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Sample records for single incision laparoscopy

  1. Physical and mental workload in single-incision laparoscopic surgery and conventional laparoscopy.

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    Koca, Dilek; Yıldız, Sedat; Soyupek, Feray; Günyeli, İlker; Erdemoglu, Ebru; Soyupek, Sedat; Erdemoglu, Evrim

    2015-06-01

    The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. Time to complete laparoscopic tasks were longer in the SILS group (P laparoscopy. Pegboard time was increased in both hands after SILS (P laparoscopy was close to reference slope, indicating there was more fatigue in biceps and deltoid muscles of both upper extremities in SILS group. NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P laparoscopy (P < .01). SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload. © The Author(s) 2014.

  2. Task performance in standard laparoscopy in comparison with single-incision laparoscopy in a modified skills trainer.

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    Wright, Andrew S; Khandelwal, Saurabh

    2016-08-01

    Single-incision laparoscopy (SIL) is similar to conventional laparoscopic surgery (LAP), but carries specific technical challenges due to lack of triangulation, reduced dexterity, conflicts due to inline instrumentation, and impaired visualization. This study was designed to evaluate technical skill performance of SIL versus LAP surgery in a simulated environment. We developed a modified laparoscopic skills trainer for SIL based upon the fundamentals of laparoscopic surgery (FLS) model. This includes a standard laparoscopic tower for visualization, allowing replication of the conflicts between scope and instruments. It also has a modified trainer box allowing use of different access devices and instruments for SIL. Sixteen subjects at different levels of training (novice through expert) completed four FLS tasks with standard LAP techniques. They then practiced the same tasks using SIL technique until they reached a steady state of performance. The first and last SIL trials were recorded. Baseline SIL peg transfer was worse than FLS (254 ± 157 s vs 99 ± 27, p < 0.0002). Final SIL time was still significantly worse than FLS (173 ± 130, p < 0.02). FLS, baseline SIL, and final SIL circle cutting were not significantly different (p = 0.058). Final SIL loop ligation was significantly faster than FLS (48 ± 19 vs 70 ± 42, p < 0.05). FLS suturing was faster than SIL suturing (281 ± 188 vs. 526 ± 105, p < 0.01). There was substantial dropout due to frustration with SIL, and only two surgeons were able to successfully complete SIL suturing. There are technical challenges with SIL that vary depending on task. Peg transfer and suturing were significantly impaired in SIL, while circle cutting was not significantly affected, and ligating loop was faster with SIL than LAP. These challenges may impact clinical outcomes of SIL and should influence training in SIL as well as future product development.

  3. Incision for abdominal laparoscopy (image)

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    Abdominal laparoscopy is a useful aid in diagnosing disease or trauma in the abdominal cavity with less scarring than ... as liver and pancreatic resections may begin with laparoscopy to exclude the presence of additional tumors (metastatic ...

  4. A triangulating operating platform enhances bimanual performance and reduces surgical workload in single-incision laparoscopy.

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    Rieder, Erwin; Martinec, Danny V; Cassera, Maria A; Goers, Trudie A; Dunst, Christy M; Swanstrom, Lee L

    2011-03-01

    Single-site laparoscopy (SSL) attempts to further reduce the surgical impact of minimally invasive surgery. However, crossed instruments and the proximity of the endoscope to the operating instruments placed through one single site leads to inevitable instrument or trocar collision. We hypothesized that a novel, single-port, triangulating surgical platform (SPSP) might enhance performance by improving bimanual coordination and decreasing the surgeon's mental workload. Fourteen participants, proficient in basic laparoscopic skills, were tested on their ability to perform a validated intracorporeal suturing task by either an SSL approach with crossed articulated instruments or a novel SPSP, providing true-right and true-left manipulation. Standard laparoscopic (SL) access served as control. Sutures were evaluated using validated scoring methods and the National Aeronautics and Space Administration Task Load Index was used to rate mental workload. All participants proficiently performed intracorporeal knots by SL (mean score 99.0; 95% CI 97.0 to 100.9). Performance decreased significantly (more than 50%, p mental workload when using true-right and true-left manipulation. This study objectively assessed SSL performance and current attempts for instrumentation improvement in single-site access. While SSL significantly impairs basic laparoscopic skills, surgical platforms providing true-left and true-right maneuvering of instruments appear to be more intuitive and address some of the current challenges of SSL that may otherwise limit its widespread acceptance. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  5. The Role of Hand-Assisted Laparoscopic Technique in the Age of Single-Incision Laparoscopy: An Effective Alternative to Avoid Open Conversion in Colorectal Surgery.

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    Jung, Kyung Uk; Yun, Seong Hyeon; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

    2018-04-01

    Continuous efforts to reduce the numbers and size of incisions led to the emergence of a new technique, single-incision laparoscopic surgery (SILS). It has been rapidly accepted as the preferred surgical approach in the colorectal area. In the age of SILS, what is the role of hand-assisted laparoscopic surgery (HALS)? We introduce the way to take advantage of it, as an effective alternative to avoid open conversion. This is a retrospective review of prospectively collected data of SILS colectomies performed by a single surgeon in Samsung Medical Center between August 2009 and December 2012. Out of 631 cases of SILS colectomy, 47 cases needed some changes from the initial approach. Among these, five cases were converted to HALS. Four of them were completed successfully without the need for open conversion. One patient with rectosigmoid colon cancer invading bladder was finally opened to avoid vesical trigone injury. The mean operation time of the 4 patients was 265.0 minutes. The mean estimated blood loss was 587.5 mL. The postoperative complication rate associated with the operation was 25%. Conversion from SILS to HALS in colorectal surgery was feasible and effective. It seemed to add minimal morbidity while preserving advantages of minimally invasive surgery. It could be considered an alternative to open conversion in cases of SILS, especially when the conversion to conventional laparoscopy does not seem to be helpful.

  6. Single-incision total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Sinha Rakesh

    2011-01-01

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

  7. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials.

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    Antoniou, S A; Morales-Conde, S; Antoniou, G A; Granderath, F A; Berrevoet, F; Muysoms, F E

    2016-02-01

    Single-incision laparoscopic surgery has been developed with the objective to reduce surgical trauma, decrease associated surgical stress and to improve cosmetic outcome. However, concerns have been raised regarding the risk of trocar-site hernia following this approach. Previous meta-analyses have suggested a trend toward higher hernia rates, but have failed to demonstrate a significant difference between single-incision and conventional laparoscopic surgery. Medline, AMED, CINAHL and CENTRAL were searched up to May 2014. Randomized controlled trials comparing single-incision and conventional laparoscopic surgery were considered for inclusion. Studies with patients aged less than 18 years and those reporting on robotic surgery were disregarded. Pooled odds ratios with 95% confidence intervals were calculated to measure the comparative risk of trocar-site hernia following single-incision and conventional laparoscopic surgery. Nineteen randomized trials encompassing 1705 patients were included. Trocar-site hernia occurred in 2.2% of patients in the single-incision group and in 0.7% of patients in the conventional laparoscopic surgery group (odds ratio 2.26, 95% confidence interval 1.00-5.08, p = 0.05). Sensitivity analysis of quality randomized trials validated the outcome estimates of the primary analysis. There was no heterogeneity among studies (I2 = 0%) and no evidence of publication bias. Single-incision laparoscopic surgery involving entry into the peritoneal cavity through the umbilicus is associated with a slightly higher risk of trocar-site hernia than conventional laparoscopy. Its effect on long-term morbidity and quality of life is a matter for further investigation.

  8. Current Status of Single-incision Laparoscopic Surgery

    DEFF Research Database (Denmark)

    Ahmed, Irfan; Ciancio, Fabio; Ferrara, Vincenzo

    2012-01-01

    Recent advances in minimally invasive surgery have centered on reducing the number of incisions required, which has led to the development of the single-incision laparoscopic technique. A panel of European single-incision laparoscopy experts met to discuss the current status of, and the future ex...... to be published to confirm its value. An ideal training route for surgeons who are adopting the technique was agreed upon, as was the need for a single, large clinical registry of data....

  9. Single incision laparoscopic colorectal resection: Our experience

    Directory of Open Access Journals (Sweden)

    Chinnusamy Palanivelu

    2012-01-01

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

  10. Single-incision laparoscopic bariatric surgery

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    Huang Chih-Kun

    2011-01-01

    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  11. [Transumbilical single-port laparoscopy combined with improved double hernia needles for pediatric hydrocele].

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    Qi, Jin-Chun; Xue, Wen-Yong; Li, Suo-Lin; Lu, Bao-Sai; Jia, Jiang-Hua; Zhang, Yan-Ping; DU, Lei; Li, Meng; Li, Wei

    2016-09-01

    To compare the clinical effect of transumbilical single-port laparoscopy combined with improved double hernia needles with that of traditional open surgery in the treatment of hydrocele in children. We retrospectively analyzed 35 cases (54 sides) of pediatric hydrocele treated by transumbilical single-port laparoscopy combined with improved double hernia needles (laparoscopy group). We recorded the operation time, intraoperative blood loss, hospital stay, scrotal edema, and postoperative complications and compared them with those of another 46 cases (58 sides) treated by traditional open surgery (open surgery group) during the same period. The laparoscopy group showed a significantly shorter operation time, less intraoperative blood loss, milder scrotal edema, and fewer hospital days than the open surgery group (all P0.05). Subcutaneous emphysema developed in 2 patients in the laparoscopy group, which disappeared after 1-3 days of oxygen inhalation and other symptomatic treatment, while scrotal hematoma occurred in 1 and incision fat liquefaction in 2 patients in the open surgery group 3 days postoperatively, which healed after debridement suture and daily dressing, respectively. The patients were followed up for 3-6 months, which revealed no late complications in the laparoscopy group but 1 case of unilateral recurrence and 2 cases of offside recurrence in the open surgery group, all cured by laparoscopic internal ring ligation. Transumbilical single-port laparoscopy combined with improved double hernia needles is superior to traditional open surgery for the treatment of pediatric hydrocele and therefore deserves clinical generalization.

  12. Single incision pediatric endoscopic surgery: advantages of relatively large incision

    International Nuclear Information System (INIS)

    Yilmaz, E.; Afsarlar, E.; Karaman, I.

    2015-01-01

    To describe Single Incision Pediatric Endoscopic Surgery (SIPES) performed on children with various diagnoses, emphasizing its advantages. Study Design: An observational case series. Place and Duration of Study: Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Child Health Hospital, Ankara, Turkey, from January 2011 to November 2014. Methodology: A review of patient charts was conducted in which SIPES was preferred as the surgical procedure. Patient demographics, operative details, operative time, clinical outcomes, postoperative pain and cosmesis were analyzed. Results: SIPES was performed on 45 patients (21 girls, 24 boys). Thirty-three appendectomies, 5 varicocelectomies, 3 oophorectomies, 2 ovarian and one paratubal cyst excision, and one fallopian tube excision were performed. All except one procedures were performed through our standard 2cm umbilical vertical or smile incision. In 18 cases, abdominal irrigation/aspiration was easily performed through the existing larger incision, as is done with open surgical technique. None of the patients had early postoperative shoulder/back pain since complete disinflation of CO/sub 2/ could be ensured. All of the patients/parents were satisfied with the cosmesis. Conclusion: SIPES has the advantages of limiting the surgical scar to within the umbilicus and providing easy disinflation of CO/sub 2/, allowing intraabdominal cleaning and extraction of large volume tissue samples through a single large umbilical incision. (author)

  13. Laparoscopy

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    ... may suggest that they be removed with laparoscopy. • Ectopic pregnancy —Laparoscopy may be done to remove an ectopic pregnancy. • Pelvic floor disorders —Laparoscopic surgery can be used ...

  14. Single-incision laparoscopic surgery for pyloric stenosis.

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    Kozlov, Yury; Novogilov, Vladimir; Podkamenev, Alexey; Rasputin, Andrey; Weber, Irina; Solovjev, Alexey; Yurkov, Pavel

    2012-04-01

    Laparoscopy is the most common procedure for correction of congenital pyloric stenosis. The standard laparoscopic approach is based on the three-port technique. In contrast to the standard laparoscopic technique, the single-incision laparoscopic surgery (SILS) requires only one incision. We report on our experience with this surgical approach. Between September 2009 and August 2010 a total of 24 children underwent a laparoscopic pyloromyotomy, 12 in SILS technique. The single incision was carried through the center of the umbilicus. The working instruments were introduced in a two-dimensional direction into the peritoneal cavity via the same umbilical incision. The two groups were compared for patients' demographics, operative report and early postoperative outcomes. All SILS procedures were performed successfully with no conversion rate. There were no differences in the preoperative parameters between the two groups regarding age before surgery and body weight at operation. Operative time and time of full enteral intake was similar to comparable procedures with usage of a standard laparoscopic approach. There were no operative or postoperative complications. The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery.

  15. Single Incision Laparoscopic Splenectomy: Our First Experiences

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    Umut Barbaros

    2011-06-01

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

  16. Single scrotal incision orchiopexy - a systematic review

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    Hugo Fabiano Fernandes Novaes

    2013-06-01

    Full Text Available Objective To conduct a systematic review on single scrotal incision orchiopexy. Materials and Methods A search was performed using Pubmed, through which 16 articles were selected out of a total of 133. The following conditions were considered exclusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic approach, retractile testes, or patients with previous testicular or inguinal surgery. Results A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were analyzed. Patients' ages ranged between 5 months and 21 years. Thirteen studies used high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%, there was a need for inguinal incision. Recurrence was observed in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site infections in 13 cases. High efficacy rates were observed, varying between 88% and 100%. Conclusions Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications.

  17. Single scrotal incision orchidopexy for palpable undescended

    International Nuclear Information System (INIS)

    Ahmad, A.; Safdar, C.A.; Yasir, U.; Rasool, N.; Kanwal, S.; Boota, M.; Rehman, J.U.

    2014-01-01

    To retrospectively asses the results of single scrotal incision orchidopexy (SSIO) performed at our centre with ligation of the patent processus vaginalis in children having palpable undescended testes (UDT). Study Design: Quasi-experimental with retrospective data. Place and Duration of Study: Department of Paediatric surgery Military Hospital Rawalpindi, from April 2007 to December 2011. Patients and Methods: After making a single transverse incision at superior scrotal border, the testis was identified; gubernaculums and the sac were dissected to the highest level and divided. The testis was placed into the scrotum and fixed to the scrotal fascia/skin. All patients were assessed at 2 weeks, 2 months and 6 months post operatively, and then yearly. Results: A total of 38 orchidopexies were performed in 33 patients. The patients age ranged from 14 months to 7 years (mean:2.1 years). Bilateral UDT were found in 5 patients (15.1%). Operative time ranged from 20 to 45 minutes (mean: 36 minutes). The single scrotal incision technique was successful in all 38 cases (100%). All testes were easily fixed in the scrotum. Two patients (5.2%) developed scrotal haematoma and one patient (2.6%) developed stitch abscess. All showed good an atomical and cosmetic results up to a minimum of six months of follow-up. Conclusion: Single scrotal incision orchidopexy for palpable undescended testis is a simple and safe technique. It has shown to consume shorter time and give good cosmetic results. (author)

  18. Single Incision Laparoscopic Cholecystectomy vs Conventional Cholecystectomy in Developing Country

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    P B Thapa

    2010-09-01

    Full Text Available INTRODUCTION: Use of laparoscopic surgery has demanded principles of less trauma of access hence less scar and so probably less complications. Hence conventional laparoscopic surgeries were tried with natural orifice transluminal surgery (NOTES and then single incision laparoscopic surgery (SILS. With refinement in instruments and surgeons skills SILS have bridged up between conventional and NOTES in order to quench the desire of less or no scar at all. METHODS: Comparative case control study between conventional laparoscopic cholecystectomy and SILS in public teaching hospital. RESULTS: Total 20 patients underwent SILS cholecystectomy and 20 underwent conventional cholecystectomy and found that no difference between both in terms of post operative pain score, hospital stay and post operative wound infection except significant difference in mean operative time and patient's level of satisfaction was less in patient with SILC if were subjected to pay for instruments in order to maintain cosmesis. CONCLUSIONS: Though SILS have gained rapid acceptance in surgical fraternity, large number of randomized controlled trials are necessary to show its benefit over conventional laparoscopic cholecystectomy. Keywords: cholecystectomy, conventional, laparoscopy, single incision, surgery

  19. Single incision laparoscopic liver resection (SILL – a systematic review

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    Benzing, Christian

    2015-12-01

    Full Text Available Background: Today, minimally invasive liver resections for both benign and malignant tumors are routinely performed. Recently, some authors have described single incision laparoscopic liver resection (SILL procedures. Since SILL is a relatively young branch of laparoscopy, we performed a systematic review of the current literature to collect data on feasibility, perioperative results and oncological outcome.Methods: A literature research was performed on Medline for all studies that met the eligibility criteria. Titles and abstracts were screened by two authors independently. A study was included for review if consensus was obtained by discussion between the authors on the basis of predefined inclusion criteria. A thorough quality assessment of all included studies was performed. Data were analyzed and tabulated according to predefined outcome measures. Synthesis of the results was achieved by narrative review. Results: A total of 15 eligible studies were identified among which there was one prospective cohort study and one randomized controlled trial comparing SILL to multi incision laparoscopic liver resection (MILL. The rest were retrospective case series with a maximum of 24 patients. All studies demonstrated convincing results with regards to feasibility, morbidity and mortality. The rate of wound complications and incisional hernia was low. The cosmetic results were good.Conclusions: This is the first systematic review on SILL including prospective trials. The results of the existing studies reporting on SILL are favorable. However, a large body of scientific evidence on the field of SILL is missing, further randomized controlled studies are urgently needed.

  20. Single-incision Laparoscopic Surgery (SILS) in general surgery: a review of current practice.

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    Froghi, Farid; Sodergren, Mikael Hans; Darzi, Ara; Paraskeva, Paraskevas

    2010-08-01

    Single-incision laparoscopic surgery (SILS) aims to eliminate multiple port incisions. Although general operative principles of SILS are similar to conventional laparoscopic surgery, operative techniques are not standardized. This review aims to evaluate the current use of SILS published in the literature by examining the types of operations performed, techniques employed, and relevant complications and morbidity. This review considered a total of 94 studies reporting 1889 patients evaluating 17 different general surgical operations. There were 8 different access techniques reported using conventional laparoscopic instruments and specifically designed SILS ports. There is extensive heterogeneity associated with operating methods and in particular ways of overcoming problems with retraction and instrumentation. Published complications, morbidity, and hospital length of stay are comparable to conventional laparoscopy. Although SILS provides excellent cosmetic results and morbidity seems similar to conventional laparoscopy, larger randomized controlled trials are needed to assess the safety and efficacy of this novel technique.

  1. Single Incision Laparoscopic Surgery for a Large Endometriotic Cyst

    African Journals Online (AJOL)

    In the last decade, laparoscopy has become the standard treatment for many gynecological conditions.[1,2] Today, laparoscopy is hailed as the standard approach in the surgical treatment of benign adnexal pathology.[1,2] Attempts to minimize access-related injuries and complications resulted in development of single port ...

  2. Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model

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    Ishii, Takuro; Aoe, Tomohiko; Yu, Wen-Wei; Ebihara, Yuma; Kawahira, Hiroshi; Isono, Shiro; Naya, Yukio

    2016-01-01

    Abstract Background: Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model. Materials and Methods: Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5–6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis. Results: One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2–4.4%) of initial weight after 3–5 hours of irrigation. Conclusions: Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free

  3. Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion: Single Incision Versus Double Incision

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    Xin-Lei Xia

    2015-01-01

    Full Text Available Background: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF with a small single posterior median incision. Methods: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI scores, Visual Analog Scale (VAS scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05. Conclusions: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

  4. Subtotal Hysterectomy with Single Port Access Laparoscopy: Gadget or Progress?

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    Abo, Carole; Roman, Horace

    2016-01-01

    The strengths of surgical laparoscopy compared to laparotomy include shorter hospitalization, reduction in post-operative pain and adhesions, and better cosmetic outcomes. Since 2008, Single Port Access Laparoscopy (SPAL) has been used in order to offer additional cosmetic benefits and to further reduce post-operative morbidity. The aim of this study was to assess the feasibility of a subtotal hysterectomy using SPAL technique, as well as the benefits and the limitations of this technique. Retrospective series of 15 women managed between September 2010 and February 2013 at our university tertiary referral center by subtotal hysterectomy using SPAL technique for benign pathologies. Twelve of the 15 procedures were performed by SPAL alone. Three conversions to classic laparoscopy were required for a large uterus (1 case) or major pelvic adhesions (2 cases). Postoperative complications were a bladder injury, a subumbilical hematoma and transcervical fragmentation of a uterus with a low-grade sarcoma. Mean operative time was 85.4 minutes (50-170). Postoperative hospitalization was of 2 days in average. The rate of patient satisfaction at 16-month follow-up was 9.2/10. Subtotal hysterectomy using SPAL technique is safe and feasible. Successful procedure requires accurate selection of patients taking into account main limitations, such as uterus weight, patient's BMI and abdominal surgical history. Notwithstanding, SPAL technique can be seen as technical progress. Celsius.

  5. Transverse Skin Crease versus Vertical Midline Incision versus Laparoscopy for Right Hemicolectomy: A Systematic Review—Current Status of Right Hemicolectomy

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    Santoro, Alberto; Gubbiotti, Francesca; Di Rocco, Giorgio

    2014-01-01

    Purpose. The right hemicolectomy may be conducted through laparoscopic or laparotomic surgery, transverse or midline incisions. The transverse laparotomy offers some advantages compared to the midline laparotomy and laparoscopy. A literature review was performed to evaluate the possible advantages of the transverse incision versus midline incision or laparoscopic right hemicolectomy. Methods. A systematic research was performed in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, and the Science Citation Index. Results. Laparotomic right hemicolectomy with transverse incision is preferable to laparotomic hemicolectomy with midline incision. A transverse incision offers a lessened postoperative pain following physical activity, a lessened need to administer analgesic therapy during the post-operative time, better aesthetic results, and a better post-operative pulmonary function. Open surgery with transverse or midline incision ensured a shorter operative time, lower costs and a greater length of the incision compared to the laparoscopic. However, there are no differences in the oncological outcomes. Conclusions. It was not possible to identify significant differences between the open right hemicolectomy with transverse incision versus the open right hemicolectomy with midline incision or laparoscopic hemicolectomy. PMID:24605333

  6. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy--a randomised pilot study.

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    Lakdawala, Muffazal A; Muda, Nor Hisham; Goel, Sunita; Bhasker, Aparna

    2011-11-01

    This is a prospective pilot study done to evaluate the feasibility and to assess the outcomes and complication rates of the single-incision sleeve gastrectomy versus the conventional five-port laparoscopic sleeve gastrectomy. A prospective comparative analysis was done of 50 patients in each arm who underwent laparoscopic sleeve gastrectomy and single-incision sleeve gastrectomy from September 2009 until April 2010. Both groups were matched for age, gender and BMI and were then randomly assigned to either group. Postoperative pain scoring was done using the visual analogue scale. Postoperative outcomes in terms of pain scores, excess weight loss, resolution of comorbidities and complication rates were compared in both groups, at the end of 6 months. Operating times in both groups were comparable with experience. Intraoperative blood loss was similar in both groups. VAS scoring revealed lesser postoperative pain after the first 8 h in the single-incision group as compared to the laparoscopy group-P < 0.0001. At 6 months, excess weight loss and resolution of comorbidities were comparable in both groups. There were no major complications or mortalities in either group. Single-incision laparoscopic sleeve gastrectomy is a feasible surgical procedure for morbid obesity in selected individuals. When compared to conventional laparoscopic sleeve gastrectomy, it has equally effective weight loss and resolution of comorbidities. It also has the added benefits of little or no visible scarring and reduced postoperative pain.

  7. Comparative study of hybrid laparoendoscopic single-site (LESS) partial nephrectomy and conventional multiport laparoscopy.

    Science.gov (United States)

    Redondo, C; Esquinas, C; Meilán, E; García-Tello, A; Arance, I; Angulo, J C

    2017-05-01

    To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. Hybrid LESS technique with auxiliary 3.5mm trocar (n=20) was compared with conventional multiport laparoscopy (n=26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. Follow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P=0.09) and benign histology (P=0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P=0.006) and hospital stay (P=0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. The voice of Holland: Dutch public and patient′s opinion favours single-port laparoscopy

    Directory of Open Access Journals (Sweden)

    Sofie AF Fransen

    2014-01-01

    Full Text Available Introduction: Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy. Materials And Methods: An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy. Results: A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population. Conclusion: Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for

  9. The voice of Holland: Dutch public and patient's opinion favours single-port laparoscopy.

    Science.gov (United States)

    Fransen, Sofie Af; Broeders, Epm; Stassen, Lps; Bouvy, Nd

    2014-07-01

    Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy. An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years) were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy. A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population. Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for the safety and feasibility of this new surgical technique needs to be obtained

  10. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome.

    Science.gov (United States)

    Bible, Jesse E; McClure, D Jake; Mir, Hassan R

    2013-11-01

    To analyze the rate of postoperative infection and nonunion after tibial fractures in patients treated for acute compartment syndrome (ACS) using (1) single-incision versus (2) dual-incision fasciotomy technique. Retrospective. Level I trauma center. Review of all adult tibial fractures operatively treated (n = 2756) over a 12-year period identified 175 patients with concurrent ACS requiring fasciotomy. Of 60 patients treated with intramedullary nails, 36 patients had single-incision fasciotomy and 24 had dual-incision fasciotomy. Of 81 patients treated with plate fixation, 59 patients had single-incision fasciotomy and 22 had dual-incision fasciotomy. Tibial fixation with fasciotomy for ACS. Occurrence of postoperative infection and nonunion. Both fasciotomy groups were similar across recorded patient and treatment characteristics. Need for skin graft was similar between fasciotomy groups. For patients treated with intramedullary nail (n = 60), 1 infection (2.8%) occurred in single-incision group versus 2 (8.3%) in dual-incision group (P = 0.558). Seven nonunions (19.4%) occurred in single-incision group versus 3 (12.5%) in dual-incision group (P = 0.726). For plate fixation patients (n = 81), 15 infections (25.4%) occurred with single-incision fasciotomy versus 5 infections (22.7%) with dual-incision fasciotomy (P = 1.000). Seven nonunions (11.9%) occurred with single-incision group versus 4 nonunions (18.2%) with dual-incision group (P = 0.479). This is the first study to compare a single-incision fasciotomy technique to a dual-incision technique in the setting of tibial fractures with ACS, with similar infection and nonunion rates with either technique. The choice of fasciotomy technique can be based on surgeon experience or patient condition as opposed to a suspected elevated infection or nonunion risk with either technique. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  11. Single-incision versus conventional laparoscopic appendectomy in 688 patients: a retrospective comparative analysis

    Science.gov (United States)

    Liang, Hung-Hua; Hung, Chin-Sheng; Wang, Weu; Tam, Ka-Wai; Chang, Chun-Chao; Liu, Hui-Hsiung; Yen, Ko-Li; Wei, Po-Li

    2014-01-01

    Background Laparoscopic surgery has become the standard for treating appendicitis. The cosmetic benefits of using single-incision laparoscopy are well known, but its duration, complications and time to recovery have not been well documented. We compared 2 laparoscopic approaches for treating appendicitis and evaluated postoperative pain, complications and time to full recovery. Methods We retrospectively reviewed the cases of consecutive patients with appendicitis and compared those who underwent conventional laparoscopic appendectomy (CLA) performed using 3 incisions and those who underwent single-incision laparoscopic appendectomy (SILA). During SILA, the single port was prepared to increase visibility of the operative site. Results Our analysis included 688 consecutive patients: 618 who underwent CLA and 70 who underwent SILA. Postsurgical complications occurred more frequently in the CLA than the SILA group (18.1% v. 7.1%, p = 0.018). Patients who underwent SILA returned to oral feeding sooner than those who underwent CLA (median 12 h v. 22 h, p cosmetic advantages, SILA led to rapid recovery and no increase in postsurgical pain or complications. PMID:24869622

  12. Single-incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS.

    Science.gov (United States)

    Vestweber, Boris; Galetin, Thomas; Lammerting, Kathrin; Paul, Claudia; Giehl, Jeanette; Straub, Eberhard; Kaldowski, Bodo; Alfes, Angelika; Vestweber, Karl-Heinz

    2013-02-01

    Compared with single-incision laparoscopy, multiport laparoscopy is associated with greater risk of postoperative wound pain, infection, incisional hernias, and suboptimal cosmetic outcomes. The feasibility of minimally invasive single-incision laparoscopic surgery (SILS) for colorectal procedures is well-established, but outcome data remain limited. Patients with benign diverticular disease, Crohn's disease, or ulcerative colitis admitted to Klinikum Leverkusen, Germany, for colonic resection between July 2009 and March 2011 (n = 224) underwent single-incision laparoscopic surgery using the SILS port system. Surgeons had ≥7 years' experience in laparoscopic colon surgery but no SILS experience. Patient demographic and clinical data were collected prospectively. Pain was evaluated by using a visual analog scale (0-10). Data were analyzed by using the SPSS PASW Statistics 18 database. The majority of patients underwent sigmoid colectomy with high anterior resection (AR) or left hemicolectomy (n = 150) for diverticulitis. Our conversion rate to open surgery was 6.3 %, half in patients undergoing sigmoid colectomy with high AR or left hemicolectomy, 95 % of whom had diverticulitis. Mean operating time was 166 ± 74 (range, 40-441) min in the overall population, with shorter times for single-port transanal tumor resection (SPTTR; 89 ± 51 min; range, 40-153 min) and longer times for proctocolectomy (325 min; range, 110-441 min). Mean hospital stay was approximately 10 days, longer after abdominoperineal rectal resection or proctocolectomy (12-16 days). Most complications occurred following sigmoid colectomy with high AR or left hemicolectomy [19/25 (76 %) of early and 4/5 (80 %) of late complications, respectively]. Pain was surgery, conducted by experienced laparoscopic surgeons without specific training in use of the SILS port.

  13. Single-incision laparoscopic partial gastrectomy for gastric submucosal tumors without compromising transumbilical stapling.

    Science.gov (United States)

    Takata, Akihiro; Nakajima, Kiyokazu; Kurokawa, Yukinori; Takahashi, Tsuyoshi; Yamasaki, Makoto; Miyata, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

    2014-01-01

    Although SILS has become an increasingly popular type of surgery, its application for gastric submucosal tumors (SMT) has been only sporadically reported. We herein describe 12 recent cases with gastric SMT located in the greater curvature or anterior wall. The aim is to validate technical feasibility and safety of single-incision laparoscopic partial gastrectomy. Thus far, this is one of the largest series of patients with gastric SMT who underwent SILS. From July 2009 to April 2013, single-incision laparoscopic partial gastrectomy was attempted in 12 consecutive patients with gastric SMT. Three trocars were assembled in the umbilical incision, and the lesion was mobilized and staple-resected with endoscopic stapling devices. SILS surgery was successfully completed without any additional trocars. The median operating time was 96.5 min, and median blood loss was 7.5 mL. The median tumor size was 30 mm, with histopathologic diagnosis of gastrointestinal stromal tumor (10) and schwannoma (2). There was no immediate postoperative morbidity. During a median follow-up of 12 months, all patients were on full regular diet without any gastrointestinal symptoms. SILS with transumbilical gastric stapling is a safe and practical alternative to conventional multiport laparoscopy in patients with gastric SMT, except for cases originating in the lesser curvature and close to the cardia/ pylorus. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  14. First Canadian experience with robotic single-incision pyeloplasty: Comparison with multi-incision technique.

    Science.gov (United States)

    Law, Jeffrey; Rowe, Neal; Archambault, Jason; Nastis, Sofia; Sener, Alp; Luke, Patrick P

    2016-01-01

    We compared the outcomes of single-incision, robot-assisted laparoscopic pyeloplasty vs. multiple-incision pyeloplasty using the da Vinci robotic system. We reviewed all consecutive robotic pyeloplasties by a single surgeon from January 2011 to August 2015. A total of 30 procedures were performed (16 single:14 multi-port). Two different single-port devices were compared: the GelPort (Applied Medical, Rancho Santa Margarita, CA) and the Intuitive single-site access port (Intuitive Surgical, Sunnyvale, CA). Patient demographics were similar between the two groups. Mean operating time was similar among the single and multi-port groups (225.2 min vs. 198.9 minutes [p=0.33]). There was no significant difference in length of hospital stay in either group (86.2 hr vs. 93.2 hr [p=0.76]). There was no difference in success rates or postoperative complications among groups. Single-port robotic pyeloplasty is non-inferior to multiple-incision robotic surgery in terms of operative times, hospitalization time, success rates, and complications. Verifying these results with larger cohorts is required prior to the wide adoption of this technique. Ongoing objective measurements of cosmesis and patient satisfaction are being evaluated.

  15. Single-incision sling operations for urinary incontinence in women.

    Science.gov (United States)

    Nambiar, Arjun; Cody, June D; Jeffery, Stephen T

    2014-06-01

    Urinary incontinence has been shown to affect up to 50% of women. Studies in the United States have shown that up to 80% of these women have an element of stress urinary incontinence. Colposuspension and now mid-urethral slings have been shown to be effective in treating patients with stress incontinence. However, associated adverse events include bladder and bowel injury, groin pain and haematoma formation. This has led to the development of third-generation single-incision slings, also referred to as mini-slings.It should be noted that TVT-Secur (Gynecare, Bridgewater, NJ, USA) is one type of single-incision sling; it has been withdrawn from the market because of poor results. However, it is one of the most widely studied single-incision slings and was used in several of the trials included in this review. Despite its withdrawal from clinical use, it was decided that data pertaining to this sling should be included in the first iteration of this review, so that level 1a data are available in the literature to confirm its lack of efficacy. To assess the effectiveness of mini-sling procedures in women with urodynamic clinical stress or mixed urinary incontinence in terms of improved continence status, quality of life or adverse events. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process; we handsearched journals and conference proceedings (searched 6 February 2013) and searched ClinicalTrials.gov (searched 20 September 2012), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 20 September 2012) and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials in women with urodynamic stress incontinence, symptoms of stress incontinence or stress-predominant mixed urinary incontinence, in which at least one trial arm involves one of the

  16. [Drainage of amoebic liver abscess by single incision laparoscopic surgery. Report of a case].

    Science.gov (United States)

    Telich-Tarriba, José Eduardo; Parrao-Alcántara, Iris Jocelyn; Montes-Hernández, Jesús Manuel; Vega-Pérez, Jesús

    2015-01-01

    Single incision laparoscopic surgery has increased recently due to successful results, achieved in several procedures. The aim of the present work is to present the first case in which single incision laparoscopy is used for the drainage of an amoebic liver abscess. A 44-year-old man presented with intense right upper quadrant pain, generalised jaundice, tachycardia, fever, hepatomegaly and a positive Murphy's sign. Laboratory results revealed an increased plasma bilirubin, elevated alkaline phosphatase and transaminases, leucocytosis, negative viral panel for hepatitis, and positive antibodies against Entamoeba histolytica. On an abdominal computed tomography a 15 × 12.1 cm hypodense lesion was observed in the patient's liver, identified as an amoebic liver abscess. Analgesics and antibiotics were started and subsequently the patient was submitted to laparoscopic drainage of the abscess using a single port approach. Drainage and irrigation of the abscess was performed. Four days later the patient was discharged without complications. Management of amoebic liver abscess is focused on the elimination of the infectious agent and obliteration of the abscess cavity in order to prevent its complications, especially rupture. Laparoscopic surgery has proved to be a safe and effective way to manage this entity. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  17. Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations.

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    Dutta, Sanjeev

    2009-09-01

    Single incision laproscopic surgery (SILS) involves performing abdominal operations with laparoscopic instruments placed through a single, small umbilical incision. The primary goal is to avoid visible scarring. This is the first report of SILS cholecystectomy in children and the first report in the literature of SILS splenectomy. A retrospective chart review was performed in 20 consecutive inpatient SILS procedures (13 males, 7 females; ages 2-17 years) from May to December 2008. Outcome measures included need for conversion, operative time, time to oral analgesia, length of hospitalization, cosmetic outcome, and complications. There were 4 total splenectomies, 3 cholecystectomies, 2 combined splenectomy/cholecystectomies, and 11 appendectomies performed. All procedures were completed successfully without need for conversion to standard laparoscopy or open surgery. Mean operative time was 90 minutes for splenectomy, 68 minutes for cholecystectomy, 165 minutes for combined splenectomy/cholecystectomy, and 33 minutes for appendectomy. Mean hospital stay was 1 day for appendectomy, 1 day for cholecystectomy, and 2.5 days for splenectomy. One splenectomy patient received 1 U packed red blood cell transfusion. All appendectomy patients were converted to oral analgesia within 24 hours and splenectomy patients within 48 hours. All families were very pleased with the cosmetic outcome. Single incision laparoscopic surgery is feasible for a variety of pediatric general surgical conditions, allowing for scarless abdominal operations. This early experience suggests that outcomes are comparable to standard laparoscopic surgery but with improved cosmesis, however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain or recovery. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempting the various procedures. Technological refinements will

  18. Initial experience with laparoscopic single-incision triangulated umbilical surgery (SITUS) in simple and radical nephrectomy.

    Science.gov (United States)

    Nagele, Udo; Walcher, Ute; Herrmann, Thomas R W

    2012-10-01

    New transumbilical laparoendoscopic procedures are an emerging field in urologic surgery. We introduced the concept of single-incision triangulated umbilical surgery (SITUS) in 2009. SITUS technique uses straight optics and instruments in a triangulated fashion via three trocars placed through an umbilical incision resulting in a familiar laparoscopic environment. Aim of the study was to demonstrate the feasibility of SITUS in simple and radical nephrectomy in daily routine. From October 2009 to July 2010, in 3 patients with cirrhotic kidneys a simple and in 12 patients a radical nephrectomy was performed in SITUS technique. The umbilical fold was incised at three-fourth of its circumference; in the patient with radical nephrectomy, additionally small "c"-shaped skin flaps were removed. After achieving a pneumoperitoneum by Verres technique, a 5-mm camera port and then a cranial 5 mm and a caudal 11 mm working trocar were placed with at a distance of 5-10 cm with the aid of two Langenbeck hooks, thus allowing triangulation except in the radical nephrectomy patients, where an 11-mm caudal trocar (Endopath, Ethicon, Hamburg, GER) was used. Using long conventional laparoscopic instruments, En-Seal pressure coagulator and dissector (Erbe, Tuebingen, Germany), Hem-O-Lock clips (Weck, Teleflex, USA), and a 30° 5-mm optic (Karl Storz, Tuttlingen, GER), the interventions were executed like conventional laparoscopic transperitoneal procedures. OR time was mean 127 min [120, 153] for cirrhotic kidney nephrectomy group and mean 137 min [91, 185] in the radical nephrectomy group. Mean hemoglobin drop was 1.5 g/dl [1.2, 1.7] in benign cases and 2.4 [1.1, 4.9] in radial nephrectomies. All except one diabetic patient with wound infection had an uneventful follow-up without postoperative complications. The patients were discharged at postoperative day 5 [3, 29]. SITUS technique for simple and radical nephrectomy is an attractive alternative to conventional laparoscopy and single

  19. The transverse colon cancer with the reversed rotation of the midgut treated with single incision laparoscopic colectomy.

    Science.gov (United States)

    Hirano, Yasumitsu; Hattori, Masakazu; Fujita, Manami; Nishida, Youji; Douden, Kenji; Hashizume, Yasuo

    2013-06-01

    Reversed rotation of the midgut is a rare type of intestinal malrotation. Moreover, synchronous colon cancer has rarely been reported. Preliminary experience with single-incision laparoscopic colectomy (SILC) for colon cancer with reversed rotation of the midgut is reported. An 82-year-old woman was admitted because of a fecal occult blood. A colonoscopy revealed transverse colon cancer. An air-barium contrast enema showed the right-sided sigmoid colon and the left-sided cecum. A computed tomography revealed that the duodenum and the transverse colon were situated at the ventral side of the superior mesenteric artery, and a preoperative diagnosis of suspicion of reversed rotation of the midgut was made. First, a lap protector was inserted through a 4.0 cm transumbilical incision. Four 5 mm ports were placed in the lap protector. On the observation of laparoscopy, the cecum and the ascending colon were not fixed with the retroperitoneum and situated on the left, and the sigmoid colon was situated on the right. We successfully mobilized the transverse colon using a single-incision laparoscopic approach. Resection was achieved following extracorporealization, and the anastomosis was performed extracorporeally using staplers. The patient was discharged on the thirteenth postoperative day. Postoperative follow-up did not reveal any umbilical wound complications. SILC for colon cancer associated with malrotation of the midgut is feasible and a promising alternative method because of its less invasiveness and its adaptability to the malrotation without extending the skin incision.

  20. Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery.

    Science.gov (United States)

    Tayar, Claude; Claude, Tayar; Subar, Daren; Daren, Subar; Salloum, Chady; Chady, Salloum; Malek, Alexandre; Alexandre, Malek; Laurent, Alexis; Alexis, Laurent; Azoulay, Daniel; Daniel, Azoulay

    2014-01-01

    Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS) has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH). From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure™ (Covidien-Valleylab. Boulder. USA), Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.). Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min) and the mean estimated blood loss was 57 ml (range: 25-150 ml). The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days). Pathology identified three benign and four malignant liver tumours with clear margins. SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.

  1. Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery

    Directory of Open Access Journals (Sweden)

    Tayar Claude

    2014-01-01

    Full Text Available Background: Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH. Patients and Methods: From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure TM (Covidien-Valleylab. Boulder. USA, Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.. Results: Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min and the mean estimated blood loss was 57 ml (range: 25-150 ml. The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days. Pathology identified three benign and four malignant liver tumours with clear margins. Conclusion: SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.

  2. Single-port laparoscopy in gynecologic oncology: seven years of experience at a single institution.

    Science.gov (United States)

    Moulton, Laura; Jernigan, Amelia M; Carr, Caitlin; Freeman, Lindsey; Escobar, Pedro F; Michener, Chad M

    2017-11-01

    Single-port laparoscopy has gained popularity within minimally invasive gynecologic surgery for its feasibility, cosmetic outcomes, and safety. However, within gynecologic oncology, there are limited data regarding short-term adverse outcomes and long-term hernia risk in patients undergoing single-port laparoscopic surgery. The objective of the study was to describe short-term outcomes and hernia rates in patients after single-port laparoscopy in a gynecologic oncology practice. A retrospective, single-institution study was performed for patients who underwent single-port laparoscopy from 2009 to 2015. A univariate analysis was performed with χ 2 tests and Student t tests; Kaplan-Meier and Cox proportional hazards determined time to hernia development. A total of 898 patients underwent 908 surgeries with a median follow-up of 37.2 months. The mean age and body mass index were 55.7 years and 29.6 kg/m 2 , respectively. The majority were white (87.9%) and American Society of Anesthesiologists class II/III (95.5%). The majority of patients underwent surgery for adnexal masses (36.9%) and endometrial hyperplasia/cancer (37.3%). Most women underwent hysterectomy (62.7%) and removal of 1 or both fallopian tubes and/or ovaries (86%). Rate of adverse outcomes within 30 days, including reoperation (0.1%), intraoperative injury (1.4%), intensive care unit admission (0.4%), venous thromboembolism (0.3%), and blood transfusion, were low (0.8%). The rate of urinary tract infection was 2.8%; higher body mass index (P = .02), longer operative time (P = .02), smoking (P = .01), hysterectomy (P = .01), and cystoscopy (P = .02) increased the risk. The rate of incisional cellulitis was 3.5%. Increased estimated blood loss (P = .03) and endometrial cancer (P = .02) were independent predictors of incisional cellulitis. The rate for surgical readmissions was 3.4%; higher estimated blood loss (P = .03), longer operative time (P = .02), chemotherapy alone (P = .03), and

  3. Single transverse extended incision for radical neck dissection

    Directory of Open Access Journals (Sweden)

    José Francisco Sales Chagas

    Full Text Available ABSTRACT Objective: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. Method: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective. Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. Results: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. Conclusions: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor.

  4. [Preliminary clinical experience of single incision laparoscopic colorectal surgery].

    Science.gov (United States)

    Wu, S D; Han, J Y

    2016-06-01

    Objective: To discuss the preliminary experience of single incision laparoscopic colorectal surgery. Methods: The clinical data and surgical outcomes of 104 selected patients who underwent single incision laparoscopic colorectal surgery in the 2 nd Department of General Surgery, Shengjing Hospital of China Medical University from January 2010 to September 2015 were retrospectively analyzed. There were 62 male and 42 female patients, aging from 21 to 87 years with a mean of (61±12) years. Eighty-five patients were diagnosed with malignancy while the rest 19 cases were benign diseases. All the procedures were performed by the same surgeon using the rigid laparoscopic instruments. Surgical and oncological outcomes were analyzed in 4 kinds of procedures which are over 5 cases respectively, including low anterior resection, abdominoperineal resection, radical right colon resection and radical sigmoidectomy. Results: Single incision laparoscopic colorectal surgery was performed in 104 selected patients and was successfully managed in 99 cases with a total conversion rate of 4.8%. Radical procedures for malignancy in cases with the number of patients more than 5 were performed for 74 cases. For low anterior resection, 35 cases with an average surgical time of (191±57) minutes, average estimated blood loss of (117±72) ml and average number of harvested lymph nodes of 14.6±1.1. For abdominoperineal resection, 9 cases with an average surgical time of (226±54) minutes, average estimated blood loss of (194±95) ml and average number of harvested lymph nodes of 14.1±1.5. For radical right colon resection, 16 cases with an average surgical time of (222±62) minutes, average estimated blood loss of (142±68) ml and average number of harvested lymph nodes of 15.4±2.4. For radical sigmoidectomy, 14 cases with an average surgical time of (159±32) minutes, average estimated blood loss of (94±33) ml and average number of harvested lymph nodes of 13.9±1.5. The overall

  5. Single-incision laparoscopic surgery for diverticulitis in overweight patients.

    Science.gov (United States)

    Rink, Andreas D; Vestweber, Boris; Hahn, Jasmina; Alfes, Angelika; Paul, Claudia; Vestweber, Karl-Heinz

    2015-10-01

    Single-incision laparoscopic surgery (SILS) has been introduced as a new technique for the treatment of various colorectal diseases. Recurrent or complicated diverticulitis of the sigmoid colon is a frequent indication for minimally invasive sigmoid colectomy. The aim of this study was to investigate the impact of obesity on the outcome of SILS sigmoid colectomy. From September 2009 to October 2014, data from 377 patients who had intended SILS sigmoid colectomy for diverticulitis at our institution were collected in a prospective database. The patients were categorized in the following subgroups: group 1 (normal weight, body mass index (BMI)  35 kg/m(2)). The groups were equivalent for sex, age, status of diverticulitis, the presence of acute inflammation in the specimen, and the percentage of teaching operations, but the percentage of patients with accompanying diseases was significantly more frequent in groups 2, 3, and 4 (p = 0.04, 0.008, and 0.018, respectively). As compared to group 1, the conversion rate was significantly increased in groups 2 and 4 (2.3 vs. 9.3% (p = 0.013) and 2.3 vs. 12.5% (p = 0.017), respectively). The duration of surgery, hospitalization, and morbidity did not differ between the four groups. Up to a body mass index of 35 kg/m(2), increased body weight does not significantly reduce the feasibility and outcome of single-incision laparoscopic surgery for diverticulitis.

  6. Single-incision laparoscopic splenectomy with innovative gastric traction suture

    Directory of Open Access Journals (Sweden)

    Srikanth G

    2011-01-01

    Full Text Available Laparoscopic splenectomy is now the gold standard for patients with idiopathic thrombocytopenic purpura (ITP undergoing splenectomy. There are a few reports in literature on single-incision laparoscopic (SIL splenectomy. Herein, we describe a patient undergoing SIL splenectomy for ITP without the use of a disposable port device. We report a 20-year-old female patient with steroid-refractory ITP having a platelet count of 14,000/cmm who underwent a SIL splenectomy. Dissection was facilitated by the use of a single articulating grasper and a gastric traction suture and splenic vessels were secured at the hilum with an endo-GIA stapler. She made an uneventful postoperative recovery and was discharged on the second postoperative day. She is doing well with no visible scar at 8-month follow-up.

  7. Transumbilical laparoendoscopic single-site surgery versus conventional laparoscopy for the resection of retroperitoneal paragangliomas.

