, Stephen E.; Chen, Elvis C. S.; Peters, Terry M.

    2012-02-01

    Radical prostatectomy surgery (RP) is the gold standard for treatment of localized prostate cancer (PCa). Recently, emergence of minimally invasive techniques such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RARP) has improved the outcomes for prostatectomy. However, it remains difficult for the surgeons to make informed decisions regarding resection margins and nerve sparing since the location of the tumor within the organ is not usually visible in a laparoscopic view. While MRI enables visualization of the salient structures and cancer foci, its efficacy in LRP is reduced unless it is fused into a stereoscopic view such that homologous structures overlap. Registration of the MRI image and peri-operative ultrasound image using a tracked probe can potentially be exploited to bring the pre-operative information into alignment with the patient coordinate system during the procedure. While doing so, prostate motion needs to be compensated in real-time to synchronize the stereoscopic view with the pre-operative MRI during the prostatectomy procedure. In this study, a point-based stereoscopic tracking technique is investigated to compensate for rigid prostate motion so that the same motion can be applied to the pre-operative images. This method benefits from stereoscopic tracking of the surface markers implanted over the surface of the prostate phantom. The average target registration error using this approach was 3.25+/-1.43mm.

  8. 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

  9. Robotically assisted total laparoscopic radical trachelectomy for fertility sparing in stage IB1 adenosarcoma of the cervix.

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    Geisler, John P; Orr, Curtis J; Manahan, Kelly J

    2008-10-01

    Adenosarcomas are rare cervical tumors with unknown optimal treatment, which often affects young women. A 23-year-old woman was found to have a stage IB1 adenosarcoma of the cervix. She underwent a robotically assisted total laparoscopic radical trachelectomy with the placement of abdominal cerclage for the sparing of fertility.

  10. Robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion

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    Jason M. Sandberg

    2016-07-01

    Full Text Available Robot-assisted radical cystectomy with intracorporeal urinary diversion (RARC-ICUD has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncologic control while benefiting from minimally invasive surgical techniques. Inspired by earlier open and laparoscopic work, initial descriptions of RARC-ICUD were published in 2003, and have since been followed by multiple larger case series which have suggested promising outcomes for our patients. However, the rate of adoption has remained relatively slow when compared to other robot-assisted procedures such as the radical prostatectomy, likely owing to longer operative times, operative complexity, costs, and uncertainty regarding oncologic efficacy. The operative technique for RARC-ICUD has evolved over the past decade and several high-volume centers have shared tips to improve efficiency and make the operation possible for a growing number of urologists. Though there are still questions regarding economic costs, effectiveness, and generalizability of outcomes reported in published data, a growing dataset has brought us ever closer to the answers. Here, we present our current operative technique for RARC-ICUD and discuss the state of the literature so that the urologist may hold an informed discussion with his or her patients.

  11. Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan.

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    Yoshioka, K; Hatano, T; Nakagami, Y; Ozu, C; Horiguchi, Y; Yonou, H; Tachibana, M; Coughlin, G; Patel, V R

    2008-07-01

    Recently, we have introduced robotic-assisted laparoscopic radical prostatectomy (RALP) in Japan. This article describes the details of a training program to shorten the learning curve in the absence of an urologist with expertise in robotic surgery. Five months after a 2-day training course of robotic surgery, RALP was first performed in Japan, and a total of 15 cases were performed in the subsequent 4 months. Our training program consisted of: (1) image training using surgical operation videos, (2) dry lab training using a sham pelvic cavity model, and (3) intraoperative mentoring. The operative procedure was divided into five consecutive stages, and time required to complete each stage was recorded. Robotic radical prostatectomy was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-h operation had been imposed by the ethics committee. The mean console time and the mean intraoperative blood loss (including urine) reduced from 264.2 min and 459.4 ml, respectively, in the first 11 cases, to 151 min and 133.3 ml, respectively, in the last three cases. With direct intraoperative guidance by the mentor during cases 13 and 14, the operation time was reduced at all five stages of the operative procedure. Our training program proved remarkably effective in reducing the learning curve of RALP in Japan, where there is no person with expertise in robotic surgery.

  12. Update on Robotic Laparoscopic Radical Prostatectomy

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    Garrett S. Matsunaga

    2006-01-01

    Full Text Available The da Vinci surgical robot has been shown to help shorten the learning curve for laparoscopic radical prostatectomy (LRP for both laparoscopically skilled and na surgeons[1,2]. This approach has shown equal or superior outcomes to conventional laparoscopic prostatectomy with regard to ease of learning, initial complication rates, conversion to open, blood loss, complications, continence, potency, and margin rates. Although the data are immature to compare oncologic and functional outcomes to open prostatectomy, preliminary data are promising.Herein, we review the technique and outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP.

  13. Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy

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    Ginzburg, Serge; Nevers, Thomas; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Kesler, Stuart S.; Laudone, Vincent P.

    2012-01-01

    Background and Objectives: To determine prostate cancer biochemical recurrence rates with respect to surgical margin (SM) status for patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP). Methods: IRB-approved radical prostatectomy database was queried. Patients were stratified as low, intermediate, and high risk according to D’Amico's risk classification. Postoperative prostate-specific antigen (PSA) values were obtained every 3 mo for the first year, then biannually and annually thereafter. Biochemical recurrence was defined as ≥0.2ng/mL. Patients receiving adjuvant or salvage treatment were included. Positive surgical margin was defined as presence of cancer cells at inked resection margin in the final specimen. Margin presence (negative/positive), margin multiplicity (single/multiple), and margin length (≤3mm focal and >3mm extensive) were noted. Kaplan-Meier curves of biochemical recurrence-free survival (BRFS) as a function of SM were generated. Forward stepwise multivariate Cox regression was performed, with preoperative PSA, Gleason score, pathologic stage, prostate gland weight, and SM as covariates. Results: At our institution, 1437 patients underwent RALP (2003-2009). Of these, 1159 had sufficient data and were included in our analysis. Mean follow-up was 16 mo. Kaplan-Meier curves demonstrated significant increase in BRFS in low-risk and intermediate-risk groups with negative SM. Overall BRFS at 5 y was 72%. Gleason score, pathologic stage, and SM status were significant prognostic factors in multivariate analysis. Conclusions: Negative surgical margins resulted in lower biochemical recurrence rates for low-risk and intermediate-risk groups. Multifocal and longer positive margins were associated with higher biochemical recurrence rates compared with unifocal and shorter positive margins. Documenting biochemical recurrence rates for RALP is important, because this treatment for localized prostate cancer is validated. PMID

  14. 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.

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

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

    2009-03-01

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

  16. 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

  17. Perioperative outcome of initial 190 cases of robot-assisted laparoscopic radical prostatectomy - A single-center experience

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    P N Dogra

    2012-01-01

    Full Text Available Objective: To analyze the perioperative outcome of the first 190 cases of robot-assisted laparoscopic radical prostatectomy performed at our center from July 2006 to December 2010. Materials and Methods: Operative and recovery data for men with localized prostate cancer undergoing robot-assisted radical prostatectomy at our center were reviewed. All surgeries were performed using the 4-arm da Vinci-S surgical robot. Preoperative data included age, body mass index (BMI, prostate specific antigen (PSA level, prostate weight, biopsy Gleason score and TNM staging, while operative and recovery data included total operative time, estimated blood loss, complications, hospital stay and catheter time. These parameters were evaluated for the safety and efficacy of this procedure in our center. Results: The mean age of our patients was 65 ± 1.2 years. The mean BMI was 25.20 ± 2.88 and the median PSA was 14.8 ng/ml. Majority of our patients belonged to clinical stage T2 (51.58%. The mean total operative time was 166.44 ± 11.5 min. Six patients required conversion to open procedure and there was one rectal injury. The median estimated blood loss was 302 ± 14.45 ml and the median duration of hospital stay was 4 days. The overall margin positivity rate was 12.63%. Conclusion: Despite our limited robotic surgery experience, our perioperative outcome and complication rate is comparable to most contemporary series. Robot-assisted laparoscopic prostatectomy (RALP is easy to learn and provides the patient with the benefits of minimally invasive surgery with minimal perioperative morbidity.

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

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    E. A. Prilepskaya

    2015-01-01

    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

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

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

    2011-01-01

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

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

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    Jacobsen, André; Berg, Kasper Drimer; Iversen, Peter

    2016-01-01

    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...

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

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

    2011-02-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

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

  3. 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.

  4. Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

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    Marc Manganiello

    2012-02-01

    Full Text Available PURPOSE: V-LocTM180 (Covidien Healthcare, Mansfield, MA is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA during robotic assisted laparoscopic prostatectomy (RALP. Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 MonocrylTM (Ethicon, Somerville, NJ. MATERIALS AND METHODS: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. RESULTS: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-LocTM180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73 as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65. There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-LocTM180 cohort (24% vs. 44%, p < 0.02. At 5 months, this difference was no longer evident. CONCLUSIONS: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable

  5. Changes in pathologic outcomes and operative trends with robot-assisted laparoscopic radical prostatectomy

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    Aaron Bernie

    2014-01-01

    Full Text Available Introduction: We hypothesized that there is a reverse stage migration, or a shift toward operating on higher-risk prostate cancer, in patients undergoing robot-assisted laparoscopic prostatectomy (RALP. We therefore evaluated the stage of disease at the time of surgery for patients with prostate cancer at a large tertiary academic medical center. Materials and Methods: After institutional review board approval, we reviewed all patients that had undergone robotic prostatectomy. These patients were separated into three categories: An early era of 2005-2008, intermediate era of 2009-2010, and a current era of 2011-2012. Results: A total of 3451 patients underwent robotic prostatectomy from 2005 to 2012. The proportion men with clinical T1 tumors declined from 88.3% in the early era to 72.2% in the current era (P < 0.0001. Men with preoperative biopsy Gleason 6 disease decreased from the early to the current era (P < 0.0001, while men with preoperative biopsy Gleason ≥ 8 showed the opposite trend, increasing from the early to the current era (P = 0.0002. From the early to the current era, the proportion of patients with National Comprehensive Cancer Network (NCCN low risk prostate cancer decreased, while those with NCCN intermediate and high-risk disease increased. The proportion of pathologic T3 disease increased from 15.5% in the early to 30.6% in the current era (P < 0.0001. On the other hand, the proportion of pathologic T2/+ SMS (surgical margin status decreased from 6.6% in the early era to 3.1% in the current era (P = 0.0002. Conclusions: We have demonstrated a reverse stage migration in men undergoing robotic prostatectomy. Despite the increasing proportion of men with extra-capsular disease undergoing RALP, the surgical margin status has remained similar. This could reflect both the changing dynamics of the population opting for surgery as well as the learning curve of the surgeons.

  6. 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.)

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

    Science.gov (United States)

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

    2007-03-01

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

  8. [First 24 Japanese cases of robotic-assisted laparoscopic radical prostatectomy using the daVinci Surgical System].

    Science.gov (United States)

    Yoshioka, Kunihiko; Hatano, Tadashi; Nakagami, Yoshihiro; Ozu, Choichiro; Horiguchi, Yutaka; Sakamoto, Noboru; Yonov, Hiroyuki; Ohno, Yoshio; Ohori, Makoto; Tachibana, Masaaki; Patel, Vipul R

    2008-05-01

    In Japan, as of September 2007, prostatectomy is conducted with open surgical procedures in more than 90% of the cases. Following the first reported robotic prostatectomy by Binder, et al. in 2000, a robotic-assisted laparoscopic radical prostatectomy (RALP) using the daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been extensively used as a standard procedure with gratifying results in the United States. In the Asian region, in contrast, RALP is still in an introductory phase. Recently, we introduced RALP in Japan. A total of 24 patients received robotic surgery within a year since August 2006. RALP was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-hour operation had been imposed by the Ethical Committee. The mean operative time using the daVinci device and the mean estimated blood loss were 232.0 (range; 136-405) minutes and 313.0 (range; 10-1,000) ml, respectively. The training program we recently developed proved remarkably effective in reducing the learning curve of robotic surgery in Japan, where there is no person with expertise in this operating procedure. In particular, the intraoperative guidance given by the expert was useful after relevant problematic points were delineated by operators who received comprehensive video-based image training and actually performed robot surgery in several cases. With direct intraoperative guidance by the mentor during cases 13 and 14, both the operation time and estimated blood loss was markedly reduced.

  9. Impact of prior abdominal surgery on the outcomes after robotic - assisted laparoscopic radical prostatectomy: single center experience

    Directory of Open Access Journals (Sweden)

    Nozomu Kishimoto

    Full Text Available ABSTRACT Purpose: To evaluate the influence of prior abdominal surgery on the outcomes after robotic-assisted laparoscopic radical prostatectomy (RALP. Materials and Methods: We retrospectively analyzed patients with prostate cancer who underwent RALP between June 2012 and February 2015 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery while considering the mean total operating, console, and port-insertion times; mean estimated blood loss; positive surgical margin rate; mean duration of catheterization; and rate of complications. Results: A total of 203 patients who underwent RALP during the study period were included in this study. In all, 65 patients (32% had a prior history of abdominal surgery, whereas 138 patients (68% had no prior history. The total operating, console, and port-insertion times were 328 and 308 (P=0.06, 252 and 242 (P=0.28, and 22 and 17 minutes (P=0.01, respectively, for patients with prior and no prior surgery. The estimated blood losses, positive surgical margin rates, mean durations of catheterization, and complication rates were 197 and 170 mL (P=0.29, 26.2% and 20.2% (P=0.32, 7.1 and 6.8 days (P=0.74, and 12.3% and 8.7% (P=0.42, respectively. Furthermore, whether prior abdominal surgery was performed above or below the umbilicus or whether single or multiple surgeries were performed did not further affect the perioperative outcomes. Conclusions: Our results suggest that RALP can be performed safely in patients with prior abdominal surgery, without increasing the risk of complications.

  10. Laparoscopic assisted cholecystostomy.

    Science.gov (United States)

    Grecu, F

    1999-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Tariq A. Khemees

    2012-01-01

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

  12. Hand-assisted laparoscopic surgery using Gelport

    Directory of Open Access Journals (Sweden)

    Gupta Puneet

    2005-01-01

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

  13. Robot-assisted laparoscopic radical prostatectomy%机器人辅助腹腔镜前列腺癌根治术

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进

    2010-01-01

    @@ 前列腺癌是老年男性最常见的泌尿生殖系统恶性肿瘤之一,严重威胁着患者的生命健康和生活质量.前列腺癌的治疗方法包括随访观察、经尿道前列腺切除术(TURP)、根治性前列腺切除术、放射治疗、冷冻治疗、内分泌治疗、综合治疗等.根治性前列腺切除术目前仍然是治疗前列腺癌的最佳方法,主要包括开放性耻骨后前列腺癌根治术(retropubic radical pro-statectomy,RRP)、腹腔镜前列腺癌根治术(laparos-copic radical prostatectomy,LRP)、机器人辅助腹腔镜前列腺癌根治术(Robot-assisted laparoscopic radicalprostatectomy,RLRP)等.

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

    Science.gov (United States)

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

    2016-09-01

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

  15. 机器人结直肠癌根治术的学习曲线%Learning curve of robot-assisted laparoscopic radical resection for colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    刘东宁; 唐城; 江群广; 李太原

    2016-01-01

    目的:评估机器人结直肠癌根治术不同阶段的手术效果,探讨机器人结直肠癌根治术学习曲线问题。方法分析2014年12月至2015年8月由同一组医师完成的75例腹腔镜结直肠癌根治术,按手术先后次序分3组(A、B、C),每组25例,比较各组机器人安装时间、手术时间、出血量、肛门排气时间、术后住院天数、术后并发症和3站淋巴结清扫数目及其总数的差异。结果 A组机器人安装时间(38±5)min,显著长于B组(22±4)min和C组(21±2)min(P均<0.05);A组手术时间(201±39)min,显著长于B组(160±42)min和C组(156±43)min(P均<0.05);A 组出血量(142±35)ml,显著多于B组(105±28)ml和C组(102±28)ml(P均<0.05)。3组肛门排气时间、术后住院天数、术后并发症和3站淋巴结清扫数目及其总数无显著性差异(P>0.05)。A组手术25例在4个月内完成,平均每月6.3台手术,B组和C组均在2个月内完成,平均每月12.5台手术。结论有丰富腹腔镜结直肠癌手术经验的外科医师行机器人结直肠癌根治术的学习曲线大约为25例,手术频度为平均每月6.3例。%ObjectiveTo evaluate the outcomes of robot-assisted laparoscopic radical colorectal resection and to define the learning curve of robot-assisted laparoscopic radical colorectal resections. MethodsClinical data of 75 cases underwent robot-assisted laparoscopic radical resection for colorectal cancer were reviewed form December 2014 to August 2015.The patients were divided into 3 groups (groups A, B and C) by operative sequence.The robotic set-up time, operating time, bleeding volume, postoperative aerofluxus time, hospital stay, postoperative complications, number of removed lymphatic nodes were compared among the 3 groups.ResultsThe robotic set-up time in group A was significantly longer than that in group B and C [ (38± 5) min vs. (22± 4) min,P0.05). The

  16. Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome.

    Science.gov (United States)

    Tillier, C; van Muilekom, H A M; Bloos-van der Hulst, J; Grivas, N; van der Poel, H G

    2017-01-12

    The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10 days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6 months. Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

  17. 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.

  18. Prophylactic antibiotic treatment following laparoscopic robot-assisted radical prostatectomy for the prevention of catheter-associated urinary tract infections: did the AUA guidelines make a difference?

    Science.gov (United States)

    Haifler, Miki; Mor, Yoram; Dotan, Zohar; Ramon, Jacob; Zilberman, Dorit E

    2016-12-16

    We sought to evaluate the effectiveness of the American Urological Association (AUA) antibiotic prophylaxis guidelines in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP). Our prospective registry database was reviewed for all RALP cases. The following variables were evaluated: age, associated comorbidities, body mass index (BMI), total operative time, length of stay (LOS), prostate weight, pathological grade and stage. Until 11/2011, RALP patients were treated with antibiotics administered in the operating room and continued until urethral catheter removal. Since 11/2011, all patients were treated with a single intravenous dose of Cephalosporin and Aminoglycoside given within 30 min of surgical incision. The rate of catheter-associated urinary tract infection (CAUTI) was evaluated in both groups. 229 RALP patients were identified. The first 60 patients (26.2%) were treated according to the old protocol (Group 1) while the remaining 169 (73.8%) were treated according to the new protocol (Group 2). Group match was identified in all categories but LOS. Moreover, LOS was found to be longer in Group 1 compared with Group 2 (5.8 vs. 4.5 days, p < 0.001). CAUTI rate was similar in both groups (8.3 vs. 8.9%, respectively, p = 0.89). Logistic regression analysis did not demonstrate any association between treatment protocol and potential risk for CAUTI. Therefore, a single preoperative dose of antibiotics does not increase the rate of CAUTI following RALP compared with prolonged antibiotic treatment. Moreover, it was found to be associated with shorter LOS. Complying with the AUA guidelines may reduce morbidity and medical costs.

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  20. 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.

  1. Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus

    Directory of Open Access Journals (Sweden)

    Jason R. Kovac

    2010-06-01

    Full Text Available Excision of renal cell carcinoma (RCC with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.

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

    Institute of Scientific and Technical Information of China (English)

    许晓晓; 张秋玲; 李凤云

    2014-01-01

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

  3. 达芬奇机器人辅助腹腔镜前列腺癌根治术的手术要点(附光盘)%Surgical techniques of Da Vinci robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进; 何威; 王晓晶; 钟山

    2013-01-01

    达芬奇机器人手术系统在泌尿外科领域的广泛应用和发展是当今世界临床医学发展的里程碑.达芬奇机器人辅助腹腔镜前列腺癌根治术(robot-assisted laparoscopic radical prostatectomy,RLRP)是所有泌尿外科机器人手术中,与开放和传统腹腔镜手术相比最具明显优势的微创手术.目前在前列腺癌高发的欧美国家,RLRP几乎成为治疗局限性前列腺癌的金标准,在国内RLRP也已取得快速发展.本文就机器人手术系统的国内外发展状况和发展趋势,RLRP的适应证和禁忌证、手术步骤和技巧、优缺点等做一概述.%The wide application and development of Da Vinci surgical system in the urology is a milestone in the development of clinical medicine. Da Vinci robot-assisted laparoscopic radical prostatectomy(RLRP)has the most obvious advantages of minimally invasive surgery among all robotic surgeries in urology compared to the laparoscopic surgeries. In the developed regions with high incidence of prostate cancer,RLRP has almost become the gold standard for the treatment of localized prostate cancer. Rapid development of RLRP has also been achieved in China. This review gives a brief account of the current situation and development trend of robotic surgical system and summarizes the main aspects of RLRP including the indications and contraindications, surgical procedures and techniques, ad vantages and disadvantages and so on.

  4. Robotic Assisted Laparoscopic Prostatectomy Performed after Previous Suprapubic Prostatectomy

    Science.gov (United States)

    Tsui, Johnson F.; Feuerstein, Michael; Jazayeri, Seyed Behzad

    2016-01-01

    Operative management of prostate cancer in a patient who has undergone previous open suprapubic simple prostatectomy poses a unique surgical challenge. Herein, we describe a case of intermediate risk prostate cancer in a man who had undergone simple prostatectomy ten years prior to presentation. The patient was found to have Gleason 7 prostate cancer on MRI fusion biopsy of the prostate for elevated PSA and underwent an uncomplicated robot assisted laparoscopic radical prostatectomy. PMID:27882057

  5. 机器人结直肠癌根治术的初步应用体会%Early experience of robot-assisted laparoscopic radical resection for colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    王首寒; 王斌; 陈佳祺; 孙小单

    2016-01-01

    Objective To investigate early experience of Da Vinci robot-assisted laparoscopic radical resection for colorectal carcinoma. Methods The clinical outcomes of 63 colorectal cancer patients undergoing robot-assisted laparoscopic radical resection from October 2014 to May 2016 were retrospectively collected and analyzed. Results All operations were completed successfully. There were no conversions to open surgery and no postoperative mortality. The robot docking time was (15.24±5.69) min. The operative time was (176.43±59.39) min. The blood loss was (28.65±22.36) ml. The number of lymph nodes harvested was (14.47±5.67). The recover time of bowel function was(51.43±12.96) hours. The postoperative hospital stay was (8.22±1.52) days. Conclusions Da Vinci robot-assisted laparoscopic radical resection for colorectal carcinoma is safe and feasible. The robotic system is suitable for clinical application.%目的:探讨达芬奇机器人手术系统应用于结直肠癌手术的初步体会。方法回顾性收集吉林省肿瘤医院腹部肿瘤科2014年10月至2016年5月的63例结直肠癌行机器人手术患者临床数据,进行整理分析。结果63例手术均顺利完成,无一例中转开腹,无术后并发症,机器人安装时间为(15.24±5.69)min,手术时间为(176.43±59.39)min,术中出血量(28.65±22.36)mL,清扫淋巴结数(14.47±5.67)枚,术后排气时间(51.43±12.96)h,术后住院日(8.22±1.52)d。结论达芬奇机器人手术系统应用于结直肠癌的手术治疗安全可行,手术效果好,术后恢复快,适合临床应用。

  6. Prospective comparative study of laparoscopic-assisted and open radical gastrectomy for gastric cancer%胃癌腹腔镜与开腹手术的前瞻性对照临床研究

    Institute of Scientific and Technical Information of China (English)

    岑庆; 张军; 蔡军; 吴国聪; 金岚; 王康里; 张忠涛

    2013-01-01

    Objective Through the prospective comparative study of laparoscopic-assistcd and open radical gastrectomy for gastric cancer,to evaluate the safety,feasibility,radical and postoperative short-term efficacy of laparoscopic-assisted gastrectomy.Methods From May 2010 to December 2011,29 gastric cancer patients matching the inclusion criteria were chosen as the laparoscopic group.According to the same inclusion criteria,29 gastric cancer patients with the same or similar clinical T stage (AJCC 7th edition) were extracted as the open group.Then the two groups information was carried out a comparative study.Results The mean operation time of the laparoscopic group was longer[(210.34 ± 44.76) min vs (151.55 ± 42.28) min,P =0.000] and the mean hospitalization costs were higher[(61 251 ±17 226) yuan vs (52 016 ±27 767) yuan,P=0.000],while the mean incision length was shorter[(5.83 ± 1.10) cm vs (15.93 ± 1.39) cm,P =O.000] than the open group.There was no significant difference on blood loss,of dissected lymph nodes number,proximal and distal resection margins,the first flatus time,the first liquid diet time,postoperative hospital stay,postoperative complications and cumulative survival rates between the two groups.Conclusion The laparoscopic-assisted gastrectomy for gastric cancer is safe and feasible,can achieve equivalent radical and short-term efficacy with the open surgery.%目的 通过对胃癌腹腔镜与开腹手术的前瞻性对照临床研究,评估前者的安全可行性、根治性及术后近期疗效.方法 2010年8月-2011年12月,选择符合人选标准的胃癌患者29例列为腹腔镜组,同时按照同一入组标准选择相同或相似临床T分期(AJCC第7版)的胃癌患者29例作为开腹对照组,对以上两组进行对比研究.结果 腹腔镜组手术时间长于开腹组[(210.34 ±44.76) min vs (151.55±42.28) min,P=0.000],住院总费用高于开腹组[(61 251±17 226)元vs(52 016 ±27 767)元,P=0.000],切口长度小于开腹组[(5

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Robot assisted transperitoneal laparoscopic pyeloplasty

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

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

  12. The perioperative nursing of robot-assisted laparoscopic radical surgery for prostate cancer%机器人辅助腹腔镜前列腺癌根治术围手术期护理

    Institute of Scientific and Technical Information of China (English)

    丁华; 赵明; 赵姗

    2009-01-01

    目的 探讨机器人辅助腹腔镜前列腺癌根治术围手术期护理.方法 采取术前针对性的心理护理,充分做好肠道准备和详细术后的功能训练指导;术后严密观察生命体征和腹部情况的变化,做好引流管的观察和护理,指导制订合理的饮食.结果 14例患者术后1年随访恢复良好,无并发症发生.结论 围手术期有针对性的系统护理,对机器人辅助腹腔镜前列腺癌治术患者早日康复有重要作用.%Objective To discuss the perioperative nursing of the robot-assisted laparoscopic radical surgery for prostate cancer. Methods The pre-operative mental nursing was adopted. Preparations of intestinal tract and detailed guidelines of postoperative function exercises were fully did. The vital signs and the changes of situations in abdomen were closely observed. Good observation and care for drainage tube were did. And a reasonable diet was constituted. Results 14 patients had good recovery after a year with no complications, through a follow-up visit of one year after the operation. Conclusions Systemic nursing for individuals during peri-operation plays an important role in the speedy recovery of robotic-assisted laparoscopic surgery for patients with prostate cancer.

  13. 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

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

    Institute of Scientific and Technical Information of China (English)

    鱼国盛; 汤黎明; 钱峻; 朱杰

    2011-01-01

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

  15. Retzus-sparing robotic-assisted laparoscopic radical prostatectomy: a step–by-step technique description of this first brazilian experience

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    Full Text Available Abstract Introduction: Retzus-sparing robotic-assisted radical prostatectomy(RARP is a newly approach that preserve the Retzus structures and provide better recovery of continence and erectile function. In Brazil, this approach has not yet been previously reported. Objective: Our goal is to describe Step-by-Step the Retzus-sparing RARP surgical technique and report our first Brazilian experience. Methods: We present a case of a 60-year-old white man with low risk prostate cancer. Surgical materials were four arms Da Vinci robotic platform system, six transperitoneal portals, two prolene wires and Polymer Clips. This surgical technique was step-by-step described according to Galfano et al. One additional step was added as a modification of Galfano et al. Primary technique description: The closure of the Denovellier fascia. Results: We have operated one patient with this technique. The operative time was 180minutes, console time was135 min, the blood loss was 150ml, none perioperative or postoperative complications was found, hospital stay of 01 day. The anatomopathological classification revealed a pT2aN0M0 specimen with free surgical margins. The patient achieved continence immediately after bladder stent retrieval. Full erection reported after 30 days of surgery. Conclusion: Retzus-sparing RARP approach is feasible and reproducible. However, further comparative studies are necessary to demonstrate potential benefits in continence and sexual outcomes over the standard approaches.

  16. Laparoscopic assisted anorectal pull through: Reformed techniques

    OpenAIRE

    2009-01-01

    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 c...

  17. 机器人辅助腹腔镜根治性膀胱切除正位新膀胱术的护理%Nursing study for robotic-assisted laparoscopic radical cystectomy and orthotopic bladder

    Institute of Scientific and Technical Information of China (English)

    周秀彬; 胡英娜; 安娜; 付清清; 张玲

    2011-01-01

    目的 分析应用da Vinci S机器人系统完成机器人辅助腹腔镜根治性膀胱切除(RARC)正位新膀胱术的疗效,探讨其围手术期临床护理体会.方法 2008年12月至2010年2月,4例男性患者接受RARC+正位新膀胱术.手术均获成功.术前着重于心理护理、肠道准备,术后进行严密的生命体征监测、引流管护理、新膀胱锻炼等护理的同时,采取积极预防措施预防并发症的发生.结果 全体患者术后恢复顺利,无严重并发症发生,疗效满意.结论 机器人辅助腹腔镜根治性膀胱切除(RARC)加正位膀胱术创伤小,安全可靠,患者术后康复快,疤痕少,值得推广、应用,但须严格护理过程.%Objective To analyze the efficacy of using da Vinci S robot system to complete the robotassisted laparoscopic radical cystectomy (RARC) orthotopic neobladder and explore the peri-operative nursing care.Methods December 2008 February 2010,four cases of male patients RARC + orthotopic neobladder.Procedure was successful. Focusing on the psychological care before surgery, bowel preparation, and postoperative care focuses on the monitoring of vital signs,drainage tube care,exercise and the new bladder,while actively preventing complications.Results All patients recovered well,without serious complications and with satisfactory effect.Conclusions Robot-assisted laparoscopic radical cystectomy (RARC) + orthotopic bladder was less trauma, safer, reliable, rapid postoperative rehabilitation, scars less, and worthy of application,but subjected to strict nursing process.

  18. Anatomic robot-assisted radical cystectomy.

    Science.gov (United States)

    Richards, Kyle A; Hemal, Ashok K

    2012-12-01

    Robot-assisted laparoscopic radical cystectomy (RARC) was initially described in 2003 and has since been gaining popularity as a minimally invasive technique in both men and women of all ages with muscle-invasive bladder cancer, selected cases of high-risk nonmuscle invasive disease, and selected cases with advanced disease.(1,2) RARC offers the patient the benefits of less blood loss, shorter hospital stay, less postoperative pain, and early recuperation with improved cosmesis. For a surgeon, it facilitates fine dissection and intracorporeal suturing in a visually conducive three-dimensional environment with ergonomic comfort. For residents, fellows, and novice surgeons, RARC can shorten the learning curve in comparison with pure laparoscopic procedures. In selected cases, nerve-sparing, vaginal-sparing, uterus-sparing, and prostate-sparing RARC can be undertaken to maintain functional outcomes and fertility. We aim to succinctly describe the indications and contraindications, preoperative workup, preoperative preparation, instrumentation needed, surgical steps, postoperative care, and management of intraoperative and postoperative complications. New advances in technique and a summary of the major published series for RARC are also reported.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    and complications of RARC in comparison with ORC and LRC. EVIDENCE ACQUISITION: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies......CONTEXT: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity. OBJECTIVE: To report a systematic literature review and cumulative analysis of perioperative outcomes...... (RC) is still regarded as a standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RC are becoming more popular. Robotic RC can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications; however, as for open RC, the risk...

  20. Laparoscopic-assisted enterolithotomy for gallstone ileus.

    Science.gov (United States)

    Gupta, Rahul A; Shah, Chetan R; Balsara, K P

    2013-06-01

    Gallstone ileus is a rare complication of cholelithiasis seen usually in elderly population with comorbidities. Most of the cases present as acute intestinal obstruction with the diagnosis being made intraoperatively. There exists controversy regarding appropriate emergency surgical treatment of gallstone ileus as to whether biliary tract surgery should be done during the first operation. Laparoscopy in recent years is also being used for management of such cases. We report a case of gallstone ileus diagnosed preoperatively and successfully treated by laparoscopic-assisted enterolithotomy.

  1. Completely Intracorporeal Robotic-Assisted Laparoscopic Ileovesicostomy

    Directory of Open Access Journals (Sweden)

    MaryEllen T. Dolat

    2014-01-01

    Full Text Available We present a report of a completely intracorporeal robotic-assisted laparoscopic ileovesicostomy with long term follow-up. The patient was a 55-year-old man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction. The procedure was performed using a da Vinci Surgical system (Intuitive Surgical, Sunnyvale, CA and took 330 minutes with an estimated blood loss of 100 mL. The patient recovered without perioperative complications. He continues to have low pressure drainage without urethral incontinence over two years postoperatively.

  2. A Pilot Study of Laparoscopic Doppler Ultrasound Probe to Map Arterial Vascular Flow within the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Ketan K. Badani

    2013-01-01

    Full Text Available Purpose. To report on the feasibility of a new Laparoscopic Doppler ultrasound (LDU technology to aid in identifying and preserving arterial blood flow within the neurovascular bundle (NVB during robotic prostatectomy (RARP. Materials and Methods. Nine patients with normal preoperative potency and scheduled for a bilateral nerve-sparing procedure were prospectively enrolled. LDU was used to measure arterial flow at 6 anatomic locations alongside the prostate, and signal intensity was evaluated by 4 independent reviewers. Measurements were made before and after NVB dissection. Modifications in nerve-sparing procedure due to LDU use were recorded. Postoperative erectile function was assessed. Fleiss Kappa statistic was used to evaluate inter-rater agreement for each of the 12 measurements. Results. Analysis of Doppler signal intensity showed maintenance of flow in 80% of points assessed, a decrease in 16%, and an increase in 4%. Plane of NVB dissection was altered in 5 patients (56% on the left and in 4 patients (44% on the right. There was good inter-rater reliability for the 4 reviewers. Use of the probe did not significantly increase operative time or result in any complications. Seven (78% patients had recovery of erections at time of the 8-month follow-up visit. Conclusions. LDU is a safe, easy to use, and effective method to identify local vasculature and anatomic landmarks during RARP, and can potentially be used to achieve greater nerve preservation.

  3. Care of the patient undergoing robotic-assisted laparoscopic pyeloplasty.

    Science.gov (United States)

    Francis, Paula; Winfield, Howard N

    2006-04-01

    Laparoscopic pyeloplasty as a treatment for ureteropelvic junction obstruction has shown comparable success rates with open pyeloplasty techniques. The use of robotic technology to assist during laparoscopic pyeloplasty procedures has been encouraged by the steep learning curve for laparoscopic surgical skills, and the complexity of laparoscopic suturing. Robotic technology provides the surgeon with the ability to filter out any physiologic hand tremor, more degrees of freedom of movement than traditional laparoscopic instruments, the ability to scale movement to provide better control for microsurgery, better ergonomics during surgery, and three-dimensional vision. Details of the procedure and specific nursing care of the patient undergoing robotic-assisted laparoscopic pyeloplasty at the University of Iowa Hospital and Clinics are described.

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

    Directory of Open Access Journals (Sweden)

    Yang Qing

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2010-01-01

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

  6. Single plus one port laparoscopic radical prostatectomy:a report of 8 cases in one center

    Institute of Scientific and Technical Information of China (English)

    GAO Yi; XU Dan-feng; LIU Yu-shan; CUI Xin-gang; CHE Jian-ping; YAO Ya-cheng; YIN Lei

    2011-01-01

    Laparoscopic radical prostatectomy is considered the first treatment of choice for local prostate cancer due to its minimal invasion advantage. To further achieve the goal of minimal invasion, single port laparoscopic radical prostatectomy has been developed to minimize the complications associated with puncture tracks. The aim of this study was to illustrate the technique for single port laparoscopic radical prostatectomy and evaluate its efficacy and safety. We reported 8 cases of radical prostatectomy with excellent early outcome carried out in Shanghai Changzheng Hospital from June 2009 to August 2009 using a home-made multiple instrument access port and adding an additional small incision at McBumey point.

  7. Minilaparoscopy-assisted transumbilical laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    GERALDO JOSÉ DE SOUZA LIMA

    2016-06-01

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

  8. 机器人辅助腹腔镜下根治性膀胱切除加尿流改道术的临床分析%Clinical analysis of robot-assisted laparoscopic radical cystectomy with urinary diversion

    Institute of Scientific and Technical Information of China (English)

    陈光富; 张旭; 史立新; 马鑫; 郭刚; 许勇; 瓦斯里江·瓦哈甫

    2012-01-01

    目的 探讨采用da Vinci S机器人系统完成机器人辅助腹腔镜下根治性膀胱切除(robotic-assisted laparoscopic radical cystectomy,RARC)加尿流改道术的临床可行性,并总结技术特点和临床效果. 方法 2007年12月至2012年3月膀胱尿路上皮癌患者22例,男20例,女2例.年龄37~ 72岁,平均62岁.体质指数22.5 ~ 30.1 kg/m2,平均26.1 kg/m2.麻醉评分1~2分.术前肿瘤活检病理诊断为浸润性或高危的非肌层浸润性膀胱尿路上皮痛,术前检查均未发现有其他邻近脏器浸润、盆腔淋巴结转移或远处转移,临床分期均低于T2N0M0.全麻下行RARC加尿流改道术,其中行体外尿流改道术15例(原位新膀胱2例,回肠膀胱术13例),行完全腹腔镜下尿流改道术7例(回肠膀胱术2例,原位新膀胱5例). 结果 本组22例手术均获得成功.手术时间300 ~ 667 min,平均480 min;出血量100 ~ 1200 ml,平均550 ml;淋巴结清扫数目6~ 25枚,平均15枚.术后2~3d下地活动,3~4d肠功能恢复,术后住院时间8~35 d,平均16d.行原位新膀胱的患者术后1个月行膀胱造影确定无吻合口漏后拔除尿管和双侧输尿管支架管.术后随访4 ~ 49个月,平均32个月,复发2例,死亡1例,出现肾积水2例,其余病例肾功能均正常,尿控较满意. 结论 根据初期的手术操作过程和随访结果,RARC加尿流改道术在临床上是可行的.更多的操作经验、长期和随机的对照研究将有助于对这一技术进行评估和推广.%Objective To investigate the clinical feasibility of robotic-assisted laparoscopic radical cystectomy (RARC) by da Vinci surgical system and to summarize the operative technique and outcomes.Methods From December 2007 to March 2012,22 patients (20 males and 2 females) with the bladder urothelial carcinomas were enrolled.Patient age was from 37 -72 years (rnean 62 years) ; the body mass index was 22.5 - 30.1 kg/m2 ( mean 26.1 kg/m2 ) ; and the American Society of

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

    Science.gov (United States)

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

    2016-01-01

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

  10. Laparoscopic assisted anorectal pull through: Reformed techniques

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    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.

  11. Laparoscopic assisted radical resection of left colon cancer located at splenic lfexure%结肠脾曲癌之腹腔镜辅助左半结肠癌根治术(附视频)

    Institute of Scientific and Technical Information of China (English)

    杨梓锋; 吴德庆; 李勇

    2016-01-01

    Laparoscopic technique has advantages of local ampliifcation, clear imaging features. Most of the domestic minimally invasive centers are in the rational use of advanced endoscopic equipment and familiar with the anatomic structure, they pay attention to new technology development and team coordination training, all schools of thoughts contend for attention, they learned from each other, and to promote the progress of the endoscopic techniques. In recent years, the long-term curative effect of laparoscopic radical resection of left colon cancer has gradually been recognized, and the CME in the colon is playing an important role. Due to the left half colon cancer radical surgery involves complicated anatomy, the surgical plan has not yet formed a consensus, the dififculty of the laparoscopic surgery, high technical requirements, thus, early operation need to be careful.%腹腔镜技术具有局部放大、清晰显像的功能,国内大部分微创中心在合理利用先进的腔镜器械及熟悉解剖结构基础上,重视新技术的发展及团队配合训练,百家争鸣,相互借鉴及学习,促进了国内腔镜技术的进步。近年来,腹腔镜左半结肠癌根治术的近远期疗效逐渐得到认可,完全结肠系膜切除(complete mesocolic excision, CME)原则在其中发挥着重要的作用。因左半结肠癌根治术解剖结构复杂、手术方案尚未形成共识,腹腔镜手术难度大,技术要求高,早期开展需慎重。

  12. HAND-ASSISTED LAPAROSCOPIC NEPHROURETERECTOMY: INITIAL CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

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

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

    Science.gov (United States)

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

    2005-01-01

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

  14. Robot-assisted laparoscopic gastrectomy for gastric cancer

    Science.gov (United States)

    Caruso, Stefano; Franceschini, Franco; Patriti, Alberto; Roviello, Franco; Annecchiarico, Mario; Ceccarelli, Graziano; Coratti, Andrea

    2017-01-01

    Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer. PMID:28101302

  15. Robotic Assisted Laparoscopic Prostatectomy after High Intensity Focused Ultrasound Failure

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    Leon Telis

    2017-01-01

    Full Text Available Background. Prostate cancer is the most common cancer diagnosed in men. As new focal therapies become more popular in treatment of prostate cancer, failure cases requiring salvage therapy with either surgical or other techniques are being reported. Objective. To report the options in treatment of prostate cancer after recurrence or failure of the primary treatment modality. Methods. We report a salvage robotic assisted laparoscopic radical prostatectomy (RALP for prostate cancer recurrence following high intensity focused ultrasound treatment (HIFU in the United States. Results. A 67-year-old man who underwent HIFU treatment for prostate adenocarcinoma 2 years prior was presented with a rising prostate specific antigen of 6.1 ng/mL to our clinic. A biopsy proven recurrent disease in the area of previous treatment documented the failure of treatment. The patient elected to undergo a salvage RALP. The operation time was 159 minutes. The patient was discharged from the hospital on postoperative day 1 with no complications. The catheter was removed on post-op day 10. The patient reserved sexual function and urinary continence. The PSA levels on 6 months’ follow-up are undetectable. Conclusions. Salvage RALP is an effective and safe treatment choice for recurrent prostate adenocarcinoma following failed HIFU treatment if operated by an experienced surgeon.