    Science.gov (United States)

    Xu, Weifeng; Li, Hanzhong; Ji, Zhigang; Yan, Weigang; Zhang, Yushi; Zhang, Xuebin; Li, Qian

    2015-09-01

    To compare transumbilical laparoendoscopic single-site surgery with conventional laparoscopy for the resection of retroperitoneal paragangliomas. In the present case-control study, we compared 11 transumbilical laparoendoscopic single-site surgery procedures with 22 conventional laparoscopy procedures carried out to treat retroperitoneal paragangliomas between June 2004 and October 2013 at Peking Union Medical Hospital, Beijing, China. Operative time, estimated intraoperative blood loss, blood transfusions, intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, postoperative fatigue time, postoperative systematic inflammation reaction syndrome, 24-h postoperative visual analog scale scores, postoperative hospital stay duration, and postoperative complications were recorded and analyzed. There were no significant differences in patient characteristics. All surgical procedures were successfully completed in both groups. Minor complications occurred in one case in the laparoendoscopic single-site surgery group and in two cases in the conventional laparoscopy group. In the laparoendoscopic single-site surgery group, the operative time was longer than that in the conventional laparoscopy group (P = 0.001). There were no significant differences in terms of intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, estimated blood loss, postoperative fatigue time, postoperative hospital stay or systematic inflammation reaction syndrome between the two groups. The 24-h postoperative visual analog scale score was lower in the laparoendoscopic single-site surgery group (P = 0.002). No recurrence or metastases were observed over the duration of the postoperative follow up. In properly selected patients, transumbilical laparoendoscopic single-site surgery is a feasible, safe and effective

  8. Single transverse extended incision for radical neck dissection.

    Science.gov (United States)

    Chagas, José Francisco Sales; Pascoal, Maria Beatriz Nogueira; Aquino, José Luís Braga; Brandi, Luís Antônio; Previtale, Evandro Von Zuben; Trillo, Ana Sofia Pontes; Curioni, Otávio Alberto; Rapoport, Abrão; Dedivitis, Rogério Aparecido

    2016-01-01

    to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor. verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio

  9. Pelvic laparoscopy

    Science.gov (United States)

    Celioscopy; Band-aid surgery; Pelviscopy; Gynecologic laparoscopy; Exploratory laparoscopy - gynecologic ... such as appendectomy , removing lymph nodes) After the laparoscopy, the carbon dioxide gas is released, and the ...

  10. Single-Incision Laparoscopic Surgery (SILS Assisted Sigma Resection Via Pfannenstiel Incision for Complicated Diverticulitis

    Directory of Open Access Journals (Sweden)

    Arne Dietrich

    2014-02-01

    Results: The operation time ranged from 89 to 280 min. There were no conversions, and no additional trocars were used. The postoperative hospital stay ranged from 5 to 14 days. All patients were discharged without any intraoperative or postoperative complications. Conclusions: SILS sigma or anterior rectum resection for complicated diverticulitis can be performed via a Pfannenstiel incision. This approach provides direct visualization and access into the pelvis as well as the option to benefit from open surgery devices. The Pfannenstiel incision may generally be recommended for the favorable cosmetic effect and the very low rate of incisional hernias, as reported in the literature. [Arch Clin Exp Surg 2014; 3(1.000: 10-15

  11. Single-Incision Laparoscopic Sterilization of the Cheetah (Acinonyx jubatus).

    Science.gov (United States)

    Hartman, Marthinus J; Monnet, Eric; Kirberger, Robert M; Schmidt-Küntzel, Anne; Schulman, Martin L; Stander, Jana A; Stegmann, George F; Schoeman, Johan P

    2015-07-01

    To describe laparoscopic ovariectomy and salpingectomy in the cheetah (Acinonyx jubatus) using single-incision laparoscopic surgery (SILS). Prospective cohort. Female cheetahs (Acinonyx jubatus) (n = 21). Cheetahs were randomly divided to receive either ovariectomy (n = 11) or salpingectomy (n = 10). The use and complications of a SILS port was evaluated in all of cheetahs. Surgery duration and insufflation volumes of carbon dioxide (CO2 ) were recorded and compared across procedures. Laparoscopic ovariectomy and salpingectomy were performed without complications using a SILS port. The poorly-developed mesosalpinx and ovarian bursa facilitated access to the uterine tube for salpingectomy in the cheetah. The median surgery duration for ovariectomy was 24 minutes (interquartile range 3) and for salpingectomy was 19.5 minutes (interquartile range 3) (P = .005). The median volume of CO2 used for ovariectomy was 11.25 L (interquartile range 3.08) and for salpingectomy was 4.90 L (interquartile range 2.52), (P = .001) CONCLUSIONS: Laparoscopic ovariectomy and salpingectomy can be performed in the cheetah using SILS without perioperative complications. Salpingectomy is faster than ovariectomy and requires less total CO2 for insufflation. © Copyright 2015 by The American College of Veterinary Surgeons.

  12. Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: protocol for a randomized controlled trial.

    Science.gov (United States)

    Grochola, Lukasz Filip; Soll, Christopher; Zehnder, Adrian; Wyss, Roland; Herzog, Pascal; Breitenstein, Stefan

    2017-02-09

    Recent advances in robotic technology suggest that the utilization of the da Vinci Single-Site™ platform for cholecystectomy is safe, feasible and results in a shorter learning curve compared to conventional single-incision laparoscopic cholecystectomy. Moreover, the robot-assisted technology has been shown to reduce the surgeon's stress load compared to standard single-incision laparoscopy in an experimental setup, suggesting an important advantage of the da Vinci platform. However, the above-mentioned observations are based solely on case series, case reports and experimental data, as high-quality clinical trials to demonstrate the benefits of the da Vinci Single-Site™ cholecystectomy have not been performed to date. This study addresses the question whether robot-assisted Single-Site™ cholecystectomy provides significant benefits over single-incision laparoscopic cholecystectomy in terms of surgeon's stress load, while matching the standards of the conventional single-incision approach with regard to peri- and postoperative outcomes. It is designed as a single centre, single-blinded randomized controlled trial, which compares both surgical approaches with the primary endpoint surgeon's physical and mental stress load at the time of surgery. In addition, the study aims to assess secondary endpoints such as operating time, conversion rates, additional trocar placement, intra-operative blood loss, length of hospital stay, costs of procedure, health-related quality of life, cosmesis and complications. Patients as well as ward staff are blinded until the 1 st postoperative year. Sample size calculation based on the results of a previously published experimental setup utilizing an estimated effect size of surgeon's comfort of 0.8 (power of 0.8, alpha-error level of 0.05, error margin of 10-15%) resulted in a number of 30 randomized patients per arm. The study is the first randomized controlled trial that compares the da Vinci Single Site™ platform to

  13. Two hundred seventy-five single-incision laparoscopic gastric band insertions: what have we learnt?

    Science.gov (United States)

    Murgatroyd, Beth; Chakravartty, Saurav; Sarma, Diwakar R; Patel, Ameet G

    2014-07-01

    Single-incision surgery in the morbidly obese patient has not been widely adopted, but remains a popular choice amongst patients. In the bariatric patient, it presents its own surgical challenges with hepatomegaly and increased abdominal adiposity. Here, we present our experience of 275 single-incision laparoscopic gastric bands.Between June 2009 and April 2013, 275 obese patients underwent single-incision laparoscopic adjustable gastric banding through a single incision using a multichannel single port and via a pars flaccida approach. Prospective data collection was undertaken including operating time, additional ports and additional procedures undertaken.In this series, median operative time was 60 (range 34-170) min. An additional port was placed in 15 patients (5%), including two conversions to four-port technique (0.7%). Of these patients (n = 15), the majority were male (p rate of success for all BMIs. Following 275 single-incision band insertions additional port placements were more commonly required in male patients, BMI >45 and earlier in the learning curve.

  14. Transvaginal Excision of an Eroded Sacrocolpopexy Mesh by Using Single-Incision Laparoscopic Surgery Equipment.

    Science.gov (United States)

    Mohr, Stefan; Siegenthaler, Franziska; Imboden, Sara; Kuhn, Annette; Mueller, Michael D

    To show a new technique of using single-incision laparoscopic surgery (SILS) equipment in vaginal surgery to create a "pneumovagina." Explanatory video demonstrating the technique and intraoperative findings. University hospital. The 68-year-old patient was referred with a vaginal mesh erosion that resulted in abscess formation at the vaginal apex. The patient was symptomatic with an increasingly foul-smelling vaginal discharge for about 1 year. She had a laparoscopic sacrocolpopexy in a remote hospital 22 months before the current operation and had a total abdominal hysterectomy 15 years ago. The, patient's history was uneventful without dyspareunia, incontinence or voiding difficulties, and she was otherwise content with the sacrocolpopexy result. The local institutional review board granted exemption for this publication. Frequently, pelvic organ prolapse can only be effectively treated if the surgical procedure comprises support of the central compartment. Laparoscopic sacrocolpopexy shows superior outcomes for this indication, with success rates of up to 96%. However, a rare side effect of laparoscopic sacrocolpopexy is mesh erosion, occurring in up to 2.4% [1]. These erosions are usually treated laparoscopically [2]. In this video we show an alternative route for excision of a symptomatic exposed mesh by using a transvaginal approach: The SILS trocar is used vaginally for abscess irrigation and mesh excision with minimally invasive instruments. For treatment of the abscess and removal of the exposed mesh, the SILS trocar was placed vaginally, and laparoscopic instruments were used. The abscess was incised, cleansed and irrigated, debrided, and the mesh excised. Because no mesh material was exposed after excision, the vagina was not closed to avoid creating a cavity with the risk of promoting reabscess formation, and secondary wound healing was anticipated. Laparoscopy was used to confirm that no intra-abdominal lesion coexisted or occurred. There were

  15. Single incision laparoscopic pancreas resection for pancreatic metastasis of renal cell carcinoma.

    Science.gov (United States)

    Barbaros, Umut; Sümer, Aziz; Demirel, Tugrul; Karakullukçu, Nazlı; Batman, Burçin; Içscan, Yalın; Sarıçam, Gülay; Serin, Kürçsat; Loh, Wei-Liang; Dinççağ, Ahmet; Mercan, Selçuk

    2010-01-01

    Transumbilical single incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain, reduced need for analgesia, and thus accelerated recovery. Herein, we report the first transumbilical single incision laparoscopic pancreatectomy case in a patient who had renal cell cancer metastasis on her pancreatic corpus and tail. A 59-year-old female who had metastatic lesions on her pancreas underwent laparoscopic subtotal pancreatectomy through a 2-cm umbilical incision. Single incision pancreatectomy was performed with a special port (SILS port) and articulated equipment. The procedure lasted 330 minutes. Estimated blood loss was 100mL. No perioperative complications occurred. The patient was discharged on the seventh postoperative day with a low-volume (20mL/day) pancreatic fistula that ceased spontaneously. Pathology result of the specimen was renal cell cancer metastases. This is the first reported SILS pancreatectomy case, demonstrating that even advanced surgical procedures can be performed using the SILS technique in well-experienced centers. Transumbilical single incision laparoscopic pancreatectomy is feasible and can be performed safely in experienced centers. SILS may improve cosmetic results and allow accelerated recovery for patients even with malignancy requiring advanced laparoscopic interventions.

  16. Influence of Lateral Incision on Inhomogeneous Deformation of a Nickel [001] - Single Cristal at Axial Compression

    Science.gov (United States)

    Lychagin, D. V.; Alfyorova, E. A.; Lychagin, M. V.; Dilun, Czyan

    2016-04-01

    We used the scanning electron microscopy and the electron backscattered diffraction to investigate a deformation relief and a crystallographic disorientation of a nickel [001] single crystal with {100} faces with a lateral incision. We identified that the lateral incision can change the shear domains distribution pattern in the sample by creating additional deformation domains near the incision. The change in the patterns of the misorientation accumulation on the mutually perpendicular faces accompanies this deformation. We established that the orientation alteration occurs toward the increase of the Schmid factor for the slip systems in two of the four (previously equally loaded) slip planes. This method of shear deformation contributes to an optimal mutually consistent deformation in the adjacent areas of the single crystal.

  17. Safety and feasibility of single-incision laparoscopic cholecystectomy in obese patients

    Directory of Open Access Journals (Sweden)

    Masaki Wakasugi

    2017-01-01

    Full Text Available Current literature frequently indicates that experienced laparoscopic surgeons can safely perform single-incision laparoscopic cholecystectomy, but there have been few reports evaluating the feasibility and safety of performing single-incision laparoscopic cholecystectomy for obese patients. Therefore, a large single-center database was retrospectively reviewed to evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy for obese patients by comparing the outcomes of normal-weight and obese patients undergoing single-incision laparoscopic cholecystectomy.A retrospective analysis of 608 patients undergoing SILC between May 2009 and May 2015 at Osaka Police Hospital was performed, and the outcomes of obese [body mass index (BMI ≥ 30 kg/m2] and normal-weight patients (18.5 ≤ BMI < 25 kg/m2 were compared.Thirty-eight obese patients (mean BMI 32.5 kg/m2 were compared to 362 normal-weight patients (mean BMI 22.0 kg/m2. The American Society of Anesthesiologists (ASA scores of the obese patients were significantly higher than those of normal-weight patients. The mean operative times in the normal-weight and the obese groups were 110 min vs. 127 min, respectively (p < 0.05. There were no significant differences in the bleeding volume and the conversion rate to a different operative procedure. Perioperative complications were seen in 6% (23/362 of the patients in the normal-weight group and 8% (3/38 of the patients in the obese group (p = 0.7. The mean postoperative hospital stay was 4.5 days for the normal-weight group and 4.4 days for the obese group (p = 0.8.Single-incision laparoscopic cholecystectomy, which offers good cosmetic outcomes, seems feasible and safe in obese patients.•Single-incision laparoscopic cholecystectomy offers good cosmetic outcomes.•Single-incision laparoscopic cholecystectomy seems feasible and safe in obese patients.

  18. Feasibility of single-incision laparoscopic surgery for appendicitis in abnormal anatomical locations: A single surgeon′s initial experience

    Directory of Open Access Journals (Sweden)

    Sanoop K Zachariah

    2013-01-01

    Full Text Available Background: Single-incision laparoscopic surgery is considered as a more technically demanding procedure than the standard laparoscopic surgery. Based on an initial and early experience, single-incision laparoscopic appendectomy (LA was found to be technically advantageous for dealing with appendicitis in unusual anatomical locations. This study aims to highlight the technical advantages of single-incision laparoscopic surgery in dealing with the abnormally located appendixes and furthermore report a case of acute appendicitis occurring in a sub-gastric position, which is probably the first such case to be reported in English literature. Materials and Methods: A retrospective analysis of the first 10 cases of single-incision LA which were performed by a single surgeon is presented here. Results: There were seven females and three males. The mean age of the patients was 30.6 (range 18-52 years, mean BMI was 22.7 (range 17-28 kg/m 2 and the mean operative time was 85.5 (range 45-150 min. The mean postoperative stay was 3.6 (range 1-7 days. The commonest position of the appendix was retro-caecal (50% followed by pelvic (30%. In three cases the appendix was found to be in abnormal locations namely sub-hepatic, sub-gastric and deep pelvic or para-vesical or para-rectal. All these cases could be managed with this technique without any conversions Conclusion: Single-incision laparoscopic surgery appears to be a feasible and safe technique for dealing with appendicitis in rare anatomical locations. Appendectomy may be a suitable procedure for the initial training in single-incision laparoscopic surgery.

  19. Advances in laparoscopy for acute care surgery and trauma.

    Science.gov (United States)

    Mandrioli, Matteo; Inaba, Kenji; Piccinini, Alice; Biscardi, Andrea; Sartelli, Massimo; Agresta, Ferdinando; Catena, Fausto; Cirocchi, Roberto; Jovine, Elio; Tugnoli, Gregorio; Di Saverio, Salomone

    2016-01-14

    The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a

  20. Fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision.

    Science.gov (United States)

    Yabe, T; Muraoka, M; Motomura, H; Ozawa, T

    2001-11-01

    Four cases of fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision are reported. Because of lack of suitable arteries for anastomosis in the amputated finger, in each case a volar radial vein was anastomosed to the proximal digital artery and external drainage was performed through a transverse tip incision. In 3 cases the replanted fingertip survived completely; partial necrosis occurred in 1 case. Because veins are more superficial and larger than arteries, they are more available for anastomosis. The results indicate that this method is a useful alternative in fingertip replantation.

  1. Single-incision laparoscopic distal gastrectomy for early gastric cancer through a homemade single port access device.

    Science.gov (United States)

    Jiang, Zhi-Wei; Zhang, Shu; Wang, Gang; Zhao, Kun; Liu, Jiang; Ning, Li; Li, Jieshou

    2015-01-01

    We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments. A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer. This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved. This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.

  2. Effect of incision design on interproximal bone loss of teeth adjacent to single implants. A randomized controlled clinical trial comparing intrasulcular vs paramarginal incision.

    Science.gov (United States)

    Girbés-Ballester, Paula; Viña-Almunia, Jose; Balaguer-Martí, Jose C; Peñarrocha-Diago, Miguel; Peñarrocha-Oltra, David

    2018-02-16

    To evaluate the effect of incision design in implant surgery on interproximal bone loss of posterior teeth adjacent to interdental single implants, comparing intrasulcular and paramarginal incision. A further aim was to assess the influence of the incision technique on peri-implant bone remodeling. A controlled randomized clinical trial was carried out in a University Clinic. All the patients received an interdental posterior single implant. The incision type was randomly divided into two groups: (a) intrasulcular or (b) paramarginal. Standardized periapical digital radiographs were made with the parallel technique and a silicone index individualized in each patient. Radiographs were made immediately after implant placement, at abutment connection, 6 and 12 months post-loading. Two radiographic reference points were detected at the interproximal aspect of the adjacent teeth: (A) the cementoenamel junction and (B) the most coronal aspect of the bone crest. The interproximal bone loss of the adjacent teeth was calculated as the difference from A to B between the different follow-up periods and baseline. Two different examiners evaluated the radiographic measurements twice. Sixty patients, each with one implant, were included, 30 in each group. A mean interproximal bone loss in teeth of 0.09 mm in the intrasulcular and 0.10 mm in the paramarginal group was found at 12 months post-loading. Mean peri-implant bone remodeling was 0.17 mm in the intrasulcular group and 0.15 mm in the paramarginal group. Differences between incision types were not statistically significant (p > .05). Both incision designs used to place interdental single implants resulted in minimum bone loss at the interproximal aspect of adjacent teeth. The incision design did not significantly influence the radiographically assessed interproximal bone loss nor peri-implant bone remodeling. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Learning Curve for Laparoendoscopic Single-Incision Live Donor Nephrectomy: Implications for Laparoendoscopic Practice and Training.

    Science.gov (United States)

    Troppmann, Christoph; Santhanakrishnan, Chandrasekar; Fananapazir, Ghaneh; Troppmann, Kathrin M; Perez, Richard V

    2017-05-01

    The learning curve for laparoendoscopic single-incision live donor nephrectomy, which is technically more complex than the multiport, conventional laparoendoscopic approach, is unknown. In a retrospective cohort study, we analyzed the learning curve of the initial 114 consecutive single-incision laparoendoscopic nephrectomies performed in nonselected live kidney donors. Median donor body mass index was 26 kg/m 2 (range 20-34). In all, 92% of the nephrectomies were performed on the left side; 18% of the recovered kidneys had multiple renal arteries. Cumulative sum (CUSUM) analysis of operating time (OT) demonstrated that the learning curve was achieved after case 61. For the learning curve phase (Group 1 [cases 1-61]) vs the postlearning phase (Group 2 [cases 62-114]), the difference of the mean OT was 20 minutes (p = 0.05). Mean warm ischemic time in the donors was significantly longer during the learning phase (Group 1, 6 minutes; Group 2, 5 minutes; p = 0.04). Rates of conversions to multiport procedures and of donor complications were not significantly different between Groups 1 and 2. For the recipients, we observed delayed graft function in 2 (2%) cases, no technical graft losses; and 1-year death-censored graft survival was 100% (p = n.s. for all comparisons of Group 1 vs 2). Single-incision laparoendoscopic donor nephrectomy had a long learning curve (>60 cases), but resulted in excellent donor and recipient outcomes. The long learning curve has significant implications for the programs and surgeons who contemplate transitioning from multiport to single-incision nephrectomy. Furthermore, our observations are highly relevant for informing the development of training requirements for fellows to be trained in single-incision laparoendoscopic nephrectomy.

  4. Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery.

    Science.gov (United States)

    Liu, Ruoyan; Wang, Yanan; Zhang, Ze; Li, Tingting; Liu, Hao; Zhao, Liying; Deng, Haijun; Li, Guoxin

    2017-06-01

    The advantages of reduced-port laparoscopic surgery (RPLS) for rectosigmoid cancer treatment have been disputed. This study evaluated the outcomes of RPLS compared to conventional laparoscopic surgery (CLS) for rectosigmoid cancer. Data from 211 patients who underwent a selective sigmoidectomy or anterior resection from August 2011 to June 2014 at a single institution were collected and analyzed via propensity score matching. Operative outcomes, inflammatory responses, pain intensity, oncologic outcomes, quality of life, and cosmetic results were compared between groups. After matching, 96 patients (48 CLS and 48 RPLS) were evaluated. Sixteen RPLS cases underwent single-incision laparoscopic surgery (SILS), and 32 underwent single-incision plus one port laparoscopic surgery (SILS + 1). Baseline clinical characteristics were comparable between the RPLS and the CLS groups. Morbidity, pathologic outcomes, and 3-year disease-free survival and overall survival rates were also comparable between the 2 groups. Compared with the CLS group, the RPLS group had a shorter total incision length (p time to liquid diet (p = 0.027), ambulation (p = 0.026), and discharge (p times, C-reactive protein levels at 24 h and 96 h, and interleukin-6 levels at 24 h postoperatively were significantly lower in the SILS + 1 group than those in the CLS and SILS groups (p cosmetic results, and both groups showed better results than the CLS group (p < 0.001). RPLS for rectosigmoid cancer is feasible, with short-term safety and long-term oncological safety comparable to that of CLS. Better cosmesis and accelerated recovery can be expected. SILS + 1 is a better choice than CLS or SILS for rectosigmoid cancer because it minimizes invasiveness and reduces technical difficulties.

  5. The Role of Laparoscopy in the Acute Neonatal Abdomen.

    Science.gov (United States)

    Burgmeier, Christine; Schier, Felix

    2016-12-01

    IntroductionThe surgical treatment of the acute neonatal abdomen still poses a challenge in pediatric surgery. Various underlying etiologies require different surgical procedures. Until today the role of laparoscopy in the surgical treatment of the acute neonatal abdomen is controversial. The aim of this study was to analyze our experiences with laparoscopy and to perform a review of the literature. Methods Retrospective, single-institution study including all term and preterm neonates initially undergoing laparoscopy due to an acute abdomen. Results Altogether, 17 neonates presenting with an acute neonatal abdomen initially underwent laparoscopy. Unnecessary laparotomy could be avoided in 9 of 17 (53%) neonates. After diagnostic laparoscopy, 2 patients did not require any further surgical intervention. Eight neonates presented midgut atresia intraoperatively, 5 of them underwent laparoscopic-assisted correction. Successful laparoscopic derotation of an acute volvulus (n = 1) and laparoscopic appendectomy (n = 1) could be performed. Conversion to open surgery was necessary in 8 neonates (47%) due to creation of a stoma (n = 5), multiple intestinal bands causing poor visualization (n = 2), and bowel necrosis (n = 1). Conclusions Laparoscopy is a useful diagnostic tool to evaluate the need for further surgical intervention in the acute neonatal abdomen and enables immediate surgical treatment of acute volvulus, appendicitis, or intestinal atresia. In case of conversion to laparotomy, precise localization of the incision is guaranteed. Minimization of the surgical trauma and avoidance of unnecessary laparotomy are the most important benefits of the minimal-invasive approach for the critically ill neonate. © The Author(s) 2016.

  6. Bariatric single incision laparoscopic surgery – review of initial experience

    Directory of Open Access Journals (Sweden)

    Agata Frask

    2011-03-01

    Full Text Available The aim of this review was to assess the results of published experience with bariatric SILS surgery, with a particular focus on treatment feasibility and safety. An EMBASE and MEDLINE database search was performed identifying 13 articles totalling 87 patients in the laparoscopic adjustable gastric banding (LAGB group, 10 patients in the laparoscopic sleeve gastrectomy (LSG group, and 1 patient in the Roux-en-Y SILS group. In most series the learning curve was steep and operating times halved with time, reaching 53 min for LAGB and 90 min for LSG. In single case reports using strict selection criteria patients were discharged up to 24 hours following surgery. Treatment safety was satisfactory. Only two studies reported some minor complications with rates of up to 9.8%, including port malposition, port site infection, and seroma or haematoma formation. There were no complications in other studies. LAGB, LSG and Roux-en-Y surgeries were feasible although technically demanding and difficult.

  7. First case of prophylactic salpingectomy with single port access laparoscopy and a new diode laser in a woman with BRCA mutation.

    Science.gov (United States)

    Angioni, S; Mais, V; Pontis, A; Peiretti, M; Nappi, L

    2014-08-01

    Single port access laparoscopy may be suggested for prophylactic salpingectomy in BRCA carriers.•Diode laser salpingectomy could preserve ovarian function as it can cut and coagulate with extreme precision and minimal thermal damage.

  8. The Evolution of the Appendectomy: From Open to Laparoscopic to Single Incision

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    Noah J. Switzer

    2012-01-01

    Full Text Available Beginning with its initial description by Fitz in the 19th century, acute appendicitis has been a significant long-standing medical challenge; today it remains the most common gastrointestinal emergency in adults. Already in 1894, McBurney advocated for the surgical removal of the inflamed appendix and is credited with the initial description of an Open Appendectomy (OA. With the introduction of minimally invasive surgery, this classic approach evolved into a procedure with multiple, smaller incisions; a technique termed Laparoscopic Appendectomy (LA. There is much literature describing the advantages of this newer approach. To name a few, patients have significantly less wound infections, reduced pain, and a reduction in ileus compared with the OA. In the past few years, Single Incision Laparoscopic Appendectomy (SILA has gained popularity as the next major evolutionary advancement in the removal of the appendix. Described as a pioneer in the era of “scarless surgery,” it involves only one transumbilical incision. Patients are postulated to have reduced post-operative complications such as infection, hernias, and hematomas, as well as a quicker recovery time and less post-operative pain scores, in comparison to its predecessors. In this review, we explore the advancement of the appendectomy from open to laparoscopic to single incision.

  9. Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques

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    Antonio Marte

    2014-01-01

    Full Text Available Background: Single-incision laparoscopic surgery (SILS has gained great popularity in paediatric surgery due to its minimally invasive approach and improved cosmetic results. Notwithstanding, reports describing its adoption in children are still fragmentary and some perplexities have been raised by some surgeons. We reviewed our experience with the SILS Palomo varicocelectomy procedure (SIL-V in children and adolescents, comparing this group with a similar series operated using conventional laparoscopic varicocelectomy (CL-V. Patients and Methods: A total of 69 Palomo laparoscopic varicocelectomies were performed in patients aged 11-17 years from January 2011 to January 2013. Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated "en bloc," clipped and cut. Operating time, visual analogue scale and post-operative results were compared to a similar group of 25 patients operated with CL-V. Results: No patient of the SIL-V group required conversion to conventional laparoscopy, none to open surgery. Mean operative time was 22 min (range: 19-28 in the SIL-V group, not significantly different compared with CL-V (mean 21 min, range: 18-25. All patients experienced a smooth recovery from surgery without any complications, and were discharged on day 1. No difficulties were found in the SIL-V group. The post-operative pain score was significantly better in SIL-V. Conclusion: The SIL-V procedure is safe and effective and allows a fast and efficient isolation of the vascular bundle. The use of conventional instruments is technically feasible in SIL-V.

  10. Multipurpose internal retractor for Single-incision surgery (SIS): single-institution case series.

    Science.gov (United States)

    Galvani, Carlos A; Garza, Ulises; Echeverria, Angela; Kaul, Amit; Samamé, Julia

    2014-04-01

    Single-incision laparoscopic surgery (SIS) is less invasive than standard laparoscopic surgery; however, it is more difficult due to restriction of motion and the impossibility to use assistants. To overcome these obstacles, we developed a self-sustaining multipurpose internal retractor by attaching a Lone Star retractor hook to a laparoscopic bulldog clamp. Herein, we report our SIS experience using our novel retractor. Between October 2008 and April 2011, 104 patients underwent SIS using the internal retractor: 67 bandings (43% simultaneous hiatal hernia repair), 8 sleeve gastrectomies, 27 cholecystectomies, and 2 Nissen fundoplication. Mean age was 40 (range, 21 to 85) and mean body mass index was 40 kg/m (range, 20 to 64 kg/m). No intraoperative complications were observed from the use of the retractor but 2 cases required additional retraction due to liver size. This retractor has been successfully used for different SIS procedures showing to be safe, adaptable, and easy to use, lessening some challenges of SIS.

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

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    Chee Wei Tay

    2013-01-01

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

  12. Outcomes of single-stage total arch replacement via clamshell incision

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    Ishizaka Toru

    2011-09-01

    Full Text Available Abstract Background Treatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction. Methods The arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest. Results Overall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days. Conclusions The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion.

  13. Single-incision, laparoscopic-assisted jejunal resection and anastomosis following a gunshot wound.

    Science.gov (United States)

    Rubin, Jacob A; Shigemoto, Reynsen; Reese, David J; Case, J Brad

    2015-01-01

    A 2 yr old castrated male Pomeranian was evaluated for a 6 wk history of chronic vomiting, intermittent anorexia, and lethargy. Physical examination revealed a palpable, nonpainful, soft-tissue mass in the midabdominal area. Abdominal radiographs and ultrasound revealed a focal, eccentric thickening of the jejunal wall with associated jejunal mural foreign body and partial mechanical obstruction. Following diagnosis of a partial intestinal obstruction as the cause of chronic vomiting, the patient underwent general anesthesia for a laparoscopic-assisted, midjejunal resection and anastomosis using a single-incision laparoscopic surgery port. The patient was discharged the day after surgery, and clinical signs abated according to information obtained during a telephone interview conducted 2 and 8 wk postoperatively. The dog described in this report is a unique case of partial intestinal obstruction treated by laparoscopic-assisted resection and anastomosis using a single-incision laparoscopic surgery port.

  14. A gross anatomic study of distal tibia and fibula for single-incision approach

    OpenAIRE

    Ma, Hui; Zhao, Jie; Yu, Baoqing; Ye, Bin

    2014-01-01

    Objective This study aimed to investigate the feasibility of single incision for plating for the treatment of distal tibia and fibula fractures by a gross anatomic study. Methods The anatomical structures of the anterolateral lower legs were identified. The lower leg length was measured from the top of fibular head to the tip of lateral malleolus. The distances between the extensor digitorum longus and anterior border of distal thirds of the tibia as well as the fibula were also measured. Add...

  15. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique: Surgical Technique and Early Outcomes

    OpenAIRE

    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.

    2016-01-01

    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the ten...

  16. Single-Incision Laparoscopic Splenectomy and Splenic Autotransplantation for an Enlarged Wandering Spleen with Torsion

    OpenAIRE

    Katsura, Shunsaku; Kawamura, Daichi; Harada, Eijiro; Enoki, Tadahiko; Hamano, Kimikazu

    2013-01-01

    A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The t...

  17. No-Drain Single Incision Liposuction Pull-Through Technique for Gynecomastia.

    Science.gov (United States)

    Khalil, Ashraf A; Ibrahim, Amr; Afifi, Ahmed M

    2017-04-01

    Several different methods have been proposed for treatment of gynecomastia, depending on the amount of breast enlargement and skin redundancy. The liposuction pull-through technique has been proposed as an efficacious treatment for many gynecomastia cases. This work aims to study the outcome of this technique when applied as an outpatient procedure, without the use of drains and through a single incision. Fifty-two patients with bilateral gynecomastia without significant skin excess were included in this study. The liposuction pull-through technique was performed through a single incision just above the inframammary fold and without the use of drains. Patients were followed up for 6 months. The proposed technique was able to treat the gynecomastia in all patients, with a revision rate of 1.9% to remove residual glandular tissues. There were no seromas, hematomas, nipple distortion, permanent affection of nipple sensation or wound healing problems. The liposuction pull-through technique is an effective treatment for gynecomastia without significant skin redundancy. It combines the benefits of the direct excision of glandular tissues, with the minimally invasive nature of liposuction. Performing the procedure through a single incision without the use of drains and without general anesthesia is a safe alternative. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

  18. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

    Science.gov (United States)

    Palanivelu, Praveenraj; Patil, Kedar Pratap; Parthasarathi, Ramakrishnan; Viswambharan, Jaiganesh K; Senthilnathan, Palanisami; Palanivelu, Chinnusamy

    2015-01-01

    The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  19. A novel locally operated master-slave robot system for single-incision laparoscopic surgery.

    Science.gov (United States)

    Horise, Yuki; Matsumoto, Toshinobu; Ikeda, Hiroki; Nakamura, Yuta; Yamasaki, Makoto; Sawada, Genta; Tsukao, Yukiko; Nakahara, Yujiro; Yamamoto, Masaaki; Takiguchi, Shuji; Doki, Yuichiro; Mori, Masaki; Miyazaki, Fumio; Sekimoto, Mitsugu; Kawai, Toshikazu; Nishikawa, Atsushi

    2014-12-01

    Single-incision laparoscopic surgery (SILS) provides more cosmetic benefits than conventional laparoscopic surgery but presents operational difficulties. To overcome this technical problem, we have developed a locally operated master-slave robot system that provides operability and a visual field similar to conventional laparoscopic surgery. A surgeon grasps the master device with the left hand, which is placed above the abdominal wall, and holds a normal instrument with the right hand. A laparoscope, a slave robot, and the right-sided instrument are inserted through one incision. The slave robot is bent in the body cavity and its length, pose, and tip angle are changed by manipulating the master device; thus the surgeon has almost the same operability as with normal laparoscopic surgery. To evaluate our proposed system, we conducted a basic task and an ex vivo experiment. In basic task experiments, the average object-passing task time was 9.50 sec (SILS cross), 22.25 sec (SILS parallel), and 7.23 sec (proposed SILS). The average number of instrument collisions was 3.67 (SILS cross), 14 (SILS parallel), and 0.33 (proposed SILS). In the ex vivo experiment, we confirmed the applicability of our system for single-port laparoscopic cholecystectomy. We demonstrated that our proposed robot system is useful for single-incision laparoscopic surgery.

  20. Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses.

    Science.gov (United States)

    Chantada, C; García-Tello, A; Esquinas, C; Moraga, A; Redondo, C; Angulo, J C

    Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy. A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n=49) or multiport laparoscopy (n=53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis. There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P=.6). Intraoperative transfusion (P=.03) and blood loss (Plaparoscopy (P=.0013). Umbilical LESS surgery with reusable platform enables various surgical techniques to be performed when treating renal masses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Single incision multi-trocar hepatic cyst excision with partial splenectomy

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    Palanivelu Chinnusamy

    2013-01-01

    Full Text Available Introduction: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. Patient and Technique: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. Conclusion: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness.

  2. Single incision multi-trocar hepatic cyst excision with partial splenectomy

    Science.gov (United States)

    Chinnusamy, Palanivelu; Ahluwalia, Jasmeet Singh; Palanisamy, Senthilnathan; Seshiyer, Rajan Pidigu

    2013-01-01

    INTRODUCTION: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. PATIENT AND TECHNIQUE: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. CONCLUSION: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness. PMID:23741118

  3. A Modified Single Mini-Incision Complete Urinary Tract Exenteration for Urothelial Carcinoma in Dialysis Patients

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    I-Hsuan Chen

    2014-01-01

    Full Text Available Objective. To present our experience with single mini-incision complete urinary tract exenteration (CUTE for female dialysis patients suffering from urothelial carcinoma (UC. Patients and Methods. Institutional review board approval was obtained. From 2005 through 2012, 14 female dialysis patients with UC underwent single mini-incision CUTE, in combination with radical hysterectomy and bilateral salpingo-oophorectomy. All were placed in the modified dorsal lithotomy position without repositioning. An infraumbilical midline mini-incision was made. Bilateral nephroureterectomy was first performed entirely extraperitoneally, followed by radical cystectomy with removal of the uterus and ovaries transperitoneally. Results. All procedures were done successfully without major complications. The median operative time was 242.5 minutes, and estimated blood loss was 500 mL. The median time to oral intake was 2 postoperative days; the median hospital stay was 11 days. Ten patients remained cancer-free at a median follow-up of 46.5 months; six patients were confirmed as having preoperatively undetectable UC or renal cell carcinoma, even after reviewing preoperative computed tomography. Conclusions. This modified technique provides a time-saving complete urinary tract extirpation to eliminate preoperatively undetectable malignancy, reduce metachronous recurrences, and avert perioperative complications associated with pneumoperitoneum and repositioning. Good cancer control and early convalescence can mutually be achieved in experienced hands.

  4. Single-incision laparoscopic cholecystectomy for cholecystitis requiring percutaneous transhepatic gallbladder drainage.

    Science.gov (United States)

    Igami, Tsuyoshi; Aoba, Taro; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Nagino, Masato

    2015-03-01

    Single-incision laparoscopic cholecystectomy (SILC) has been performed for patients with gallbladder stones but without acute cholecystitis. We report our experience of performing SILC for patients with cholecystitis requiring percutaneous transhepatic gallbladder drainage (PTGBD). We performed SILC via an SILS-Port with additional 5-mm forceps through an umbilical incision in ten patients with cholecystitis requiring PTGBD. All procedures were completed successfully. The mean operative time was 124 min (range 78-169 min) and there were no intraoperative or postoperative complications. The mean postoperative hospital stay was 2.7 days. All patients were satisfied with the cosmetic results. Our procedure may represent an alternative to conventional laparoscopic cholecystectomy (CLC) for patients who fervently demand the cosmetic advantages, despite cholecystitis requiring PTGBD. SILC should be performed carefully to avoid bile duct injury because the only advantage of SILC over CLC is cosmetic.

  5. Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial.

    Science.gov (United States)

    Kok, Niels F M; Lind, May Y; Hansson, Birgitta M E; Pilzecker, Desiree; Mertens zur Borg, Ingrid R A M; Knipscheer, Ben C; Hazebroek, Eric J; Dooper, Ine M; Weimar, Willem; Hop, Wim C J; Adang, Eddy M M; van der Wilt, Gert Jan; Bonjer, Hendrik J; van der Vliet, Jordanus A; IJzermans, Jan N M

    2006-07-29

    To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function. Single blind, randomised controlled trial. Two university medical centres, the Netherlands. 100 living kidney donors. Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy. The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival. Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P fatigue was less (difference - 1.3, 95% confidence interval - 2.4 to - 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy). Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.

  6. Diagnostic usefulness of laparoscopy versus exploratory laparotomy for dogs with suspected gastrointestinal obstruction.

    Science.gov (United States)

    Barry, Katie S; Case, J Brad; Winter, Matthew D; Garcia-Pereira, Fernando L; Buckley, Gareth; Johnson, Matthew D

    2017-08-01

    OBJECTIVE To evaluate the feasibility of laparoscopy versus exploratory laparotomy for the diagnosis of specific lesions in dogs with suspected gastrointestinal obstruction. DESIGN Controlled trial. ANIMALS 16 client-owned dogs with physical and radiographic findings consistent with gastrointestinal obstruction. PROCEDURES Single-incision laparoscopy with intracorporeal and extracorporeal examination of the gastrointestinal tract was performed by 1 surgeon. Immediately afterward, exploratory laparotomy was performed by a second surgeon. Accessibility and gross appearance of organs, surgical diagnoses, incision lengths, procedure duration, and complications were compared between diagnostic techniques. RESULTS Mean (95% confidence interval) incision length was 4.9 cm (3.9 to 5.9 cm) for laparoscopy and 16.4 cm (14.0 to 18.7 cm) for exploratory laparotomy. Mean (95% confidence interval) procedure duration was 36.8 minutes (31.6 to 41.2 minutes) and 12.8 minutes (11.4 to 14.3 minutes), respectively. Diagnoses of the cause of obstruction were the same with both methods. In 13 dogs, the laparoscopic examination was successfully completed, and in the other 3, it was incomplete. In 4 dogs in which laparoscopy was successful, conversion to exploratory laparotomy or considerable extension of the laparoscopic incision would have been required to allow subsequent surgical treatment of identified lesions. No dogs developed major complications, and minor complication rates were similar between procedures. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopy was feasible and clinically applicable in dogs with suspected gastrointestinal obstruction. Careful patient selection and liberal criteria for conversion to an open surgical approach are recommended when laparoscopy is considered for the diagnosis of gastrointestinal lesions in dogs.

  7. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus

    Directory of Open Access Journals (Sweden)

    Praveenraj Palanivelu

    2015-01-01

    Full Text Available Background: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. Material and Methods: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11 and with corrugated drain (2.09 needlescopic method (1.2, Umbilical tape sling (1.95, crural stitch method (2.5. Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. Conclusions: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  8. Role of laparoscopy in hepatobiliary malignancies

    Directory of Open Access Journals (Sweden)

    Prabhu Arumugam

    2016-01-01

    Full Text Available The many benefits of laparoscopy, including smaller incision, reduced length of hospital stay and more rapid return to normal function, have seen its popularity grow in recent years. With concurrent improvements in non-surgical cancer management the importance of accurate staging is becoming increasingly important. There are two main applications of laparoscopic surgery in managing hepato-pancreatico-biliary (HPB malignancy: accurate staging of disease and resection. We aim to summarize the use of laparoscopy in these contexts. The role of staging laparoscopy has become routine in certain cancers, in particular T[2] staged, locally advanced gastric cancer, hilar cholangiocarcinoma and non-Hodgkin's lymphoma. For other cancers, in particular colorectal, laparoscopy has now become the gold standard management for resection such that there is no role for stand-alone staging laparoscopy. In HPB cancers, although staging laparoscopy may play a role, with ever improving radiology, its role remains controversial.

  9. Role of laparoscopy in hepatobiliary malignancies.

    Science.gov (United States)

    Arumugam, Prabhu; Balarajah, Vickna; Watt, Jennifer; Abraham, Ajit T; Bhattacharya, Satyajit; Kocher, Hemant M

    2016-04-01

    The many benefits of laparoscopy, including smaller incision, reduced length of hospital stay and more rapid return to normal function, have seen its popularity grow in recent years. With concurrent improvements in non-surgical cancer management the importance of accurate staging is becoming increasingly important. There are two main applications of laparoscopic surgery in managing hepato-pancreatico-biliary (HPB) malignancy: accurate staging of disease and resection. We aim to summarize the use of laparoscopy in these contexts. The role of staging laparoscopy has become routine in certain cancers, in particular T[2] staged, locally advanced gastric cancer, hilar cholangiocarcinoma and non-Hodgkin's lymphoma. For other cancers, in particular colorectal, laparoscopy has now become the gold standard management for resection such that there is no role for stand-alone staging laparoscopy. In HPB cancers, although staging laparoscopy may play a role, with ever improving radiology, its role remains controversial.

  10. Diagnostic laparoscopy

    Science.gov (United States)

    ... cavity. These complications could lead to immediate open surgery ( laparotomy ). Diagnostic laparoscopy may not be possible if you have a swollen bowel, fluid in the abdomen (ascites), or you have had a past surgery.

  11. Endoscopic incision of protruding right ureterocele in a single collecting system: a case report

    Directory of Open Access Journals (Sweden)

    Rinto Hariwibowo

    2017-01-01

    Full Text Available Protruding ureterocele is a very rare case found in the literature. We are reporting a 21 year-old female with an intermittent protruding mass from urethra, accompanied by dysuria, hematuria, and recurrent urinary tract infection. Inspection of the external genitalia revealed a protruding mass from the urethra which could be reduced manually. Excretory urography showed bilateral single collecting systems, grade II hydronephrosis of the right kidney, and a cobra head appearance of the lower right pelvis. The patient was diagnosed with a protruding right ureterocele in a single collecting system, and thus, endoscopic incision of a ureterocele was performed. Ultrasonography which was carried out three weeks after the procedure confirmed no residual hydronephrosis or ureterocele in the bladder. Voiding cystourethrography (VCUG underwent at a three-month-follow up revealed a grade 5 vesico-ureteral reflux (VUR on the right side. Surgical reimplantation was then considered. In conclusion, endoscopic incision was safe and yielded good result for protruding ureteroceles, but the need for secondary surgery in several conditions should be considered.

  12. Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study

    Directory of Open Access Journals (Sweden)

    Rajeev Sinha

    2014-01-01

    Full Text Available Introduction: The feasibility of the single incision, multiport transumbilical approach(SILC for the treatment of symptomatic gallbladder calculus disease has been established. Aims: The study examines both short and long term morbidity of the SILC approach. Materials and Methods: All the 1338 patients were operated by the same surgeon through a transversely placed umbilical incision in the upper third of the umbilicus.Three conventional ports,10,5 and 5 mm were introduced through the same skin incision but through separate transfascial punctures.The instruments were those used for standard laparoscopic cholecystectomy(SLC.Patients with acute cholecystitis and calculous pancreatitis were included,while those with choledocholithiasis were excluded.Results were compared with those of SLC. Results: Forty patients had difficult gall bladders, 214 had acute cholecystitis, and 16 had calculous pancreatitis.The mean operating time was 24.7 mins as compared to 18.4 mins in SLC. Intracorporeal knotting was required in four patients. Conversion to SLC was required in 12 patients.Morrisons pouch drain was left in 3 patients.Injectable analgesics were required in 85% vs 90% (SILC vs SLC on day 1 and 25% vs 45% on day 2 and infection was seen in 6(0. 45% patients.Port site hernia was seen in 2 patients. The data was compared with that of SLC and significance calculated by the student ′t′ test. A p value less than 0.05 was considered as significant. Conclusions: Trans umbilical SILC gives comparable results to SLC, and is a superior alternative when cosmesis and postoperative pain are considered, but the operative time is significantly more.

  13. Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar

    Directory of Open Access Journals (Sweden)

    Kamil Gulpinar

    2011-01-01

    Full Text Available Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization.

  14. Hybrid Single-Incision Laparoscopic Colon Cancer Surgery Using One Additional 5 mm Trocar.

    Science.gov (United States)

    Kim, Hyung Ook; Choi, Dae Jin; Lee, Donghyoun; Lee, Sung Ryol; Jung, Kyung Uk; Kim, Hungdai; Chun, Ho-Kyung

    2018-02-01

    Single-incision laparoscopic surgery (SILS) is a feasible and safe procedure for colorectal cancer. However, SILS has some technical limitations such as collision between instruments and inadequate countertraction. We present a hybrid single-incision laparoscopic surgery (hybrid SILS) technique for colon cancer that involves use of one additional 5 mm trocar. Hybrid SILS for colon cancer was attempted in 70 consecutive patients by a single surgeon between August 2014 and July 2016 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine. Using prospectively collected data, an observational study was performed on an intention-to-treat basis. Hybrid SILS was technically completed in 66 patients, with a failure rate of 5.7% (4/70). One patient was converted to open surgery for para-aortic lymph node dissection. Another was converted to open surgery due to severe peritoneal adhesion. An additional trocar was inserted for adhesiolysis in the other two cases. Median lengths of proximal and distal margins were 12.8 cm (interquartile range [IQR], 10.0-18.6), and 8.2 cm (IQR, 5.5-18.3), respectively. Median total number of lymph nodes harvested was 24 (IQR, 18-33). Overall rate of postoperative morbidity was 12.9%, but there were no Clavien-Dindo grade III or IV complications. There was no postoperative mortality or reoperation. Median postoperative hospital stay was 6 days (IQR, 5-7). Hybrid SILS using one additional 5 mm trocar is a safe and effective minimally invasive surgical technique for colon cancer. Experienced laparoscopic surgeons can perform hybrid SILS without a learning curve based on the formulaic surgical techniques presented in this article.

  15. Immune and stress mediators in response to bilateral adnexectomy: comparison of single-port access and conventional laparoscopy in a porcine model.

    Science.gov (United States)

    Gracia, Meritxell; Sisó, Cristian; Martínez-Zamora, M Àngels; Sarmiento, Laura; Lozano, Francisco; Arias, Maria Teresa; Beltrán, Joan; Balasch, Juan; Carmona, Francisco

    2014-01-01

    To evaluate systemic markers of immune and stress responses after bilateral adnexectomy performed using 2 different laparoscopic techniques in pigs. Prospective comparative study (Canadian Task Force classification II-2). University teaching hospital, research hospital, and tertiary care center. Twenty female Yorkshire pigs undergoing laparoscopic surgery. Animals underwent bilateral salpingo-oophorectomy (ovary and fallopian tube extraction), performed via conventional laparoscopy (n = 10) or the single-port access approach (n = 10). Injury provokes an acute-phase response, primarily produced by cytokines. The inflammatory response has been well described for major surgery and for conventional laparoscopy; however, little information is currently available for single-port laparoscopy, and none in the gynecologic field. This is the first study to compare serum cytokine interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) concentrations at baseline and in the early postoperative period (2, 4, and 20 hours) after bilateral salpingo-oophorectomy performed via conventional laparoscopy (n = 10) or single-port access (n = 10) in a porcine model. The stress response was measured using glucose and cortisol concentrations and the animals' response to surgery via a 6-category observation-based behavior test. Both IL-6 and TNF-α concentrations peaked at 4 hours after surgery, and were significantly lower in the single-port access group (p = .02) than in the conventional laparoscopy group (p = .02). In addition, in the single-port access group, concentrations of stress markers were slightly lower at all intervals recorded and were statistically significant at 2 hours after the operation for glucose concentration (mean [SD], 164.50 [26.73] mg/dL for conventional laparoscopy vs 86.50 [17.93] mg/dL for single-port access; p = .02). Evidence of improved inflammatory and stress responses was recorded in the minimally invasive single-port group. More clinical

  16. Single-incision laparoscopic splenectomy and splenic autotransplantation for an enlarged wandering spleen with torsion.

    Science.gov (United States)

    Katsura, Shunsaku; Kawamura, Daichi; Harada, Eijiro; Enoki, Tadahiko; Hamano, Kimikazu

    2014-06-01

    A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The transplanted splenic tissues could be identified on a spleen scintigram obtained 3 months after the surgery. Howell-Jolly bodies were not observed in blood specimens. This procedure is able to prevent an overwhelming postsplenectomy infection, and leads to satisfactory cosmetic results.

  17. Transobturator Midurethral Slings versus Single-Incision Slings for Stress Incontinence in Overweight Patients

    Directory of Open Access Journals (Sweden)

    Omer Bayrak

    2015-08-01

    Full Text Available ABSTRACTPurpose:To compare transobturator midurethral sling (TOS and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥25-29.9 kg/m2 female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL.Materials and Methods:In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®,Promedon, Cordoba, Argentina procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL.Results:There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05. ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively. In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190.Conclusions:The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.

  18. Single incision laparoscopic-assisted intestinal surgery (SILAIS) in 7 dogs and 1 cat.

    Science.gov (United States)

    Case, J Brad; Ellison, Gary

    2013-06-01

    To describe the clinical findings and short-term outcome in 7 dogs and 1 cat undergoing single-incision laparoscopic-assisted intestinal surgery (SILAIS) using an SILS™ or EndoCone™ port. Prospective case series. Dogs (n = 7) and cat (n = 1). An SILS™ port using three 5-mm instrument cannulas or EndoCone™ port was used to perform an initial limited laparoscopic abdominal exploration. The stomach and descending duodenum were explored intracorporeally and the jejunum through orad descending colon was explored extracorporeally. All intestinal procedures (enterotomy, biopsy, resection, and anastomosis) were performed extracorporeally. Omentalization of affected bowel was accomplished either intracorporeally or extracorporeally. Short-term outcome was determined. SILAIS was completed successfully in all but 1 dog and all animals had a good short-term outcome. Most (n = 5) animals were discharged the day after surgery. SILAIS was performed in a median of 120 minutes (interquartile range; 82-148 minutes) and was associated with a moderate level of difficulty. No major complications occurred but conversion to celiotomy (n = 1) and enlargement of the incision (n = 3) was required because of inability to exteriorize the affected bowel. SILAIS using an SILS™ or EndoCone™ port in dogs and cats is feasible and appears effective in selected cases. Single portal laparoscopic-assisted intestinal surgery might be an effective method of minimizing morbidity in dogs and cats with uncomplicated intestinal disease. © Copyright 2013 by The American College of Veterinary Surgeons.

  19. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique

    Science.gov (United States)

    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.

    2016-01-01

    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the tendon edge was complimented by the other strand passing through the central aspect of the distal tendon and advanced to pull the tendon edge down to the bone with appropriate tension. Patients with revision surgery and the use of allograft were excluded. Clinical outcomes included elbow range of motion and grip strength. All patients completed a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and reported satisfaction level, pain level, and any postoperative complications. Results: Fourteen patients with an average age of 51.3 years (range, 27.8-66.4 years) were included in the study. The dominant arm was injured in 9 cases. At an average of 16.4 months’ follow-up (range, 6.8-34.3 months), all patients had elbow range of motion of 0° to >130°, and grip strength was 101.5% of the uninjured arm (range, 70.6%-121.4%). The Average QuickDASH score was 6.5 (range, 0-36.5). Conclusion: Single incision biceps repair with suture anchor fixation using our hemi-Krackow stitch provided a strong repair allowing easy tensioning of the biceps tendon to bone and showed satisfactory functional outcomes at early follow-up. No patients required revision surgery, and there was only 1 case of transient nerve complaints. PMID:27390570

  20. Triple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review.

    LENUS (Irish Health Repository)

    Conroy, Eimear

    2010-07-01

    Femoral head incongruency at skeletal maturity is associated with the development of osteoarthritis in early adulthood. Containment of the femoral head provides a larger surface area for remodelling of the collapsed femoral head and the development of spherical congruency. Triple pelvic osteotomy has a role to play in Legg-Calve-Perthes\\' disease by improving femoral head containment and preventing subluxation. This is traditionally a two-incision approach with significant associated morbidity. In our unit we perform triple osteotomies through a single anterolateral incision. To retrospectively review the clinical and radiographic outcome of children who had triple osteotomies performed through a single incision over a 4-year period. In our unit from 2003 to 2006 we performed eight triple osteotomies through a single incision in children aged between 6 and 12 years with Legg-Calve-Perthes\\' disease. The procedure was performed through a single anterolateral incision made beneath the middle of the iliac crest and carried forward according to Salter\\'s osteotomy. Image intensification was used to confirm iliac, pubic and ischial cuts. After performing a standard Salter\\'s osteotomy the acetabular fragment was free to rotate anteriorly and laterally. None of the children were casted and all were allowed immediate mobilization nonweight bearing with crutches for 6 weeks. Clinical results and hip function were measured preoperatively and postoperatively using the modified Harris hip score. The average length of hospital stay was 4.7 days. None of the children had a nonunion. The centre edge angle of Wiberg was measured on all preoperative and postoperative anteroposterior pelvic radiographs. In all our patients there was an improvement in the centre edge angle of Wiberg and in the modified Harris hip score. The preoperative modified Harris hip scores ranged from 38 to 60 and postoperatively ranged from 77 to 92. The preoperative centre edge angle of Wiberg ranged

  1. Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience.

    Science.gov (United States)

    Spinoglio, Giuseppe; Lenti, Luca Matteo; Maglione, Valeria; Lucido, Francesco Saverio; Priora, Fabio; Bianchi, Paolo Pietro; Grosso, Federica; Quarati, Raul

    2012-06-01

    Single-incision laparoscopic surgery is an emerging procedure developed to decrease parietal trauma and improve cosmetic results. However, many technical constraints, such as lack of triangulation, instrument collisions, and cross-handing, hamper this approach. Using a robotic platform may overcome these problems and enable more precise surgical actions by increasing freedom of movement and by restoring intuitive instrument control. We retrospectively collected, under institutional review board approval, data on the first 25 patients who underwent single-site robotic cholecystectomies (SSRC) at our center. Patients enrolled in this study underwent SSRC for symptomatic biliary gallstones or polyposis. Exclusion criteria were: BMI > 33; acute cholecystitis; previous upper abdominal surgery; ASA > II; and age >80 and <18 years. All procedures were performed with the da Vinci Si Surgical System and a dedicated SSRC kit (Intuitive). After discharge, patients were followed for 2 months. These SSRC cases were compared to our first 25 single-incision laparoscopic cholecystectomies (SILC) and with the literature. There were no differences in patient characteristics between groups (gender, P = 0.4404; age, P = 0.7423; BMI, P = 0.5699), and there were no conversions or major complications in either cohort. Operative time was significantly longer for the SILC group compared with SSRC (83.2 vs. 62.7 min, P = 0.0006), and SSRC operative times did not change significantly along the series. The majority of patients in each group were discharged within 24 h, with an average length of hospital stay of 1.2 days for the SILC group and 1.1 days for the SSRC group (P = 0.2854). No wound complications (infection, incisional hernia) were observed in the SSRC group and in the SILC. Our preliminary experience shows that SSRC is safe, can easily be learned, and performed in a reproducible manner and is faster than SILC.

  2. Impact of adding a second-layer to a single unlocked closure of Cesarean uterine incision: a randomized controlled trial

    DEFF Research Database (Denmark)

    Rudnicki, Martin; Bennich, G; Wilken-Jensen, C

    2016-01-01

    The purpose of the present study was to investigate short- and long term effects on residual myometrial thickness (RMT) by adding a second-layer to a single unlocked closure of caesarean uterine incision. METHOD: he study was a randomized double-blind controlled trial. Healthy nulliparous scheduled...

  3. Single-Incision Laparoscopic Colectomy for Cancer: Short-Term Outcomes and Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Rodrigo Pedraza

    2013-01-01

    Full Text Available Introduction. Single-incision laparoscopic colectomy (SILC is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies ( and anterior resections (. There were no significant differences in operative time (127.9 versus 126.7 min, conversions (0 versus 1, complications (14% versus 8%, length of stay (4.5 versus 4.0 days, readmissions (2% versus 2%, and reoperations (2% versus 2%. Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques.

  4. Single-incision trocar-less endoscopic management of giant liver hydatid cyst in children

    Science.gov (United States)

    Acharya, Himanshu; Agrawal, Vikesh; Tiwari, Abhishek; Sharma, Dhananjaya

    2018-01-01

    Introduction: Laparoscopic management of giant hydatid cyst has limitations such as spillage, poor control, difficulties in suctioning the contents through special ports which are not easily available, difficulty in the obliteration of residual cavity and recurrence. We describe single-incision trocar-less endoscopic (SITE) technique which simplifies enucleation and management of residual cavity. Method: Inclusion criteria for these cases were patients having single uncomplicated giant hydatid cyst >5 cm present at the surface of the liver and palpable on clinical examination. The cysts which were <5 cm, multiple, deep-seated and impalpable were excluded from the study. Technique: An incision of 1 cm is marked over the site of the maximum bulge and deepened to open peritoneum, cyst is held with two stay sutures, injection of scolicidal agent and aspiration is done and suction of the cyst content is done. After suction of the contents, 5 mm telescope is inserted, and the cyst cavity is inspected, clearance and cyst procedure is done. Results: In 6 years, 62 cases of giant hydatid cyst fulfilling the inclusion criteria and were taken for SITE technique. SITE was successful in all patients and none needed a conversion. Twenty-nine (46.77%) underwent omentopexy and three (4.83%) underwent SITE capitonnage. There was post-operative biliary leak in one (0.016%) patient who underwent capitonnage, which was managed by prolonged drainage which resolved in 10 days. Mean operative duration was 52 min (30 min to 85 min). Mean follow-up was for 18 months (12–36 months). One (0.016%) patient had cyst recurrence. Discussion: SITE has advantages of endoscopic clearance and does not require special ports which are expensive, technically difficult to use and often unavailable. It allows controlled handling, effective suction and easier management of bile communication. SITE can be a preferred procedure for endoscopic management of giant liver hydatid cysts. Conclusion: SITE

  5. Is laparoscopy equal to laparotomy in detecting and treating small bowel injuries in a porcine model?

    Science.gov (United States)

    Shan, Cheng-Xiang; Ni, Chong; Qiu, Ming; Jiang, Dao-Zhen

    2012-01-01

    AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model. METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to evaluate the abdominal injuries, particularly the types, sites, and numbers of SBIs. Traditional open surgery or therapeutic laparoscopy was then performed. All pigs were kept alive within the observational period (postoperative 72 h). The postoperative recovery of each pig was carefully observed. RESULTS: The vital signs of all pigs were stable within 1-2 h after shooting and none of the pigs died from gunshot wounds or SBIs immediately. The SBI model was successfully established in all pigs and definitively diagnosed with single or multiple SBIs either by exploratory laparotomy or laparoscopy. Compared with exploratory laparotomy, laparoscopy took a significantly longer time for diagnosis (41.27 ± 12.04 min vs 27.64 ± 13.32 min, P = 0.02), but the time for therapeutic laparoscopy was similar to that of open surgery. The length of incision was significantly reduced in the laparoscopy group compared with the laparotomy group (5.27 ± 1.86 cm vs 15.73 ± 1.06 cm, P surgery, both laparotomy and laparoscopy offered a definitive diagnosis with no missed injuries. Postoperative complications occurred in four cases (three following laparotomy and one following laparoscopy, P = 0.326). The average recovery period for bowel function, vital appearance, and food re-intake after laparoscopy was 10.36 ± 4.72 h, 14.91 ± 3.14 h, and 15.00 ± 7.11 h, respectively. All of these were significantly shorter than after laparotomy (21.27 ± 10.17 h, P = 0.004; 27.82 ± 9.61 h, P laparotomy

  6. Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8).

    Science.gov (United States)

    Galvez, Carlos; Lirio, Francisco; Sesma, Julio; Baschwitz, Benno; Bolufer, Sergio

    2017-01-01

    Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5 th postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months.

  7. Single and dual incision technique for acute distal biceps rupture: clinical and functional outcomes

    Science.gov (United States)

    Guglielmino, Claudia; Massimino, Paolo; Ioppolo, Francesco; Castorina, Sergio; Musumeci, Giuseppe; Di Giunta, Angelo

    2016-01-01

    Summary Background Distal bicep tendon injuries are a traumatic event though rather rare. The pathogenesis is not entirely clear. The most common cause for injury is an unexpected load on the biceps when the elbow is in an extended position. Although several studies have provided insight into the pathogenetic processes of the lesion, the literature suggests to treat all injuries surgically (whether partial or total) if there is high functional demand. Methods Between January 2006 and March 2016 were studied 20 patients surgically treated for a disconnected distal bicep, 15 with a total lesion and 5 with a partial lesion. The patients were divided into 2 groups. Surgical access with single incision was performed on 13 patients while a double surgical access was performed on 7 patients. The clinical and functional results were studied using an Ewald System Score (ESS). Results In both groups, the most rapid improvement was achieved for the parameters of pain and deformity with excellent results, while those of function and movement were normalized as gradual and progressive over next 2 months. Conclusion The clinical and functional outcomes during the follow-up examination after surgery showed excellent results in patients treated with both types of surgical procedures. PMID:28217566

  8. Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy

    Science.gov (United States)

    Guo, Wei; Liu, Yang; Han, Wei; Liu, Jun; Jin, Lan; Li, Jian-She; Zhang, Zhong-Tao

    2015-01-01

    Background: We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC) was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC). Moreover, the influencing factors of SILC were analyzed. Methods: A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138) or TLC (n = 414). Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle. Results: Among SILC group, 4 (2.9%) cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P 5 (≥100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015). Conclusions: The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery. PMID:26668145

  9. Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Wei Guo

    2015-01-01

    Full Text Available Background: We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC. Moreover, the influencing factors of SILC were analyzed. Methods: A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138 or TLC (n = 414. Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle. Results: Among SILC group, 4 (2.9% cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P 5 (≥100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015. Conclusions: The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.

  10. Single-incision laparoscopic surgery in a survival animal model using a transabdominal magnetic anchoring system.

    Science.gov (United States)

    Cho, Yong Beom; Park, Chan Ho; Kim, Hee Cheol; Yun, Seong Hyeon; Lee, Woo Yong; Chun, Ho-Kyung

    2011-12-01

    Though single-incision laparoscopic surgery (SILS) can reduce operative scarring and facilitates postoperative recovery, it does have some limitations, such as reduction in instrument working, difficulty in triangulation, and collision of instruments. To overcome these limitations, development of new instruments is needed. The aim of this study is to evaluate the feasibility and safety of a magnetic anchoring system in performing SILS ileocecectomy. Experiments were performed in a living dog model. Five dogs (26.3-29.2 kg) underwent ileocecectomy using a multichannel single port (OCTO port; Darim, Seoul, Korea). The port was inserted at the umbilicus and maintained a CO(2) pneumoperitoneum. Two magnet-fixated vascular clips were attached to the colon using an endoclip applicator, and it was held together across the abdominal wall by using an external handheld magnet. The cecum was then retracted in an upward direction by moving the external handheld magnet, and the mesocolon was dissected with Ultracision(®). Extracorporeal functional end-to-end anastomosis was done using a linear stapler. All animals survived during the observational period of 2 weeks, and then re-exploration was performed under general anesthesia for evaluation of intra-abdominal healing and complications. Mean operation time was 70 min (range 55-100 min), with each subsequent case taking less time. The magnetic anchoring system was effective in achieving adequate exposure in all cases. All animals survived and convalesced normally without evidence of clinical complication during the observation period. At re-exploration, all anastomoses were completely healed and there were no complications such as abscess, bleeding or organ injury. SILS ileocecectomy using a magnetic anchoring system was safe and effective in a dog model. The development of magnetic anchoring systems may be beneficial for overcoming the limitations of SILS.

  11. Distal biceps brachii tendon repairs: a single-incision technique using a cortical button with interference screw versus a double-incision technique using suture fixation through bone tunnels.

    Science.gov (United States)

    Shields, Edward; Olsen, Joshua R; Williams, Richard B; Rouse, Lucien; Maloney, Michael; Voloshin, Ilya

    2015-05-01

    Distal biceps brachii tendon repairs performed with a tension slide technique using a cortical button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature. To perform a clinical comparison of the single-incision CB and double-incision BT techniques. Cohort study; Level of evidence, 3. Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients>1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand). Patients in the CB group (n=20) were older (52±9.5 vs 43.7±8.7 years; P=.008), had a shorter interval from surgery to evaluation (17.7±5 vs 30.8±16.5 months; P=.001), and were less likely to smoke (0% vs 28.5%; P=.02) compared with the BT patients (n=21). DASH scores were similar between groups (4.46±4.4 [CB] vs 5.7±7.5 [BT]; P=.65). Multivariate analysis revealed no differences in range of motion or strength between groups. More CB patients (30%; n=6) experienced a complication compared with those in the BT group (4.8%; n=1) (P=.04), and these complications were predominantly paresthesias of the superficial radial nerve that did not resolve. There were no reoperations or repair failures in either group. Both the single-incision CB and double-incision BT techniques provided excellent clinical results. Complications were more common in the single-incision CB group and most commonly involved paresthesias of the superficial radial nerve. © 2015 The Author(s).

  12. Single incision laparoscopic surgery (SILS) in gynaecology: feasibility and operative outcomes.

    Science.gov (United States)

    Behnia-Willison, Fariba; Foroughinia, Leila; Sina, Maryam; McChesney, Phil

    2012-08-01

    Single incision laparoscopic surgery (SILS) represents the latest advancement in minimally invasive surgery, combining the benefits of conventional laparoscopic surgery, such as less pain and faster recovery, with improved cosmesis. Although the successful use of this technique is well reported in general surgery and urology, there is a lack of studies on SILS in gynaecology. To evaluate the feasibility, safety, cosmesis and outcome of SILS in gynaecology. A prospective case series analysis of 105 women scheduled to undergo surgery by SILS from August 2010 to November 2011. Intra-operative data such as operative time, estimated blood loss, complications, additional ports and hospital stay were collected. Post-operative pain and cosmetic outcomes (scar size) were also recorded. Out of 105 women, SILS was performed for 84 (60 excisions of endometriosis, 13 divisions of adhesions, five hysterectomies, two mesh sacrohysteropexies and four ovarian cystectomies). SILS was not undertaken for 21 women because of a number of factors, including the lack of required equipment (eg bariatric scope, SILS port, roticulating instruments and diathermy leads). Four women required insertion of additional ports because of surgical difficulties. One intra-operative (uterine perforation) and seven post-operative complications (six wound infections and one vault haematoma) occurred. Mean operation times were as follows: mesh sacrohysteropexy - 60 min, excision of endometriosis - 55 min, hysterectomy - 150 min, laparoscopic division of adhesions - 62 min and ovarian cystectomy - 40 min. Our experience shows that SILS is a feasible and safe technique for the surgical management of various gynaecological conditions. Satisfaction is high because of improved cosmesis and reduced analgesic requirements post-operatively. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  13. Single incision versus reduced port splenectomy--searching for the best alternative to conventional laparoscopic splenectomy.

    Science.gov (United States)

    Monclova, Julio Lopez; Targarona, Eduardo M; Vidal, Pablo; Peraza, Yerald; Garcia, Francisco; Otero, Carlos Rodriguez; Pallares, Luis; Balague, Carmen; Trias, Manuel

    2013-03-01

    Laparoscopic splenectomy (LS) is a well accepted approach for the treatment of multiple hematologic diseases. Single port access splenectomy (SPAS) emphasizes the concept of surgery through one small incision. The reduced port access splenectomy (RPAS) entails the use of fewer trocars of smaller sizes. The aim of this study was to compare the clinical outcomes after LS, SPAS, and RPAS, and to analyze the aesthetic result and patient satisfaction. We included patients who underwent LS (group 1, n = 15), SPAS (group 2, n = 8), and RPAS (group 3, n = 10) between June 2008 and February 2012, whose final spleen weight was less of 500 g. The outcome parameters analyzed were operative time, need of additional trocars, blood loss, blood transfusion, weight of the spleen, postoperative complications, and duration of hospital stay. To evaluate the cosmetic result, patients were asked to take the Body Image Questionnaire. Patients in group 3 were younger than group 1. Operative time was significantly longer in group 2 compared to groups 1 and 3 (83 ± 19 vs. 131 ± 43 vs. 81 ± 22 min, p = 0.01). There was no need to convert to open surgery in any group, nor were there differences in intra- or postoperative outcome. There were no differences between the groups in relation to the analgesic requirements. Twenty-two out of the 33 patients answered the questionnaire. There was a significant advantage in group 2 and 3 in the body image index with respect to group 1. There were no differences between groups 2 and 3 (7.3 ± 2.8 vs. 5.8 ± 1.3 vs. 5.1 ± 0.4, p RPAS is a good alternative to LS and SPAS. It improves the aesthetic results as compared to LS, whereas minimizes the technical challenges faced with SPAS.

  14. A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Hajong, Ranendra; Hajong, Debobratta; Natung, Tanie; Anand, Madhur; Sharma, Girish

    2016-10-01

    Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=post-operative pain, with lesser analgesic requirements (p=operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.

  15. Prevalence of Infraumbilical Adhesions in Women With Previous Laparoscopy

    Science.gov (United States)

    Ku, Lowell; Wong, Herb; Liu, C. Y.; Phelps, John Y.

    2007-01-01

    Background and Objectives: The aim of this study is to evaluate the prevalence of intraabdominal adhesions to the umbilicus following gynecologic laparoscopy through an umbilical incision. Methods: A retrospective review was performed of all gynecologic laparoscopic procedures in a private practice setting to identify patients with a repeat laparoscopy who had a history of a previous laparoscopy through an umbilical incision. Patients with a history of other surgeries were excluded. All repeat laparoscopies used a left upper quadrant entry technique where the abdominal cavity was surveyed for adhesions. We also reviewed adverse events attributable to the left upper quadrant entry approach. Results: We identified 151 patients who underwent a second laparoscopy and had a previous umbilical scar. Thirty-two of the 151 (21.2%) patients with a history of a laparoscopy had evidence of adhesions to the umbilical undersurface. No adverse events or injuries were attributed to the left upper quadrant entry technique. Conclusions: Adhesions to the umbilical undersurface occur in 21.2% of patients who have undergone a prior laparoscopy through an umbilical incision. For this reason, we recommend an alternate location for entry in patients with an umbilical scar from a previous laparoscopy. PMID:17651555

  16. Video. Chopstick surgery: a novel technique enables use of the Da Vinci Robot to perform single-incision laparoscopic surgery.

    Science.gov (United States)

    Joseph, R A; Salas, N A; Johnson, C; Goh, A; Cuevas, S P; Donovan, M A; Kaufman, M G; Miles, B; Reardon, P R; Bass, B L; Dunkin, B J

    2010-12-01

    Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with "wristed" instruments could overcome this limitation but the "arms" collide when working coaxially. This video demonstrates a new technique of "chopstick surgery," which enables use of the robotic arms through a single incision without collision. Experiments were conducted utilizing the da Vinci S® robot (Sunnyvale, CA) in a porcine model with three laparoscopic ports (12 mm, 2-5 mm) introduced through a single "incision." Pilot work conducted while performing Fundamentals of Laparoscopic Surgery (FLS) tasks determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, an experienced robotic surgeon performed a cholecystectomy and nephrectomy in a porcine model utilizing the "chopstick" technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This arrangement prevents collision of the external robotic arms. To correct for the change in handedness, the robotic console is instructed to drive the "left" instrument with the right hand effector and the "right" instrument with the left. Both procedures were satisfactorily completed with no external collision of the robotic arms, in acceptable times and with no technical complications. This is consistent with results obtained in the box trainer where the chopstick configuration enabled significantly improved times in all tasks and decreased number of errors and eliminated instrument collisions. Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or transluminal surgery.

  17. "Chopstick" surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery.

    Science.gov (United States)

    Joseph, Rohan A; Goh, Alvin C; Cuevas, Sebastian P; Donovan, Michael A; Kauffman, Matthew G; Salas, Nilson A; Miles, Brian; Bass, Barbara L; Dunkin, Brian J

    2010-06-01

    Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with wristed instruments could overcome this limitation, but the arms often collide when working coaxially. This study tests a new technique of "chopstick" surgery to enable use of the robotic arms through a single incision without collision. Experiments were conducted utilizing the da Vinci S robot (Intuitive Surgical, Inc., Sunnyvale, CA) in a Fundamentals of Laparoscopic Surgery (FLS) box trainer with three laparoscopic ports (1 x 12 mm, 2 x 5 mm) introduced through a single "incision." Pilot work determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, five experienced robotic surgeons performed three FLS tasks utilizing either a standard robotic arm setup or the chopstick technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This results in separation of the robotic arms outside the box. To correct for the change in handedness, the robotic console is instructed to drive the "left" instrument with the right-hand effector and the "right" instrument with the left. Performances were compared while measuring time, errors, number of clutching maneuvers, and degree of instrument collision (Likert scale 1-4). Compared with the standard setup, the chopstick configuration increased surgeon dexterity and global performance through significantly improved performance times, eliminating instrument collision, and decreasing number of camera manipulations, clutching maneuvers, and errors during all tasks. Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or

  18. [Single-port versus mini-laparoscopy in benign adnexal surgery: Results of a not randomized pilot study].

    Science.gov (United States)

    Peretti, V; Chereau, E; Lambaudie, E; Greco, F; Butarelli, M; Jauffret, C; Rua-Ribeiro, S; Houvenaeghel, G

    2016-11-01

    Carry out a preliminary study comparing postoperative pain and intraoperative and postoperative complications between micro-laparoscopy and laparoscopic monotrocart non-oncological adnexal surgery. All patients should benefit from a benign adnexal surgery were included prospectively from February to May 2014. The insufflation pressure, infiltration of trocar holes with a local anesthetic, postoperative analgesics were prescribed standardized. Operative and postoperative complications, type and length of hospital stay as well as EVA and analgesic consumption were recorded. Nine patients were included in monotrocart group versus 7 in the micro-laparoscopy group. There were no differences in operative and postoperative complications, the type and length of hospital stay, as well as cosmetics satisfaction. However, there was a significant difference in the VAS to D2 (2.15 vs. 4.08, P=0.04) and analgesic consumption at D0 (P=0.04), D1 (P=0.04), D2 (P=0.02) and D3 (P=0.01), for the benefit of micro-laparoscopy. Despite an enrollment of patients low, micro-laparoscopy appears to have a significant advantage over the monotrocart laparoscopy for postoperative pain in benign adnexal surgery. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Large-scale single incised valley from a small catchment basin on the western Adriatic margin (central Mediterranean Sea)

    Science.gov (United States)

    Maselli, Vittorio; Trincardi, Fabio

    2013-01-01

    The Manfredonia Incised Valley (MIV) is a huge erosional feature buried below the Apulian shelf, on the western side of the Adriatic margin. The incision extends more than 60 km eastward, from the Tavoliere Plain to the outer shelf, not reaching the shelf edge. High-resolution chirp sonar profiles allow reconstruction of the morphology of the incision and its correlation at regional scale. The MIV records a single episode of incision, induced by the last glacial-interglacial sea level fall that forced the rivers draining the Tavoliere Plain to advance basinward, reaching their maximum extent at the peak of the Last Glacial Maximum. The valley was filled during a relatively short interval of about 10,000 yr during the Late Pleistocene-Holocene sea level rise and almost leveled-off at the time of maximum marine ingression, possibly recording the short-term climatic fluctuations that occurred. The accommodation space generated by the lowstand incision was exploited during the following interval of sea level rise by very high rates of sediment supply that allowed the preservation of up to 45 m of valley fill. High-resolution chirp sonar profiles highlight stratal geometries that are consistent with a typical transgressive valley fill of an estuary environment, including bay-head deltas, central basin and distal barrier-island deposits, organized in a backstepping configuration. The highest complexity of the valley fill is reached in the shallowest and most proximal area, where a kilometric prograding wedge formed during a period dominated by riverine input, possibly connected to high precipitation rates. Based on the depth of the valley margins during this interval, the fill was likely isochronous with the formation of sapropel S1 in the Mediterranean region and may have recorded significant fluctuations within the hydrological cycle.

  20. Single port laparoscopic ileocaecal resection for Crohn's disease: a multicentre comparison with multi-port laparoscopy

    NARCIS (Netherlands)

    Carvello, M.; de Groof, E. J.; de Buck van Overstraeten, A.; Sacchi, M.; Wolthuis, A. M.; Buskens, C. J.; D'Hoore, A.; Bemelman, W. A.; Spinelli, A.

    2018-01-01

    AimSingle port (SP) ileocaecal resection (ICR) is an established technique but there are no large studies comparing SP and multi-port (MP) laparoscopic surgery in Crohn's disease (CD). The aim of this study was to compare postoperative pain scores and analgesia requirements after SP and MP

  1. Single-Incision Carpal Tunnel Release and Distal Radius Open Reduction and Internal Fixation: A Cadaveric Study.

    Science.gov (United States)

    Gaspar, Michael P; Sessions, Blane A; Dudoussat, Bryan S; Kane, Patrick M

    2016-08-01

    The safety of surgical approaches for single- versus double-incision carpal tunnel release in association with distal radius open reduction and internal fixation remains controversial. The purpose of this study was to identify critical structures to determine if a single-incision extension of the standard flexor carpi radialis (FCR) approach can be performed safely. Nine cadaveric arms with were dissected under loupe magnification, utilizing a standard FCR approach. After the distal radius exposure was complete, the distal portion of the FCR incision was extended to allow release of the carpal tunnel. Dissection of critical structures was performed, including the recurrent thenar motor branch of the median nerve, the palmar cutaneous branch of the median nerve (PCBm), the palmar carpal and superficial palmar branches of the radial artery, and proximally the median nerve proper. The anatomic relationship of these structures relative to the surgical approach was recorded. Extension of the standard FCR approach as described in this study did not damage any critical structure in the specimens dissected. The PCBm was noted to arise from the radial side of the median nerve an average of 6.01cm proximal to the proximal edge of the transverse carpal ligament. The PCBm became enveloped in the layers of the antebrachial fascia and the transverse carpal ligament at the incision site, protecting it from injury. The recurrent motor branch of the median nerve, branches of the radial artery and the median nerve proper were not at risk during extension of the FCR approach to release the carpal tunnel. Extension of the standard FCR approach to include carpal tunnel release can be performed with minimal risk to the underlying structures. This exposure may offer benefits in both visualization and extent of carpal tunnel release.

  2. Single-Incision Versus Three-Port Laparoscopic Appendectomy: Short- and Long-Term Outcomes.

    Science.gov (United States)

    Vellei, Samatha; Borri, Alessandro

    2017-08-01

    To compare the outcome of patients who had undergone single-incision laparoscopic appendectomy (SILA) with others who had undergone three-port laparoscopic appendectomy (3-PORT). Data from all adults with uncomplicated appendicitis treated by laparoscopic appendectomy between June 2012 and December 2015 were prospectively collected. Patients with chronic pain, appendix malignancy, at least two previous laparotomies, and those undergoing concomitant surgery for different condition were excluded from analysis. Postoperative pain was assessed by a visual analog scale (VAS). Patients were reviewed postoperatively at 7 days and 1 month in the outpatient clinic. Late complications were assessed with a telephonic interview. A total of 91 patients were included (46 SILA; 45 3-PORT). There were 16 males and 30 females in the SILA group (mean age = 26.76 ± 10.58 years) and 18 males and 27 females in the 3-PORT group (mean age = 26.84 ± 10.79 years). The mean operative time for SILA was 48.54 ± 12.80 min, for the 3-PORT group the mean operative time was 46.33 ± 15.54 min (P = 0.46). No case required conversion. Mean postoperative hospital length of stay was 1.87 ± 0.69 days for SILA and 2.38 ± 1.11 days for 3-PORT (P = 0.01). VAS value of 3.91 ± 1.96 and mean ketorolac usage of 0.38 ± 0.65 in 3-PORT group and SILA patients reported 3.70 ± 1.58 and 0.39 ± 0.58, respectively (P = 0.91). Our mean follow-up in SILA group was 25.75 ± 10.82 months, for 3-PORT group the mean follow-up was 26.9 ± 11.8 months. Eleven patients missed long-term follow-up. No incisional hernia was found. There is a statistically significant difference in cosmetic evaluation in favor of SILA (P PORT laparoscopic appendectomy, but after SILA procedure discharge was quicker and long-term cosmetic satisfaction was superior.

  3. Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery

    Directory of Open Access Journals (Sweden)

    Wassef M

    2013-11-01

    Full Text Available Michael Wassef, David Y Lee, Jun L Levine, Ronald E Ross, Hamza Guend, Catherine Vandepitte, Admir Hadzic, Julio TeixeiraDepartment of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USAPurpose: The transversus abdominis plane (TAP block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS scores.Patients and methods: After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL, a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups.Results: Sensory block ranged from T5–L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04 within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4–10 after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSG surgery

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

    Science.gov (United States)

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

    2016-08-01

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

  5. Vaginal mesh repair SYSTEMS for pelvic organ prolapse: Anatomical study comparing transobturator/trangluteal versus single incision techniques.

    Science.gov (United States)

    Campagna, Giuseppe; Panico, Giovanni; Morciano, Andrea; Gadonneix, Pierre; Delmas, Vincent; Cervigni, Mauro; Ercoli, Alfredo; Scambia, Giovanni

    2017-09-18

    The present study aim to compare the anatomic landmarks of two pelvic floor repair systems, in order to identify the potential neurovascular lesions related to different mesh fixation techniques. Abdominal and perineal dissections of 10 fresh cadavers after prolapse surgery using transobturator/transgluteal versus single incision techniques. Neuro-vascular structures of obturator region and perineum were isolated. Distances between needles and anatomical structures were measured. During transobturator anterior repair, the superficial cannula passed 2.5 ± 0.6 cm medially to the obturator canal. The distance of superficial arm to the anterior obturator vessels was 2.2 ± 0.4 cm. The distance of deep cannula to the posterior obturator vessels branches was 1.3 ± 0.5 cm. In two of these cases we observed a lesion of posterior obturator vessels. During single incision repair the distance between the obturator canal and the superficial arms was 2.3 ± 0.7. The mean distances of superficial arms to the anterior and posterior obturator vessels were, respectively, 2.3 ± 0.5 cm and 3.2 ± 0.7 cm. During transgluteal posterior repair the distance between the cannula guide and the ischial spine was 1.7 ± 0.5 cm while it measured 2.3 ± 0.4 cm when single incision posterior device was placed. Anterior transobturator system presents an increased risk of posterior obturator vessels branches injury. During posterior transgluteal repair the distance of the ischio-anal fossa to sacrospinous ligament represents a way that could rule against the correct needle positioning with increased risk of pudendal lesions. Single incision approach offers an easier access to the sacrospinous ligament with lower risk of pudendal lesions. © 2017 Wiley Periodicals, Inc.

  6. Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

    DEFF Research Database (Denmark)

    Mynster, Tommie; Wille-Jørgensen, Peer

    2013-01-01

    of administrations or amount of opioids were seen. Conclusion. With reservation of a small study group we find SILS is like worthy to CLS in colorectal cancer surgery and a benefit in postoperative recovery and pain is possible, but has to be investigated in larger randomised studies.......Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...

  7. Laparoscopy and complicated meckel diverticulum in children.

    Science.gov (United States)

    Alemayehu, Hanna; Stringel, Gustavo; Lo, Irene J; Golden, Jamie; Pandya, Samir; McBride, Whitney; Muensterer, Oliver

    2014-01-01

    Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the management of Meckel diverticulum is established. We reviewed our experience with complicated cases of Meckel diverticulum in children managed with laparoscopy. A 15-year retrospective chart review revealed 14 cases of complicated Meckel diverticulum managed with laparoscopy. Incidentally found Meckel diverticulum and cases done by laparotomy were excluded. Ages varied from 2 years to 16 years old. There were 10 males and four females. Eight cases had small bowel obstruction; of those, three had extensive intestinal gangrene. Four cases had significant rectal bleeding, three had acute diverticulitis, and two had intussusception caused by the diverticulum. Eleven cases were treated with laparoscopic Meckel diverticulectomy and three with laparoscopic-assisted bowel resection because of extensive gangrene of the intestine. Two of the three cases with significant intestinal gangrene returned several weeks later with small bowel obstruction secondary to adhesions. They were successfully managed with laparoscopic lysis of adhesions. There were no other complications. Laparoscopy is safe and effective in the management of complicated Meckel diverticulum in children. Most cases can be managed with simple diverticulectomy. Laparoscopy is useful when the diagnosis is uncertain. When extensive gangrene is present, laparoscopy can help to mobilize the intestine and evaluate the degree of damage, irrigate and cleanse the peritoneal cavity, and minimize the incision necessary to accomplish the bowel resection.

  8. Transfibular ankle arthrodesis using burring, curettage, multiple drilling, and fixation with two retrograde screws through a single lateral incision.

    Science.gov (United States)

    Lee, H J; Min, W K; Kim, J S; Yoon, S D; Kim, D H

    2016-04-01

    To review the outcome of 23 ankle arthrodeses using burring, curettage, multiple drilling, and fixation with 2 retrograde screws through a single lateral incision. Records of 22 consecutive patients aged 39 to 79 (mean, 62.4) years who underwent 23 ankle arthrodeses for end-stage ankle arthritis were reviewed. Through a single lateral incision, articular cartilage was removed using burring and curettage, and multiple holes were drilled using a Kirschner wire, followed by fixation with 2 retrograde screws. The resected distal fibula was fixed to the distal part of the talus and tibia. The position of the ankle and subtalar joint arthrosis was assessed by 2 orthopaedic specialists. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) scores were evaluated. The mean operating time was 122 minutes. The mean follow-up period was 41 months. The mean postoperative ankle alignment was suboptimal: 2.7º varus, 6.7º plantar flexion, and 2.9º internal rotation. The mean AOFAS score improved from 30 to 71 (pfixation with 2 retrograde screws achieved a high union rate and acceptable functional score without serious complications.

  9. Single-incision Laparoscopic Appendectomy for acute Appendicitis using a 10-mm Laparoscope and the Glove Port Technique.

    Science.gov (United States)

    Tsushimi, Takaaki; Mori, Hirohito; Sudo, Manabu; Minami, Yoshihide; Ueki, Koichi; Tamai, Makoto

    2017-01-01

    To evaluate the single incision laparoscopic appendectomy (SILA) using existing instruments, the 10-mm laparoscope, and glove port technique. SILA was performed on 16 patients (8 male cases, 8 female cases) between June 2012 and September 2015. A 20-mm incision was made in the umbilicus and a wound retractor was placed. A 10-mm trocar for the laparoscope and two 5-mm trocars were fixed to the three fingers of the latex gloves and it was attached to the wound retractor. Another thin forceps were inserted from right low abdomen. Average age of patients was 32.6 ± 17.7 years. Preoperative average white blood cell was 13,325 ± 4,584 /mm 3 , and average CRP was 1.81 ± 3.70 mg/dL. Preoperative body temperature was 36.8 ± 0.5°C. The mean appendix size was 9.6 ± 2.3 mm and none of the patients had an abscess on preoperative CT. The CT also revealed a fecal pellet in 5/16 (31%) of patients. Mean operation time was 66.4 ± 25.4 minutes, and minimal intraoperative bleeding was observed in all patients. Average hospital stay was 5.3 ± 1.9 days and none of the patients had complications. SILA using the 10-mm laparoscope and glove port technique may be a safe and feasible operation for mild to moderate appendicitis.

  10. Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Bo Sung Yoon

    2014-12-01

    Conclusion: SPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.

  11. Evaluating single-incision slings in female stress urinary incontinence: the usefulness of the CONSORT statement criteria.

    Science.gov (United States)

    Diallo, Stéphanie; Cour, Florence; Josephson, Anne; Vidart, Adrien; Botto, Henri; Lebret, Thierry; Bonan, Brigitte

    2012-09-01

    To evaluate the usefulness and applicability of the Consolidated Standards of Reporting Trials (CONSORT) for journal articles reporting randomized, controlled trials evaluating single-incision slings in the treatment of female stress urinary incontinence. Original articles reporting randomized, controlled trials assessing single-incision slings in the treatment of female stress urinary incontinence were searched for in the PubMed and Embase databases in 2011. Reporting quality was studied by 2 hospital pharmacists and 2 urologic surgeons. Primary outcome was the score out of 20 in the abstract CONSORT checklist. Secondary outcomes were the scores in the standard CONSORT checklist and the extension CONSORT additional items for trials assessing nonpharmacologic treatments. Among 135 articles retrieved, 8 met the inclusion criteria and were assessed. Abstract scores ranged from 4.7-14.1. Standard scores were >10.0 out of 20 for most articles; the extension scores did not exceed 5.0 out of 10. Four reported trials were not identified as randomized in the title. The interventions were incompletely reported. Four articles reported whether blinding was achieved but lack of blinding was never discussed as a potential source of bias. Few articles reported the operators and centers characteristics and their impact on statistical analysis. The combination of the 3 checklists was considered a useful guideline to enhance and assess the reporting quality of a surgical trial. Our results support the further use of CONSORT criteria as a basic standardized tool in all stages of clinical evaluation for any prosthetic device in female pelvic surgery. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Transumbilical single-incision laparoscopic subtotal gastrectomy and total intracorporeal reconstruction of the digestive tract in the treatment of benign peptic ulcers.

    Science.gov (United States)

    Chen, Yong-Sheng; Wu, Shuo-Dong; Kong, Jing

    2014-12-01

    Single-incision laparoscopic surgery is being applied increasingly in many surgical specialties. However, few reports are available regarding its use in the treatment of benign peptic ulcer disease. We report here on nine patients with gastric or duodenal ulcers who underwent transumbilical single-incision laparoscopic subtotal gastrectomy (SILSG) between November 2010 and June 2013. All procedures were performed with conventional laparoscopic instruments placed through a single operating portal of entry created within the umbilicus. Total intracorporeal gastrojejunostomy or gastroduodenostomy was then performed for reconstruction of the digestive tract. Only one case required conversion from single-incision to multiple-incision surgery. Among the eight patients who successfully underwent SILSG, total intracorporeal gastroduodenostomy was performed in two and gastrojejunostomy in six. The mean operation time was 290 ± 50 min (range 230-360 min), and blood loss was 200 ± 66 mL (range 100-300 mL). The patients recovered fully, and the single umbilical scars healed well. We believe this is the first report of SILSG with total intracorporeal gastrojejunostomy or gastroduodenostomy in the treatment of benign peptic ulcers. On the basis of this initial experience, SILSG for this indication in the hands of experienced surgeons appears to be feasible and safe. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Comparison of laparoscopic and mini incision open donor nephrectomy: Single blind, randomised controlled clinical trial

    NARCIS (Netherlands)

    N.F.M. Kok (Niels); M.Y. Smits-Lind (May); B.M.E. Hansson (Birgitta); D. Pilzecker (Desiree); I.R.A.M. Mertens Zur Borg (Ingrid); B.C. Knipscheer (Ben); E.J. Hazebroek (Eric Jasper); I.M. Dooper (Ine); W. Weimar (Willem); W.C.J. Hop (Wim); E.M.M. Adang (Eddy); G.-J. van der Wilt (Gert-Jan); H.J. Bonjer (Jaap); J.A. van der Vliet (Adam); J.N.M. IJzermans (Jan)

    2006-01-01

    markdownabstractOBJECTIVES: To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function. DESIGN: Single blind, randomised controlled trial. SETTING: Two university medical centres, the Netherlands. PARTICIPANTS: 100 living

  14. Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial.

    NARCIS (Netherlands)

    Kok, N.F.; Lind, M.Y.; Hansson, B.M.; Pilzecker, D.; Mertens zur Borg, I.R.; Knipscheer, B.C.; Hazebroek, E.J.; Dooper, P.M.M.; Weimar, W.; Hop, W.C.J.; Adang, E.M.M.; Wilt, G.J. van der; Bonjer, H.J.; Vliet, J.A. van der; Ijzermans, J.N.M.

    2006-01-01

    OBJECTIVES: To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function. DESIGN: Single blind, randomised controlled trial. SETTING: Two university medical centres, the Netherlands. PARTICIPANTS: 100 living kidney donors.

  15. Guidelines for emergency laparoscopy

    Directory of Open Access Journals (Sweden)

    Sauerland Stefan

    2006-10-01

    Full Text Available Abstract Acute abdominal pain is a leading symptom in many surgical emergency patients. Laparoscopy allows for accurate diagnosis and immediate therapy of many intraabdominal pathologies. The guidelines of the EAES (European Association for Endoscopic Surgery provides scientifically founded recommendations about the role of laparoscopy in the different situations. Generally, laparoscopy is well suited for the therapy of the majority of diseases that cause acute abdominal pain.

  16. Application of lasers in laparoscopy

    Science.gov (United States)

    Stanowski, Edward; Domaniecki, Janusz

    1995-03-01

    The application of laser light and laparoscopy attenuates operative trauma owing to the use of small incisions for introducing the trochars necessary for conveying the surgical instruments and fiber optics which allow for precise cutting and coagulation of small vessels under control of the image on a TV monitor. The present, most remarkable development of laparoscopic surgery is due to the fascination of physicians and patients by this procedure. The method enables the physician to operate with great precision and to take advantage of the most recent attainments of electronics and laser technique, as well as of his own ability. The patients profit by attenuation of postoperative pain, limitation of the probability of infection, reduced blood loss, decreased number of postoperative complications, shortening of the hospitalization period, and rapid return to physical fitness and work.

  17. Laparoscopy-assisted ERCP (LA-ERCP) following bariatric gastric bypass surgery: initial experience of a single UK centre.

    Science.gov (United States)

    Paranandi, Bharat; Joshi, Deepak; Mohammadi, Borzoueh; Jenkinson, Andrew; Adamo, Marco; Read, Samantha; Johnson, Gavin J; Chapman, Michael H; Pereira, Stephen P; Webster, George J

    2016-01-01

    Bariatric gastric bypass surgery is being increasingly performed, but endoscopic retrograde cholangiopancreatography (ERCP) in these patients poses a unique challenge because of a lack of per-oral access to the stomach. Small series suggest a higher technical success rate using laparoscopy-assisted ERCP (LA-ERCP) than with an enteroscopic approach via the Roux-en-Y anastomosis. We present initial experience of LA-ERCP in our unit. Retrospective case series of consecutive patients undergoing LA-ERCP in our unit between September 2011 and July 2014. Data was retrieved from electronic, clinical and endoscopy records. Seven LA-ERCPs were performed. All seven patients were female, with median age 44 years (range 36-71). Indications included symptomatic bile duct stones (5/7), benign papillary fibrosis (1/7) and retained biliary stent (1/7). 5/7 (71%) patients had had a prior cholecystectomy. To facilitate LA-ERCP, laparoscopic gastrostomy ports were created in all patients. Duodenal access, biliary cannulation and completion of therapeutic aim were achieved in all patients. 6/7 (86%) patients required endoscopic sphincterotomy. The median duration of procedures was 94 min (range 70-135). Median postoperative length of stay was 2 days (range 1-9). One patient developed mild postprocedural acute pancreatitis, and another patient developed a mild port-site infection. Otherwise, no procedure-related complications were seen. All patients remained well on follow-up (median 14 months (range 1-35) from date of ERCP), with no evidence of further biliary symptoms. Our early experience of LA-ERCP is that it is safe and effective. The technique may require particular consideration, as bariatric surgery is increasingly performed, in a patient group at significant risk of bile duct stones.

  18. Comparison of the clinical outcomes of transobturator and single-incision slings for stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Ling-Ying Wu

    2016-07-01

    Full Text Available The aim of this study was to compare the clinical outcomes of anti-incontinence surgeries employing the transobturator sling and single-incision sling (SIS. Our hypothesis is that the outcome of the SIS is not inferior to the obturator sling. This retrospective study reviewed the medical records of patients who underwent anti-incontinence surgery with the transobturator sling or SIS from July 2005 to November 2014. Patients who underwent concomitant pelvic organ reconstruction with an artificial mesh were excluded. Assessments included preoperative and postoperative urodynamic examinations, perioperative complications, and postoperative urogenital symptoms. A total of 122 women were recruited according to the inclusion and exclusion criteria. Among them, 68 patients underwent transobturator sling procedures while 54 patients underwent SIS procedures. The subjective failure rate of the transobturator sling and SIS were 10.2% and 18.5%, respectively (p = 0.292. The objective failure rate, defined as a pad test showing more than 2 g of urine, was 10.2% for the transobturator sling and 12.9% for the SIS (p = 0.777. SIS resulted in less blood loss, operative time, length of hospital stay, and transient voiding dysfunction after the operation. No major complication occurred after either surgical intervention. In conclusion, SIS and transobturator slings might have similar efficacy, safety, and effects on new-onset urogenital symptoms.