  16. Percutaneously Assisted "Two-Ports" Transperitoneal Radical Nephrectomy: Initial Series.

    Science.gov (United States)

    Porpiglia, Francesco; Bertolo, Riccardo; Morra, Ivano; Fiori, Cristian

    2016-06-01

    Looking for a virtually "scarless" surgery mini-laparoscopy (ML) could be a viable alternative to conventional laparoscopy. ML is a reproducible technique and allows for the preservation of the triangulation concept, the cornerstone of laparoscopic surgery. Drawback of ML could be the poor performance of miniaturized instruments that could affect the confidence of the surgeon and limit the indications. The recent availability of a novel mini-laparoscopic platform in our center expanded the indications of ML to radical nephrectomy even in cases of large renal tumors in kidneys with abundant perirenal fat. The platform is composed by mini-instruments with the peculiarity of a 2.9-mm shaft that is mounted on a handle and a jaw that are comparable in size and performance to those of conventional instruments, increasing the ergonomy and the confidence perceived by the surgeon. Allowing for inclusion criteria, nine consecutive patients were enrolled in our prospective study and underwent percutaneously assisted "two-ports" radical nephrectomy. Preliminary data showed that the novel platform allowed us to perform a safe and effective procedure with acceptable perioperative outcomes and apparent improvements in cosmesis. Larger sample size and comparative studies are needed to confirm these findings.

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

    Institute of Scientific and Technical Information of China (English)

    孙康伟; 袁建林; 杨晓剑; 王延柱; 孟平; 张龙龙; 武鹏

    2014-01-01

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

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

    Science.gov (United States)

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

    2003-06-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

  20. Laparoscopic assisted appendicectomy in District Hospital, Joypurhat, Bangladesh.

    Science.gov (United States)

    Bashar, M K; Alam, M Z; Aziz, M M; Nur-E-Elahi, M; Taher, M A; Jahan, I

    2014-01-01

    "Laparoscopic assisted appendicectomy" refers to visualization of abdominal cavity, identification of appendix, drawing the appendix out through the port wound and appendicectomy. The objective of this study is to evaluate the outcome of the procedure of laparoscopic assisted appendicectomy. In this prospective study patients with appendicitis were randomly selected for laparoscopic assisted appendicectomy from August 2007 to February 2009 in the Department of Surgery, Modernized District Hospital, Joypurhat, Bangladesh. Out of 73 patients Laparoscopic assisted appendicectomy was performed successfully in 95.89% cases and conversion rate was 4.11%. Male to female ratio was almost 1:2 with mean±SD age 18.62±9.16 years. The wound infection rate was 8.2% and urinary retention 2.7%. Early postoperative feeding was started within 24 hours in 86.3% cases and mean duration of hospital stay was 2 days in 76.71% patients. More than 82% returned to their home and started social activities within 5 days. Duration of surgery was almost similar in emergency and interval appendicectomy group (19.35±10.13 vs. 23.66±9.43) minutes. Postoperative morbidity in emergency appendicectomy group showed significantly higher morbidity than interval appendicectomy group (p=0.003). This study indicates that the laparoscopic assisted appendicectomy is feasible for the majority of the patients with appendicitis in both emergency and interval settings. It reduces the operative time, shortens hospital stay and helps in early resumption of normal activities with good cosmetic outcome and patients' satisfaction.

  1. 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

  2. Robot-assisted laparoscopic liver resection: A review.

    Science.gov (United States)

    Salloum, C; Lim, C; Malek, A; Compagnon, P; Azoulay, D

    2016-12-01

    Surgery using a robotic platform is expanding rapidly today, with a notable surge since its authorization on the international medical market by the US Food and Drug Administration in 2000. The first hepatectomy by a robotic approach was reported in 2002, 10 years after the first laparoscopic hepatectomy. Yet, in hepatic surgery, series are scarce and the lack of relevant data in the literature is an obstacle to the development of robot-assisted laparoscopic hepatectomy (RALH). Based on a review of the literature, this update focuses on current indications, short-term and oncologic outcomes following RALH.

  3. Single trocar laparoscopic-assisted colostomy in newborns.

    Science.gov (United States)

    Liem, N T; Quynh, T A

    2013-06-01

    To present the technique and outcomes of single trocar laparoscopic-assisted colostomy in newborns. A rectangular skin flap was developed at the left subcostal area and detached from the fascia. Then the fascia and peritoneum were opened longitudinally around 11 mm, and then a 10-mm trocar was inserted into the abdominal cavity. The 10-mm operating laparoscope (Stema, Germany) was inserted through the trocar. The left transverse colon was inspected, grasped and brought outside the abdominal cavity with a Babcock grasper. The skin flap was inserted through a window created at the colon mesentery and secured to the opposite side to elevate the colon. A loop colostomy was performed. From August 2009 to December 2011, single trocar laparoscopic-assisted colostomy was performed for 39 newborns with anorectal malformations, including 26 boys and 13 girls. Mean operative time was 24 ± 4 min (range 20-30 min). There were no perioperative deaths or complications. Mean postoperative stay was 3 ± 0.6 days. Single trocar laparoscopic-assisted colostomy is a feasible and safe procedure in newborns.

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

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    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.

  5. Synchronous single-port access laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy

    Science.gov (United States)

    Ybañez-Morano, Jessica; Tiu, Andrew C.

    2017-01-01

    Laparoscopic surgery through a single incision is gaining popularity with different stakeholders. The advantages of improved cosmetics, decreased postoperative pain and blood loss continue to attract patients from different surgical fields. Multidisciplinary approach to different surgical entities through a single incision has just been introduced. We report the first case of a synchronous single-port access (SPA) laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy through a single incision above the umbilicus in a 48-year-old female with ascending colon mass and uterine mass with good postoperative outcomes. SPA laparoscopic surgery is feasible for multidisciplinary approach in resectable tumors. PMID:28096321

  6. Hand-assisted laparoscopic nephrectomy in living donor

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    Luiz S. Santos

    2003-02-01

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

  7. Hand-assisted right laparoscopic nephrectomy in living donor

    Directory of Open Access Journals (Sweden)

    Fernando Meyer

    2005-02-01

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

  8. Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review

    Directory of Open Access Journals (Sweden)

    Puliyath Geetha

    2012-01-01

    Full Text Available Background : Over the last two decades, numerous studies have indicated the feasibility of minimally invasive surgery for early cervical cancer without compromising the oncological outcome. Objective : Systematic literature review and meta analysis aimed at evaluating the outcome of laparoscopic and robotic radical hysterectomy (LRH and RRH and comparing the results with abdominal radical hysterectomy (ARH. Search Strategy : Medline, PubMed, Embase, Cochrane library and Reference lists were searched for articles published until January 31 st 2011, using the terms radical hysterectomy, laparoscopic radical hysterectomy, robotic radical hysterectomy, surgical treatment of cervical cancer and complications of radical hysterectomy. Selection Criteria : Studies that reported outcome measures of radical hysterectomy by open method, laparoscopic and robotic methods were selected. Data collection and analysis: Two independent reviewers selected studies, abstracted and tabulated the data and pooled estimates were obtained on the surgical and oncological outcomes. Results : Mean sample size, age and body mass index across the three types of RH studies were similar. Mean operation time across the three types of RH studies was comparable. Mean blood loss and transfusion rate are significantly higher in ARH compared to both LRH and RRH. Duration of stay in hospital for RRH was significantly less than the other two methods. The mean number of lymph nodes obtained, nodal metastasis and positive margins across the three types of RH studies were similar. Post operative infectious morbidity was significantly higher among patients who underwent ARH compared to the other two methods and a higher rate of cystotomy in LRH. Conclusions : Minimally invasive surgery especially robotic radical hysterectomy may be a better and safe option for surgical treatment of cervical cancer. The laparoscopic method is not free from complications. However, experience of surgeon may

  9. 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.

  10. 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.

  11. Robot-assisted laparoscopic augmentation ileocystoplasty in a tubercular bladder

    Directory of Open Access Journals (Sweden)

    Prem Nath Dogra

    2014-01-01

    Full Text Available Some of the patients with genitourinary tuberculosis (GUTB present to the urologist with small contracted bladders or with significant renal damage. [1] Additional reconstructive procedures are often required along with anti-tubercular treatment in these patients. These procedures commonly performed via the open approach, now have the advantage of minimally invasive approach provided by laparoscopic and robotic surgery. The technique of robot-assisted laparoscopic augmentation ileocystoplasty in a patient with a small contracted bladder due to GUTB will be described. The procedure was performed via a completely intra-corporeal technique using an ileal "cap" created from a 15 cm segment of distal ileum which was anastomosed to the urinary bladder bi-valved in the mid-sagittal plane. The procedure lasted for 420 minutes and the patient was discharged on postoperative day 5. At 6 month follow-up, the patient has no irritative urinary symptoms and voiding with insignificant post-void residual urine.

  12. Robot - assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor

    Science.gov (United States)

    Torricelli, Fabio C. M.; Jardim, Denis; Guglielmetti, Giuliano B.; Patel, Vipul; Coelho, Rafael F.

    2017-01-01

    ABSTRACT Introduction and objective Retroperitoneal lymph node dissection (RPLND) is indicated for patients with non-seminomatous germ cell tumor (NSGCT) with residual disease after chemotherapy. Although the gold standard approach is still the open surgery, few cases of robot-assisted laparoscopic RPLND have been described. Herein, we aim to present the surgical technique for robot-assisted laparoscopic RPLND. Patient and method A 30 year-old asymptomatic man presented with left testicular swelling for 2 months. Physical examination revealed an enlarged and hard left testis. Alpha-fetoprotein (>1000ng/mL) and beta-HCG (>24.000U/L) were increased. Beta-HCG increased to >112.000U/L in less than one month. The patient underwent a left orchiectomy. Pathological examination showed a mixed NSGCT (50% embryonal carcinoma; 30% teratoma; 10% yolk sac; 10% choriocarcinoma). Computed tomography scan revealed a large tumor mass close to the left renal hilum (10x4x4cm) and others enlarged paracaval and paraortic lymph nodes (T2N3M1S3-stage III). Patient was submitted to 4 cycles of BEP with satisfactory response. Residual mass was suggestive of teratoma. Based on these findings, he was submitted to a robot-assisted RPLND. Results RPLND was uneventfully performed. Operative time was 3.5 hours. Blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. Pathological examination showed a pure teratoma. After 6 months of follow-up, patient is asymptomatic with an alpha-fetoprotein of 2.9ng/mL and an undetectable beta-HCG. Conclusion Robot-assisted laparoscopic RPLND is a feasible procedure with acceptable morbidity even for post chemotherapy patients when performed by an experienced surgeon.

  13. A Literature-Based Analysis of the Learning Curves of Laparoscopic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Daniel W. Good

    2014-05-01

    Full Text Available There is a trend for the increased adoption of minimally invasive techniques of radical prostatectomy (RP – laparoscopic (LRP and robotic assisted (RARP – from the traditional open radical retropubic prostatectomy (ORP, popularised by Partin et al. Recently there has been a dramatic expansion in the rates of RARP being performed, and there have been many early reports postulating that the learning curve for RARP is shorter than for LRP. The aim of this study was to review the literature and analyse the length of the LRP learning curves for the various outcome measures: perioperative, oncologic, and functional outcomes. A broad search of the literature was performed in November 2013 using the PubMed database. Only studies of real patients and those from 2004 until 2013 were included; those on simulators were excluded. In total, 239 studies were identified after which 13 were included. The learning curve is a heterogeneous entity, depending entirely on the criteria used to define it. There is evidence of multiple learning curves; however the length of these is dependent on the definitions used by the authors. Few studies use the more rigorous definition of plateauing of the curve. Perioperative learning curve takes approximately 150-200 cases to plateau, oncologic curve approximately 200 cases, and the functional learning curve up to 700 cases to plateau (700 for potency, 200 cases for continence. In this review, we have analysed the literature with respect to the learning curve for LRP. It is clear that the learning curve is long. This necessitates centralising LRP to high volume centres such that surgeons, trainees, and patients are able to utilise the benefits of LRP.

  14. 达芬奇机器人辅助腹腔镜下肾癌根治术的疗效及其对护理的影响%Effects of da Vinci robot-assisted laparoscopic radical nephrectomy on renal cancer and nursing

    Institute of Scientific and Technical Information of China (English)

    张曌; 陆建平

    2011-01-01

    目的 探讨达芬奇机器人辅助腹腔镜下肾癌根治术的疗效及其对护理的影响.方法 观察9例行达芬奇机器人辅助腹腔镜下肾癌根治术患者(试验组)与10例行传统开放肾癌根治术患者(对照组)的术中出血量、手术时间、下床活动时间、引流管拔除时间以及术后住院天数等,以及两种手术对护理的影响,再进行比较和统计学分析.结果 试验组在术中出血量、引流管拔除时间、下床活动时间、术后住院天数等方面均优于对照组(P<0.05).结论 达芬奇机器人辅助腹腔镜肾癌根治术是一种创伤小、出血昔少和术后恢复快的新医疗方法,能降低护理难度和提高护理的质苗与效率.%Objective To study the outcome and effects of da Vinci robotic surgery on renal tumors and nursing. Methods 19 elderly patients with renal cancer were divided into experimental group (n=9) underwent laparoscopic radical nephrectomy by da Vinci robotic surgery and control group (n = 10) treated with traditional open surgery. The Blood loss, operative time, ambulation time, time to drainage tube removal, and postoperative hospital stay days were evaluated, while the effects of the two kinds of surgeries on the nursing were assessed and compared. Results The blood loss, drainage tube removal time, ambulation time, postoperative hospital stay days in the experimental group were better than the control group. Conclusion da Vinci robot-assisted laparoscopic radical nephrectomy is a new medical treatment because of its less invasion, less blood loss and rapid postoperative recovery and can reduce the difficulty of nursing care and improve nursing care quality and efficiency.

  15. A Comparative Study of Single-Port Laparoscopic Surgery Versus Robotic-Assisted Laparoscopic Surgery for Rectal Cancer

    DEFF Research Database (Denmark)

    Levic, Katarina; Donatsky, Anders Meller; Bulut, Orhan

    2015-01-01

    INTRODUCTION: Conventional laparoscopic surgery is the treatment of choice for many abdominal procedures. To further reduce surgical trauma, new minimal invasive procedures such as single-port laparoscopic surgery (SPLS) and robotic assisted laparoscopic surgery (RALS) have emerged. The aim...... in either of the groups. There was no difference in median follow-up time between groups (P = .58). CONCLUSION: Both SPLS and RALS may have a role in rectal surgery. The short-term oncological outcomes were similar, although RALS harvested more lymph nodes than the SPLS procedure. However, SPLS seems...

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

    Science.gov (United States)

    Lee, Sang Hyub; Kim, Dong Soo; Chang, Sung-Goo; Jeon, Seung Hyun

    2015-07-01

    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 case shows that robot-assisted retroperitoneal lymph node dissection is technically feasible, safe, and cosmetically favorable, even when performed on patients with high-stage disease or after chemotherapy.

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

    OpenAIRE

    Tanya Nazemi; Anton Galich; Samuel Sterrett; Douglas Klingler; Lynette Smith; Balaji, K. C.

    2006-01-01

    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 2...

  18. 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.

  19. Effect of Da Vinci robot-assisted laparoscopic radical prostatectomy on the respiratory system of elderly patients in intensive care units%达芬奇机器人辅助前列腺癌根治术对ICU老年患者呼吸系统的影响

    Institute of Scientific and Technical Information of China (English)

    蒲虹; 黄晓波; 王茜; 刘竞

    2016-01-01

    Objective To explore the effect of Da Vinci robot⁃assisted laparoscopic radical prostatecto⁃my on the respiratory function of elderly in Intensive Care Units( ICU) . Methods Thirty⁃nine elderly patients received Da Vinci robot⁃assisted laparoscopic radical prostatectomy ( RARP ) from January 2015 to April 2016 and 25 cases received conventional laparoscopic radical prostatectomy from January 2014 to December 2014 ad⁃mitted into ICU were retrospectively analyzed. Their comorbidities,blood loss and transfusion during surgery,ate⁃rial blood gas(ABG) analysis and respiratory complications after operation,clinical outcomes between the two groups were compared. Results Compared with conventional laparoscopic radical prostatectomy,RARP group spent more time in surgery((4. 23±1. 44) h vs. (3. 25±1. 31) h,t=2. 783,P<0. 05),more patients need venti⁃lation(11 vs. 1,χ2=4. 378,P<0. 05) . ABG analysis showed respiratory and metabolic acidosis with lower pH (7. 29±0. 09 vs. 7. 35±0. 05,t=3. 886,P<0. 05),HCO3⁃((20. 05±2. 50) mmol/L vs. (22. 86±2. 53) mmol/L,t=3. 473,P<0. 05),BE(-5. 11±3. 94 vs.-3. 64±1. 17,t=5. 018,P<0. 05) and higher pCO2(46. 15±8. 31 vs. 40. 25±6. 57,t=2. 475,P<0. 05),Lac((3. 54±1. 99) mmol/L vs. (2. 91±1. 39) mmol/L,t=2. 254,P<0. 05) . Conclusion RARP may cause carbon dioxide retention and respiratory complications on elderly pa⁃tients. It may reduce postoperative respiratory complications by shortening surgery time,lowering pneumoperitone⁃um pressure,hyperventilation,recruitment maneuvers and chest physical therapy.%目的:探讨达芬奇机器人辅助前列腺癌根治术对老年患者呼吸功能的影响。方法采用回顾性方法,纳入2015年1月至2016年4月四川省人民医院重症医学科( ICU)收治的达芬奇机器人辅助前列腺癌根治术患者,以及2014年1⁃12月术后入ICU的普通腹腔镜前列腺癌根治术患者。比较达芬奇与腹腔镜两组患者基础病情、术中失血

  20. 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.

  1. 延续护理在机器人辅助腹腔镜膀胱全切尿流改道术患者中的应用效果%Application effect of Continuation Nursing in Robot Assisted Laparoscopic Radical Cystectomy and Urinary Diversion Surgery

    Institute of Scientific and Technical Information of China (English)

    丁华; 赵美玲; 侯翠翠; 王芳

    2015-01-01

    Objective To explore the application effect of continuation nursing in robot assisted laparoscopic radical cystectomy and urinary diversion surgery.Methods To establish the ward continued nursing team, standardizing the continued nursing forms,refinement of continuing nursing content.By convenience sampling,70 cases of robot assisted laparoscopic radical cystectomy and urinary diversion surgery were selected,and investigated by using the knowledge of disease questionnaire and general quality of life assessment questionnaire when discharge and 1 and 3 months after discharge.Results Patients were lack of disease relevant knowledge when discharge,with the continues of the continuation nursing,patients’mastery level of relevant knowledge was getting better compared with the time of discharge.The score of quality of life at three month of discharge were lower than the time of discharge and first month of discharge (all P <0.05).Conclusion Continuing nursing can improve patient’s cognitive level and the quality of life,reduce the incidence of complications and twice admission rate,reduce the financial burden on families,save medical resources and improve the trust degree of patients to the medical staffs and the reputation of the hospital.%目的:探讨延续护理在机器人辅助腹腔镜膀胱全切尿流改道术患者中的应用效果。方法2009年1月至2014年3月,建立病区延续护理团队,规范延续护理形式,细化延续护理内容。便利抽样法选取在解放军总医院海南分院泌尿外科采用机器人辅助腹腔镜膀胱全切尿流改道术后出院患者70例为研究对象,患者出院时、出院后1、3个月分别采用疾病知识调查表及生活质量综合评定问卷表对其进行测评。结果患者出院时对所患疾病相关知识掌握欠佳,随着延续护理的持续,患者对疾病康复知识掌握情况较出院时有提高;出院3个月后患者的生活质量评分

  2. Robot-assisted radical prostatectomy is a safe procedure

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Rosenblatt Gregory S

    2006-09-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    BACKGROUND: Robot-assisted laparoscopy has been reported to be a safe and feasible alternative to traditional laparoscopy. The aim of this study was to compare short-term results in patients with colonic cancer who underwent robot-assisted laparoscopic colonic resection (RC) or laparoscopic colonic...... journals. Biochemical markers [C-reactive protein (CRP), hemoglobin, white blood cell count, and thrombocyte count] were recorded before surgery and for the first 3 days after surgery. RESULTS: A total of 101 patients underwent RC and 162 patients underwent LC. There were no significant differences...... in the rate of conversion to open surgery, number of permanent enterostomies, number of intraoperative complications, level of postoperative cellular stress response, number of postoperative complications, length of postoperative hospital stay, or 30-day mortality between the two groups...

  5. Robotic-Assisted Laparoscopic Ovarian Cystectomy during Pregnancy.

    Science.gov (United States)

    Carter, Susanna; Depasquale, Steven; Stallings, Shawn

    2011-09-01

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

  6. Fertility and Symptom Relief following Robot-Assisted Laparoscopic Myomectomy

    Directory of Open Access Journals (Sweden)

    Michael C. Pitter

    2015-01-01

    Full Text Available Objective. To examine success of robot-assisted laparoscopic myomectomy (RALM measured by sustained symptom relief and fertility. Methods. This is a retrospective survey of 426 women who underwent RALM for fibroids, symptom relief, or infertility at three practice sites across the US. We examined rates of symptom recurrence and pregnancy and factors associated with these outcomes. Results. Overall, 70% of women reported being symptom-free, with 62.9% free of symptoms after three years. At >3 years, 66.7% of women who underwent surgery to treat infertility and 80% who were also symptom-free reported achieving pregnancy. Factors independently associated with symptom recurrence included greater time after surgery, preoperative dyspareunia, multiple fibroid surgeries, smoking after surgery, and preexisting diabetes. Factors positively correlated with achieving pregnancy included desiring pregnancy, prior pregnancy, greater time since surgery, and Caucasian race. Factors negatively correlated with pregnancy were advanced age and symptom recurrence. Conclusions. This paper, the first to examine symptom recurrence after RALM, demonstrates both short- and long-term effectiveness in providing symptom relief. Furthermore, RALM may have the potential to improve the chance of conception, even in a population at high risk of subfertility, with greater benefits among those who remain symptom-free. These findings require prospective validation.

  7. Robotic-Assisted Laparoscopic Ovarian Cystectomy during Pregnancy

    Directory of Open Access Journals (Sweden)

    Susanna Carter

    2011-09-01

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

  8. Robotic assisted radical prostatectomy: a different treatment for prostate cancer?

    OpenAIRE

    Julio,Alexandre Den; Ahlering,Thomas Edward; Korkes, Fernando; Lopes Neto,Antonio Correa; Tobias-Machado,Marcos; Pompeo, Antonio Carlos Lima; Wroclawski,Eric Roger

    2010-01-01

    ABSTRACTConsidering the Health Care System in Brazil, a developing country, and public healthcare policies, robotic surgery is a reality to very few citizens. Therefore, robotic assisted radical prostatectomy is far removed from the daily practice of the vast majority of Brazilian urologists. Scientific evidence of the superiority of robotic assisted radical prostatectomy does not presently justify public investments for widespread development of robotic centers. Maybe over time and with redu...

  9. Peri operative nursing progress on patients undergoing laparoscopic radical cystectomy and orthotopic ileal neo-bladder%腹腔镜根治性膀胱切除原位回肠新膀胱术病人的围术期护理进展

    Institute of Scientific and Technical Information of China (English)

    张珊; 温贤秀; 雷花; 杨显芳; 祝玲; 匡玲

    2016-01-01

    It reviewed the peri operative nursing progress on patients undergoing laparoscopic radical cystecto-my and orthotopic ileal neobladder,so as to provide references for the nursing model of patients undergoing the robot assisted robotic assisted laparoscopic radical cystectomy and orthotopic ileal neobladder.%综述腹腔镜根治性膀胱切除原位回肠新膀胱术围术期护理进展,为机器人辅助腹腔镜根治性膀胱切除原位回肠新膀胱术护理模式的建立提供参考。

  10. Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: highlight of key surgical steps

    Directory of Open Access Journals (Sweden)

    A. Sim

    Full Text Available ABSTRACT Objective: Vascular involvement in the form of renal vein (RV or inferior vena cava (IVC thrombus can be seen in 4-10% of patients presented with RCC. In patients without presence of metastasis, surgical treatment in the form of radical nephrectomy remains the treatment of choice with 5-year survival rates of 45-70%. Open surgery is still the first treatment option of choice at the moment for RCC patients with IVC thrombus. Materials and Methods: In our study, we are reporting a case of patient with RCC and level I IVC thrombus treated with laparoscopy. Our patient is a 72 years old man with underlying co-morbidity of hypertension and chronic kidney disease (CKD presented with right-sided RCC. The CT scan done showed a large right renal upper pole tumor measuring 8.4x5.2cm with level I IVC thrombus (Figure-1. There were no regional lymphadenopathy and the staging scans were negative. Results: The operative time was 124 minutes and blood loss was minimal. The patient was progressed to diet on POD 1 with bowel movement on POD 2. There was no significant change in the pre and post-operative glomerular filtration rate (GFR. The surgical drain was removed on POD2. The patient was discharged well on POD 5. There were no perioperative complications. The pathology was pT3bN0M0 Fuhrman grade II clear cell RCC. Conclusions: As a conclusion, laparoscopic radical nephrectomy and IVC thrombectomy is a complex and technically demanding surgery. With advancement of surgical skills as well as technology, more cases of minimally invasive laparoscopic radical nephrectomy and IVC thrombectomy can performed to improve the perioperative outcomes of carefully selected patients in a high volume center.

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

    Directory of Open Access Journals (Sweden)

    Hiroki Sugishita

    2009-11-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    BACKGROUND: Transversus abdominis plane (TAP) block is widely used as a part of pain management after various abdominal surgeries. We evaluated the effect of TAP block as an add-on to the routine analgesic regimen in patients undergoing robot-assisted laparoscopic hysterectomy. METHODS......: In a prospective blinded study, 70 patients scheduled for elective robot-assisted laparoscopic hysterectomy were randomised to receive either TAP block (ropivacaine 0.5%, 20 ml on each side) or sham block (isotonic saline 0.9%, 20 ml on each side). All patients had patient-controlled analgesia (PCA) with morphine...... 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....

  13. Umbilical incision laparoscopic surgery with one assist port for an elderly patient with recurrent sigmoid volvulus.

    Science.gov (United States)

    Matsuoka, Tasuku; Osawa, Naoshi; Yoh, Taiho; Hirakawa, Kosei

    2012-12-12

    Single-port access laparoscopic surgery has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. Herein, we report the experience of transumbilical incision laparoscopic sigmoidectomy with one assist port in a 71-year-old man who had developed recurrent sigmoid volvulus in these several years since his first visit to the hospital. The patient presented abdominal distension and severe constipation. A plain x-ray film and CT of the abdomen showed grossly distended sigmoid colon loops and stenosis of recto-sigmoid colon. Sigmoid volvulus associated with megacolon was diagnosed and emergence endoscopic decompression was performed. After his condition improved, transumbilical incision laparoscopic sigmoidectomy was carried out as the minimally invasive approach, due to the several risk of patient such as aging and pulmonary disorder. Postoperative course was uneventful and on postoperative visit to the hospital he reported resolution of abdominal distension.

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

    Directory of Open Access Journals (Sweden)

    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

  15. Laparoscopic radical cystectomy with orthotopic ileal neobladder: report of 33 cases

    Institute of Scientific and Technical Information of China (English)

    HUANG Jian; XU Ke-wei; YAO You-sheng; GUO Zheng-hui; XIE Wen-lian; JIANG Chun; HAN Jin-li; LI Si-yao

    2005-01-01

    Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated. We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results.Methods The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier's space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra-neobladder anastomosis. This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004.Results The operating time was 5.5-8.5 hours with an average of 6.5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml. The surgical margins of the bladder specimen were negative in all patients. There was no evidence of local recurrence at follow-up of 1-21 months in all the patients. However lymph node metastases were found in one case at 9 months postoperatively. Most of patients achieved urine control 1 to 3 months after surgery. The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases). Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases. The mean value of neobladder capacity was (296±37) ml. The mean value of maximum flow rate was (18.7±7.1) ml/s. The mean residual urine volume was (32±19) ml. In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up. Cystography showed neobladders being similar in

  16. Effect on changes of blood coagulation function, cytokines and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jia-Qi Liu; Shao-Jun Yang; Jie-Qing Chen; Ru-Kui Su; Zhong Huang; Yin-Zhuo Qi

    2017-01-01

    Objective:To explore the changes of coagulation function, cytokines and T lymphocyte in patients undergoing laparoscopic radical gastrectomy for gastric cancer and its clinical significance.Methods: 40 cases of laparoscopic radical gastrectomy for gastric cancer patients and 40 cases of open radical gastrectomy for gastric cancer patients in our hospital were selected to detect and investigate the perioperative coagulation function [APTT (activated partial thromboplastin time), FIB (fibrinogen), and PLT (platelet)], cytokines [CRP (C reactive protein), IL-6 (IL-6) and TNF-alpha (Tumor necrosis factor-alpha)] and T lymphocytes (CD4+, CD8+ and CD4+/CD8+) changes and clinical meaning of patients in the two groups.Results: The coagulation function related indicators, cytokines and T lymphocytes of the two groups before treatment did not change significantly (P>0.05). 1 d after operation, blood coagulation, TNF-alpha, CD4+ and CD4+/CD8+ levels were significantly lower than that before operation in two groups of patients (P<0.05), while IL-6, CRP and CD8+ were significantly higher than that before the operation (P<0.05), and the index change in open group was more obvious. 3 d after surgery, the APTT, IL-6, CRP, CD4+, CD8+ and PLT levels in two group patients were significantly lower than that 1 d after surgery, while FIB, TNF-alpha and CD4+/CD8+ were significantly higher than that 1 d after surgery; blood coagulation index, TNF-alpha and CD4+ and CD4+/CD8+ were significantly lower in the laparotomy group patients than in laparoscopic group, while IL-6, CRP and CD8+ were significantly higher than the laparoscopic group (P<0.05). 5 d after operation, the APTT, TNF-alpha, FIB, CD4+, CD4+/CD8+ and PLT in two groups were significantly higher than that 3 d after surgery (P<0.05), while IL-6, CRP and CD8+ levels were significantly lower than that of 3 d after surgery (P<0.05); blood coagulation index, TNF-alpha and CD4+ and CD4+/CD8+ in the laparotomy group patients were

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

    Science.gov (United States)

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

    2010-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Lucas Marques Colomé

    2014-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  20. Endolaparoscopic left hemicolectomy and synchronous laparoscopic radical nephrectomy for obstructive carcinoma of the descending colon and renal cell carcinoma.

    Science.gov (United States)

    Ng, Simon S M; Yiu, Raymond Y C; Li, Jimmy C M; Chan, Chi Kwok; Ng, Chi Fai; Lau, James Y W

    2006-06-01

    Colorectal self-expandable metal stents (SEMS) have been used successfully as preoperative bridges to surgery for obstructive left-sided colorectal carcinoma. Endoscopic relief of the obstruction allows for full bowel preparation and accurate preoperative staging. A laparoscopic approach, considered by many to be contraindicated in the presence of obstruction, becomes feasible after endoscopic decompression. We present a case of obstructive carcinoma of the descending colon successfully treated with endoscopic decompression with colorectal SEMS. Subsequent staging with computed tomography revealed a renal cell carcinoma in the left kidney. Synchronous laparoscopic resection of the two carcinomas was performed, with no morbidity. To the best of our knowledge, this is the first report of endolaparoscopic left hemicolectomy and synchronous laparoscopic radical nephrectomy for obstructive carcinoma of the descending colon and renal cell carcinoma. The advantages of colorectal SEMS and the endolaparoscopic approach in managing obstructive colorectal carcinoma are discussed.

  1. 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.

  2. Hand-assisted right laparoscopic live donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Anibal W. Branco

    2005-10-01

    Full Text Available PURPOSE: Laparoscopic live donor nephrectomy has acquired an important role in the era of minimally invasive surgery. Laparoscopic harvesting of the right kidney is technically more challenging than that of the left kidney because of the short right renal vein and the need to retract the liver away from the right kidney. The aim of this article is to report our experience with right laparoscopic live donor nephrectomies. MATERIALS AND METHODS: We performed a retrospective review of 28 patients who underwent right laparoscopic donor nephrectomies at our service. Operative data and postoperative outcomes were collected, including surgical time, estimated blood loss, warm ischemia time, length of hospital stay, conversion to laparotomy and complications. RESULTS: The procedure was performed successfully in all 28 patients. The mean operative time was 83.8 minutes (range 45 to 180 minutes, with an estimated blood loss of 111.4 mL (range 40 to 350 mL and warm ischemia time of 3 minutes (range 1.5 to 8 minutes. No donor needed conversion to open surgery and all kidneys showed immediate function after implantation. The average time to initial fluid intake was 12 hours (range 8 to 24 hours. Two cases of postoperative ileus and a case of hematoma on the hand-port site were observed. The mean postoperative hospital stay was 3 days (range 1 to 7 days. CONCLUSIONS: Our data confirm the safety and feasibility of right laparoscopic donor nephrectomy and we believe that the right kidney should not be avoided for laparoscopic donor nephrectomy when indicated.

  3. Life-threatening rupture of an external iliac artery pseudoaneurysm caused by necrotizing fasciitis following laparoscopic radical cystectomy: a case report

    OpenAIRE

    Hata, Shinro; Satoh, Ryuta; Shin, Toshitaka; Mori, Kenichi; Sumino, Yasuhiro; Satoh, Fuminori; Mimata, Hiromitsu

    2014-01-01

    Background Pseudoaneurysms are caused by trauma, tumors, infections, vasculitis, atherosclerosis and iatrogenic complications. In this paper, we report about a patient with rupture of an external iliac artery pseudoaneurysm, which lead to hemorrhagic shock, after undergoing laparoscopic radical cystectomy and extended pelvic lymphadenectomy. Case presentation The patient was a 68-year-old Japanese male diagnosed with invasive bladder cancer. Laparoscopic radical cystectomy and extended pelvic...

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

    Science.gov (United States)

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

    2011-03-01

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

  5. Robot-assisted laparoscopic hiatal hernia and antireflux surgery

    NARCIS (Netherlands)

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

    2015-01-01

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

  6. Promising early results after hand-assisted laparoscopic partial nephrectomy in carefully selected patients

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Christensen, Tom

    2012-01-01

    was dissected using hand-assisted laparoscopic technique, the gerotic fascia was dissected and a complete exploration of the kidney was achieved. A vascular bulldog clamp was removed from the renal artery immediately after the tumour resection bed had been closed with a running suture with Hem-o-Lok clips...

  7. 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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  9. Robot-assisted laparoscopic rectovaginopexy for rectal prolapse: a prospective cohort study on feasibility and safety

    NARCIS (Netherlands)

    Draaisma, W.A.; Nieuwenhuis, D.H.; Janssen, L.W.M.; Broeders, I.A.M.J.

    2008-01-01

    Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort stud

  10. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-09-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  11. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-01-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  12. A matched-pair comparison between bilateral intrafascial and interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Tao Zheng; Xu Zhang; Xin Ma; Hong-Zhao Li; Jiang-Pin Gao; Wei Cai; Jun Dong

    2013-01-01

    The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy.From March 2010 to August 2011,65 patients with localized prostate cancer (PCa) underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy.These patients were matched in a 1:2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011.Operative data and oncological and functional results of both groups were compared.There was no difference in operative data,pathological stages and overall rates of positive surgical margins between the groups.There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group,respectively.The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique.Equal results in terms of continence were found in both groups at 12 months.Better rates of potency at 6 months and 12 months were found in younger patients (age ≤65 years) and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy.Biochemical progression-free survival rates 1 year postoperatively were similar in both groups.Using strict indications,compared with the interfascial nerve-sparing technique,the intrafascial technique provided similar operative outcomes and short-term oncological results,quicker recovery of continence and better potency.The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative Potency.

  13. Total Laparoscopic Radical Hysterectomy for Treatment of Uterine Malignant Tumors:Analysis of Short-term Therapeutic Efficacy

    Institute of Scientific and Technical Information of China (English)

    沈怡; 王泽华

    2010-01-01

    To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009.Data collected included operative time,estimated blood loss,lymph node count,time for the recovery of normal temperature and time to resumption of normal bladder function,intraopera...

  14. Robot-assisted Radical Prostatectomy: How I Do It

    Directory of Open Access Journals (Sweden)

    Cemil Uygur

    2016-06-01

    Full Text Available In this article, we describe surgical technique for robot assisted radical prostatectomy using the four-arm da Vinci robotic surgical system (SI, Intuitive Surgical, Sunnyvale, CA, USA. We have continually refined our technique to improve patient outcomes.

  15. Robot-Assisted Laparoscopic Partial Colpectomy and Intracorporeal Ileal Conduit Urinary Diversion (Bricker for Cervical Adenocarcinoma Recurrence

    Directory of Open Access Journals (Sweden)

    Jennifer Uzan

    2015-01-01

    Full Text Available Ileal conduit urinary diversion (Bricker is a standard surgical open procedure. The Da Vinci robot allowed precision for this surgical procedure, especially for intracorporeal suturing. Meanwhile, few reports of robot-assisted laparoscopic ileal conduit diversion (Bricker are described in the literature. We report the case of a 69-year-old patient with a vaginal recurrence of cervical adenocarcinoma associated with vesicovaginal fistula treated by robot-assisted laparoscopic partial colpectomy and ileal conduit urinary diversion (Bricker. The robot-assisted laparoscopic procedure followed all surgical steps of the open procedure. Postoperative period was free of complications.

  16. Effect of laparoscope and open radical resection on immunological and stress levels in patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Xia-Fei Sun; Zi-Rui He

    2016-01-01

    Objective:To explore the effect of laparoscope and open radical resection of gastric cancer on the immunological and stress levels in patients with advanced gastric cancer.Methods:A total of 80 patients with advanced gastric cancer who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into the laparoscope group and open group according to different treatment protocols. The morning fasting venous blood 1 d before operation, and 1 d, 3 d, and 5 d after operation in the two groups was collected, and centrifuged for the serum. The scatter turbidimetry was used to detect CRP. ELISA was used to detect IL-6. FCM was used to detect CD4+ and CD8+. CD4+/CD8+ were calculated.Results:The comparison of CRP and IL-6 levels before operation between the two groups was not statistically significant (P>0.05). CRP and IL-6 levels 1 d after operation were significantly elevated, and were gradually reduced 3 d and 5 d after operation. CRP and IL-6 levels 3 d and 5d after operation in the laparoscope group were significantly lower than those in the open group (P0.05). CD4+ 1 d after operation reached the peak, while CD8+ and CD4+/CD8+ were reduced to the lowest. CD4+, CD8+, and CD4+/CD8+ 3 d and 5 d after operation were gradually recovered, and the recovered degree of the above indicators in the laparoscope group were significantly superior to that in the open group (P<0.05).Conclusions:Due to the significant advantage of small effect on the stress reaction and immunosuppression, the laparoscopic radical gastrectomy should be preferred.

  17. A comparison of surgeon's postural muscle activity during robotic-assisted and laparoscopic rectal surgery.

    Science.gov (United States)

    Szeto, Grace P Y; Poon, Jensen T C; Law, Wai-Lun

    2013-09-01

    This study compared the muscular activity in the surgeon's neck and upper limbs during robotic-assisted laparoscopic (R-Lap) surgery and conventional laparoscopic (C-Lap) surgery. Two surgeons performed the same procedure of R-Lap and C-Lap low anterior resection, and real-time surface electromyography was recorded in bilateral cervical erector spinae, upper trapezius (UT) and anterior deltoid muscles for over 60 min in each procedure. In one surgeon, forearm muscle activities were also recorded during robotic surgery. Similar levels of cervical muscle activity were demonstrated in both types of surgery. One surgeon showed much higher activity in the left UT muscle during robotic surgery. In the second surgeon, C-Lap was associated with much higher levels of muscle activity in both UT muscles. This may be related to the bilateral abducted arm posture required in maneuvering the laparoscopic instruments. In the forearm region, the "ulnaris" muscles for wrist flexion and extension bilaterally showed high amplitudes during robotic-assisted surgery. Robotic-assisted surgery seemed to demand a higher level of muscle work in the forearm region while greater efforts of shoulder muscles were involved during laparoscopic surgery. There are also individual variations in postural habits and motor control that can affect the muscle activation patterns. This study demonstrated a method of objectively examining the surgeon's physical workload during real-time surgery in the operating theatre, and further research should explore the surgeon's workload in a larger group of surgeons performing different surgical procedures.

  18. Postural Mechatronic Assistant for Laparoscopic Solo Surgery (PMASS)

    OpenAIRE

    Martinez, Arturo Minor; Espinoza, Daniel Lorias

    2010-01-01

    The use of new technology in surgery is enabling surgeons to operate solo in some procedures. The advantages are adequate work space on the operating table and maneuverability. However, although active and passive systems offer these advantages, the time required to relocate or reaccommodate optics and clean the laparoscope between operations has not been reduced. In addition, there is a perceptual difference between what the surgeon wishes to see and the proximity he/she achieves with the ac...

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

    Institute of Scientific and Technical Information of China (English)

    肖俊峰; 暨玲; 阮小蛟; 郑晓风

    2013-01-01

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

  20. Transvesical Laparoendoscopic Single-Site Management of Distal Ureter During Laparoscopic Radical Nephroureterectomy.

    Science.gov (United States)

    Nunez Bragayrac, Luciano A; Machuca, Victor; Saenz, Eric; Cabrera, Marino; de Andrade, Robert; Sotelo, Rene J

    2014-09-11

    Abstract Objective: To describe the management of the distal ureter during radical nephroureterectomy with the transvesical laparoendoscopic single-site surgery (T-LESS) approach. Methods: Between January 2010 and October 2013, five patients underwent laparoscopic radical nephroureterectomy for upper urinary tract carcinoma (UTUC) with the T-LESS approach. Patients were placed in the supine position. A 2.5-cm skin incision was made in the line between the pubis and the umbilicus. The bladder was identified and a multiport was inserted into the bladder. The patients were repositioned to a lateral decubitus position; pneumovesicum was established and the ureteral openings were identified. We marked the bladder cuff with electrocautery all the way through to the extravesical fat. The bladder defect was sealed with sutures. After checking for any leak or bleeding, the multiport was removed and the bladder was closed. At this point, we continued with nephrectomy by standard laparoscopy or LESS. A 18F Foley catheter was placed into the bladder. Results: The mean age was 70 years (range 58-81 years), the mean operative time was 198 minutes (range 115-390 minutes), the mean time for the management of the distal ureter was 35 minutes (range 27-45 minutes), the mean estimated blood loss was 234 mL (range 60-850 mL), and the mean hospital stay was 3.8 days (range 2-8 days). In all patients the bladder cuff was free of disease. Conclusion: The transvesical laparoendoscopic single-site approach to the distal ureter for UTUC appears safe and reproducible, with faster closure of the bladder defect and improved cosmesis.