  19. Single-Incision Pediatric Endosurgery (SIPES oophoropexy in an adolescent with Hodgkin lymphoma prior to pelvic irradiation

    Directory of Open Access Journals (Sweden)

    Aaron D. Seims

    2015-07-01

    Full Text Available Oophoropexy for fertility preservation during pelvic irradiation dates back to the mid-1960s. For Hodgkin lymphoma (HL, this was performed during a staging laparotomy. Laparoscopic ovarian fixation has supplanted open pexy with advancements in technology and abandonment of staging laparotomies. Single-Incision Pediatric Endosurgery (SIPES is applicable to numerous multi-port operations. Use of this technique for oophoropexy prior to pelvic irradiation, however, has not been reported. A 19 year-old with stage IVb HL involving the left iliac node basin was to receive radiotherapy and was evaluated for bilateral oophoropexy. An Olympus TriPort™ was introduced at the umbilicus, through which a 5 mm zero-degree laparoscope and a needle driver were introduced. Transabdominal passage of a ski needle through a 2 mm nick in the skin of the anterolateral wall allowed for right sided fixation of the ovaries. Operative recovery was uncomplicated, and post-operative imaging demonstrated satisfactory positioning of the gonads outside the planned radiation field. In conclusion, SIPES oophoropexy is a technically simple method for fertility preservation that offers improved cosmesis.

  20. The feasibility and safety of single-incision totally extraperitoneal inguinal hernia repair after previous lower abdominal surgery: 350 procedures at a single center.

    Science.gov (United States)

    Wakasugi, Masaki; Suzuki, Yozo; Tei, Mitsuyoshi; Anno, Kana; Mikami, Tsubasa; Tsukada, Ryo; Koh, Masahiro; Furukawa, Kenta; Masuzawa, Toru; Kishi, Kentaro; Tanemura, Masahiro; Akamatsu, Hiroki

    2017-03-01

    To evaluate the feasibility and safety of single-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair (SILS-TEP) with previous lower abdominal surgery (PLAS). A retrospective analysis of 350 patients undergoing SILS-TEP for a primary inguinal hernia from January 2012 to December 2015 at Osaka Police Hospital was performed, and the outcomes of the patients with and without PLAS were compared. SILS-TEP was performed in 84 patients with PLAS and 266 patients without PLAS. Appendectomy was the most common previous operative procedure. There were more patients with an ASA score of ≥3 in the PLAS group than in the control group (p < 0.05). The mean operative time, and the rates of conversion and postoperative complications were comparable between the two groups. There were no cases of recurrence in either group. SILS-TEP could be safely performed in patients with PLAS and achieved better cosmetic outcomes than conventional laparoscopic surgery.

  1. Is There a Cosmetic Advantage to Single-Incision Laparoscopic Surgical Techniques Over Standard Laparoscopic Surgery? A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Evans, Luke; Manley, Kate

    2016-06-01

    Single-incision laparoscopic surgery represents an evolution of minimally invasive techniques, but has been a controversial development. A cosmetic advantage is stated by many authors, but has not been found to be universally present or even of considerable importance by patients. This systematic review and meta-analysis demonstrates that there is a cosmetic advantage of the technique regardless of the operation type. The treatment effect in terms of cosmetic improvement is of the order of 0.63.

  2. Role of staging laparoscopy in the management of Pancreatic Duct Carcinoma (PDAC): Single-center experience from a tertiary hospital in Brazil.

    Science.gov (United States)

    de Jesus, Victor Hugo Fonseca; da Costa Junior, Wilson Luiz; de Miranda Marques, Tomás Mansur Duarte; Diniz, Alessandro Landskron; de Castro Ribeiro, Héber Salvador; de Godoy, André Luis; de Farias, Igor Correia; Coimbra, Felipe José Fernandez

    2018-03-06

    Proper staging is critical to the management of pancreatic ductal carcinoma (PDAC). Laparoscopy has been used to stage patients without gross metastatic disease with variable success. We aimed to identify the frequency of patients diagnosed by laparoscopy with occult metastatic disease. Also, we looked for variables related to a higher chance of occult metastasis. Patients with PDAC submitted to staging laparoscopy either immediately before pancreatectomy or as a separate procedure between January 2010 and December 2016 were included. None presented gross metastatic disease at initial staging. We used logistic regression to search for variables associated with metastatic disease. The study population consisted of 63 patients. Among all patients, nine (16.7%) had occult metastases at laparoscopy. Unresectable tumor (Odds ratio = 18.0, P = 0.03), increasing tumor size (Odds ratio = 1.36, P = 0.01), and abdominal pain (Odds ratio = 5.6, P = 0.04) significantly predicted the risk of occult metastases in univariate analysis. In multivariate analysis, only tumor size predicted the risk of occult metastases. Laparoscopy remains a valuable tool in PDAC staging. Patients with either large or unresectable tumors, or presenting with abdominal pain present the highest risk for occult intra-abdominal metastases. © 2018 Wiley Periodicals, Inc.

  3. Alopecia Following Bicoronal Incisions.

    Science.gov (United States)

    Kadakia, Sameep; Badhey, Arvind; Ashai, Sara; Lee, Thomas S; Ducic, Yadranko

    2017-05-01

    Multiple techniques may be used to perform bicoronal incisions, and alopecia is a known postoperative complication of this procedure. To date, no large studies exist comparing alopecia outcomes among bicoronal incision techniques with and without the use of Raney clips. To determine (1) whether postoperative alopecia is more common when bicoronal incisions are performed with monopolar cautery, Colorado microdissection tip cautery, or traditional cold steel and (2) whether this outcome is affected by the use of Raney clips. This retrospective study of postoperative alopecia included 505 patients undergoing bicoronal incisions in a single head and neck surgery practice from 1997 to 2015 with a minimum follow-up of 1 year. Patients with preexisting baldness as well as patients not following up for the minimum period were excluded. All data analysis took place between 1997 and 2015. Maximum alopecia width was measured in the postoperative period and compared among the technique groups both with and without Raney clip use. Raney clip duration as a product of surgery length was also compared. A total of 505 patients (301 male, 204 female) ranging in age from 3 to 97 years were included in the study (median age, 53.9 years). Of these, 236 underwent bicoronal incisions to approach the skull base, 78 to treat chronic frontal sinusitis unresponsive to endoscopic management or frontal sinus mucocele, 143 for trauma, and 48 for craniofacial surgery. For 173 patients, the cold steel technique was used for both skin and subcutaneous incision, 102 of whom needed Raney clips. For 161 patients, cold steel technique was used for skin incisions and monopolar cautery for subcutaneous incision; 81 of these patients required Raney clips. For 171 patients, Colorado tip microdissection cautery was used for both skin and subcutaneous incision, with Raney clips used in 66 of these patients. Incisions made with cold steel for both skin and subcutaneous tissue, regardless of Raney clip use

  4. Laparoendoscopic Single-site Surgery (LESS) for Prophylactic Salpingo-oophorectomy Improves Cosmetic Satisfaction Compared to Standard Laparoscopy.

    Science.gov (United States)

    Miailhe, Gregoire; Dauchy, Sarah; Bentivegna, Enrica; Gouy, Sebastien; Charles, Cecile; Delaloge, Suzette; Morice, Philippe; Uzan, Catherine

    2015-11-01

    Less invasive prophylactic bilateral salpingo-oophorectomy (PBSO) may diminish the general consequences of surgery for BRCA mutation carriers. The objective of the present study was to compare the psychological impact and satisfaction following minimal-invasive laparoendoscopic single-site surgery (LESS) versus that observed with the standard procedure. This prospective longitudinal study was proposed to all consecutive patients who underwent ambulatory PBSO between January 2012 and January 2014 at our Center. The psychological impact and esthetic satisfaction were prospectively studied. Patients rated their satisfaction using the 4-grade Likert scale. Their emotional state and postoperative pain were explored respectively with validated questionnaires (IES-R, PANAS) and the Verbal Numerical Rating Scale (VNRS). Operative outcomes were also analyzed. Twenty patients underwent LESS PBSO and 10 patients had the standard laparoscopic (SL) PBSO. The mean satisfaction scores were significantly higher in the LESS group one month and six months after surgery. Both groups reported a reduction of intrusive thoughts and negative affects after surgery. Postoperative pain and operative outcomes were similar. A significant improvement of cosmetic satisfaction after LESS compared to SL could help patients accept PBSO. The emotional impact of PBSO is not modified by ambulatory LESS. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  5. Laparoscopy in abdominal trauma

    African Journals Online (AJOL)

    distal pancreatectomy has been advised. Laparoscopy has been successfully used both in acute and delayed distal pancreatectomies following trauma. It has been reported that magnification obtained through laparoscopic camera allows excellent identification of vessels and dissection of pancreas from splenic artery and ...

  6. A safety study of transumbilical single incision versus conventional laparoscopic surgery for colorectal cancer: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Wang, Yanan; Liu, Ruoyan; Zhang, Ze; Xue, Qi; Yan, Jun; Yu, Jiang; Liu, Hao; Zhao, Liying; Mou, Tingyu; Deng, Haijun; Li, Guoxin

    2015-11-30

    Single-incision laparoscopic surgery (SILS) is an emerging minimally invasive surgery to reduce abdominal incisions. However, despite the increasing clinical application of SILS, no evidence from large-scale, randomized controlled trials is available for assessing the feasibility, short-term safety, oncological safety, and potential benefits of SILS compared with conventional laparoscopic surgery (CLS) for colorectal cancer. This is a single-center, open-label, noninferiority, randomized controlled trial. A total of 198 eligible patients will be randomly assigned to transumbilical single incision plus one port laparoscopic surgery (SILS plus one) group or to a CLS group at a 1:1 ratio. Patients ranging in age from 18 to 80 years with rectosigmoid cancer diagnosed as cT1-4aN0-2 M0 and a tumor size no larger than 5 cm are considered eligible. The primary endpoint is early morbidity, as evaluated by an independent investigator. Secondary outcomes include operative outcomes (operative time, estimated blood loss, and incision length), pathologic outcomes (tumor size, length of proximal and distal resection margins, and number of harvested lymph nodes), postoperative inflammatory and immune responses (white blood cells [WBC], neutrophil percentage [NE %], C-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]), postoperative recovery (time to first ambulation, flatus, liquid diet, soft diet, and duration of hospital stay), pain intensity, body image and cosmetic assessment, 3-year disease free survival (DFS), and 5-year overall survival (OS). Follow-up visits are scheduled for 1 and 3 months after surgery, then every 3 months for the first 2 years and every 6 months for the next 3 years. This trial will provide valuable clinical evidence for the objective assessment of the feasibility, safety, and potential benefits of SILS plus one compared with CLS for the radical resection of rectosigmoid cancer. The hypothesis is that SILS plus one is

  7. Minimal Incision Scar-Less Open Umbilical Hernia Repair in Adults - Technical Aspects and Short Term Results

    Directory of Open Access Journals (Sweden)

    Sanoop Koshy Zachariah

    2014-09-01

    Full Text Available Background: There is no gold standard technique for umbilical hernia repair .Conventional open umbilical hernia repair often produces an undesirable scar. Laparoscopic umbilical hernia repair requires multiple incisions beyond the umbilicus, specialized equipments, and expensive tissue separating mesh. We describe our technique of open umbilical hernia repair utilizing a small incision. The technique was derived from our experience with single incision laparoscopy. We report the technical details and short term results. Methods: This is a retrospective analysis of the first 20 patients who underwent minimal incision scar-less open umbilical hernia repair, from June 2011 to February 2014. A single intra-umbilical curved incision was used to gain access to the hernia sac. Primary suture repair was performed for defects upto 2cm.Larger defects were repaired using an onlay mesh. In patients with a BMI of 30 kg/m2 or greater, onlay mesh hernioplasty was performed irrespective of the defect size.Results: A total of 20 patients, 12 males and 8 females underwent the procedure. Mean age was 50 (range 29 - 82 years. Mean BMI was 26.27 (range 20. -33.1 kg/m2. Average size of the incision was 1.96 range (1.5 to 2.5 cm. Mesh hernioplasty was done in 9 patients. 11 patients underwent primary suture repair alone. There were no postoperative complications associated with his technique. Average post operative length of hospital stay was 3.9 (range 2-10 days. Mean follow-up was 29.94 months, (2 weeks to 2.78 years. On follow up there was no externally visible scar in any of the patients. There were no recurrences on final follow up. Conclusion: This technique provides a similar cosmetic effect as obtained from single port laparoscopy. It is easy to perform safe, offers good cosmesis, does not require incisions beyond the umbilicus and cost effective, with encouraging results on short term follow up. Further research is needed to assess the true potential of the

  8. Laparoscopy After Previous Laparotomy

    Directory of Open Access Journals (Sweden)

    Zulfo Godinjak

    2006-11-01

    Full Text Available Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previouslaparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.

  9. Single minimum incision endoscopic radical nephrectomy for renal tumors with preoperative virtual navigation using 3D-CT volume-rendering

    Directory of Open Access Journals (Sweden)

    Shioyama Yasukazu

    2010-04-01

    Full Text Available Abstract Background Single minimum incision endoscopic surgery (MIES involves the use of a flexible high-definition laparoscope to facilitate open surgery. We reviewed our method of radical nephrectomy for renal tumors, which is single MIES combined with preoperative virtual surgery employing three-dimensional CT images reconstructed by the volume rendering method (3D-CT images in order to safely and appropriately approach the renal hilar vessels. We also assessed the usefulness of 3D-CT images. Methods Radical nephrectomy was done by single MIES via the translumbar approach in 80 consecutive patients. We performed the initial 20 MIES nephrectomies without preoperative 3D-CT images and the subsequent 60 MIES nephrectomies with preoperative 3D-CT images for evaluation of the renal hilar vessels and the relation of each tumor to the surrounding structures. On the basis of the 3D information, preoperative virtual surgery was performed with a computer. Results Single MIES nephrectomy was successful in all patients. In the 60 patients who underwent 3D-CT, the number of renal arteries and veins corresponded exactly with the preoperative 3D-CT data (100% sensitivity and 100% specificity. These 60 nephrectomies were completed with a shorter operating time and smaller blood loss than the initial 20 nephrectomies. Conclusions Single MIES radical nephrectomy combined with 3D-CT and virtual surgery achieved a shorter operating time and less blood loss, possibly due to safer and easier handling of the renal hilar vessels.

  10. No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Christoffersen, Mette W; Brandt, Erik; Oehlenschläger, Jacob

    2015-01-01

    and matched 1:2 with patients subjected to CLC using pre-defined criteria. Follow-up data were obtained from the Danish National Patient Registry, mailed patient questionnaires, and clinical examination. A port-site hernia was defined as a repair for a port-site hernia or clinical hernia located at one......BACKGROUND: Conventional laparoscopic cholecystectomy (CLC) is regarded as the gold standard for cholecystectomy. However, single-incision laparoscopic cholecystectomy (SLC) has been suggested to replace CLC. This study aimed at comparing long-term incidences of port-site hernia and chronic pain...... after SLC versus CLC. METHODS: We conducted a matched cohort study based on prospective data (Jan 1, 2009-June 1, 2011) from the Danish Cholecystectomy Database with perioperative information and clinical follow-up. Consecutive patients undergoing elective SLC during the study period were included...

  11. A comparison of single-suture and double-suture incision closures in seaward-migrating juvenile Chinook salmon implanted with acoustic transmitters: implications for research in river basins containing hydropower structures

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Richard S.; Deters, Katherine A.; Cook, Katrina V.; Eppard, M. B.

    2013-07-15

    Reductions in the size of acoustic transmitters implanted in migrating juvenile salmonids have resulted in the ability to make shorter incisions that may warrant using only a single suture for closure. However, it is not known if one suture will sufficiently hold the incision closed, particularly when outward pressure is placed on the surgical site such as when migrating fish experience pressure changes associated with passage at hydroelectric dams. The objective of this research was to evaluate the effectiveness of single-suture incision closures on juvenile Chinook salmon (Oncorhynchus tshawytscha). Juvenile Chinook salmon were surgically implanted with a 2012 Juvenile Salmon Acoustic Telemetry System (JSATS) transmitter (0.30 g) and a passive integrated transponder tag (0.10 g) and incisions were closed with either one suture or two sutures. Mortality and tag retention were monitored and fish were examined after 7 and 14 days to evaluate tissue responses. In a separate experiment, surgically implanted fish were exposed to simulated turbine passage and then examined for expulsion of transmitters, expulsion of viscera through the incision, and mortal injury. With incisions closed using a single suture, there was no mortality or tag loss and similar or reduced tissue reaction compared to incisions closed with two sutures. Further, surgery time was significantly reduced when one suture was used, which leads to less handling and reduced stress. No tags were expelled during pressure scenarios and expulsion of viscera only occurred in two non-mortally injured fish (5%) with single sutures that were also exposed to very high pressure changes. No viscera expulsion was present in fish exposed to pressure scenarios likely representative of hydroturbine passage at many Columbia River dams (e.g. <2.7 ratio of pressure change; an acclimation pressure of 146.2 absolute kpa and a lowest exposure pressure of ~ 53.3 absolute kpa). Based on these results, we recommend the use of a

  12. Role of laparoscopy in non-trauma emergency pediatric surgery: a 5-year, single center experience a retrospective descriptive study with literature review.

    Science.gov (United States)

    Abbas, Tariq O; Hayati, Ahmed; Ali, Mansour

    2012-10-05

    Although laparoscopy is rapidly becoming the abdominal surgical modality of choice in adults, there are obstacles to its use in children. We analyzed our experience with pediatric laparoscopic surgery over the past 5 years, with particular emphasis on emergency procedures. We retrospectively evaluated the records of patients aged time, total length of hospital stay, and postoperative complications.During the 5-year study period, 482 laparoscopic procedures were performed on patients aged times and shorter postoperative hospital stays. The numbers of laparoscopic procedures performed increased over time. Pediatric laparoscopic surgery for emergency conditions provides excellent results, including better exposure and cosmetic outcomes than laparotomy. At our institution, the numbers and types of laparoscopic procedures performed have increased over time, and the outcomes of laparoscopic procedures have improved.

  13. Laparoscopy in penetrating abdominal trauma.

    Science.gov (United States)

    Uranues, Selman; Popa, Dorin Eugen; Diaconescu, Bogdan; Schrittwieser, Rudolph

    2015-06-01

    If morbidity and mortality are to be reduced in patients with penetrating abdominal trauma, first priority goes to prompt and accurate determination of peritoneal penetration and identification of the need for surgery. In this setting, laparoscopy may have an important impact on the rate of negative or non-therapeutic laparotomies. We analyzed indications and patient selection criteria for laparoscopy in penetrating trauma along with outcomes. The analysis focused on identification of peritoneal penetration and injuries to the diaphragm, small intestine, and mesentery. Results from the early phase of laparoscopy were compared with those from recent decades with more advanced laparoscopic equipment and instruments and more experienced surgeons. A systematic review of the role of laparoscopy in penetrating abdominal trauma shows a sensitivity ranging from 66.7 to 100%, specificity from 33.3 to 100% and accuracy from 50 to 100%. Publications from the 1990s found trauma laparoscopy to be inadequate for detecting intestinal injuries and so to lead to missed injuries. Twenty-three of the 50 studies including the most recent ones report sensitivity, specificity, and accuracy of 100%. Laparoscopy is more cost effective than negative laparotomy. Laparoscopy can be performed safely and effectively on stable patients with penetrating abdominal trauma. The most important advantages are reduction of morbidity, accuracy in detecting diaphragmatic and intestinal injuries, and elimination of prolonged hospitalization for observation, so reducing the length of stay and increasing cost effectiveness.

  14. Laparoscopy-assisted hepatectomy versus conventional (open) hepatectomy for living donors: when you know better, you do better.

    Science.gov (United States)

    Makki, Kausar; Chorasiya, Vishal Kumar; Sood, Gaurav; Srivastava, Piyush Kumar; Dargan, Puneet; Vij, Vivek

    2014-10-01

    The conventional incision for donor hepatectomy is a right subcostal incision with a midline extension. With increased experience in both donor hepatectomy and laparoscopy, the conventional incision can be shortened to a significant extent. Laparoscopic mobilization of the liver coupled with a hand port allows the insertion of one hand inside the abdomen for control; this makes small-incision donor hepatectomy a technically feasible alternative. We compared 26 right lobe donor hepatectomies performed with a laparoscopy-assisted technique (the laparoscopy-assisted donor hepatectomy group) to 24 donor hepatectomies performed with the conventional open technique (the conventional donor hepatectomy group). The donors in both groups and their recipients were followed for 6 months. Pain, discomfort related to the scar [including abdominal wall sensorineural deficits (numbness and differences in tactile and temperature sensations) and tightness around the scar], and donor quality of life (assessed with the International Quality of Life Assessment Short Form 8 scoring system) were compared between the 2 groups. In conclusion, laparoscopy-assisted surgery can be a technically feasible alternative in experienced hands, and as with other minimally invasive surgeries, it has advantages such as significantly less pain, reduced incision-related complications, and better donor quality of life during the early postoperative period without compromising donor safety. © 2014 American Association for the Study of Liver Diseases.

  15. Single-Port Laparoscopic Surgery in Children: Concept and Controversies of the New Technique

    Directory of Open Access Journals (Sweden)

    Felix C. Blanco

    2012-01-01

    Full Text Available Single-incision laparoscopic surgery (SILS is emerging as an alternative technique to conventional laparoscopy for the treatment of common surgical diseases. Despite its wide use, the adoption of SILS in children has been slower since the broad application of minimally invasive techniques in children, in general, has historically lagged behind those in adults. This paper reviews the evolution of SILS from its original conception and its application in the field of pediatric surgery.

  16. Single incision device (TVT Secur) versus retropubic tension-free vaginal tape device (TVT) for the management of stress urinary incontinence in women: a randomized clinical trial.

    Science.gov (United States)

    Ross, Sue; Tang, Selphee; Schulz, Jane; Murphy, Magnus; Goncalves, Jose; Kaye, Stephen; Dederer, Lorel; Robert, Magali

    2014-12-22

    In 2006, Ethicon Inc. introduced a new minimally invasive single incision sling device for the surgical treatment of stress urinary incontinence, the Gynecare TVT Secur®. For device licensing, no new evidence of TVT Secur efficacy and safety was needed: rather evidence was provided of the long-term follow-up of patients who had a procedure using a predecate retropubic tension-free vaginal tape device. Before adopting TVT Secur into our routine clinical practice, we decided to evaluate it. The objective of our Canadian multi-centre pragmatic randomized controlled trial was to compare the effectiveness of the new single-incision device, TVT Secur, to the established TVT device, in terms of objective cure of stress urinary incontinence (SUI) at 12 months postoperatively. Other outcomes included: complications, symptoms, and incontinence-related quality of life. The sample size estimate for our trial was 300, but the trial stopped early because of poor recruitment. 74 women participated (40 allocated to TVT Secur, 34 to TVT). At 12 months postoperatively, 27/33(82%) of TVT Secur group were cured, compared with 25/28(89%) of the TVT group (relative risk 0.92, 95% confidence interval 0.75 to 1.13, p=0.49). Most women reported little or no SUI symptoms (35/37(95%) vs 29/30(97%), >0.999). Quality of life improved significantly from baseline for both groups (IIQ-7 mean change -25 for both groups) but did not differ between groups (p=0.880). Our small randomized trial did not find statistically significant differences in outcomes between women allocated to the TVT Secur device versus those allocated to the TVT device for stress urinary incontinence. Despite the discontinuation of TVT Secur in March 2013 for commercial reasons, the importance of our study lies in making evidence available for the many women who had a TVT Secur device implanted and their physicians who may be considering alternative treatments. Our experience illustrates the difficulty of undertaking research

  17. Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy.

    Science.gov (United States)

    Newman, Richard M; Umer, Affan; Bozzuto, Bethany J; Dilungo, Jennifer L; Ellner, Scott

    2016-03-01

    As the cost of health care is subjected to increasingly greater scrutiny, the assessment of new technologies must include the surgical value (SV) of the procedure. Surgical value is defined as outcome divided by cost. The cost and outcome of 50 consecutive traditional (4-port) laparoscopic cholecystectomies (TLC) were compared with 50 consecutive, nontraditional laparoscopic cholecystectomies (NTLC), between October 2012 and February 2014. The NTLC included SILS (n = 11), and robotically assisted single-incision cholecystectomies (ROBOSILS; n = 39). Our primary outcomes included minimally invasive gallbladder removal and same-day discharge. Thirty-day emergency department visits or readmissions were evaluated as a secondary outcome. The direct variable surgeon costs (DVSC) were distilled from our hospital cost accounting system and calculated on a per-case, per item basis. The average DVSC for TLC was $929 and was significantly lower than NTLC at $2,344 (p day discharge. There were no differences observed in secondary outcomes in 30-day emergency department visits (TLC [2%] vs NTLC [6%], p = 0.61) or readmissions (TLC [4%] vs NTLC [2%], p > 0.05), respectively. The relative SV was significantly higher for TLC (1) compared with NTLC (0.34) (p < 0.05), and SILS (0.66) and ROBOSILS (0.36) (p < 0.05). Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Laparoscopy-assisted combined resection for synchronous gastrointestinal multiple primary cancers.

    Science.gov (United States)

    Fang, Jia-feng; Zheng, Zong-heng; Huang, Yong; Wei, Bo; Huang, Jiang-long; Lei, Pu-run; Wei, Hong-bo

    2015-03-01

    Synchronous gastrointestinal multiple primary cancers (SGMPC) is infrequent. This study aimed to investigate the feasibility and outcomes of laparoscopy-assisted combined resection for SGMPC. We retrospectively reviewed 16 cases of SGMPC underwent either open or laparoscopy-assisted combined resection in the Third Affiliated Hospital of Sun Yat-sen University from Jan. 2005 to Jan. 2014. Sixteen cases contained synchronous colon cancers (n = 10), gastric and rectal cancer (n = 5), gastric and duodenal cancer (n = 1). Either laparoscopy-assisted or open procedure was performed. Compared with the open group, the laparoscopy group presented less blood loss (77.1 ± 46.3 ml vs. 145.0 ± 75.9 ml, P = 0.047) and shorter incision length (5.2 ± 0.7 cm vs. 16.4 ± 1.9 cm, P = 0.000), while no differences in operative time (228.3 ± 38.8 min vs. 188.8 ± 47.7 min, P > 0.05) and postoperative hospital stay (10.0 ± 3.4 days vs. 12.0 ± 4.8 days, P > 0.05). Two cases of postoperative complications occurred in the open group and one case of incision infection occurred in the laparoscopy one. Upon follow-up, 2 cases of open group (50.0%) and 8 cases of laparoscopy group (66.7%) were under status of disease free survival. Laparoscopy-assisted combined resection for SGMPC is feasible, safe and effective. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Contasure-Needleless® single incision sling compared with transobturator TVT-O® for the treatment of stress urinary incontinence: long-term results.

    Science.gov (United States)

    Martinez Franco, Eva; Amat Tardiu, Lluís

    2015-02-01

    This study compared transobturator tension-free vaginal tape (TVT-O®) and Contasure-Needleless (C-NDL®) at long-term follow-up . Non-inferiority, prospective, single-centre , quasi-randomised trial started in September 2006 and finished in April 2011 to compare C-NDL® with transobturator vaginal tape (TVT-O®) mesh in the treatment of stress urinary incontinence (SUI) . Epidemiological information, intraoperative and postoperative complications, subjective estimates of blood loss and pain levels were recorded. We also analysed the postoperative stress test, the subjective impression of improvement using the Sandvik Severity Index and the quality of life during follow-up using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) . Two hundred and fifty-seven women with primary SUI were scheduled to receive TVT-O® or C-NDL® and were followed up at least 3 years after the procedure . One hundred and eleven women in the C-NDL® group (84.7%) had a negative stress test, compared with 54 women (88.9%) in the TVT-O® group (p = 0.0065 for the non-inferiority test). The postoperative Sandvik Severity Index was 0 or better than the preoperative score in 90.7% of patients in the C-NDL® group and 95.4% of patients in the TVT-O® group (p = 0.0022). The complication rate was similar in both groups. There were significant differences (p = 0.02) in postoperative pain within the TVT-O® group. The degree of satisfaction was not statistically significant between the two groups. The outcomes for the C-NDL® group were similar to those of the TVT-O® group, adding the concept of "single incision tape" to the tension-free sling option.

  20. Open, intraperitoneal, ventral hernia repair: lessons learned from laparoscopy.

    Science.gov (United States)

    Ponsky, Todd A; Nam, Arthur; Orkin, Bruce A; Lin, Paul P

    2006-03-01

    Recent literature suggests that laparoscopic repair of ventral hernias may have very low recurrence rates. However, laparoscopy may not be feasible in certain situations. We describe an open technique that uses the tension-free retrofascial principles of laparoscopic repair without the need for subcutaneous flaps. Through an incision in the hernia, the peritoneum is entered and adhesions are taken down. A piece of DualMesh (W.L. Gore & Associates, Inc, Newark, Del) is trimmed to fit with a 5-cm circumferential overlap. A vertical incision is made in the mid portion of the mesh. The mesh is fixed in an intraperitoneal retrofascial position using GORE-TEX sutures (W.L. Gore & Associates, Inc). The sutures are brought through the abdominal wall using a laparoscopic suture passer and tied into place on one side of the mesh. That side is then tacked to the posterior fascia with a spiral tacking device. The other side is sutured into place in a similar fashion and then tacked to the fascia by passing the spiral tacking device through the incision in the mesh. The mesh incision is closed with a running GORE-TEX suture. The overlying tissues are closed in layers.

  1. A robust motion estimation system for minimal invasive laparoscopy

    Science.gov (United States)

    Marcinczak, Jan Marek; von Öhsen, Udo; Grigat, Rolf-Rainer

    2012-02-01

    Laparoscopy is a reliable imaging method to examine the liver. However, due to the limited field of view, a lot of experience is required from the surgeon to interpret the observed anatomy. Reconstruction of organ surfaces provide valuable additional information to the surgeon for a reliable diagnosis. Without an additional external tracking system the structure can be recovered from feature correspondences between different frames. In laparoscopic images blurred frames, specular reflections and inhomogeneous illumination make feature tracking a challenging task. We propose an ego-motion estimation system for minimal invasive laparoscopy that can cope with specular reflection, inhomogeneous illumination and blurred frames. To obtain robust feature correspondence, the approach combines SIFT and specular reflection segmentation with a multi-frame tracking scheme. The calibrated five-point algorithm is used with the MSAC robust estimator to compute the motion of the endoscope from multi-frame correspondence. The algorithm is evaluated using endoscopic videos of a phantom. The small incisions and the rigid endoscope limit the motion in minimal invasive laparoscopy. These limitations are considered in our evaluation and are used to analyze the accuracy of pose estimation that can be achieved by our approach. The endoscope is moved by a robotic system and the ground truth motion is recorded. The evaluation on typical endoscopic motion gives precise results and demonstrates the practicability of the proposed pose estimation system.

  2. Surgeon-tailored polypropylene mesh as a needleless single-incision sling versus TVT-O for the treatment of female stress urinary incontinence: a comparative study.

    Science.gov (United States)

    ElSheemy, Mohammed S; Fathy, Hesham; Hussein, Hussein A; Hussein, Eman A; Hassan, Sarah Mohamed

    2015-06-01

    To compare safety and efficacy of surgeon-tailored polypropylene mesh through needleless single-incision technique (STM) versus tension-free vaginal tape-obturator (TVT-O) aiming to decrease cost of treatment of stress urinary incontinence (SUI). This is important in developing countries due to limited healthcare resources. A retrospective cohort study was done at Urology and Gynecology Departments (dual-center), Cairo University, from January 2011 to August 2013. STM was inserted in 72 females, while TVT-O was inserted in 48 females. Females evaluated by cough stress test, stress and urge incontinence quality of life questionnaire (SUIQQ), Q max and abdominal leak point pressure (ALPP) were included. Different factors were compared between both groups using paired t, Wilcoxon's signed rank, McNemar, Chi-square, Fisher's exact, independent t or Mann-Whitney tests. Age, parity, previous surgeries, ALPP, intrinsic sphincter deficiency (ISD), associated prolapse and associated prolapse repair were comparable in both groups. No significant difference was found between both groups in postoperative complications (except groin pain), cure, SUIQQ indices improvement and Q max decline. In total, 65 (90 %) cured, 6 (8 %) improved while failure was detected in one (1 %) patient in STM group, while 42 (87 %) cured, 4 (8 %) improved and failure was detected in two (4 %) patients in TVT-O group. Presence of ISD (p = 0.565), urgency (p = 0.496), UUI (p = 0.531), previous surgeries (p = 0.345), associated urogenital prolapse (p = 0.218) or associated prolapse repair (p = 0.592) did not lead to any significant difference in outcome between both groups. Cost of mesh decreased from US$500 (TVT-O) to US$10 (STM). Outcome of STM is comparable to TVT-O. Furthermore, STM is more economic.

  3. Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy: A randomized controlled trial.

    Science.gov (United States)

    Bava, Ejas P; Ramachandran, Rashmi; Rewari, Vimi; Chandralekha; Bansal, Virinder Kumar; Trikha, Anjan

    2016-01-01

    Transversus abdominis plane (TAP) block has been used to provide intra- and post-operative analgesia with single incision laparoscopic (SIL) bariatric and gynecological surgery with mixed results. Its efficacy in providing analgesia for SIL cholecystectomy (SILC) via the same approach remains unexplored. The primary objective of our study was to compare the efficacy of bilateral TAP block with local anesthetic infiltration for perioperative analgesia in patients undergoing SILC. This was a prospective, randomized, controlled, double-blinded trial performed in a tertiary care hospital. Forty-two patients undergoing SILC were randomized to receive either ultrasound-guided (USG) bilateral mid-axillary TAP blocks with 0.375% ropivacaine or local anesthetic infiltration of the port site. The primary outcome measure was the requirement of morphine in the first 24 h postoperatively. The data were analyzed using t -test, Mann-Whitney test or Chi-square test. The 24 h morphine requirement (mean ± standard deviation) was 34.57 ± 14.64 mg in TAP group and 32.76 ± 14.34 mg in local infiltration group ( P = 0.688). The number of patients requiring intraoperative supplemental fentanyl in TAP group was 8 and in local infiltration group was 16 ( P = 0.028). The visual analog scale scores at rest and on coughing were significantly higher in the local infiltration group in the immediate postoperative period ( P = 0.034 and P = 0.007, respectively). USG bilateral TAP blocks were not effective in decreasing 24 h morphine requirement as compared to local anesthetic infiltration in patients undergoing SILC although it provided some analgesic benefit intraoperatively and in the initial 4 h postoperatively. Hence, the benefits of TAP blocks are not worth the effort and time spent for administering them for this surgery.

  4. Feasibility of single-incision thoracoscopic surgery using a modified chest wall pulley for primary spontaneous pneumothorax: a propensity score matching analysis.

    Science.gov (United States)

    Tsuboshima, Kenji; Nagata, Machiko; Wakahara, Teppei; Matoba, Yasumi; Maniwa, Yoshimasa

    2017-09-01

    Recently, single-incision thoracoscopic surgery (SITS) has been recognized as a favorable treatment choice for primary spontaneous pneumothorax (PSP) compared with conventional three-port video-assisted thoracoscopic surgery (VATS). However, conventional SITS bullectomy often results in collisions with surgical devices. Therefore, we devised a method of SITS using a chest wall pulley for lung excision (PulLE) and modified PulLE (mPulLE) system, which substitutes threads to eliminate such collisions. We compared the mPulLE system with conventional procedures using propensity score matching (PSM) to adjust for patient backgrounds. Using PSM, we evaluated the surgical results of 210 PSP patients who underwent VATS, including mPulLE (n = 23) and three-port VATS (n = 102), at our institution between January 2010 and August 2016. We selected 17 mPulLE cases and 17 three-port VATS. There were no marked differences between the groups in the patient backgrounds or surgical results. However, there was a significant difference between the mPulLE cases and the three-port VATS cases in the operative time (71.7 ± 15.7 vs. 85.9 ± 25.5 min, respectively, P = 0.0388) and the number of autosutures used (3.6 ± 1.2 vs. 4.5 ± 1.2, respectively, P = 0.0178). The surgical results of mPulLE in patients with PSP with multiple lesions were equivalent to those achieved with three-port VATS under the same conditions.

  5. Evaluation of Patient Satisfaction Using the EORTC IN-PATSAT32 Questionnaire and Surgical Outcome in Single-Port Surgery for Benign Adnexal Disease: Observational Comparison with Traditional Laparoscopy

    Directory of Open Access Journals (Sweden)

    Alessandro Buda

    2013-01-01

    Full Text Available Laparoscopic surgery has been demonstrated as a valid approach in almost all gynaecologic procedures including malignant diseases. Benefits of the minimally invasive approach over traditional open surgery have been well demonstrated in terms of minimal perioperative morbidity and reduced postoperative pain and hospital stay duration, with consequent quick postoperative recovery (Medeiros et al. (2009. Single-port surgery resurfaced in gynaecology surgery in recent years and renewed interest among other surgeons and within the industry to develop this field (Podolsky et al. (2009. Patient satisfaction is emerging as an increasingly important measure of quality which represents a complex entity that is dependent on patient demographics, comorbidities, disease, and, to a large extent, patient expectations (Tomlinson and Ko (2006. It can be broadly thought to refer to all relevant experiences and processes associated with health care delivery (Jackson et al. (2001. In this study we aim to compare single-port surgery (SPS with conventional laparoscopy in terms of patient satisfaction using the EORTC IN-PATSAT32 questionnaire. We also evaluate the main surgical outcomes of both minimally invasive approaches.

  6. Microlaparoscopy versus conventional laparoscopy in transperitoneal pyeloplasty.

    Science.gov (United States)

    Benson, Aaron D; Juliano, Trisha M; Viprakasit, Davis P; Herrell, S Duke

    2014-12-01

    Laparoscopic pyeloplasty has emerged as the gold standard for repair of ureteropelvic junction obstruction. Microlaparoscopic (MLP, MLP, using a 5-mm camera in a hidden umbilical incision, and 1.9 or 3 mm working instruments and compared with patients undergoing conventional laparoscopic pyeloplasty (CLP). The data for MLP and CLP were compared using the Student t test, Pearson chi-square test, and Fisher exact test, where appropriate. Between January 2009 and May 2013, there were 19 MLP and 27 CLP procedures performed. The MLP group mean age was younger than the CLP group (34 vs 50 years; P=0.0003). Body mass index, previous treatment rates, operative time, length of stay, ureteral stent duration, and complication rates were not statistically different between the MLP and CLP groups. Strict success rates (indicated by follow-up renal scan T½MLP and CLP groups (89.5% vs 88.9%; P=0.95). No MLP procedures were converted to CLP or open approaches. From technical, perioperative, and outcome perspectives, transperitoneal pyeloplasty with microlaparoscopy is both safe and feasible in our hands compared with conventional laparoscopy, and results in subjectively superior cosmesis. This is the largest MLP series to date and contains, to our knowledge, the only cases described using prototype 1.9 mm instruments.

  7. [A retrospective controlled clinical study of single-incision plus one port laparoscopic surgery for sigmoid colon and upper rectal cancer].

    Science.gov (United States)

    Li, G X; Li, J M; Wang, Y N; Deng, H J; Mou, T Y; Liu, H

    2017-07-01

    Objective: To evaluate the short-term and oncologic outcomes of single-incision plus one port laparoscopic surgery (SILS+ 1) for sigmoid colon and upper rectal cancer. Methods: The clinic data of 46 patients with sigmoid colon and upper rectal cancer underwent SILS+ 1 at Department of General Surgery, Nanfang Hospital, Southern Medical University from September 2013 to September 2014 were retrospectively reviewed (SILS+ 1 group). After generating 1∶1 ration propensity scores given the covariates of age, gender, body mass index, American Society of Anesthesiologists score, surgeons, tumor location, the distance of tumor from anal, tumor diameter, and pathologic TNM stage, 46 patients with sigmoid colon and upper rectal cancer underwent conventional laparoscopic surgery (CLS) in the same time were matched as CLS group. The baseline characteristics and short-term outcomes were compared using t test, χ(2) test or Wilcoxon signed ranks test. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of disease free survival. Results: The two study groups were well balanced with respect to the baseline characteristics of the propensity score derivation model. As compared to the CLS group, patients in SILS+ 1 group had a smaller incision ((6.9±1.1) cm vs . (8.4±1.2) cm, t =6.502, P =0.000), less estimated blood loss (20(11) ml vs . 50(30) ml, Z =2.414, P =0.016), shorter intracorporeal operating time ((67.0±25.8) minutes vs . (75.5±27.7) minutes, t =2.062, P =0.042) and significantly faster recovery course including shorter time to first ambulation ((46.7±20.3) hours vs . (78.6±28.0) hours, t =6.255, P =0.000), shorter time to first oral diet ((64.7±28.8) hours vs . (77.1±30.0) hours, t =2.026, P =0.047), shorter time of postoperative hospital stay ((7.8±2.2) days vs . (6.5±2.2) days, t =2.680, P =0.009), and lower postoperative visual analogue scale scores ( F =4.721, P =0.032). No significant difference was observed in total operating

  8. Laparoscopy in cholecysto-choledocholithiasis

    NARCIS (Netherlands)

    van Dijk, A. H.; Lamberts, M.; van Laarhoven, C. J. H. M.; Drenth, J. P. H.; Boermeester, M. A.; de Reuver, P. R.

    2014-01-01

    Gallstone disease is one of the most common problems in the gastroenterology and is associated with significant morbidity. It may present as stones in the gallbladder (cholecystolithiasis) or in the common bile duct (choledocholithiasis). At the end of the 1980s laparoscopy was introduced and first

  9. Sexual function and quality of life following retropubic TVT and single-incision sling in women with stress urinary incontinence: results of a prospective study.

    Science.gov (United States)

    Naumann, Gert; Steetskamp, Joscha; Meyer, Mira; Laterza, Rosa; Skala, Christine; Albrich, Stefan; Koelbl, Heinz

    2013-05-01

    The objective of this prospective cohort study was to compare effectiveness, morbidity, quality of life (QoL) and sexual function in women treated with tension-free vaginal tape (TVT) versus single-incision sling (SIS) in the treatment of female stress urinary incontinence (SUI). Retropubic TVT sling or SIS was implanted in local anesthesia and patients were followed post-operatively for 6 months. Evaluation was performed to assess post-operative rate of continence, complications, changes in sexual function and patient reported quality of life. Female sexual function was evaluated before and after sling procedure using Female Sexual Function Index (FSFI) in sexually active patients. From January 2009 to December 2011, 150 patients were enrolled and underwent a procedure to implant the retropubic TVT (n = 75) or the MiniArc(®) and Ajust(®) SIS (n = 75). Overall, 93.3 % of the patients who successfully received SIS demonstrated total restoration (84 %) or improvement of continence (9.3 %) at the 6 month post-operative study visit. In TVT group we found 88 % total continence and 6.7 % improvement, respectively. Improvements were seen in the QoL scores related to global bladder feeling (89.3 %) in SIS group and 96 % for TVT. Post-operative FSFI score improves significantly and were comparable in both groups (SIS pre-operative 24.30 ± 4.56 to 27.22 ± 4.66 (P TVT 24.63 ± 6.62 to 28.47 ± 4.41, respectively). The SIS procedure appears to be as effective in improving incontinence-related quality of life and sexual function as the TVT through 6 months of post-operative follow-up. No differences in complications and sexual function were demonstrated between the groups.

  10. Effects of Reiki on Pain and Vital Signs When Applied to the Incision Area of the Body After Cesarean Section Surgery: A Single-Blinded, Randomized, Double-Controlled Study.

    Science.gov (United States)

    Sagkal Midilli, Tulay; Ciray Gunduzoglu, Nazmiye

    This study was conducted to determine the effects of Reiki on pain and vital signs when applied for 15 minutes to the incision area of the body after cesarean section surgery. The study was single-blinded, randomized, and double-controlled (Reiki, sham Reiki, and control groups). Forty-five patients, equalized by age and number of births, were randomly assigned to the Reiki, sham Reiki, and control groups. The treatment, which was applied to the patients in these 3 groups, was applied for 15 minutes to the incision area of body in the first 24 and 48 hours after the operation within 4 to 8 hours of the application of standard analgesics. The study data were collected using a patient follow-up form and a visual analog scale. Mean visual analog scale measurement values were significantly different from each other according to groups and times (P Reiki group patients between day 1 pre-tx and after application on the second day (day 2 post-tx) measurements. Mean breathing rate and systolic blood pressure measurement values were significantly different from each other according to groups (P Reiki group was observed to use fewer analgesics throughout the study and to need them after a longer time than the sham Reiki and control groups (P Reiki applied for 15 minutes to the incision area after a cesarean operation had the expected effects on pain and the need for the use of analgesics, but it had no effect on vital signs.

  11. Development of urologic laparoscopy in Germany, Austria, and Switzerland: a survey among urologists.

    Science.gov (United States)

    Imkamp, Florian; Herrmann, Thomas R W; Stolzenburg, Jens U; Rassweiler, Jens; Sulser, Tullio; Zimmermann, Uwe; Dziuba, Sebastian; Kuczyk, Markus A; Burchardt, Martin

    2014-12-01

    Laparoscopy introduction has dramatically changed urology. Novel techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES), might also have substantial influence. This 2012 survey evaluated present laparoscopy use, its appraisal among urologic surgeons, laparoscopy training, and use of new techniques. Results were compared to the previous surveys, demonstrating the 10-year development of laparoscopy. A detailed questionnaire regarding demographic data, laparoscopy use, attitudes concerning laparoscopy, and novel techniques was send to 424 departments in Germany, Austria, and Switzerland. Procedures performed in 25 indications were quantitatively evaluated. The response rate was 63 % (269). Eighty-six percent of the respondents reported performing laparoscopy, compared to 54 % in 2002. Only 16 % expected economic advantages with laparoscopy, whereas 67 % expected shorter hospitalization. Seventy percent of responders anticipated comparable functional and oncological results between laparoscopic procedures and open surgery. Slow learning curves (81 %) and insufficient training facilities (32 %) were reported to impair laparoscopic surgery. On average, laparoscopic and non-laparoscopic surgical teams consisted of 2.5 and 3.5 members, respectively. LESS procedures were performed at 15 % of institutions. Twenty-two percent of respondents considered NOTES techniques valuable for future urology. Few indications (laparoscopic prostatectomies or nephrectomies) were performed frequently in specialized centers, and the rapidly increasing procedure numbers observed between 2002 and 2007 had dropped to a mild accretion. The results demonstrate broad acceptance of laparoscopy in German urologic surgery, depict the need for structured training facilities, and indicate limited impact of novel techniques (LESS and NOTES). The survey demonstrates the 10-year development of urologic laparoscopy and the broad acceptance

  12. [Role of diagnostic laparoscopy in the treatment plan of gastric cancer].

    Science.gov (United States)

    Li, Haojie; Zhang, Qi; Chen, Ling; Min, Lingqiang; Wang, Xuefei; Liu, Fenglin; Sun, Yihong

    2017-02-25

    To assess the clinical value of the diagnostic laparoscopy in choosing treatment strategies for patients with gastric cancer. Retrospective analysis was performed on clinical and pathological data collected from 2 023 patients undergoing gastric cancer surgery in the Zhongshan Hospital of Fudan University from 2009 to 2014. All the patients were diagnosed as gastric cancer by endoscopic biopsy and staged by imaging examination before surgery. During the diagnostic laparoscopy procedure, a small periumbilical incision was made and a pneumoperitoneum with CO 2 under 10-15 mmHg was established through a port. A 10 mm trocar was put in, and the camera was inserted. Two 5 mm trocars were put in two ports which located in midclavicular line two fingers under the left and right costal margin and then the instruments were inserted. A thorough inspection included ascites, the abdominal cavity, liver, diaphragm, spleen, greater omentum, colon, small intestine, mesentery, adnexa (female) and pelvic floor. If the tumor located at the posterior part of the stomach, the gastrocolic ligament was opened in order to look for carcinomatosis in the omental bursa. The accuracy rate of diagnostic laparoscopy in diagnosing adjacent organ invasion and intra-abdominal metastasis was calculated, and the rate of adjusting treatment plans after diagnostic laparoscopy was also calculated. There were 52.7%(1 067/2 023) of patients underwent diagnostic laparoscopy. The accuracy rate of diagnostic laparoscopy in evaluating adjacent organ invasion and intra-abdominal metastasis were 98.3%(1 049/1 067) and 98.1%(1 047/1 067) respectively. Besides, 14 patients with stage T4b and 32 with intra-abdominal metastasis, which were missed by imaging examination, were diagnosed by diagnostic laparoscopy. The treatment plans of 9.3% (99/1 067) of patients were changed after diagnostic laparoscopy, and 65 (6.1%) cases of non-therapeutic laparotomy were avoided. However, 18 cases of adjacent organ invasion

  13. Laparoscopy in the acute abdomen.

    Science.gov (United States)

    Navez, Benoit; Navez, Julie

    2014-02-01

    Laparoscopy has become a routine procedure in the management of acute abdominal disease and can be considered both an excellent therapeutic and additional diagnostic tool in selected cases. However, a high level of expertise in laparoscopic and emergency surgery is required. Hemodynamic instability, huge abdominal distension, fecal peritonitis and perforated cancer are relative contraindications for the laparoscopic approach. In recent years, abdominal emergencies have increasingly been managed successfully by laparoscopy. In acute appendicitis, acute cholecystitis and perforated peptic ulcer, randomized controlled trials have proven that the laparoscopic approach is as safe and as effective as open surgery, with fewer complications and a quicker postoperative recovery. Other indications such as blunt and penetrating trauma to the abdomen, small bowel occlusion and perforated diverticular disease are under debate, indicating that more randomized controlled trials comparing laparoscopic and open surgery are still necessary. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Laparoscopy in cholecysto-choledocholithiasis.

    Science.gov (United States)

    van Dijk, A H; Lamberts, M; van Laarhoven, C J H M; Drenth, J P H; Boermeester, M A; de Reuver, P R

    2014-02-01

    Gallstone disease is one of the most common problems in the gastroenterology and is associated with significant morbidity. It may present as stones in the gallbladder (cholecystolithiasis) or in the common bile duct (choledocholithiasis). At the end of the 1980s laparoscopy was introduced and first laparoscopic cholecystectomy was performed in 1985. The laparoscopic technique for removing the gallbladder is the current treatment of choice, although indications for open surgery exist. To perform laparoscopic cholecystectomy as safe as possible multiple safety measures were developed. The gold standard for diagnosing and removing common bile duct stones is Endoscopic Retrograde Cholangiopancreatography (ERCP). The surgical treatment option for choledocholithiasis is laparoscopic cholecystectomy with common bile duct exploration. If experience is not available, than ERCP followed by elective cholecystectomy is by far the best therapeutic modality. The present review will discuss the use, benefits and drawbacks of laparoscopy in patients with cholecystolithiasis and choledocholithiasis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Three-dimensional laparoscopy vs 2-dimensional laparoscopy with high-definition technology for abdominal surgery

    DEFF Research Database (Denmark)

    Fergo, Charlotte; Burcharth, Jakob; Pommergaard, Hans-Christian

    2017-01-01

    BACKGROUND: This systematic review investigates newer generation 3-dimensional (3D) laparoscopy vs 2-dimensional (2D) laparoscopy in terms of error rating, performance time, and subjective assessment as early comparisons have shown contradictory results due to technological shortcomings. DATA...

  16. Cardiorespiratory Changes and Pain Response of Lift Laparoscopy Compared to Capnoperitoneum Laparoscopy in Dogs.

    Science.gov (United States)

    Fransson, Boel A; Grubb, Tamara L; Perez, Tania E; Flores, Krystina; Gay, John M

    2015-07-01

    To compare intraoperative physiologic variables and post-operative pain associated with lift laparoscopy and conventional capnoperitoneum laparoscopy. Prospective randomized case controlled study. Healthy dogs (n = 30). Dogs having laparoscopic ovariohysterectomy were randomly assigned to lift laparoscopy (n = 14) or capnoperitoneum (16) laparoscopy. Physiologic variables measured intraoperatively were documented. Postoperatively, pain response was assessed in a blinded fashion using the short Glasgow pain scale and von Frey filament aesthesiometry. Lift laparoscopy was associated with less frequency of hypercapnia, required less anesthetic gas, and was not more time-consuming or painful than capnoperitoneum laparoscopy. Lift laparoscopy is a feasible alternative to capnoperitoneum laparoscopy, especially in dogs where pressurized capnoperitoneum is not desired. © Copyright 2014 by The American College of Veterinary Surgeons.

  17. Telerobotics surgery in a transatlantic experiment: application in laparoscopy

    Science.gov (United States)

    Rovetta, Alberto; Sala, Remo; Cosmi, Francesca; Wen, Xia; Sabbadini, Dario; Milanesi, Santo; Togno, Arianna; Angelini, Licinio; Bejczy, Antal K.

    1993-12-01

    This paper describes the significance in human, scientific, and technical terms of the first experiment of robotic telesurgery effected between the Telerobotics Laboratory of the Politecnico di Milano and the Jet Propulsion Laboratory, NASA, in Pasadena California, on 7 July 1993. An Italian surgeon controlled from the U.S. A. an Italian robot in the Telerobotics Laboratory in such a way that the robot performed a biopsy, on a model containing the organs of a pig, carrying out an aspiration of organic material and two incisions for the commencement of the surgical operation of laparoscopy. Transmission was effected by means of a double satellite link with three stations -- one in Italy, one in New York and one in Pasadena -- and two geostationary satellites, the first over the Atlantic and the second over the United States.

  18. Do soft skills predict surgical performance?: a single-center randomized controlled trial evaluating predictors of skill acquisition in virtual reality laparoscopy.

    Science.gov (United States)

    Maschuw, K; Schlosser, K; Kupietz, E; Slater, E P; Weyers, P; Hassan, I

    2011-03-01

    Virtual reality (VR) training in minimal invasive surgery (MIS) is feasible in surgical residency and beneficial for the performance of MIS by surgical trainees. Research on stress-coping of surgical trainees indicates the additional impact of soft skills on VR performance in the surgical curriculum. The aim of this study was to evaluate the impact of structured VR training and soft skills on VR performance of trainees. The study was designed as a single-center randomized controlled trial. Fifty first-year surgical residents with limited experience in MIS ("camera navigation" in laparoscopic cholecystectomy only) were randomized for either 3 months of VR training or no training. Basic VR performance and defined soft skills (self-efficacy, stress-coping, and motivation) were assessed prior to randomization using basic modules of the VR simulator LapSim(®) and standardized psychological questionnaires. Three months after randomization VR performance was reassessed. Outcome measurement was based on the results derived from the most complex of the basic VR modules ("diathermy cutting") as the primary end point. A correlation analysis of the VR end-point performance and the psychological scores was done in both groups. Structured VR training enhanced VR performance of surgical trainees. An additional correlation to high motivational states (P trained intervention group (P > 0.05). Low self-efficacy and negative stress-coping strategies seem to predict poor VR performance. However, structured training along with high motivational states is likely to balance out this impairment.

  19. Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures.

    Science.gov (United States)

    Pontis, Alessandro; Sedda, Federica; Mereu, Liliana; Podda, Mauro; Melis, Gian Benedetto; Pisanu, Adolfo; Angioni, Stefano

    2016-09-01

    To critically appraise published randomized controlled trials (RCTs) comparing laparo-endoscopic single site (LESS) and multi-port laparoscopic (MPL) in gynecologic operative surgery; the aim was to assess feasibility, safety, and potential benefits of LESS in comparison to MPL. A systematic review and meta-analysis of eleven RCTs. Women undergoing operative LESS and MPL gynecologic procedure (hysterectomy, cystectomy, salpingectomy, salpingo-oophorectomy, myomectomy). Outcomes evaluated were as follows: postoperative overall morbidity, postoperative pain evaluation at 6, 12, 24 and 48 h, cosmetic patient satisfaction, conversion rate, body mass index (BMI), operative time, blood loss, hemoglobin drop, postoperative hospital stay. Eleven RCTs comprising 956 women with gynecologic surgical disease randomized to either LESS (477) or MPL procedures (479) were analyzed systematically. The LESS approach is a surgical procedure with longer operative and better cosmetic results time than MPL but without statistical significance. Operative outcomes, postoperative recovery, postoperative morbidity and patient satisfaction are similar in LESS and MPL. LESS may be considered an alternative to MPL with comparable feasibility and safety in gynecologic operative procedures. However, it does not offer the expected advantages in terms of postoperative pain and cosmetic satisfaction.

  20. Modified tubularized incised plate urethroplasty

    Directory of Open Access Journals (Sweden)

    Shivaji Mane

    2013-01-01

    Full Text Available Aim: To share our experience of doing tubularized incised plate urethroplasty with modifications. Materials and Methods: This is a single surgeon personal series from 2004 to 2009. One hundred patients of distal hypospadias were subjected for Snodgrass urethroplasty with preputioplasty. The age range was 1 to 5 year with mean age of 2.7 years. Selection criteria were good urethral plate, without chordee and torsion needing complete degloving. Main technical modification from original Snodgrass procedure was spongioplasty, preputioplasty, and dorsal slit when inability to retract prepuce during surgery. Results: Average follow-up period is 23 months. Seven (7% patients developed fistula and one patient had complete preputial dehiscence. Phimosis developed in three (3% patients and required circumcision. Dorsal slit was required in seven patients. One patient developed meatal stenosis in postoperative period. All other patients are passing single urinary stream and have cosmesis that is acceptable. Conclusions: Modified tubularized incised plate urethroplasty with preputioplasty effectively gives cosmetically normal looking penis with low complications.

  1. Hypospadias and concomitant undescended testis: Comparison of no skin incision with inguinal and scrotal skin incision orchiopexy.

    Science.gov (United States)

    Sabetkish, Shabnam; Kajbafzadeh, Abdol-Mohammad; Sabetkish, Nastaran

    2015-10-01

    To present the feasibility of no skin incision orchiopexy in children with concomitant hypospadias and undescended testis (UDT) by a single subcoronal incision technique. To introduce the creation of subdartos muscle scrotal pouch with no scrotal skin incision. From one thousand and twenty-one children with hypospadias, 61 patients presented with concomitant palpable UDT and hypospadias. In group I (N = 34) single subcoronal incision with no scrotal skin incision was applied. In group II (N = 27), multi-incision technique was applied for classical orchiopexy and hypospadias surgery. For hypospadias reconstruction, all patients had classical subcoronal and para urethral plate incision with penile skin degloving according to the location of urethral meatus. Early and late complications, surgical time, hospital stay, and cosmetic results were recorded. Children with unilateral UDT and hypospadias had one incision in group I and three skin incisions in group II. Patients with bilateral UDT had one incision in group I and five skin incisions in group II. The operation time was significantly shorter in group I (93 ± 11 min) compared with group II (138 ± 17 min) (P = 0.03). Both groups were operated as day care basis; however, the hospital stay was slightly longer in group II (group I = 12 ± 2 h, vs group II = 16 ± 3 h) (P = 0.07). All testes were satisfactorily positioned into the bottom of the scrotum without development of any testicular atrophy. Single subcoronal penile skin incision is a feasible, safe, and cosmetically satisfactory technique in patients with hypospadias and concomitant UDT. Reduced postoperative pain, better objective cosmetic results, shorter operative time and comfortable post-operative period are the most significant advantages of this approach. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  2. Video stereo-laparoscopy system

    Science.gov (United States)

    Xiang, Yang; Hu, Jiasheng; Jiang, Huilin

    2006-01-01

    Minimally invasive surgery (MIS) has contributed significantly to patient care by reducing the morbidity associated with more invasive procedures. MIS procedures have become standard treatment for gallbladder disease and some abdominal malignancies. The imaging system has played a major role in the evolving field of minimally invasive surgery (MIS). The image need to have good resolution, large magnification, especially, the image need to have depth cue at the same time the image have no flicker and suit brightness. The video stereo-laparoscopy system can meet the demand of the doctors. This paper introduces the 3d video laparoscopy has those characteristic, field frequency: 100Hz, the depth space: 150mm, resolution: 10pl/mm. The work principle of the system is introduced in detail, and the optical system and time-division stereo-display system are described briefly in this paper. The system has focusing image lens, it can image on the CCD chip, the optical signal can change the video signal, and through A/D switch of the image processing system become the digital signal, then display the polarized image on the screen of the monitor through the liquid crystal shutters. The doctors with the polarized glasses can watch the 3D image without flicker of the tissue or organ. The 3D video laparoscope system has apply in the MIS field and praised by doctors. Contrast to the traditional 2D video laparoscopy system, it has some merit such as reducing the time of surgery, reducing the problem of surgery and the trained time.

  3. [Diagnostic laparoscopy in acute abdomen].

    Science.gov (United States)

    Keller, R; Kleemann, M; Hildebrand, P; Roblick, U J; Bruch, H-P

    2006-11-01

    Acute abdomen is not a disease in itself but a description of a complex of symptoms combined with severe abdominal pain developed within a time frame of less than 24 h. All strategies for the management of acute abdomen underline the need for an interdisciplinary approach to diagnosis and therapy. This requires focused and intelligent use of efficient diagnostic procedures. Diagnostic laparoscopy may be a key to solving the diagnostic dilemma of unspecific acute abdomen. Furthermore, it allows not only direct inspection of the abdominal cavity but also surgical intervention, if needed. In particular the rate of negative laparotomies can be reduced.

  4. Single-port versus conventional multiport access prophylactic laparoscopic bilateral salpingo-oophorectomy in high-risk patients for ovarian cancer: a comparison of surgical outcomes

    Directory of Open Access Journals (Sweden)

    Angioni S

    2015-06-01

    Full Text Available Stefano Angioni,1 Alessandro Pontis,1 Federica Sedda,1 Theodoros Zampetoglou,2 Vito Cela,3 Liliana Mereu,4 Pietro Litta51Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; 2Obstetrics and Gynecology, Iaso Thessalia Hospital, Larissa, Greece; 3Department of Obstetrics and Gynecology, University of Pisa, Pisa, 4Ospedale S Chiara, Trento, 5Department of Obstetrics and Gynecology, University of Padua, Padua, ItalyAbstract: Bilateral salpingo-oophorectomy (BSO in carriers of BRCA1 and BRCA2 mutations is widely recommended as part of a risk-reduction strategy for ovarian or breast cancer due to an underlying genetic predisposition. BSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. BSO may be performed via a minimally invasive approach with the use of three to four 5 mm and/or 12 mm ports inserted through a skin incision. To further reduce the morbidity associated with the placement of multiple port sites and to improve cosmetic outcomes, single-port laparoscopy has been developed with a single access point from the umbilicus. The purpose of this study was to evaluate the surgical outcomes associated with reducing the risks of salpingo-oophorectomy performed in a single port, while comparing multiport laparoscopy in women with a high risk for ovarian cancer. Single-port laparoscopy–BSO is feasible and safe, with favorable surgical and cosmetic outcomes when compared to conventional laparoscopy.Keywords: prophylactic salpingectomy, single-port access laparoscopy, BRCA carriers

  5. Hypoxaemia During Gynaecological Laparoscopy Under Local ...

    African Journals Online (AJOL)

    Conclusion: A significant degree of desaturation occurs during gynaecologic laparoscopy under pentazocine and diazepam sedation. It is recommended that oxygen should be administered to all patients during the procedure. Key Words: Gynaecological Laparoscopy, Sedation, Hypoxaemia. [Trop J Obstet Gynaecol, 2002, ...

  6. Reoperation for recurrent hepatolithiasis: laparotomy versus laparoscopy.

    Science.gov (United States)

    Pu, Qingfan; Zhang, Chuanrong; Huang, Zhenfeng; Zeng, Yu

    2017-08-01

    Laparoscopy has been proposed for the management of recurrent hepatolithiasis, but no comparative study of its relative efficacy versus laparotomy has been performed, and the patient selection criteria for laparoscopy are not clear. This study aimed to investigate the therapeutic effect of laparoscopy versus laparotomy for repeated hepatolithiasis and to highlight how to select patients best suited for laparoscopy. We performed a cohort study of 94 patients who underwent laparotomy or laparoscopy for recurrent hepatolithiasis between January 2010 and May 2014. The clinical data of 53 patients who underwent open biliary exploration (laparotomy group) and 41 patients who underwent laparoscopic biliary exploration (laparoscopy group) for recurrent hepatolithiasis were retrospectively analyzed and compared. Intestinal adhesions to the porta hepatis occurred in 62 (66%) patients. There was no difference in operating time between the two groups. In comparing the laparoscopic group versus the laparotomy group, the intraoperative blood loss was less (P = .001), the incidence of postoperative ascites (9.8 vs. 30.2%, P = .016) and/or pleural effusion (7.3 vs. 28.3%, P = .010) was lower, and the stone clearance rates were comparable. Wound morbidity appeared peculiarly in 15 (28.3%) patients among the laparotomy group. The postoperative hospital stay in the laparoscopy group was shorter than that in the laparotomy group (P = .000). Laparoscopy is a safe and effective treatment for recurrent hepatolithiasis patients who are scheduled for bile duct exploration.

  7. The mandibular incisive foramen.

    OpenAIRE

    Serman, N J

    1989-01-01

    An anatomical variant in the region of the mental foramen is discussed. In these cases the inferior alveolar nerve divides into its two terminal branches only after it has exited through the mental foramen. The incisive nerve thus commences outside the mandible, and has a short extra-osseous course before it enters the mandible through a separate foramen on the same horizontal plane. For the distance between these two foramina there is no nerve supply within the mandible. The groove between t...

  8. Tissue identification during Pneumoperitoneum in laparoscopy

    Science.gov (United States)

    Chang, Yin; Tseng, Chi-Yang

    2015-03-01

    Pneumoperitoneum is the beginning procedure of laparoscopy to enlarge the abdominal cavity in order to allow the surgical instruments to insert for surgical purpose. However, the insertion of Veress needle is a blind fashion that could cause blood vessels or visceral injury without attention and results in undetectable internal bleeding. Seriously it may cause a life-threatened complication. We have developed a method that can monitor the tissue reflective spectrum, which can be used for tissue discrimination, in real time during the puncture of the Veress needle. The system includes a modified Veress needle which containes an optical bundle, a light spectrum analyzing and control unit. Therefore, the tissue reflective spectrum can be vivid observed and analyzed through the fiber optical technology during the procedure of the Veress needle insertion. In this study, we have measured the reflective spectra of various porcine abdominal tissues. The features of their spectra were analyzed and characterized to build up the data base and create an algorithm for tissue discrimination in laparoscopy. The results showed that the correlation coefficient (r) of the reflective spectrum can be 0.79-0.95 for the wavelength range of 350-1000 nm and 0.85-0.98 for the wavelength range of 350-650 nm in the same tissue of various samples which were obtained from different days. An alternative way for tissue discrimination is achieved through a decision making tree according to the characteristics of tissue spectrum. For single blind test the success rate is nearly 100%. It seems that both the algorithms mentioned above for tissue discrimination are all very promising. Therefore, these algorithms will be applied to in vivo study in animal in the near future.

  9. Two-Step Incision for Periarterial Sympathectomy of the Hand.

    Science.gov (United States)

    Jeon, Seung Bae; Ahn, Hee Chang; Ahn, Yong Su; Choi, Matthew Seung Suk

    2015-11-01

    Surgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire. A total of 40 patients (17 men and 23 women) with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS) and the Wake Forest University rating scale. The total patient score was 8.59 (range, 6-15) in the two-step incision group and 9.62 (range, 7-18) in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034) but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03). Compared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

  10. Two-Step Incision for Periarterial Sympathectomy of the Hand

    Directory of Open Access Journals (Sweden)

    Seung Bae Jeon

    2015-11-01

    Full Text Available BackgroundSurgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire.MethodsA total of 40 patients (17 men and 23 women with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS and the Wake Forest University rating scale.ResultsThe total patient score was 8.59 (range, 6-15 in the two-step incision group and 9.62 (range, 7-18 in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034 but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03.ConclusionsCompared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

  11. Nipple-sparing mastectomy using a hemi-periareolar incision with or without minimal medial-lateral extensions; clinical outcome and patient satisfaction: A single centre prospective observational study.

    Science.gov (United States)

    El Hage Chehade, Hiba; Headon, Hannah; Wazir, Umar; Carmaichael, Amtul R; Choy, Christina; Kasem, Abdul; Mokbel, Kefah

    2017-06-01

    Nipple-sparing mastectomy (NSM) is becoming a viable oncoplastic option. There is debate regarding the best approach that balances oncological safety with aesthetics. In this study, we describe an approach involving a hemi-periareolar incision and evaluate its safety and outcomes. Patients treated at single center between 2012 and 2015 were observed prospectively. After a histologically negative subareolar biopsy, immediate reconstruction with implant and acellular dermal matrix was performed after NSM. Primary end points were wound complications and explantation. Secondary end points included local recurrence, quality of life, patient satisfaction, and esthetic outcome. Sixty-three patients were included with 92 procedures. Twenty-seven percent received chemotherapy and 12.7% received radiotherapy. Mean follow-up was 27.6 months. There were only 2 wound complications, and no recurrences. Mean outcome scores were promising (Breast Q = 88%, subjective esthetic = 9.2, objective esthetic = 9.3, hardening = 2.6). NSM via a hemi-periareolar incision is oncologically safe with a low-complication rate and high patients' satisfaction. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Robotic-assisted laparoscopy vs conventional laparoscopy for the treatment of advanced stage endometriosis.

    Science.gov (United States)

    Nezhat, Camran R; Stevens, Amanda; Balassiano, Erika; Soliemannjad, Rose

    2015-01-01

    To compare robotic-assisted laparoscopy with conventional laparoscopy for treatment of advanced stage endometriosis insofar as operative time, estimated blood loss, complication rate, and length of hospital stay. Retrospective cohort study (Canadian Task Force classification II2). All procedures were performed by one surgeon between January 2004 and July 2012. Data was collected via chart review. Tertiary referral center for treatment of endometriosis. Four hundred twenty women with advanced endometriosis. Fertility-sparing surgery to treat advanced endometriosis, either via conventional or robotic-assisted laparoscopy. Patient demographic data, operative time, estimated blood loss, complication rate, and length of hospital stay were compared between the 2 groups. Two hundred seventy-three patients underwent conventional laparoscopy and 147 patients underwent robotic-assisted laparoscopy for fertility-sparing treatment of advanced stage endometriosis. Patients in both groups had similar characteristics insofar as age, body mass index, and previous abdominal surgeries. There were no significant differences in blood loss or complication rate between the 2 groups. Mean operative time in the conventional laparoscopy group was 135 minutes (range, 115-156 minutes), and in the robotic-assisted laparoscopy group was 196 minutes (range, 185-209 minutes), with a mean difference in operative time of 61 minutes (p laparoscopy group. Most patients who underwent conventional laparoscopy were discharged to home on the day of surgery. Of 273 patients in the conventional laparoscopy group, only 63 remained in the hospital overnight, and all 147 patients in the robotic-assisted laparoscopy group were discharged on postoperative day 1. Conventional laparoscopy and robotic-assisted laparoscopy are excellent methods for treatment of advanced stages of endometriosis. However, use of the robotic platform may increase operative time and might also be associated with longer hospital stay

  13. Esophageal-gastric anastomosis in radical resection of esophageal cancer under thoracoscopy combined with laparoscopy.

    Science.gov (United States)

    Hao, Zhang; Zhenya, Shen; Lei, Wang

    2014-10-01

    To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Experimental study. Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed.

  14. Esophageal - Gastric Anastomosis in Radical Resection of Esophageal Cancer under Thoracoscopy Combined with Laparoscopy

    International Nuclear Information System (INIS)

    Hao, Z.; Lei, W.; Zhenya, S.

    2014-01-01

    Objective: To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Study Design: Experimental study. Place and Duration of Study: Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Methodology: Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. Results: The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. Conclusion: The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed. (author)

  15. Outcomes of minimally invasive lung transplantation in a single centre: the routine approach for the future or do we still need clamshell incision?

    Science.gov (United States)

    Marczin, Nandor; Popov, Aron-Frederik; Zych, Bartlomiej; Romano, Rosalba; Kiss, Rudolf; Sabashnikov, Anton; Soresi, Simona; De Robertis, Fabio; Bahrami, Toufan; Amrani, Mohamed; Weymann, Alexander; McDermott, Grainne; Krueger, Heike; Carby, Martin; Dalal, Paras; Simon, André Ruediger

    2016-05-01

    Minimally invasive lung transplantation (MILT) via bilateral anterior thoracotomies has emerged as a novel surgical strategy with potential patient benefits when compared with transverse thoracosternotomy (clamshell incision, CS). The aim of this study is to compare MILT with CS by focusing on operative characteristics, postoperative organ function and support and mid-term clinical outcomes at Harefield Hospital. It was a retrospective observational study evaluating all bilateral sequential lung transplants between April 2010 and November 2013. CS was performed in 124 patients and MILT in 70 patients. Skin-to-skin surgical time was less in the MILT group [285 (265, 339) min] compared with CS [380 (306, 565) min] and MILT-cardiopulmonary bypass [426 (360, 478) min]. Ischaemic time was significantly longer (502 ± 116 vs 395 ± 145 min) in the MILT group compared with CS (P mechanical ventilation was shorter (26 vs 44 h, P benefits compared with our traditional approach of clamshell operations. These observations warrant larger definite studies to further evaluate the impact of MILT on physiological, clinical and patient-reported outcomes. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. Advances in Pediatric Urologic Laparoscopy

    Directory of Open Access Journals (Sweden)

    M. C. Smaldone

    2007-01-01

    Full Text Available The spectrum of laparoscopic surgery in children has undergone a dramatic evolution. Initially used as a diagnostic modality for many pediatric urologists, complex as well as reconstructive procedures are now being performed laparoscopically. Laparoscopic orchiopexy and nephrectomy are well established and are being performed at many centers. Laparoscopic partial nephrectomy, adrenalectomy, and dismembered pyeloplasty series have reported shortened hospital stays and operative times that are comparable to that of open techniques or are decreasing with experience. The initial experiences with laparoscopic ureteral reimplantation and laparoscopic-assisted bladder reconstructive surgery have been described, reporting encouraging results with regards to feasibility, hospital stay, and cosmetic outcome. This report will provide a directed review of the literature to establish the current indications for laparoscopy in pediatric urologic surgery.

  17. The inverted Batman incision: a new incision in transcolumellar incision for open rhinoplasty.

    Science.gov (United States)

    Nakanishi, Yuji; Nagasao, Tomohisa; Shimizu, Yusuke; Miyamoto, Junpei; Fukuta, Keizo; Kishi, Kazuo

    2013-12-01

    Columellar and nostril shapes often present irregularity after transcolumellar incision for open rhinoplasty, because of the contracture of the incised wound. The present study introduces a new technique to prevent this complication, and verifies its efficacy in improving cosmetic appearance. In our new method, a zig-zag incision with three small triangular flaps is made on the columella and in the pericolumellar regions of the bilateral nostril rims. Since the shape of the incision resembles the contour of an inverted "batman", we term our new method the "Inverted Batman" incision. To verify the effectiveness of the Inverted Batman incision, aesthetic evaluation was conducted for 21 patients operated on using the conventional transcolumellar incision (Conventional Group) and 19 patients operated on using the Inverted Batman incision (Inverted Batman Group). The evaluation was performed by three plastic surgeons, using a four-grade scale to assess three separate items: symmetry of bilateral soft triangles, symmetry of bilateral margins of the columella, and evenness of the columellar surface. The scores of the two groups for these three items were compared using a non-parametric test (Mann-Whitney U-test). With all three items, the Inverted Batman group patients present higher scores than Conventional Group patients. The Inverted Batman incision is effective in preserving the correct anatomical structure of the columella, soft triangle, and nostril rims. Hence, we recommend the Inverted Batman incision as a useful technique for open rhinoplasty.

  18. [Laparoendoscopic single-site surgery in gynecology: the situation in 2013].

    Science.gov (United States)

    Rabischong, B; Compan, C; Savary, D; Bourdel, N; Canis, M; Mage, G; Botchorishvili, R

    2013-09-01

    Single-incision laparoscopic surgery (SILS) is a recent technic of minimally invasive surgery that arouses a growing interest due to its potential benefits in terms of pain and cosmetic. However, in gynecology as well as in other surgical specialties, preliminary results seem to be controversial. Its feasibility and interest by comparison with conventional laparoscopy (CL) have not been confirmed by randomized multicenter studies. Compare in gynecological surgery, feasibility and surgical outcomes (conversion rate and complications, postoperative pain, duration of surgery, length of hospital stay, appearance and cost) between SILS and CL. For this, a review of the literature from a PUBMED and Medline databases was conducted. The clinical cases and series with fewer than 10 patients were excluded. Eligible data were compared and analyzed. A total of 46 studies including five prospective randomized were studied in gynecology. Conversion rates and complications appear identical to those of the CL. The learning curve is also comparable. The technique is not standardized and some ergonomic problems are described. Operating time and duration of hospitalization seems to be comparable. The postoperative pain assessment found conflicting results. The cosmetic results are in favor of the single incision laparoscopy. Finally, the cost is higher. According to the literature, the single incision laparoscopy seems feasible and safe, with better cosmetic results. But the cost is increased and associated with no benefit in terms of pain, operating time and duration of hospitalization. Beyond cosmetics results, further randomized studies are needed to identify a possible benefit. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. Laparoscopic single port surgery in children using Triport: our early experience.

    Science.gov (United States)

    de Armas, Ismael A Salas; Garcia, Isabella; Pimpalwar, Ashwin

    2011-09-01

    Laparoscopy has become the gold standard technique for appendectomy and cholecystectomy. With the emergence of newer laparoscopic instruments which are roticulating and provide 7 degrees of freedom it is now possible to perform these operations through a single umbilical incision rather than the standard 3-4 incisions and thus lead to more desirable cosmetic results and less postoperative pain. The newer reticulating telescopes provide excellent exposure of the operating field and allow the operations to proceed routinely. Recently, ports [Triports (Olympus surgery)/SILS ports] especially designed for single incision laparoscopic surgery (SILS) have been developed. We herein describe our experience with laparoscopic single port appendectomies and cholecystectomies in children using the Triport. This is a retrospective cohort study of children who underwent single incision laparoscopic surgery between May 2009 and August 2010 at Texas Children's Hospital and Ben Taub General Hospital in Houston Texas by a single surgeon. Charts were reviewed for demographics, type of procedure, operative time, early or late complications, outcome and cosmetic results. Fifty-four patients underwent SILS. A total of 50 appendectomies (early or perforated) and 4 cholecystectomies were performed using this new minimally invasive approach. The average operative time for SILS/LESS appendectomy was 54 min with a range between 25 and 205 min, while operative time for SILS cholecystectomy was 156 min with a range of 75-196 min. Only small percentage (4%) of appendectomies (mostly complicated) were converted to standard laparoscopy, but none were converted to open procedure. All patients were followed up in the clinic after 3-4 weeks. No complications were noted and all patients had excellent cosmetic results. Parents were extremely satisfied with the cosmetic results. SILS/LESS is a safe, minimally invasive approach for appendectomy and cholecystectomy in children. This new approach is

  20. The fourth incision: a cosmetic autopsy incision technique.

    Science.gov (United States)

    Patowary, Amarjyoti

    2010-03-01

    Autopsy procedure includes thorough external examination as well as internal examination including opening of all the body cavities for proper visualization of all the visceral organs. As such, there remains incision marks with stitches which harts the sentiment of the already traumatized relatives of the deceased. Moreover, it looks odd especially in cases of otherwise healthy dead bodies. So, autopsy incisions should be such that, we can get maximum possible visualization of the body cavities, particularly the thorax and abdomen, and at the same time the incision as well as the stitch marks are also hidden. This article is aimed to describe few modifications in the autopsy incisions for opening the thorax and abdomen and also proper visualization of the neck structures during autopsy where the incisions and the stitches are kept hidden.

  1. Hysterosalpingography and laparoscopy in infertile women

    International Nuclear Information System (INIS)

    Konarzewska, J.; Bianek-Bodzak, A.; Mielcarek, P.; Kobierski, J.

    2009-01-01

    Background: Despite dynamic development of diagnostic imaging methods and endoscopic procedures, X-ray hysterosalpingography remains the basic diagnostic procedure when anatomical cause of infertility is suspected. The aim of the study was to assess the correlation between HSG results and laparoscopy findings, especially in infertile women with normal results of hysterosalpingography. Material/Methods: The results of HSG and laparoscopies performed between 2002 and 2005 years in 53 infertile women were analyzed retrospectively. The indication for HSG was primary infertility in 44 cases and secondary infertility in 9 cases.Results: The result of HSG was normal in 51%. Pathological findings were observed in 49% of HSG and in 93% of laparoscopies. The most common pathological findings observed during laparoscopy were tubal occlusion (26% cases) and endometriosis (25% cases). Polycystic ovaries and myomas were observed in 20% of the performed laparoscopies. HSG and laparoscopy yield consistent results in evaluation of tubal patency (p < 0.001). Conclusions: HSG remains the method of first choice in the diagnostics of uterine malformations and tubal diseases as causes of infertility. When mechanical factors of female infertility are suspected, HSG allows the optimal choice of more invasive procedure. (authors)

  2. Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case-control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost.

    Science.gov (United States)

    Fujii, Shoichi; Watanabe, Kazuteru; Ota, Mitsuyoshi; Watanabe, Jun; Ichikawa, Yasushi; Yamagishi, Shigeru; Tatsumi, Kenji; Suwa, Hirokazu; Kunisaki, Chikara; Taguri, Masataka; Morita, Satoshi; Endo, Itaru

    2012-05-01

    Single-incision laparoscopic surgery (SILS) has been used for colorectal cancer as a minimally invasive procedure. However, there are still difficulties concerning effective triangulation and countertraction. The study's purpose was to clarify the usefulness of the colon-lifting technique (CLT) in SILS for colorectal cancer. SILS was performed for cancer (cT2N0 or less) of the right-sided colon (near the ileocecum), sigmoid, or rectosigmoid. The SILS™ Port was used for transumbilical access. A suture string was inserted through the abdominal wall and passed through the mesocolon. The colon was retracted anteriorly and fixed to the abdominal wall. The main mesenteric vessels were placed under tension. Lymph node dissection was performed by medial approach. Short-term surgical outcomes and access port costs were compared between SILS (using CLT) and the standard multiport technique (MPT). The two groups were case-matched by propensity scoring. Analyzed variables included preoperative Dukes stage and tumor location. From June 2009 to April 2011, 27 patients underwent SILS, and from April 2005 to April 2011, 85 patients underwent MPT. Propensity scoring generated 23 matched patients per group for SILS versus MPT comparisons. There were no significant differences in operating time, blood loss, early complications, postoperative analgesic frequency, or length of hospital stay. One MPT patient was converted to open surgery (4.5%); no SILS patients were converted. There were no significant differences in the length of distal cut margin and the number of harvested lymph nodes, except incision length (SILS vs. MPT: 33 vs. 55 mm, P Japanese yen, P CLT was safe and effective in providing radical treatment of cT2N0 cancer in the right-sided colon, sigmoid, or rectosigmoid. SILS was advantageous with respect to cosmesis and lower cost of access instruments.

  3. Randomized trial of a comparison of the efficacy of TVT-O and single-incision tape TVT SECUR systems in the treatment of stress urinary incontinent women--2-year follow-up.

    Science.gov (United States)

    Masata, Jaromir; Svabik, Kamil; Zvara, Karel; Drahoradova, Petra; El Haddad, Rachid; Hubka, Petr; Martan, Alois

    2012-10-01

    The aim of this study was to compare the efficacy of the use of tension-free vaginal tape obturator (TVT-O) and single-incision TVT SECUR, hammock and U approach (TVT-S, H and U), in the treatment of urodynamic stress urinary incontinence (SUI). This single-center randomized three-arm trial compared the objective and subjective efficacy and early failure rate of the TVT-O and TVT-S H and U approach by objective criteria (cough test) and subjective criteria using the International Consultation on Incontinence Questionnaire--Short Form (ICIQ-UI SF). The objective efficacy rate was defined as the number of patients with a negative cough stress test. Subjective cure was defined by no stress leakage of urine after surgery based on the evaluation of ICIQ-UI SH (when patients ticked "Never"/"Urine does not leak" in answer to question 6: When does urine leak?). Objective and subjective efficacy were evaluated using Last Failure Carried Forward analysis, i.e., final analysis also included patients with early failure. To describe outcome at different time points, the Last Observation Carried Forward method was also implemented. One hundred ninety-seven women with proven SUI were randomized into three groups--TVT-O (n = 68), TVT-S H (n = 64), and TVT-S U (n = 65). Each patient allocated to a treatment group received the planned surgery. There were no differences in each group in preoperative characteristics. Median follow-up after surgery was 2 years (SD, 0.8; range, 0.1 to 3.8 years). Of the subjects, 92.6% in the TVT-O group, 68.8% in the TVT-S H group, and 69.2% in the TVT-S U group had negative stress test (p TVT-O group, 68.8% in the TVT-S H group, and 61.5% in the TVT-S U group were subjectively continent (p = 0.02). Our study demonstrated a significantly lower subjective and objective cure rate in the single-incision TVT group compared to the TVT-O group.

  4. Comparison of the efficacy of tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of female stress urinary incontinence: a 1-year follow-up randomized trial.

    Science.gov (United States)

    Masata, Jaromir; Svabik, Kamil; Zvara, Karel; Hubka, Petr; Toman, Ales; Martan, Alois

    2016-10-01

    The aim of this study was to compare the efficacy of the tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of stress urinary incontinence in a randomized two-arm study with a 1-year follow-up. This single-centre randomized trial compared the objective and subjective cure rates of TVT-O and Ajust using objective criteria (cough test) and subjective criteria (International Consultation on Incontinence Questionnaire short form, ICIQ-UI SF). The objective cure rate was defined as the number of patients with a negative cough stress test. Subjective cure was defined as no stress leakage of urine after surgery based on the ICIQ-UI SF. The primary outcome was to establish differences in objective and subjective cure rates between the TVT-O and Ajust groups. We also compared postoperative pain profiles using a visual analogue scale (VAS), improvement in quality of life using the ICIQ- UI SF and the Incontinence Quality of Life questionnaire, and overall satisfaction with the surgical procedure using a VAS and a five-item Likert scale. Inclusion criteria were age over 18 years, signed informed consent, and urodynamic stress urinary incontinence. Following a power calculation, 50 patients were enrolled into each group (Ajust and TVT-O). The mean follow-up after surgery was 445 days (SD 157.6 days) in the TVT-O group and 451.8 days (SD 127.6 days) in the Ajust group (p = 76.6 %). At 1 year, 47 patients were evaluated in the TVT-O group and 49 in the Ajust group. No differences in subjective cure rates or objective cure rates were observed. In the Ajust and TVT-O groups, the rates for no subjective stress leakage were 89.8 % and 91.5 %, respectively (p = 1.0, OR 1.22, 95 % CI 0.24 - 6.58), and the rates for a negative stress test were 89.8 % and 87.2 %, respectively (p = 0.76, OR 0.77, 95 % CI 0.17 - 3.32). In the Ajust group two patients reported de novo pain during sexual

  5. Three-dimensional laparoscopy: Principles and practice

    Directory of Open Access Journals (Sweden)

    Rakesh Y Sinha

    2017-01-01

    Full Text Available The largest challenge for laparoscopic surgeons is the eye–hand coordination within a three-dimensional (3D scene observed on a 2D display. The 2D view on flat screen laparoscopy is cerebrally intensive. The loss of binocular vision on a 2D display causes visual misperceptions, mainly loss of depth perception and adds to the surgeon's fatigue. This compromises the safety of laparoscopy. The 3D high-definition view with great depth perception and tactile feedback makes laparoscopic surgery more acceptable, safe and cost-effective. It improves surgical precision and hand–eye coordination, conventional and all straight stick instruments can be used, capital expenditure is less and recurring cost and annual maintenance cost are less. In this article, we have discussed the physics of 3D laparoscopy, principles of depth perception, and the different kinds of 3D systems available for laparoscopy. We have also discussed our experience of using 3D laparoscopy in over 2000 surgeries in the last 4 years.

  6. The Utility of Diagnostic Laparoscopy in Post-Bariatric Surgery Patients with Chronic Abdominal Pain of Unknown Etiology.

    Science.gov (United States)

    Alsulaimy, Mohammad; Punchai, Suriya; Ali, Fouzeyah A; Kroh, Matthew; Schauer, Philip R; Brethauer, Stacy A; Aminian, Ali

    2017-08-01

    Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies. A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative preoperative CT scan and upper endoscopy were included. Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n = 12), chronic cholecystitis (n = 4), mesenteric defect (n = 2), internal hernia (n = 1), and necrotic omentum (n = 1). Two patients developed post-operative complications including a pelvic abscess and an abdominal wall abscess. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients required long-term medical treatment for management of chronic abdominal pain. Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 40% of patients who undergo diagnostic laparoscopy and 70% of patients with positive findings on laparoscopy experience significant symptom improvement. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases.

  7. Prognostic significance of diagnostic laparoscopy for spontaneous fertility

    NARCIS (Netherlands)

    Mol, B. W.; Swart, P.; Bossuyt, P. M.; van der Veen, F.

    1999-01-01

    OBJECTIVE: To determine the prognostic significance of laparoscopy results for fertility outcome. STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and laparoscopy for subfertility in our department between May 1985 and November 1987 were identified from medical records. The impact

  8. Postoperative pain and recovery after conventional laparoscopy compared with robotically assisted laparoscopy.

    Science.gov (United States)

    El Hachem, Lena; Acholonu, Uchenna C; Nezhat, Farr R

    2013-03-01

    To compare postoperative pain after conventional laparoscopic and robotically assisted laparoscopic surgery in gynecology. This is a prospective nonrandomized analysis of patients undergoing conventional laparoscopy or robotically assisted laparoscopy in a university-affiliated hospital between March 2011 and March 2012. Postoperative pain was measured using the Numeric Rating Scale and the narcotic use converted to morphine sulfate equivalents. The primary outcome was the Numeric Rating Scale pain score obtained on the first postoperative day. One hundred ten patients were enrolled; 91 were included in the statistical analysis. Both groups were similar with regard to race, history of abdominopelvic surgeries, psychiatric history, and substance abuse. Patients undergoing robotically assisted laparoscopy were 6 years older and had a body mass index 6 points higher. Median length of hospital stay for conventional laparoscopy and robotically assisted laparoscopy was 2 days and 3 days, respectively (P<.001); median to being off narcotics was 4 days and 4.5 days, respectively (P=.336); and median return to normal activities was 13 days and 21 days, respectively (P=.021). There were no significant differences in mean Numeric Rating Scale pain scores over time (P=.499) or mean narcotic requirements (P=.393) between groups. Robotically assisted laparoscopy is equivalent to conventional laparoscopy in terms of subjective and objective measures of postoperative pain.

  9. Letter: Laparoscopy explosion hazards with nitrous oxide.

    Science.gov (United States)

    Khunda, S; Ghanima, K Y

    1976-05-08

    With reference to your correspondence (September 27, p. 764, and December 27, p. 760) regarding laparoscopy explosion hazards with nitrous oxide, in our experience this is not substantiated. In the last 18 months we have done some 123 laparoscopies in the Medical City Hospital, Baghdad. We have done 16 sterilizations by tubal diathermy and not fewer than 12 cases where biopsies were taken from ovaries in case of tuberculosis or for other reasons, where diathermy was used. In all our laparoscopy procedures we always used nitrous oxide gas because carbon dioxide cylinders are difficult to otain. We did not have any incident of explosion, and most of our patients stayed in hospital not more than 24 hours postoperatively, during which time no complications were reported. None of these cases was readmitted for any complications. It seems to us that the hazard of explosion with nitrous oxide is more theoretical than real.

  10. Myomectomy by laparoscopy: a preliminary report of 43 cases.

    Science.gov (United States)

    Dubuisson, J B; Lecuru, F; Foulot, H; Mandelbrot, L; Aubriot, F X; Mouly, M

    1991-11-01

    To evaluate the technique and short-term results of intraperitoneal (IP) myomectomies. From January 1, 1990, to March 1, 1991, IP myomectomies were performed in all cases in which it appeared feasible. This study was conducted in a tertiary care center, the Port-Royal University Hospital. Among 49 consecutive patients with interstitial or subserous myomas, 6 patients with voluminous, multiple myomas had laparotomies. Intraperitoneal myomectomy was performed in 43 patients. The indication for laparoscopy was a pelvic mass in 29 cases, infertility in 13, and severe endometriosis in 1 case. Thermocoagulation or monopolar coagulation was used for the uterine incision. Myometrium and serosa were sutured in 23 of 43 patients. Myomas were removed through the suprapubic puncture site after fragmentation of large myomas. We evaluated the length of the procedures, blood loss, and postoperative course. Ninety-two myomas were removed laparoscopically. No complication was observed. In selected cases, IP myomectomy appears to be a safe technique with the advantages of laparoscopic surgery.

  11. Role of laparoscopy in diagnosis and treatment of ectopic pregnancy.

    Science.gov (United States)

    Shrestha, J; Saha, R

    2011-09-01

    Laparoscopy has a great role in early and effective diagnosis and treatment of ectopic pregnancy. This study was carried out to evaluate the feasibility and role of laparoscopy in diagnosis and treatment of ectopic pregnancy. This is a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital from April 2009 to March 2011. All the women who underwent laparoscopy for ectopic pregnancy or diagnosed as ectopic pregnancy during laparoscopy done for other diagnosis were included. Data were collected by interviewing patients, operating surgeons, reviewing charts and operative notes and following up patients. There were 42 cases of ectopic pregnancy during study period, of whom 16 (38.1%) underwent laparoscopy. Preoperative diagnosis of ectopic pregnancy was confirmed clinically in 6 (37.5%) patients, who underwent laparoscopy as an operative procedure. In the remaining 6 (37.5%), laparoscopy was performed as a diagnostic procedure as clinical diagnosis was doubtful; two cases of negative laparoscopy was noted. Incidental diagnosis of ectopic pregnancy was made in another 4 (25%) patients who had undergone laparoscopy for other pre operative diagnosis. All the patients were surgically managed by laparoscopy without converting it to laparotomy. There were no intraoperative or postoperative complications except for primary port infection in few (25%). Therefore, laparoscopy has a significant role in the diagnosis of ectopic pregnancy and operative laparoscopy is a safe approach with minimal complications.

  12. Experience with gynaecological laparoscopy in a tertiary hospital ...

    African Journals Online (AJOL)

    All the case notes of patients that had diagnostic laparoscopy during the stated period were retrieved and analyzed. Results: A total of 975 gynaecological ... The mean duration of hospital stay was 1.9 ±0.9days, making our laparoscopy, therefore, not completely an outpatient procedure. Conclusion: Diagnostic laparoscopy ...

  13. Experience with diagnostic laparoscopy for gynecological indications

    African Journals Online (AJOL)

    2012-02-27

    Feb 27, 2012 ... Diagnostic laparoscopy for gynecological indications is safe and wider application of this modern ... JI Ikechebelu. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, and Life Fertility. Centre .... The hemorrhage would have been controlled or control attempted ...

  14. Comparison of hysterosalpingograms with laparoscopy in the ...

    African Journals Online (AJOL)

    Introduction: The objectives were to assess the diagnostic value of hysterosalpingography (HSG) with laparoscopy as gold standard in the evaluation of tubal patency and pelvic adhesions in women suffering from infertility. Methods: We conducted a comparative cross sectional study on 208 medical files of infertile women ...

  15. Adhesions and Adhesiolysis: The Role of Laparoscopy

    Science.gov (United States)

    Kavic, Suzanne M.

    2002-01-01

    Background: Adhesions commonly result from abdominal and pelvic surgical procedures and may result in intestinal obstruction, infertility, chronic pain, or complicate subsequent operations. Laparoscopy produces less peritoneal trauma than does conventional laparotomy and may result in decreased adhesion formation. We present a review of the available data on laparoscopy and adhesion formation, as well as laparoscopic adhesiolysis. We also review current adjuvant techniques that may be used by practicing laparoscopists to prevent adhesion formation. Database: A Medline search using “adhesions,” “adhesiolysis,” and “laparoscopy” as key words was performed for English-language articles. Further references were obtained through cross-referencing the bibliography cited in each work. Discussion: The majority of studies indicate that laparoscopy may reduce postoperative adhesion formation relative to laparotomy. However, laparoscopy by itself does not appear to eliminate adhesions completely. A variety of adjuvant materials are available to surgeons, and the most recent investigation has demonstrated significant potential for intraperitoneal barriers. Newer technologies continue to evolve and should result in clinically relevant reductions in adhesion formation. PMID:12113430

  16. Bowel injury as a complication of laparoscopy

    NARCIS (Netherlands)

    van der Voort, M.; Heijnsdijk, E. A. M.; Gouma, D. J.