  1. 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.

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

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

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

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

    Science.gov (United States)

    Wei, Hongbo; Zheng, Zongheng

    2015-06-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  5. Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence.

    Science.gov (United States)

    Manley, Lauren; Gibson, Luke; Papa, Nathan; Beharry, Bhawanie Koonj; Johnson, Liana; Lawrentschuk, Nathan; Bolton, Damien M

    2016-12-01

    The aim of the study was to evaluate the effect of pelvic floor muscle (PFM) assessment and training before and after robot-assisted laparoscopic radical prostatectomy (RARP) in improving PFM strength and urinary continence. We performed an analysis of a database of patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) performed by two urologists from 2011 to 2013. Pelvic floor muscle (PFM) activation and strength were graded by a trained pelvic floor physiotherapist. Patients were given an exercise program, grouped according to the strength of their pelvic floor as graded by assessment, to complete before and after surgery. PFM strength was recorded preoperatively, 4 days post-catheter removal and 4 weeks post-catheter removal. Continence was recorded at 4 weeks postop and was defined as the requirement of no continence aids. A total of 98 patients had RARP and a preoperative physiotherapy assessment plus postoperative appointments at around 1 and 4 weeks post-RARP. The majority of men improved their PFM strength regardless of preoperative strength with no significant predictors of postoperative strength found. Age was the only significant predictor of postoperative incontinence. In this pilot study, a majority of patients increased their pelvic floor strength with time. Pelvic floor physiotherapy is an important modifiable patient factor, which does have an impact in improving patients' urinary continence by strengthening the pelvic floor muscles. Patient age influences response to pelvic floor physiotherapy.

  6. Laparoscopic - assisted transpyelic rigid nephroscopy - simple alternative when flexible ureteroscopy is not available

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    Full Text Available ABSTRACT Introduction: In special situations such as malrotated or ectopic kidneys and UPJ stenosis treatment of renal lithiasis can be challenging. In these rare cases laparoscopy can be indicated. Objective: Describe the Laparoscopic-assisted rigid nephroscopy performed via transpyelic approach and report the feasibility. Patients and methods: We present two cases of caliceal lithiasis. The first is a patient that ESWL and previous percutaneous lithotripsy have failed, with pelvic kidney where laparoscopic dissection of renal pelvis was carried out followed by nephroscopy utilizing the 30 Fr rigid nephroscope to remove the calculus. Ideal angle between the major axis of renal pelvis and the rigid nephroscope to allow success with this technique was 60-90 grades. In the second case, the kidney had a dilated infundibulum. Results: The operative time was 180 minutes for both procedures. No significant blood loss or perioperative complications occurred. The bladder catheter was removed in the postoperative day 1 and Penrose drain on day 2 when patients were discharged. The convalescence was completed after 3 weeks. Patients were stone free without symptons in one year of follow-up. Conclusions: Laparoscopic-assisted rigid nephroscopy performed via tranpyelic approach can be done safely with proper patient selection and adherence to standard laparoscopic surgical principles. This approach is an alternative in cases where flexible endoscope is not available and when standard procedure is unlikely to produce a stone-free status.

  7. Laparoscopic - assisted transpyelic rigid nephroscopy - simple alternative when flexible ureteroscopy is not available

    Science.gov (United States)

    Tobias-Machado, Marcos; Hidaka, Alexandre Kiyoshi; Nunes-Silva, Igor; Chagas, Carlos Alberto; Leal, Leandro Correa; Pompeo, Antonio Carlos Lima

    2016-01-01

    ABSTRACT Introduction: In special situations such as malrotated or ectopic kidneys and UPJ stenosis treatment of renal lithiasis can be challenging. In these rare cases laparoscopy can be indicated. Objective: Describe the Laparoscopic-assisted rigid nephroscopy performed via transpyelic approach and report the feasibility. Patients and methods: We present two cases of caliceal lithiasis. The first is a patient that ESWL and previous percutaneous lithotripsy have failed, with pelvic kidney where laparoscopic dissection of renal pelvis was carried out followed by nephroscopy utilizing the 30 Fr rigid nephroscope to remove the calculus. Ideal angle between the major axis of renal pelvis and the rigid nephroscope to allow success with this technique was 60-90 grades. In the second case, the kidney had a dilated infundibulum. Results: The operative time was 180 minutes for both procedures. No significant blood loss or perioperative complications occurred. The bladder catheter was removed in the postoperative day 1 and Penrose drain on day 2 when patients were discharged. The convalescence was completed after 3 weeks. Patients were stone free without symptons in one year of follow-up. Conclusions: Laparoscopic-assisted rigid nephroscopy performed via tranpyelic approach can be done safely with proper patient selection and adherence to standard laparoscopic surgical principles. This approach is an alternative in cases where flexible endoscope is not available and when standard procedure is unlikely to produce a stone-free status. PMID:27564304

  8. Hand-assisted laparoscopic surgery for complex gallstone disease: A report of five cases

    Institute of Scientific and Technical Information of China (English)

    Qi Wei; Lai-Gen Shen; He-Ming Zheng

    2005-01-01

    AIM: To describe the use of hand-assisted laparoscopic surg-ery (HALS) as an alternative to open conversion for complex gall-stone diseases, including Mirizzi syndrome (MS) and mimic MS.METHODS: Five patients with MS and mimic MS of 232 consecutive patients undergoing laparoscopic cholecystectomies were analyzed. HALS without a hand-port device was performed as an alternative to open conversion if the anatomy was still unclear after the neck of the gallbladder was reached.RESULTS: HALS was performed on three patients with MS type Ⅰ and 2 with mimic MS owing to an undear or abnormal anatomy, or an unusual circumstance in which an impacted stone was squeezed out from the infundibulum or the aberrant cystic duct impossible with laparoscopic approach. The median operative time was 165 min (range, 115-190 min). The median hand-assisted time was 75 min (range, 65-100 min). The median postoperative stay was 4 d (range, 3-5 d). The postoperative course was uneventful, except for 1 patient complicated with a minor incision infection. CONCLUSION: HALS for MS type Ⅰ and mimic MS is safe and feasible. It simplifies laparoscopic procedure, and can be used as an alternative to open conversion for complex gallstone diseases.

  9. Ovariectomy by laparotomy, a video-assisted approach or a complete laparoscopic technique in Santa Ines sheep

    OpenAIRE

    Teixeira, P. P. M; Padilha, L. C.; Motheo,T.F.; M.A.M. Silva; Oliveira, M.e.f. [UNESP; Silva, A. S. L. DA; Barros,F.F.P.C; Coutinho, L. N. [UNESP; F.N. Flores; Lopes,M.C.S.; Rodrigues, L. F. S.; W.R.R. Vicente

    2011-01-01

    The aim of the study was to compare the use of open ovariectomy, to the video-assisted laparoscopic approach or total laparoscopic ovariectomy in Santa Ines ewes. Surgical time and body weight gain/loss were recorded and post-surgical pain assessed using a behavioral scale. Laparotomy involved a longer surgical time (75 +/- 29.5 min), than the video-assisted (37.5 +/- 13.04 min; p < 0.05) or total laparoscopic approach (27.5 +/- 2.89; p < 0.01). Behavioral pain recorded score was higher for t...

  10. 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.

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

    OpenAIRE

    Fabrizio Dal Moro

    2014-01-01

    Introduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP) have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontinence remains a frustrating side-effect. Anatomically, bladder neck (BN) serves as an internal sphincter. The longitudinal fibres of BN may be identified and isolated with a meticulous dissection at...

  12. Clinical effect of laparoscopic-assisted radical gastrectomy in treatment of advanced gastric cancer and its effects on serum tumor markers and high sensitive C reactive protein in elderly patients%腹腔镜辅助胃癌根治术治疗老年进展期胃癌的临床效果及对血清肿瘤标志物和高敏C反应蛋白的影响

    Institute of Scientific and Technical Information of China (English)

    赵昕波; 游红勇; 李兵; 陈智敏; 刘东涛

    2015-01-01

    Objective To investigate the long-term clinical efficiency of laparoscopic-assisted radical gastrectomy in the treatment of advanced gastric cancer and the effects on the serum tumor markers and high sensitive C reactive protein (hs-CRP) in elderly patients.Methods Totally 86 elderly patients of advanced gastric cancer from August 2008 to June 2012 were enrolled and divided into laparoscopic group (43 cases) and laparotomy group (43 cases).The long-term therapeutic efficiency was evaluated.The levels of serum tumor markers including carcino embryonic antigen (CEA),neuron-specific enolase (NSE),cytokeratin fragment antigen 21-1 (CYFRA21-1) carbohydrate antigen 125 (CA125) and carbohydrate antigen 19-9(CA19-9),hs-CRP,blood coagulation index before and after operation were measured and compared between two groups.Results The operation time and the number of dissected lymph node showed no significant difference between two groups (P > 0.05);bleeding,using times of analgesic,gastrointestinal recovery time,hospitalization time and incidence of adverse reactions in laparoscopic group were significantly lower than those in traditional laparotomy group [(89 ±19) mlvs (122±25) ml,(0.68 ±0.28) timesvs (2.19 ±0.53) times,(2.6 ±0.4) d vs (3.9 ±0.5) d,(9.1 ±1.8) d vs (12.6 ±2.4) d,14.0% (6/43) vs 39.5% (17/43),P<0.05];overall survival of laparoscopic group and laparotomy group had no significant difference [10.2 months (95% CI:8.211-13.089) and 9.7 months (95% CI:5.804-10.596) (x2 =3.481,P =0.062).The serum tumor markers,coagulation indices and hs-CRP showed no significant differences between two groups before operation (P > 0.05);they were all improved after operation.The levels of CEA,NSE,CA125,CA19-9 and hs-CRP in laparoscopic group were all significantly lower compared with those in laparotomy group after operation [(10.1 ± 2.6) μg/L vs (18.8 ±5.2) μ.g/L,(14±3) μg/L vs (22±7) μg/L,(31 ±7) kU/L vs (45 ±7) kU/L,(28 ±7) kU/L vs (47±17) kU/L,(2

  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

    2013-01-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Omar M. Aboumarzouk

    2012-06-01

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

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

    Science.gov (United States)

    Patel, Vipul; Thaly, Rahul; Shah, Ketul

    2007-02-01

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

  17. 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. ...

  18. 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.

  19. Learning Curve Analysis of Different Stages of Robotic-Assisted Laparoscopic Hysterectomy

    Science.gov (United States)

    Tang, Feng-Hsiang

    2017-01-01

    Objective. To analyze the learning curves of the different stages of robotic-assisted laparoscopic hysterectomy. Design. Retrospective analysis. Design Classification. Canadian Task Force classification II-2. Setting. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Patient Intervention. Women receiving robotic-assisted total and subtotal laparoscopic hysterectomies for benign conditions from May 1, 2013, to August 31, 2015. Measurements and Main Results. The mean age, body mass index (BMI), and uterine weight were 46.44 ± 5.31 years, 23.97 ± 4.75 kg/m2, and 435.48 ± 250.62 g, respectively. The most rapid learning curve was obtained for the main surgery console stage; eight experiences were required to achieve duration stability, and the time spent in this stage did not violate the control rules. The docking stage required 14 experiences to achieve duration stability, and the suture stage was the most difficult to master, requiring 26 experiences. BMI did not considerably affect the duration of the three stages. The uterine weight and the presence of adhesion did not substantially affect the main surgery console time. Conclusion. Different stages of robotic-assisted laparoscopic hysterectomy have different learning curves. The main surgery console stage has the most rapid learning curve, whereas the suture stage has the slowest learning curve. PMID:28373977

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

    Science.gov (United States)

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

    2014-11-01

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

  1. Contemporary Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Qiang Fu

    2011-01-01

    Full Text Available Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

  2. Evaluating the oncologic outcomes in 152 patients undergoing extraperitoneal laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    LI Xun-gang; QU Fa-jun; WANG Jun-kai; CHEN Ming; CHEN Jie; CHEN Lu; WANG Kai; ZHANG Dong-xu; CUI Xin-gang; XU Dan-feng; HONG Yi; LI Yao; GAO Yi; LIU Yu-shan; YIN Lei

    2012-01-01

    Background Although many midterm oncologic data have been reported for extraperitoneal laparoscopic radical prostatectomy (ELRP) in westem countries,few oncologic data of the extraperitoneal procedure was published in China.The aim of the study was to evaluate the oncologic outcomes of patients treated with ELRP in China.Methods From January 2005 to March 2010,a total of 152 consecutive patients diagnosed with clinically localized prostate cancer were included in this study and treated with ELRP.The patients were staged according to the TNM (tumor,nodes,metastases) system.Median and mean postoperative follow-up were 28.1 months and 27.0 months,respectively.The patients were retrospectively analyzed for progression-free survival.Results One hundred and twelve cases (73.7%) were postoperatively diagnosed as pT2 in,and 40 cases (26.3%) as pT3.Positive lymph nodes were shown in 5 patients (3.3%).Gleason score was <7 in 49 men (32.2%),7 in 69 men (45.4%),and >7 in 34 men (22.4%).Positive surgical margins (PSM) were observed in 15 patients (9.9%),which included 32.0% of all pT3a cases and 46.7% of all pT3b cases,respectively.The overall prostate-specific antigen recurrence-free survival rate was 86% in all patients.The recurrence-free survival rates were 91.8% and 62.2% in pT2N0 patients and pT3N0 patients,respectively.Preoperative prostate-specific antigen,surgical margins,tumor stage,and lymph nodal status were identified as independent predictors of biochemical recurrence-free survival using multivariate Cox proportional hazard model.Conclusions ELRP is a precise,safe and effective procedure at this particular Chinese institution.The prognostic power of prostate-specific antigen relapse after ELRP is not identical to that described previously with transperitoneal or open retropubic approaches.

  3. Advances in Robotic-Assisted Radical Prostatectomy over Time

    Directory of Open Access Journals (Sweden)

    Emma F. P. Jacobs

    2013-01-01

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

  4. 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...

  5. 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.

  6. Comparison of Perioperative Outcomes of Total Laparoscopic and Robotically Assisted Hysterectomy for Benign Pathology during Introduction of a Robotic Program

    Directory of Open Access Journals (Sweden)

    Gokhan Sami Kilic

    2011-01-01

    Full Text Available Study Objective. Prospectively compare outcomes of robotically assisted and laparoscopic hysterectomy in the process of implementing a new robotic program. Design. Prospectively comparative observational nonrandomized study. Design Classification. II-1. Setting. Tertiary caregiver university hospital. Patients. Data collected consecutively 24 months, 34 patients underwent laparoscopic hysterectomy, 25 patients underwent robotic hysterectomy, and 11 patients underwent vaginal hysterectomy at our institution. Interventions. Outcomes of robotically assisted, laparoscopic, and vaginal complex hysterectomies performed by a single surgeon for noncancerous indications. Measurements and Main Results. Operative times were 208.3±59.01 minutes for laparoscopic, 286.2±82.87 minutes for robotic, and 163.5±61.89 minutes for vaginal (<.0001. Estimated blood loss for patients undergoing laparoscopic surgery was 242.7±211.37 cc, 137.4±107.50 cc for robotic surgery, and 243.2±127.52 cc for vaginal surgery (=0.05. The mean length of stay ranged from 1.8 to 2.3 days for the 3 methods. Association was significant for uterine weight (=0.0043 among surgery methods. Conclusion. Robotically assisted hysterectomy is feasible with low morbidity, a shorter hospital stay, and less blood loss. This suggests that robotic assistance facilitates a minimally invasive approach for patients with larger uterine size even during implementing a new robotic program.

  7. 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

    BACKGROUND: An increasing number of women are offered robotic-assisted laparoscopic hysterectomy as treatment for early-stage endometrial cancer in the developed world. OBJECTIVE: The aim of this study was to explore how women diagnosed with early-stage endometrial cancer experienced robotic......-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 guard," and "preparing oneself by seeking information." The women had confidence in the robotic technique and experienced fast recovery after robotic-assisted laparoscopic hysterectomy; however, they had uncertainties and unanswered questions concerning the postoperative course. Shortly after discharge...

  8. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Thomas Lendvay

    2008-01-01

    Full Text Available 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 trained in robotics, we anticipate an expansion of the applications of robotics in children. We believe that it is necessary to develop robotic surgery curricula for novice roboticists and residents so that patients may experience improved surgical outcomes.

  9. 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.

  10. Analysis Application Value of D2 Radical Excision for Gastric Cancer Assist for Laparoscopy%腹腔镜辅助下胃癌D2根治术的应用价值分析

    Institute of Scientific and Technical Information of China (English)

    王刚; 曹广东; 李敏慧; 刘选文

    2015-01-01

    目的:探讨腹腔镜辅助下胃癌D2根治术的安全性与可行性。方法对比腹腔镜下胃癌D2根治术(腹腔镜组)与常规开腹行胃癌D2根治术(常规开腹组)的治疗效果。结果腹腔镜组出血量、手术切口、术后胃肠功能恢复时间优于开腹组,P<0.05,差异具有统计学意义。结论腹腔镜胃癌D2根治术与开腹手术效果相当,创伤小且恢复快。%Objective To explore the safety and feasibility of laparoscopic assisted radical resection of gastric cancer under D2. Methods Comparison treatment effect on laparoscopic radical resection of gastric cancer D2 and conventional open radical resection for gastric cancer D2. Results Laparoscopic bleeding volume, operation incision, postoperative gastrointestinal function recovery time was better than the open group. Conclusion Laparoscopic D2 gastric cancer radical operation and open operation effect pretty, little trauma and quick recovery.

  11. Left Hand-assisted Laparoscopic Nephrectomy With Renal Vein Thrombectomy for Stage T3b Renal Cell Carcinoma.

    Science.gov (United States)

    Ghareeb, George M; Kenleigh, Dorian A; Brown, James A

    2016-04-01

    A 60-year-old male was found to have an 8.0 cm left renal mass and associated renal vein thrombus on computed tomography. The thrombus extended 3 mm beyond the right aortic border to within 1.6 cm of the left border of the inferior vena cava. The patient underwent left nephrectomy with renal vein thrombectomy using a hand-assisted laparoscopic approach. The tumor thrombus was "milked" proximally back into left renal vein, which was then divided with an endovascular stapler. Left renal vein thrombi extending to right margin of the aorta can be managed with hand-assisted laparoscopic approach.

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  13. Vesicovaginal fistula: An unusual complication of laparoscopic assisted nephroureterectomy

    Directory of Open Access Journals (Sweden)

    Pillai Rajiv

    2006-01-01

    Full Text Available We report a case of vesicovaginal fistula in 71-year-old lady who had previously undergone a lapascopic assisted nephroureterectomy for transitional cell carcinoma in her right ureter and kidney. The surgery was uncomplicated with no post-operative problems and was discharged on day on seven. She later presented five weeks following the initial operation with signs and symptoms suggestive of a vesicovaginal fistula, which was confirmed on cystogram and flexible cystosopy. She proceeded to have an abdominal (O′Connor′s repair of the fistula together with cystodiathermy for a few superficial bladder recurrences. The area of the fistula (within the bladder was noted to be tumour free. She had an uneventful post-operative recovery and was discharged from hospital on day 11. At six month follow-up, there was another superficial recurrence in the bladder that was resected, with no sign of fistula.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mori Masahiko

    2011-08-01

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

  16. Hand-Assisted Laparoscopic (HAL) Multiple Segmental Colorectal Resections: Are They Feasible and Safe?

    Science.gov (United States)

    Taggarshe, Deepa; Attuwaybi, Bashir O; Matier, Brian; Visco, Jeffrey J; Butler, Bryan N

    2015-04-01

    The objective of this study was to evaluate the short-term outcomes of synchronous hand-assisted laparoscopic (HAL) segmental colorectal resections. The surgical options for synchronous colonic pathology include extensive colonic resection with single anastomosis, multiple synchronous segmental resections with multiple anastomoses, or staged resections. Traditionally, multiple open, synchronous, segmental resections have been performed. There is a lack of data on HAL multiple segmental colorectal resections. A retrospective chart review was compiled on all patients who underwent HAL synchronous segmental colorectal resections by all the colorectal surgeons from our Group during the period of 1999 to 2014. Demographics, operative details, and short-term outcomes are reported. During the period, 9 patients underwent HAL synchronous multiple segmental colorectal resections. There were 5 women and 4 men, with median age of 54 (24-83) years and median BMI of 24 (19.8-38.7) kg/m(2). Two patients were on long-term corticosteroid therapy. The median operative time was 210 (120-330) minutes and median operative blood loss was 200 (75-300) mLs. The median duration for return of bowel function was 2 days and the median length of stay was 3.5 days. We had 2 minor wound infections. There were no deaths. Synchronous segmental colorectal resections with anastomoses using the hand-assisted laparoscopic technique are safe. Early conversion to open and use of stomas are advisable in challenging cases.

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

    Science.gov (United States)

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

    2015-04-01

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

  18. Place of Schauta's radical vaginal hysterectomy.

    Science.gov (United States)

    Roy, Michel; Plante, Marie

    2011-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Fernanda O. de Carvalho

    2014-04-01

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

  20. Synchronous Laparoscopic Radical Nephrectomy Left and Contralateral Right Hemicolectomy during the Same Endoscopic Procedure

    OpenAIRE

    2011-01-01

    Synchronous renal cell carcinoma in patients with colorectal carcinoma is reported in various percentages ranging from 0.03 up to 4.85% (Halak et al. (2000), Capra et al. (2003)). When surgical treatment is indicated usually two separate operations are planned for resection. In open surgery, in such cases simultaneous resection is recommended if possible. Few reports have described the resection of colorectal and renal cell carcinoma in a single laparoscopic procedure. We have shown that comb...

  1. Perioperative outcomes of laparoscopic radical nephrectomy for renal cell carcinoma in patients with dialysis-dependent end-stage renal disease.

    Science.gov (United States)

    Yamashita, Kaori; Ito, Fumio; Nakazawa, Hayakazu

    2012-06-01

    The aims of this study were: (i) to analyze the perioperative outcomes of laparoscopic radical nephrectomy for renal cell carcinoma in patients with dialysis-dependent end-stage renal disease and (ii) to reveal perioperative management problems that are unique to these patients. Between June 2004 and June 2011, laparoscopic radical nephrectomy was performed in 39 patients who had renal cell carcinoma and dialysis-dependent end-stage renal disease. The operative outcomes of these patients were compared with the operative outcomes of 104 non-end-stage renal disease patients with sporadic renal cell carcinoma who underwent laparoscopic radical nephrectomy during the same period. Laparoscopic surgery was completed in thirty-eight end-stage renal disease patients. One patient was converted to open surgery because of an intraoperative injury to the inferior vena cava. This patient was excluded from the analysis. The mean operative time was 240 min; blood loss, 157 mL; and postoperative hospital stay, 9.6 days. Postoperative complications were observed in six patients, as follows: retroperitoneal hematoma and abscess in one patient, thrombosis of the arteriovenous fistula in three patients, pneumonia in one patient, and gastrointestinal bleeding in one patient. Eleven patients required blood transfusions. There was no significant difference between the end-stage renal disease patients and the non-end-stage renal disease patients in the mean operative time or the amount of blood loss. In conclusion, laparoscopic radical nephrectomy is feasible for dialysis-dependent end-stage renal disease patients, as well as for non-end-stage renal disease patients; however, end-stage renal disease patients may have a higher probability of experiencing non-life-threatening complications.

  2. Robotic Camera Assistance and Its Benefit in 1033 Traditional Laparoscopic Procedures: Prospective Clinical Trial Using a Joystick-guided Camera Holder.

    Science.gov (United States)

    Holländer, Sebastian W; Klingen, Hans Joachim; Fritz, Marliese; Djalali, Peter; Birk, Dieter

    2014-11-01

    Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, Aktormed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Eight of nine surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable, but it cannot fully replace a human assistant.

  3. Study on the change of metabolic indexes and digestive enzymes of patients with laparoscopic radical gastrectomy for gastric cancer during the perioperative period

    Institute of Scientific and Technical Information of China (English)

    Wen-Tao He; Jun Huang; Na Hu

    2016-01-01

    Objective:To investigate the influence degree of laparoscopic radical gastrectomy for gastric cancer on the related body indexes during the perioperative period, including metabolic indexes and digestive enzymes.Methods:A total of 70 patients with gastric cancer who received treatment during the time of January 2014 to November 2015 in our hospital were divided into two groups by the method of random number table, 35 patients with gastric cancer in control group were treated with open radical gastrectomy, 35 patients with gastric cancer in observation group were treated with laparoscopic radical operation, then the proteometabolism and digestive enzymes indexes at different time before and after the operations of two groups were detected and compared.Results:The differences of detection results of two groups before the operation were not obvious, while the related indexes of proteometabolism of observation group at first, third, seventh and fourteenth day after the operation were all higher than those of control group, and the related indexes of digestive enzymes were all better than those of control group, which were all obviously different.Conclusion: The influence of laparoscopic radical gastrectomy on the fluctuation of the metabolic indexes and digestive enzymes of patients during the perioperative period are relatively smaller, and the postoperative recovery of patients are relatively better.

  4. Robot-assisted partial nephrectomy in contemporary practice

    Directory of Open Access Journals (Sweden)

    Youssef S. Tanagho

    2013-01-01

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

  5. 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.

  6. Effect of serum testosterone and percent tumor volume on extra-prostatic extension and biochemical recurrence after laparoscopic radical prostatectomy

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    Eu Chang Hwang

    2016-01-01

    Full Text Available Several studies have revealed that the preoperative serum testosterone and percent tumor volume (PTV predict extra-prostatic extension (EPE and biochemical recurrence (BCR after radical prostatectomy. This study investigated the prognostic significance of serum testosterone and PTV in relation to EPE and BCR after laparoscopic radical prostatectomy (LRP. We reviewed 520 patients who underwent LRP between 2004 and 2012. PTV was determined as the sum of all visually estimated tumor foci in every section. BCR was defined as two consecutive increases in the postoperative prostate-specific antigen (PSA >0.2 ng ml−1 . The threshold for serum total testosterone was 3.0 ng ml−1 . Multivariate logistic regression was used to define the effect of variables on the risk of EPE and BCR. A low serum testosterone (<3.0 ng ml−1 was associated with a high serum PSA, Gleason score, positive core percentage of the prostate biopsy, PTV, and all pathological variables. On multivariate analysis, similar to previous studies, the serum PSA, biopsy positive core percentage, Gleason score, and pathological variables predicted EPE and BCR. In addition, low serum testosterone (<3.0 ng ml−1 , adjusted OR, 8.52; 95% CI, 5.04-14.4, P= 0.001 predicted EPE and PTV (adjusted OR, 1.02; 95% CI, 1.01-1.05, P= 0.046 predicted BCR. In addition to previous predictors of EPE and BCR, low serum testosterone and PTV are valuable predictors of EPE and BCR after LRP.

  7. Laparoscopic-assisted resection of giant sigmoid lipoma under colonoscopic guidance.

    Science.gov (United States)

    Ladurner, R; Mussack, T; Hohenbleicher, F; Folwaczny, C; Siebeck, M; Hallfeld, K

    2003-01-01

    Colonic lipomata are rare and mostly asymptomatic lesions; but as they become larger they may produce abdominal pain, constipation, diarrhea, hemorrhage, and intussusception. We report the case of a 75-year-old man who suffered from nonspecific recurrent abdominal pain in the left upper and lower quadrants and had variable episodes of diarrhea and constipation of 4 weeks' duration. During colonoscopy, a giant intraluminal polyp was diagnosed at 35 cm. Abdominal helical computed tomography (CT) revealed a constipating colonic tumor with a diameter of >or=50 mm and density values equal to fat. During laparoscopic surgery in the lithotomy position, the sigmoid and the descending colon were mobilized using a Harmonic scalpel. The origin of the polyp was localized precisely under colonoscopic guidance. The former 12-mm incision in the left lower quadrant was expanded to approximately 70 mm for extracorporal tumor resection. The left and sigmoid colon resections were carried out, and the polyp was removed by full-wall excision. After closure with a single-layer suture, the colon was pushed back into the peritoneal cavity. The patient had an uneventful recovery and was discharged 10 days postoperatively. Histology confirmed a benign lipoma of the descending colon. Laparoscopic-assisted resection under endoscopic guidance proved to be suitable for the removal of large colonic polyps without complications.

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

    Science.gov (United States)

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

    2016-05-01

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

  9. 达芬奇机器人辅助腹腔镜前列腺癌根治术患者围手术期护理%Perioperative nursing of patients undergoing laparoscopic radical prostatectomy with Da Vinci robot

    Institute of Scientific and Technical Information of China (English)

    王芸; 李萍

    2016-01-01

    Objective:To summarize the perioperative nursing methods of Da Vinci robot assisted laparoscopic radical prostatectomy to improve the quality of nursing. Methods:Selected 60 cases of patients undergoing laparoscopic radical prostatectomy assisted with Da Vinci robot dated from July December in 2015 were selected as observation objects in this study. The preoperative nutritional diet, preoperative preparation and psychological nursing were strengthened. Make sure good coordination was conducted during the operation. Postoperative monitoring and good prevention and care of complications were conducted af-ter the operation. Results:Perioperative nursing was performed and 60 patients safely passed the perioperative period. Conclusion:Effective care measures for patients during robot-assisted laparoscopic radical prostatectomy can effectively improve the quality of nursing and promote patient rehabilitation.%目的::总结达芬奇机器人辅助腹腔镜前列腺癌根治术围手术期的护理方法,以提高护理质量。方法:选取我科2015年7~12月60例实施达芬奇机器人辅助腹腔镜前列腺癌根治术的患者作为观察对象,加强患者术前营养饮食、术前准备及心理护理,术中做好手术配合,术后严密监测,做好并发症的预防及护理。结果:通过做好围术手期的护理措施,60例患者均安全度过围手术期。结论:对机器人辅助腹腔镜前列腺癌根治术的患者,采取有效的护理措施,可有效提高护理质量,促进患者康复。

  10. Robotic-Assisted Laparoscopic “Salvage” Rectopexy for Recurrent Ileoanal J-Pouch Prolapse

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    Madhu Ragupathi

    2010-01-01

    Full Text Available Total restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA has become the standard of care for the surgical treatment of ulcerative colitis. Despite its correlation with an excellent quality of life and favorable long-term outcomes, RP/IPAA has been associated with several complications. Prolapse of the ileoanal pouch is a rare and debilitating complication that should be considered in the differential diagnosis of pouch failure. Limited data exist regarding the prevalence and treatment of pouch prolapse. We present the case of a recurrent J-pouch prolapse treated with a novel minimally invasive “salvage” approach involving a robotic-assisted laparoscopic rectopexy with mesh.

  11. Hand-assisted laparoscopic colectomy for colovesical fistula associated with diverticular disease.

    Science.gov (United States)

    Spector, Rona; Bard, Vyacheslav; Zmora, Oded; Avital, Shmuel; Wasserberg, Nir

    2014-06-01

    To evaluate the feasibility and short-term outcome of hand-assisted laparoscopic colectomy (HALC) for the treatment of colovesical fistula complicating diverticulitis, we reviewed the files of all 34 patients who underwent surgery for diverticular colovesical fistula in 1999 to 2010 at a major tertiary medical center. Twenty-one were treated with HALC and 13 with open colectomy. There were no differences in demographic parameters among the groups. HALC and open colectomy had similar operating time. HALC was associated with a significantly shorter hospital stay compared with open colectomy (5 vs. 8 d, P=0.001). HALC proved to be technically feasible and safe in this setting. It provided benefits of tactile feedback and manual manipulation as in open colectomy while maintaining the advantages of a minimal invasive approach.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  13. Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

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    William T. Lowrance

    2010-01-01

    Full Text Available The rapid adoption of robotic-assisted laparoscopic radical prostatectomy (RALP has occurred despite a lack of high-quality evidence demonstrating its oncologic advantages, safety, or cost effectiveness compared with open radical retropubic prostatectomy (ORP. This review examines the current literature comparing ORP and RALP, focusing on perioperative, oncologic, functional, and economic outcomes.

  14. 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

    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...... 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...... in Danish kroner between total abdominal hysterectomy and robotic-assisted laparoscopic hysterectomy. RESULTS: The average cost of consumables was 12,642 Danish kroner more expensive per patient for robotic-assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7...

  15. [Robotic assisted laparoscopic colposacropexy in the treatment of pelvic organ prolapse].

    Science.gov (United States)

    Moreno Sierra, Jesús; Galante Romo, Isabel; Ortiz Oshiro, Elena; Núñez Mora, Carlos; Silmi Moyano, Angel

    2007-05-01

    Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clinico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair.

  16. Robotic versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for the treatment of early cervical cancer

    Directory of Open Access Journals (Sweden)

    Jagdishwar G Goud

    2014-02-01

    Conclusions: According to our experience, robotic radical hysterectomy appears to be safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences when compared to TLRH, with respect to operative time, blood loss, hospital stay. Regarding the oncological outcome, Robotic radical hysterectomy is superior in terms of number of lymph nodes and parametrial bulk; although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcome. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 34-39

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

    Directory of Open Access Journals (Sweden)

    Fabrizio Dal Moro

    2014-06-01

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

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

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    Elizabeth M. Carnicom

    2014-10-01

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

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

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    Tiberio M. Siqueira Jr.

    2010-08-01

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

  20. 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.

  1. Radical prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Sønksen, Jens; Jakobsen, Henrik

    2014-01-01

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

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

    Science.gov (United States)

    Patel, Vipul; Thaly, Rahul; Shah, Ketul

    2007-02-01

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

  3. [A case of gallstone ileus which the cholecystoduodenal fistula closed spontaneously after laparoscopic-assisted simple enterolithotomy].

    Science.gov (United States)

    Okubo, Hitoshi; Nogawa, Tatsuhiko; Jibiki, Masaaki

    2006-10-01

    A 47-year-old woman complaining of diarrhea and vomiting was admitted on the suspicion of gallstone ileus 4 days after onset. Upper gastrointestinal radiography by Gastrografin showed a cholecystoduodenal fistula. Laparoscopic-assisted simple enterolithotomy was performed. The omentum was severely adherent to the gall bladder and fistula, though biliary surgery was not performed. Without second look operation, for cholecystoduodenal fistula closed spontaneously.

  4. Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study

    OpenAIRE

    Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

    2016-01-01

    Background Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). Methods The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italia...

  5. Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Avinash Chennamsetty

    2015-01-01

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

  6. Camera and trocar placement for robot-assisted radical and partial nephrectomy: which configuration provides optimal visualization and instrument mobility?

    Science.gov (United States)

    Cabello, Jose M; Bhayani, Sam B; Figenshau, Robert S; Benway, Brian M

    2009-10-01

    Proper camera and trocar placement is critical to the success of minimally invasive procedures. For robot-assisted renal surgery, two basic trocar configurations have been described. The medial approach, using a 30° downward-angled lens mimics a traditional transperitoneal laparoscopic configuration. An alternative configuration, using a 0° or 30° upward-angled lens approach locates the camera laterally, evoking a position sense similar to a retroperitoneal approach. Our objective is to compare the differences between these two standard approaches for robot-assisted renal surgery. After performing a review and analysis of available literature, our group tested both the medial and lateral camera approaches during robotic renal surgery performed in human patients. The medial approach provides a wide field of view, because of the relatively greater distance to the target structures and a horizon line closer to the patient's midline. The lateral configuration offers significantly different visualization. The relative proximity to the target structures and a higher horizon line results in a comparatively restricted field of vision. Instrument mobility is comparable between the two approaches. Meta-analysis of the literature reveals that both approaches provide comparable overall operative times for both radical and partial nephrectomy, though there is a trend towards shorter overall operative times for partial nephrectomy performed through a medial approach. The medial trocar configuration provides a familiar working environment for both surgeon and assistant; the wide-angle view enables enhanced visualization of surrounding structures and tracking of the instruments inserted by the assistant. The lateral approach offers the potential advantage of a closer view of the kidney, but does so at the expense of a significantly restricted field of view. In our experience, a medial trocar configuration offers significant advantages over the lateral trocar configuration, and

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

    Directory of Open Access Journals (Sweden)

    Whitney R. Halgrimson

    2010-01-01

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

  8. Laparoscopic assistant operation for 51 cases with rectal cancer%腹腔镜辅助下直肠癌手术51例体会

    Institute of Scientific and Technical Information of China (English)

    宋枫; 高峰; 杨增强; 徐明; 赵勇; 石磊

    2011-01-01

    Objective To explore laparoscopic assistant operation for rectal cancer surgical methods and clinical effects. Methods A retrospective analysis of 51 patients undergone laparoscopic radical operation for rectal cancer from Mar 2007 to October 2010 in our section office were done. Results 51 cases had the successful completion of surgery, the average operative time was 150 min, mean blood loss was 80 ml, the av-erage recovery time of postoperative bowel function was 48h, average length of stay was 9 d; no periopera-tive death and complications occurred; postoperative follow-up from 1 to 36 months, no tumor cultivation in incision and Trocar, one cases recurrenced. Conclusion Laparoscopic radical rectal cancer surgery can be safely performed in patients with colorectal cancer which have light trauma, less blood loss, less pain, few complication and rapid recovery.%目的 探讨腹腔镜辅助下直肠癌根治术的手术方法及疗效.方法 回顾分析2007年3月至2010年10月我科51例直肠癌患者行腹腔镜辅助下直肠癌根治术的临床资料.结果 51例均顺利完成手术,平均手术时间150 min,平均出血80mL,术后肠道功能平均恢复时间48 h,平均住院9 d;无围手术期死亡及并发症发生;术后随访1~36个月,切口及Trocar处未见肿瘤种植转移.结论 腹腔镜直肠癌根治术患者创伤小、出血少、痛苦轻、并发症少、康复快,是治疗直肠癌安全有效的方法.

  9. Effect of deep anesthesia on blood gas and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Zhen Wang; Xiao-Fan Li; Hui Wang; Zhi-Jun Mao; Tong Xue; Rui Yang

    2016-01-01

    Objective:To investigate the effects of deep anesthesia on blood gas and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer. Methods:A total of 84 gastric cancer patients in our hospital were randomly divided into observation group (42 cases) and control group (42 cases). Patients in observation group were treated by deep anesthesia, while the control group was treated with shallow anesthesia. The blood gas was observed and compared before and after CO2 pneumoperitoneum, and the immune function was observed and compared before anesthesia, after operation and 72 h post-operation. Results:The PaCO2 and pH level of patients in the two groups had no significant difference before pneumoperitoneum;Compared with before pneumoperitoneum, no obvious blood gas change was observed in the observation group, the difference had no statistically significant;Blood gas level of control group was significantly higher than that of before pneumoperitoneum , the difference was statistically significant, pH (7.26±0.07) was statistically decreased;After pneumoperitoneum, the level of PaCO2 and pH was significantly different in both groups , the difference was statistically significant. Indexes of the patients in the observation and control group of CD3+, CD4+, CD4+/CD8+, NK level had no significant difference before anesthesia, the difference was not statistically significant;The immunology index of CD3+, CD4+, CD4+/CD8+and NK cell levels of the postoperative patients in both groups were significantly lower than before anesthesia, and the differences were statistically significant, but each index in the observation group decreased significantly less than that of the control group, the difference was statistically significant;The immunological indexes can be restored to before anesthesia postoperative 72 h with two groups, and had no significant difference. Conclusion:The blood gas analysis index was stable and the immune function was suppressed in

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine the incid......INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine...... the incidence of complications according to the Clavien-Dindo scale after robotic-assisted laparoscopic hysterectomy (RALH) for early-stage endometrial cancer and atypical complex hyperplasia. The Clavien-Dindo scale grades the severity of complications. METHODS: This was a retrospective, descriptive cohort....... CONCLUSION: The types and frequency of complications observed in this study resemble those reported in similar studies of RALH for malignant gynaecologic conditions. Health-care professionals treating and caring for women with early-stage endometrial cancer should know of the types and frequency of post...

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  12. Robotic assisted laparoscopic adrenalectomy: Initial experience from a tertiary care centre in India

    Directory of Open Access Journals (Sweden)

    Mrinal Pahwa

    2015-01-01

    Full Text Available Introduction: Laparoscopic adrenalectomy (LA is now considered the standard for treatment of surgically correctable adrenal disorders. Robotic adrenalectomy has been performed worldwide and has established itself as safe, feasible and effective approach. We hereby present the first study in robotic transperitoneal LA from Indian subcontinent. Materials and Methods: We conducted a retrospective evaluation of 25 patients who had undergone robotic assisted LA at a tertiary health centre by a single surgeon. Demographic, clinical, histopathological and perioperative outcome data were collected and analysed. Results: Mean age of the patients was 45 years (range: 27-65 years. Eleven male and 14 female patients were operated. Mean operative time was 139 min ± 30 min (range: 110-232 min and mean blood loss was 85 ml ± 12 ml (range: 34-313 ml. Mean hospital stay was 2.5 ± 1.05 days (range: 2-6 days. Mean visual analogue scale score was 3.2 (range: 1-6 mean analgesic requirement was 50 mg diclofenac daily (range: 0-150 mg. Histopathological evaluation revealed 11 adenomas, eight phaeochromocytomas, two adrenocortical carcinomas, and four myelolipomas. According to Clavien-Dindo classification, three patients developed Grade I post-operative complications namely hypotension and pleural effusion. Conclusion: Robotic adrenalectomy is safe, technically feasible and comfortable to the surgeon. It is easier to perform with a short learning curve.

  13. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer

    Science.gov (United States)

    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan

    2017-01-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications. PMID:28344966

  14. [A technic for laparoscopic gastrostomy].