    2004-01-01

    Background: Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury. Methods: The review was carried out using the MeSH browser within

  17. Laparoscopy: Learning a New Surgical Anatomy?

    Science.gov (United States)

    Jimenez, Angel Martin; Aguilar, Jose-Francisco Noguera

    2009-01-01

    Operative laparoscopy has progressed rapidly in recent years, and this alternative to the conventional approach for abdominal surgery has allowed the description of new planes, spaces, and anatomic references as a result of the artificial rupture of the "anatomical continuum". Magnified laparoscopic views and the ability to deeply explore anatomic…

  18. Experience with diagnostic laparoscopy for gynecological indications

    African Journals Online (AJOL)

    Context: Diagnostic laparoscopy is an endoscopy procedure, which has become indispensable in the evaluation of the female reproductive organs especially in infertility. Aim: Experience with conversion to open laparotomy is presented and ways of averting this complication are discussed. Settings and Design: A ...

  19. Laparoscopy In Unexplained Abdominal Pain: Surgeon's Perspective.

    Science.gov (United States)

    Abdullah, Muhammad Tariq; Waqar, Shahzad Hussain; Zahid, Muhammad Abdul

    2016-01-01

    Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients.

  20. Transabdominal Cervical Cerclage: Laparoscopy Versus Laparotomy.

    Science.gov (United States)

    Ades, Alex; Dobromilsky, Kim C; Cheung, King T; Umstad, Mark P

    2015-01-01

    To evaluate the obstetric outcome, surgical morbidity, and pre-abdominal cerclage characteristics of women undergoing transabdominal cerclage (TAC) via laparotomy or laparoscopy. Prospective cohort study (Canadian Task Force classification II-2). University hospital. Between 2007 and 2014, 51 patients underwent laparoscopic abdominal cervical cerclage to treat cervical incompetence. These women were compared with a historical cohort of 18 patients who underwent the same procedure via laparotomy between 1995 and 2011. All of the women had a diagnosis of cervical incompetence based on previous obstetric history and/or a short or absent cervix. The fetal survival rate postcerclage was 100% in the laparotomy group (n = 30 pregnancies) and 98% in the laparoscopy group (n = 54 pregnancies). There were no perioperative pregnancy losses in either group. The median gestation age was 36.9 weeks (range: 35.0-37.3) in the laparotomy group and 37.0 weeks (range: 34.7-38.0) in the laparoscopy group. Complications were recorded in 4 (22%) cases from the laparotomy group and 1 (2%) of the laparoscopies; however, the types of complications might not be comparable between groups. There were no conversions to laparotomy in the laparoscopy group. Pre-TAC median gestational age in the laparotomy group was 24.0 weeks (range: 20.0-25.1) with 19 (57.6%) previous pregnancies occurring after transvaginal cervical cerclage placement. The corresponding laparoscopy pre-TAC median gestational age was 22.0 weeks (range 19.0-34.0) with 40 (40%) previous pregnancies having a transvaginal cerclage. Before the TAC, women in the laparotomy group had lost 25 babies, and 63 babies were lost in the laparoscopy group. After TAC, these numbers were 0 and 1. Our findings show that transabdominal cervical cerclage placed laparoscopically appears to be as effective as TAC placed via laparotomy. Neither approach was associated with serious or long-term complications. Because of this finding, the approach

  1. Rectus abdominis atrophy after ventral abdominal incisions: midline versus chevron.

    Science.gov (United States)

    Vigneswaran, Y; Poli, E; Talamonti, M S; Haggerty, S P; Linn, J G; Ujiki, M B

    2017-08-01

    Although many outcomes have been compared between a midline and chevron incision, this is the first study to examine rectus abdominis atrophy after these two types of incisions. Patients undergoing open pancreaticobiliary surgery between 2007 and 2011 at our single institution were included in this study. Rectus abdominis muscle thickness was measured on both preoperative and follow-up computed tomography (CT) scans to calculate percent atrophy of the muscle after surgery. At average follow-up of 24.5 and 19.0 months, respectively, rectus abdominis atrophy was 18.9% greater in the chevron (n = 30) than in the midline (n = 180) group (21.8 vs. 2.9%, p 20% atrophy at follow-up compared with 10% with a midline incision [odds ratio (OR) 9.0, p atrophy of the rectus abdominis compared with midline incisions. The long-term effects of transecting the rectus abdominis and disrupting its innervation creates challenging abdominal wall pathology. Atrophy of the abdominal wall can not be readily fixed with an operation, and this significant side effect of a transverse incision should be factored into the surgeon's decision-making process when choosing a transverse over a midline incision.

  2. Laparoscopy in Urology Practice at a Tertiary Care Centre

    International Nuclear Information System (INIS)

    Quddus, M. B.; Mahmud, S. M.

    2014-01-01

    Objective: To describe the results of laparoscopic procedures at a Urology - Nephrology tertiary care centre. Study Design: Case series / observational study. Place and Duration of Study: The Kidney Centre Postgraduate Training Institute, Karachi, from August 2007 to March 2012. Methodology: Medical records of all planned laparoscopic surgery conducted during the study period were reviewed. Those cases which to open surgery were excluded. All were performed by a single surgeon, initially as supervised and later independently. Data was maintained for demographic data, procedure details, length of hospital stay, and complications including conversion to open surgeries. Data was analyzed through SPSS 17.0. Results: There were 36 planned laparoscopic surgeries in the specified period. Out of 36 cases, 8 were converted to open surgery. Those who underwent laparoscopic surgery include two diagnostic procedures and renal cyst deroofing each, four ureterolithotomy, nineteen simple nephrectomy and one radical nephrectomy. So in total 28 cases were performed on 15 females and 13 males with mean age of 33.01 A +- 10.9 years. The mean operative time was 216 A +- 100 minutes and mean length of hospital stay was as 2.7 A +- 1.04 days. There were 10 complications in 28 cases, majority being Clavien Grade II including 7% (2/28) blood transfusion. Conclusion: There are technical challenges in learning laparoscopy for practicing urologists. Following some learning model in a systematic manner will help surmounting the technical challenges in learning laparoscopy. (author)

  3. Laparoscopy of rats with experimental liver metastases

    DEFF Research Database (Denmark)

    Kobaek-Larsen, Morten; Rud, Lene; Østergaard-Sørensen, Finn

    2004-01-01

    Metastatic disease to the liver is one of the major factors determining the outcome of colonic resection with curative interventions in human patients. Therefore, animal models for studies of liver metastasis have been developed. Humane endpoints are needed for the evaluation of the animal...... impression of the metastases was obtained. We suggest, as a new humane endpoint, that one animal should only have 1-2 separately growing metastases, each of a maximum size of 10 mm(2). In future, the method has to be developed further to measure the size of the metastases in a more quantitatively precise...... manner. Although the animal has to be anaesthetized each time, laparoscopy is considered a minor surgical procedure as only two small puncture wounds are made through the abdominal wall. Because laparoscopy offers a direct view of the hidden tumours and their sizes, as well as of possible complications...

  4. Biliary lithiasis approach in open laparoscopy

    International Nuclear Information System (INIS)

    Pose, J.; Hermida, M.; Berhouet, H.; Delgado, F.

    2000-01-01

    Laparoscopic approach is currently the elective approach in the treatment of non complicated biliary lithiasis.There was a time when an umbilical herniation presented a series of problems at the time of deciding on the approach to be taken.The paper refers to 2 cases of laparoscopic approach in the treatment of symptomatised biliary lithiasis, with an open laparoscopy technique through umbilical hernia ton ring.The repair of herniation was performed in the same operative act with good immediate results

  5. Emergency laparoscopy--current best practice.

    Science.gov (United States)

    Warren, Oliver; Kinross, James; Paraskeva, Paraskevas; Darzi, Ara

    2006-08-31

    Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.

  6. Incision for pleural tissue biopsy (image)

    Science.gov (United States)

    ... open pleural biopsy, a small piece of the pleural tissue is removed through a surgical incision in the chest. After the sample is obtained, a chest tube is placed and the incision is closed with ...

  7. Clinical Appliance of Laparo-Endoscopic Single-Site Surgery (LESS) in Urology.

    Science.gov (United States)

    Liatsikos, Evangelos; Kyriazis, Iason; Kallidonis, Panagiotis; Do, Minh; Anja, Anja; Rigopoulos, Christos; Al-Aown, Abdulrahman; Stolzenburg, Jens-Uwe

    2010-04-01

    Laparoscopy has gained a place in everyday surgical routine as an alternative surgical approach that decreases morbidity and postoperative hospitalization. Single port laparoscopic surgery has been introduced as a further development of laparoscopy. The feasibility and safety of single port laparoscopy is under extensive evaluation in specialized laparoscopic centers. Nevertheless, wide acceptance of the technique requires adequate documentation of the advantages of the approach over conventional laparoscopy and further refinement of surgical instrumentation to overcome intraoperative ergonomic problems.

  8. The SIMS trial: adjustable anchored single-incision mini-slings versus standard tension-free midurethral slings in the surgical management of female stress urinary incontinence. A study protocol for a pragmatic, multicentre, non-inferiority randomised controlled trial

    Science.gov (United States)

    Abdel-Fattah, Mohamed; MacLennan, Graeme; Kilonzo, Mary; Assassa, R Phil; McCormick, Kirsty; Davidson, Tracey; McDonald, Alison; N’Dow, James; Wardle, Judith; Norrie, John

    2017-01-01

    Introduction Single-incision mini-slings (SIMS) represent the third generation of midurethral slings. They have been developed with the aim of offering a true ambulatory procedure for treatment of female stress urinary incontinence (SUI) with reduced morbidity and earlier recovery while maintaining similar efficacy to standard midurethral slings (SMUS). The aim of this study is to determine the clinical and cost-effectiveness of adjustable anchored SIMS compared with tension-free SMUS in the surgical management of female SUI, with 3-year follow-up. Methods and analysis A pragmatic, multicentre, non-inferiority randomised controlled trial. Primary outcome measure The primary outcome measure is the patient-reported success rate measured by the Patient Global Impression of Improvement at 12 months. The primary economic outcome will be incremental cost per quality-adjusted life year gained at 12 months. Secondary outcome measures The secondary outcomes measures include adverse events, objective success rates, impact on other lower urinary tract symptoms, health-related quality of life profile and sexual function, and reoperation rates for SUI. Secondary economic outcomes include National Health Service and patient primary and secondary care resource use and costs, incremental cost-effectiveness and incremental net benefit. Statistical analysis The statistical analysis of the primary outcome will be by intention-to-treat and also a per-protocol analysis. Results will be displayed as estimates and 95% CIs. CIs around observed differences will then be compared with the prespecified non-inferiority margin. Secondary outcomes will be analysed similarly. Ethics and dissemination The North of Scotland Research Ethics Committee has approved this study (13/NS/0143). The dissemination plans include HTA monograph, presentation at international scientific meetings and publications in high-impact, open-access journals. The results will be included in the updates of the National

  9. Mini-Laparoscopy for Removal (Partial) of Adnexae at the Time of Hysterectomy.

    Science.gov (United States)

    Setúbal, António Gutierrez; Alves, João Sequeira; Lavado, Olga; Faria, Joana

    2017-02-01

    To demonstrate our technique of mini-laparoscopic adnexectomy or salpingectomy at the time of total laparoscopic hysterectomy (TLH). Step-by-step video demonstration of our technique. The advantages of laparoscopic surgery have been widely recognized, including improved visualization and exposure, reduced operative trauma owing to smaller incisions and gentler tissue handling, and faster postoperative recovery. Continuing technological developments have allowed the use of smaller-caliber instruments while maintaining a high standard of surgical performance. Mini-laparoscopy requires the use of 3-mm or smaller ports. The main advantage of mini-laparoscopy is the reduced incision size, which can translate into a lower incidence of incision-related complications such as postoperative pain, infection, and trocar site herniation, along with superior cosmetic results. Today, in younger patients, prophylactic salpingectomy can be considered instead of adnexectomy, taking into account the well-known benefits of ovarian conservation. Prophylactic salpingectomy involves Fallopian tube removal for primary prevention of epithelial carcinoma of the fallopian tubes, ovaries, and peritoneum in women undergoing pelvic surgery for another indication. Other advantages of this intervention are the avoidance of hydrosalpinx (which affects ∼30% women after hysterectomy), the 7.8% lifetime risk of revision surgery [1], tubal infection, and benign and malignant Fallopian tube tumors. Finally, salpingectomy has no known physiological side effects, is safe and feasible, does not worsen surgical outcomes, does not significantly increase the operative time, and is not related to increased rates of intraoperative and postoperative complications or readmission. The patient is a 44-year-old woman with a history of 2 previous cesarean sections with adenomyosis and endometriosis infiltration of the uterosacral ligaments. After discussion about the risks and benefits of ovarian conservation with

  10. [Treatment of adnexal tumors with laparoscopy].

    Science.gov (United States)

    Treviño Alanís, R; Martínez Ramírez, A; Garza Treviño, F G; Calanda, A

    1997-04-01

    This article shows the experience in 61 patients with adnexal tumors studied from June 1988 to June 1994; the origin of the patients in private and semiprivate, to whom we practiced a diagnostic and operative laparoscopy (56/61) at the same time. The inclusion and exclusion criteria were determined by clinical history (past history, age, symptoms, size, etc.), vaginal ultrasonography scan (ascites, papillas, cyst's content, etc.), laboratory tests (Ca 125 in postmenopausal patients), the macroscopic assessment during the diagnostic laparoscopy, transoperative biopsy (19/61) was made in order to confirm the benign findings seen before laparoscopy; and the results were accordingly on the 61 cases. The cause of consult was infertility in 24/61; 18/61 were primary infertility; 6/61 were secondary infertility. We did 22 cystectomies and 2 oophorectomies; 10 of them became pregnant. 37 from 61 had pain, nine of this group we did an oophorectomy (2 by torsion, 3 had hemorrhagic cysts that were ruptured and 4 were residual ovary), the rest 28 we performed cystectomy with frank improvement of their symptoms. The postoperative diagnosis of the tumors were: luteomas 13/61; functional cysts 17/61, Hemorrhagic cysts 8/61; endometriomas 9/61; serous cystoadenoma 3/61; mucinous cystoadenoma 1/61; ovaric fibroma 1/61; mature cystic teratoma 2/61; residual ovaries 4/61; paraovaric cysts 2/61 and Morgagni's hydatide 1/61. It is concluded that if one follows all the correct parameters for the evaluation of adnexal tumors, the endoscopic procedure could be safe with the benefits of the laparoscopic procedure.

  11. Emergency laparoscopy – current best practice

    Directory of Open Access Journals (Sweden)

    Paraskeva Paraskevas

    2006-08-01

    Full Text Available Abstract Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.

  12. Study of Primary Infertility in females by Diagnostic Laparoscopy ...

    African Journals Online (AJOL)

    Tubal block was one of the major causes of primary infertility. The diagnostic laparoscopy with hysterosalpingography (HSG) can be helpful to diagnose the tubal pathology. Keywords: Primary infertility, Diagnostic laparoscopy, hysterosalpingography, Tubal block. Internet Journal of Medical Update Vol. 1 (2) 2006: pp. 6-8.

  13. Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?

    NARCIS (Netherlands)

    Ankum, W. M.; van der Veen, F.; Hamerlynck, J. V.; Lammes, F. B.

    1993-01-01

    Laparoscopy is regarded as the final decisive diagnostic test in suspected ectopic pregnancy. The new non-invasive diagnostic methods of transvaginal sonography and serum human chorionic gonadotrophin (HCG) monitoring now challenge this pivotal role of laparoscopy. In this prospective study the

  14. A structured four-step curriculum in basic laparoscopy

    DEFF Research Database (Denmark)

    Strandbygaard, Jeanett; Bjerrum, Flemming; Maagaard, Mathilde

    2014-01-01

    The objective of this study was to develop a 4-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component.......The objective of this study was to develop a 4-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component....

  15. The hysterosalpingography examination verified by laparoscopy; Laparoskopowa weryfikacja obrazow histerosalpingograficznych

    Energy Technology Data Exchange (ETDEWEB)

    Popiela, A.; Kasiak, J.; Heimrath, T.; Cislo, M. [Akademia Medyczna, Wroclaw (Poland)

    1993-12-31

    The authors discuss 47 cases in which the hysterosalpingography (HSG) examination showed secondary tubar unpatency, then verified by laparoscopy. In the opinion of the authors supported by the results the HSG examination may be considered only as a preliminary element of tubar patency examination. In case of planned microsurgery the only qualifying or disqualifying examination is the laparoscopy with introduction of color contrast. (author)

  16. Patient perceptions about laparoscopy at Komfo Anokye Teaching Hospital, Ghana.

    Science.gov (United States)

    Gyedu, Adam; Fugar, Setri; Price, Raymond; Bingener, Juliane

    2015-01-01

    Laparoscopy has become the gold standard for many surgical cases in the developed world. It however, remains a rarity in developing countries for several reasons, a major one being cost. This study aimed to determine the knowledge and attitude of patients attending Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana toward laparoscopic surgery and their willingness to pay for it. A cross-sectional survey was conducted among patients attending specialist clinics at KATH. 1070 patients participated. Mean age was 40±15 years. 54% were city-dwellers. 14% had salary-paying jobs. None had undergone prior laparoscopic surgery. 3% had knowledge of laparoscopy. 95% preferred laparoscopy to open surgery mainly because of faster recovery and less post-op pain. Age >45 years (AOR = 0.53, p = 0.03) and higher education (AOR = 2.00, p = 0.04) were significant predictors of patient choice. Among those preferring laparoscopy, 78% were willing to pay more than the baseline cost of open surgery for laparoscopy. A history of previous abdominal surgery (AOR = 0.67, p = 0.02), having a salaried job compared with being unemployed (AOR = 2.36, p laparoscopy. Knowledge about laparoscopy and its benefits are severely lacking among patients at KATH. Once educated about its benefits, most people prefer laparoscopy even if they needed to pay more for it even in resource-limited countries like Ghana.

  17. Selective use of diagnostic laparoscopy in patients with suspected appendicitis

    NARCIS (Netherlands)

    van den Broek, W. T.; Bijnen, A. B.; van Eerten, P. V.; de Ruiter, P.; Gouma, D. J.

    2000-01-01

    BACKGROUND: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy and to analyze the efficacy of

  18. Three versus four radial keratotomy incisions.

    Science.gov (United States)

    Melles, G R; Go, A T; Beekhuis, W H; van Rij, G; Binder, P S

    1992-01-01

    Radial keratotomy (RK) is currently performed with four or eight semi-radial incisions. To evaluate the effect of a theoretically more stable three-incision RK pattern, centripetal incisions were made in 16 human donor eyes (eight pairs), using a double-edged diamond blade set to 90% of central pachymetry and a 3.5 mm optical clear zone. Intraocular pressure was maintained at 15 mm Hg during surgery and while keratometry readings were made. One randomly selected eye of each pair had three radial incisions made at 12, 4 and 8 o'clock; the other eye had four radial incisions at 12, 3, 6, and 9 o'clock. Corneal flattening was 6.08 diopters (D) with four incisions and 4.84 D with three incisions (P less than .05). Astigmatism increased 0.44 D and 0.69 D, respectively (P greater than .1). Histologically measured mean incision depth (77.4%) did not differ significantly between the groups (P greater than .1). This study shows that 80% of the effect of a four-incision RK pattern can be obtained with a theoretically more stable three-incision pattern.

  19. Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy.

    Science.gov (United States)

    Soliman, Ahmed M; Du, Ella Xiaoyan; Yang, Hongbo; Wu, Eric Q; Haley, Jane C

    2017-06-01

    Hysterectomy and laparoscopy are the two most common surgical options used to treat women with endometriosis, yet the disease may still recur. This study aimed to determine the long-term retreatment rates among endometriosis patients in the United States who received either hysterectomy or laparoscopy. Patients aged 18-49 years with endometriosis who underwent hysterectomy or laparoscopy were identified in the Truven Health MarketScan claims database (2004-2013). The retreatment rate up to 8 years after the initial surgery was estimated using Kaplan-Meier survival analysis. The relative risk of retreatment among patients with hysterectomy versus laparoscopy was assessed using a Cox proportional hazard model. A total of 24,915 patients with endometriosis who underwent hysterectomy and 37,308 patients with endometriosis who underwent laparoscopy were identified. The estimated retreatment rates were 3.3%, 4.7%, and 5.4% in the 2nd, 5th, and 8th year following hysterectomy, respectively, while the rates following laparoscopy were 15.8%, 27.5%, and 35.2%, respectively. The hazard ratio of retreatment was 0.157 (95% confidence interval [CI]: 0.146-0.169) comparing hysterectomy to laparoscopy. In the sensitivity analysis, which expanded the definition of retreatment by including medical treatments, the retreatment rate increased by a factor of 11-14 for the hysterectomy cohort and by a factor of 2-4 for the laparoscopy cohort, and the hazard ratio of retreatment rate for hysterectomy versus laparoscopy was 0.490 (95% CI: 0.477-0.502). Our study results indicated that the disease retreatment rate after laparoscopy is high among patients with endometriosis; even hysterectomy does not guarantee freedom from retreatment.

  20. Laparoscopy in Pediatric Abdominal Trauma: A 13-Year Experience.

    Science.gov (United States)

    Tharakan, Sasha J; Kim, Aimee G; Collins, Joy L; Nance, Michael L; Blinman, Thane A

    2016-10-01

    Introduction  Abdominal injuries are common, costly, deadly, and a source of considerable uncertainty in pediatric trauma. In some circumstances, laparoscopy offers a diagnostic and therapeutic alternative with less morbidity than standard exploration, and more certainty than most imaging. In this study, we review our experience with laparoscopic exploration for trauma. We hypothesized that laparoscopy could be employed effectively in stable blunt or penetrating trauma patients in whom diagnostic uncertainty was unresolved by imaging. Patients and Methods  A retrospective review of the trauma database identified all children admitted to our Level I pediatric trauma center between January 1, 2000, and December 31, 2012, requiring surgical abdominal exploration. The utilization of laparoscopy and laparotomy was charted over the 13-year period. Negative laparoscopies and laparotomies and nontherapeutic laparoscopies and laparotomies were examined to investigate clinical scenarios in which laparotomy might have been avoided. Statistical analyses were performed using descriptive statistics, simple linear regression analysis, and Mann-Whitney U test ( p  laparoscopy. In 13 patients (34.2%), laparoscopic exploration ruled out injuries. In nine patients (23.7%), laparoscopy identified an injury for which no surgical intervention was necessary. In nine patients (23.7%), an injury was repaired laparoscopically. In seven cases (18.4%), the identified injury required conversion to laparotomy. There were no missed injuries. In the laparotomy group, a less invasive approach could have yielded the same information in 8.7% of patients. Laparoscopy was more likely to be used after a qualitative change in institutional minimally invasive surgical capability. Conclusion  Laparoscopy reliably resolves diagnostic uncertainty in selected cases of pediatric abdominal blunt and penetrating trauma. In a hemodynamically stable patient with a concerning exam and inconclusive imaging

  1. Indications for staging laparoscopy in pancreatic cancer

    Science.gov (United States)

    De Rosa, Antonella; Cameron, Iain C.; Gomez, Dhanwant

    2015-01-01

    Background To identify indications for staging laparoscopy (SL) in patients with resectable pancreatic cancer, and suggest a pre-operative algorithm for staging these patients. Methods Relevant articles were reviewed from the published literature using the Medline database. The search was performed using the keywords ‘pancreatic cancer’, ‘resectability’, ‘staging’, ‘laparoscopy’, and ‘Whipple's procedure’. Results Twenty four studies were identified which fulfilled the inclusion criteria. Of the published data, the most reliable surrogate markers for selecting patients for SL to predict unresectability in patients with CT defined resectable pancreatic cancer were CA 19.9 and tumour size. Although there are studies suggesting a role for tumour location, CEA levels, and clinical findings such as weight loss and jaundice, there is currently not enough evidence for these variables to predict resectability. Based on the current data, patients with a CT suggestive of resectable disease and (1) CA 19.9 ≥150 U/mL; or (2) tumour size >3 cm should be considered for SL. Conclusion The role of laparoscopy in the staging of pancreatic cancer patients remains controversial. Potential predictors of unresectability to select patients for SL include CA 19.9 levels and tumour size. PMID:26776846

  2. Three-dimensional laparoscopy vs 2-dimensional laparoscopy with high-definition technology for abdominal surgery: a systematic review.

    Science.gov (United States)

    Fergo, Charlotte; Burcharth, Jakob; Pommergaard, Hans-Christian; Kildebro, Niels; Rosenberg, Jacob

    2017-01-01

    This systematic review investigates newer generation 3-dimensional (3D) laparoscopy vs 2-dimensional (2D) laparoscopy in terms of error rating, performance time, and subjective assessment as early comparisons have shown contradictory results due to technological shortcomings. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) comparing newer generation 3D-laparoscopy with 2D-laparoscopy were included through searches in Pubmed, EMBASE, and Cochrane Central Register of Controlled Trials database. Of 643 articles, 13 RCTs were included, of which 2 were clinical trials. Nine of 13 trials (69%) and 10 of 13 trials (77%) found a significant reduction in performance time and error, respectively, with the use of 3D-laparoscopy. Overall, 3D-laparoscopy was found to be superior or equal to 2D-laparoscopy. All trials featuring subjective evaluation found a superiority of 3D-laparoscopy. More clinical RCTs are still awaited for the convincing results to be reproduced. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Carbon footprint of robotically-assisted laparoscopy, laparoscopy and laparotomy: a comparison.

    Science.gov (United States)

    Woods, Demetrius L; McAndrew, Thomas; Nevadunsky, Nicole; Hou, June Y; Goldberg, Gary; Yi-Shin Kuo, Dennis; Isani, Sara

    2015-12-01

    To date there have been no comprehensive, comparative assessments of the environmental impact of surgical modalities. Our study seeks to quantify and compare the total greenhouse gas emissions, or 'carbon footprint', attributable to three surgical modalities. A review of 150 staging procedures, employing laparotomy (LAP), conventional laparoscopy (LSC) or robotically-assisted laparoscopy (RA-LSC), was performed. The solid waste generated (kg) and energy consumed (kWh) during each case were quantified and converted into their equivalent mass of carbon dioxide (kg CO(2) e) release into the environment. The carbon footprint is the sum of the waste production and energy consumption during each surgery (kg CO(2) e). The total carbon footprint of a RA-LSC procedure is 40.3 kg CO(2) e/patient (p environmental impact of their decisions to facilitate adoption of sustainable practices. Copyright © 2015 John Wiley & Sons, Ltd.

  4. [Partial cystectomy for bladder endometriosis: Robotic assisted laparoscopy versus standard laparoscopy].

    Science.gov (United States)

    le Carpentier, M; Merlot, B; Bot Robin, V; Rubod, C; Collinet, P

    2016-06-01

    To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. A retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level. We included 15 patients in the RL group and 22 in the CL group. The median age was 29 years±7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P=0.04. The median size of the bladder lesion was 30±8mm in the RL group vs 23±7mm in the CL group, P=0.03. The median operative time was 210 vs 225min, P=0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P>0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P=0.6 and the pregnancy rate was 93 vs 86%, P=0.6. Robot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. The effect of escalating feedback on the acquisition of psychomotor skills for laparoscopy.

    Science.gov (United States)

    Van Sickle, K R; Gallagher, A G; Smith, C D

    2007-02-01

    In the acquisition of new skills that are difficult to master, such as those required for laparoscopy, feedback is a crucial component of the learning experience. Optimally, feedback should accurately reflect the task performance to be improved and be proximal to the training experience. In surgery, however, feedback typically is in vivo. The development of virtual reality training systems currently offers new training options. This study investigated the effect of feedback type and quality on laparoscopic skills acquisition. For this study, 32 laparoscopic novices were prospectively randomized into four training conditions, with 8 in each group. Group 1 (control) had no feedback. Group 2 (buzzer) had audio feedback when the edges were touched. Group 3 (voiced error) had an examiner voicing the word "error" each time the walls were touched. Group 4 (both) received both the audio buzzer and "error" voiced by the examiner All the subjects performed a maze-tracking task with a laparoscopic stylus inserted through a 5-mm port to simulate the fulcrum effect in minimally invasive surgery (MIS). A computer connected to the stylus scored an error each time the edge of the maze was touched, and the subjects were made aware of the error in the aforementioned manner. Ten 2-min trials were performed by the subjects while viewing a monitor. At the conclusion of training, all the subjects completed a 2-min trial of a simple laparoscopic cutting task, with the number of correct and incorrect incisions recorded. Group 4 (both) made significantly more correct incisions than the other three groups (F = 12.13; df = 3, 28; p < 0.001), and also made significantly fewer errors or incorrect incisions (F = 14.4; p < 0.0001). Group 4 also made three times more correct incisions and 7.4 times fewer incorrect incisions than group 1 (control). The type and quality of feedback during psychomotor skill acquisition for MIS have a large effect on the strength of skills generalization to a simple

  6. Three United Laparoscopic Surgery for the Treatment of Gastric Cardia Cancer-A Comparative Study with Laparotomy and Laparoscopy-Assisted Surgery.

    Science.gov (United States)

    Zhang, Zhanxue; Sun, Shuyuan; Qi, Jinchun; Qiu, Shaofan; Wang, Haijun; Ru, Lina; Lin, Lin; Li, Zhong; Zhao, Zongmao

    2017-02-01

    Gastric cancer is a leading cause of cancer-related mortality worldwide. We have invented a novel hand-assist device that allows the placement of surgical instruments and the maneuvering of the surgeon's hand, and we have established a new hand-assisted laparoscopic technique called Three United Laparoscopic Surgery (TULS) for laparoscopic dissection of advanced gastric cancer. The present study aimed at exploring the usefulness of TULS in the treatment of advanced gastric cardia cancer. A retrospective study on 100 patients with advanced gastric cardia cancer admitted from January 2014 to June 2015 was done. There were 38 cases of TULS, 30 cases of laparotomy, and 32 cases of laparoscopy-assisted surgery. Statistical comparisons between three treatment groups in operative time, incision length, amount of bleeding, number of lymph nodes dissected, time to flatus after surgery, rate of postoperative complications, hospital stay, and expense were done. For lymph node dissection, there were no significant differences between TULS, laparotomy, and laparoscopy-assisted surgery. However, compared with conventional laparotomy, TULS and laparoscopy-assisted surgery were found to be able to minimize incision length, reduce blood loss during surgery, lower postoperative complication rate, and shorten time to flatus and hospital stay. The differences were statistically significant (P laparoscopy-assisted surgery (P < .05), and it was comparable to that of laparotomy. TULS is as efficient as laparotomy in lymph node dissection, and it shows the advantages of minimally invasive surgery. It can be considered a novel and promising surgical intervention for treatment of advanced gastric cancer.

  7. [Laparoscopic cholecystectomy with three-port and 25 millimeters long incision.

    Science.gov (United States)

    Gómez Tagle-Morales, Enrique David

    2013-01-01

    Background: three-port and 25 mm total incision laparoscopic cholecystectomy has shown benefits compared to conventional laparoscopy. The aim was to examine the safety and feasibility of this technique. Methods: a three-port laparoscopic cholecystectomy trial was conducted through Cinvestav metasearcher, Seriunam and Rencis. The eligibility criteria were: three port laparoscopic cholecystectomy, 25 mm total incision, and score = 17 on Data Review System. Trials which employed instruments smaller than 5 mm in diameter were excluded. The comparative variables were documented and results obtained in the selected trials were described. Results: four trials were selected, comprising 1767 cases (1329 females and 438 males), average age was 44.3 years. Chronic cholecystitis was documented in 84.3 %, and acute cholecystitis in 14.7 %. Average surgical time was 54.5 minutes. An additional port was required in 4.8 % and 1.4 % was converted to open technique. Bile duct injury was presented in 0.11 %. The success rate was 94.9 %. Conclusions: three port and 25 mm total incision in laparoscopic cholecystectomy is safe and feasible.

  8. Prospective observational study comparing traditional laparoscopy and three-dimensional laparoscopy in gynecologic surgery.

    Science.gov (United States)

    Lara-Domínguez, Maria D; López-Jiménez, Araceli; Grabowski, Jacek P; Arjona-Berral, Jose E; Zapardiel, Ignacio

    2017-03-01

    To compare perioperative details among patients who underwent gynecologic surgery between traditional laparoscopy and three-dimensional laparoscopy. The present prospective non-randomized study enrolled all consecutive patients diagnosed with gynecologic pathology who underwent laparoscopic surgery at Reina Sofia Hospital, Cordoba, Spain between January 1 and April 30, 2014. Perioperative data, adverse events, and patient satisfaction were compared between patients who underwent treatment with two-dimensional and three-dimensional laparoscopic surgery techniques. The study enrolled 60 consecutive patients; 31 (52%) patients who underwent three-dimensional surgery and 29 (48%) who underwent traditional two-dimensional surgery. No significant differences were observed in the adverse-event rate, operating time, or perioperative parameters. A higher use of sealing devices was recorded among patients who underwent three-dimensional laparoscopy (P=0.021). No difference was recorded in patient satisfaction between the two patient groups. Although there was no impact on surgical outcomes, three-dimensional surgery could give a more accurate view of the surgical field. Performing three-dimensional surgery could be beneficial for more complex procedures although further comparative studies are required to investigate this hypothesis. © 2016 International Federation of Gynecology and Obstetrics.

  9. Laparoscopy, computerised tomography and fluorodeoxyglucose positron emission tomography in the management of gastric and gastro-oesophageal junction cancers.

    Science.gov (United States)

    Mirza, A; Galloway, S

    2016-07-01

    The staging laparoscopy has been used in the management of gastrointestinal cancers. The aim of this study was to evaluate the role of staging laparoscopy, in comparison with computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in staging patients with gastro-oesophageal junction (GOJ) and gastric cancers. The data were collected for patients between 1996 and 2013 undergoing investigation and treatment for GOJ and gastric cancers at a single institute. The pre-operative data (staging data), intraoperative details, post-operative course and follow-up were analysed for individual cases. Staging laparoscopy altered management plan in 64 (17 %) of 387 patients with negative staging CT and FDG-PET scan. Twenty-seven (7 %) patients with GOJ cancer (types I, II and III) were identified with pathological intraperitoneal nodes, 15 (4 %) gastric cancer with metastatic intraperitoneal deposits and liver metastases and 3 % gastric cancers with positive ascitic fluid for cancer cells. Ten (3 %) of patients were downstaged and were offered curative resection. Patients with metastatic disease were referred for palliative chemotherapy. The overall sensitivity of staging laparoscopy in diagnosing intraabdominal pathology was 86 % in comparison with CT (81 %) and FDG-PET (78 %). The diagnostic laparoscopy is useful for detecting and confirming nodal involvement and distant metastatic disease not evident on the staging CT scan and FDG-PET. This could potentially alter treatment and prognosis in patients with upper gastrointestinal cancer. The diagnostic laparoscopy should be performed as part of investigation and treatment planning for patients suffering from GOJ and gastric cancers. This can help to avoid surgery in patients with advanced disease.

  10. The Transferability of Generic Minimally Invasive Surgical Skills: Is There Crossover of Core Skills Between Laparoscopy and Arthroscopy?

    Science.gov (United States)

    Akhtar, Kash; Sugand, Kapil; Wijendra, Asanka; Sarvesvaran, Muthuswamy; Sperrin, Matthew; Standfield, Nigel; Cobb, Justin; Gupte, Chinmay

    2016-01-01

    The primary objective was observing transferability of minimally invasive surgical skills between virtual reality simulators for laparoscopy and arthroscopy. Secondary objectives were to assess face validity and acceptability. Prospective single-blinded crossover randomized controlled trial. MSk Laboratory, Imperial College London. Student doctors naïve to simulation and minimally invasive techniques. A total of 72 medical students were randomized into 4 groups (2 control groups and 2 training groups), and tested on haptic virtual reality simulators. Group 1 (control; n = 16) performed a partial laparoscopic cholecystectomy and Group 2 (control; n = 16) performed a diagnostic knee arthroscopy. Both groups then repeated the same task a week later. Group 3 (training; n = 20) completed a partial laparoscopic cholecystectomy, followed by an arthroscopic training program, and repeated the laparoscopic cholecystectomy a week later. Group 4 (training; n = 20) performed a diagnostic knee arthroscopy, followed by a laparoscopic training program, and then repeated the initial arthroscopic test a week later. The time taken, instrument path length, and speed were recorded for each participant and analyzed. Time taken for task: All 4 cohorts were significantly quicker on their second attempt but the 2 training groups outperformed the 2 control groups, with the laparoscopy-trained group improving the most (p laparoscopy-trained group improving the most (p laparoscopy-trained group improving the most (p laparoscopy simulator are transferable to arthroscopy and vice versa, with greater effect after training on the laparoscopy simulator. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  11. Laparoscopy in the management of hilar cholangiocarcinoma

    Science.gov (United States)

    Cho, Akihiro; Yamamoto, Hiroshi; Kainuma, Osamu; Muto, Yorihiko; Yanagibashi, Hiroo; Tonooka, Toru; Masuda, Takahito

    2014-01-01

    The use of minimally invasive surgery has become widely accepted in many gastrointestinal fields, even in patients with malignancy. However, performing laparoscopic resection for the treatment of hilar cholangiocarcinoma is still not universally accepted as an alternative approach to open surgery, and only a limited number of such procedures have been reported due to the difficulty of performing oncologic resection and the lack of consensus regarding the adequacy of this approach. Laparoscopy was initially limited to staging, biopsy and palliation. Recent technological developments and improvements in endoscopic procedures have greatly expanded the applications of laparoscopic liver resection and lymphadenectomy, and some reports have described the use of laparoscopic or robot-assisted laparoscopic resection for hilar cholangiocarcinoma as being feasible and safe in highly selected cases, with the ability to obtain an adequate surgical margin. However, the benefits of major laparoscopic surgery have yet to be conclusively proven, and carefully selecting patients is essential for successfully performing this procedure. PMID:25386064

  12. Successful resuscitation after carbon dioxide embolism during laparoscopy

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Burgdorf, Stefan; Lolle, Ida

    2012-01-01

    Venous air embolism (VAE) is a rare life-threatening complication that can occur during laparoscopy. A 50-year-old previously healthy woman underwent laparoscopic cholecystectomy and liver cyst fenestration. Immediately after the surgeon had left the operating room, the patient became hypotensive...... to another hospital, where she received hyperbaric oxygen treatment. The patient was discharged 14 days after surgery without any sequelae. It is important that the general surgeon suspects VAE during laparoscopy whenever the patient develops sudden and unexplained severe hypotension or cardiac arrest during...... or immediately after laparoscopy....

  13. Day surgery for gynaecological laparoscopy: Clinical results from an RCT

    DEFF Research Database (Denmark)

    Gudex, Claire; Sørensen, Jan; Clausen, Ingo

    2006-01-01

    This randomized controlled trial compared the clinical outcome from inpatient and ambulatory laparoscopy for benign gynaecological conditions. While 658 consecutive patients were considered for inclusion into the study, data from 26 inpatients and 40 ambulatory cases were analysed. Inpatient surg...

  14. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome

    NARCIS (Netherlands)

    Mol, B. W.; Collins, J. A.; Burrows, E. A.; van der Veen, F.; Bossuyt, P. M.

    1999-01-01

    In this study, we compare the prognostic significance of hysterosalpingography (HSG) and laparoscopy for fertility outcome. In a prospective cohort study in 11 clinics participating in the Canadian Infertility Treatment Evaluation Study (CITES), consecutive couples who registered between 1 April

  15. [The role of laparoscopy in emergency abdominal surgery].

    Science.gov (United States)

    Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M

    2005-01-01

    Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

  16. Implementation of a Cross-specialty Training Program in Basic Laparoscopy.

    Science.gov (United States)

    Bjerrum, Flemming; Sorensen, Jette Led; Thinggaard, Jette; Strandbygaard, Jeanett; Konge, Lars

    2015-01-01

    Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the implementation of a regional cross-specialty training program for basic laparoscopy, to increase the flexibility of educational courses, and to provide a more efficient use of simulation equipment. Using a regional training program in basic laparoscopy for gynecology as a model, we developed a cross-specialty training program for residents in surgery, gynecology, urology, and thoracic surgery. We reviewed data on training for the first year of the program and evaluated the program by using a scoring system for quality criteria for laparoscopic curricula and skills. We held 6 full-day theoretical courses involving 67 residents between September 1, 2013, and August 31, 2014. In the weeks following each course, residents practiced in a self-directed, distributed, and proficiency-based manner at a simulation center and in local hospital departments. A total of 57 residents completed the self-practice and a subsequent practical animal laboratory-based course. The structure of the training program was evaluated according to identified quality criteria for a skills laboratory, and the program scored 38 of a maximum 62 points. Implementation of a regional cross-specialty training program in basic laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up.

  17. Laparoscopy in 100 consecutive patients with 128 impalpable testes

    DEFF Research Database (Denmark)

    Cortes, Dina; Thorup, J M; Lenz, K

    1995-01-01

    To investigate the value of laparoscopy in boys with impalpable testes, to carry out a histological examination of testicular biopsies or orchidectomy specimens, and to present a clinical description of boys with impalpable testes.......To investigate the value of laparoscopy in boys with impalpable testes, to carry out a histological examination of testicular biopsies or orchidectomy specimens, and to present a clinical description of boys with impalpable testes....

  18. Laparoscopy After Liver Transplant: Result of an Initial Series.

    Science.gov (United States)

    Maurette, R; Garcia Ejarque, M; Silberman, E; Bregante, M; Bogetti, D; Pirchi, D

    2015-10-01

    There are few reports about laparoscopic approach after liver transplantation (LT). The aim of this paper is to analyze in terms of feasibility and therapeutic effectiveness an initial experience with laparoscopy in patients who have had a liver transplantation. Laparoscopic procedures were divided into "early" and "late" laparoscopy. A total of 10 laparoscopic procedures after LT were performed in 9 patients: 3 early and 7 late. The early laparoscopic procedures were performed in 3 patients who had a torpid evolution in their liver transplant: 2 were diagnostic only and 1 was also therapeutic. There were no intraoperative events or conversions. We recorded 2 complications. In 7 patients a late laparoscopy was performed: 4 in the upper abdomen and 3 in the lower abdomen. Of the 4 in the upper abdomen, 3 were liver procedures and 1 was in the transverse colon, on the other side; in addition, 2 laparoscopic inguinal hernia repairs and 1 laparoscopic appendectomy also were performed. None of these 7 cases was converted, and there were no intraoperative events. The early postoperative period, in critically ill patients diagnostic and eventually therapeutic laparoscopy was feasible and effective in our cases. Late laparoscopy in the upper abdomen is difficult due to adhesions and adds to the risk of poor graft function, but was feasible for both diagnostic and therapeutic purposes. Late laparoscopy in the lower abdomen with good graft function has the same safety and efficacy as those performed on nontransplanted patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Occult microscopic endometriosis: undetectable by laparoscopy in normal peritoneum.

    Science.gov (United States)

    Khan, Khaleque Newaz; Fujishita, Akira; Kitajima, Michio; Hiraki, Koichi; Nakashima, Masahiro; Masuzaki, Hideaki

    2014-03-01

    Is there any occurrence of hidden (occult) endometriotic lesions in normal peritoneum of women with and without visible endometriosis? We detected a slightly higher occurrence of occult microscopic endometriosis (OME) in normal peritoneum of women with visible endometriosis than in control women. Based on a small number of cases, the concept of invisible microscopic endometriosis in visually normal peritoneum has been reported for more than a decade but there is controversy regarding their tissue activity and clinical significance. This case-controlled research study was conducted with prospectively collected normal peritoneal samples from 151 women with and 62 women without visible endometriosis. Normal peritoneal biopsy specimens from different pelvic sites of were collected during laparoscopy. A histological search of all peritoneal biopsy specimens for the detection of invisible endometriosis was done by immunoreaction to Ber-EP4 (epithelial cell marker), CD10 (stromal cell marker) and Calretinin (mesothelial cell marker). Tissue expression of estrogen/progesterone receptors (ER/PR) and cell proliferation marker, Ki-67, was performed by immunohistochemistry to identify tissue activity. Three different patterns of OME were detected based on (I) the presence of typical gland/stroma, (II) reactive hyperplastic change of endometrioid epithelial cells with surrounding stroma and (III) single-layered epithelium-lined cystic lesions with surrounding stroma. A higher tendency toward the occurrence of OME was found in women with visible endometriosis (15.2%, 23/151) compared with control women (6.4%, 4/62) (P = 0.06, χ(2) test). The epithelial cells and/or stromal cells of OME lesions were immunoreactive to Ber-EP4 and CD10 but not reactive to Calretinin. ER and PR expression was observed in all patterns of OME lesions. Ki-67 index was significantly higher in pattern I/II OME lesions than in pattern III OME lesions (Pendometriosis due to the presence of adhesions in

  20. Staging Laparoscopy in Patients With Extrahepatic Biliary Carcinoma

    Science.gov (United States)

    Weber, Sharon M.; DeMatteo, Ronald P.; Fong, Yuman; Blumgart, Leslie H.; Jarnagin, William R.

    2002-01-01

    Objective To evaluate the benefit of staging laparoscopy in patients with gallbladder cancer and hilar cholangiocarcinoma. Summary Background Data In patients with extrahepatic biliary carcinoma, unresectable disease is often found at the time of exploration despite extensive preoperative evaluation, thus resulting in unnecessary laparotomy. Methods From October 1997 to May 2001, 100 patients with potentially resectable gallbladder cancer (n = 44) and hilar cholangiocarcinoma (n = 56) were prospectively evaluated. All patients underwent staging laparoscopy followed by laparotomy if the tumor appeared resectable. Surgical findings, resectability rate, length of stay, and operative time were analyzed. Results Patients underwent multiple preoperative imaging tests, including computed tomography scan, ultrasound, magnetic resonance cholangiopancreatography, and direct cholangiography. Laparoscopy identified unresectable disease in 35 of 100 patients. In the 65 patients undergoing open exploration, 34 were found to have unresectable disease. Therefore, the overall accuracy for detecting unresectable disease was 51%. There was no difference in the accuracy of laparoscopy between patients with gallbladder cancer and hilar cholangiocarcinoma. Laparoscopy detected the majority of patients with peritoneal or liver metastases but failed to detect all locally advanced tumors. In patients undergoing biopsy only, laparoscopic identification of unresectable disease significantly reduced operative time and length of stay compared with patients undergoing laparotomy. The yield of laparoscopy was 48% in patients with gallbladder cancer (56% in those who did not undergo previous cholecystectomy), but only 25% in patients with hilar cholangiocarcinoma. However, in patients with locally advanced but potentially resectable hilar cholangiocarcinoma, the yield of laparoscopy was greater, 36% (12/33, T2/T3 tumors) versus 9% (2/23, T1 tumors). Conclusions Laparoscopy identifies the majority

  1. [Significance of laparoscopy in gynaecological oncology].

    Science.gov (United States)

    Altgassen, Christopher; Hertel, Hermann

    2009-01-01

    By now laparoscopy has become an established access route in gynaecological surgery. It took many years to get to this stage for various obstacles had to be overcome. In the end, it was the low intra- and postoperative complication rates together with the rapid reconvalescence of the patients and their wish to be quickly discharged from hospital which led to an unstoppable diffusion of the method. With the increased use of the procedure and the expertise of the surgeons, it entered the field of gynaecological oncology and met similar reservations. Once again the same convincing advantages helped overcome the resistance. Thus, laparoscopic surgical procedures have secured a place in the treatment of corpus and cervical carcinomas, as their surgical safety has been proved. The aim of future examinations should be the proof of non-inferiority compared to the open techniques because the advantages of the laparoscopic procedure have been sufficiently proved. Regardless of the required proof, the method is rapidly expanding with robot-assisted procedures, while surgeons develop exenterative techniques.