    Science.gov (United States)

    Kala, Z; Vomela, J; Hanke, I

    1995-08-01

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

  15. THE CLINICAL STUDY ON LAPAROSCOPIC RADICAL GASTRECTOMY FOR GASTRIC CANCER%腹腔镜胃癌根治手术的临床研究

    Institute of Scientific and Technical Information of China (English)

    李俊; 谭忆广; 周志涛; 毛常青; 吕培标; 钟国英; 王存川

    2011-01-01

    [目的]探讨腹腔镜胃癌根治手术的安全性、可行性及肿瘤根治性.[方法]选择2005年12月~2010年12月普外科行腹腔镜胃癌D2根治术35例为腹腔镜组,并选择同期开腹胃癌根治术40例为对照组,比较两组手术相关指标、肿瘤根治性指标及术后随访患者的生存率.[结果]腹腔镜组手术时间较对照组长,术中出血量较对照组少,切口长度较对照组短.差异具有统计学意义(均P<0.05);腹腔镜组术后排气时间、首次进流质时间及术后住院时间明显较对照组缩短(P<0.05),两组总并发症发生率比较差异无统计学意义(P>0.05);腹腔镜组肿瘤根治性指标淋巴结清扫数目、近远端切缘距离及1、3、5年生存率均与对照组差异无统计学意义(P>0.05).[结论]腹腔镜胃癌D2根治术是安全、可行的,能达到与开腹根治性全胃切除术相同的肿瘤根治性,且比开腹手术更具微创优势.%[Objective] To study the safety, feasibility and curative result of laparoscopic radical gastrectomy for gastric cancer. [Methods] 35 cases of laparoscopic radical gastrectomy for gastric cancer and 40 cases of open D2 radical gastrectomy were operated in our department from December 2005 to December 2010. The operative index, curative result index and survival rate in two groups were compared. [ Results] The operation time was longer, volume of bleeding was less, and the length of incision was shorter in laparoscopic radical gastrectomy group (P < 0.05) ; postoperative time of farting, the time of eating fluid and hospital stay were shorter in laparoscopic group compared to those in control group (P < 0.05). There was no significant difference in the rates of postoperative complications. The clear number of lymph node dissection , the proximal and distal margin from tumor and the 1-, 3-and 5-Y survival rate between the two groups were not different (P > 0.05). [ Conclusion] The laparoscopic D2 radical

  16. Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches

    Science.gov (United States)

    Sheng, Qin-Song; Pan, Zhe; Chai, Jin; Cheng, Xiao-Bin; Liu, Fan-Long; Wang, Jin-Hai; Chen, Wen-Bin

    2017-01-01

    Purpose To demonstrate the feasibility, safety, and technical strategies of hand-assisted laparoscopic complete mesocolic excision (HAL-CME) and to compare oncological outcomes between HAL-CME and the open approach (O-CME) for right colon cancers. Methods Patients who were scheduled to undergo a right hemicolectomy were divided into HAL-CME and O-CME groups. Measured outcomes included demographic variables, perioperative parameters, and follow-up data. Demographic variables included age, sex distribution, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, previous abdominal surgery, tumor localization, and potential comorbidities. Perioperative parameters included incision length, operative time, blood loss, conversion rate, postoperative pain score, postoperative first passage of flatus, duration of hospital stay, total cost, number of lymph nodes retrieved, TNM classification, and postoperative complications. Follow-up data included follow-up time, use of chemotherapy, local recurrence rate, distant metastasis rate, and short-term survival rate. Results In total, 150 patients (HAL-CME, 78; O-CME, 72) were included. The groups were similar in age, sex distribution, BMI, ASA classification, history of previous abdominal surgeries, tumor localization, and potential comorbidities. Patients in the HAL-CME group had shorter incision lengths, longer operative times, less operative blood loss, lower pain scores, earlier first passage of flatus, shorter hospital stay, higher total costs, similar numbers of lymph nodes retrieved, similar TNM classifications, and a comparable incidence of postoperative complications. The 2 groups were also similar in local recurrence rate, distant metastasis rate, and short-term survival rate. Conclusion The results demonstrate that the HAL-CME procedure is a safe, valid, and feasible surgical method for right hemicolon cancers. PMID:28203556

  17. Laparoscopic-assisted Ventral Hernia Repair: Primary Fascial Repair with Polyester Mesh versus Polyester Mesh Alone.

    Science.gov (United States)

    Karipineni, Farah; Joshi, Priya; Parsikia, Afshin; Dhir, Teena; Joshi, Amit R T

    2016-03-01

    Laparoscopic-assisted ventral hernia repair (LAVHR) with mesh is well established as the preferred technique for hernia repair. We sought to determine whether primary fascial closure and/or overlap of the mesh reduced recurrence and/or complications. We conducted a retrospective review on 57 LAVHR patients using polyester composite mesh between August 2010 and July 2013. They were divided into mesh-only (nonclosure) and primary fascial closure with mesh (closure) groups. Patient demographics, prior surgical history, mesh overlap, complications, and recurrence rates were compared. Thirty-nine (68%) of 57 patients were in the closure group and 18 (32%) in the nonclosure group. Mean defect sizes were 15.5 and 22.5 cm(2), respectively. Participants were followed for a mean of 1.3 years [standard deviation (SD) = 0.7]. Recurrence rates were 2/39 (5.1%) in the closure group and 1/18 (5.6%) in the nonclosure group (P = 0.947). There were no major postoperative complications in the nonclosure group. The closure group experienced four (10.3%) complications. This was not a statistically significant difference (P = 0.159). The median mesh-to-hernia ratio for all repairs was 15.2 (surface area) and 3.9 (diameter). Median length of stay was 14.5 hours (1.7-99.3) for patients with nonclosure and 11.9 hours (6.9-90.3 hours) for patients with closure (P = 0.625). In conclusion, this is one of the largest series of LAVHR exclusively using polyester dual-sided mesh. Our recurrence rate was about 5 per cent. Significant mesh overlap is needed to achieve such low recurrence rates. Primary closure of hernias seems less important than adequate mesh overlap in preventing recurrence after LAVHR.

  18. Laparoscopic radical cystectomy with orthotopic ileal neobladder:report of 9 cases%腹腔镜根治性膀胱切除及回肠原位新膀胱术(附9例报告)

    Institute of Scientific and Technical Information of China (English)

    卢猛; 程欢; 陈家存; 温儒民; 李望; 毛立军; 刘俊杰

    2013-01-01

    目的 性.术后9例日间尿控均良好,2例存在夜间尿失禁.术后随访2~8个月,1例出现新膀胱腹壁瘘,1例发生新膀胱前假性尿液囊肿,2例出现肾盂肾炎.结论 腹腔镜根治性膀胱切除加回肠原位新膀胱术具有切口小、损伤少、疼痛轻、出血少、术后恢复快等优势,将成为肌层浸润性膀胱癌的标准手术方式.%Objective To summarize the experience and benefits of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer. Methods 9 patients with bladder cancer underwent laparoscopic radical eystectomy with orthotopic ileal neobladder. The surgical procedure included standard laparoscopic pelvic lymphadenectomy , radical resection of bladder , extracorporeal formation of ileal pouch , extracorporeal implantation of ureters , and laparoscopic urethra - neobladder anastomosis. Results Laparoscopic radical cystectomy was successfully performed in 9 patients with orthotopic ileal neobladder. No operations were converted to open surery and there was no peri -operative mortality. The mean operation time was 370 min and mean blood loss was 650 ml. No involvement of incisional edge was found in all the patients. Continence in all patients receiving neobladder was fully satisfactory during the day , 2 patients had urinary incontinence at night. The follow -up of 2 -8 months showed complications including 1 fistula between neobladder and abdominal wall, 1 secondary urinoma anterior neobladde and 2 pyelonephritis. Conclusion Laparoscopic radical cystectomy has the advantage of being minimally invasive , decreased blood loss and postoperative pain , as well as a shorter hospital stay and recovery. It will become a standard treatment of muscle -invasive bladder cancer.

  19. Oncologic outcomes and complication rates after laparoscopic-assisted cryoablation: a EuRECA multi-institutional study

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjaergaard; Lagerveld, Brunolf W; Keeley, Francis;

    2016-01-01

    -30) mm. The transperitoneal approach was used in 77.7% of the patients. The median postoperative hospital stay was 2 days. In all, 514 patients with a biopsy-confirmed renal cell carcinoma (RCC) were available for survival analyses. The median (IQR) follow-up for the RCC-cohort was 36 (14-56) months......OBJECTIVE: To assess complication rates and intermediate oncological outcomes of laparoscopic-assisted cryoablation (LCA) in patients with small renal masses (SRMs). PATIENTS AND METHODS: A retrospective review of 808 patients treated with LCA for T1a SRMs from 2005 to 2015 at eight European...

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    OBJECTIVE: The aim of this prospective cohort study using patient-reported outcome measures (PROMs) was to detect short term changes in functioning, symptoms and health-related quality of life (HRQoL) after robotic-assisted laparoscopic hysterectomy (RALH) for endometrial cancer or atypical complex...... level in a diary during the first 5 weeks after surgery. RESULTS: We found a clinically relevant decrease in HRQoL after 1 week. At 5 weeks postoperatively, HRQoL was again at the preoperative level. Fatigue, pain, constipation, gastrointestinal symptoms, and appetite were all negatively affected 1 week...

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

    Institute of Scientific and Technical Information of China (English)

    李雪梅; 季惠翔; 潘进洪; 方强; 周占松; 陈志文

    2013-01-01

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

  2. Laparoscopic Partial Nephrectomy

    Directory of Open Access Journals (Sweden)

    Ender Özden

    2015-03-01

    Full Text Available Patients with renal tumors <7 cm and those at risk for a significant loss of renal function should be managed with a partial nephrectomy if it is technically feasible. Partial nephrectomy (PN results in similar oncologic outcomes with radical nephrectomy. With advent of the technology and increase utilization of laparoscopic surgery, laparoscopic approach is considered as one of the option for partial nephrectomy. However laparoscopic partial nephrectomy is technically very difficult procedure and should be performed only by physicians with extensive experience using this approach. In this section, we aimed to present the technical steps of laparoscopic partial nephrectomy

  3. Applications of robot assisted laparoscopic operation in urinary surgery%机器人辅助腹腔镜手术在泌尿外科的应用

    Institute of Scientific and Technical Information of China (English)

    袁建林; 孟平

    2015-01-01

    近年来机器人辅助腹腔镜手术系统开展范围较广,技术较为成熟,正逐步应用于泌尿外科手术领域,目前可施行肾切除术、肾肿瘤剜除术、肾上腺肿瘤切除术、肾盂成形术、全膀胱切除术、前列腺癌根治术等,具有出血少、恢复快、住院时间短、并发症少等优点。本文就其在泌尿外科的应用作一综述。%In recent years,application of robot assisted laparoscopic operation has been carried out many fields and gradually used in urinary surgery.Currently,it has been used in a number of urological operations such as nephrectomy,renal tumor enucleation, excision of adrenal tumor,nephropyeloplasty,total cystectomy and radical prostatectomy.The technique has advantages of less bleeding, quicker recovery,shorter hospitalization time and less complications.This article reviewed its application in urinary surgery.

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

    Institute of Scientific and Technical Information of China (English)

    何洪生; 曾文龙; 朱柏炼; 杜永御; 赖扬城

    2014-01-01

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

  5. Avoiding and managing vascular injury during robotic-assisted radical prostatectomy.

    Science.gov (United States)

    Sotelo, René; Nunez Bragayrac, Luciano A; Machuca, Victor; Garza Cortes, Roberto; Azhar, Raed A

    2015-02-01

    There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented.

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

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

  7. 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

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

    Directory of Open Access Journals (Sweden)

    D. Yu. Pushkar

    2010-01-01

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

  9. Care of the patient undergoing radical cystectomy with a robotic approach.

    Science.gov (United States)

    Overstreet, Dana L; Sims, Terran Warren

    2006-04-01

    Radical cystectomy or cystoprostatectomy with urinary diversion is the gold standard for the treatment of muscle-invasive bladder cancer. Cystectomy can be through an open or robotic-assisted laparoscopic approach. Advances in laparoscopy, robotic surgery, and urological oncology have made it possible for select surgeons to perform nerve-sparing robotic-assisted laparoscopic radical cystoprostatectomy. Advantages of robotic surgery may be minimal blood loss, shorter hospital stay, quicker recovery, and possibly more precise and rapid removal of the bladder depending on the experience and expertise of the surgeon. Appropriate patient selection and thorough pre-operative evaluation, however, are key in maximizing positive surgical outcomes. The experience at the University of Virginia with robotic-assisted laparoscopic radical cystectomy will be discussed.

  10. Robot-Assisted Laparoscopic Radical Prostatectomy in the Morbidly Obese Patient

    Directory of Open Access Journals (Sweden)

    Jennifer Yates

    2011-01-01

    Full Text Available Introduction. Obesity and prostate cancer are among the more common health issues affecting men in the United States. Methods. We retrospectively reviewed morbidly obese (BMI ≥ 40 kg/m2 patients undergoing RALP between 2004–2009 at our institution. Parameters including operative time, estimated blood loss, hospital stay, pathology, and complication rate were examined. Results. A total of 15 patients were included, with a mean BMI of 43 kg/m2. Mean preoperative PSA was 5.78 ng/dL, and Gleason score was 6.6. Mean operative time was 163 minutes, and mean estimated blood loss was 210 mL. The mean hospital stay was 1.3 days. Positive margins were noted in 2 (13% patients, each with pT3 disease. There were no blood transfusions, open conversions, or Clavien Grade II or higher complications. Conclusions. In our experience, RALP is feasible in morbidly obese patients. We noted several challenges in this patient population which were overcome with modification of technique and experience.

  11. Standardized procedure of robotic assisted laparoscopic radical prostatectomy from case 1 to case 1200

    Directory of Open Access Journals (Sweden)

    Sheng-Chun Hung

    2016-12-01

    Conclusions: Meticulous preoperative evaluation, MRI planning and a dedicated robotic team to do RALP is essential. The procedure was standardized during each step. Complications were minimized. High risk patients had an acceptable oncologic outcome.

  12. Laparoscopic assisted synchronous gastrectomy and colectomy with lymphadenectomy for double cancer in our experience.

    Science.gov (United States)

    Hanai, Tsunekazu; Uyama, Ichiro; Sato, Harunibu; Masumori, Kouji; Katsuno, Hidetoshi; Ito, Masahiro; Maeda, Koutaro

    2012-10-01

    Laparoscopic gastrointestinal surgery with lymphadenectomy is rarely performed for multiple gastrointestinal cancers. We report four patients undergoing laparoscopic surgery for synchronous cancer of the stomach and colon. Resection of each organ with lymphadenectomy was performed by each specialist and the region of the lymphadenectomy was determined according to the lesion of cancer and its depth. The selection of gastric anastomosis, whether intracorporeal or extracorporeal, depended on the resecting areas of the large bowel to allow a small incision. All four cases were male with the median age of 69 (range 59-77) years. The median number of trocars used were 6 (range 5-8) and median length of incision was 4.5 cm (range 4-4.5 cm). The median operative time and blood loss were 495.5 minutes (range 390-605) and 88 g (range 36-245), respectively. In all four cases, laparoscopic surgery with a lymphadenectomy on each region was successfully accomplished according to the respective progression stage. Anastomosis was completed with a small incision by using techniques and devices to provide a variation of anastomosis methods and incision positions. Laparoscopic surgery with lymphadenectomy was also undertaken for a patient with gastric remnant cancer and colorectal cancer. The median length of the postoperative hospital stay was 14.5 days (range 12-29). No complications were observed after the surgery. There was no case of recurrence during a median follow-up of 84.3 months (range 54.9-111.5). Laparoscopic surgery was feasible for patients with double cancer of the stomach and colon.

  13. 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.

  14. Laparoscopic splenectomy and infection

    Directory of Open Access Journals (Sweden)

    Seyyit Kuş

    2013-03-01

    Full Text Available Partial laparoscopic splenectomy is performed commonly in hereditary spherocytosis. Vaccination against capsulatedbacteria is essential before undergoing splenectomy. Hand-assisted laparoscopic splenectomy is known to be effectiveand convenient in the removal of a spleen larger than 20 cm in size. Laparoscopic splenectomy provides less hemorrhage,reduced surgical trauma and pain, shorter duration of hospital stay, and early recovery. Laparoscopic approachwas particularly effective in reducing the infectious complication rate compared with the open surgery. Infectious complicationsof splenectomy were observed to be wound infection, subphrenic abscess, and sometimes pulmonary infection.J Microbiol Infect Dis 2013; 3(1: 1-2Key words: Laparoscopy, splenectomy, infection

  15. 经后腹膜腔途径和经腹腔途径腹腔镜下根治性肾切除术安全性和疗效的Meta分析%Retroperitoneal laparoscopic radical nephrectomy versus transperitoneal laparoscopic radical nephrectomy: a meta-analysis of safety and efficiency

    Institute of Scientific and Technical Information of China (English)

    赵强; 张骞; 金杰

    2014-01-01

    目的 对经后腹膜腔途径与经腹腔途径腹腔镜下根治性肾切除术的相关文献进行Meta分析,以比较两种术式的安全性和疗效. 方法 检索2000年1月至2012年10月关于腹腔镜下根治性肾切除术的相关文献.国外文献选用Pubmed、Embase、Cochrane library数据库,以transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy为关键词.国内文献选用中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库和万方中文数据库,以经腹腔、经后腹膜腔、根治性肾切除、腹腔镜作为关键词.由2名评价者共同评价纳入研究的质量,并采用Cochrane协作网提供的Revman 5.0统计软件对纳入文献进行Meta分析. 结果 共有9篇临床对照研究符合纳入标准,包括7篇国外文献和2篇中文文献,基线资料具有可比性.共纳入患者1 306例,其中经后腹膜腔途径组520例,经腹腔途径组786例.在手术时间(OR=16.23,95%CI 1.62~30.84)和术后并发症发生率(OR=2.44,95%CI 1.35 ~4.41)方面,经后腹膜腔途径显著优于经腹腔途径,差异均有统计学意义(P<0.05).在手术切口长度、术中出血量、住院时间、中转开放率、5年无复发生存率和5年总体生存率等方面两者比较差异均无统计学意义(P>0.05). 结论 经后腹膜腔途径腹腔镜下根治性肾切除术在手术时间和术后并发症方面显著优于经腹腔途径,但两种术式的疗效无显著差异,各中心可根据自身习惯选择手术方式.%Objective To compare the safety and efficiency of retroperitoneal laparoscopic and transperitoneal laparoscopic radical nephrectomy by meta-analysis.Methods A systematic review of the literature about laparoscopic radical nephrectomy was performed,searching Medline,Embase,Cochrane library,CBM,CNKI,VIP and Wan Fang database from January 2000 to October 2012.The key words were transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy

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

    OpenAIRE

    Rajiv Yadav; Somendra Bansal; Narmada P Gupta

    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 patie...

  17. Nerve-sparing techniques and results in robot-assisted radical prostatectomy

    OpenAIRE

    Tavukçu, Hasan Hüseyin; Aytac, Omer; Atug, Fatih

    2016-01-01

    Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative an...

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

    Institute of Scientific and Technical Information of China (English)

    徐立伟

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

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

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    Henry Y. Lin

    2015-03-01

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

  2. Operative procedures of single-incision laparoscopic repair of pediatric epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle

    Directory of Open Access Journals (Sweden)

    Kyoichi Deie

    2016-01-01

    Full Text Available We describe a simple and feasible procedure for single-incision laparoscopic repair of a pediatric epigastric hernia using a novel suture-assisting needle. A multichannel port was inserted through the umbilical vertical incision. After the orifice of the hernia was identified, a suture-assisting needle, which can hold a suture at its tip, with a 2-0 thread was pierced through the skin into one side of the rectus muscle sheath into the abdominal cavity. Next, after releasing the thread, the needle was pulled out to the subcutis and pierced through another side of the rectus muscle sheath. The needle, grasping the thread again, was subsequently pulled out through the abdominal wall outside, and the thread was tied extracorporeally. This knot was buried subcutaneously. Operative procedures of single-incision laparoscopic repair of an epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle with an excellent cosmetic result.

  3. Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Seo, Hyun-Ju; Lee, Na Rae; Son, Soo Kyung; Kim, Dae Keun

    2016-01-01

    Purpose To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer. Materials and Methods Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies. Results A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up. Conclusion RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP. PMID:27401648

  4. Short term effects of transanal endoscopic radical resection for rectal carcinoma with laparoscopic as-sistance%腹腔镜辅助经肛内镜直肠癌根治术的近期疗效

    Institute of Scientific and Technical Information of China (English)

    陈远光; 陈劲松; 柯传烽; 梁剑荣; 胡明; 雷建; 黄炯强; 成武; 王荣; 曾毅克; 夏同义

    2013-01-01

    Objective To investigate the safety, feasibility and short-term outcomes of transanal endo-scopic radical resection for rectal carcinoma with laparoscopic assistance, and to determine if synchronous use is superior to sequential use of transanal endoscopic and transabdominal laparoscopic procedure. Methods The clinical data of 19 patients with rectal carcinoma treated with the procedure were retrospectively analyzed,and the results of synchronous group (the latter 10 cases) were compared to what of sequential group (the former 9 cases). Results Among 19 consecutive patients, two cases were conversed to laparoscopic procedure. The mean operative time, median blood loss, mean number of lymph nodes harvested, mean time of first ambula-tion, mean time of anal function recovery were ( 3.85 ± 0.98)h, 80(50, 120)ml, (21.89 ± 9.21), (2.09 ± 0.94) d, (7.95 ± 3.49)d, respectively. Macroscopic evaluation of 16 specimens were classified as complete, 3 as nearly complete. Two patients developed postoperative anastomotic leakage. One patient encounted local recurrence and was treated with local R0 resection. There were no ureteral injury, presacral hemorrhage, abdominal infec-tion and mortality. Compared to sequential group,the synchronous group showed significant decrease of opera-tive time (3.39 ± 0.96 vs. 4.36 ± 0.75 h,P<0.05)and mean time of first ambulation (2.10 ± 0.99 vs. 3.78 ± 1.56 d,P<0.05). Conclusion Transanal endoscopic radical resection for rectal carcinoma with laparoscopic Assistance is safe, feasible and radical, synchronous use is superior to sequential use of transanal endoscopic and transabadominal laparoscopic procedure.%目的探讨腹腔镜辅助经肛内镜直肠癌根治术的安全性、可行性及近期效果,并探讨经肛内镜和经腹腹腔镜两者同步使用是否优于序贯使用。方法回顾性分析19例中下段直肠癌患者腹腔镜辅助经肛内镜直肠癌根治术及术后恢复情况,并将经肛内镜和经腹腹

  5. 经阴道NOTES辅助腹腔镜下肾切除术%Transvaginal NOTES-assisted laparoscopic nephrectomy

    Institute of Scientific and Technical Information of China (English)

    邹晓峰; 刘敏; 徐辉; 刘佛林; 薛义军; 江波; 钟辛; 张旭; 张国玺; 肖日海; 袁源湖; 龙大治; 吴玉婷; 伍耿青; 王晓宁; 杨军

    2010-01-01

    目的 探讨经阴道NOTES辅助腹腔镜下肾切除术的安全性和可行性.方法 应用经阴道NOTES辅助腹腔镜技术行肾切除术5例.均为女性,中位年龄41(36~63)岁.其中输尿管结石并肾重度积水无功能肾4例,结核肾1例;左侧2例,右侧3例.全麻,截石位,患侧垫高约60.,于左右脐缘置入5 mm和10 mm套管;自阴道后穹窿置入10 mm套管,并由此置入腹腔镜,充分游离患肾后完整切除,装入标本袋自阴道后穹窿切口取出.结果 5例手术均成功完成.术中术后未发生并发症.中位手术时间190(150~260)min,术中中位失血量185(150~210)ml.5例术后第1天下床活动,第2天排气并进饮食.腹腔及盆腔引流管引流液少,术后第3天B超检查腹腔及盆腔无积液,先后拔除引流管.术后第7天脐部切口拆线痊愈出院,经窥阴器检查阴道后穹窿切口愈合良好.结论 经阴道NOTES辅助腹腔镜下肾切除术安全可行,较普通腹腔镜和单孔腹腔镜手术创伤更小,美容效果更佳.%Objective To describe the initial clinical experience of transvaginal NOTES-assisted laparoscopic nephrectomy. Methods From May to June 2010, 4 female patients with non-functioning kidney and 1 female patient with renal tuberculosis underwent transvaginal NOTES-assisted laparoscopic nephrectomy. The median age was 41 years (range 36 to 63). Three lesions were on the right side, and 2 on the left. After induction of general anesthesia, the patients were positioned in lithotomy with ipsilateral lumbar at 60° angle to the operating table. A 5 mm Trocar and a 10 mm Trocar were placed through the umbilicus, and a 10 mm Trocar for 30° laparoscope was placed through the posterior vaginal fornix under direct vision. The kidneys were put into a home-made bag and removed via the incision of posterior vaginal fornix after there were completely resected. Results The 5 procedures were successfully finished. The median operative time was 190 (range 150 to 260

  6. Anatomical basis for carrying out a state-of-the-art radical prostatectomy.

    Science.gov (United States)

    Takenaka, Atsushi; Tewari, Ashutosh K

    2012-01-01

    Robotic-assisted laparoscopic prostatectomy has consolidated the position of surgical treatment for localized prostate cancer in the USA. In a few years, it is expected to spread rapidly worldwide. However, surgical anatomy has trailed the advance in surgical techniques of robotic-assisted laparoscopic prostatectomy. Therefore, we reviewed the recent literature, which sometimes refutes the established consensus on pelvic anatomy, for the state-of-the-art technique. We also describe the anatomical findings for each basic step during robotic-assisted laparoscopic prostatectomy, and show evidence-based surgical techniques. Of course, these findings will also be useful for radical retropubic, perineal and conventional laparoscopic prostatectomy. Surgical anatomy should always be developing and changing with advances in surgical approaches.

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

    Science.gov (United States)

    Miyake, Hideaki; Fujisawa, Masato

    2016-01-01

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

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

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth

    2016-01-01

    . These changes should be addressed in the preoperative information and at the post-operative follow-up. It is difficult imagining a RCT of robotic-assisted laparoscopic hysterectomy being conducted in the future due to reluctance towards randomisation to open surgery. However, it would be advisable continuously...... to monitor relevant surgical and patient-reported outcomes as indications for robotic surgery may alter, experiences may develop and further technical advances may change robotic surgery for women with endometrial cancer in the future.......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...

  9. Feasibility of robot-assisted modified radical neck dissection by post-auricular facelift approach.

    Science.gov (United States)

    Tae, K; Ji, Y B; Song, C M; Sung, E S; Chung, J H; Lee, S H; Park, H J

    2016-11-01

    The aim of this study was to evaluate the technical feasibility and safety of robot-assisted modified radical neck dissection (MRND) for head and neck cancer patients with a clinically node-positive neck. The cases of 10 head and neck cancer patients who underwent unilateral therapeutic robot-assisted MRND by post-auricular facelift approach were analyzed. The robot-assisted MRND was completed successfully in all patients without any conversion to conventional neck dissection. The mean number of lymph nodes removed was 36.7±8.6. The mean duration of surgery for robot-assisted MRND was 274±65min (range 175-395min). Transient marginal nerve palsy occurred in two patients and partial necrosis of the skin flap occurred in one patient. In terms of cosmetic satisfaction, 70% of patients were very satisfied or satisfied with postoperative cosmesis. In conclusion, robot-assisted MRND by post-auricular facelift approach is technically feasible and safe in selected patients with head and neck cancer, and yields excellent postoperative cosmesis.

  10. Pedagogic approach in the surgical learning: The first period of “assistant surgeon” may improve the learning curve for laparoscopic robotic-assisted hysterectomy.

    Directory of Open Access Journals (Sweden)

    Angeline Favre

    2016-11-01

    Full Text Available Background: Hysterectomy is the most frequently surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal and appear as a promising surgical technique in gynaecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring.Methods: We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France. We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1 and the control of surgical skills phase (Phase 2. The phase was defined by mastering the basic surgical tasks. Secondarily we compared these two periods for operative time, blood losses, Body Mass Index (BMI, days of hospitalisations and uterine weight. We finally studied the difference of the learning curve between an experimented surgeon (S1 who practised the first the robot-assisted hysterectomies and a less experimented surgeon (S2 who first assisted S1 and then operated on his own patients.Results: 154 robot-assisted hysterectomies were analysed. 20 procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 minutes compared to the control of surgical skills phase (125.8 minutes, p=0.003. No difference between these two periods for blood losses, BMI, days of hospitalisations and uterine weight were demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant

  11. Robot-assisted laparoscopic right hemicolectomy for colonic cancer%达芬奇机器人系统辅助右半结肠切除术

    Institute of Scientific and Technical Information of China (English)

    鲍扬; 江志伟; 谢立飞; 刘凤涛; 黎介寿

    2011-01-01

    Objective To investigate the safety and feasibility of robot-assisted laparoscopic right hemicolectomy for colonic cancer. Methods These 5 patients with ascending colonic cancer received robot-assisted laparoscopic right hemicolectomy. Results All operations were performed successfully. There was no postoperative complications. Da Vinci surgical system was found to be associated with fewer hemorrhage, rapid postoperative intestinal recovery, and therefore a shorter hospital stay. Conclusions Robot-assisted laparoscopic right hemicolectomy can be applied safely and with feasibility for colonic cancer.%目的 探讨达芬奇机器人系统辅助右半结肠切除术的安全性与可行性.方法 总结2010年5-11月完成的5例达芬奇辅助右半结肠切除术的方法 及术后恢复情况.结果 5例患者行右半结肠切除,其中1例同时行胆囊切除.手术均顺利完成,无中转开腹.手术时间140~200 min,术中失血量30~80 ml.术后无并发症发生.结论 达芬奇机器人系统应用于右半结肠癌手术是安全可行的.

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

    Institute of Scientific and Technical Information of China (English)

    刘圣芳; 刘新国

    2014-01-01

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

  13. 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.

  14. 经阴道联合腹腔镜下根治性女性全膀胱切除原位回肠新膀胱术%Transvaginal laparoscopic radical cystectomy with orthotopic ileal neobladder in the female

    Institute of Scientific and Technical Information of China (English)

    吴刚; 靳风烁; 叶锦; 张尧; 郭建新; 白巍; 梁平; 王鹏; 周波; 李黔生

    2010-01-01

    目的 探讨经阴道联合腹腔镜下根治性女性全膀胱切除及原位回肠新膀胱的手术方法.方法浸润性膀胱癌患者6例,平均年龄61(55~73)岁.5孔法先行腹腔镜下手术:游离输尿管后分侧清扫盆腔淋巴结;举宫器配合下,用血管闭合器LigaSure切断子宫相关韧带及膀胱两侧血管蒂;电凝钩分离子宫直肠陷窝及膀胱前间隙;LigaSure切断阴蒂背血管复合体;超声刀切开膀胱颈尿道后游离膀胱颈后壁至阴道前穹窿部.阴道手术:直视下剪开阴道前后穹窿,于阴道取出标本,缝合阴道.回肠新膀胱术:下腹正中4~5 cnl切口,将回肠拉出切口外,游离30~40 cm回肠,剖开后w形折叠缝合形成贮尿囊;插入法植入输尿管后将贮尿囊还纳腹腔.缝合切口后重新开启气腹,腔镜下行新膀胱尿道吻合. 结果 手术时间平均6.2(4~8)h;出血量平均665(400~1200)ml.术后1~3个月患者均恢复较满意的控尿功能,IVU显示双肾功能良好,无膀胱输尿管反流及梗阻.新膀胱最大容量平均427(300~600)ml.无新膀胱阴道瘘等需要手术处理的严重并发症.术后平均随访16(9~30)个月,6例均存活.1例术后8个月发现肝转移. 结论 经阴道联合腹腔镜下根治性女性全膀胱切除回肠新膀胱术治疗女性浸润性膀胱癌可行、有效,应用举宫器及经阴道直视下手术可一定程度上降低腹腔镜下全膀胱切除术的手术难度、缩短手术时间.由于阴道切口整齐、缝合确切,新膀胱阴道瘘等并发症的发生机会减少.%Objective To present the initial experience and results of laparoscopic transvaginal radical cystectomy (LATRC) with orthotopic ileal neobladder. Methods Six female patients with muscle invasive bladder carcinoma underwent LATRC with orthotopic ileal neobladder. The mean age was 61 years (range 55 to 73 years) . The LATRC with orthotopic ileal neobladder consisted of 4 major steps, namely laparoscopic cystectomy

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

    Institute of Scientific and Technical Information of China (English)

    朱畅; 潘凯; 谢海慧; 夏利刚

    2015-01-01

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

  16. 完全腹腔镜胆囊癌根治术的临床疗效%Clinical effect of totally laparoscopic radical resection for gallbladder cancer

    Institute of Scientific and Technical Information of China (English)

    徐鋆耀; 姜海; 喻志敏; 闵军; 陈亚进

    2016-01-01

    Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer.Methods The retrospective cross-sectional descriptive study was adopted.The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected.The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients,and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection.The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination.Observation indicators included (1) operation situations,including surgical procedures,operation time,volume of intraoperative blood loss and number of lymph node dissected,(2) postoperative situations,including time for outoff-bed activity,time for diet intake,time of drainage tube removal,occurrence of complications and duration of hospital stay,(3) results of postoperative pathological examination,including tumor stage and surgical margin,(4) postoperative adjuvant treatment,(5) follow-up situation including the survival of patients,tumor recurrence and metastasis.The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Count data were represented as average (range).Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection + lymph node dissection at N1 region.Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection + Roux-en-Y hepaticojejunostomy,without perioperative death.The average operation time,average volume of intraoperative

  17. 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.

  18. 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

  19. Nerve-sparing techniques and results in robot-assisted radical prostatectomy

    Science.gov (United States)

    Aytac, Omer; Atug, Fatih

    2016-01-01

    Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative anatomic variations may affect the nerve-sparing technique, nerve-sparing degree and the approach. There is lack of randomized control trials for different nerve-sparing techniques and approaches in RARP, therefore accurate preoperative and intraoperative assessment of the patient is crucial. Current data shows that, performing the maximum possible nerve-sparing using athermal techniques have better functional outcomes. PMID:27995221

  20. Early biochemical recurrence, urinary continence and potency outcomes following robot-assisted radical prostatectomy

    DEFF Research Database (Denmark)

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

    2014-01-01

    OBJECTIVE: The aim of this study was to describe recovery of urinary continence and potency and report oncological and functional outcomes using the survival, continence and potency (SCP) system for patients undergoing robot-assisted radical prostatectomy (RARP). MATERIAL AND METHODS: From 2009...... with preoperative ESI, 77.6% (67.9-86.1) and 34.4% (24.1-47.5) maintained ESI 12 months postoperatively after bilateral and unilateral nerve-sparing surgery (NS), respectively. NS (p .... Using the SCP system and defining potency as ESI, functional and oncological success 12 months after surgery was achieved in 69 out of 135 (51.1%) preoperative continent and potent patients who underwent unilateral or bilateral NS, and did not require adjuvant treatment; when defining potency as IIEF...

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  2. Intraoperative prognostic factors and atypical patterns of recurrence in patients with upper urinary tract urothelial carcinoma treated with laparoscopic radical nephroureterectomy.

    Science.gov (United States)

    Carrion, Albert; Huguet, Jorge; García-Cruz, Eduard; Izquierdo, Laura; Mateu, Laura; Musquera, Mireia; Ribal, Maria José; Alcaraz, Antonio

    2016-08-01

    Objective The aims of this study were to identify clinical, intraoperative and pathological prognostic factors for predicting extraurothelial recurrence and cancer-specific survival (CSS) in patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone laparoscopic radical nephroureterectomy (LRNU), and to investigate the site-specific patterns of recurrence and the associated outcomes. Materials and methods A retrospective revision was undertaken of 117 consecutive patients who had undergone transperitoneal LRNU for UTUC between 2007 and 2012. Univariate and multivariate Cox regression analyses were used to identify prognostic factors and Kaplan-Meier was used to estimate CSS. Results With a median follow-up of 20 months, 36 patients (30%) developed extraurothelial recurrence (local and/or distant). In the multivariate analysis, entering the urinary tract during LRNU was related to local recurrence (p = 0.04), management of the distal ureter to CSS (p = 0.003), pathological stage and positive margins to local (p = 0.001, p = 0.013), distant (p = 0.028, p = 0.009) and global recurrence (p = 0.05, p = 0.012) and CSS (p = 0.011, p = 0.042), and multifocality to distant recurrence (p = 0.024). Median time to recurrence was 11.4 months after LRNU. Of 36 patients with progression, 23 (64%) had simultaneous local and distant recurrence and eight had atypical metastases: two port-site metastases, five peritoneal, two subcutaneous and two abdominal wall implants. The 5 year CSS was 61% for all patients with UTUC and 9% for those with recurrence. Conclusions Intraoperative events could have a negative impact on the oncological outcomes of patients with UTUC treated with LRNU. The use of laparoscopy for advanced UTUC may be related to atypical ways of spreading.

  3. Another novel application of Hem-o-Lok clips for transient vascular occlusion in robot-assisted laparoscopic partial nephrectomy: an alternative to laparoscopic bulldog and Satinsky clamps.

    Science.gov (United States)

    Ho, Henry Sun Sien; Peschel, Reinhard; Neururer, Richard; Steiner, Hannes; Schwentner, Christian; Bartsch, Georg

    2008-08-01

    We describe our technique of achieving transient vascular occlusion utilizing Hem-o-Lok clips during robotassisted laparoscopic partial nephrectomy (RLPN) A once-folded vascular loop is threaded through a 2-cm feeding tube. After passing around the renal vessel, its tail goes through the U-loop, creating a tourniquet. Vascular occlusion begins when the tube slides towards the vessel and a Hem-o-Lok clip is applied on the vascular loop next to the exposed end of the tube. When no longer needed, it is released. Since July 2006, 25 patients underwent RLPN utilizing this technique, which required bulldog or Satinsky clamps.

  4. Laparoscopic-assisted one-stage resection of rectal cancer with synchronous liver metastasis utilizing a pfannenstiel incision

    Directory of Open Access Journals (Sweden)

    Murad Aljiffry

    2014-01-01

    Full Text Available Laparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer. However, simultaneous resection of colorectal carcinoma with synchronous liver metastases is still a subject of debate. The present case describes combined laparoscopic rectal and liver resections for a patient with primary rectal cancer and a synchronous liver metastasis utilizing a Pfannenstiel incision for specimen extraction. The operative time was 370 min and estimated blood loss was 400 mL. Postoperatively, the patient required parenteral analgesia for 48 h, resumed normal diet on day 3 and was discharged on day 7 after the operation. A laparoscopic approach utilizing a Pfannenstiel extraction incision may present an advantageous and attractive option for simultaneous laparoscopic rectal and liver resection in selected patients with the aim of improving short-term outcomes.

  5. Laparoscopic-assisted one-stage resection of rectal cancer with synchronous liver metastasis utilizing a pfannenstiel incision.

    Science.gov (United States)

    Aljiffry, Murad; Alrajraji, Mawaddah; Al-Sabah, Salman; Hassanain, Mazen

    2014-01-01

    Laparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer. However, simultaneous resection of colorectal carcinoma with synchronous liver metastases is still a subject of debate. The present case describes combined laparoscopic rectal and liver resections for a patient with primary rectal cancer and a synchronous liver metastasis utilizing a Pfannenstiel incision for specimen extraction. The operative time was 370 min and estimated blood loss was 400 mL. Postoperatively, the patient required parenteral analgesia for 48 h, resumed normal diet on day 3 and was discharged on day 7 after the operation. A laparoscopic approach utilizing a Pfannenstiel extraction incision may present an advantageous and attractive option for simultaneous laparoscopic rectal and liver resection in selected patients with the aim of improving short-term outcomes.

  6. [Radical prostatectomy - pro robotic].

    Science.gov (United States)

    Gillitzer, R

    2012-05-01

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

  7. Laparoscopic-assisted one-stage resection of rectal cancer with synchronous liver metastasis utilizing a pfannenstiel incision

    OpenAIRE

    2014-01-01

    Laparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer. However, simultaneous resection of colorectal carcinoma with synchronous liver metastases is still a subject of debate. The present case describes combined laparoscopic rectal and liver resections for a patient with primary rectal cancer and a synchronous liver metastasis utilizing a Pfannenstiel incision for specimen extraction. The operative time was 370 min and estimated blood l...

  8. Analysis of Quality of Life of Patients with Cervical Cancer After Laparoscopic Radical Resection%腹腔镜下宫颈癌根治术后患者生存质量的调查分析

    Institute of Scientific and Technical Information of China (English)

    蔡颖; 赵健; 张顺仓; 李东红

    2016-01-01

    目的:探讨腹腔镜下宫颈癌根治术后患者的生存质量。方法收集500例宫颈癌患者,并对其进行生存质量问卷调查。问卷采用生存质量核心量表中文版(quality of life core questionaire,QLQ—C30)。结果腹腔镜下宫颈癌根治术后患者的生存质量与多种因素有关,分别为文化水平、收入水平、职业状态、就医费用来源、临床病理分期、治疗手段以及术后患者性生活质量。结论对腹腔镜下宫颈癌根治术后的患者给予积极的社会支持,并提供相关的健康教育知识,对于提高患者的生存质量有积极的意义。%Objective To investigate the quality of life of patients with cervical cancer after laparoscopic radical opera -tion.Methods 500 patients with cervical cancer were selected ,and the quality of life questionnaire survey was conducted (quali-ty of life core questionaire,QLQ—C30).Results Educational level,income level,occupational status,source of medical expen-ses,clinical and pathological stage ,therapeutic tools ,and postoperative sexual life quality were related to the quality of life in pa-tients with cervical cancer after laparoscopic radical resection .Conclusion Active social support and relevant health education knowledge can help improve the quality of life of cervical cancer patients after laparoscopic radical resection .

  9. Are Preexisting Retinal and Central Nervous System-Related Comorbidities Risk Factors for Complications Following Robotic-Assisted Laparoscopic Prostatectomy?

    Directory of Open Access Journals (Sweden)

    David Chalmers

    2015-08-01

    Full Text Available ABSTRACTPurpose:To assess whether retinal and central nervous system (CNS comorbidities are risk factors for complications following robotic assisted laparoscopic prostatectomy (RALP.Materials and Methods:A retrospective review of our RALP database identified 1868 patients who underwent RALP by a single surgeon between December 10, 2003-March 14, 2014. We hypothesized that patients with preexisting retinal or CNS comorbidities were at a greater risk of suffering retinal and CNS complications following RALP. Perioperative complications and risk of recurrence were graded using the Clavien and D'Amico systems, respectively.Results:40 (2.1% patients had retinal or CNS-related comorbidities, of which 15 had a history of retinal surgery and 24 had a history of cerebrovascular accident, aneurysm and/or neurosurgery. One additional patient had a history of both retinal and CNS events.Patients with retinal or CNS comorbidities were significantly older, had elevated PSA levels and CCI (Charlson Comorbidity Index scores than the control group. Blood loss, length of stay, surgical duration, BMI, diagnostic Gleason score and T-stage were not statistically different between groups.No retinal or CNS complications occurred in either group. The distribution of patients between D'Amico risk categories was not statistically different between the groups. There was also no difference in the incidence of total complications between the groups.Conclusions:RALP-associated retinal and CNS complications are rare. While our RALP database is large, the cohort of patients with retinal or CNS-related comorbidities was relatively small. Our dataset suggests retinal and CNS pathology presents no greater risk of suffering from perioperative complications following RALP.

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

    Directory of Open Access Journals (Sweden)

    Roy López-Arias

    2010-12-01

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

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

    Institute of Scientific and Technical Information of China (English)

    吴小凤; 盛夏; 吴震杰; 吕晨; 杨波

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    Objective. Erectile function with and without use of erectile aids was compared in high-, intermediate- and low-risk prostate cancer patients at a mean of 3 years after robot-assisted laparoscopic prostatectomy (RALP). Materials and methods. A sample of 982 men who underwent RALP at Oslo University...... according to the preoperative D'Amico classification. Based on questionnaire data, two primary outcomes were defined: ability to have intercourse (sufficient erection), and use and effect of erectile aids. Results. Sufficient erection with or without erectile aids was reported by 19% of the high-, 30...

  13. Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

    Directory of Open Access Journals (Sweden)

    Achilles Ploumidis

    2013-01-01

    Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

  14. 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.

  15. Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients

    Science.gov (United States)

    Boylu, Uğur; Bindayi, Ahmet; Küçük, Eyüp Veli; Önol, Fikret Fatih; Gümüş, Eyüp

    2017-01-01

    Objective To evaluate the benefit of robot-assisted radical prostatectomy (RARP) in the low-risk prostate cancer (PCa) patients suitable for active surveillance and in the high-risk PCa patients who would be considered for alternative treatments such as radiotherapy (RT) and androgen deprivation therapy (ADT) instead of radical prostatectomy. Material and methods Of 548 patients, who underwent RARP, 298 PCa patients (258 low-risk and 40 high-risk) with a mean of 3.6 years follow-up, were included into this study. Oncological outcomes were compared separately in low- and high-risk PCa patients. Results The pathologic Gleason scores were ≥7 in 73 (28%), and 68 (26%) patients had a pathologic stage of T3, 29 (11%) patients had a positive surgical margin (PSM), and 20 (7%) patients had biochemical recurrence (BCR) in the first year follow-up in the low-risk group. Of 258 low-risk PCa patients, a total of 93 (36%) patients had not either BCR, pathologic Gleason score ≥7, or ≥pT3 disease with PSM. In the high-risk group, the pathologic stage was pT2 in 14 (35%) patients and 29 (72%) patients had no biochemical recurrence in the follow-up of these high-risk PCa patients. Of 40 high-risk PCa patients, in a total of 25 (62.5%) patients ≥pT3b disease, BCR, pT3a disease with PSM were not detected. Conclusion Approximately two thirds of high-risk PCa patients benefit from RARP without additional RT or ADT. Besides, more than one third of low-risk PCa patients who fit active surveillance criteria would have unfavorable results. PMID:28270949

  16. 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.

  17. Organic Radical-Assisted Electrochemical Exfoliation for the Scalable Production of High-Quality Graphene.

    Science.gov (United States)

    Yang, Sheng; Brüller, Sebastian; Wu, Zhong-Shuai; Liu, Zhaoyang; Parvez, Khaled; Dong, Renhao; Richard, Fanny; Samorì, Paolo; Feng, Xinliang; Müllen, Klaus

    2015-11-04

    Despite the intensive research efforts devoted to graphene fabrication over the past decade, the production of high-quality graphene on a large scale, at an affordable cost, and in a reproducible manner still represents a great challenge. Here, we report a novel method based on the controlled electrochemical exfoliation of graphite in aqueous ammonium sulfate electrolyte to produce graphene in large quantities and with outstanding quality. Because the radicals (e.g., HO(•)) generated from water electrolysis are responsible for defect formation on graphene during electrochemical exfoliation, a series of reducing agents as additives (e.g., (2,2,6,6-tetramethylpiperidin-1-yl)oxyl (TEMPO), ascorbic acid, and sodium borohydride) have been investigated to eliminate these radicals and thus control the exfoliation process. Remarkably, TEMPO-assisted exfoliation results in large graphene sheets (5-10 μm on average), which exhibit outstanding hole mobilities (∼405 cm(2) V(-1) s(-1)), very low Raman I(D)/I(G) ratios (below 0.1), and extremely high carbon to oxygen (C/O) ratios (∼25.3). Moreover, the graphene ink prepared in dimethylformamide can exhibit concentrations as high as 6 mg mL(-1), thus qualifying this material for intriguing applications such as transparent conductive films and flexible supercapacitors. In general, this robust method for electrochemical exfoliation of graphite offers great promise for the preparation of graphene that can be utilized in industrial applications to create integrated nanocomposites, conductive or mechanical additives, as well as energy storage and conversion devices.

  18. Role of robot-assisted radical prostatectomy in the management of high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Akshay Sood

    2014-01-01

    Full Text Available We aimed to evaluate the role of robot-assisted radical prostatectomy (RARP in the management of high-risk prostate cancer (PCa, with a focus on oncological, functional and perioperative outcomes. Further, we also aimed to briefly describe our novel modification to conventional RARP that allows immediate organ retrieval and examination for intra-operative surgical margin assessment. A literature search of PubMed was performed for articles on the management of high-risk PCa. Papers written in English and concerning clinical outcomes following RARP for locally advanced and high-risk PCa were selected. Outcomes data from our own center were also included. A total of 10 contemporary series were evaluated. Biopsy Gleason score ≥ 8 was the most common cause for classification of patients into the high-risk PCa group. Biochemical failure rate, in the few series that looked at long-term follow-up, varied from 9% to 26% at 1 year. The positive surgical margin rate varied from 12% to 53.3%. Urinary continence rates varied from 78% to 92% at 1 year. The overall complication rates varied from 2.4% to 30%, with anastomotic leak and lymphocele being the most common complications. Long-term data on oncological control following RARP in high-risk patients is lacking. Short-term oncological outcomes and functional outcomes are equivalent to open radical prostatectomy (RP. Safety outcomes are better in patients undergoing RARP when compared with open RP. Improved tools for predicting the presence of organ-confined disease (OCD are available. High-risk patients with OCD would be ideal candidates for RARP and would benefit most from surgery alone.

  19. 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 ...

  20. Histerectomia Vaginal Assistida por Laparoscopia em Pacientes com Necessidade de Anexectomia Laparoscopically Assisted Vaginal Histerectomy in Patients Requiring Adnexectomy

    Directory of Open Access Journals (Sweden)

    Francisco José Cândido dos Reis

    1998-12-01

    Full Text Available Objetivos: avaliar as vantagens da laparoscopia como instrumento para conversão de histerectomias abdominais em vaginais em pacientes com indicação de anexectomia concomitante, considerando-se a segurança e os custos hospitalares adicionais relativos ao procedimento. Pacientes e Métodos: estudo de caso controle envolvendo 9 pacientes submetidas à Histerectomia Vaginal Assistida por Laparoscopia (HVAL e 18 pacientes-controle submetidas à Histerectomia Abdominal (HA, associadas à anexectomia. Foram avaliadas as características pré-operatórias e os resultados do procedimento. Os grupos HVAL e HA são semelhantes quanto à idade, paridade, cesáreas anteriores, cirurgias prévias e IMC. Resultados: o grupo HVAL apresentou tempo cirúrgico médio de 163,9 minutos e o grupo HA de 142,8 minutos. Não ocorreram complicações pós-operatórias no grupo HVAL, ao passo que no grupo HA houve 2 casos de deiscência de sutura e 1 caso de hérnia incisional. A mediana do tempo de internação foi de 1 dia no grupo HVAL e 2 dias no grupo HA; a mediana do período de convalescença por sua vez foi de 2 e 4 semanas respectivamente. No grupo HVAL, 55,6% das pacientes necessitaram de medicação analgésica no pós-operatório, o que ocorreu em 100% das pacientes do grupo HA. Conclusões: a HVAL mostrou-se vantajosa em relação à HA em termos de melhor recuperação e menor incidência de complicações no pós-operatório. O procedimento é factível com segurança em um Hospital Universitário, não implicando tampouco em custos adicionais com equipamentos ou instrumental.Purpose: to evaluate the advantages of the laparoscopic approach for conversion of abdominal hysterectomies in vaginal hysterectomies in patients with indication of concomitant adnexectomy, being considered the safety and the additional costs of the procedure. Patients and Methods: cases: 9 patients submitted to Laparoscopically Assisted Vaginal Hysterectomy (LAVH associated with

  1. Laparoscopic Nephrectomy for Wilms Tumor

    OpenAIRE

    Andolfi C; Randi B; Ruggeri G.; Lima M.

    2014-01-01

    Wilms tumor is the most frequent primary renal malignancy in children. The surgical resection is traditionally performed through laparotomy. The advent of laparoscopic surgery for benign renal lesions has led the surgeon to use a minimal invasive approach for the nephroblastoma. We describe a 9-months-old girl who presented with a left renal mass. A laparoscopic resection of the tumor with left radical nephroureterectomy was performed. The specimens were removed in an endoscopic bag through a...

  2. 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.

  3. Rapid rehabilitation in elderly patients after laparoscopic colonic resection

    DEFF Research Database (Denmark)

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

    2000-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    延学军

    2015-01-01

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

  6. 腹腔镜下膀胱根治性切除-原位回肠新膀胱术108例分析%Laparoscopic radical cystectomy with orthotopic Heal neobladder: report of 108 cases

    Institute of Scientific and Technical Information of China (English)

    林天歆; 郭正辉; 尹心宝; 董文; 黄健; 许可慰; 江春; 黄海; 韩金利; 张彩霞; 姚友生; 谢文练

    2008-01-01

    Objective To analyze the effects, complication, and outcome of laparoscopic radical cystectomy. Methods 108 patients with bladder cancer, 96 males and 12 females, aged 61 (36 -81) underwent laparoscopic radical cystectomy with orthotopic ileal neobladder. Five-port transperitoneal approach was applied. The surgical procedure included standard laparoscopic pelvic lymphadenectomy, radical resection of bladder, extracorporeal formation of ileal pouch; extracorporeal implantation of ureters; and laparoscopic urethra-neobladder anastomosis. Erectile nerve sparing procedure was performed for 26 cases. The patients were followed up for 1 -53 months. Results The median operation time was 330 min, and the median blood loss was 320 ml. Conversion to open surgery was not necessary in any of the patients. There was no peri-operative mortality. The complication rate was 18.5% (20/108). Surgical margins were tumor free for all cases. The day-time and night-time continence rates were 90.7% and 82.6% respectively in 6 months postoperatively. 10 of the 26 patients undergoing erectile nerve-sparing procedure had potency for intercourse. Follow-up showed 5 cases with local recurrence, 1 case with trocar site seeding and 6 cases with distant metastasis, 8 of the patients died of tumor-related disease and 3 died of diseases not related to tumor. Conclusion Laparoscopic radical cystectomy with extracorporeal formation of orthotopic ileal neobladder is a feasible technique with low morbidity and acceptable neobladder function.%目的 报道108例腹腔镜下膀胱根治性切除-原位回肠新膀胱术手术资料及术后并发症、性功能、控尿功能和肿瘤根治情况.方法 2002年12月至2007年5月,108例膀胱癌患者施行了腹腔镜下膀胱根治性切除-原位回肠新膀胱术,其中男96例,女12例.采用5孔经腹入路,首先进行完全腹腔镜下标准的双侧盆腔淋巴结清扫及根治性膀胱切除,然后行体外回肠新膀胱的构建和输尿管

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

    Science.gov (United States)

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

    2007-09-01

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

  8. Robotic-assisted laparoscopic hysteromyoma enucleation%机器人辅助腹腔镜子宫肌瘤剥除术临床分析

    Institute of Scientific and Technical Information of China (English)

    蔡圣芸; 吕昆明; 汪静文; 李励; 奚佳燕; 徐明娟

    2014-01-01

    目的:探讨达芬奇机器人手术系统辅助腹腔镜子宫肌瘤剥除手术的安全性与可行性。方法回顾性总结2012年12月至2013年10月实施的16例达芬奇机器人辅助子宫肌瘤剥除手术的治疗效果。结果16例患者手术均顺利完成,无中转开腹。手术时间(170.0±45.3)min,术中失血量(196.9±186.9)ml,术后肠蠕动恢复时间为(45.1±8.2)h,术后住院时间(4.2±1.5)d,除1例术后出现尿潴留,留置尿管3d后恢复排尿功能外,未出现出血、感染等并发症。结论达芬奇机器人手术系统应用于子宫肌瘤剥除手术安全可行。%Objective To investigate the safety and feasibility of robotic-assisted laparoscopic hysteromyoma enucleation. Methods The clinical outcomes of 16 patients with hysteromyoma undergoing robotic-assisted laparoscopic enucleation from December 2012 to October 2013 were retrospectively evaluated. Results All the operations were performed successfully.The operative time was(170.0 ± 45.3)min.The estimated blood loss was(196.9 ± 186.9)m1.Time to the return of bowel function was(45.1 ± 8.2)h and postoperative hospital stay was (4.2 ± 1.5)d. There was one patient had a retention of urine at the first afternoon after operation,and recovered after 3-days-long indwelling catheter.No bleeding,infections,or other complications were found. Conclusion Robotic-assisted laparoscopic hysteromyoma enucleation is safe and feasible.

  9. 机器人辅助腹腔镜肾上腺手术的应用现状%Current application status of robot-assisted laparoscopic adrenalectomy

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进; 许天源

    2015-01-01

    泌尿外科是达芬奇机器人手术系统(Da Vinci surgical system,DVSS)应用的最主要领域之一,其开展范围广,技术较为成熟.近年来,机器人辅助腹腔镜肾上腺切除术(robot-assisted laparoscopic adrenalectomy,RALA)开展日益增多,适用于巨大、压迫下腔静脉的肾上腺肿瘤,不适于采用传统腹腔镜手术的肾上腺小肿瘤等.结合本中心开展的RALA的临床经验及RALA国内外应用现状,可以得出RALA可行、安全、微创的结论,是传统腹腔镜肾上腺切除术(laparoscopic adrenalectomy,LA)强有力的替代手术方式,是未来肾上腺手术的主要方法之一.

  10. 6 cases of erectile-function preserving laparoscopic radical cystectomy with orthotopic neobladder%保留勃起功能的腹腔镜原位回肠膀胱术6例

    Institute of Scientific and Technical Information of China (English)

    赵行兵; 张先觉; 田学章

    2011-01-01

    目的:观察保留勃起功能的腹腔镜原位回肠膀胱术在年轻膀胱癌患者中的应用及疗效.方法:6例膀胱移行细胞癌患者在腹腔镜下行保留神经血管束和前列腺远端包膜的膀胱切除,切取肠管缝制成新膀胱,分别与输尿管和前列腺包膜吻合,实现原位尿流改道.结果:6例手术均成功,手术时间为280~410 min,平均310 min.随访24~40个月,6例均存活,无尿道复发,无转移及前列腺癌.术后1个月均有自发性阴茎勃起现象.术后6~24个月,5例患者可顺行射精,1例顺行和逆行射精共存.结论:保留勃起功能的腹腔镜原位回肠膀胱术可较好维持年轻膀胱癌患者勃起功能,提高患者生活质量.%Objective: To evaluate the application and efficacy of erectile function-preserving laparoscopic radical cystec -tomy with orthotopic neobladder in young patients with bladder cancer. Methods: 6 patients with bladder transitional cell carcinoma were undertaken laparoscopic radical cystectomy with orthotopic neobladder keeping the neurovascular bundles and distal diolame of prostate. A segment of intestine was divided to make neobladder, and then the neobladder was coin -cided with bilateral ureters and distal diolame of prostate to realize orthotopic urinary division. Results: All the operations were successful. The operative time was 280-410 min, 310 min in average. During the follow-up of 24-40 months, all patients were alive without urethral recurrence, metastasis and prostatic cancer. 6 patients retained the normal erection within 1 month after operation. 5 patients had anterograde ejaculation and one gained intermittent anterograde and retrograde e -jaculation at 6 to 24 months of postoperation. Conclusion: Erectile-function preserving laparoscopic radical cystectomy with orthotopic neobladder can improve the continence and voiding functions of the orthotopic neobladder, maintain the erectile function, and improve the quality of life of young

  11. The Diagnosis and Treatment of Rare Hernia After Laparoscopic Radical Resection for Rectal Carcinoma%腹腔镜直肠癌根治术后少见疝的诊断和治疗

    Institute of Scientific and Technical Information of China (English)

    程龙庆; 彭翔; 邓建中

    2013-01-01

    Objective To approach the causes, prevention methods, diagnosis and treatment of rare hernia after laparoscopic radical resection for rectal carcinoma. Methods 10 cases of herniation after laparoscopic radical resection for rectal carcinoma were retrospectively analyzed in our department. Results 6 case of 12-mm trocar hernia, 2 cases of postsigmoidostomic hernia, 1 case of pelvi-peritoneal hernia and 1 case of lateral umbilical fold hernia were observed. All patients were performed emergency operation,2 cases were performed small bowel resection because of intestine necrosis, 1 case had incisional infection after second operation. Conclusion 12-mm trocar site, pelvic peritoneal hole, lateral umbilical fold hole and left paracolic sulci gap are the artificial defects after laparoscopic radical resection for rectal carcinoma, abdominal and intraperitoneal hernias are rare postoperative complication, emergency operation is necessary in order to avoiding intestine necrosis.%  目的探讨腹腔镜直肠癌根治术后少见疝发生的原因、预防和诊治。方法对我科1999年7月至2012年12月发生的10例围手术期少见疝的临床资料进行回顾性分析。结果6例主操作孔疝,2例乙状结肠造口旁沟疝,1例盆底腹膜裂孔疝,1例脐外侧襞裂孔疝,患者均需行急诊手术,有2例发生小肠坏死需行肠管部分切除术,1例出现切口感染。结论主操作孔、盆底腹膜裂孔、脐外侧襞裂孔和左结肠旁沟间隙是腹腔镜直肠癌手术后留下的人为缺损,可能发生腹壁疝或腹内疝,一旦发生应尽早手术以避免肠坏死的吧发生。

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

    Science.gov (United States)

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

    2016-01-01

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

  13. Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

    Science.gov (United States)

    Franks, P J; Bosanquet, N; Thorpe, H; Brown, J M; Copeland, J; Smith, A M H; Quirke, P; Guillou, P J

    2006-01-01

    The short-term clinical results of the CLASICC trial indicated that clinical outcomes were similar between laparoscopic and open approaches. This study presents the short-term (3 month) cost analysis undertaken on a subset of patients entered into the CLASICC trial (682 of 794 patients). As expected the costs associated with the operation were higher in the 452 patients randomised to laparoscopic surgery (lap) compared with the 230 randomised to open procedure (open), £1703 vs £1386. This was partially offset by the other hospital (nontheatre) costs, which were lower in the lap group (£2930 vs £3176). The average cost to individuals for reoperations was higher in the lap group (£762 vs £553). Overall costs were slightly higher in the lap group (£6899 vs £6631), with mean difference of £268 (95%CI −689 to 1457). Sensitivity analysis made little difference to these results. The cost of rectal surgery was higher than for colon, for lap (£8259 vs £5586) and open procedures (£7820 vs £5503). The short-term cost analysis for the CLASICC trial indicates that the costs of either laparoscopic or open procedure were similar, lap surgery costing marginally more on average than open surgery. PMID:16755298

  14. Optimization of ultrasonic-assisted extraction and radical-scavenging capacity of phenols and flavonoids from Clerodendrum cyrtophyllum Turcz leaves.

    Directory of Open Access Journals (Sweden)

    Jing Zhou

    Full Text Available Ultrasonic-assisted extraction (UAE was developed to extract phenolic and flavonoid antioxidants from Clerodendrum cyrtophyllum Turcz leaves. The optimal experimental parameters for antioxidant extraction from C. cyrtophyllum leaves were measured using single-factor experimentation combined with response surface methodology (RSM. Total phenolic content (TPC and total flavonoid content (TFC assays were used to quantify antioxidant compounds. Next, antioxidant radical scavenging capacity was measured using 2,2'-diphenyl-1-picrylhydrazyl (DPPH and 2,2' -azino-bis(3-ethylbenzothiazoline-6-sulphonicacid (ABTS radicals. Optimized extraction conditions for UAE from C. cyrtophyllum leaves were as follows: 60.9% ethanol, 85.4 min, and 63.3°C for maximal TPC extraction (16.8 ± 0.2 mg GAE/g DW; 67.7% ethanol, 82.9 min, and 63.0 °C for maximal TFC extraction (49.3 ± 0.4 mg RT/g DW; 48.8% ethanol, 85.1 min, and 63.9 °C for maximal DPPH radical-scavenging capacity (86.8 ± 0.2%; and 50.6% ethanol, 81.3 min, and 63.4 °C for maximal ABTS radical-scavenging capacity (92.9 ± 0.5%. Ethanol concentration was the most important factor in the extraction process. Our work offers optimal extraction conditions for C. cyrtophyllum as a potential source of natural antioxidants.

  15. Optimization of ultrasonic-assisted extraction and radical-scavenging capacity of phenols and flavonoids from Clerodendrum cyrtophyllum Turcz leaves.

    Science.gov (United States)

    Zhou, Jing; Zheng, Xiaoxue; Yang, Qi; Liang, Zhenyi; Li, Donghai; Yang, Xiaobo; Xu, Jing

    2013-01-01

    Ultrasonic-assisted extraction (UAE) was developed to extract phenolic and flavonoid antioxidants from Clerodendrum cyrtophyllum Turcz leaves. The optimal experimental parameters for antioxidant extraction from C. cyrtophyllum leaves were measured using single-factor experimentation combined with response surface methodology (RSM). Total phenolic content (TPC) and total flavonoid content (TFC) assays were used to quantify antioxidant compounds. Next, antioxidant radical scavenging capacity was measured using 2,2'-diphenyl-1-picrylhydrazyl (DPPH) and 2,2' -azino-bis(3-ethylbenzothiazoline-6-sulphonicacid) (ABTS) radicals. Optimized extraction conditions for UAE from C. cyrtophyllum leaves were as follows: 60.9% ethanol, 85.4 min, and 63.3°C for maximal TPC extraction (16.8 ± 0.2 mg GAE/g DW); 67.7% ethanol, 82.9 min, and 63.0 °C for maximal TFC extraction (49.3 ± 0.4 mg RT/g DW); 48.8% ethanol, 85.1 min, and 63.9 °C for maximal DPPH radical-scavenging capacity (86.8 ± 0.2%); and 50.6% ethanol, 81.3 min, and 63.4 °C for maximal ABTS radical-scavenging capacity (92.9 ± 0.5%). Ethanol concentration was the most important factor in the extraction process. Our work offers optimal extraction conditions for C. cyrtophyllum as a potential source of natural antioxidants.

  16. 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.

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

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

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

  18. 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.

  19. Laparoscopic-assisted Anorectoplasty for Imperforate Anus in Children%腹腔镜技术在小儿肛门闭锁中的应用

    Institute of Scientific and Technical Information of China (English)

    王寿青; 李炳; 陈卫兵; 刘树立; 李龙

    2011-01-01

    目的 探讨腹腔镜辅助下先天性高位、中位肛门闭锁患儿手术的可行性. 方法 6例先天性高位、中位肛门闭锁患儿,均在腹腔镜监视下游离出直肠盲端及痿管,切断瘘管,腹腔镜下修补尿瘘或阴道瘘.电刺激找到盆底肌肉中心点,做成一隧道,将直肠盲端从此隧道内拖出,与肛穴缘皮肤吻合. 结果 6例均在腹腔镜辅助下完成直肠肛门成形术.腹腔镜手术操作时间35 ~74 min(平均46.5 min),术中出血量<15 ml,住院时间10 ~18 d(平均14.5 d).无并发症发生.术后随访6~12个月,无肛门失禁、直肠后间隙感染等并发症,均能够正常排便.肛门功能评分优4例,良2例. 结论 腹腔镜辅助下直肠肛门成形术是一种安全、有效的方法,处理瘘管方便,辨认盆底肌中心准确,手术后可获得良好的排便功能,具有创伤小、恢复快、疗效优等特点.%Objective To study the feasibility of laparoscopic-assisted anorectal pull through for high or middle imperforate anus. Methods This study included 6 infants (4 male and 2 female, aged between 7 days and 6 months) with high or middle imperforate anus. Laparoscopic sharp dissection and cautery were used to expose the rectal pouch down to the urethral or vaginal fistula, which was ligated distally and cut off. The pelvic floor musculature was then assessed and the center of the levator muscle was identified. Externally, a 10-mm skin incision was made at the center of the anal dimple, guided by laparoscopy. The rectum was grasped using the perineal trocar and exteriorized to the perineum afterwards, and anorectal anastomosis was performed with absorbable interrupted suture. Results Laparoscopic-assisted anorectoplasty was successfuluy performed on the six cases. The mean operation time was 46. 5 min (35-74 min) , and the intraopeative blood loss was less than 15 ml. The patients were discharged from hospital in 10-18 days ( mean ,14.5 d) after operation. No

  20. 进展期胃癌腹腔镜淋巴结清扫的研究进展%Research progress of laparoscopic-assisted lymphadenectomy in patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    任宝清

    2013-01-01

    The diagnosis rate of early gastric cancer in China is low,most patients seeing the doctor are already in advanced period.Lymphadenectomy is the key factor affecting the tumor treatment and prognosis.With the depth of the research on tumor immunology,the function of lymph nodes in tumor immunity has been gradually paid more and more attention.The role of lymphadenectomy according to the rule of the lymph nodes metastasis has become the research point of the radical gastrectomy.Gastrectomy with D2 lymphadenectomy is the standard surgical treatment for advanced cancer.Laparoscopic-assisted gastrectomy with D3 lymphadenectomy is also in active exploring.In this article,the application of laparoscopy in advanced gastric cancer of current status,near-term efficacy,long-term outcome and complications are reviewed.%中国早期胃癌诊断率低,大部分患者就诊时已处于进展期.随着肿瘤免疫学研究的深入,淋巴结在肿瘤免疫中的作用逐渐受到重视.根据淋巴结转移规律进行淋巴结清扫已成为胃癌根治术研究的重点.D2根治术是治疗进展期胃癌的标准术式,而腹腔镜下D3根治术目前亦在积极探索之中.就腹腔镜在进展期胃癌淋巴结清扫应用中的现状、近期和远期疗效等进行综述.

  1. 完全腹腔镜下根治性膀胱切除及原位U形回肠新膀胱术19例报告%Pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder: report of 19 cases

    Institute of Scientific and Technical Information of China (English)

    刘锋; 王帅; 祁小龙; 郑珉; 张琦; 毛祖杰; 张大宏

    2015-01-01

    Objective To report the surgical methods and results of pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder.Methods From August 2010 to April 2014,19 patients with locally advanced bladder cancer (cT2-3 N0-2 M0) underwent pure laparoscopic radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction.Perioperative and follow-up data were collected.Results The surgeries were successful in all 19 cases with the operating time ranging from 261 to 380 min,blood loss of 100 to 350 ml.Postoperative hospital stay was 21±4 (15-26) days,postoperative intestinal function recovery time at 1.9±0.4 (1.5-2.3) days.Surgical margins were all negative.Lymph node positive rate was 32% (6/19).Complications were including 1 case of lymphatic leakage; 3 cases of new bladder and urethra anastomotic fistula.There were 17 cases of urinary incontinence,all these cases were improved after 3 months,but there were still 8 cases of night-time incontinence.Three cases had unilateral ureteral reflux,ureter mild hydrocephalus,1 of the cases had recurrent infections within 1 month after surgery.After the anti-inflammatory and catheterization treatment,the symptoms were improved.Two cases had unilateral ureteral anastomotic stricture,one underwent percutaneous nephrostomy and cystoscope-assisted double J tube placement,another underwent laparoscopic ureteral neobladder reimplantation.One case had bilateral ureteral stenosis due to recurrent infections,and underwent bilateral laparoscopic ureteral-new bladder reimplantation.Patients were followed up for 8-42 months,no recurrence or distant metastasis was found.Conclusion Pure laparoscopic radical cystectomy with endo-GIA assisted orthotopic U-shape ileal neobladder can reduce surgical trauma and help patient's postoperative recovery.%目的 探讨完全腹腔镜下根治性膀胱切除及原位U形回肠新膀胱术的手术方法及效果.方法 2010年8月至2014年4月,19例临床诊断

  2. Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

    OpenAIRE

    2013-01-01

    Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and...

  3. A novel silk suture-assisted laparoscopic technique for the repair of a gastrocolic fistula in a pediatric patient

    Directory of Open Access Journals (Sweden)

    Seher Mughal

    2016-10-01

    Full Text Available Percutaneous placement of gastrostomy was first described in 1980. Since then it has become widely used in pediatric surgery throughout the world. Inherent in the technique is the possibility of inadvertent damage to adjacent anatomical structures, most commonly the transverse colon. Management previously had involved laparotomy and correction of the gastrocolic fistula. Here we describe a novel laparoscopic approach to the repair of a gastrocolic fistula following percutaneous gastrostomy, avoiding the morbidity of laparotomy in an immunocompromised patient with a rotund abdomen secondary to steroid usage.

  4. Laparoscopic splenectomy for massive splenomegaly: technical aspects of initial ligation of splenic artery and extraction without hand-assisted technique.

    Science.gov (United States)

    Trelles, Nelson; Gagner, Michel; Pomp, Alfons; Parikh, Manish

    2008-06-01

    A 37-year-old man was referred for massive splenomegaly. In November 2005, he was diagnosed with non-Hodgkin's B-cell lymphoma in the setting of splenomegaly and thrombocytopenia. His laboratory results showed a coagulopathy owing to lupus anticoagulant. A computed tomography scan showed a 36 x 26 x 11 cm spleen and a prominent and sinuous splenic artery. The authors performed a laparoscopic splenectomy with an initial ligation of the splenic artery. The patient tolerated the procedure well and was discharged home on the fourth postoperative day in stable condition. Discussed in this paper is the safety and feasibility of the minimally invasive approach in massive splenomegaly.

  5. Clinical comparison of laparoscopy-assisted radical gastrectomy and open radical gastrectomy in gastric cancer after endoscopic submucosal dissection%内镜黏膜下剥离术后复发胃癌行腹腔镜与开腹根治术的临床对比

    Institute of Scientific and Technical Information of China (English)

    魏法星; 陈志红; 蒋鹏程

    2014-01-01

    目的:评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术后复发胃癌行腹腔镜下胃癌根治术的安全性和优越性.方法:回顾性分析ESD术后复发胃癌行胃癌根治性切除术的61例患者的临床资料.其中,41例行腹腔镜辅助下胃癌根治术(腹腔镜组),20例行开腹胃癌根治术(开腹组).统计并对比分析两组患者的一般资料、手术相关指标以及术后恢复的相关资料.结果:两组患者的年龄、性别、肿瘤距切缘长度、清扫淋巴结数目、病理分期,术中损伤情况以及术后并发症等差异均无统计学意义(P均>0.05).与开腹组比较,腹腔镜组手术时间长,住院费用高(P均<0.01),但C-反应蛋白低、手术切口长度小、术中出血量少以及术后镇痛药物使用例数少、首次通气时间早、胃肠减压拔除时间早、首次进流质饮食时间早、腹腔引流管拔除时间早及住院天数短(P均<0.05).结论:腹腔镜胃癌根治术治疗ESD术后复发胃癌安全、有效,与开腹胃癌根治术比较,具有明显的创伤小,出血量少,恢复快等优势.%Objective:To evaluate the safety and superiority of laparoscopy-assisted radical gastrectomy (LARG) for gastric cancer after endoscopic submucosal dissection (ESD).Methods:A total of 61 patients who underwent laparoscopic-assisted radical gastrectomy (LARG group,n =41) or open radical gastrectomy (open group,n =20) for gastric cancer after ESD were retrospectively analyzed.The general data,indicators related to the operation and postoperative recovery of relevant information of two group patients were analyzed.Results:There were no differences in the age,gender,length of the tumor to the cut edge,number of cleaning lymph nodes,pathological staging,intraoperative injury,postoperative complications between LARG group and open group (both P > 0.05).Compared with the open group,LARG group had longer operative time and higher expenditure(both P <0

  6. Effect analysis of three-dimensional and two-dimensional imaging systems in laparoscopic radical resection of rectal cancer%3D与2D腹腔镜直肠癌根治术的疗效分析

    Institute of Scientific and Technical Information of China (English)

    费秉元; 姜俊男; 房学东; 季福建

    2016-01-01

    Objective To compare the clinical effect of three-dimensional(3D)and two-dimensional(2D)imaging systems in laparoscopic radical resection of rectal cancer.Methods The retrospective cohort study was adopted.The clinical data of the 97 patients who underwent laparoscopic radical resection of rectal cancer at the Xinmin Branch of the China-Japan Union Hospital of Jilin University between May 2012 and December 2014 were collected.Of 97 patients,47 undergoing 3D laparoscopic radical resection of rectal cancer were allocated into the 3D group and 50 undergoing 2D laparoscopic radical resection of rectal cancer were allocated into the 2D group.The operation followed strictly tumor-free and total mesorectal excision principles.Observation indicators included:(1)surgical situations:operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected,postoperative complications and duration of hospital stay.(2)Follow-up situations:follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Measurement data with normal distribution were presented as-x±s and comparison between groups was analyzed using the t test.Count data were analyzed using the chi-square test.Results(1)Surgical situations:all the patients underwent successful laparoscopic radical resection of rectal cancer,without conversion to open surgery.Operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected and duration of postoperative hospital stay were(134.6±18.5)minutes,(21.2±2.7)minutes,(65±20)mL,(16±3)mL,23.6±3.5,(8.2±2.3)days in the 3D group and(157.4±17.8)minutes,(25.2±2.5)minutes,(89±27)mL,(23±5)mL,20.5±2.8,(9.4±2.1)days in the 2D group,respectively,with statistically significant

  7. Telerobotic-assisted laparoscopic operation performed at a remote site: initial experience Cirurgia laparoscópica robotizada a distância: experiência inicial

    Directory of Open Access Journals (Sweden)

    Cássio Andreoni

    2004-06-01

    Full Text Available Robotic surgery is an option to laparoscopy that may offer some benefits including the possibility of performing surgery when the surgeon is geographically away from the patient and faster tireless repetitive movements with greater precision. At present, robot-assisted surgery has been done routinely in several institutions around the world, however, to the best of our knowledge, it is the first time such procedure is performed in our academic environment and herein is reported the first telerobotic-assisted laparoscopic cystectomy performed in a domestic pig at our institution using the Zeus®robotic system (Computer Motion, EUA. The procedure was performed using two different operating rooms geographically apart from each other. The assistant was in an operating room that was set with the operating table and the pig as well as with the Zeus® robotic arms. In the other operating room, the surgeon was seated in the control console with a three-dimensional imaging five meters away from the operating table connected with electric cables. The assistant surgeon established the pneumoperitoneum and five trocars were placed in a fan configuration. The surgeon started performing the surgery using three out of the five ports taking control of the laparoscope (voice control and manual control of laparoscopic instruments connected to the robotic arms using the joysticks. The other two ports were used by the assistant for traction and clips placement that was also necessary for exchanging the many laparoscopic instruments connected to the robot. The laparoscopic total cystectomy was successfully performed in 25 minutes with no complications. The truly benefits as well as the cost-effectiveness of the robotic surgery in our environment is yet to be determined after experience acquisition with telerobotic before start performing such procedures routinely in humans. The present report shows the technical feasibility of telerobotic surgery in a developing

  8. Laparoscopic Nephrectomy for Wilms Tumor

    Directory of Open Access Journals (Sweden)

    Andolfi C

    2014-02-01

    Full Text Available Wilms tumor is the most frequent primary renal malignancy in children. The surgical resection is traditionally performed through laparotomy. The advent of laparoscopic surgery for benign renal lesions has led the surgeon to use a minimal invasive approach for the nephroblastoma. We describe a 9-months-old girl who presented with a left renal mass. A laparoscopic resection of the tumor with left radical nephroureterectomy was performed. The specimens were removed in an endoscopic bag through a low suprapubic incision. The patient had an uncomplicated recovery. Minimally invasive techniques may be considered for resection of nephroblastoma if oncologic principles are carefully followed.

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

    Institute of Scientific and Technical Information of China (English)

    许菡; 胡艳艳; 金艳; 奚蓓华; 施晓群; 吴蓓雯

    2012-01-01

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

  10. Laparoscopic Surgery

    Science.gov (United States)

    ... surgeon’s perspective, laparoscopic surgery may allow for easier dissection of abdominal scar tissue (adhesions), less surgical trauma, ... on Facebook About ACG ACG Store ACG Patient Education & Resource Center Home GI Health and Disease Recursos ...

  11. [Laparoscopic surgery in Europe. Where are we going?].

    Science.gov (United States)

    Cuschieri, Alfred

    2006-01-01

    The most important factors that have facilitated the development of laparoscopic surgery (LS) are technological innovations and the vision of a small number of surgeons who took advantage of these advances. There are few surgical innovations that have stimulated such controversies and concerns and have raised so many medico-legal issues as LS. Although much progress has been made in LS, some important controversies remain unresolved, which are reviewed in the present article: 1. Evolution of the laparoscopic approach: total laparoscopic approach through positive-pressure capnoperitoneum, gasless laparoscopy, hand-assisted laparoscopy, and laparoscopy-assisted surgery. 2. Classification of current instrumental technology in laparoscopic surgery: a) facilitating instruments (high-power ultrasonic dissection systems); b) enabling instruments (endostapling and linear dissection devices), and c) complementary instruments: the Da Vinci robotic system. 3. Current laparoscopic surgical practice: a) interventions that definitively improve the patient's outcome (diagnostic and staging laparoscopy, cholecystectomy, adrenalectomy, splenectomy, antireflux surgery, cardiomyotomy, bariatric surgery, laparoscopic colon surgery, living donor nephrectomy); b) interventions that seem to be useful to the patient (distal pancreatic surgery, laparoscopic left hepatic resection, gastric and esophageal resections, hernioplasty), and c) interventions with uncertain benefit (right hepatectomy, pancreatoduodenectomy). 4. Future lines of development: video monitors in laparoscopic surgery, endoluminal surgery, robotic surgery, and finally, 5. Problems faced by laparoscopic surgery: quality guarantees in laparoscopic surgery, training the future laparoscopic generation, and allocation of sufficient material and human resources to laparoscopic surgery and its subspecialties.

  12. Laparoscopic hemicolectomy in a patient with situs inversus totalis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus.We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.

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

    Institute of Scientific and Technical Information of China (English)

    周荣杰

    2016-01-01

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

  14. 机器人辅助腹腔镜下孤立肾肾部分切除术的临床研究%Clinical research of robot-assisted laparoscopic partial nephrectomy in solitary kidney

    Institute of Scientific and Technical Information of China (English)

    刘竞; 李波; 李利军; 王东

    2016-01-01

    目的 分析孤立肾肿瘤患者行机器人辅助肾部分切除术的临床数据,探讨该术式治疗孤立肾肿瘤的近期疗效.方法 回顾性分析2014年9月至2015年9月我科收治的9例行机器人辅助腹腔镜下肾部分切除术的孤立肾肿瘤患者的临床资料,男6例,女3例;年龄46 ~ 78岁,平均60岁.肾肿瘤位于左侧5例,右侧4例;肿瘤直径2.8~7.6 cm,平均4.5 cm.其中1例为先天性孤立肾,1例为对侧萎缩肾,2例曾因对侧肾脏良性疾患切除患肾,5例曾因对侧肾脏恶性肿瘤行根治性肾切除术.结果 9例手术均获成功,无中转开放病例.手术时间104 ~ 215 min,平均129 min;术中失血量50 ~350 ml,平均120 ml,术中无输血病例;热缺血时间10~28 min,平均18 min;无术中并发症发生.术后3~5d拔除引流管及导尿管,住院天数8~17d,平均12 d.术后1例出现肾脏切缘出血,1例出现漏尿,无透析病例.术后病理示:肾透明细胞癌7例,乳头状细胞癌1例,错构瘤1例,无阳性切缘病例.术后随访1 ~12个月,未见转移及复发.结论 机器人辅助腹腔镜肾部分切除术在肿瘤控制及肾功能保存等方面安全可靠,是治疗孤立肾肿瘤的一种安全有效的微创方法.%Objective To investigate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy in solitary kidney.Methods From September 2014 to September 2015, 9 patients underwent robot-assisted laparoscopic partial nephrectomy in solitary kidney.6 of these patients were male, while the others were female.The average age of these patients was 60 years, ranged from 46-78 years.The lesion was located in left kidney of 5 cases, and the remaining in right kidney.The average diameter of lesion was 4.5 cm, ranged from 2.8-7.6 cm.One case was congenital solitary kidney, one was contralateral atrophic kidney, 2 cases were performed nephrectomy due to benign lesion, 5 cases were performed radical nephrectomy due to malignancy.All the cases

  15. The use of a bulldog clamp to control the dorsal vein complex during robot-assisted radical prostatectomy.

    Science.gov (United States)

    Tüfek, Ilter; Atuğ, Fatih; Argun, Burak; Keskin, Selçuk; Obek, Can; Coşkuner, Enis; Kural, Ali Riza

    2012-12-01

    Optimal control of the dorsal venous complex (DVC) is a critical step in robot-assisted radical prostatectomy (RARP). If DVC is not controlled properly, bleeding may occur during the apical dissection. On the other hand, if it is controlled well, a bloodless field is attained and, thus, a precise apical dissection and urethral division is possible. Suture ligation is the most common technique used for dorsal vein control, while some authors recommend using an endovascular stapler. Recently, athermal division and selective suture ligation technique has been reported for DVC control. We describe a new technique: Use of a bulldog clamp to control the DVC during RARP. The control of the DVC with a bulldog clamp allows a bloodless field with precise apical dissection and provides preservation of maximum urethral length while avoiding sphincteral injury.

  16. Effective Downsizing of a Large Oesophageal Gastrointestinal Stromal Tumour with Neoadjuvant Imatinib Enabling an Uncomplicated and without Tumour Rupture Laparoscopic-Assisted Ivor-Lewis Oesophagectomy.