  2. Single-port laparoscopy : an assessment of safety and feasibility

    NARCIS (Netherlands)

    van der Linden, Yoen T. Kim

    2017-01-01

    Nowadays laparoscopic surgery is the standard procedure for many abdominal diseases. Compared with open surgery, laparoscopic surgery offers several advantages, such as reduction of postoperative pain, faster postoperative recovery and shorter admission times to the hospital. The continuous drive to

  3. Open Versus Closed Laparoscopy: Yet an Unresolved Controversy.

    Science.gov (United States)

    Taye, Milan Kumar; Fazal, Syed Abul; Pegu, David; Saikia, Dayanada

    2016-02-01

    Safe placement of the Verres needle or the primary trocar for establishment of pneumoperitoneum is the most critical step in laparoscopic procedure as it is associated with bowel, bladder and life threatening vascular injuries and embolism. In the last few decades many techniques and guidelines have been introduced to eliminate complications in creation of pneumoperitoneum. Classical closed technique (Verres needle) and the open classic technique (Hasson) are the most commonly used techniques for creation of pneumoperitoneum. To compare the rate of occurrence and nature of complications in open and closed laparoscopy during establishment of pneumoperitoneum in different surgical and gynaecological procedures. This was a comparative study conducted at three hospitals in Dibrugarh district, Assam, India from January 2012 to December 2014. Total 3000 cases were included in the study with 1500 cases of open laparoscopy and 1500 cases of closed laparoscopy. Complications occurring in both the groups were compared by using Fisher's-exact test. In closed laparoscopy group minor complications occurred in 80 (5.33%) and major complications in 20 (1.33%) cases. In open laparoscopy group minor complications were observed in 60 (4%) and major complications in 2 (0.13%). The p-value of the difference between the two groups for minor complications was 0.0834 and for major complications was 0.0001(significant). Open laparoscopy was seen to be better than closed laparoscopy in terms of not only the rate of occurrence of complications but also the nature and severity of the complications. This study is clinically relevant as there is no consensus for a particular method of safe entry in to the peritoneal cavity warranting the need for more research. Open technique can be performed in all cases irrespective of previous operative scar, suspected intra peritoneal adhesions or obesity. Favourable outcome may be achieved in closed technique in cases of normal BMI, absence of

  4. Does laparoscopy still has a role in modern fertility practice?

    Directory of Open Access Journals (Sweden)

    Ahmad Mahran

    2017-12-01

    Full Text Available Background: More than 3 decades after the introduction of in vitro fertilization (IVF and despite the improved success rates of assisted reproductive technologies, the argument for performing laparoscopy as a part of the infertility workup still stands. Objective: To evaluate the role of laparoscopy±hysteroscopy in diagnosis and management of infertility in our setting in view of modern fertility practice. Materials and Methods: This case control study was carried out on 600 infertile women subjected to laparoscopy or combined laparoscopy and hysteroscopy at endoscopy unit in Minia University Hospital, Egypt during the period from January 2012 to December 2014. Results: The causes of infertility as identified by laparoscopy±hysteroscopy were polycystic ovary syndrome (25.1%, tubal factor (30%, uterine cause (4%, and endometriosis (2.7%. No cause was identified in 38.2% of cases. Based on operative findings, women were treated with different options. Expectant management was used in 92 cases (15.3%. Ovulation induction with anti-estrogens or gonadotropins was used in 372 cases (62%. Sixty cases (10% had intrauterine insemination and sixty four cases (10.7% underwent in vitro fertilization (IVF / intracytoplasmic sperm injection (ICSI treatment. Within 1 yr after laparoscopy, 180 cases achieved pregnancy (30%. The most favorable outcome was recorded in women with unexplained infertility (36.7% of cases got pregnant followed by women with polycystic ovary syndrome (27.8%. Participants with uterine and tubal infertility factor achieved pregnancy in 25% and 22.8% of cases, respectively. The worst outcome was recorded in women with endometriosis. Conclusion: Laparoscopy still has an important role in the diagnosis and treatment of infertility.

  5. Surgical incision can alter capsaicin-induced central sensitization in rat brainstem nociceptive neurons.

    Science.gov (United States)

    Lam, D K; Sessle, B J; Hu, J W

    2008-10-15

    Surgical trauma can affect spinal neuronal excitability, but there have been no studies of the effects of surgical cutaneous injury on central nociceptive processing of deep afferent inputs evoked by noxious stimuli such as capsaicin. Thus our aim was to test the effect of surgical cutaneous incision in influencing central sensitization induced by capsaicin injection into the temporomandibular joint (TMJ). The activity of single nociceptive neurons activated by noxious mechanical stimulation of the TMJ was recorded in the trigeminal subnucleus caudalis/upper cervical cord of halothane-anesthetized rats. The cutaneous mechanoreceptive field (RF), cutaneous mechanical activation threshold (MAT) and TMJ MAT of neurons before and after both surgical cutaneous incision alone and capsaicin injection were compared with results of incision and lidocaine pretreatment of the facial skin overlying the TMJ and capsaicin injection into the TMJ. Incision itself induced a barrage of neuronal spikes and excitability increases reflecting central sensitization (cutaneous RF expansion, cutaneous MAT reduction) in most neurons tested whereas lidocaine pretreatment significantly attenuated the barrage and central sensitization. Capsaicin injection into the TMJ induced cutaneous RF expansion, cutaneous MAT reduction and TMJ MAT reduction following lidocaine pretreatment of the cutaneous incision site whereas capsaicin injection following incision alone not only failed to induce further central sensitization but also decreased the existing incision-induced central sensitization (no cutaneous RF expansion, increased cutaneous MAT and TMJ MAT) in most neurons tested. These findings suggest that central sensitization induced by capsaicin alone or by cutaneous incision alone can readily occur in TMJ-responsive nociceptive neurons and that following incision-induced excitability increases, capsaicin may result in a temporary suppression of nociceptive neuronal changes reflecting central

  6. DNA Methylation Modulates Nociceptive Sensitization after Incision.

    Directory of Open Access Journals (Sweden)

    Yuan Sun

    Full Text Available DNA methylation is a key epigenetic mechanism controlling DNA accessibility and gene expression. Blockade of DNA methylation can significantly affect pain behaviors implicated in neuropathic and inflammatory pain. However, the role of DNA methylation with regard to postoperative pain has not yet been explored. In this study we sought to investigate the role of DNA methylation in modulating incisional pain and identify possible targets under DNA methylation and contributing to incisional pain. DNA methyltranferase (DNMT inhibitor 5-Aza-2'-deoxycytidine significantly reduced incision-induced mechanical allodynia and thermal sensitivity. Aza-2'-deoxycytidine also reduced hindpaw swelling after incision, suggesting an anti-inflammatory effect. Global DNA methylation and DNMT3b expression were increased in skin after incision, but none of DNMT1, DNMT3a or DNMT3b was altered in spinal cord or DRG. The expression of proopiomelanocortin Pomc encoding β-endorphin and Oprm1 encoding the mu-opioid receptor were upregulated peripherally after incision; moreover, Oprm1 expression was further increased under DNMT inhibitor treatment. Finally, local peripheral injection of the opioid receptor antagonist naloxone significantly exacerbated incision-induced mechanical hypersensitivity. These results suggest that DNA methylation is functionally relevant to incisional nociceptive sensitization, and that mu-opioid receptor signaling might be one methylation regulated pathway controlling sensitization after incision.

  7. A small incision technique facilitates pterygium removal

    Directory of Open Access Journals (Sweden)

    Shu Zhang

    2015-09-01

    Full Text Available AIM: To verify the advantages of an improved protocol for pterygium surgery(small incision removalover a conventional protocol of this surgery.METHODS: Totally 40 primary pterygium cases were divided into two groups(n=20 eachaccording to the protocols: small incision removal versus conventional removal. In our small incision removal, group 1, the pterygium body was cut open with a small incision firstly, through which the conjunctiva was separated from the underlying degenerated Tenon's layer; while in the conventional protocol, group 2, the whole head of pterygium was taken down before the separation. Then the head of pterygium was torn down in our protocol using a forceps instead of cutting it down with a blade, which was facilitated by a special corneal epithelial flap formation method. Surgery time, pain score and corneal wound healing were measured to provide objective comparison of outcome between the two protocols. RESULTS: In the group using small incision removal, the average surgery time was 7.72min(or 48.9%shorter than that of the control group using conventional protocol(PPCONCLUSION: The small incision pterygium removal protocol was easier to perform and resulted in a better outcome than the conventional protocol.

  8. Submillimeter-Resolution Fluorescence Laparoscopy of Pancreatic Cancer in a Carcinomatosis Mouse Model Visualizes Metastases Not Seen with Standard Laparoscopy

    Science.gov (United States)

    Cao, Hop S. Tran; Kaushal, Sharmeela; Menen, Rhiana S.; Metildi, Cristina A.; Lee, Claudia; Snyder, Cynthia S.; Talamini, Mark A.; Hoffman, Robert M.

    2011-01-01

    Abstract Background Staging laparoscopy can visualize peritoneal and liver metastases in pancreatic cancer otherwise undetectable by preoperative imaging. However, false-negative rates may be as high as 18%–26%. The aim of the present study was to improve detection of metastatic pancreatic cancer with the use of fluorescence laparoscopy (FL) in a nude-mouse model with the tumors expressing green fluorescent protein (GFP). Methods The carcinomatosis mouse model of human pancreatic cancer was established by intraperitoneal injections of green fluorescent protein-expressing MiaPaca-2 human pancreatic cancer cells into 6-week-old female athymic mice. Two weeks later, mice underwent diagnostic laparoscopy. Laparoscopy was performed first under standard brightfield lighting, followed by fluorescent lighting. The number of metastatic foci identified within the four quadrants of the peritoneal cavity was recorded. After laparoscopy, the animals were sacrificed, opened, and imaged with the OV-100 Small Animal Imaging system as a positive control to identify metastasis. Tumors were collected and processed for histologic review. Results FL enabled visualization of pancreatic cancer metastatic foci not visualized with standard brightfield laparoscopy (BL). Under FL, in 1 representative mouse, 26 separate micrometastatic lesions were identified. In contrast, only very large tumors were seen using BL. Use of the OV-100 images, as positive controls, confirmed the presence of tumor foci. FL thus allowed identification and exact localization of submillimeter tumor foci. Such small-sized tumor foci were not distinguished from surrounding tissue under BL. All malignant lesions were histologically confirmed. Conclusions The use of FL enables the identification of tumor foci that cannot be seen with standard laparoscopy. The technology described in this report has important potential for the clinical development of FL. PMID:21699431

  9. Laser laparoscopy in the treatment of polycystic ovarian disease

    Science.gov (United States)

    Mutrynowski, Andrzej; Zabielska, Renata

    1996-03-01

    A polycystic ovaries disease occurs in the case of women with anovulatory cycles as the result of neurohormonal disorders. Patients with this disease suffer from infertility and many symptoms, such as: irregular menstrual bleeding, hirsutism, obesity. The paper presents a method of the carbon dioxide laser laparoscopy in the polycystic ovary disease treatment. The study included 96 women operated on (carbon dioxide laser laparoscopy) in the II Clinic Of Obstetric and Gynecology in Warsaw. Each woman measured her body temperature in order to evaluate her menstrual cycle and had vaginal USG examination or a cytohormonal one before laparoscopy and within 6 months after the surgery. Performing the laparoscopy the operator punctured each ovary in at least 15 points using the carbon dioxide laser. The patients were followed-up for 6 months. The Chi test was used to make the statistic analysis. Comparing the percent of ovulatory cycles and regular ones before and after surgery we noticed that the differences were statistically relevant. Eighty-five patients (88%) had regular cycles and in 88 cases (92%) there was a diphasic curve of the body temperature after the laparoscopy. Fourteen percent of infertile women with polycystic ovary disease conceived.

  10. Fluorescence staging laparoscopy for gastrointestinal malignancies: experimental experience

    Science.gov (United States)

    Prosst, Ruediger L.; Pietschmann, Mathias; Rheinwald, Markus; Haase, Thomas; Herfarth, Christian; Gahlen, Johannes

    2001-01-01

    Accurate staging can be a major problem in therapeutic planning of advanced abdominal malignancies. We experimentally combined conventional staging laparoscopy with aminolevulinic acid (ALA) induced fluorescence diagnosis (FD) to improve the detection of disseminated peritoneal tumors. Using different photosensitization times and ALA concentrations we evaluated the optimal fluorescence parameters for laparoscopic fluorescence diagnosis of intra abdominal tumor spread. In a rat tumor model we performed conventional and fluorescence laparoscopy to determine the increase of sensitivity gained by FD in terms of additionally detected lesions. After laparoscopic examination, the fluorescence emission from the tumors was spectrometically analyzed. Serum levels of ALA and PpIX were measured by HPLC to determine their systemic metabolism. Fluorescence staging laparoscopy was able to visualize even macroscopically occult neoplasms. Using 1.5 percent ALA solution and a photosensitization time of 4 hours as favorable parameters the diagnostic value of conventional staging laparoscopy was significantly improved: 35 percent of all malignant lesions were detected only by FD. Therefore, fluorescence laparoscopy suggest to be a highly promising preoperative staging tool requiring minimal technical and clinical expenditure. It provides the laparoscopist with a rapid and accurate technique to assess more thoroughly the full extent of malignant tumor growth in the abdominal cavity.

  11. Factors affected by surgical technique when treating total colonic aganglionosis: laparoscopy-assisted versus open surgery.

    Science.gov (United States)

    Miyano, Go; Ochi, Takanori; Lane, Geoffrey J; Okazaki, Tadaharu; Yamataka, Atsuyuki

    2013-04-01

    We compared laparoscopy-assisted Duhamel (Lap-D) with open surgery (Duhamel or Soave = D/S) for treating total colonic aganglionosis (TCA) in children to establish what factors may affect outcome. Fourteen TCA cases treated between 1990 and 2010 were reviewed. Open D/S (O-D/S) through a vertical midline abdominal incision was routine from 1990 to 2005, whereupon Lap-D became routine. Lap-D involves laparoscopic colon resection, ileostomy take-down, and ileum pull-through through an additional Pfannenstiel incision. We compared pre-operative nutrition, operating time, intraoperative blood loss, duration until oral challenge, postoperative analgesic usage, incidence of enterocolitis, early complications that arose within 30 days of surgery, and late complications, and wound cosmesis 1 year postoperatively (Grade-1: unacceptable, Grade-2: passable, Grade-3: excellent). Six had O-D/S (2D, 4S) and eight had Lap-D. Differences in patient demographics, mean ages/weights at surgery, average length of the aganglionic segment from the terminal ileum, operating time, and time taken for oral challenge were all not significant, full feeding took longer in O-D/S (6.7 vs. 5.9 days). Preoperative central vein intravenous hyperalimentation was required for one case in O-D/S and two cases in Lap-D. These three required hospitalization for at least 30 days postoperatively and parenteral nutrition after discharge. Although there were no intraoperative complications in either group, there was one case of transient ileus in O-D/S that resolved conservatively. Cosmesis was significantly better in Lap-D (O-D/S = 1.2; Lap-D = 2.1; p < 0.05). Cosmesis was the only factor that was significantly different between Lap-D and O-D/S; all other factors were similar.

  12. Abdominal incisions in General Surgery: a review | Ajao | Annals of ...

    African Journals Online (AJOL)

    There is this wrong notion that the only standard abdominal incision is the midline incision. Cases have been seen in which an abdominal incision extends from the xyphoid process to the symphysis pubis just to remove a perforated appendix! It is also not unusual to see a groin incision together with a lower abdominal ...

  13. Laparoscopic cholecystectomy with two mini cosmetic incisions.

    Science.gov (United States)

    Tavassoli, Alireza; Noorshafiee, Sajad

    2017-12-18

    Minimally invasive surgery gained popularity between general surgeons especially laparoscopic four-port cholecystectomy. By introducing different methods such as NOTES and SILS, the costs elevated with its cosmetics. We aim to study a new technique of laparoscopic cholecystectomy by two incisions with best cosmetics, and same quality and lower cost as conventional four-port laparoscopic cholecystectomy and make a comparison between them. In a double-blind clinical trial from December 2012 to September 2014, patients with cholelithiasis who presented to general surgery clinic and candidate for laparoscopic cholecystectomy were studied. Half of patients underwent double-incision laparoscopic cholecystectomy and other half underwent conventional four-port laparoscopic cholecystectomy. The mean age and BMI were higher in double-incision and four-port group, respectively, but not statistically different. Also male to female ratio was 6:1 in double-incision group and 9:1 in four-port group, and they were not statistically different. The mean operation time was about 2 min more in double-incision group, but it is trivial to consider a significant difference at level of 5%. The mean pain score (0-10) was significantly lower in double incision group in comparison with four-port group (p < 0.0001). Patients in double incision group reported higher satisfaction and were sooner in return to work than in four-port group (p < 0.0001). It seems that DILS for uncomplicated cholelithiasis is safe. By reducing port number, we succeed in reducing the pain and need for analgesics, reducing hospital staying and sooner return to work. By taking into account using conventional CLS instrument and lowering the hospital charges, it could be a good alternative to SILS.

  14. Laparoscopy comparison to hysterosalpingography in infertile women; Porownanie histerosalpingografii i laparoskopii u nieplodnych kobiet

    Energy Technology Data Exchange (ETDEWEB)

    Micinski, P.; Poreba, R.; Smoczynska, W. [Slaska Akademia Medyczna, Tychy (Poland)

    1993-12-31

    A diagnostic laparoscopy was performed in 57 unexplained infertility patients with apparently normal hysterosalpingography pictures. Despite it, laparoscopy revealed 51% pathologic changes of reproductive organs in pelvis minor. (author) 13 refs, 3 tabs

  15. The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management

    Directory of Open Access Journals (Sweden)

    Meher Tabassum

    2017-01-01

    Full Text Available Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.

  16. Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery

    Directory of Open Access Journals (Sweden)

    Nidhi Jauhari

    2014-12-01

    Full Text Available AIM:To determine the surgically induced astigmatism (SIA in Straight, Frown and Inverted V shape (Chevron incisions in manual small incision cataract surgery (SICS.METHODS:A prospective cross sectional study was done on a total of 75 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (25 each. Each group received a particular type of incision (Straight, Frown or Inverted V shape incisions. Manual SICS with intraocular lens (IOL implantation was performed. The patients were compared 4wk post operatively for uncorrected visual acuity (UCVA, best corrected visual acuity (BCVA and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program. The study was analyzed using SPSS version 15.0 statistical analysis software.RESULTS:The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees with Inverted V incision which was statistically significant.CONCLUSION:Inverted V (Chevron incision gives minimal SIA.

  17. Role of laparoscopy in evaluation of chronic pelvic pain

    Directory of Open Access Journals (Sweden)

    Hebbar Shripad

    2005-01-01

    Full Text Available Introduction: Chronic pelvic pain (CPP is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%, followed by congestive dysmenorrhoea (26.7%. 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%, followed by pelvic congestion (18.6%. Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%. Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001. Adhesiolysis helps only small proportion of women in achieving pain control.

  18. Hemodynamic Consequences of Laparoscopy for Patients on Mechanical Circulatory Support.

    Science.gov (United States)

    Reich, Heidi; Ramzy, Danny; Czer, Lawrence; Esmailian, Fardad; Moriguchi, Jaime; Ihnken, Kai; Yusufali, Taizoon; D'Attellis, Nicola; Arabia, Francisco; Annamalai, Alagappan

    2015-12-01

    Technologic advances and superior survival with mechanical circulatory support (MCS) have led to an expanding population that develops intraabdominal conditions requiring intervention. Whether laparoscopy can be performed without detrimental effects on hemodynamics and device function is not well described. Effects of laparoscopy performed on MCS were retrospectively assessed. Intraoperative hemodynamics and device function were compared with the same time interval 24 hours prior to surgery using intrapatient paired t tests. Outcomes included survival, transfusion, thromboembolic events, and infection. Twelve patients with ventricular assist devices or total artificial hearts underwent laparoscopy from 2012 to 2014. Median follow-up was 116 days. Operations included cholecystectomy, diagnostic laparoscopy, gastrojejunostomy, and gastrostomy. There were no differences between preoperative and intraoperative mean arterial pressure, heart rate, and inotrope or vasopressor requirements (P > .05). Device fill volume, flow, rate, and power were unchanged (P > .05), whereas pulsatility index decreased by 0.2 (95% confidence interval, 0.03, 0.36) with laparoscopy (P = .03). All intraoperative fluctuations in hemodynamics and device function improved with reduction of pneumoperitoneum, adjusting device speed, or pharmacologic support. There were no operative mortalities. Thirty-day survival and survival to discharge were 75% and 50%, respectively. Despite antiplatelet therapy and preoperative international normalization ratio of 2.2 ± 0.9, there were no re-operations for bleeding, and 50% did not require transfusion. Two patients with recent cardiac surgery had thromboembolic events: one stroke and one device thrombus. None had postoperative bacteremia or driveline infection. Laparoscopy can be performed on MCS with low morbidity and mortality and minimal perturbations in hemodynamics and device function.

  19. Laparoscopy-assisted hydrostatic in situ reduction of intussusception: A reasonable alternative?

    Directory of Open Access Journals (Sweden)

    V. V. S. S. Chandrasekharam

    2011-01-01

    Full Text Available Aim: To evaluate an alternative way of reducing intussusceptions under laparoscopic guidance. Materials and Methods: This is a retrospective observational study of children who underwent laparoscopy-assisted hydrostatic in situ reduction of intussusceptions (LAHIRI. Under general anesthesia with laparoscopic vision, warm saline was infused into the rectum with a 16-18 F Foley catheter and a drip set till the intussusception was reduced. Results: Eleven patients [age 7.8 (±2.8 months] were operated over a period of 1 year. Ten (90.9% patients had ileocolic intussusception, which got completely reduced, but one (9% had ileo-ileocolic intusussception, in whom manual reduction by extending the subumbilical incision was required to reduce the ileoileal part. The mean duration of surgery was 38.5 (±6.6 min. No patient had bowel ischemia and there were no intra- or postoperative complications. Conclusions: LAHIRI appears to be an effective and safe technique in children. Specific advantages are that it is performed in a controlled environment in the operating room, avoids patient apprehension and discomfort, avoids bowel handling, provides a safe opportunity to create higher intraluminal pressure, ensures visual assessment of bowel vascularity and completeness of reduction.

  20. Laparoscopy can be used to diagnose peritoneal tuberculosis

    DEFF Research Database (Denmark)

    Ferløv Schwensen, Jakob; Bulut, Mustafa; Nordholm-Carstensen, Andreas

    2014-01-01

    A 17-year-old man with weight loss, abdominal pain and fever for three months was admitted to the Digestive Disease Centre. Laboratory tests revealed leucocytosis and a low haemoglobin level, and a CT-scan of the abdomen indicated non-specific abscess cavities. Diagnostic laparoscopy was conducted...... and widespread pale nodules were found throughout the peritoneum. Consequently, the patient was diagnosed with peritoneal tuberculosis. This case demonstrates that atypical manifestations of tuberculosis exist in Denmark and that laparoscopy with biopsy can be performed to obtain the diagnosis when suspecting...

  1. Laparoscopy and hysteroscopy in a Tertiary Hospital: A 4 year review

    African Journals Online (AJOL)

    or hysteroscopy in AKTH within the study period were retrieved from the operation record book; their case files were retrieved, studied and recorded in a ... Key words: Anaesthesia; hysteroscopy; laparoscopy. Introduction. Laparoscopy and ... local anaesthesia with sedation may also be used for office laparoscopy.[3].

  2. Comparison of primary total hip replacements performed with a standard incision or a mini-incision.

    Science.gov (United States)

    Woolson, Steven T; Mow, Christopher S; Syquia, Jose Fernando; Lannin, John V; Schurman, David J

    2004-07-01

    Primary total hip replacement performed through an incision that is a minimally invasive technique. Proponents have claimed that mini-incision techniques reduce blood loss, transfusion requirements, postoperative pain, and the length of the hospital stay compared with standard techniques through a longer incision. However, we are aware of no well-designed comparison study that supports these claims. The purpose of the present study was to compare the short-term results of a mini-incision with a standard incision technique for total hip replacement. A consecutive series of patients who underwent 135 primary unilateral total hip replacements (fifty with use of a mini-incision [a standard incision) by three surgeons at one hospital were studied. Each surgeon selected patients to have a mini-incision procedure and performed a standard approach in the remaining patients. A posterior approach was used for all procedures. In-hospital data were collected retrospectively, and the initial postoperative radiographs were analyzed. Because of the selection process, the patients who had a mini-incision had both a significantly lower average body-mass index (p = 0.008) and a lower average score on the American Society of Anesthesiologists rating (p = 0.006), indicating that they were thinner and healthier than the patients who had a standard incision. With the numbers of patients available, no significant differences were found between the groups with respect to the average surgical time, intraoperative blood loss, in-hospital transfusion rate, length of hospital stay, or the patients' disposition after discharge. The mini-incision group was found to have a significantly higher risk of a wound complication (p = 0.02), a higher percentage of acetabular component malposition (p = 0.04), and poor fit and fill of femoral components inserted without cement (p = 0.0036). There was no evidence that the mini-incision technique resulted in less bleeding or less trauma to the soft tissues

  3. Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy

    Science.gov (United States)

    Fu, Kuang I; Hamahata, Yukihiro; Tsujinaka, Yasunobu

    2010-01-01

    We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum. Endoscopic mucosal resection (EMR) was carried out successfully and completely with the assistance of laparoscopy. A 71-year-old man was admitted to our hospital because of melena and anemia. Emergent colonoscopy showed diverticulosis in the right-sided colon. However, endoscopy could not exactly detect the bleeding site. A flat elevated polyp was found within a single diverticulum located in the descending colon and diagnosed as an intramucosal carcinoma, as magnifying chromoendoscopy revealed a type IV pit pattern. As his diverticular bleeding repeated, a right-sided hemicolectomy was decided for treatment, the polyp within the diverticulum was also completely removed by EMR with the assistance of laparoscopy. Although a colonic perforation was detected immediately after EMR, the perforation was closed with endoclips intraluminally and also repaired laparoscopically from the serosal side. Histologically, the resected lesion was an intramucosal well-differentiated adenocarcinoma and the surgical margin was free of tumor. PMID:20333800

  4. Small Incision Cataract Surgery (SICS with Clear Corneal Incision and SICS with Scleral Incision – A Comparative Study

    Directory of Open Access Journals (Sweden)

    Md Shafiqul Alam

    2014-01-01

    Full Text Available Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3% was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of

  5. A randomised trial comparing laparoscopy with laparotomy in the ...

    African Journals Online (AJOL)

    A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy. ... South African Medical Journal ... Ruptured ectopic pregnancy (REP) is a common gynaecological emergency in resource-poor settings, where laparotomy is the standard treatment despite ...

  6. Gynaecological laparoscopy courses in the United Arab Emirates ...

    African Journals Online (AJOL)

    Background: Laparoscopic surgery is important for gynaecological practice and became the method of choice for many gynaecological procedures having advantages over open surgery. Objective: To report our modified teaching methods, and evaluation of the gynaecological laparoscopy courses in United Arab Emirates.

  7. Laparoscopy can be used to diagnose peritoneal tuberculosis

    DEFF Research Database (Denmark)

    Ferløv Schwensen, Jakob; Bulut, Mustafa; Nordholm-Carstensen, Andreas

    2014-01-01

    and widespread pale nodules were found throughout the peritoneum. Consequently, the patient was diagnosed with peritoneal tuberculosis. This case demonstrates that atypical manifestations of tuberculosis exist in Denmark and that laparoscopy with biopsy can be performed to obtain the diagnosis when suspecting...... peritoneal tuberculosis....

  8. Laser visual guidance versus two-dimensional vision in laparoscopy

    DEFF Research Database (Denmark)

    Sørensen, Stine Maya Dreier; Mahmood, Oria; Konge, Lars

    2017-01-01

    BACKGROUND: During laparoscopy, the surgeon's loss of depth perception and spatial orientation is problematic. Laser visual guidance (LVG) is an innovative technology that improves depth perception to enhance the visual field. In this trial, we examined the effect of LVG on surgical novices' motor...

  9. Laparoscopy in unexplained abdominal pain: surgeon's perspective

    International Nuclear Information System (INIS)

    Abdullah, M.T.; Waqar, S.H.; Zahid, M.A.

    2016-01-01

    Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. Methods: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Results: Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Conclusion: Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients. (author)

  10. A Review Of Laparoscopy At A Dedicated Assisted Reproductive ...

    African Journals Online (AJOL)

    While 4 patients had laparoscopic tubal sterilization with Filshie clip, 1 patient each had laparoscopic ovarian cyst drainage and IUCD retrieval. The overall complication rate was 2.34%. Conclusion: Laparoscopy is a useful tool in trained hands as important diagnostic and surgical procedures can be carried out, obviating ...

  11. Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions ...

    African Journals Online (AJOL)

    Introduction: Laparoscopy has proved to be an important tool in the minimally invasive exploration of selected patients with chronic abdominal disorders, whose diagnosis remains uncertain, despite exploring the requisite laboratory and imaging investigations like ultrasonography, computed tomography (CT) scan, and the ...

  12. Robotic-assisted laparoscopy in reproductive surgery: a contemporary review.

    Science.gov (United States)

    Jayakumaran, Jayapriya; Patel, Sejal D; Gangrade, Bhushan K; Narasimhulu, Deepa Maheswari; Pandian, Soundarya Ramanatha; Silva, Celso

    2017-06-01

    Robotic surgery is a conceptual fusion of the conventional open surgery and the minimally invasive laparoscopic surgery. We reviewed the current role of robotic-assisted laparoscopy in the field of reproductive surgery by a literature search in PubMed database. We analyzed the reported advantages and limitations of the use of robotics in reproductive surgeries like myomectomy, tubal reanastomosis, endometriosis, ovarian tissue cryopreservation, and ovarian transposition. Overall, robotic assistance in reproductive surgery resulted in decreased blood loss, less post-operative pain, shorter hospital stay, and faster convalescence, whereas reproductive outcomes were similar to open/laparoscopic approaches. The main drawbacks of robotic surgery were higher cost and longer operating times. It is as safe and effective as the conventional laparoscopy and represents a reasonable alternate to abdominal approach. Procedures that are technically challenging with the conventional laparoscopy can be performed with robotic assistance. It has advantages of improved visualization and Endowrist™ movements allowing precise suturing. This helps to overcome the limitations of laparoscopy, especially in complicated procedures, and may shorten the steep learning curve in minimal invasive surgery. Randomized controlled trials looking at both short- and long-term outcomes are warranted to strengthen the role of robotic surgery in the field of reproductive surgery.

  13. Laparoscopy in the diagnosis of tuberculosis in chronic pelvic pain.

    Science.gov (United States)

    Rajaram, Shalini; Gupta, Priyanka; Gupta, Bindiya; Kaur, Iqbal R; Goel, Neerja

    2016-09-01

    To estimate the prevalence of genital tuberculosis in women with idiopathic chronic pelvic pain on laparoscopy, correlate laparoscopic findings with microbiological and histological diagnosis of tuberculosis and assess the response to anti tubercular treatment (ATT) in these cases. In a prospective cohort study, fifty women with idiopathic chronic pelvic pain were enrolled. Diagnostic laparoscopy was done in all women and fluid from pouch of Douglas and/or saline washings were sent for acid fast bacilli (AFB) smear, conventional and rapid culture and DNA polymerase chain reaction (PCR) analysis for diagnosis of genital TB. The results of these tests were analyzed and agreement with laparoscopy was assessed using Kappa statistics. Pain scores using visual analogue scale were compared before and after treatment. Pelvic pathology was present in 44 (88%) women of idiopathic chronic pelvic pain, with a 34% prevalence rate of genital tuberculosis. Pelvic inflammation was associated with positive peritoneal fluid PCR (n=4) and AFB culture (n=3). Acid fast bacilli PCR had substantial agreement (kappa statistics=0.716) with visual findings at laparoscopy. There was a significant reduction in pain scores after treatment. Genital tuberculosis contributes to one-third cases of chronic pelvic pain. Pelvic inflammation is an early feature of genital TB and peritoneal fluid PCR has the best co-relation with laparoscopic findings of genital tuberculosis. Copyright © 2016 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  14. Diagnostic Laparoscopy to the rescue: The first experience in EKSUTH

    African Journals Online (AJOL)

    Summary: Diagnostic Laparoscopy is an established investigative procedure. Its advantage in establishing accurate diagnosis has been proven over time. The duration is short, it provides direct visualization of the lesion and it avoids exposure to irradiation. It is also far cheaper to set up compared to CT scan and MRI.

  15. Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions ...

    African Journals Online (AJOL)

    Since the days of Hippocrates, medical science is constantly thriving to peep into dark places of the body and to achieve such techniques that would bring perfection to diagnosis. Laparoscopy, one such achievement developed in the twentieth century, offers a simple, rapid, and safe method to evaluate and diagnose ...

  16. Rasmussen's model of human behavior in laparoscopy training.

    Science.gov (United States)

    Wentink, M; Stassen, L P S; Alwayn, I; Hosman, R J A W; Stassen, H G

    2003-08-01

    Compared to aviation, where virtual reality (VR) training has been standardized and simulators have proven their benefits, the objectives, needs, and means of VR training in minimally invasive surgery (MIS) still have to be established. The aim of the study presented is to introduce Rasmussen's model of human behavior as a practical framework for the definition of the training objectives, needs, and means in MIS. Rasmussen distinguishes three levels of human behavior: skill-, rule-, and knowledge-based behaviour. The training needs of a laparoscopic novice can be determined by identifying the specific skill-, rule-, and knowledge-based behavior that is required for performing safe laparoscopy. Future objectives of VR laparoscopy trainers should address all three levels of behavior. Although most commercially available simulators for laparoscopy aim at training skill-based behavior, especially the training of knowledge-based behavior during complications in surgery will improve safety levels. However, the cost and complexity of a training means increases when the training objectives proceed from the training of skill-based behavior to the training of complex knowledge-based behavior. In aviation, human behavior models have been used successfully to integrate the training of skill-, rule-, and knowledge-based behavior in a full flight simulator. Understanding surgeon behavior is one of the first steps towards a future full-scale laparoscopy simulator.

  17. Predicting opportunities to increase utilization of laparoscopy for colon cancer.

    Science.gov (United States)

    Keller, Deborah S; Parikh, Niraj; Senagore, Anthony J

    2017-04-01

    Despite proven safety and efficacy, rates of minimally invasive approaches for colon cancer remain low in the USA. Given the known benefits, investigating the root causes of underutilization and methods to increase laparoscopy is warranted. Our goal was to develop a predictive model of factors impacting use of laparoscopic surgery for colon cancer. The Premier Hospital Database was reviewed for elective colorectal resections for colon cancer (2009-2014). Patients were identified by ICD-9-CM diagnosis code and then stratified into open or laparoscopic approaches by ICD-9-CM procedure codes. An adjusted multivariate logistic regression model identified variables predictive of use of laparoscopy for colon cancer. A total of 24,245 patients were included-12,523 (52 %) laparoscopic and 11,722 (48 %) open. General surgeons performed the majority of all procedures (77.99 % open, 71.60 % laparoscopic). Overall use of laparoscopy increased from 48.94 to 52.03 % over the study period (p colon cancer laparoscopically. Colorectal surgeons were 32 % more likely to approach a case laparoscopically than general surgeons (OR 1.315, 95 % CI [1.222, 1.415], p characteristics that can be identified preoperatively to predict who will undergo surgery for colon cancer using laparoscopy. However, additional patients may be eligible for laparoscopy based on patient-level characteristics. These results have implications for regionalization and increasing teaching of MIS. Recognizing and addressing these variables with training and recruiting could increase use of minimally invasive approaches, with the associated clinical and financial benefits.

  18. DOES TUBULARIZED INCISED PLATE URETHROPLASTY FIT ...

    African Journals Online (AJOL)

    Objective To evaluate prospectively our experience using tubularized incised plate (TIP) urethroplasty in primary and repeat penile shaft hypospadias. Patients and Methods Thirty-two boys with penile shaft hypospadias were selected to undergo TIP procedure. Their age ranged from 22 months to 9 years. Twenty-two cases ...

  19. Laparoscopic pyeloplasty: Initial experience with 3D vision laparoscopy and articulating shears.

    Science.gov (United States)

    Abou-Haidar, Hiba; Al-Qaoud, Talal; Jednak, Roman; Brzezinski, Alex; El-Sherbiny, Mohamed; Capolicchio, John-Paul

    2016-12-01

    Laparoscopic reconstructive surgery is associated with a steep learning curve related to the use of two-dimensional (2D) vision and rigid instruments. With the advent of robotic surgery, three-dimensional (3D) vision, and articulated instruments, this learning curve has been facilitated. We present a hybrid alternative to robotic surgery, using laparoscopy with 3D vision and articulated shears. To compare outcomes of children undergoing pyeloplasty using 3D laparoscopy with articulated instruments with those undergoing the same surgery using standard laparoscopy with 2D vision and rigid instruments. Medical charts of 33 consecutive patients with ureteropelvic junction obstruction who underwent laparoscopic pyeloplasty by a single surgeon from 2006 to 2013 were reviewed in a retrospective manner. The current 3D cohort was compared with the previous 2D cohort. Data on age, weight, gender, side, operative time, dimension (2D = 19 patients, 3D = 8 patients), presence of a crossing vessel, length of hospital stay, and complication rate were compared between the two groups. Articulating shears were used for pelvotomy and spatulation of the ureter in the 3D group. Statistical tests included linear regression models and chi square tests for trends using STATA software. Operative time per case was decreased by an average of 48 min in the group undergoing 3D laparoscopic pyeloplasty compared with the group undergoing 2D laparoscopic pyeloplasty (p = 0.02) (Figure). Complication rate and length of hospital stay were not significantly affected by the use of 3D laparoscopy. These favorable results are in accordance with previous literature emphasizing the importance of 3D vision in faster and more precise execution of complex surgical maneuvers. The use of flexible instruments has also helped overcome the well-described delicate step of a dismembered pyeloplasty, namely the pelvotomy and ureteral spatulation. Limitations of this study are those inherent to the

  20. Using three-dimensional laparoscopy as a novel training tool for novice trainees compared with two-dimensional laparoscopy.

    Science.gov (United States)

    Chiu, Chieh Jack; Lobo Prabhu, Kristel; Tan-Tam, Clara Chia-Hua; Panton, Ormond Neely M; Meneghetti, Adam

    2015-05-01

    Laparoscopic skills training is an essential component of general surgery training. This study proposes the use of three-dimensional (3D) laparoscopy as the initial training tool for beginners to shorten the learning curve. This study evaluates the surgical performance and subjective experience of junior and senior trainees with 3D versus two-dimensional laparoscopy. Peg transfer task was used as the objective time measurement. A subjective evaluation of the 2 systems using a questionnaire was also used. The mean difference in the juniors was 16.33 seconds, while in the seniors it was only 3.46 seconds (P = .036). The time difference between groups was much smaller in the 3D than the two-dimensional (P = .14 vs .02) laparoscopy. In the subjective evaluation, the novice group also scored significantly higher for the 3D system in the bimanual dexterity category (P = .004, .007). Our study demonstrates the feasibility of using 3D laparoscopy for laparoscopic skills training in novices. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Radiological findings after endoscopic incision of ureterocele

    International Nuclear Information System (INIS)

    Cheon, Jung Eun; Kim, In One; Seok, Eul Hye; Cha, Joo Hee; Choi, Gook Myung; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Kwang Myung; Choi, Hwang; Cheon, Jung Eun; Seok, Eul Hye; Cha, Joo Hee; Choi, Guk Myung

    2001-01-01

    Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. We retrospectively reviewed the radiological findings (ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)) in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M:F 3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when medical treatment was still required, and second operation when additional surgical treatment was required. Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchima was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grase 3 during the follow-up period-was required by nine (56%). Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of uronary tract obstructon, while to assess the extend of VUR during the follow-up period , postoperative VCU is required

  2. A multicentre prospective randomised study of single-incision mini-sling (Ajust®) versus tension-free vaginal tape-obturator (TVT-O™) in the management of female stress urinary incontinence: pain profile and short-term outcomes.

    Science.gov (United States)

    Mostafa, Alyaa; Agur, Wael; Abdel-All, Mohamed; Guerrero, Karen; Lim, Chi; Allam, Mohamed; Yousef, Mohamed; N'Dow, James; Abdel-fattah, Mohamed

    2012-11-01

    To compare the postoperative pain profile, peri-operative details, and short-term patient-reported and objective success rates of single-incision mini-slings (SIMS) versus standard mid-urethral slings (SMUS). In a multicentre prospective randomised trial in six UK centres in the period between October 2009 and October 2010, 137 women were randomised to either adjustable SIMS (Ajust®, C. R. Bard Inc., NJ, USA), performed under local anaesthesia as an opt-out policy (n=69), or SMUS (TVT-O™, Ethicon Inc., Somerville, USA) performed under general anaesthesia (n=68). Randomisation was done through number-allocation software and using telephone randomisation. Postoperative pain profile (primary outcome) was assessed on a ten-point visual analogue scale at fixed time-points. Pre- and post operatively (4-6 months) women completed symptom severity, urgency perception scale (UPS), quality of life and sexual function questionnaires. In addition, women completed a Patient Global Impression of Improvement Questionnaire and underwent a cough stress test at 4-6 months follow up. Sample size calculation was performed and data were analysed using SPSS 18. Descriptive analyses are given and between-group comparisons were performed using chi-square, Fischer exact test and Mann-Whitney test as appropriate. Significance level was set at 5%. Women in the SIMS Ajust® group had a significantly lower postoperative pain profile up to 4 weeks (p=TVT-O™ groups respectively. There was a trend towards higher rates of de novo urgency or worsening of pre-existing urgency in the SIMS Ajust® group (21.7% versus 8.8%) but this did not reach statistical significance (p=0.063). Women in the SIMS Ajust® group had shorter hospital stay (median (IQR) 3.65 (2.49, 4.96)) compared to (4.42 (3.16, 5.56)) the TVT-O™ group 95% CI (-0.026, 1.326), with significantly earlier return to normal activities (p=0.025) and to work (p=0.006). The adjustable single-incision mini-sling (Ajust®) is associated

  3. Laparoscopy in the second and third trimesters of pregnancy for abdominal surgical emergencies.

    Science.gov (United States)

    Guterman, S; Mandelbrot, L; Keita, H; Bretagnol, F; Calabrese, D; Msika, S

    2017-05-01

    To assess complications and outcomes of pregnancies following laparoscopic abdominal surgery during the second and third trimesters of pregnancy. Retrospective single-center study of 23 cases of laparoscopic surgery in the second or third trimesters of pregnancy between January 2005 and May 2016. The laparoscopies were performed between 15 and 33 weeks of gestation, a mean of 23 weeks+2 days, with 6 cases in the 3rd trimester. The operations were: 11 cholecystectomies, 6 appendectomies, 1 intestinal occlusion (volvulus on a gastric band), 3 adnexal torsions, 1 ovarian cyst and 1 paratubal cyst with torsion. No secondary laparotomy was required. The postoperative courses were favorable in most cases. However, 3 appendectomies were complicated, one by chorioamnionitis and miscarriage at 20½ weeks of gestation and 2 by right iliac fossa abscesses requiring percutaneous radiological drainage, one of these women delivered a healthy term baby and the other had chorioamnionitis and preterm delivery at 34 weeks, followed by neonatal death. Laparoscopy can be safely performed for surgical indications in the second and third trimesters of pregnancy. In case of abdominal symptoms, a timely diagnosis is required to decide whether or not to operate and imaging should not be withheld particularly in case of suspected appendicitis which has a high risk of complications. Copyright © 2017. Published by Elsevier Masson SAS.

  4. COMPARISON OF POSTOP SIA IN MSICS WITH STRAIGHT INCISION VERSUS FROWN INCISION

    Directory of Open Access Journals (Sweden)

    Shayana Bhumbla

    2017-05-01

    Full Text Available BACKGROUND Surgically-Induced Astigmatism (SIA is one of the commonest causes of poor postoperative vision even after uneventful cataract surgery. Recent advances have led to a newer concept of “refractive cataract surgery.” The aim of the study is to study the comparison of postop SIA in Manual Small Incision Cataract Surgery (MSICS with straight versus frown incision. MATERIALS AND METHODS 50 patients of cataract were divided into 2 groups (25 each - group A underwent MSICS with 6 mm straight incision, group B underwent MSICS with 6 mm frown incision. BCVA, keratometry readings were recorded with auto kerato-refractometer preop, at 1 week, 1 month, 3 months and SIA was calculated with SIA calculator version 2.1, a free software program. RESULTS Mean SIA in group A and B were - 1.14D versus 0.92D at 1 week; 1.26D versus 0.97D at 1 month; 1.29D versus 0.95D at 3 months. The difference was statistically significant at each follow up visit (p<0.05. CONCLUSION Frown incision gives lesser SIA than straight incision in MSICS.

  5. Outcomes of Phacoemulsification Using Different Size of Clear Corneal Incision in Eyes with Previous Radial Keratotomy.

    Directory of Open Access Journals (Sweden)

    Jing Shang Zhang

    Full Text Available To evaluate visual outcomes and complications after phacoemulsification in eyes with cataract and previous radial keratotomy (RK cuts using different sizes of clear corneal incisions.The study was a retrospective study. Thirty eyes with cataract and previous RK underwent phacoemulsification and intraocular lens (IOL implantation. Among them 7 eyes had 8 RK cuts, 13 eyes had 12 RK cuts, and 10 eyes had 16 RK cuts. Phacoemulsification and IOL implantation were performed through a 2.0-3.2 mm clear corneal incision by a single surgeon. In the 8 RK cuts group, 3.2 mm clear corneal incisions were used in 4 eyes, and 3.0 mm clear corneal incisions were used in 3 eyes. In the 12 RK cuts group, 3.2 mm clear corneal incisions were used in 6 eyes, and 2.2 mm clear corneal incisions were used in 7 eyes. In the 16 RK cuts group, 3.2 mm clear corneal incisions were used in 5 eyes, and 2.0 mm clear corneal incisions were used in 5 eyes. Patients were followed up 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively and were examined for the dehiscence of RK cuts during or after the surgery, post-operative best-corrected visual acuity (BCVA, corneal astigmatism, corneal endothelial cell density and complications.Successful phacoemulsification with IOL implantation was performed in all eyes. No wound dehiscence was noted in any eyes with 8 or 12 RK cuts. Wound dehiscence was noted in 2 eyes with 16 RK cuts. The dehiscence of RK cuts was closed successfully by injecting an air bubble with or without viscoelastic agent into the anterior chamber at the end of surgery. During the follow-up, the cuts were well apposed in all eyes, and no new dehiscence of RK cuts was noted. At the last follow-up, mean BCVA (0.2 ± 0.18 logMAR was better than preoperative BCVA(0.45±0.19 logMAR (P < 0.001. There was no significant difference between the long-term preoperative and postoperative mean corneal astigmatism (P = 0.3. However, there was a

  6. One-incision versus two-incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults.

    Science.gov (United States)

    Rezende, Fernando C; Moraes, Vinícius Y; Franciozi, Carlos Es; Debieux, Pedro; Luzo, Marcus V; Belloti, João Carlos

    2017-12-15

    Anterior cruciate ligament (ACL) tears are serious knee injuries that are frequently treated surgically in the form of arthroscopically assisted reconstruction with grafts from the patella or hamstrings tendons. We reviewed the evidence for the choice of arthroscopically assisted ACL reconstruction technique in terms of whether it should involve one incision (femoral tunnel drilled from inside the knee joint under arthroscopic visualisation) or two incisions (femoral tunnel drilled from outside to inside the knee joint). To assess the effects (benefits and harms) of one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Latin American and Caribbean Health Sciences (LILACS), the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, reference lists, and conference abstracts. The date of the search was 16 August 2017. Randomised and quasi-randomised controlled clinical trials evaluating one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. Two review authors independently searched and selected studies, and extracted data and assessed the risk of bias of the eligible studies. We undertook limited pooling of data using the fixed-effect model. We included five trials (four randomised and one quasi-randomised) evaluating a total of 320 participants who were mainly in their 20s. All participants underwent ACL reconstruction with patella tendon grafts. All five included trials were at a high risk of bias, particularly performance bias. Based on these limitations and the insufficiency of the available data resulting in imprecision of effect estimates, we judged the quality of the evidence as very low for all outcomes. This means that we are uncertain of the findings of the

  7. Two-incision minimally invasive total hip arthroplasty - results and complications

    NARCIS (Netherlands)

    van Oldenrijk, Jakob; Hoogervorst, Paul; Schaap, Gerard R.; van Dijk, C. Niek; Schafroth, Matthias U.

    2011-01-01

    The purpose of this study was to determine the complication rate and functional result after two-incision minimally invasive total hip arthroplasty in a retrospective consecutive case series of the first 45 patients treated by a single surgeon. The mean follow up period was 2.1 years. There were 4

  8. Single-port laparoscopic extraperitoneal para-aortic lymphadenectomy.

    Science.gov (United States)

    Iacoponi, Sara; De Santiago, Javier; Diestro, Maria D; Hernandez, Alicia; Zapardiel, Ignacio

    2013-11-01

    The aim of this study was to evaluate the feasibility and the safety of single-port extraperitoneal laparoscopic para-aortic lymphadenectomy for patients with gynecologic cancer. From July 2012 to January 2013, a total of 7 patients with gynecologic cancer underwent a laparoscopic pelvic and para-aortic lymphadenectomy with a single-port device. An extraperitoneal approach was performed for para-aortic lymphadenectomy using only one 2.5-cm incision on the left side. In 6 patients, additionally, hysterectomy and pelvic lymphadenectomy with conventional laparoscopy were performed to complete the treatment. Aortic dissection was complete in all cases without complications. The median age of the patients was 63 years (range, 48-78 years), and the median patient body mass index was 31 kg/m(2) (range, 19-38 kg/m(2)). The median number of para-aortic nodes was 17 (range, 10-25); the median operative time was 204 minutes (range, 120-300 minutes). The median hospital stay was 4 days (range, 3-6 days). No patient encountered postoperative complications. This study demonstrates the feasibility of single-port laparoscopic extraperitoneal para-aortic lymphadenectomy.