    Science.gov (United States)

    Neofytou, Kyriakos; Costa Neves, Mafalda; Giakoustidis, Alexandros; Benson, Charlotte; Mudan, Satvinder

    2015-01-01

    Neoadjuvant imatinib for gastrointestinal stromal tumours (GISTs) is increasingly used nowadays. As oesophagectomy is associated with high morbidity and mortality, a preoperative downsizing of an oesophageal GIST to limit the extent of resection would be ideal. Because these tumours are rare and neoadjuvant treatment with imatinib is recent, there is limited literature available regarding neoadjuvant administration of imatinib in patients with oesophageal GISTs. A 50-year-old woman presented with total dysphagia. An upper endoscopy and biopsy revealed a large submucosal KIT-positive GIST obstructing the mid oesophagus. CT confirmed a lesion measuring 99 mm × 50 mm × 104 mm. Because the size and location of the tumour increased the risk of intraoperative rupture, it was decided to administer preoperative imatinib. The patient had an excellent clinical and radiological response. Her dysphagia gradually resolved and the follow-up CT scans of the first 10 months showed a gradually reducing tumour size to 54 mm × 33 mm × 42 mm. The patient underwent an uneventful laparoscopic-assisted Ivor-Lewis oesophagectomy. Postoperatively, the patient continued with adjuvant imatinib. At the last follow-up, 1 year from operation and 38 months from the diagnosis, the patient is disease free.

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

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

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

  18. Laparoscopic-assisted mini percutaneous nephrolithotomy in the ectopic pelvic kidney: Outcomes with the laser dusting technique

    Directory of Open Access Journals (Sweden)

    Nischith Dsouza

    2016-01-01

    Conclusion: Laparoscopy-assisted mini PCNL with Laser dusting offers advantages in ectopic pelvic kidneys in achieving good stone clearance, especially in patients with a large stone burden or failed ESWL or RIRS.

  19. 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

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

    Directory of Open Access Journals (Sweden)

    Hou CP

    2014-12-01

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

  1. 高龄患者腹腔镜下胃癌及直肠癌联合根治术两例%Laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer in elderly patients: report of two cases

    Institute of Scientific and Technical Information of China (English)

    方佳峰; 卫洪波; 陈图锋; 黄勇; 魏波; 郑宗珩; 黄江龙; 徐皓中

    2012-01-01

    .The patients were followed up for 13 and 12 months and no postoperative recurrence or metastasis was noticed.Conclusion Laparoscopy-assisted combined radical resection for elderly synchronous rectal and gastric cancer is safe and feasible when performed by surgeons with plentiful experience in laparoscopic technology,and associated with less injury and faster recovery.

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

    Institute of Scientific and Technical Information of China (English)

    许晓晓; 武伟; 李凤云; 孙建荷

    2011-01-01

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

  3. Risk Factors Analysis for Positive Surgical Margins in Laparoscopic Radical Prostatectomy%腹腔镜根治性前列腺切除术后切缘阳性的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    阎乙夫; 黄毅; 马潞林

    2011-01-01

    Objective:To analysis the risk factors for positive surgical margins in laparoscopic radical prostatectomy. Methods: We retrospectively analyzed the clinical and pathological data of 188 cases, who received laparoscopic radical prostatectomy from Jan. 2004 to Dec. 2010 in our hospital. The patients average 72 years old. All patients were dignosised by pathology before prostatectomy, and no metastasis was found before surgery. Univari-able analyse were used to estimate the relationship between the parameters and surgical margin status. Multivari-able logistic regression analyse were used to determine relative risk factors for positive surgical margins. Results; Except that two patients were converted to open surgery, laparoscopic radical prostatectomy was successfully applied in other 186 patients. The operating time was average 246 min, the blood loss during operation was average 309 ml. 76 cases (40. 5%) had positive surgical margin. Result from univariable analyse showed there were significance difference between positive and negtive surgical margins patients on biopsy Gleason score, number of positive biopsy cores, surgical Gleason score, and pathological stage. On multivariable logistic regression analyses, surgical Gleason score and pathological stage were independent factor of positive surgical margins. A surgical Gleason score more than 7 was associated with a 17. 1-fold higher chance of positive surgical margin than a surgical Gleason score not more than 6 (OR:17. 131, 95%CI:5. 237-56. 037,F<0. 001). A pathological stage of T3 was associated with a 9. 0-fold higher risk of positive surgical margin than a psthology stage of T2 (OR:8. 970, 95%CI: 4. 128-19. 493,P<0. 001). Conclusions; Surgical Gleason score and pathological stage were independent factors of positive surgical margins in laparoscopic radical prostatectomy. Patients with surgical Gleason score more than 7 and pathological stage of T3 had a higher rate of positive surgical margins.%目的:分析

  4. Detection of Radical Adducts with Small Molecular Weights by Matrix-Assisted Laser Desorption/Ionization with Fourier Transform Mass Spectrometry

    Institute of Scientific and Technical Information of China (English)

    TIAN,Yao-Wei; SUN,Shi-Hao; XIE,Jian-Ping; ZONG,Yong-Li; NIE,Cong; GUO,Yin-Long

    2007-01-01

    As an alternative method, matrix-assisted laser desorption/ionization with Fourier transform mass spectrometry (MALDI-FTMS) has been successfully used to detect and identify free radical adducts with small molecular weights of hydroxyl and 2-cyano-2-propyl radicals trapped with 5,5-dimethylpyrroline N-oxide (DMPO). The detection and identification by MS/MS experiments using sustained offresonance irradiation collision-induced dissociation (SORI-CID) of [(DMPO+·OH-·H)+H+] (m/z 130.0868) and [DMPO+2 ·CH(CH3)2CN+H+] (m/z 250.1917) have demonstrated that MALDI-FTMS could be an effective method for detection and identification of free radical adducts. Other radical adducts have been also detected and identified. The approach of MALDI-FTMS is simple, fast, and sensitive which has potential for high-throughput analysis.

  5. 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

  6. 机器人辅助腹腔镜肝切除术的经验初探%Preliminary experience of robotic-assisted laparoscopic liver resection

    Institute of Scientific and Technical Information of China (English)

    肖乐; 李建伟; 郭鹏; 王小军; 别平; 郑树国

    2016-01-01

    Objective To summarize the preminiary experience of robotic-assisted laparoscopic liver resection. Methods The clinical data of 60 consecutive patients who underwent robot-assisted laparosopic liver resections for liver diseases at our institute from Jan 2010 to Jan 2016 were retrospectively analyzed. Results There were 57 cases who received successful robotic-assisted laparoscopic hepatectomy and 3 cases (5.0%) converted to open surgery. Operative time was (353±121) min. Intraoperative blood loss was(390±287) mL with transfusion rate 11.7%. Postoperative complications occurred in 15 cases (25.0%) and complications with Clavien≥3b accounted for 3.3%. Hospital stay was (9.1±3.3) days. The stone remove rate was 100%(22 cases) including 21 cases with hepatolithiasis(95.5%) removed intraoperatively and 1 case with residual stone successfully removed using choledochoscopy via a T-tube sinus postoperatively. No death occurred during perioperative period. All cases were followed-up for (18.8±12.0)(2-50)months. During the follow-up period,7 in 24 cases with cancer were found recurrence and 17 cases without. Among the cases with recurrence,4 cases died and 3 survived with tumor. Two in 22 cases with hepatolithiasis recurred and received reoperation and the other 2 cases experienced chronic cholangitis and resolved after medical treatment. Conclusions Robotic-assisted laparoscopic hepatectomy is safe, feasible and efficacious for selected patients with advantages of minimally invasive surgery.%目的:总结机器人辅助腹腔镜肝切除的初步经验。方法:回顾性分析我院2010年1月至2016年1月连续60例达芬奇机器人辅助腹腔镜肝切除术病人的临床资料。结果:60例中57例完成机器人辅助腹腔镜肝切除术,3例中转开腹,中转率为5.0%。平均手术时间(353±121) min,术中失血量(390±287) mL,术中输血率11.7%,术后并发症发生率25.0%(15例),其中3b级以上发生率3.3%

  7. LAPAROSCOPIC HERNIOPLASTY

    Institute of Scientific and Technical Information of China (English)

    Bittner R; Leibl BJ; Kraft K; Schmedt CG

    2003-01-01

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

  8. Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy

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    Vikram Batra

    2015-01-01

    Full Text Available Introduction: Pelvic lymphadenectomy during radical prostatectomy (RP improves staging and may provide a therapeutic benefit. However, there is no clear consensus on the selection criteria for subjecting patients to this additional procedure. With a growing adoption of robot assisted radical prostatectomy (RARP in India, it has become imperative to study the incidence and predictive factors for lymph node involvement in our patients. Materials and Methods: From February 2010 to February 2014, 452 RARP procedures were performed at our institution. A total of 100 consecutive patients from July 2011 to August 2012 were additionally subjected to a robotic extended pelvic lymphadenectomy (EPLND. Lymph node positivity rates and lymph node density were analyzed on the basis of preoperative prostate specific antigen (PSA, Gleason score, clinical stage, D′Amico risk category and magnetic resonance imaging (MRI findings. Multivariate analysis was performed to ascertain factors associated with lymph node positivity in our cohort. Results: The mean age of the patients was 65.5 (47-77 years and the body mass index was 26.3 (16.3-38.7 kg/m 2 . The mean console time for EPLND was 45 (32-68 min. A median of 17 (two to 40 lymph nodes were retrieved. Seventeen patients (17% had positive lymph nodes (median of 1, range 1-6. Median lymph node density in these patients was 10%. When stratified by PSA, Gleason score, clinical stage, D′Amico risk category and features of locally advanced disease on MRI, a trend towards increasing incidence of lymph node positivity was observed, with an increase in adverse factors. However, on multivariate analysis, clinical stage > T2a was the only significant factor impacting lymph node positivity in our cohort. Conclusions: A significant proportion of men undergoing RARP in India have positive lymph nodes on EPLND. While other variables may also have a potential impact, a higher clinical stage predisposes to an increased

  9. 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

  10. Early vascular unclamping reduces warm ischaemia time in robot-assisted laparoscopic partial nephrectomy [v1; ref status: indexed, http://f1000r.es/570

    Directory of Open Access Journals (Sweden)

    Kevin Lah

    2015-05-01

    Full Text Available Introduction: The aim of this study was to assess the outcomes of early vascular release in robot-assisted laparoscopic partial nephrectomy (RAPN to reduce warm ischaemia time (WIT and minimise renal dysfunction. RAPN is increasingly utilised in the management of small renal masses. To this end it is imperative that WIT is kept to a minimum to maintain renal function. Methods: RAPN was performed via a four-arm robotic transperitoneal approach. The renal artery and vein were individually clamped with robotic vascular bulldog clamps to allow cold scissor excision of the tumour. The cut surface was then sutured with one or two running 3-0 V-LocTM sutures, following which the vascular clamps were released. Specific bleeding vessels were then selectively oversewn and the collecting system repaired. Renorrhaphy was then completed using a running horizontal mattress 0-0 V-LocTM suture. Results: A total of 16 patients underwent RAPN with a median WIT of 15 minutes (range: 8-25, operative time 230 minutes (range: 180-280 and blood loss of 100 mL (range: 50-1000. There were no transfusions, secondary haemorrhages or urine leaks. There was one focal positive margin in a central 5.5 cm pT3a renal cell carcinomas (RCC. Long-term estimated glomerular filtration rate (eGFR was not significantly different to pre-operative values. Conclusion: In this patient series, early vascular release effectively minimised WIT and maintained renal function without compromising perioperative safety.

  11. Perioperative Nursing Experience of Laparoscopic-assisted Surgery for Gastric Cancer%腹腔镜辅助胃癌根治术围手术期的护理

    Institute of Scientific and Technical Information of China (English)

    印义琼; 刘春娟; 文曰; 钟静; 刘丽容; 梁涛

    2011-01-01

    Objective: To explore the perioperative nursing experience of laparoscopic-assisted surgery for gastric cancer patients. Methods: 120 cases of patients with gastric cancer were selected from March 2006 to December 2009 and their perioperative nursing records after laparoscopic-assisted surgery were analyzed stastistically. Results: Hiccup appeared on 1 patient and stomach paralyzed appeared on 1 patient after operation. Both of them were cured by conservative treatment. All the selected patients were fully recovered from the surgery and the average resident time were( 11.05 ± 5.43 )days. Conclusion: There are effective perioperative nursing measures for laparoscopic-assisted surgery of gastric cancer besides general care including various forms of psychological nursing, early postoperative activities, guidance of diet, tube-nursing.%目的:探讨腹腔镜辅助胃癌根治术围手术期护理策略.方法:总结2006年3月至2009年12月间120例腹腔镜辅助胃癌根治术的围手术期护理措施.结果:术后发生呃逆及胃瘫各1例,经保守治疗后好转,所有患者均痊愈出院,平均住院日为11.05天±5.43天.结论:除腹腔镜微创手术术后常规护理措施外,多种形式的心理护理、患者术后早期活动及饮食的个体指导和管道护理等是腹腔镜辅助胃癌根治术围手术期积极有效的护理措施.

  12. 达芬奇机器人与腹腔镜行胃癌根治术的对照研究%Comparative study on da Vince robotic and laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    刘江; 阮虎; 赵坤; 王刚; 李民; 江志伟

    2014-01-01

    Objective To compare the short-term clinical outcomes of laparoscopic and da Vince robotic radical gastrectomy for gastric cancer and evaluate the safety and efficacy of robotic system. Methods Clinical data of 200 consecutive gastric cancer patients undergoing radical gastrectomy , including 100 cases of robotic (RRG group) and 100 cases of laparoscopic (LRG group), in our department from January 2012 to May 2013 were retrospectively analyzed. Reconstruction of the alimentary tract was achieved using extracorporeal method through a minilaparotomy in LRG group, and intracorporeal robot-sewn anastomosis in RRG group. Comparative analysis between the two groups for intraoperative factors (conversion, blood loss, operative time, incision length), oncologic outcomes (TMN stage, lymph node dissection, margin) and postoperative parameters (ventilation time, hospital stay, complications, mortality) was performed. Result There was only 1 conversion in LRG group. As compared to LRG group, RRG group was associated with less blood loss [(60±16) vs. (98±17) ml, P=0.005], longer operative time [(215±46) vs. (188±52) min, P=0.001], shorter incision length [(4.2± 1.7) vs. (8.9±2.6) cm, P=0.028], and shorter postoperative hospital stay [(4.5±2.6) vs. (5.7±3.1) d, P=0.018] in RRG group. While there were no significant differences in other aspects between the two groups, such as number of harvested lymph nodes, distance to upper or lower margin of tumor, postoperative bowel function recovery, and postoperative complication morbidity. Conclusion Robotic radical gastrectomy is feasible and safe for gastric cancer , and has better short-term and oncologic outcomes compared with laparoscopic radical gastrectomy.%目的:探讨全机器人系统进行胃癌根治术的安全性和有效性。方法回顾性分析2012年1月至2013年7月间在南京军区南京总医院行机器人胃癌根治术的100例胃癌患者(机器人组)的临床资料,并选取同期

  13. Surgical Approach of Laparoscopic D2 Radical Gastrectomy for Distal Gastric Cancer%腹腔镜远端胃癌D2根治术手术路径的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    徐建; 王守光; 滕世岗; 季志刚; 刘忠诚

    2011-01-01

    目的 探讨腹腔镜远端胃癌D2根治术手术路径的临床效果. 方法 2007年10月~2010年5月,对56例远端胃癌实施腹腔镜远端胃癌D2根治手术.手术路径:大网膜切除和横结肠系膜前叶剥离;解剖腹腔动脉、肝总动脉、脾动脉及清扫相应淋巴结;处理胃右动脉和5组淋巴结;清扫12a组淋巴结等顺序进行,淋巴清扫以4d→4 sb→14v→6→7/9→11 p→8a→5→12a→1→3的路径进行. 结果 手术时间130 ~375 min,(203.4±48.4) min.清扫淋巴结13 ~21枚,(16.2±1.2)枚.术后胃肠功能恢复时间48 ~120 h,(80.6±17.7)h.标本远近切缘无癌残留.无围手术期死亡病例.术后72 h吻合口出血1例,96 h输出端梗阻1例.56例术后随访2~31个月,(14.1±6.9)月,死亡8例:肿瘤广泛转移6例,心脑血管疾病2例;带瘤生存5例,无瘤生存43例,无瘤生存时间最长已31个月. 结论 腹腔镜远端胃癌D2根治术按照合理的路径进行手术,能够保证手术在正确的间隙和解剖层面进行,有利于在遵循肿瘤根治的原则下完成手术.%Objective To investigate the clinical effects of the surgical pathway of laparoscopic D2 radical gastrectomy for distal gastric cancer. Methods Totally 56 patients underwent laparoscopic D2 radical resection for distal gastric cancer from October 2007 to May 2010. The operation included 5 main steps in a certain order; first, resecting the omentum and divesting anterior lobe of the transverse mesocolon; second, anatomizing the celiac, common hepatic, splenic arteries and dissecting corresponding lymph nodes; third, managing the right gastric artery and five lymph node groups; fourth, dissecting the lymph node of 12a group;finally, the lymph nodes were dissected following the order of 4d→4sb→14v→6→7/9→llp→8a→5→12a→1→3. Results The operation time was 130 - 375 minutes [ mean, (203. 4 ±48. 4) minutes], number of harvested lymph nodes was 13 - 21 ( mean,16. 2 ± 1. 2) , and the

  14. Application of Laparoscopic Radical Prostatectomy for High-risk Prostate Cancer%腹腔镜技术在高危前列腺癌根治术中的应用

    Institute of Scientific and Technical Information of China (English)

    程晓冬; 吴岩; 马贵; 徐新宇; 于得水; 李琛

    2015-01-01

    Objective To evaluate the feasibility and clinical efficacy of laparoscopic radical prostatectomy for high-risk prostate cancer. Methods From January 2012 to December 2014, 48 patients with high-risk prostate cancer underwent laparoscopic radical prostatectomy ( LRP) when pathological results of pelvic lymphadenectomy were negative.Firstly we incised prevesical space and pelvic floor fascia next to the prostate capsule.Then the puboprostatic ligament amputation and bladder neck transaction were conducted, and the retropubic dorsal vein complex was sutured with absorbable sutures.The Denonvillier ligament and prostate lateral ligament were incised to expose the urethra.After the incision of urethra, the reconstructed bladder neck was anastomosed with the urethra. Results Of all the 48 patients, 47 patients underwent radical prostatectomy successfully, and 1 patient received a conversion to open operation because of ureteral injury.The catheters were removed within 9-14 days after the operation.Thirty-five patients had normal urination, while 12 patients suffered from temporary urinary incontinence which became normal after expectant treatment in 30-90 days after the operation.The postoperative pathological results of all patients confirmed prostate cancer, 13 of which had positive margin and underwent adjuvant endocrine therapy.The TPSA levels fell to 0-2.77μg/L, and none of the patients had local recurrence or distant metastasis in follow-ups for 6-38 months. Conclusion Laparoscopic radical prostatectomy for high-risk prostate cancer is feasible and effective.%目的:探讨腹腔镜技术在高危前列腺癌根治术中应用的可行性和临床疗效。方法2012年1月~2014年12月腹腔镜下对高危前列腺癌行根治性切除术48例,先行双侧盆腔淋巴结清扫活检,病理检查报告阴性后行前列腺癌根治术。打开膀胱前间隙,靠近前列腺包膜切开盆底筋膜,离断耻骨前列腺韧带,“8”字贯穿缝扎阴

  15. 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

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Pikulin, Alexander, E-mail: pikulin@ufp.appl.sci-nnov.ru; Bityurin, Nikita [Institute on Laser and Information Technologies, Russian Academy of Sciences, Svyatoozerskaya St. 140700 Shatura Moscow Region (Russian Federation); Institute of Applied Physics of Russian Academy of Sciences, 46, Ul’yanov Str., Nizhniy Novgorod, 603950 (Russian Federation); Sokolov, Viktor I. [Institute on Laser and Information Technologies, Russian Academy of Sciences, Svyatoozerskaya St. 140700 Shatura Moscow Region (Russian Federation)

    2015-12-15

    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)

  18. 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.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    Tracy L Hull

    1995-01-01

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

  1. [Laparoscopic choledochoduodenostomy].

    Science.gov (United States)

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

    2013-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    赵佳佳; 王武亮; 王晨阳

    2016-01-01

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

  4. 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

  5. Comparison of laparoscopic and open surgery for radical cystectomy with orthotopic ileal neobladder%腹腔镜与开放根治性膀胱全切-回肠原位新膀胱术的疗效对比

    Institute of Scientific and Technical Information of China (English)

    吴鑫; 周利群; 刘沛; 朱雨泽; 郑卫; 唐琦; 姚林; 张崔建; 郝瀚; 李学松

    2015-01-01

    Objective To compare the clinical outcomes of laparoscopic cystectomy (LRC) and open radical cystectomy (ORC) in the treatment of orthotopic ileal neobladder .Methods The demographic parameters of patients ,perioperative da-ta ,postoperative complications ,new bladder function and oncology results were recorded and evaluated .Results The LRC group had less estimated blood loss (P=0 .013) ,shorter oral intake time (P=0 .001) and hospital stay (P=0 .005) compared with the ORC group . There was no difference in postoperative complications ( P= 0 .725 ) , the mean number of dissected lymph nodes (P=0 .393) ,and lymph node positive rate (P=0 .562) between the two groups .The median follow-up was 28 .5 months (8~47 months) .One year after operation ,the day-time and night-time continence rate were 88 .2% and 70.6% for the LRC group ,84 .6% and 76 .9% for the ORC group (P>0 .05) ,with no statistical significance .During the follow-up ,4 patients developed tumor recurrence and metastasis .There was no significant difference in cancer-specific survival rates and re-currence-free survival rates between the two groups (all P>0 .05 ) .Conclusions Compared with open radical cystectomy , laparoscopic cystectomy has advantages of less blood loss ,earlier oral intake and shorter hospital stay in the treatment of ortho-topic ileal neobladder .Additionally ,it produces comparable continence and tumor control as open radical cystectomy;there-fore ,laparoscopic cystectomy should be the optimal treatment modality .%目的:比较开放及腹腔镜根治性膀胱全切-回肠原位新膀胱术的临床疗效。方法回顾性分析我院自2010年9月至2014年3月行开放(ORC)及腹腔镜(LRC)根治性膀胱全切-回肠原位新膀胱术患者的资料,其中ORC组13例,LRC组21例。对两组患者的术前基本资料、围术期数据、术后并发症情况、术后控尿情况及肿瘤学随访数据进行对比分析。结果LRC组较ORC组

  6. Analysis of Methods and Skills for Urination Control in the Extraperitoneal Laparoscopic Radical Prostatectomy%经腹膜外途径腹腔镜前列腺癌根治术中尿控技巧探讨

    Institute of Scientific and Technical Information of China (English)

    李前跃; 李志坤; 汤磊; 赵亚伟; 马柳疆; 王砺

    2016-01-01

    目的:回顾性总结探讨经腹膜外途径腹腔镜下前列腺癌根治术中处理尿控的方法及技巧。方法临床选择T1~T3 a前列腺癌患者44例,年龄为58~82岁,平均年龄为70.5岁。术前前列腺总特异性抗原(TPSA)为8.9~38.6 ng/ml。所有患者术前均行经直肠前列腺穿刺活检,病理明确诊断证实为前列腺癌,平均Gleason评分(5.6±2.5)分,44例患者均行经腹膜外途径腹腔镜下前列腺癌根治术。结果44例患者均顺利完成手术,手术时间150~410分钟,平均手术时间(220±85)分钟;术中出血量300~1500ml,平均(400±220)ml;术后完全尿控33例(75.0%),部分尿控9例(20.5%)(1周后恢复),完全性尿失禁2例(4.5%)(持续3个月以上),术后病理切缘阳性6例(13.6%);直肠损伤1例,经保守治疗治愈。结论腹腔镜下前列腺癌根治术治疗局限性前列腺癌安全、有效,术后尿控效果与术中神经血管束(NVB)、远端尿道保留长度、正确处理膀胱颈部、膀胱尿道吻合的技巧处理及术者的经验相关。%Objective To explore the methods and skills for urination control of extraperitoneal laparoscopic radical prostatectomy. Methods 44 patients was be collected,the age was from 58y to 82y,the average age was 70. 5y. The total prostate specific antigen (TPSA)before operation was 8. 9~38. 6 ng/ml. Every patient was performed transrectal prostate biopsy and diagnosed confirmedly as prostate cancer by pathology. The average Gl-eason was (5 . 6 ± 2 . 5 ). 44 patients were all be performed the operation of extraperitoneal laparoscopic radical prostatectomy. Results 44 patients were all successfully completed the operation. The operation time was 150~410minutes,and average time was (220 ± 85)minutes. After operations,33 cases could control the urination completely (75 . 0%),and 9 cases could control the urination partly

  7. 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

  8. 手术机器人系统与腹腔镜辅助胃癌切除术的临床疗效对比%Comparative study on clinical efficacy of robot-assisted and laparoscopic gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    张小磊; 江志伟; 赵坤

    2012-01-01

    Objective To compare the clinical efficacy of robot-assisted procedure with laparoscopic surgery for gastric cancer.Methods The clinical data of patients who underwent gastrectomy in the Department of General Surgery in the Affiliated Jinling Hospital,Nanjing University Medical College from January 2009 to December 2011 were retrospectively analyzed.There were 97 patients undergoing robotic gastrectomy(ROB group) and 70 patients undergoing laparoscopic gastrectomy (LAP group).The following parameters were compared between these two groups:intraoperative factors,oncologic outcomes,and short-term surgical outcomes.Results All the operations were performed successfully without conversion.Compared with the LAP group,the ROB group had less intraoperative blood loss [(80.8±53.1) vs.(153.7±26.4) ml,P=0.001],more number of lymph node dissection [(23.1±5.4) vs.(20.0±4.3),P=0.001],longer operative time[ (272.3±46.1) vs.(240.3±89.1) min,P=0.001],earlier semifluid diet time[(3.2±0.8) vs.(3.6±1.2) d,P=0.002],shorter postoperative hospital stay[(6.1±2.6) vs.(6.9±2.3) d,P=0.037].There were no significant differences in the length of distal and proximal margin,postoperative ambulation time,ventilation time and postoperative complications (all P>0.05).Conclusions The robotic gastrectomy is safe and feasible for gastric cancer.It has many advantages such as less blood loss,more number of lynph node dissection and quicker recovery.Similar radical resection can be achieved compared to laparoscopic gastrectomy.%目的 对比分析达芬奇手术机器人系统与腹腔镜辅助胃癌根治术的临床疗效.方法 回顾性分析2009年1月至2011年12月南京军区南京总医院普通外科实施胃癌手术患者的临床资料.其中达芬奇手术机器人系统进行胃癌手术97例(机器人组),腹腔镜辅助胃癌手术70例(腹腔镜组),对比分析两组患者的手术指标、病理指标及短期疗效指标.结果 两组患者手术均顺利完成,无中

  9. 机器人辅助与传统腹腔镜进行胆囊手术效果的系统评价%Comparison of the Effect of Robot Assisted and Traditional Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    于艺; 解龙; 王长淼

    2015-01-01

    Objective To compare the safety and ef icacy of robot assisted surgery and laparoscopic surgery ingal bladder with respect to adult patients. Methods A systematic article search and review were performed. Foreign and Chinese database were used in our study.Published studies comparing robot assisted sugery versus laparoscopic surgery was eligible for inclusion. The main outcome were conversion rate, complication, blood loss and second outcomes were operation time, postoperative hospital stay. RevMan5.2 software was used to do statistical analysis. Results Five artical reporting data on 586 patients have been included in our study, There was no significant dif erences between robot assisted surgery and laparoscopic surgery in conversion rate, complication, bloodloss, operationtime, postoperative hospital stay. There was significant dif erence between robot assisted surgery and laparoscopic surgery in operative time. Conclusion Based on cur ent studies, we cannot concluded robot assisted surgery is bet er than laparoscopic surgery. We need more wel designed multicenter randomized control ed trial to assess the safety and ef icacy of robot-assisted surgery.%目的对机器人辅助与传统腹腔镜在胆囊微创外科的效果进行荟萃分析。方法制定并严格遵照文献的纳入与排除标准,从中外文数据库检索近10年的有关机器人和传统腹腔镜治疗胆囊疾病的公开发表的论文或会议论文。按照Cochrane风险评估偏倚工具进行文献质量评价,选取转开腹率、并发症、术中出血量为主要结局指标;选取住院时间、手术时间为次要结局指标。应用RevMan5.2软件对提取数据进行统计学分析。结果文献检索最终有5篇文献符合纳入标准,5篇文献中共报告了586例患者,其中机器人组309例,腹腔镜组277例。与腹腔镜手术系统相比,机器人手术系统在并发症发生率、中转开腹率、术中出血量及住院时间方面无明显

  10. Laparoscopically Assisted Proximal Gastrectomy with Esophagogastrostomy Using a Novel "Open-Door" Technique : LAPG with Novel Reconstruction.

    Science.gov (United States)

    Hosoda, Kei; Yamashita, Keishi; Moriya, Hiromitsu; Mieno, Hiroaki; Ema, Akira; Washio, Marie; Watanabe, Masahiko

    2016-12-26

    Laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy using a novel "open-door" technique was introduced recently, with the aim of preventing gastroesophageal reflux. However, quantitate assessment of gastroesophageal reflux after this surgery has not been performed till date. The aims of the current study were to investigate the safety and feasibility of this operation and to elucidate the postoperative reflux status. Twenty consecutive patients (18 men) with (y)cStage I gastric cancer in the upper third of the stomach who underwent LAPG at Kitasato University Hospital from May 2015 through September 2016 were retrospectively reviewed. We performed 24-h impedance-pH monitoring 3 months after surgery for the first eight patients and analyzed the postoperative reflux status. Median operation time was 333 min, while median anastomotic time was 81 min. None of the 20 patients experienced anastomotic leakage while two patients experienced anastomotic stricture requiring endoscopic balloon dilatation. No patient experienced heartburn without antacid drugs. During the 24-h impedance-pH monitoring, all but one patient had normal gastroesophageal acid reflux with the acid percent time of technique is a safe and feasible procedure for LAPG. The degree of gastroesophageal reflux was acceptable using this technique. Randomized controlled trials with long-term follow-ups are required to confirm that this technique would be superior to the others.

  11. Hand-assisted laparoscopic nephrectomy as a minimally invasive option in the treatment of large renal specimens

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado

    2005-12-01

    Full Text Available INTRODUCTION: We describe our experience with hand-assisted laparoscopy (HAL as an option for the treatment of large renal specimens. MATERIALS AND METHODS: Between March 2000 and August 2004, 13 patients candidate to nephrectomies due to benign renal conditions with kidneys larger than 20 cm were included in a prospective protocol. Unilateral nephrectomy was performed in cases of hydronephrosis (6 patients or giant pyonephrosis (4 patients. Bilateral nephrectomy was performed in 3 patients with adult polycystic kidney disease (APKD with low back pain refractory to clinical treatment previous to kidney transplant. The technique included the introduction of 2 to 3 10 mm ports, manual incision to allow enough space for the surgeon's wrist without a commercial device to keep the pneumoperitoneum. The kidney was empty, preferably extracorporeally, enough to be removed through manual incision. We have assessed operative times, transfusions, complications, conversions, hospital stay and convalescence. RESULTS: The patients mean age (9 women and 4 men was 58 years. Mean operating time was 120 ± 10 min (hydronephrosis, 160 ± 28 min (pyonephrosis and 190 ± 13 min (bilateral surgery for APKD. There was a need for a conversion in 1 case and another patient needed a transfusion due to a lesion in the renal vein; 2 patients had minor complications. CONCLUSION: HAL surgery is a minimally invasive alternative in the treatment of large renal specimens, with or without significant inflammation.

  12. Hematuria at laparoscopic hysterectomy: a 9-year review at Sydney West Advanced Pelvic Surgery, Australia.

    Science.gov (United States)

    Wilson, Matthew; Merkur, Harry

    2008-01-01

    The aim of this study was to estimate the prevalence and significance of hematuria during laparoscopic hysterectomy for benign uterine disease. The review assessed its incidence, risk factors, site of associated urinary tract injuries, methods of diagnosis, management strategies, and most likely intraoperative point at which hematuria occurred during laparoscopic hysterectomies. A retrospective review of 755 cases of laparoscopic-assisted and total laparoscopic hysterectomies from January 1998 through December 2006 was undertaken at Sydney West Advanced Pelvic Surgery, Sydney, Australia.

  13. Second laparoscopic resection for recurrent hepatocellular carcinoma after initial laparoscopic

    Institute of Scientific and Technical Information of China (English)

    LIANG Xiao; CAI Xiu-jun; YU Hong; WANG Yi-fan; LIANG Yue-long

    2009-01-01

    @@ With the development of laparoscopic techniques,laparoscopic hepatectomy is feasible for hepatocellular carcinoma as reported in recent years.Although several reports have been published on laparoscopic surgery for metastatic liver cancer,1,2 few of them deals with second laparoscopic resection of recurrent hepatocellular carcinoma. We report a case of second laparoscopic resection for recurrent hepatocellular carcinoma after initial laparoscopic hepatectomy.

  14. 腹腔镜辅助下腹膜法阴道成形术%Laparoscopically assisted neovaginaplasty using peritoneum as vaginal mucous substitute

    Institute of Scientific and Technical Information of China (English)

    秦荣生; 马勇光; 毕宏森; 杨欣; 张洁; 袁炯; 李健宁

    2008-01-01

    目的 探讨应用1972年Rothman首创并经过改进的一种更加微创、符合生理、满足患者生理要求的阴道再造手术方法.方法 于会阴部造穴,在腹腔镜辅助下应用腹膜再造阴道衬里,关闭盆底腹膜、切开远端的腹膜以形成顶端为盲端的阴道.结果 2005年3月至2006年9月,将该方法用于诊断为先天性无阴道的患者10例.年龄最大32岁,最小19岁.手术平均用时2.34 h.平均住院20.5 d.随访3~12个月,无手术并发症,性生活满意.结论 腹腔镜辅助下带蒂腹膜代阴道黏膜的阴道成形术是一种较为理想的阴道再造术术式.%Objective To practice a more atraumatic,physiological and aesthetically valued approach of construction for neovagina.Methods Laparoscopically using peritoneum as neovaginal lining.Results From March 2005 to September 2006,this technique was adopted to treat 10 patients whose diagnosis was congenital absence of vagina.The ages of the patients were from 19 to 32.The operation lasted average 2.34 hours.And hospitalization was about 20.5 days.Follow-up ranged from 3~12 months.No complication occurred.All of the patients was satisfied with their sexual life.Conclusions Laparoseopically assisted neovaginaplasty,in which peritoneum was substituted for vaginal mucous membrane,was a kind of ideal approach of vaginal creation.

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

    Institute of Scientific and Technical Information of China (English)

    关冰

    2012-01-01

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

  16. Rapid rehabilitation in elderly patients after laparoscopic colonic resection

    DEFF Research Database (Denmark)

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

    2000-01-01

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

  17. 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.

  18. Extraperitoneal Laparoscopic Radical Prostatectomy (Report of 151 Cases)%经腹膜外腹腔镜下前列腺癌根治术(附151例报告)

    Institute of Scientific and Technical Information of China (English)

    李勋钢; 崔心刚; 徐丹枫; 李尧; 贺仕芳

    2011-01-01

    Objective:To probe into the skill and effect of extraperitoneal laparoseopic radical prostatectomy (ELRP)on patients with prostate cancer. Methods: From January 2006 to January 2011, extraperitoneal laparoscopic radical prostatectomy was performed on 151 men,mean aged 69 (range 53 to 78) years,who were appropriate candidates for radical retropubic prostatectomy. Patient characteristics, surgical statistics, and pathologic results were prospectively collected. CT, MRI and ECT revealed there was no lymph node or seminal vesicle involvement and there was no bone metastasis. Results:The mean preoperative prostate-specific antigen level was 16.40 ng · ml-1 (range 3.27 to 165.00). The preoperative Gleason sum was less than 7 in 63 patients (41.7%),7 in 58 (38. 4%) ,and more than 7 in 30 patients (19.9%). The mean operating time was 178 minutes (range 60 to 390).The estimated blood loss averaged 260 ml (range 20 to 1 000),and 5 patients (3.3 %) required blood transfusions.One (0.67 %) was compilicated by rectal injury. Positive surgical margins were reported in 14 specimens (9.3 %).5 (3.3%) case was found having obturator lymph node metastasis. The mean catheterization time was 13.5(range 6 to 69) d,The mean length of hospital stay was 14.4(range 4 to 74) d. There was 2(1.3%)complication of urethra stricture during mean 27(range 4 to 62) months follow-up and was underwent surgery,2 (1.3%) unilateral Inguinal hernia, 31 (20. 5 % ) incontinence and 15 (9.9 % ) biochemical recurrence. Conclusions: Extraperitoneal laparoscopie radical prostatectomy is an effective and safe approach for localized prostate cancer. Control of hemorrhage and laparoscopic suture technique are the keys to successful operation.%目的:探讨经腹膜外腹腔镜下前列腺癌根治术(ELRP)的手术技巧和疗效.方法:回顾分析2006年1月~2011年1月,行ELRP 151例患者的临床资料.术前均经病理检查确诊,患者平均年龄69(53~78)岁,盆腔CT、MRI和

  19. 腹腔镜辅助下小切口治疗婴幼儿腹股沟疝新术式探讨%Investigation of small incision new technique with laparoscopic-assisted in inguinal hernia treatment for infants

    Institute of Scientific and Technical Information of China (English)

    李忠; 李平; 邓立军; 聂斌; 曾勇

    2013-01-01

    Objective To discuss the clinical applications of small incision new technique with Laparoscopic-assisted in inguinal hernia treatment for infants.Methods Data of 210 clinical patients with small incision new technique with Laparoscopic-assisted in inguinal hernia treatment were analyzed.Operation points:firstly umbilical pneumoperitoneum establishment,secondly small transverse incision of subcutaneous ring were down,thirdly hernia sac were toped out through the small incision,while the laparoscopic get into the hernia through inner ring,finally Stripping hernia sac and ligation.Results Totally 210 patients were successfully cured,all the patients were leaved the hospital after three days.185 cases were not recurrenced in the following observation from 2 to 12 months.Conclusion Laparoscopic surgical advantages were used combined with inguinal hernia infant anatomical characteristics,follow the principle of pediatric inguinal hernia surgery,achieved satisfactory results,new technique is worth the clinical promotion.%目的 探讨腹腔镜辅助下小切口治疗婴幼儿腹股沟疝新术式的临床应用价值.方法 回顾分析采用该术式治疗婴幼儿腹股沟疝210例临床资料.手术要点:脐部建立气腹,在皮下环处做横形小切口,腹腔镜经内环进入疝囊,并将疝囊从小切口处顶出,剥离疝囊并高位结扎.结果 手术均获成功,术后3d内出院.术后随访185例2月至12月,无一例复发.结论 该术式利用腹腔镜优势,结合婴幼儿腹股沟疝的解剖特点,遵循小儿腹股沟疝手术原则,取得满意效果,有一定的临床应用和推广价值.

  20. 腹腔镜辅助阴式全子宫切除术112报告%The clinical analysis of 112 cases of laparoscopically assisted vaginal hysterectomy

    Institute of Scientific and Technical Information of China (English)

    李荣

    2012-01-01

    目的:探讨腹腔镜辅助阴式全子宫切除术(laparoscopiclly assisted vaginal hysterectomy,LAVH)的临床疗效及安全性.方法:回顾分析为112例有子宫切除指征的患者行LAVH的临床资料,术后应用抗生素规范治疗.观察术中、术后患者一般情况、手术时间、出血量、住院时间、并发症及术后随访等.结果:112例均顺利完成手术,无一例中转开腹,术后患者临床症状完全消失.6例术后阴道残端出血,经再缝扎宫颈残端后治愈;无一例发生术后腹壁切口感染、泌尿系感染、膀胱及直肠破裂、尿路刺激症状、尿潴留、术后阴道膀胱瘘等并发症.远期随访效果均满意.结论:LAVH治疗妇科良性疾病临床疗效显著,安全性高,是目前较理想的治疗方法,值得推广应用.%Objective:To explore the clinical efficacy and safety of laparoscopically assisted vaginal hysterectomy. Methods; Laparoscopically assisted vaginal hysterectomy was carried out in 112 patients who were analyzed retrospectively with hysteromyoma, u-terine adenomyoma,ovarian tumor,cervical intraepithelial neoplasia grade Ⅲ ,or atypical hyperplasia of endometrium, which were all indications for uterus resection and treated with antibiotic standard treatment. The intraoperative and postoperative general condition of patients ,surgical time,blood loss,hospital stay,complications and postoperative follow-up were observed. Results;All operations were successful , no one conveij to laparotomy and clinical symptoms disappeared post operation. Postoperative vaginal bleeding occurred in 6 cases and disappeared after suture cervical residual sheath cure. Other complications including postoperative abdominal wall wound infection , urinary tract infection, rupture of the bladder and rectum, urinary irritation symptoms, urinary retention and postoperative vaginal bladder fistula complications were not occurred. The long-term follow-up were satisfying. Conclusions: Using

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

    Directory of Open Access Journals (Sweden)

    Vipul Gupta

    2013-01-01

    Full Text Available 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 skills. The aim of this study was to review experience as a mentor in training laparoscopic skills through condensed training programme based on high volume low risk procedure of pediatric laparoscopic orchidopexy. Materials and Methods: In order to implement a condensed laparoscopic curriculum in a short period of time while maintaining utmost patient safety, laparoscopic orchidopexy was used as the technique of choice. The course was conducted over a period of 5 days starting from 1 st November 2010 in a tertiary pediatric surgical center under guidance of an expert mentor. A total of 30 testicular units in 27 pediatric patients of different age group diagnosed with impalpable undescended testis underwent laparoscopic intervention. The course was conducted in three stages with the aim to deliver laparoscopic skills to trainee. In stage one out of eight cases operated by mentor with assistance of trainee six were operated on day 1 and two cases were operated on second day. The trainee performed 12 cases of laparoscopy independently with assistance of mentor in stage two which was carried out on day 2, 3 and 4. Finally all 7 cases including two second stage laparoscopic orchidopexy procedures were carried out independently by trainee under observer ship of mentor in stage three during day 4 and 5 of training programme. The feasibility and efficacy of laparoscopic orchidopexy in training laparoscopic skills through condensed training programme was assessed

  2. 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.

  3. 腹腔镜超声影像技术引导机器人辅助腹部手术的临床应用%Clinical effects of laparoscopic ultrasound imaging in robot-assisted abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    姜朋; 牟培源; 周宁新; 白媛媛

    2013-01-01

    AIM: To explore the clinical effects of laparo-scopic ultrasound imaging technique in robot-assisted abdominal surgery. METHODS: Twenty-eight patients (including three with intrahepatic bile duct stones, three with calculous cholecystitis, eight with hepatic tumor, seven with hilar cholangiocarcinoma, four with pancreatic tumor, and three with hypersplenism) who underwent laparoscopic ultrasound-guided robot-assisted abdominal surgery in our hospital were included in our study. Laparoscopic ultrasound was used to determine the location of lesions and their relation with nearby tissue, choose the optimal surgical method, guide the pathway and evaluate the effects during surgery. The clinical effects were evaluated by ultrasound, contrast-enhanced CT, MRCP and biochemical assays after surgery. RESULTS: All surgical procedures were performed successfully, and no serious intraopera-tive or postoperative complications occurred. Biochemical parameters returned or approached -to normal levels. In RFA regions, color Doppler ultrasound imaging showed no color signal and contrast-enhanced CT showed no enhancement. Ultrasonography, CT or MRCP detected no abnormity in the bile duct. The volume of the entire spleen and damaged part of the spleen from RFA regions were measured by enhanced CT, and the percentages of damaged part of the spleen were 43%, 45% and 49%. CONCLUSION: Laparoscopic ultrasound can not only determine the lesion and guide the operative route but also help surgeons to select the operative strategy. With the development of robot-assisted surgical system, laparoscopic ultrasound will become an indispensable part of this surgery.%目的:探讨腹腔镜超声影像技术引导机器人辅助腹部手术的临床应用效果.方法:对28例患者(肝内胆管结石3例,结石性胆囊炎3例,肝占位8例,肝门部胆管癌7例,胰腺占位4例,脾功能亢进3例)实施腹腔镜超声引导机器人辅助腹部手术治疗,手术过程中应用腹腔镜超声探

  4. Effect of laparoscopic radical prostatectomy on the early postoperative urinary control in patients with partial proximal end of the prostate%腹腔镜前列腺癌根治术保留部分近端前列腺部尿道对术后早期尿控恢复的影响

    Institute of Scientific and Technical Information of China (English)

    谢喜

    2016-01-01

    Objective To investigate the effect of laparoscopic radical prostatectomy in the treatment of early postoperative urinary control in patients with benign prostatic carcinoma, and to provide reference for the treatment of the disease. Meth-ods 52 cases of prostate cancer patients in our hospital from September to April 2013 were selected, including 28 patients who underwent laparoscopic radical prostatectomy to retain part of the proximal end of the prostate urethra, as the treatment group, 24 patients underwent laparoscopic radical prostatectomy for non retained part of the proximal end of the prostate urethra, as control group, cases were treated with laparoscopic radical prostatectomy. Compared with the two groups of patients with peri-operative clinical parameters and early urinary control of the basic normal cases. Results The operation time, bleeding volume, indwelling catheter time, positive resection margin, recent complications, hospital days and the control group, the difference was not statistically significant;treatment group 0, 14, 90d urinary control basic normal cases and the control group, the difference was statistically significant. Conclusion The clinical effect of laparoscopic radical prostatectomy is similar to the clinical results of proximal urethra and non retained part of proximal urethra, but it can significantly increase the recovery of early postoperative urinary control, which is worthy of clinical use.%目的:探讨腹腔镜前列腺癌根治术保留部分近端前列腺部尿道对术后早期尿控恢复的影响,以期为该类疾病的治疗提供参考。方法:选取2013年4月~2015年9月在我院就诊的前列腺癌患者52例,其中28例患者行腹腔镜前列腺癌根治术保留部分近端前列腺部尿道,设为治疗组,24例患者行腹腔镜前列腺癌根治术非保留部分近端前列腺部尿道,设为对照组。比较两组患者围手术期临床参数和早期尿控基本正常例数。结果

  5. Editor’s Pick: Recent Developments in Minimally Invasive Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Jarno Riikonen

    2015-01-01

    Full Text Available Minimally invasive surgery has gained a dominant status in prostate cancer surgery during the last decade. The benefits of minimally invasive prostatectomy were demonstrated by pioneers of conventional laparoscopic prostatectomy, however, the real domination of laparoscopy in radical prostatectomy (RP started after the dissemination of robotic surgery. Robot-assisted surgery still remains the most widespread method to perform minimally invasive RP, although the recent evolution of laparoscopic technology and instruments has evoked interest in conventional laparoscopy again. The recent developments in the technique of RP are focused on decreasing invasiveness and complications. The recent methods to improve postoperative functional outcome of RP can be utilised without compromising the oncological results.

  6. 机器人手术系统辅助结肠癌手术13例%Robotic-assisted laparoscopic colectomy for colon cancer: a report of 13 cases

    Institute of Scientific and Technical Information of China (English)

    鲍扬; 江志伟; 谢立飞; 刘凤涛; 黎介寿

    2011-01-01

    Objective To investigate the safety and feasibility of robotic-assisted laparoscopic colectomy for colonic cancer. Methods The clinical outcomes of 13 patients with colon cancer undergoing robotic-assisted laparoscopic colectomy from May 2010 to November 2010 were retrospectively evaluated. Results All the operations were performed successfully, including 5 right colectomies, 3 left colectomies, and 3 sigmoidectomies. The operative time was (171.5±31.8) minutes. The estimated blood loss was (54.6±21.8) ml. Time to the return of bowel function was (60.9±15.8) hours and postoperative hospital stay was (6.4±3.6) days. There was one patient developed fat liquefaction at the incision. No bleeding, anastomotic fistula, anastomotic stenosis, or other complications were found. Conclusion Robotic-assisted laparoscopic colectomy is safe and feasible for colon cancer resection.%目的 探讨达芬奇机器人手术系统辅助结肠癌手术的安全性与可行性.方法 回顾性总结2010年5-11月实施的13例达芬奇机器人手术系统辅助结肠癌手术的治疗效果.结果 13例结肠癌患者行右半结肠切除5例、左半结肠切除3例、乙状结肠切除5例.手术均顺利完成,无中转开腹.手术时间(171.5±31.8)min,术中失血量(54.6±21.8)ml,术后肠蠕动恢复时间为(60.9±15.8)h,术后住院时间(6.4±3.6)d.术后除1例切口脂肪液化外,未出现出血、吻合口瘘、吻合口狭窄等并发症.结论 达芬奇机器人手术系统应用于结肠癌手术安全可行.

  7. 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

  8. Effects of assisted magnetic field to an atmospheric-pressure plasma jet on radical generation at the plasma-surface interface and bactericidal function

    Science.gov (United States)

    Liu, Chih-Tung; Kumakura, Takumi; Ishikawa, Kenji; Hashizume, Hiroshi; Takeda, Keigo; Ito, Masafumi; Hori, Masaru; Wu, Jong-Shinn

    2016-12-01

    A configuration of magnetic-assisted-plasma (MAP) on helium-based atmospheric-pressure plasma jet (APPJ) with an axial magnetic-field of 0.587 T is proposed, which provides good ability for killing bacteria Escherichia coli on the agar surface. Optically, we confirmed that the MAP increased approximately 2.4 times in the electron density estimated by the Stark broadening of H β line emission, and approximately 1.5 times enhancement of atomic oxygen concentration measured by vacuum ultraviolet absorption spectroscopy (VUVAS). Moreover, the generation of hydroxyl radical in the water increased 1.5 times, confirmed by the spin-trapping electron spin-resonance technique. In addition, the bactericidal experiments demonstrated 2.4 times higher for E. coli by the MAP treatment. The MAP configuration is proposed to be highly useful for future bio-medical applications by enhancing the radical generation at the plasma/substrate interface region.

  9. Simultaneous laparoscopic resection of primary colorectal cancer and associated liver metastases: a systematic review.

    Science.gov (United States)

    Lupinacci, R M; Andraus, W; De Paiva Haddad, L B; Carneiro D' Albuquerque, L A; Herman, P

    2014-02-01

    As many as 25 % of colorectal cancer (CRC) patients have liver metastases at presentation. However, the optimal strategy for resectable synchronous colorectal liver metastasis remains controversial. Despite the increasing use of laparoscopy in colorectal and liver resections, combined laparoscopic resection of the primary CRC and synchronous liver metastasis is rarely performed. The potential benefits of this approach are the possibility to perform a radical operation with small incisions, earlier recovery, and reduction in costs. The aim of this study was to review the literature on feasibility and short-term results of simultaneous laparoscopic resection. We conducted a systematic search of all articles published until February 2013. Search terms included: hepatectomy [Mesh], "liver resection," laparoscopy [Mesh], hand-assisted laparoscopy [Mesh], surgical procedures, minimally invasive [Mesh], colectomy [Mesh], colorectal neoplasms [Mesh], and "colorectal resections." No randomized trials are available. All data have been reported as case reports, case series, or case-control studies. Thirty-nine minimally invasive simultaneous resections were identified in 14 different articles. There were 9 (23 %) major hepatic resections. The most performed liver resection was left lateral sectionectomy in 26 (67 %) patients. Colorectal resections included low rectal resections with total mesorectal excision, right and left hemicolectomies, and anterior resections. Despite the lack of high-quality evidence, the laparoscopic combined procedure appeared to be feasible and safe, even with major hepatectomies. Good patient selection and refined surgical technique are the keys to successful simultaneous resection. Simultaneous left lateral sectionectomy associated with colorectal resection should be routinely proposed.

  10. Laparoscopic Spleen Removal (Splenectomy)

    Science.gov (United States)

    ... Laparoscopic Appendectomy Surgery Patient Information from SAGES Laparoscopic Colon Resection Surgery Patient Information from ... and Endoscopic Surgeons 11300 W. OIympic Blvd Suite 600 Los Angeles, CA 90064 USA webmaster@sages.org Tel: (310) 437- ...

  11. Laparoscopic Adrenal Gland Removal

    Science.gov (United States)

    ... Laparoscopic Appendectomy Surgery Patient Information from SAGES Laparoscopic Colon Resection Surgery Patient Information from ... and Endoscopic Surgeons 11300 W. OIympic Blvd Suite 600 Los Angeles, CA 90064 USA webmaster@sages.org Tel: (310) 437- ...

  12. Laparoscopic Spine Surgery

    Science.gov (United States)

    ... Exhibit Opportunities Sponsorship Opportunities Log In Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Laparoscopic Spine Surgery Your spine surgeon has determined that you need ...

  13. 经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的影响因素分析%Study on Factors of Positive Margins after Transperitoneal Laparoscopic Radical Prostatectomy

    Institute of Scientific and Technical Information of China (English)

    宋伟; 赵勇; 金讯波; 王慕文; 张海洋

    2015-01-01

    目的 探讨经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的相关影响因素. 方法 2009年9月至2014年5月,采用经腹腔途径行腹腔镜下前列腺癌根治术61例. 患者年龄56~74岁,平均71岁. 术前均经直肠超声引导下穿刺病理证实前列腺癌诊断. 通过回顾性研究了解术前血清前列腺特异性抗原( PSA)、穿刺后Gleason评分、穿刺针数阳性百分率,术前TNM分期对手术切缘阳性的影响. 结果 61例前列腺癌患者术后切缘阳性率19.7%(12/61),病理分期与手术切缘阳性成正相关(γ=0.311,P=0.001),且对手术切缘阳性有统计学意义(χ2 =16.32,P=0.001);对于手术切缘阳性率,术前血清PSA<20ng/ml组与血清PSA≥20ng/ml组比较,差异有统计学意义(χ2 =7.32,P=0.007);穿刺后Gleason评分<7分组与Gleason评分≥7分组差异无统计学意义了(χ2 =1.43,P=0.23);穿刺针数阳性百分率,<50%组与≥50%组差异有统计学意义(χ2 =4.32,P=0.017). 结论 穿刺后TNM分期,血清PSA水平,穿刺阳性百分率的差异对手术切缘阳性有统计学意义. 前列腺癌穿刺标本Gleason评分与术后病理切缘之间无相关性.%Objective To explore the relative risk factors for positive surgical margins ( PSM) in transperito-neal laparoscopic radical prostatectomy ( LRP).Methods From September 2009 to May 2014, 61 patients ( mean age 71 years old) with prostate cancers underwent transperitoneal LRP.The retrospective study recruited 61 patients with prostate cancer underwent transperitoneal laparoscopic radical prostatectomy to access the impact of pathological stage, PSA, Gleason scores and positive percentage of the needle biopsy on positive surgical mar-gins.Results The overall margin positivity rate was 19.7% (12/61).We found positive correlation (γ=0.311, P=0.001) between positive surgical margin and pathologic staging, and the difference was statistically significant (χ2 =16.32 , P=0.001).There was significant difference

  14. 腹腔镜与开放根治性膀胱全切-回肠膀胱术疗效比较%Comparison of laparoscopic and open surgery for radical cystectomy with ileal conduit surgery

    Institute of Scientific and Technical Information of China (English)

    梅延辉; 燕东亮; 张冰; 苏庆国; 曹景源; 邱新凯

    2016-01-01

    Objective To compare the clinical efficacy of laparoscopic radical cystectomy(LRC) and open radical cystectomy (ORC) for the treatment of ileal conduit surgery .Methods Sixty-two patients with LRC and ORC for the treatment of ileal conduit surgery from 2011 January to 2016 June were retrospectively reviewed .A total of 30 patients received LRC and ileal conduit surgery ,and 32 cases of ORC were enrolled for comparison .The demographic parameters of patients ,perioperative da-ta ,postoperative complication and oncology results were recorded and evaluated .Results The LRC group had less extimated blood loss(P=0.000) ,shorter hospital stay(P=0.000) compared with the ORC group .There was no difference in the mean number of dissected lymph nodes(P=0.085) ,and lymph node positive rate(P=0.922) between the two groups .There was no difference in term of tumor pathological staging classification .The median follow-up was 36 .5 months (6~56 months) .The ORC group had lower incidence of intestinal obstruction(P=0.040) .Conclusion Compared with ORC ,LRC has advantages of less blood loss ,shorter hospital stay in the treatment of ileal conduit surgery .It produces comparable tumor control as ORC .It had higher incidence of intestinal obstruction .We believed that in the process of the laparoscopic surgery the cause is that we can't keep peritoneal integrity .%目的:比较腹腔镜与开放根治性膀胱全切-回肠膀胱术的临床疗效。方法回顾性分析我院自2011年6月至2016年1月行开放(O RC )及腹腔镜(L RC )根治性膀胱全切-回肠膀胱术62例患者的资料,其中O RC组32例,L RC组30例。对两组患者的术前基本资料、围术期数据、术后并发症情况进行对比分析。结果 L RC组较O RC组具有术中出血量少(P=0.000),住院时间短(P=0.000)的特点。所有患者术后切缘均为阴性,两组患者在淋巴结清扫个数(P=0.085)以及淋巴结阳性率(P=0.922)方面

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

    Institute of Scientific and Technical Information of China (English)

    干思舜; 徐丹枫; 高轶; 崔心刚; 王军凯

    2012-01-01

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

  16. 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.

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

    Institute of Scientific and Technical Information of China (English)

    林发牧; 许小兵

    2014-01-01

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

  18. Clinical comparison of robotic-assisted and traditional laparoscopic hysterectomy%机器人及传统腹腔镜全子宫切除术的临床比较

    Institute of Scientific and Technical Information of China (English)

    孙小单; 袁勇

    2015-01-01

    Objective To compare the clinical data of robotic-assisted laparoscopic hysterectomy (RALH)and traditional laparoscopic hysterectomy (LH)and to explore the advantages of robotic surgery system.Methods A retrospective analysis of patients in Jilin Province Tumor Hospital Department 2 of Gynecologic Oncology from Oct.2014 to Dec.2014 undergoing RALH (n =30)was carried out.A matched group of 30 patients undergoing LH (n =30)was selected as the control group.The operating time,blood loss,postoperative 24 hours drainage,postoperative bowel recovery time and postoperative hospitalization length were observed.Results The blood loss was significantly less in patients with robotic laparoscopic group,postoperative bowel recovery time and hospital stay were shorter than the laparoscopic group,The operating time was slightly longer than the laparoscopic group,the two sets of data were significantly different (P 0.05).Conclusion Robotic-assisted laparoscopy is feasible and safe,worthy of promotion for less bleeding,less damage,faster recovery,less pain for patients and shortens the mean length of stay.%目的:比较机器人辅助与传统腹腔镜两种手术方式行全子宫切除术的临床资料,探讨机器人手术系统的优势。方法回顾性分析吉林省肿瘤医院妇科肿瘤二科2014年10月至2014年12月使用机器人辅助腹腔镜下全子宫切除术(RALH)30例(机器人组),并选取同期与之匹配的采用传统腹腔镜全子宫切除术(LH)30例为腹腔镜组,观察数据包括两组的手术时间、术中出血量、术后24 h 引流量、术后首次排气时间及术后住院天数等。结果两组比较,机器人组术中出血量明显少于腹腔镜组,术后首次排气时间及住院时间均短于腹腔镜组,手术时间略长于腹腔镜组,差异有统计学意义(P <0.05);术后24 h 引流量比较,差异无统计学意义(P >0.05)。结论机器人辅助腹腔镜手术具备术中

  19. 结直肠手术中机器人辅助与传统腹腔镜手术效果的meta分析%A meta-analysis of robotic-assisted and laparoscopic colorectal surgery

    Institute of Scientific and Technical Information of China (English)

    邓军; 童强; 吴珂; 卢晓明; 王国斌

    2012-01-01

    Objective:To access the safety and feasibility of robotic-assisted laparoscopie colorectal surgery. Method: A system review and a meta-analysis were conducted to compare several indexes between the robotic-assisted laparoscope and traditional laparoscope applied in colorectal surgery. A comprehensive search of electronic database: Pubmed and EMbase from building the database to Jan, 2012 was completed for controlled studies and random trails comparing robotic-assistant and laparoscope used in colorectal surgery. Two independent reviewers joined in the work of data admitting and excluding. All the statistical analysis was performed with Stata 10. 0. Result :15 articles including 1 182 patients met the criteria and were finally included in this meta-analysis. No statistically significant difference was found in estimated blood loss, number of dissected lymph nodes, distal resection margin, time of bowel function recovery, time to oral diet, hospital stay, total cost, number of total complications and number of conversion to open surgery between two groups. Conclusion: This systematic review demonstrated that robotic- assisted colorectal surgery is emerging as a safe and feasible option in colorectal surgery compared with traditional laparoscopic surgery.%目的:应用Meta分析的方法比较机器人和传统腹腔镜在结直肠手术应用中各项临床指标,以评价机器人辅助与传统腹腔镜治疗效果的安全性及差异.方法:本文在两个英文数据库:Pubmed和EMbase检索了建库至2012年1月关于机器人辅助腹腔镜与传统腹腔镜在结直肠手术中应用对比的文献,由两位不同的作者独立进行排除、纳入与数据提取,将符合标准的文献数据利用Stata10.0进行分析.结果:本文最终纳入了15篇符合标准的文献,共包含了 1 182个病人.总的机器人辅助手术并发症发生率为17%,中转开腹手术的转换率为2%,有死亡病例均为0.机器人辅助腹腔镜组手术时间比

  20. 腹腔镜与开腹直肠癌根治术保留盆腔自主神经对男性排尿及性功能影响的对比研究%The comparative study of urinary and sexual function after laparoscopic and open radical resection of rectal carcinoma withpelvic autonomic nerve preservation in males

    Institute of Scientific and Technical Information of China (English)

    郭炜; 王昭顺; 郭澎; 孙军席; 刘铁

    2011-01-01

    Objective:To evaluate the urinary and sexual functions after pelvic autonomic never preserving in laparoscopic radical resection for rectal cancer in male patients. Methods:Retrospective analysis was made on clinical data of 210 male patients with rectal cancer during 2007 to 2010. They were divided into two groups ( laparoscopic group, n = 96; open group, n = 114 ). Results: The urinary disorder rates, effective disorder rates and ejaculation disorder rates of laparoscopic group were 10.42%, 13.54% and 19.79% ,while values of open group were 18.42% ,25.43% and 29.82%. The difference between them was statistically significant( P <0.05 ). Conclusions: The laparoscopic radical resection with pelvic autonomic nerve preservation can effectively reduce the incidence of urinary dysfunction and sexual dysfunction after operation ,and improve patients'quality of life after operation.%目的:探讨腹腔镜直肠癌根治术保留盆腔自主神经对男性患者术后排尿及性功能的影响.方法:回顾分析2007~2010年为96例男性直肠癌患者施行腹腔镜手术的临床资料,总结其对患者术后排尿及性功能的影响,并与114例开腹手术对比.结果:腹腔镜组术后排尿功能障碍率10.42%,勃起功能障碍率13.54%,射精功能障碍率19.79%;开腹组分别为18.42%,25.43%,29.82%,两组差异均有统计学意义(P<0.05).结论:腹腔镜直肠癌根治术保留盆腔自主神经可有效降低男性患者术后排尿功能及性功能障碍的发生率,提高患者的生活质量.

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

    Institute of Scientific and Technical Information of China (English)

    王涛; 李丽霞; 董薪; 蔡康灵

    2014-01-01

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

  2. Effect of Positive End-Expiratory Pressure on the Sonographic Optic Nerve Sheath Diameter as a Surrogate for Intracranial Pressure during Robot-Assisted Laparoscopic Prostatectomy: A Randomized Controlled Trial

    Science.gov (United States)

    Chin, Ji-Hyun; Kim, Wook-Jong; Lee, Joonho; Han, Yun A.; Lim, Jinwook; Hwang, Jai-Hyun; Cho, Seong-Sik

    2017-01-01

    Background Positive end-expiratory pressure (PEEP) can increase intracranial pressure. Pneumoperitoneum and the Trendelenburg position are associated with an increased intracranial pressure. We investigated whether PEEP ventilation could additionally influence the sonographic optic nerve sheath diameter as a surrogate for intracranial pressure during pneumoperitoneum combined with the Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy. Methods After anesthetic induction, 38 patients were randomly allocated to a low tidal volume ventilation (8 ml/kg) without PEEP group (zero end-expiratory pressure [ZEEP] group, n = 19) or low tidal volume ventilation with 8 cmH2O PEEP group (PEEP group, n = 19). The sonographic optic nerve sheath diameter was measured prior to skin incision, 5 min and 30 min after pneumoperitoneum and the Trendelenburg position, and at the end of surgery. The study endpoint was the difference in the sonographic optic nerve sheath diameter 5 min after pneumoperitoneum and the Trendelenburg position between the ZEEP and PEEP groups. Results Optic nerve sheath diameters 5 min after pneumoperitoneum and the Trendelenburg position did not significantly differ between the groups [least square mean (95% confidence interval); 4.8 (4.6–4.9) mm vs 4.8 (4.7–5.0) mm, P = 0.618]. Optic nerve sheath diameters 30 min after pneumoperitoneum and the Trendelenburg position also did not differ between the groups [least square mean (95% confidence interval); 4.5 (4.3–4.6) mm vs 4.5 (4.4–4.6) mm, P = 0.733]. Conclusions An 8 cmH2O PEEP application under low tidal volume ventilation does not induce an increase in the optic nerve sheath diameter during pneumoperitoneum combined with the steep Trendelenburg position, suggesting that there might be no detrimental effects of PEEP on the intracranial pressure during robot-assisted laparoscopic prostatectomy. Trial Registration ClinicalTrial.gov NCT02516566 PMID:28107408

  3. Perioperative nursing on robot-assistant laparoscopic nephron-sparing surgery%机器人辅助腹腔镜保留肾单位肾部分切除术的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    周秀彬; 王岩; 张玲; 胡英娜; 付清清

    2011-01-01

    目的 探讨机器人辅助腹腔镜保留肾单位肾部分切除术的围手术期护理措施和效果.方法 对6例行达芬奇机器人(Da Vinci S手术机器人系统)辅助腹腔镜保留肾单位肾部分切除术的患者进行术前心理护理和术前准备,术后心理护理、生命体征监测、引流管护理、并发症的监测、活动训练、饮食护理等围手术期护理.结果 6例手术患者中,1例改开放性保留肾单位肾部分切除术,其余5例手术均成功.全体患者术后恢复顺利,无并发症发生.结论 围手术期系统护理可保证机器人辅助腹腔镜下保留肾单位肾部分切除术的顺利进行,加快患者康复,效果满意.%Objective To analyze and discuss the systemic nursing strategy and effectiveness for robotassistant laparoscopic nephron-sparing surgery. Methods A total of 6 patients had undergone robot-assistant laparoscopic nephron-sparing partial nephrectomy. All the patients were given systemic perioperative nursing which was described as the following: peroperative psychological nursing and preoperative preparation; the postoperative monitoring of patients' vital sign, drainage tube; the postoperative nursing of psychophysiology,food and drink and rehabilitation training; prophylactic nursing of postoperative complications. Results All procedures were successfully completed with one case open conversion. All the patients had successful postoperative recovery without postoperative complications. Conclusions The postoperative systemic nursing strategy was feasible and safe for robot-assistant laparoscopic nephron-sparing surgery.

  4. Preliminary investigation on the video-assisted thoracic radical resection of esophageal carcinoma%胸腔镜辅助下食管癌根治术的初步探讨

    Institute of Scientific and Technical Information of China (English)

    姚杰; 臧国辉; 陈斌

    2016-01-01

    Objective:To investigate the feasibility and safety of radical resection of upper or middle esophageal carcinoma by video-assisted thoracic sur-gery (VATS).Methods:Twelve patients with upper or middle esophageal cancer underwent esophagectomy by VATS.Resection of the thoracic esophagus was carried out at the right side of the chest under the thoracoscope,with the esophagus and mediastinal lymph nodes being dissected.Middle incision at the lower or upper abdomen was performed under the laparoscope to construct tubular stomach ,around which the lymph nodes were dissected before anasto-mosis of the esophagus with the left neck of the stomach.Results:Operation was successful in the 12 cases,and no single case required conversion to thora-cotomy.No perioperative death or severe complications occurred.Averagely,(13 ±9) lymph nodes were dissected.The operative time was (310 ±70) min,and intraoperative blood loss was (260 ±70) mL.By Numerical Rating Scale(NRS) 72 hours after the operation,the incision pain at the chest was 3.45 ±1.18.The follow-up so far showed no relapse,no metastasis and no death.Conclusion:Radical resection of the esophageal caner by video-assisted esophagectomy may be safe and effective for the cancer at stage Ⅰ and Ⅱ,which is wider recommended in hospitals in municipal level .%目的:探讨胸腔镜辅助下中、上段食管癌根治术的可行性及安全性。方法:12例中、上段食管癌患者行胸腔镜辅助下食管癌根治术,胸段食管行右侧胸部胸腔镜下操作,游离食管,清扫纵隔淋巴结。腹腔镜下或上腹正中切口游离胃并制成管状胃,清扫胃周,胃左淋巴结,食管,胃行左颈部吻合。结果:12例食管癌患者手术均成功,无中转开胸,无围手术期死亡及严重并发症发生。平均清扫淋巴结(13±9)枚。手术时间(310±70) min,术中出血量(260±70) mL,术后72 h胸部切口疼痛采用疼痛数字评价量表( NRS

  5. 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.

  6. 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.

  7. 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.

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

    Institute of Scientific and Technical Information of China (English)

    卫洪波; 郑宗珩

    2015-01-01

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

  9. Laparoscopic radical prostatectomy for high-risk prostate cancer (49 cases)%经腹膜外腹腔镜前列腺癌根治术治疗高危前列腺癌的临床研究(附49例报告)

    Institute of Scientific and Technical Information of China (English)

    乔鹏; 邢念增

    2016-01-01

    Objective To evaluate the safety and effect of extraperitoneal laparoscopic radical prostatectomy for high-risk prostate cancer. Methods From January 2012 to August 2015, 49 patients diagnosed high-risk prostate cancer underwent extraperitoneal laparoscopic radical prostatectomy with 'sandwich' urethra reconstruction. Results None converted to open surgery and the mean operative time was (2.15 ±0.29) h, mean intraoperative blood loss was (60.25 ± 20.29) ml. No rectal injury was observed. The patients were ambulant 1 to 2 days postoperatively. Pelvic lymph nodes metastasis was found in 5 cases. Positive margin was found in 13 cases. Mild urinary incontinence oc-curred in 3 cases. Urethral stenosis occurred in 2 cases. Biochemical relapses occurred on 5 cases during the follow-ing period of 1~43 months for 46 cases. Conclusions Extraperitoneal laparoscopic radical prostatectomy is safe and effective in treatment of high-risk prostate cancer. The very key is to master the anatomy of prostate and laparoscop-ic techniques.%目的:评价经腹膜外腹腔镜前列腺癌根治术治疗高危前列腺癌患者的安全性及疗效。方法该科自2012年1月-2015年8月对49例高危前列腺癌患者行经腹膜外腹腔镜前列腺癌根治术,术中采用了“三明治”法进行尿道重建。结果49例手术均获得成功,无中转开放手术。手术时间平均(2.15±0.29)h,术中出血量(60.25±20.29)ml,没有直肠损伤出现。患者术后1或2 d可以下地活动。术后病理显示盆腔淋巴结转移5例,切缘阳性13例。3例患者术后出现轻度尿失禁,2例患者出现尿道狭窄。对其中46例患者随访1~43个月,5例患者出现生化复发。结论经腹膜外腹腔镜前列腺癌根治术治疗高危前列腺癌安全、有效。熟悉前列腺局部解剖及熟练掌握各种腹腔镜下操作技术是手术成功的关键。

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李太原; 江群广

    2016-01-01

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

  14. Histopathologic Outcomes of Robotic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Vipul R. Patel

    2006-01-01

    Full Text Available Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and shortterm PSA outcomes of 500 robotic radical prostatectomies. 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 were collected every 3 months for the first year, then every 6 months for a year, then yearly. The average preoperative PSA was 6.9 (1–90 with Gleason’s score of 5 (2%, 6 (52%, 7 (40%, 8 (4%, and 9 (2%; postoperatively, histopathologic analysis showed Gleason's 6 (44%, 7 (42%, 8 (10%, and 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, and 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 it was 31% for nonorgan-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% multifocal. Ninety-five percent of patients (n = 500 have undetectable PSA (<0.1 at average follow-up of 9.7 months. Recurrence has only been seen with nonorgan-confined tumors. Of those patients with a minimum follow-up of 1 year (average 15.7 months, 95% have undetectable PSA (<0.1. Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall, positive margin rate. Shortterm

  15. 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.

  16. Laparoscopic Renal Cryoablation

    Science.gov (United States)

    Schiffman, Marc; Moshfegh, Amiel; Talenfeld, Adam; Del Pizzo, Joseph J.

    2014-01-01

    In light of evidence linking radical nephrectomy and consequent suboptimal renal function to adverse cardiovascular events and increased mortality, research into nephron-sparing techniques for renal masses widely expanded in the past two decades. The American Urological Association (AUA) guidelines now explicitly list partial nephrectomy as the standard of care for the management of T1a renal tumors. Because of the increasing utilization of cross-sectional imaging, up to 70% of newly detected renal masses are stage T1a, making them more amenable to minimally invasive nephron-sparing therapies including laparoscopic and robotic partial nephrectomy and ablative therapies. Cryosurgery has emerged as a leading option for renal ablation, and compared with surgical techniques it offers benefits in preserving renal function with fewer complications, shorter hospitalization times, and allows for quicker convalescence. A mature dataset exists at this time, with intermediate and long-term follow-up data available. Cryosurgical recommendations as a first-line therapy are made at this time in limited populations, including elderly patients, patients with multiple comorbidities, and those with a solitary kidney. As more data emerge on oncologic efficacy, and technical experience and the technology continue to improve, the application of this modality will likely be extended in future treatment guidelines. PMID:24596441

  17. 腹腔镜下宫颈癌根治术与传统经腹宫颈癌根治术的临床疗效对照%Comparison of therapeutic effect of the ventral cervical cancer treated with traditional laparoscopic cervical cancer radical curative effect of cervical dis -ease

    Institute of Scientific and Technical Information of China (English)

    肖红

    2013-01-01

    目的:观察腹腔镜下宫颈癌根治术与传统经腹宫颈癌根治术对宫颈癌疾病治疗的临床疗效。方法对我院收治的90例宫颈癌(Ia-IIa期)患者随机分为治疗组和对照组,各45例,对比两组患者治疗效果。结果两组患者清扫淋巴结数目比较无统计学意义( P>0.05);对比两组患者术中出血量、肛门排气时间、下床活动时间、切口感染发生率及平均住院时间,有统计学意义(P<0.05)。结论腹腔镜下宫颈癌根治术治疗宫颈癌疾病较传统手术方式优越。%Objective To observe the ventral cervical cancer treated with traditional laparoscopic cervical cancer radical curative effect of cervical disease .Methods our hospital 90 cases of cervical cancer patients were divided into treatment group and control group ,45 cases ,com-pared two groups of patients with therapeutic effect .Results Two groups of patients with cleaning the lymph node number is no statistical signifi-cance (P>0.05);Compared to two groups of patients with intraoperative blood loss ,anal exhaust time ,ambulation time ,incision infection rate and the average length of hospital stay ,was statistically significant (P<0.05) .Conclusion Laparoscopic treatment of cervical cancer radical cervi-cal cancer disease effect is remarkable .

  18. Ergonomics in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Supe Avinash

    2010-01-01

    Full Text Available 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 comfortable in the operating room but also reduce physical strains on surgeon.

  19. Single incision laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    Arun; Prasad

    2010-01-01

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

  20. Ergonomics in Laparoscopic Surgery

    OpenAIRE

    Supe Avinash; Kulkarni Gaurav; Supe Pradnya

    2016-01-01

    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...

  1. 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.

  2. Application of fibrin sealant at the urethrovesical anastomosis in robotic assisted radical prostatectomy: does it enable earlier Foley catheter and Jackson-Pratt drain removal?

    Science.gov (United States)

    Flury, Sarah C; Starnes, Danielle N; Steers, William D

    2008-01-01

    Leakage at the urethrovesical anastomosis in the post-operative period can result in morbidity including ileus. We examined the effectiveness of using a fibrin sealant at the anastomosis to limit urine leakage thereby facilitating earlier Jackson-Pratt drain and Foley catheter removal following robotic assisted laparoscopic prostatectomy (RALRP). Forty consecutive patients underwent RALRP by one surgeon at our institution. The first 20 patients underwent standard operation and served as the control group. The subsequent 20 patients underwent the same operation with addition of fibrin sealant following a running absorbable sutured urethrovesical anastomosis. The two groups were compared for age (60.5 vs. 58.2 years), pre-operative PSA (5.23 vs. 4.71), Gleason score (6.3 vs. 6.5), stage at resection, and prostate size at resection (51.7 vs. 47.7 g). Wilcoxon rank sum test determined no statistically significant differences in the groups. Patients in the fibrin sealant group had 1.3 versus 2.1 days with a Jackson-Pratt drain, 9.75 versus 12.1 days with a catheter, and an average of 38.6 versus 63.2 cc of drainage per shift. Catheters were removed when a cystogram demonstrated no extravasation of contrast. Two patients in the control group and no patients in the fibrin sealant group had large-volume leakage and ileus post-operatively. In patients undergoing RALRP, application of fibrin sealant at the urethrovesical anastomosis appears to facilitate sealing, thereby allowing earlier removal of the JP drain, by 0.8 days, and the Foley catheter, by 2.35 days, than in controls. No patients in the fibrin sealant group suffered post-operative ileus. This adjunct may be especially useful early in the learning process to reduce morbidity.

  3. 腹腔镜下全膀胱切除术疗效及早期并发症的临床分析%Early stage postoperative complications of laparoscopic radical cystectomy

    Institute of Scientific and Technical Information of China (English)

    许传亮; 杨波; 高旭; 侯建国; 王林辉; 孙颖浩; 曾蜀雄; 张振声; 于晓雯; 宋瑞祥; 韦荣超; 鲁欣; 李惠珍; 周铁

    2014-01-01

    ,术后并发症发生率较低,但术后患者白蛋白明显降低,需注意维持术后营养平衡。%Objective To investigate feasibility and early stage postoperative complications of lapa-roscopic radical cystectomy ( LRC) . Methods We retrospectively analyzed the data of 63 consecutive pa-tents (58 males and 5 females) who underwent LRC from Oct .2011 to Oct.2013 in our institute.Of these patients, 46 patients underwent ileal conduit , 9 patients underwent ureterocutaneostomy , and 8 patients un-derwent orthotopic ileal neobladder urinary diversion .The average age and body mass index of patients were 67.7±11.1 (33-84) years and 23.3±2.1 (18.8-28.7) kg/m2, respectively.The mean hemoglobin and al-bumin of patients were (130.7±20.3) g/L and (38.9±4.1) g/L, respectively.Comorbidities of hyperten-sion, diabetes, coronary heart disease and decompensated liver cirrhosis were found in 10, 6, 2 and 1 pa-tient, respectively.10 of 61 patients had a history of abdominal surgery .The indications for cystectomy were classified as muscle invasive bladder cancer for 30 patients, unresectable superficial bladder cancer for 19 patients and recurrent bladder cancer for 14 patients.Postoperative data and early stage postoperative compli-cations within 3 months after surgery were collected . Results The median operative time for LRC and uri-nary diversion was 390 (260-480) min, with a median estimated blood loss of 400 (100-1 500) ml.This was one patient converted to open surgery .The mean postoperative hemoglobin and albumin of patients was 108.5±14.7 g/L and 29.5±3.7 g/L, respectively, both of which significantly reduced compared with pre-operative data (P<0.01).The median duration of hospital stay was 15 days.The median time for liquid in-take, abdominal drainage removal and ureteral stent removal was 4 days, 9 days and 2 months after surgery , respectively.Catheter was removed 2 weeks after laparoscopic orthotopic cystectomy .21 (33.3%) of 63 pa-tients suffered

  4. Radical hybrid video-assisted thoracic segmentectomy: long-term results of minimally invasive anatomical sublobar resection for treating lung cancer.

    Science.gov (United States)

    Okada, Morihito; Tsutani, Yasuhiro; Ikeda, Takuhiro; Misumi, Keizo; Matsumoto, Kotaro; Yoshimura, Masahiro; Miyata, Yoshihiro

    2012-01-01

    We analysed the results of radical segmentectomy achieved through a hybrid video-assisted thoracic surgery (VATS) approach that used both direct vision and television monitor visualization at a median follow-up of over 5 years. Between April 2004 and October 2010, 102 consecutive patients able to tolerate lobectomy to treat clinical T1N0M0 non-small cell lung cancer (NSCLC) underwent hybrid VATS segmentectomy in which we used electrocautery without a stapler to divide the intersegmental plane detected by selective jet ventilation in addition to the path of the intersegmental veins. Curative resection was achieved in all patients. The median surgical duration and blood loss during the surgery were 129 min (range, 60-275 min) and 50 ml (range, 10-350 ml), respectively. The complication rate was 9.8% (10/102) with the most frequent being prolonged air leak, and there was no case of in-hospital death or 30-day mortality post procedure. Five and seven patients developed locoregional and distant recurrences, respectively. The overall and disease-free 5-year survival rates were 89.8% and 84.7%, respectively. Radical hybrid VATS segmentectomy including atypical resection of (sub)segments is a useful option for clinical stage-I NSCLC. The exact identification of anatomical intersegmental plane followed by dissection using electrocautery is critical from oncological and functional perspectives.

  5. 完全腹腔镜下根治性膀胱全切除加原位回肠新膀胱术(附3例报告)%Totally laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder(Report of 3 cases)

    Institute of Scientific and Technical Information of China (English)

    陈光富; 瓦斯里江·瓦哈甫; 马鑫; 许勇; 李宏召; 董隽; 张旭

    2012-01-01

    Objective:To investigate the clinical feasibility of totally laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder and to summarize the operative technique. Methods: The operative technique of totally laparoscopic radical cystectomy with extensive pelvic lymph node dissection and intracorporeal orthotopic ileal neobladder with a Studer limb was performed in 3 patients. Results: All patients were completed totally laparoscopic procedure as planned without any intraoperative complications or open conversion. Total operative time was 510, 470 and 450 min, respectively, with blood loss 300, 150 and 210ml. The number of removed lymph nodes was 23, 20(1 node positive) and 25, and surgical margins of the bladder specimen were negative in each case. All patients resumed ambulation on postoperative days 2, and bowel function were recovered on days 3. The il-eoureteral stents and the urethral catheter were removed at 1 month after a cystogram confirmed watertight healing. No complications of ureteral reflux, urine and intestinal leaks occurred during the early postoperative period. Hospital stay was 17, 13 and 16 days, respectively. During follow up of 4, 3 and 3 months, renal function was normal in all 3 patients and no local or systemic progression. Conclusions: With the initial surgical experience and short-term follow-up, totally laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder are feasible. More extensive experiences, longer-term and randomized trials will be required to better assess the appropriateness and true potential of this technique.%目的:探讨完全腹腔镜下根治性膀胱全切除加原位回肠新膀胱术的临床可行性,并总结手术技巧.方法:对3例膀胱癌患者行腹腔镜下根治性膀胱全切术加扩大淋巴结清扫,并在腹腔镜下制备Studer新膀胱术.结果:3例手术均获成功,手术时间分别为510、470和450 min,出血量300、150和210ml

  6. Operative coordination of robot assisted retroperitoneal laparoscopic partial nephrectomy%机器人辅助后腹腔镜肾部分切除术的手术配合

    Institute of Scientific and Technical Information of China (English)

    崔茜; 管春丽; 王涛

    2016-01-01

    Objective To investigate the nursing coordination for robot assisted retroperitoneal laparoscopic partial nephrectomy. Methods The nursing coordination for 117 cases of robot assisted retroperitoneal laparoscopic partial nephrectomy which were received and cured in the department of urology, chinese PLA general hospital from Dec. 2014 to Dec. 2015, was analysised. By means of preoperative interview and evaluate, adequate preparing of instruments and articles, reasonable layout of the operating room, standardized coordination during operation, postoperative nursing and interview, the patients pass through perioperative period successfully. Results Nursing coordination was successfully completed to the 117 cases, and the effect of medical coordination is satisfactory. No postoperative complication occurred by short term follow up. Conclusions Adequate preoperative preparation, reasonable layout of the operating room, skilled coordination during operation could improve the operating efficiency, which is the important link of successful operations.%目的:探讨机器人辅助后腹腔镜肾部分切除术的护理配合流程。方法对解放军总医院泌尿外科2014年12月至2015年12月的117例机器人辅助后腹腔镜肾部分切除术的护理配合进行分析,通过术前访视评估、器械及物品的充分准备、合理的手术间布局、术中精准化配合及术后护理及访视,使患者顺利度过围手术期。结果117例患者顺利完成,医护配合效果满意,短期随访无术后并发症发生。结论充分的术前准备,合理的手术间布局,熟练的术中配合能提高术者手术效率,手术顺利完成的重要环节。

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

    Institute of Scientific and Technical Information of China (English)

    沈群; 杨波; 王燕; 过菲; 高旭; 盛夏

    2014-01-01

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

  8. Ultrasound assisted free radical polymerization of glycidyl methacrylate by a new disite phase-transfer catalyst system: A kinetic study.

    Science.gov (United States)

    Sankar, Kavitha; Rajendran, Venugopal

    2012-11-01

    The kinetics of multi-site phase-transfer catalyzed free radical polymerisation of glycidyl methacrylate (GMA) using potassium peroxy disulphate (PDS) as water soluble initiator and newly synthesized 1,4-dihexadecylpyrazine-1,4-diium dibromide as multi-site phase-transfer catalyst (MPTC) has been investigated in ethyl acetate/water two phase system at constant temperature 65±1°C under nitrogen atmosphere and ultrasound irradiation conditions. The rate of polymerization increases with an increase in concentrations of GMA, PDS and MPTC. The order with respect to monomer, initiator and MPTC were found to be 1.0, 0.5 and 1.0, respectively. The comparative study reveals that the Rp of GMA determined in the presence of PTC combined with ultrasound has shown more enhancements in the activity than PTC alone. Based on the observed results a suitable mechanism has been proposed to account for the experimental observations and its significance was discussed.

  9. Laparoscopic Surgery - What Is It?

    Science.gov (United States)

    ... Surgery - What is it? Laparoscopic Surgery - What is it? Laparoscopic Surgery - What is it? | ASCRS WHAT IS LAPAROSCOPIC SURGERY? Laparoscopic or “minimally ... information about the management of the conditions addressed. It should be recognized that these brochures should not ...

  10. 腹腔镜下根治性前列腺切除术膀胱尿道单针连续吻合法%Single needle running suture method for urethrovesical anastomosis during laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    张旭; 居正华; 王超; 艾星; 马鑫; 史涛坪; 张国玺; 王保军

    2009-01-01

    目的 介绍一种简单易行的腹腔镜下膀胱尿道连续吻合法. 方法 前列腺癌患者45例.均行根治性前列腺切除术,并采用单针连续吻合法进行膀胱尿道吻合:首先在膀胱后壁4点处做一单纯全层缝合并打结固定;然后在其附近处另起1针做顺时针膀胱尿道单纯连续缝合;从5点到8点处,每点吻合1针以确保后壁的严密;以后每2点吻合1针;为防止滑脱,每吻合3针做1针锁边吻合;最后在2点处与原预留线尾打第2个结完成吻合.吻合膀胱壁时遵循"由外到内"原则,吻合尿道壁时遵循"由内到外"原则;如出现吻合121漏,则加用单纯缝合来修补. 结果 所有吻合均顺利完成.吻合时间12~25 min,平均16 min.手术时间112~185 min,平均132 min.尿管留置7~14d,平均9 d.3例因发生暂时性漏尿需延长尿管留置时间至2周.44例(97.8%)术后1年内完全尿控,1例(2.2%)因轻微尿失禁每天使用尿垫2片;无尿道缩窄及其他短期或永久性并发症. 结论 单针连续缝合法耗时短,相对简单,易于掌握,并发症并未相应增加.%Objective To describe the single needle running suture method for the urethrovesi-cal anastomosis during laparoscopic radical prostatectomy(LRP). Methods Forty-five patients of prostate cancer underwent LRP with the single needle running suture method. The technique was initi-ated by performing a fixing suture at the posterior lip of bladder neck at 4 o' clock and tying the first knot. Another suture at the nearby position of the first suture was performed to leave the first knot outside. From 5 o' clock to 8 o' clock, sutures were performed every one o' clock to secure posterior approximation, then every two o'clock a suture. To avoid a loose anastomosis, lock sutures were per-formed every 3 sutures. After completing the full circumference, the needle was drawn at the 2 o' clock for the second knot. The needle was always driven full-thickness outside-in in the bladder neck

  11. 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.

  12. Radical prostatectomy

    Science.gov (United States)

    ... to see inside your belly during the procedure. Robotic surgery : Sometimes, laparoscopic surgery is performed using a robotic ... near the operating table. Not every hospital offers robotic surgery. Perineal : Your surgeon makes a cut in the ...

  13. Short-term Clinical Outcomes of Laparoscopic Fertility-preserving Radical Hysterectomy in the Management of Early-stage Cervical Cancer%腹腔镜下保留生育功能宫颈癌根治术治疗早期子宫颈癌的近期临床疗效

    Institute of Scientific and Technical Information of China (English)

    刘开江; 刘青; 韩娜娜; 王娟; 李培全; 茹明芳

    2011-01-01

    Objective To investigate the feasibility and effectiveness of laparoscopic radical trache-lectomy and lymphadenectomy in the treatment of early-stage cervical cancer. Methods The clinical data of 6 patients ( stage I a2 to I bl) , who underwent laparoscopic fertility-preserving radical operation for cervical cancer in our department from February 2009 to October 2010, were retrospectively analyzed in terms of operation duration, intra-operative blood loss, postoperative pathology, complications, and pregnancy. Results Both radical resection of cervical and pelvic lymph node dissection were completed under laparoscopy, and only the cervical and vaginal cuffs were closed from vagina. The operation duration ranged 155-210 min ( mean; 185 min) and the intra-operative blood loss was approximately 60-120 ml (mean: 105 ml). The average length of hospital stay was 18 days without complications, postoperative infection, and bleeding. Postoperative pathology showed no lymph node metastasis, and no ligament, blood vessels, vaginal cutting margin, or upper part of cervix was invaded by tumor cells. During the 8-20-month follow-up, 1 patient had become pregnant for 4 months and no case experienced tumor recurrence. Conclusion Laparoscopic fertility-preserving lymphadenectomy and radical trachelectomy is feasible for patients with early-stage cervical cancer who have strong wish to have a child.%目的 探讨腹腔镜下根治性子宫颈切除术和盆腔淋巴结切除术治疗早期子宫颈癌的可行性和效果.方法 回顾分析6例Ⅰa2~Ⅰb1期行腹腔镜下保留生育功能子宫颈癌根治术患者的临床资料,分析手术时间、出血量、手术后病理、并发症、妊娠情况等.结果 根治性子官颈切除术和盆腔淋巴结清扫术均在腹腔镜下完成,仅宫颈和阴道断端缝合经阴道完成.手术时间155 ~210 min,平均185 min;术中出血量约60~120ml,平均105 ml.术中及术后均无并发症.术后病理学检查未

  14. 腹腔镜下直肠癌根治术与开腹手术的疗效比较%Comparison of the Therapeutic Effect Between Rectal Cancer and Open Operation for Laparoscopic Radical Resection

    Institute of Scientific and Technical Information of China (English)

    于湛

    2015-01-01

    目的:研究分析腹腔镜下直肠癌根治术以及开腹手术的临床应用效果,评价其应用价值。方法抽取接受腹腔镜直肠癌根治术治疗的64例直肠癌患者和同期接受传统开腹手术治疗的64例患者,对其临床治疗效果进行回顾性分析。结果腹腔镜组患者手术耗时长于开腹组(P<0.05);腹腔镜组术中出血量少于开腹组(P<0.05);腹腔镜组患者手术结束后的排气时间、留置尿管时间以及进食流质食物的时间、下床时间、住院时间均少于开腹组(P<0.05);两组患者术后并发症发生率无明显差异(P>0.05)。结论在腹腔镜的直视下开展直肠癌根治术,能够有效减少手术创伤,减少术中出血量,缓解手术疼痛,降低患者痛苦,治疗效果良好。%Objective To study the effect of laparoscopic colorectal cancer resection and abdominal surgery and evaluate the value. Methods 64 cases of colorectal cancer who underwent extraction underwent laparoscopic colorectal cancer resection and 64 patients who underwent synchronous accept traditional open surgery were retrospectively analyzed. Results Laparoscopic surgery group took signiifcantly longer than the laparotomy group (P0.05). Conclusion The direct vision in laparoscopic colorectal cancer resection can effectively reduce surgical trauma, reduce blood loss, surgery to alleviate pain, reduce the suffering of patients.

  15. Laparoscopic repair of vesicovaginal fistula

    Directory of Open Access Journals (Sweden)

    Miłosz Wilczyński

    2011-06-01

    Full Text Available A vesicovaginal fistula is one of the complications that a gynaecologist is bound to face after oncological operations, especially in postmenopausal women. Over the years there have been introduced many techniques of surgical treatment of this entity, including transabdominal and transvaginal approaches.We present a case of a 46-year-old patient who suffered from urinary leakage via the vagina due to the presence of a vesicovaginal fistula that developed after radical abdominal hysterectomy and subsequent radiotherapy. The decision was made to repair it laparoscopically due to retracted, fibrous and scarred tissue in the vaginal apex that precluded a transvaginal approach. A small cystotomy followed by an excision of fistula borders was performed. After six-month follow-up no recurrence of the disease has been noted.We conclude that laparoscopy is an interesting alternative to traditional approaches that provides comparable results.

  16. 腹腔镜辅助D2根治术治疗进展期胃癌的效果观察%Effect of laparoscopy-assisted gastric D2 radical surgery in treating advanced gastris cancer

    Institute of Scientific and Technical Information of China (English)

    何平; 梁杰雄; 邵天松; 宋辉; 郭洋; 李洋

    2016-01-01

    Objective To investigate the clinical effect of laparoscopy-assisted gastric D2 radical surgery in treating advanced gastris cancer.Methods Totally 78 cases with advanced gastric cancer from January 2008 to June 2013 were randomly divided into observation group (36 cases) receiving laparoscopic D2 radical gastrectomy and control group (40 patients) receiving laparotomy D2 radical gastrectomy.The incision length,operation duration,intraoperative blood loss,number of lymph nodes dissected,time of liquid diet intake,anal exhaust time,duration of hospitalization,complications and survival rate were compared between groups.Results The incision length,intraoperative blood loss,exhaust time,duration of hospitalization,incidence of complications in observation group were all significantly lower than those in control group [(5.7 ±0.4) cm vs (17.4 ± 1.5) cm,(164 ±35) ml vs (255 ± 87) ml,(2.8 ±1.6) d vs (4.9±2.5) d,(4.2±0.8) d vs (6.7±1.0) d,(12±3) d vs (15 ±4) d,13.9% (5/36) vs 32.5% (13/40)] (P <0.05);the operation duration,number of lymph nodes dissected,survival rate were not significantly different between two groups (P >0.05).Conclusion Laparoscopy-assisted distal gastric resection D2 is safe and feasible,it can achieve similar curative effect with laparotomy in treating advanced gastric cancer.%目的 探究腹腔镜辅助D2根治术治疗进展期胃癌的疗效.方法 对2008年1月至2013年6月于首都医科大学附属北京安贞医院接受手术治疗的76例进展期胃癌患者的临床资料进行回顾性分析,根据手术方式分为腹腔镜辅助手术组(观察组,36例)和开腹手术组(对照组,40例).比较2组患者切口长度、手术时间、术中出血量、清扫淋巴结个数、进食流质时间、肛门排气时间、术后住院时间、并发症发生情况以及术后存活率.结果 观察组患者切口长度、术中出血量、排气时间、进食流质时间、住院时间、术后并发症发

  17. The robotic-assisted laparoscopic surgery treating urological diseases: experiences of 600 cases in a single medical center%机器人辅助腔镜技术处理泌尿系统疾病:单中心600例报道

    Institute of Scientific and Technical Information of China (English)

    夏丹; 来翀; 王平; 景泰乐; 叶孙益; 秦杰; 孔德波; 汪朔

    2016-01-01

    目的 总结单中心机器人辅助泌尿外科手术的临床资料,提高对机器人技术在泌尿系疾病处理中的认识.方法 回顾性分析2014年9月至2015年11月本中心600例应用da Vinci手术机器人系统进行泌尿外科手术的临床资料.男473例,女127例.年龄17 ~ 82岁,平均(67.2±6.8)岁.对病例的分布、手术方式、围术期和术后情况进行总结.结果 600例机器人辅助腹腔镜手术均顺利完成,无中转开放手术.其中根治性前列腺切除术304例,肾癌手术185例(包括根治性肾切除术9例,肾部分切除术174例,根治性肾切除术+腔静脉取癌栓术2例),肾盂输尿管离断成形术27例,根治性膀胱切除术12例(包括Bricker膀胱术11例,Studer原位新膀胱术1例),其他手术共72例(包括肾上腺切除术、腹膜后肿瘤切除术、腹膜后淋巴清扫术、腔静脉后输尿管成形术、左肾静脉移位吻合术等).117例(19.5%)患者术后出现并发症,无一例死亡.对根治性前列腺切除术和肾部分切除术重点进行了经腹腔和经腹膜后两种手术入路的比较.经腹膜后途径与经腹腔途径相比并不增加住院时间和切缘阳性率(P>O.05).结论 da Vinci机器人手术系统在泌尿系疾病处理中应用广泛,尤其适用于需要腔内缝合及在狭小空间内操作的手术类型.经腹膜后途径行根治性前列腺切除术和肾部分切除术安全、可行.%Objective To analyze and summarize the clinical data of 600 robotic-assisted urological surgeries at a single center,aiming to acquire a better understanding of the robotic techniques and emphasize its role in treating urological diseases.Methods Six hundred patients with urological diseases underwent robotic-assisted laparoscopic surgeries from September 2014 to November 2015,including 473 males and 127 females with a mean age of (67.2 ± 6.8) years.The disease categary,surgical procedure selection,intraand post-operative data and short

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

    Science.gov (United States)

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

    2014-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

    王小冬; 汪宝林; 褚朝顺; 王翔; 赵庆洪; 李昌阳

    2013-01-01

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

  20. Laparoscopic total pancreatectomy

    Science.gov (United States)

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344

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

    Directory of Open Access Journals (Sweden)

    Marcel Autran C. Machado

    2009-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

    朱琳; 彭顺秀; 黄俊平; 梁绍基; 陶云燕

    2014-01-01

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

  3. 腹腔镜根治性全膀胱切除回肠新膀胱术治疗浸润性膀胱癌(附30例报告)%Laparoscopic radical cystectomy(LRC) with orthotopic ileal neobladder for invasive bladder cancer(report of 30 cases)

    Institute of Scientific and Technical Information of China (English)

    黄金杯; 郑清水; 许宁; 薛学义; 李晓东; 周辉良; 江涛; 罗义麒

    2013-01-01

    Objectives To present the surgical methods and the clinical efficacy of the laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder.Methods The clinical data of 30 cases of patients underwent laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder were analysed retrospectively and summarized between May,2007 and Oct,2011.Results All the operations were successfully completed without conversion to open surgery.The operation time is 180 ~360min with a mean of 240min.The intraoperative bleeding is 150 ~450 ml with a mean of 220 ml.The bowel recovery time was 4 ~ 8 days.The followed up time were from 6 to 60 mouths,median follow-up time was 26 mouths.30 cases achieved urine control function with satisfaction.the mean value of neobladder maximum capacity were 398 ml and the night-time urination were 1 ~ 3 times.1 case occurred nocturnal enuresis and 2 cases occurred urinary leak.Cystoscopy were not found the cancer recurrence in urethra.2 cases died of metastasis of the primary disease and the blood biochemical examination of other patients were essentially normal with following up for 6 months,B-ultrasonic examination were not found the dilation or seeper in bilateral upper urinary tract.Conclusions Laparoscopic radical cystectomy (LRC) with orthotopicileal neobladder was a ideal operation method treatment of invasive bladder cancer(IBC).As its had the advantage of fewer traumas,less bleeding,complete pelvic lymph node dissection,rapider recovery and produced a higher rate of urinary continence.%目的 探讨腹腔镜下根治性全膀胱切除原位回肠新膀胱术的手术方法及临床疗效.方法 收集2007年5月至2011年10月应用腹腔镜下根治性全膀胱切除原位回肠新膀胱术的浸润性膀胱癌患者30例.对其临床资料进行回顾性分析和总结.结果 所有手术均获得成功,无中转开放,手术时间180~360 min(平均240 min),术中出血量150~450mL(平均220 mL).术后4~8d恢复

  4. 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.

  5. Simultaneous laparoscopic resection of colorectal cancer and synchronous metastatic liver tumor.

    Science.gov (United States)

    Hayashi, Michihiro; Komeda, Koji; Inoue, Yoshihiro; Shimizu, Tetsunosuke; Asakuma, Mitsuhiro; Hirokawa, Fumitoshi; Okuda, Junji; Tanaka, Keitaro; Kondo, Keisaku; Tanigawa, Nobuhiko

    2011-01-01

    Laparoscopic colorectal resection has been applied to advanced colorectal cancer. Synchronous liver metastasis of colorectal cancer would be treated safely and effectively by simultaneous laparoscopic colorectal and hepatic resection. Seven patients with colorectal cancer and synchronous liver metastasis treated by simultaneous laparoscopic resection were analyzed retrospectively. Three patients received a hybrid operation using a small skin incision, 2 patients underwent hand-assisted laparoscopic surgery using a small incision produced for colonic anastomosis, and 2 patients were treated with pure laparoscopic resection. The mean total operation duration was 407 minutes, and mean blood loss was 207 mL. Negative surgical margins were achieved in all cases. Mean postoperative hospital stay was 16.4 days. No recurrence at the surgical margin was observed in the liver. For selected patients with synchronous liver metastasis of colorectal cancer, simultaneous laparoscopic resection is useful for minimizing operative invasiveness while maintaining safety and curability, with satisfying short- and long-term results.

  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. Laparoscopic liver resection: Experience based guidelines

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Laparoscopic liver resection (LLR) has been progressivelydeveloped along the past two decades. Despiteinitial skepticism, improved operative results madelaparoscopic approach incorporated to surgical practiceand operations increased in frequency and complexity.Evidence supporting LLR comes from case-series,comparative studies and meta-analysis. Despite lack oflevel 1 evidence, the body of literature is stronger andexisting data confirms the safety, feasibility and benefitsof laparoscopic approach when compared to openresection. Indications for LLR do not differ from thosefor open surgery. They include benign and malignant(both primary and metastatic) tumors and living donorliver harvesting. Currently, resection of lesions locatedon anterolateral segments and left lateral sectionectomyare performed systematically by laparoscopy in hepatobiliaryspecialized centers. Resection of lesions locatedon posterosuperior segments (1, 4a, 7, 8) and majorliver resections were shown to be feasible but remaintechnically demanding procedures, which should bereserved to experienced surgeons. Hand-assisted andlaparoscopy-assisted procedures appeared to increasethe indications of minimally invasive liver surgery andare useful strategies applied to difficult and majorresections. LLR proved to be safe for malignant lesionsand offers some short-term advantages over openresection. Oncological results including resection marginstatus and long-term survival were not inferior to openresection. At present, surgical community expects highquality studies to base the already perceived betteroutcomes achieved by laparoscopy in major centers'practice. Continuous surgical training, as well as newtechnologies should augment the application of lap-aroscopic liver surgery. Future applicability of newtechnologies such as robot assistance and image-guidedsurgery is still under investigation.

  8. The clinical features of preventive enterostomy with laparoscopic radical operation for colorectal cancer and its nursing countermeasures%腹腔镜直肠癌根治预防性肠造口的临床特点与护理对策

    Institute of Scientific and Technical Information of China (English)

    谢海珊; 胡海英; 邹小红; 潘凯; 朱畅

    2014-01-01

    目的:探讨腹腔镜直肠癌根治行预防性肠造口术的临床特点及其并发症的护理对策。方法将151例腹腔镜直肠癌根治术患者分为 A 组和 B 组进行对比研究,A 组75例行预防性横结肠造口,B 组76例行预防性末端回肠造口,观察两组的临床特点及其并发症,并采取相应的护理对策。结果两组在并发症的发生率比较差异上有统计学意义,A 组的造口脱垂、造口周围感染发生率高于B 组,而造口狭窄、造口粪水性皮炎、造口回缩的发生率低于 B 组。经过积极治疗和护理后,两组患者均痊愈出院。结论根据横结肠造口和末端回肠造口的特点,分别采取针对性护理措施,可以帮助患者促进康复、改善预后。%Objective This research is to discuss clinical features of preventive enterostomy with laparoscopic radical operation for colorectal cancer and its nursing countermeasures. Methods 151 cases of colorectal cancer patients with laparoscopic radical operation were divided into two groups and studied comparatively. 75 cases of patients from group A received preventive transverse colostomy while 76 cases of patients received preventive terminal ileum colostomy. Clinical features and complications of patients from two groups were observed and corresponding nursing countermeasures were taken. Results The difference of the incidence rate of complications between the two groups is statistically significant. The incidence rate of colostomy prolapse and infection around the colostomy of patients from group A is higher than those from group B while the incidence rate of colostomy stenosis, colostomy dung water-based dermatitis and colostomy retraction of patients from group A is lower than those from group B. After active treatment and nursing, two groups of patients were recovered. Conclusions Specific and targeted nursing measures based on different characteristics of transverse colostomy and terminal

  9. Laparoscopic Management of Benign Ovarian Masses

    Directory of Open Access Journals (Sweden)

    Rachana Saha

    2013-12-01

    Full Text Available Introduction: Laparoscopic surgery is one of the most common procedures performed for benign ovarian masses. The aim of the study was to analyze all benign ovarian masses treated laparoscopically to assess safety, feasibility and outcome. Methods: A prospective study was carried out at Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal. All the patients undergoing laparoscopic surgery for benign ovarian masses from 1st January 2012 to 31st December 2012 were included in the study. The pre-operative findings, intra-operative findings, operative techniques and post-operative complications were analyzed. Results: Thirty-six patients were taken for the study. Two cases were excluded since intra-operatively they were tubo-ovarian masses. The most common tumor was dermoid cyst (n=13; 38.23% and endometriotic cyst (n=14; 41.17%. Out of 34 cases, five cases of endometriotic cyst (14.70% were converted to laparotomy due to severe adhesions and four cases of endometriotic cyst underwent deroofing surgery. Two cases underwent laparoscopic assisted vaginal hysterectomy with bilateral salphingo-oopherectomy. Successful cystectomies were carried out in 22 cases. None were malignant. Major complications were not noted while minor complications like port-site infection (n=3; 8.82% and subcutaneous emphysema (n=1; 2.9% were present. Conclusions: Laproscopic management of benign ovarian masses is safe and feasible.

  10. Laparoscopic Colon Resection

    Science.gov (United States)

    ... thorough evaluation by a surgeon qualified in laparoscopic colon resection in consultation with your primary ... Olympic Blvd., Suite 600 Los Angeles, CA 90064 Tel: (310) 437-0544 Fax: (310) 437- ...

  11. Correlation between the preoperative serum prostate specific antigen, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy: An Indian experience

    Directory of Open Access Journals (Sweden)

    P Singh

    2011-01-01

    Full Text Available Objectives: To correlate the preoperative serum prostate specific antigen (PSA, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy (RARP in Indian men with clinically localized cancer prostate. Materials and Methods: A prospective study analysis was done for 166 consecutive patients of prostate cancer who underwent RARP at our center from June 2006 to October 2009. Preoperative workup included serum PSA, biopsy Gleason score, and clinical staging. The preoperative parameters were correlated with final Gleason score, capsular penetration, seminal vesicle involvement, and lymph node status on final histopathology. Results: The mean age was 64 years (range: 50-76 years with mean and median PSA of 17.98 ng/ml (range: 0.3-68.3 ng/ml and 12.1 ng/ml, respectively. With increase in preoperative Gleason score, chance of organ confinement decreases (P=0.002 and capsular penetration increases (P=0.004 linearly. With increasing serum PSA, there is linear decrease in trend of organ-confined disease (P=0.03 and increased chances of seminal vesicle involvement (P=0.02. Patients with higher clinical stage have less probability of localized disease (P=0.007 and more chances of capsular penetration (P=0.04 and seminal vesicle involvement (P=0.004. Conclusion: Our data suggest that patients with higher preoperative serum PSA, Gleason score, and clinical stage have more chances of advanced pathological stage following RARP.

  12. 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.

  13. Laparoscopic Distal Pancreatectomy

    Science.gov (United States)

    Melotti, Gianluigi; Butturini, Giovanni; Piccoli, Micaela; Casetti, Luca; Bassi, Claudio; Mullineris, Barbara; Lazzaretti, Maria Grazia; Pederzoli, Paolo

    2007-01-01

    Objective: To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team. Summary Background Data: Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. Methods: A consecutive series of patients affected by solid and cystic tumors were selected prospectively to undergo laparoscopic distal pancreatectomy performed by the same surgical team. Clinical characteristics as well as diagnostic preoperative assessment and intra- and postoperative data were prospectively recorded. A follow-up of at least 3 months was available for all patients. Results: Fifty-eight patients underwent laparoscopic resection between May 1999 and November 2005. All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. Splenic vessel preservation was possible in 84.4% of spleen-preserving procedures. There were no mortalities. The overall median hospital stay was 9 days, while it was 10.5 days for patients with postoperative pancreatic fistulae (27.5% of all cases). Follow-up was available for all patients. Conclusions: Our experience in 58 consecutive patients was characterized by the lack of conversions and by acceptable rates of postoperative pancreatic fistulae and morbidity. Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible. PMID:17592294

  14. Robotic versus conventional laparoscopic pyeloplasty: A single surgeon concurrent cohort review

    Directory of Open Access Journals (Sweden)

    Rajeev Kumar

    2013-01-01

    Conclusions: Robotic assistance helps decrease the operative time for laparoscopic pyeloplasty. It seems ergonomically superior for the surgeon, allowing multiple procedures in the same list. These may be important benefits in busy centers.

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

    Science.gov (United States)

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

    2010-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  17. Laparoscopic liver resection: Experience based guidelines.

    Science.gov (United States)

    Coelho, Fabricio Ferreira; Kruger, Jaime Arthur Pirola; Fonseca, Gilton Marques; Araújo, Raphael Leonardo Cunha; Jeismann, Vagner Birk; Perini, Marcos Vinícius; Lupinacci, Renato Micelli; Cecconello, Ivan; Herman, Paulo

    2016-01-27

    Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.

  18. Transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic partial nephrectomy%经阴道自然腔道内镜手术辅助腹腔镜下肾部分切除术的临床研究

    Institute of Scientific and Technical Information of China (English)

    王晓宁; 张国玺; 邹晓峰; 袁源湖; 肖日海; 伍耿青; 薛义军; 刘佛林; 徐辉

    2015-01-01

    Objective To describe the initial clinical experience of transvaginal NOTES-assisted laparoscopy for partial nephrectomy,and evaluate its feasibility and efficacy.Methods Between Aug.2013 and Aug.2014,6 females underwent transvaginal NOTES-assisted laparoscopic partial nephrectomy.All patients were married and delivered.The median age was 37 (30 to 48) yrs.The median tumour size was 3.5 (2.5 to 6.5) cm.Under general anesthesia,the patient was placed in the lithotomy position with the affected side elevated by 60°.Two trocars were placed at the medial margin on both sides of umbilicus.A trocar was placed through the vagina into the abdominal cavity under the direct vision from a flexible-tip 5.4 mm 0° laparoscope.The patients underwent surgeries with main renal artery clamping,segmental renal artery clamping and renal artery unclamping,respectively.The mass was excised using the laparoscopic scissors maintaining a 0.5 cm margin.The inner layer was sutured for closing the collecting system and the second layer was sutured for closing the renal parenchyma with the Quill self-retaining suture.Specimen was placed inside a homemade bag and removed through the posterior vaginal fornix incision.Results Five procedures were completed successfully.One patient with a right upper-pole tumor was converted to radical nephrectomy for continuous bleeding after removing the bulldog clip.All the procedures were finished without conversion to conventional laparoscopy and with no additional trocar.The warm ischaemia time (WIT) was 20,25 and 28 min for the three patients who underwent surgeries with main renal artery clamping,respectively.The WIT was 35 and 40 min for the two patients who underwent surgeries with segmental renal artery clamping,respectively.One patient underwent surgeries with renal artery unclamping.The median operating time was 130 (110 to 190) min.The estimated blood loss was 150 (100 to 400) ml.One patient who was subjected to postoperative bleeding recovered

  19. 机器人辅助腹腔镜胰十二指肠切除术中护理问题评估及护理措施%Nursing Problem Evaluation and Nursing Measures in Robot-assisted Laparoscopic Pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    喻晓芬; 王知非; 何茫茫; 张琴芳

    2016-01-01

    [Summary] This paper summarized the nursing experience of 18 cases of robot-assisted laparoscopic pancreaticoduodenectomy (RLPD) from September 2014 to June 2015.The pertinent nursing measures were discussed .The operative duration was 370-495 min (mean, 405 ±35 min).During the operation, the robot and instrument malfunctions occurred for 5 times, all of which were successfully resolved.No complications occurred .According to patients ’ age and co-morbidities, a comprehensive assessment was carried out to propose probable nursing problems , and corresponding nursing measures were implemented to effectively prevent the nursing risk and to protect the safety of patients .%本文总结2014年9月~2015年6月18例机器人辅助腹腔镜胰十二指肠切除术的护理经验,探讨相应的护理措施。手术时间370~495 min,(405±35)min。术中发生机器人和器械故障5次,均顺利排除。无手术并发症。术前根据患者年龄、合并疾病进行全面评估,提出术中可能存在的护理问题,并实施相应护理措施,有效防范护理风险,保障患者安全。

  20. 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

    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/min, average 41.3 ml/min, in those 3 patients who had

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

    Institute of Scientific and Technical Information of China (English)

    祝强; 符伟军; 张旭

    2015-01-01

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

  2. Laparoscopic repair of femoral hernia

    OpenAIRE

    Yang, Xue-Fei; Liu, Jia-Lin

    2016-01-01

    Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. Femoral hernia could be repaired through the laparoscopic procedures for inguinal hernia. These procedures have clear anatomic view in the operation and preoperatively undiagnosed femoral hernia could be confirmed and treated. Lower recurrence ratio was reported in laparoscopic procedures compared with open procedures for repair of femoral hernia. The technical details of laparoscopic repair of femoral hernia, ...

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  4. 经腹腔镜手术治疗3个月内婴儿先天性胆总管囊肿%Laparoscopic-assisted treatments of congenital choledochal cyst in 3 months infant

    Institute of Scientific and Technical Information of China (English)

    周崇高; 王海阳; 许光; 邹婵娟; 夏仁鹏; 赵凡; 马体栋; 李碧香

    2016-01-01

    目的:探讨经腹腔镜行囊肿切除、肝管空肠 Roux-en-Y 吻合治疗3个月以内先天性胆总管囊肿的可行性和治疗效果。方法本院2011年7月至2015年7月经腹腔镜手术治疗的3个月以内先天性胆总管囊肿患儿41例,其中男13例,女28例,均为囊肿型;手术年龄8~89 d,平均(50.2±23)d,体重2.7~6.47 kg,平均(4.47±1.01)kg。33例合并黄疸,8例大便颜色变浅,7例出现白陶土样便;31例术前检查转氨酶升高。全部病例均采用经腹腔镜完整囊肿切除,肝管空肠 Roux-en-Y 吻合术。结果40例患儿成功完成手术,手术时间117~296 min,平均(186±42)min,出血量<5 mL;1例损伤门静脉,中转开腹,出血50 mL;术后无一例发生肠瘘、胆瘘和胰瘘;随访5~53个月,无胆管狭窄、胆管炎、粘连性肠梗阻等发生。结论3个月以内婴儿胆总管囊肿容易发生肝功能损害、肝脏纤维化,应尽早手术治疗。经腹腔镜手术治疗先天性胆总管囊肿安全有效。%Objetive To study the treatment efficiency and the feasibility of in laparoscopic-assisted to-tal cyst excision of choledochal cyst with Roux-en-Y hepatoenterostomy in 3 months infant.Methods A retro-spective analysis was made on 41 cases of choledochal cyst under 3 months infants treated in our hospital from July 2010 to July 2015.Among them,28 were female and 13 were male,with their age ranging from 8 day to 89 days (mean 50.2 ±23 days),and the choledochal cysts were all cyst type.Their weight ranged from 2.7 to 6. 47 kg(mean 4.47 ±1.01).Among all the cases,33 patients were found with jaundice,8 with Stools colorless,7 with white pottery clay;31 with transaminase elevation in the preoperative examination.The operation method was laparoscopic-assisted total cyst excision of choledochal cyst with Roux-en-Y hepatoenterostomy. Re-sults Laparoscopic operation was finished successfully in 40 infants

  5. Laparoscopic Nephrectomy with Adrenalectomy for Synchronous Adrenal Myelolipoma and Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Kallappan Senthil

    2015-01-01

    Full Text Available Introduction. Adrenal myelolipomas are uncommon nonfunctioning tumors of the adrenal. Synchronous renal cell carcinomas with adrenal myelolipomas are very rare. We present the case report of adrenal myelolipoma with synchronous RCC managed laparoscopically. Case Report. A 60-year-old old gentleman presented with incidental right upper polar mass with right adrenal mass. Metastatic work-up was negative. Laparoscopic radical nephrectomy with adrenalectomy was done under general anesthesia. The biopsy report was right kidney clear cell adenocarcinoma (T1b with right adrenal myelolipoma. Conclusion. This is the first case report of laparoscopic adrenalectomy with nephrectomy for ipsilateral synchronous renal cell carcinoma with adrenal myelolipoma.

  6. Laparoscopic reintervention in colorectal surgery.

    NARCIS (Netherlands)

    Broek, RP Ten; Goor, H. van

    2008-01-01

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

  7. Laparoscopic treatment of genitourinary fistulae.

    Science.gov (United States)

    Garza Cortés, Roberto; Clavijo, Rafael; Sotelo, Rene

    2012-09-01

    We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail

  8. Advantages of robot-assisted laparoscopic surgery in urinary bladder and prostate :an initial clinical experience with 4 cases%机器人外科手术系统辅助腹腔镜在膀胱及前列腺手术中的优势(附4例报道)

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 钟山; 何威; 张荣明; 祝宇; 王浩飞; 王先进

    2011-01-01

    目的 探讨机器人外科手术系统辅助腹腔镜在根治性膀胱切除术和根治性前列腺切除术中的操作体会.方法 上海交通大学附属瑞金医院于2010年3-10月间应用达芬奇S机器人外科系统辅助腹腔镜行下尿路手术4例,其中3例前列腺癌患者行根治性前列腺切除术,1例膀胱癌患者行根治性膀胱切除+原位双U形回肠代膀胱术.结果 3例前列腺癌患者的手术时间为200~270 min(包括体位摆放及机器人外科手术系统到位的时间共45 min),术中失血量为300~800 mL,输血0~400 mL.术后无1例发生尿漏,术后第5天拔除左侧引流管,第6天拔除右侧引流管.术后1周复查前列腺特异性抗原(PSA)均<0.17 ng/mL.术后3周拔除导尿管,可自行排尿,排尿控制良好.1例膀胱癌患者的手术时间为330 min,其中全膀胱切除的时间为165 min,原位膀胱术的时间为120 min.术中失血量为800 mL,输血300 mL.术后病理检查提示膀胱尿路上皮癌.术后第10天拔除双侧输尿导管,术后3周拔除导尿管,可自行排尿,排尿控制良好.结论 达芬奇S机器人外科手术系统辅助腹腔镜下尿路手术的创伤更小,更适用于高龄、高危前列腺癌等下尿路肿瘤患者,是一种具有广泛应用前景的手术方法,但须充分关注手术的潜在风险.%Objective To assess the feasibility and safety of robot-assisted laparoscopic radical cystectomy (RLRC) with double U-shaped ileal neobladder and robot-assisted laparoscopic radical prostatectomy (RLRP).Methods One patient with bladder carcinoma underwent RLRC with double U-shaped ileal neobladder and three patients with prostate carcinoma underwent RLRP using the da Vinci robotic surgical system during March 2010 to October 2010.All patients had histologically-confirmed adenocarcinoma of prostate or bladder biopsy and a negative bone scan.Peri-operative and early surgical outcome data were collected prospectively and functional recovery was

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  10. The learning curve in laparoscopic major liver resection.

    Science.gov (United States)

    Kluger, Michael D; Vigano, Luca; Barroso, Ryan; Cherqui, Daniel

    2013-02-01

    Laparoscopic major hepatectomy remains a relatively rare operation because it is a difficult and technically demanding procedure, and a standard, safe, reproducible technique has not been widely adopted. This is compounded by "major hepatectomy" encompassing multiple different operations each with their own anatomic and procedural considerations. In 2010, we investigated our learning curve for laparoscopic liver resection. We found a significant increase in the number of major hepatectomies performed over a 12-year period, with concurrent reductions in the use of hand-assistance, pedicle clamping, median clamping time, median operative time, blood loss and morbidity. This learning curve was confirmed by a subsequent multinational study. Both hospital and surgeon volume have been shown to affect outcomes, and defining a sufficient number of repetitions before the learning curve plateaus is not easy for laparoscopic major hepatectomy. We recommend that laparoscopic competencies be developed upon a foundation of open liver surgery and that laparoscopic major hepatectomy should only be attempted after competency with less technically complex laparoscopic resections. A center advanced along its institutional learning curve provides the collective expertise necessary for safe patient selection and management. An environment with colleagues willing to share their acquired proficiency allows the surgeon to observe and critique his or her performance against colleagues. Also, the guidance of like-minded surgeons supports technical development and improved outcomes. In conclusion, steady progress can be made along the learning curve through committed practice of increasingly complex tasks and with proper coaching in a high-volume environment.

  11. Analysis of clinical effect of transperitoneal approach and extraperitoneal approach for laparoscopic radical prostatectomy%经腹腔途径与经腹膜外途径腹腔镜下前列腺癌根治术临床疗效比较研究

    Institute of Scientific and Technical Information of China (English)

    郑清水; 蔡海; 许宁; 薛学义; 魏勇; 李晓东; 黄金杯; 江涛; 孙雄林

    2013-01-01

    目的:比较经腹腔途径(Transperitoneal laparoscopic radical prostatectomy,T-LRP)与经腹膜外途径腹腔镜下前列腺癌根治术(Extraperitoneal laparoscopic radical prostatectomy,E-LRP)临床疗效。方法回顾分析我院2010年1月至2012年12月收治腹腔镜下前列腺癌根治术130例,其中经腹腔途径腹腔镜下前列腺癌根治术72例;经腹膜外途径58例。比较两种术式患者体重指数(BMI)、术前PSA、术前穿刺Glesson评分、临床TNM分期(c-TNM)、前列腺体积、手术时间、术中出血量、术中输血比例、术后胃肠功能恢复时间、术后留置导尿时间、术后住院天数、围手术期并发症、病理分期(p-TNM)、术后尿控等指标。结果130例手术均获得成功,中转开放手术2例,其中T-LRP组1例,E-LRP组1例;T-LRP组平均手术时间长于E-LRP组,(120.6±92.6) min 对(110.8±100.5)min,(P <0.001);T-LRP组术中平均出血量多于E-LRP组,(110.9±50.6)ml对(95.8±123.5)ml,(P<0.05);T-LRP组术后平均留置尿管时间长于E-LRP组,(13.42±4.64)d对(12.33±4.82)d,(P<0.05);T-LRP组术后平均住院时间长于E-LRP组,(14.54±5.25)d对(11.63±5.82)d,(P<0.05)。随访时间为6~42月,中位时间32月;T-LRP组与E-LRP组在拔尿管时、术后半年,尿控满意率分别为48.6%(35/72)对34.5%(20/58)、63.8%(46/72)对89.6%(52/58),有统计学意义(P值分别为:P<0.05、P<0.001),但其1年后尿控率无明显差异(P>0.05)。结论 E-LRP相对T-LRP具有相同的远期控瘤效果和尿控效果,但E-LRP术后的早期尿控效果优于T-LRP。经腹膜外途径路入较经腹腔路入具有术中出血少、手术时间短,术后腹腔并发症少,术后恢复快等优点。%Objective To evaluate the efficiency of transperitoneal laparoscopic radical prostatectomy (T-LRP) and extraperitoneal

  12. 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.

  13. Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy

    Science.gov (United States)

    Song, Wan; Kim, Chan Kyo; Park, Byung Kwan; Jeon, Hwang Gyun; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo; Choi, Han Yong; Lee, Hyun Moo

    2017-01-01

    Introduction We sought to investigate the impact of preoperative and postoperative membranous urethral length (MUL) on urinary continence using 3 Tesla (3T) magnetic resonance imaging (MRI) after robotic-assisted radical prostatectomy (RARP). Methods Between 2008 and 2013, 190 men with RARP underwent preoperative and postoperative MRI. Patients who received adjuvant radiotherapy or who were lost to followup were excluded, leaving 186 patients eligible for analysis. Preoperative MUL was estimated from the prostate apex to the penile bulb, while postoperative MUL was estimated from the bladder neck to penile bulb. Patients with no pads or protection were considered to have complete continence. Logistic regression analysis was used to identify predictors associated with urinary incontinence at six and 12 months. Results Age was commonly associated with urinary incontinence at six and 12 months. In addition, diabetes mellitus (DM) was another factor associated with urinary incontinence at 12 months. When adjusting these variables, preoperative MUL ≤16 mm (95% confidence interval [CI] 1.01–1.14; p=0.022), postoperative MUL ≤14 mm (95% CI 1.16–9.80; p=0.025) and percent change of MUL >18% (95% CI 1.17–7.23; p=0.021) were significantly associated with urinary incontinence at six months. However, at 12 months, preoperative MUL ≤13.5 mm (95% CI 1.85–19.21; p=0.003) and postoperative MUL ≤13 mm (95% CI 1.24–13.84; p=0.021) had impacts on urinary incontinence, but not percent change of MUL. Conclusions Preoperative and postoperative MUL were significantly associated with urinary continence recovery after RARP. Therefore, efforts to preserve MUL are highly recommended during surgery for optimal continence outcomes after RARP. PMID:28360954

  14. 联合血管切除重建的腹腔镜和达芬奇机器人根治性胰十二指肠切除术五例%Laparoscopic and robotic radical pancreaticoduodenectomy combined with major vascular resection and reconstruction: a report of 5 patients

    Institute of Scientific and Technical Information of China (English)

    洪德飞; 张宇华; 沈国樑; 张军港; 成剑; 张远标

    2016-01-01

    Objective To analyze our experience on laparoscopic and Da Vinci robotic