  9. Efficient cleavage of single and clustered AP site lesions within mono-nucleosome templates by CHO-K1 nuclear extract contrasts with retardation of incision by purified APE1

    Science.gov (United States)

    Eccles, Laura J.; Menoni, Hervé; Angelov, Dimitar; Lomax, Martine E.; O’Neill, Peter

    2015-01-01

    Clustered DNA damage is a unique characteristic of radiation-induced DNA damage and the formation of these sites poses a serious challenge to the cell’s repair machinery. Within a cell DNA is compacted, with nucleosomes being the first order of higher level structure. However, few data are reported on the efficiency of clustered-lesion processing within nucleosomal DNA templates. Here, we show retardation of cleavage of a single AP site by purified APE1 when contained in nucleosomal DNA, compared to cleavage of an AP site in non-nucleosomal DNA. This retardation seen in nucleosomal DNA was alleviated by incubation with CHO-K1 nuclear extract. When clustered DNA damage sites containing bistranded AP sites were present in nucleosomal DNA, efficient cleavage of the AP sites was observed after treatment with nuclear extract. The resultant DSB formation led to DNA dissociating from the histone core and nucleosomal dispersion. Clustered damaged sites containing bistranded AP site/8-oxoG residues showed no retardation of cleavage of the AP site but retardation of 8-oxoG excision, compared to isolated lesions, thus DSB formation was not seen. An increased understanding of processing of clustered DNA damage in a nucleosomal environment may lead to new strategies to enhance the cytotoxic effects of radiotherapeutics. PMID:26439176

  10. Drainage basins and channel incision on Mars

    Science.gov (United States)

    Aharonson, Oded; Zuber, Maria T.; Rothman, Daniel H.; Schorghofer, Norbert; Whipple, Kelin X.

    2002-02-01

    Measurements acquired by the Mars Orbiter Laser Altimeter on board the Mars Global Surveyor indicate that large drainage systems on Mars have geomorphic characteristics inconsistent with prolonged erosion by surface runoff. We find the topography has not evolved to an expected equilibrium terrain form, even in areas where runoff incision has been previously interpreted. By analogy with terrestrial examples, groundwater sapping may have played an important role in the incision. Longitudinally flat floor segments may provide a direct indication of lithologic layers in the bedrock, altering subsurface hydrology. However, it is unlikely that floor levels are entirely due to inherited structures due to their planar cross-cutting relations. These conclusions are based on previously unavailable observations, including extensive piece-wise linear longitudinal profiles, frequent knickpoints, hanging valleys, and small basin concavity exponents.

  11. Three-dimensional versus two-dimensional vision in laparoscopy

    DEFF Research Database (Denmark)

    Sørensen, Stine D; Savran, Mona Meral; Konge, Lars

    2016-01-01

    were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction. RESULTS: Three hundred and forty articles were screened for eligibility, and 31 RCTs were included...... through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. METHODS: A systematic search of the literature...... in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71 %) showed a reduction in performance time, and 12 out of 19...

  12. Laparoscopy: a safe approach to appendicitis during pregnancy.

    Science.gov (United States)

    Sadot, Eran; Telem, Dana A; Arora, Manjit; Butala, Parag; Nguyen, Scott Q; Divino, Celia M

    2010-02-01

    The aim of this study was to evaluate laparoscopic versus open surgery for suspected appendicitis during pregnancy. A hospital-based retrospective review of 65 consecutive pregnant patients who underwent surgery for suspected appendicitis from 1999 to 2008 was performed. Significance was determined by Pearson's chi(2) test, Fisher's exact test, Mann-Whitney test, and Kruskal-Wallis test. Of the 65 patients, 48 cases were laparoscopic and 17 open. Use of the laparoscopic versus open approach was significantly increased in the first (100% vs. 0%, p appendicitis. While methodological limitations preclude a definitive recommendation, laparoscopy appears to be a safe, feasible, and efficacious approach for pregnant patients with presumed acute appendicitis. We conclude that it is likely not the surgical approach but the underlying diagnosis combined with maternal factors that determine the risk for pregnancy complications. A benefit of laparoscopy is the diagnostic ability to identify other intra-abdominal pathology which may mimic appendicitis and harbor pregnancy risks.

  13. 3-dimensional versus conventional laparoscopy for benign hysterectomy

    DEFF Research Database (Denmark)

    Hoffmann, Elise; Bennich, Gitte; Larsen, Christian Rifbjerg

    2017-01-01

    of the study is to determine if 3D laparoscopy gives better quality of life, less postoperative pain, less per- and postoperative complications, shorter operative time, or a shorter stay in hospital and a faster return to work or normal life, compared to conventional laparoscopy for benign hysterectomy...... of 12 points on SF 36 questionnaire, a risk of type I error of 3.3% and a risk of type II error of 10% a sample size of 190 patients in each arm of the trial is needed. Secondarily, we will investigate operative time, time to return to work, length of hospital stay, and - and postoperative complications...... for benign hysterectomy. TRIAL REGISTRATION: This study is registered at ClinicalTrial.gov: NCT02610985 November 16th 2015. November 2015. The regional Ethical committee approved it on the 12. November 2015, approval number: SJ-498. Data handling was approved by the Danish Data Protection Agency: REG-109...

  14. Effect of abdominal insufflation for laparoscopy on intracranial pressure.

    Science.gov (United States)

    Kamine, Tovy Haber; Papavassiliou, Efstathios; Schneider, Benjamin E

    2014-04-01

    Increased abdominal pressure may have a negative effect on intracranial pressure (ICP). Human data on the effects of laparoscopy on ICP are lacking. We retrospectively reviewed laparoscopic operations for ventriculoperitoneal shunt placement to determine the effect of insufflation on ICP. Nine patients underwent insufflation with carbon dioxide (CO(2)) at pressures ranging from 8 to 15 mm Hg and ICP measured through a ventricular catheter. We used a paired t test to compare ICP with insufflation and desufflation. Linear regression correlated insufflation pressure with ICP. The mean ICP increase with 15-mm Hg insufflation is 7.2 (95% CI, 5.4-9.1 [P pressure (P = .04). Maximum ICP recorded was 25 cm H(2)O. Intracranial pressure significantly increases with abdominal insufflation and correlates with laparoscopic insufflation pressure. The maximum ICP measured was a potentially dangerous 25 cm H(2)O. Laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.

  15. Primary closure of equine laryngotomy incisions

    DEFF Research Database (Denmark)

    Lindegaard, C.; Karlsson, L.; Ekstrøm, Claus Thorn

    2016-01-01

    The objective was to report healing characteristics and complications after primary closure of equine laryngotomies and analyse factors potentially associated with complications. This retrospective case series of the medical records of horses (n = 180) undergoing laryngoplasty and laryngotomy...... after primary closure of equine laryngotomy incisions are infrequent and considered of minimal severity and can be performed safely when paying careful attention to the closure of the cricothyroid membrane....

  16. Dual daughter strand incision is processive and increases the efficiency of DNA mismatch repair.

    Science.gov (United States)

    Hermans, Nicolaas; Laffeber, Charlie; Cristovão, Michele; Artola-Borán, Mariela; Mardenborough, Yannicka; Ikpa, Pauline; Jaddoe, Aruna; Winterwerp, Herrie H K; Wyman, Claire; Jiricny, Josef; Kanaar, Roland; Friedhoff, Peter; Lebbink, Joyce H G

    2016-08-19

    DNA mismatch repair (MMR) is an evolutionarily-conserved process responsible for the repair of replication errors. In Escherichia coli, MMR is initiated by MutS and MutL, which activate MutH to incise transiently-hemimethylated GATC sites. MMR efficiency depends on the distribution of these GATC sites. To understand which molecular events determine repair efficiency, we quantitatively studied the effect of strand incision on unwinding and excision activity. The distance between mismatch and GATC site did not influence the strand incision rate, and an increase in the number of sites enhanced incision only to a minor extent. Two GATC sites were incised by the same activated MMR complex in a processive manner, with MutS, the closed form of MutL and MutH displaying different roles. Unwinding and strand excision were more efficient on a substrate with two nicks flanking the mismatch, as compared to substrates containing a single nick or two nicks on the same side of the mismatch. Introduction of multiple nicks by the human MutLα endonuclease also contributed to increased repair efficiency. Our data support a general model of prokaryotic and eukaryotic MMR in which, despite mechanistic differences, mismatch-activated complexes facilitate efficient repair by creating multiple daughter strand nicks. © The Author(s) 2016. Published by Oxford University Press on behalf of Nucleic Acids Research.

  17. Circumareolar incision-subdermal tunneling dissection for excision of multiple breast fibroadenomata

    Directory of Open Access Journals (Sweden)

    S O Agodirin

    2017-01-01

    Full Text Available Excision of multiple fibroadenomas (MF in separate breast quadrants presents difficulties of number and location of incision(s and extent of tissue dissection and may be associated with more complications and poorer cosmetic outcome. This is a report of excision of MF in multiple quadrants of the breast using a modification of subcutaneous dissection technique dubbed the circumareolar incision and subdermal tunneling (CAST dissection. After exposure of the superficial fascia with circumareolar incision, subdermal cone-wise dissection was made to allow mobilization of the segment bearing the lump(s. The lump(s were enucleated and removed. MF were removed from four breasts in three young unmarried females. The first patient had multiple adenomas removed from three quadrants of both breasts: 14 on the right and six on the left. The second patient had excision of three lumps in three separate quadrants, and the third patient had excision of two lumps in two separate quadrants. All patients had edema and bruising. One breast had wound infection and dehiscence. There were no skin necrosis, no nipple loss, and no breast distortion. All ensuing scars were camouflaged. CAST dissection was used for excision of MF in multiple quadrants of the breast with preservation of excellent cosmetic outcome of a single circumareolar incision.

  18. A Semicircular Incision in the Superior Umbilical Fold for SILS Preserves the Umbilical Profile

    Directory of Open Access Journals (Sweden)

    S. C. Blackburn

    2012-01-01

    Full Text Available Background. Single Incision Laparoscopic Surgery (SILS has been highlighted in the recent literature as a means of performing a range of common, minimal access, paediatric surgical procedures. The primary attraction is the absence of visible scarring. Aim. This study aims to describe a cosmetically advantageous means of SILS port placement in children, which preserves the umbilical profile. Methods. We describe a paediatric case series utilising a semicircular incision in the superior umbilical fold for SILS procedures. The linea alba is exposed over 2 cm just superior to the umbilical ring and stay sutures are applied. A vertical incision is made over this distance without entering the umbilical ring. Data were recorded prospectively in a Microsoft Excel database. Results. Twenty-one cases were performed in a 1-year period. Ten appendicectomies, 5 ovarian/paraovarian cystectomies, 2 Palomo procedures, 3 nephrectomy/heminephrectomies, and 1 Meckel’s diverticulectomy were performed. There was 1 wound infection. No incisional hernias occurred. Discussion. We believe that our technique, which maintains the integrity of the umbilical ring and allows preservation of the umbilical profile, offers a distinct cosmetic advantage over other incisions for SILS which distort it. Conclusion. We have demonstrated the aesthetic benefits of utilising a superior umbilical-fold incision for SILS in children.

  19. A Semicircular Incision in the Superior Umbilical Fold for SILS Preserves the Umbilical Profile.

    Science.gov (United States)

    Blackburn, S C; Adams, S D; Mahomed, A A

    2012-01-01

    Background. Single Incision Laparoscopic Surgery (SILS) has been highlighted in the recent literature as a means of performing a range of common, minimal access, paediatric surgical procedures. The primary attraction is the absence of visible scarring. Aim. This study aims to describe a cosmetically advantageous means of SILS port placement in children, which preserves the umbilical profile. Methods. We describe a paediatric case series utilising a semicircular incision in the superior umbilical fold for SILS procedures. The linea alba is exposed over 2 cm just superior to the umbilical ring and stay sutures are applied. A vertical incision is made over this distance without entering the umbilical ring. Data were recorded prospectively in a Microsoft Excel database. Results. Twenty-one cases were performed in a 1-year period. Ten appendicectomies, 5 ovarian/paraovarian cystectomies, 2 Palomo procedures, 3 nephrectomy/heminephrectomies, and 1 Meckel's diverticulectomy were performed. There was 1 wound infection. No incisional hernias occurred. Discussion. We believe that our technique, which maintains the integrity of the umbilical ring and allows preservation of the umbilical profile, offers a distinct cosmetic advantage over other incisions for SILS which distort it. Conclusion. We have demonstrated the aesthetic benefits of utilising a superior umbilical-fold incision for SILS in children.

  20. Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review.

    Science.gov (United States)

    Kyle, Esther B; Maheux-Lacroix, Sarah; Boutin, Amélie; Laberge, Philippe Y; Lemyre, Madeleine

    2016-01-01

    The optimal intraperitoneal pressure during laparoscopy is not known. Recent literature found benefits of using lower pressures, but the safety of doing abdominal surgery with low peritoneal pressures needs to be assessed. This systematic review compares low with standard pneumoperitoneum during gynecologic laparoscopy. We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing intraperitoneal pressures during gynecologic laparoscopy. Two authors reviewed references and extracted data from included trials. Risk ratios, mean differences, and standard mean differences were calculated and pooled using RevMan5. Of 2251 studies identified, three were included in the systematic review, for a total of 238 patients. We found a statistically significant but modest diminution in postoperative pain of 0.38 standardized unit based on an original 10-point scale (95% confidence interval [CI], -0.67 to -0.08) during the immediate postoperative period when using low intraperitoneal pressure of 8 mm Hg compared with ≥ 12 mm Hg and of 0.50 (95% CI, -0.80 to -0.21) 24 hours after the surgery. Lower pressures were associated with worse visualization of the surgical field (risk ratio, 10.31; 95% CI, 1.29-82.38). We found no difference between groups over blood loss, duration of surgery, hospital length of stay, or the need for increased pressure. Low intraperitoneal pressures during gynecologic laparoscopy cannot be recommended on the behalf of this review because improvement in pain scores is minimal and visualization of the surgical field is affected. The safety of this intervention as well as cost-effectiveness considerations need to be further studied.

  1. Single-access laparoscopic low anterior resection with vertical suspension of the rectum.

    Science.gov (United States)

    Uematsu, Dai; Akiyama, Gaku; Narita, Maiko; Magishi, Akiko

    2011-05-01

    Single-access laparoscopic surgery was first introduced for colectomy and later adapted for anterior resection. During single-access laparoscopic pelvic procedures, such as total mesorectal excision, it is often difficult to obtain an adequate operative field. By suspending the rectum vertically, we were able to execute a total mesorectal excision with single-access laparoscopy. We describe here the use of this new procedure to treat rectal cancer. The selected 7 patients (1 male and 6 female) with stage II or III rectal cancer underwent the procedure. Single-port access to the abdomen was provided by a 3.0-cm incision at the right iliac fossa. The descending mesocolon was dissected by use of a medial approach, and a columnar magnet was placed on the surface of the abdominal wall to restore triangulation. The inferior mesenteric artery was skeletonized and the superior rectal artery divided during lymph node dissection. The total mesorectal excision extended to the pelvic floor and the rectum was vertically retracted with a suspending bar in collaboration with an extracorporeal magnet tool. The rectum was then transected below the reflection of the peritoneum. Intracorporeal anastomosis was performed with the double-stapling technique. Two pelvic drains were inserted through the single incision and the anus, respectively, for all patients. A defunctioning ileostomy was not created in any patient. Median total surgical time was 205 minutes (range, 175-245 min). Intraoperative blood loss was minimal in all patients (range, 1-20 mL). None of the cases required conversion to open surgery or addition of a second port. The only preoperative or postoperative complication occurred in one patient with clinical anastomotic leakage. Low anterior single-access laparoscopic resection seems safe and feasible when the rectum is suspended like a swing to ensure an adequate operative field.

  2. The position of the vermiform appendix at laparoscopy.

    Science.gov (United States)

    Ahmed, Irfan; Asgeirsson, Kristjan S; Beckingham, Ian J; Lobo, Dileep N

    2007-03-01

    The vermiform appendix has no constant position and the data on the variations in its position are limited. The aim of this study was to determine the frequency of the various positions of the appendix at laparoscopy. Patients undergoing emergency or elective laparoscopy at a university teaching hospital between April and September 2004 were studied prospectively. The positions of the appendix and the caecum were determined after insertion of the laparoscope, prior to any other procedure and the relative frequencies calculated. A total of 303 (102 males and 201 females) patients with a median age of 52 years (range 18-93 years) were studied. An emergency appendicectomy was performed in 67 patients, 49 had a diagnostic laparoscopy, 179 underwent a laparoscopic cholecystectomy and eight had other procedures. The caecum was at McBurney's point in 245 (80.9%) patients, pelvic in 45 (14.9%) and high lying in 13 (4.3%). The appendix was pelvic in 155 (51.2%) patients, pre-ileal in 9 (3.0%), para-caecal in 11 (3.6%), post-ileal in 67 (22.1%) and retrocaecal in 61 (20.1%) patients. Contrary to the common belief the appendix is more often found in the pelvic rather than the retrocaecal position. There is also considerable variation in the position of the caecum.

  3. Right Kocher’s incision: a feasible and effective incision for right hemicolectomy: a retrospective study

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    Theodosopoulos Theodosios

    2012-06-01

    Full Text Available Abstract Background The choice of surgical incision is determined by access to the surgical field, particularly when an oncological resection is required. Special consideration is also given to other factors, such as postoperative pain and its sequelae, fewer complications in the early postoperative period and a lower occurrence of incisional hernias. The purpose of this study is to compare the right Kocher’s and the midline incision, for patients undergoing right hemicolectomy, by focusing on short- and longterm results. Methods Between 1995 and 2009, hospital records for 213 patients that had undergone a right hemicolectomy for a right- sided adenocarcinoma were retrospectively studied. 113 patients had been operated via a Kocher’s and 100 via a midline incision. Demographic details, operative data (explorative access to the peritoneal cavity, time of operation, recovery parameters (time with IV analgesic medication, time to first oral fluid intake, time to first solid meal, time to discharge, and oncological parameters (lymph node harvest, TNM stage and resection margins were analyzed. Postoperative complications were also recorded. The two groups were retrospectively well matched with respect to demographic parameters and oncological status of the tumor. Results The median length of the midline incision was slightly longer (12 vs. 10 cm, p  Conclusions The Kocher’s incision approach for right- sided colon cancer is technically feasible, safe and overall very well tolerated. It can achieve the same standards of tumor resection and surgical field accessibility as the midline approach, while reducing postoperative recovery.

  4. Use of laparoscopy for diagnosing experimentally induced acute pancreatitis in dogs.

    Science.gov (United States)

    Kim, Hyun-wook; Oh, Ye-in; Choi, Ji-hye; Kim, Dae-yong; Youn, Hwa-young

    2014-12-01

    Diagnosis of acute pancreatitis in dogs remains a significant challenge despite the development of advanced diagnostic methodologies. Visual inspection and pancreas biopsy using laparoscopy are generally considered to be procedures free of complications when conducted on healthy animals. However, the usefulness of laparoscopy for diagnosing acute pancreatitis has not been assessed. In the present study, the efficacy of laparoscopy for diagnosing acute pancreatitis in dogs was evaluated in animals with experimentally induced acute pancreatitis. Gross appearance of the pancreatic area was examined by laparoscopy to survey for the presence of edema, adhesions, effusion, pseudocysts, hemorrhage, and fat necrosis. Laparoscopic biopsy was performed and the histopathologic results were compared to those of pancreatic samples obtained during necropsy. The correlation between laparoscopy and histopathologic findings of the pancreas was evaluated. The presence of adhesions, effusion, and hemorrhage in the pancreatic area observed by laparoscopy significantly correlated with the histopathologic results (p pancreatitis in dogs.

  5. The "Propeller" incision for transpalatal advancement pharyngoplasty: a new approach to reduce post-operative oronasal fistulae.

    Science.gov (United States)

    Shine, Neville Patrick; Lewis, Richard Hamilton

    2008-09-01

    To present a new soft tissue approach for transpalatal advancement pharyngoplasty (TPA), the propeller incision, and to compare the rates of post-operative oronasal fistula in those undergoing TPA with the traditional "Gothic Arch" incision described by Woodson and those with the propeller incision. A prospectively maintained adult sleep apnoea surgery database was used to identify those patients undergoing TPA, either alone or in combination with other procedures, for obstructive sleep apnoea syndrome (OSAS) between February 2001 and September 2006 in a tertiary referral centre by a single surgeon (RHL). In addition to the incision used during TPA, patient demographic data, previous surgery of the upper airways, smoking history, pre-operative body mass index, respiratory disturbance index, oxygen saturation index and the occurrence of oronasal fistula post-operatively, were recorded. The propeller incision technique is described. A total of 89 patients who underwent TPA were identified. A total of 49 patients had a "Gothic Arch" incision and 40 had a "Propeller" incision. The two groups of patients were comparable in age, sex, previous tonsillar and uvulopalatopharyngoplasty surgery, smoking histories and pre-operative disease severity. In the "Gothic Arch" group, eight patients (16%) developed oronasal fistulae in the post-operative period versus only one patient (2.5%) in the "Propeller" group. The difference between the two groups was statistically significant (P=0.038, Fisher's exact test). Of the total cases with post-operative oronasal fistula (n=9), only one patient (from the Gothic Arch incision group) required operative closure which was performed under local anesthesia and healed without complication. The propeller incision provides an anatomically sensible axial-based flap that provides adequate access to perform TPA. It is associated with a lower incidence of oronasal fistula and is recommended by the authors.

  6. Cost-effectiveness of diagnostic laparoscopy for assessing resectability in pancreatic and periampullary cancer.

    Science.gov (United States)

    Morris, Stephen; Gurusamy, Kurinchi S; Sheringham, Jessica; Davidson, Brian R

    2015-04-02

    Surgical resection is the only curative treatment for pancreatic and periampullary cancer, but many patients undergo unnecessary laparotomy because tumours can be understaged by computerised tomography (CT). A recent Cochrane review found diagnostic laparoscopy can decrease unnecessary laparotomy. We compared the cost-effectiveness of diagnostic laparoscopy prior to laparotomy versus direct laparotomy in patients with pancreatic and periampullary cancer with resectable disease based on CT scanning. Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. One-way and probabilistic sensitivity analyses were undertaken. When laparotomy following diagnostic laparoscopy occurred in a subsequent admission, diagnostic laparoscopy incurred similar mean costs per patient to direct laparotomy (£7470 versus £7480); diagnostic laparoscopy costs (£995) were offset by avoiding unnecessary laparotomy costs. Diagnostic laparoscopy produced significantly more mean QALYs per patient than direct laparotomy (0.346 versus 0.337). Results were sensitive to the accuracy of diagnostic laparoscopy and the probability that disease was unresectable. Diagnostic laparoscopy had 63 to 66% probability of being cost-effective at a maximum willingness to pay for a QALY of £20 000 to £30 000. When laparotomy was undertaken in the same admission as diagnostic laparoscopy the mean cost per patient of diagnostic laparoscopy increased to £8224. Diagnostic laparoscopy prior to laparotomy in patients with CT-resectable cancer appears to be cost-effective in pancreatic cancer (but not in periampullary cancer), when laparotomy following diagnostic laparoscopy occurs in a subsequent admission.

  7. Initial experience with single-port robotic hysterectomy.

    Science.gov (United States)

    Gomes, Mariano Tamura Vieira; Machado, Andréa Maria Novaes; Podgaec, Sérgio; Barison, Gustavo Anderman Silva

    2017-01-01

    this technique in elective hysterectomy and other gynecological procedures in the future, as described in large reference centers of advanced surgery worldwide. Specifically, in gynecological practice, existing evidence on the use of robot-assisted, single-port surgery seems promising, and although it is not indicated in all cases, it should be considered as a surgical option. Nonetheless, further randomized and controlled clinical studies are necessary to establish the preeminence of robot-assisted, single-port surgery versus single-incision and conventional laparoscopy.

  8. Clinical effects of gynecologic laparoscopy courses in the United Arab Emirates.

    Science.gov (United States)

    Elbiss, Hassan M; Raheel, Hina; George, Sami; Abu-Zidan, Fikri M

    2014-01-01

    To evaluate the impact of gynecologic laparoscopy courses on the participants' laparoscopy practice. We conducted 5 repeated laparoscopy courses between 2008 and 2012 at the United Arab Emirates University in Al Ain, United Arab Emirates, so as to enhance performance in the operating room. An electronic questionnaire was sent to all participants from each of the courses to evaluate the impact of course attendance on clinical practice. Of 70 participants who were approached to complete the online questionnaire, 38 (54.3%) responded. The majority were female (94.7%) and specialists (65.8%). Half the participants (50.0%) thought they would probably not have started performing laparoscopy without having attended the course. Of the participants, 18.4% thought that their operating skills had greatly improved, 63.2% felt that their operating skills had improved moderately to a lot, and 6/12 participants who had not been performing laparoscopy before attendance of the course began doing so. Overall, the course had no significant impact on the participants' performance of laparoscopy (P=0.51, McNemar test), but the proportion of participants who performed level II laparoscopy was significantly increased after course attendance (10.5% versus 47.4%; P=0.001, McNemar test). Gynecologic laparoscopy courses encourage gynecologists to use laparoscopy in clinical practice. © 2013.

  9. Echinococcus multilocularis Detection in Live Eurasian Beavers (Castor fiber Using a Combination of Laparoscopy and Abdominal Ultrasound under Field Conditions.

    Directory of Open Access Journals (Sweden)

    Róisín Campbell-Palmer

    Full Text Available Echinococcus multilocularis is an important pathogenic zoonotic parasite of health concern, though absent in the United Kingdom. Eurasian beavers (Castor fiber may act as a rare intermediate host, and so unscreened wild caught individuals may pose a potential risk of introducing this parasite to disease-free countries through translocation programs. There is currently no single definitive ante-mortem diagnostic test in intermediate hosts. An effective non-lethal diagnostic, feasible under field condition would be helpful to minimise parasite establishment risk, where indiscriminate culling is to be avoided. This study screened live beavers (captive, n = 18 or wild-trapped in Scotland, n = 12 and beaver cadavers (wild Scotland, n = 4 or Bavaria, n = 11, for the presence of E. multilocularis. Ultrasonography in combination with minimally invasive surgical examination of the abdomen by laparoscopy was viable under field conditions for real-time evaluation in beavers. Laparoscopy alone does not allow the operator to visualize the parenchyma of organs such as the liver, or inside the lumen of the gastrointestinal tract, hence the advantage of its combination with abdominal ultrasonography. All live beavers and Scottish cadavers were largely unremarkable in their haematology and serum biochemistry with no values suspicious for liver pathology or potentially indicative of E. multilocularis infection. This correlated well with ultrasound, laparoscopy, and immunoblotting, which were unremarkable in these individuals. Two wild Bavarian individuals were suspected E. multilocularis positive at post-mortem, through the presence of hepatic cysts. Sensitivity and specificity of a combination of laparoscopy and abdominal ultrasonography in the detection of parasitic liver cyst lesions was 100% in the subset of cadavers (95%Confidence Intervals 34.24-100%, and 86.7-100% respectively. For abdominal ultrasonography alone sensitivity was only 50% (95%CI 9

  10. Single-incision laparoscopic surgery and conventional laparoscopic ...

    African Journals Online (AJOL)

    Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated “en bloc,” clipped and cut. Operating time, visual analogue scale and post-operative results were ...

  11. Small-incision lenticule extraction (SMILE)

    DEFF Research Database (Denmark)

    Hansen, Rasmus Søgaard; Lyhne, Niels; Grauslund, Jakob

    2016-01-01

    PURPOSE: To study the outcomes of small-incision lenticule extraction (SMILE) for treatment of myopia and myopic astigmatism. METHODS: Retrospective study of patients treated for myopia or myopic astigmatism with SMILE, using a VisuMax(®) femtosecond laser (Carl Zeiss Meditec, Jena, Germany...... surgery was 0.07 ± 0.03 (logMAR). However, 12 eyes (1.6 %) lost 2 or more lines of CDVA from before surgery to 3 months postoperatively. Simultaneous treatment of up to 3.00 D of astigmatism was not associated with less predictable refractive outcomes. CONCLUSIONS: In the short term, SMILE seemed...

  12. Short-term outcomes of laparoscopy-assisted hybrid living donor hepatectomy: a comparison with the conventional open procedure.

    Science.gov (United States)

    Kitajima, Toshihiro; Kaido, Toshimi; Iida, Taku; Seo, Satoru; Taura, Kojiro; Fujimoto, Yasuhiro; Ogawa, Kohei; Hatano, Etsuro; Okajima, Hideaki; Uemoto, Shinji

    2017-12-01

    Although minimally invasive living donor surgery has been increasingly accepted, its safety remains to be fully clarified in a large-scale study. This study evaluated the safety and effectiveness of our laparoscopy-assisted hybrid living donor surgery (LAHDS) procedure with an upper median incision in comparison with conventional open donor hepatectomy (ODH). From 2011 to 2016, 153 adult living donors [right lobe (RL) graft: 80 donors; left lobe (LL) graft: 73 donors] were enrolled and divided into LAHDS (n = 76) and ODH (n = 77) groups. Donor characteristics, surgical outcomes, and postoperative complications were compared between the 2 groups in each graft subgroup. Postoperative liver function tests (LFTs), inflammatory markers, pain parameters, incision-related symptoms, and recipient outcomes were compared between the 2 groups in all donors. In RL donors, operative blood loss was significantly lower in the LAHDS group than in the ODH group (201 vs. 313 g; p = 0.034). In LL donors, duration of surgery was significantly longer in the LAHDS group than in the ODH group (459 vs. 403 min; p = 0.034). The incidence of complications, length of hospital stay, and postoperative changes in both LFTs and inflammatory markers were comparable. The incidence of postoperative scar discomfort or tightness was significantly lower in the LAHDS group than in the ODH group (2.6 vs. 31.2%; p < 0.001), whereas postoperative pain parameters were comparable. The incidence of wound problems and abdominal wall numbness tended to be lower, but not significantly so, in the LAHDS group. This large consecutive case series demonstrates that our LAHDS procedure can be performed as safely as ODH, and it can improve quality of life without impaired donor and recipient outcomes.

  13. Role of laparoscopy in evaluation of abdominal pain

    International Nuclear Information System (INIS)

    Masud, M.; Adil, M.; Gondal, Z.I.; Aquil, A.

    2017-01-01

    Objective: To evaluate the diagnostic efficacy of laparoscopy in ill-defined recurrent chronic abdominal pain. Study Design: Prospective study. Place and Duration of Study: Surgical department, Military Hospital Rawalpindi, from Jul 2011 to Dec 2013. Material and Methods: A total of 102 patients who presented to surgical department with chronic recurrent abdominal pain of unknown etiology and underwent diagnostic laparoscopy were included in our study. Patients with acute onset of abdominal pain, hemodynamically unstable, pregnant or those in which diagnosis can be made by radiological techniques were excluded from our study. Patient's demographic data, clinical findings and laparoscopic findings were recorded. Finally data was analyzed by using SPSS version 21. Results: Out of 110 patients 96 were female while remaining 14 were male. The age range of the patients was 20- 70 years with mean age of 50 +- 10 years. The most common site of pain was lower abdomen while mean duration of abdominal pain was 34 weeks. Laparoscopic findings include acute recurrent appendicitis in 32 (29.09%) patients, cholecystitis with biliary sludge in 14 (12.72%), pelvic inflammatory disease in 12 (10.90%), ovarian cyst in 11(10%), adhesions in 10(9.09%), intestinal tuberculosis in 8 (7.27%), mesenteric lymphadenitis in 7 (6.36%), lymphoma in 4 (3.63%), ectopic pregnancy in 3 (2.7%), CA gallbladder in 2 (1.81%), meckels diverticulum in 2 (1.81%), endometriosis in 2 (1.81%) and crohns disease in 1 (0.9%) patients. Mean operative time was 48 min while average hospital stay was 2-3 days. No major complications were noticed. Conclusion: Laparoscopy in our clinical setup has significant role in diagnosing cases of vague abdominal pain which cannot be diagnosed by routine investigations. (author)

  14. [Bowel injuries after port insertion in laparoscopy. Gynerisq's database analysis].

    Science.gov (United States)

    Cesario, E; Crochet, P; Boyer de Latour, F-X; Eglin, G; De Rochambeau, B; Agostini, A

    2016-11-01

    Port insertion is a high-risk period during laparoscopy. The French Gynecologist and Obstetricians College (CNGOF) published recommendations in 2010 to minimize those risks. The aim of our analysis was to establish the accidents' circumstances and consequences and to determine if those incidents could have been depending on whether recommendations had been respected or not. Gynerisq is an approved organism by the Haute Autorité de santé (HAS). Its mission is to evaluate and improve practices by a risk management centered approach. We analysed incidents reported by Gynerisq's adherents in an experience report database. Above 114 incidents analysed in the Gynerisq's database, we reported 31 bowel injuries. Those injuries occurred for 77.4% (24/31) during planned interventions. For 32.3% of the cases (10/31), interventions were judged complex by the surgeons. A total of 54.8% (17/31) of the patients had a history of laparotomy. Above 27 injuries occurred during Veress needle or open laparoscopy, 17 could have been avoided regarding to the surgeon. The causes reported were in 10 cases that the recommendations had not been respected, in 2 cases another cause and in 5 cases no causes were given to explain the incident. Our analysis shows that bowel injuries after port insertion, in open laparoscopy or Veress needle use, do not seem to occur only in an emergency context or during complicated interventions. However, most of the incidents occurred for patients with risk factors. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. The emerging role of robotics and laparoscopy in stone disease.

    Science.gov (United States)

    Humphreys, Mitchell R

    2013-02-01

    The surgical management of urolithiasis has undergone a remarkable clinical evolution over the past three decades. The once common practice of open stone surgery has nearly been relegated to historical interest by modern technology. The introduction of minimally invasive techniques, laparoscopy and robot-assisted surgery, have emerged to complete the urologist's armamentarium. The benefits to patients when other endourologic procedures have failed include less pain, shorter hospitalization and convalescence, and improved cosmesis. This chapter explores the historical shift from open to minimally invasive management for stone disease and the unique risks and outcomes associated with these procedures in modern urology. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. The efficacy of virtual reality simulation training in laparoscopy

    DEFF Research Database (Denmark)

    Larsen, Christian Rifbjerg; Oestergaard, Jeanett; Ottesen, Bent S

    2012-01-01

    medical subject headings (MeSh) terms: Laparoscopy/standards, Computing methodologies, Programmed instruction, Surgical procedures, Operative, and the following free text terms: Virtual real* OR simulat* AND Laparoscop* OR train* Limits: Controlled trials. Study eligibility criteria. All randomized...... regarding VR training efficacy compared with traditional or no training, with outcome measured as surgical performance in humans or animals. Data sources. In June 2011 Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar were searched using the following...

  17. Incision of the Jezero Crater Outflow Channel by Fluvial Sediment Transport

    Science.gov (United States)

    Holo, S.; Kite, E. S.

    2017-12-01

    Jezero crater, the top candidate landing site for the Mars 2020 rover, once possessed a lake that over-spilled and eroded a large outflow channel into the Eastern rim. The Western deltaic sediments that would be the primary science target of the rover record a history of lake level, which is modulated by the inflow and outflow channels. While formative discharges for the Western delta exist ( 500 m3/s), little work has been done to see if these flows are the same responsible for outflow channel incision. Other models of the Jezero outflow channel incision assume that a single rapid flood (incision timescales of weeks), with unknown initial hydraulic head and no discharge into the lake (e.g. from the inflow channels or the subsurface), incised an open channel with discharge modulated by flow over a weir. We present an alternate model where, due to an instability at the threshold of sediment motion, the incision of the outflow channel occurs in concert with lake filling. In particular, we assume a simplified lake-channel-valley system geometry and that the channel is hydraulically connected to the filling/draining crater lake. Bed load sediment transport and water discharge through the channel are quantified using the Meyer-Peter and Mueller relation and Manning's law respectively. Mass is conserved for both water and sediment as the lake level rises/falls and the channel incises. This model does not resolve backwater effects or concavity in the alluvial system, but it does capture the non-linear feedbacks between lake draining, erosion rate, channel flow rate, and slope relaxation. We identify controls on incision of the outflow channel and estimate the time scale of outflow channel formation through a simple dynamical model. We find that the observed 300m of channel erosion can be reproduced in decades to centuries of progressive bed load as the delta forming flows fill the lake. This corresponds to time scales on the order of or smaller than the time scale

  18. Laparoscopy and hysteroscopy in a Tertiary Hospital: A 4 year review

    African Journals Online (AJOL)

    Objective: To determine various indications for laparoscopy and hysteroscopy in Aminu Kano Teaching, hospital (AKTH), Kano. Materials and Methods: This is a descriptive study conducted at the (AKTH, which involved all the patients who had laparoscopy and or hysteroscopy from January 2011 to December 2014 (4 year) ...

  19. European Hernia Society guidelines on the closure of abdominal wall incisions.

    Science.gov (United States)

    Muysoms, F E; Antoniou, S A; Bury, K; Campanelli, G; Conze, J; Cuccurullo, D; de Beaux, A C; Deerenberg, E B; East, B; Fortelny, R H; Gillion, J-F; Henriksen, N A; Israelsson, L; Jairam, A; Jänes, A; Jeekel, J; López-Cano, M; Miserez, M; Morales-Conde, S; Sanders, D L; Simons, M P; Śmietański, M; Venclauskas, L; Berrevoet, F

    2015-02-01

    The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for important costs savings in health care. The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II instrument. An update of these guidelines is planned for 2017. For many of the Key Questions that were studied no high quality data was detected. Therefore, some strong recommendations could be made but, for many Key Questions only weak recommendations or no recommendation could be made due to lack of sufficient evidence. To decrease the incidence of incisional hernias it is strongly recommended to utilise a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use of rapidly absorbable sutures. It is suggested using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current recommended method of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears effective and safe and can be suggested in high

  20. Intraoral removal of a thyroglossal duct cyst using a frenotomy incision.

    Science.gov (United States)

    Kim, Jin Pyeong; Park, Jung Je; Lee, Eun Jae; Woo, Seung Hoon

    2011-12-01

    Thyroglossal duct cyst (TGDC) is one of the most common causes of anterior neck swelling close to the midline. Surgical removal of a TGDC is usually accomplished through an external neck incision, including the removal of the middle part of hyoid bone and a block of tissues extending to the foramen cecum. However, this procedure inevitably results in a neck scar. We report the case of a 20-year-old woman with TGDC. We implemented a modified approach to TGDC removal through a frenotomy incision of the mouth using an endoscope system. The patient received a modified approach to TGDC removal. The total operative time was 60 minutes. She remains free of disease 12 months after her surgery. We describe, in a single patient, a procedure in detail for endoscope-assisted transoral TGDC excision using an intraoral frenotomy incision. The advantage of this approach is the avoidance of a neck scar. Our experience with this patient indicates that resection of a TGDC appears to be feasible through a transoral endoscope-assisted approach using a frenotomy incision in the mouth. Further experience with this procedure is required.

  1. Role of Laparoscopy in Management of Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Hasina Banu

    2015-09-01

    Full Text Available Ectopic pregnancy means implantation of fertilized ovum outside the endometrial lining of the uterus. It remains the leading cause of early pregnancy-related death. Delay in diagnosis and treatment puts the life of women at risk. Laparoscopic surgery is increasingly becoming the preferred approach for ectopic pregnancy management. Laparoscopic treatment in ectopic pregnancy raises question of safety and feasibility when compared to laparotomy. In this review article our objective is to summarize the role of laparoscopy in management of ectopic pregnancy in comparison to laparotomy. For this, a literature search was done by using Google and PubMed. The selected articles were analyzed on laparoscopic treatment outcomes such as surgery success rate, operating time, intraoperative and postoperative complications, hospital stay, future fertility, postoperative recurrent ectopic pregnancy, cost-effectiveness in comparison to laparotomy. After analyzing all selected articles, it can be concluded that the laparoscopic management of ectopic pregnancy is safe, effective, and economical in comparision to laparotomy. So, for the patients’ benefit, laparoscopy should be considered as the gold standard method in management of ectopic pregnancy and is worthy to be popularized in clinical practice.

  2. Highly immersive virtual reality laparoscopy simulation: development and future aspects.

    Science.gov (United States)

    Huber, Tobias; Wunderling, Tom; Paschold, Markus; Lang, Hauke; Kneist, Werner; Hansen, Christian

    2018-02-01

    Virtual reality (VR) applications with head-mounted displays (HMDs) have had an impact on information and multimedia technologies. The current work aimed to describe the process of developing a highly immersive VR simulation for laparoscopic surgery. We combined a VR laparoscopy simulator (LapSim) and a VR-HMD to create a user-friendly VR simulation scenario. Continuous clinical feedback was an essential aspect of the development process. We created an artificial VR (AVR) scenario by integrating the simulator video output with VR game components of figures and equipment in an operating room. We also created a highly immersive VR surrounding (IVR) by integrating the simulator video output with a [Formula: see text] video of a standard laparoscopy scenario in the department's operating room. Clinical feedback led to optimization of the visualization, synchronization, and resolution of the virtual operating rooms (in both the IVR and the AVR). Preliminary testing results revealed that individuals experienced a high degree of exhilaration and presence, with rare events of motion sickness. The technical performance showed no significant difference compared to that achieved with the standard LapSim. Our results provided a proof of concept for the technical feasibility of an custom highly immersive VR-HMD setup. Future technical research is needed to improve the visualization, immersion, and capability of interacting within the virtual scenario.

  3. Vascular injuries during gynecological laparoscopy: the vascular surgeon's advice

    Directory of Open Access Journals (Sweden)

    Marcello Barbosa Barros

    Full Text Available CONTEXT: Iatrogenic vascular problems due to laparoscopy are a well recognized problem and lead to significant repercussions. In this context, a ten-year review of cases topic is presented, based on experience gained while heading two important vascular surgery services. CASES: Five patients with vascular injuries during elective laparoscopy are described. These patients presented with seven lesions of iliac vessels. All cases were evaluated immediately and required laparotomy, provisional hemostasis and urgent attendance by a vascular surgeon. Direct suturing was performed in three cases. One aortoiliac bypass and one ilioiliac reversed venous graft were made. Venous lesions were sutured. One case of a point-like perforation of the small bowel was found. There were no deaths and no complications during the postoperative period. DISCUSSION: Important points on this subject are made, and advice is given. There needs to be immediate recognition of the vascular injury, and expert repair by a vascular surgeon is recommended, in order to significantly reduce the degree of complications.

  4. Diathermy versus Scalpel incision in elective midline laparotomy: A ...

    African Journals Online (AJOL)

    ... two groups with respect to the mean length of hospital stay (p = 0.834). Conclusion: We conclude that diathermy incision in elective midline laparotomy has significant advantages compared with the scalpel because of reduced incision time, less blood loss, reduced early postoperative pain and analgesic requirements.

  5. Temporal versus Superior Limbal Incision: Any difference in visual ...

    African Journals Online (AJOL)

    Dr. C. Pedro-Egbe

    Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. ABSTRACT. Aim: To compare the visual outcome of a superiorly placed limbal incision ..... Roman SJ, Auclin FX, Chong-Sit DA, Ullern MM. Surgically induced astigmatism with superior and temporal incisions in cases of ...

  6. Mini transverse versus longitudinal incision in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Korkmaz, M.; Cepoglu, M.C.

    2013-01-01

    Objective: To evaluate the effectiveness of mini-transverse compared with mini-longitudinal incision for carpal tunnel release (CTR) with reference to postoperative functional capacity, symptom severity and complication rate. Study Design: Analytical study. Place and Duration of Study: Cumhuriyet University Medical Faculty, Department of Orthopaedics, Tokat State Hospital, Department of Orthopaedics and Medical Park Tokat Hospital, Department of Neurosurgery, from January 2007 to January 2009. Methodology: This study included 93 hands of 79 patients with carpal tunnel syndrome (CTS), which were operated between 2007 and 2009. Patients were divided according to incision types into Group-1 (undergoing mini-longitudinal incision) and Group-2 (undergoing mini-transverse incision). Patients were evaluated initially and at 3 weeks after treatment according to symptom severity and functional status of Boston Questionnaire (BQ). Demographic and clinical data were analyzed and compared statistically between two groups. Results: Statistically significant differences were observed in BQ symptom and functional scores between the pre- and postoperative period (p < 0.0001). BQ symptom and functional scores at postoperative period were better in Group-1 than Group-2 (p = 0.044 and p = 0.023 respectively). The scar hypersensitivity (p = 0.258) and tenderness (p = 1.00) associated with the incision sites were not statistically different. Conclusion: Longitudinal incision is more effective on symptom and functional conditions than transverse incision. However, there was less scar formation with transverse incision. (author)

  7. Transurethral incision of urethral diverticulum in the female

    DEFF Research Database (Denmark)

    Miskowiak, J; Honnens de Lichtenberg, M

    1989-01-01

    A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.......A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time....

  8. Temporal versus Superior Limbal Incision: Any difference in visual ...

    African Journals Online (AJOL)

    Aim: To compare the visual outcome of a superiorly placed limbal incision with a temporal limbal incision in extracapsular cataract surgery. The main outcome measures are visual acuity and the degree of stigmatism based on refraction. Method: A retrospective non randomized comparative study. Medical records of 40 ...

  9. Vertical compared with transverse incisions in abdominal surgery

    DEFF Research Database (Denmark)

    Grantcharov, T P; Rosenberg, J

    2001-01-01

    OBJECTIVE: To reach an evidence-based consensus on the relative merits of vertical and transverse laparotomy incisions. DESIGN: Review of all published randomised controlled trials that compared the postoperative complications after the two main types of abdominal incisions, vertical and transverse...... postoperative pain and fewer pulmonary complications. Vertical laparotomy, however, is associated with shorter operating time and better possibilities for extension of the incision. The pooled odds ratio for burst abdomen in the vertical incision group was 2.86 (95% confidence interval 1.72 to 4.73, p = 0.......0001), and regarding late incisional hernia the pooled odds ratio was 1.68 (95% confidence interval 1.10 to 2.57. p = 0.02). CONCLUSIONS: Transverse incisions in abdominal surgery are based on better anatomical and physiological principles. They should be recommended, as the early postoperative period is associated...

  10. Incisive canal deflation for correct implant placement: case report.

    Science.gov (United States)

    Spin-Neto, Rubens; Bedran, Telma Blanca Lombardo; de Paula, Wagner Nunes; de Freitas, Rubens Moreno; de Oliveira Ramalho, Lizeti Toledo; Marcantonio, Elcio

    2009-12-01

    This article is a case report of a patient in whom the prosthetic planning indicated the necessity of an incisive canal deflation for the correct installation of an implant that is to be osseointegrated. In the reopening phase after the bone graft installation, the incisive canal deflation (biopsy of its content) was done and titanium implants were installed with one of them invading the anatomical space occupied previously by the incisive canal. The biopsy analysis showed fragments of the incisive artery and nerve, which are responsible for the anterior upper-tooth pulp, the periodontium vascularization and the innervation. From the anastomosis present along with other structures allied with the absence of teeth in the region, there was no detriment to the patient caused by the deflation. Incisive canal deflation is a viable technique in implantology. It can permit ideal prosthetic planning with no detriment to the patient.

  11. Single-port Robotic Pelvic Bulky Lymph Node Resection: A Case Report.

    Science.gov (United States)

    Gungor, Mete; Takmaz, Ozguc; Afsar, Selim; Ozbasli, Esra; Gundogan, Savas

    To report the feasibility of bulky pelvic lymph node resection with robotic-assisted single-port laparoscopy in a patient with cervical cancer before chemoradiation therapy. Resection of pelvic bulky lymph nodes with a narrated video of da Vinci single-port platform surgery (Intuitive Surgical, Sunnyvale, CA) (Canadian Task Force classification III). Although not enough evidence exists to reveal that single-site surgery is better than traditional endoscopic surgery, several studies have suggested that single-site robotic surgery has certain advantages such as less postoperative analgesic use, shorter hospital stay, and quicker recovery. Furthermore, robotic single-site surgery has evolved single-site procedures. Compared with the single-port laparoendoscopic procedure, the robotic-assisted single-port laparoscopic procedure offers some advantages to minimally invasive surgery such as greater dexterity, 3-dimensional visualization, and fewer instrument clashes. These advantages make robotic single-port surgery more preferable; nevertheless, the lack of articulating instruments and the low quality of optical exposure are still challenges. Robotic single-port pelvic lymphadenectomy was first described by Tateo et al [1] in an endometrial carcinoma patient. We present a robotic single-port pelvic bulky lymph node resection in an advanced cervical cancer patient. Even though current data are controversial about removing bulky lymph nodes in patients with advanced cervical cancer, some studies have recommended that debulking of tumor-involved lymph nodes before chemoradiation may be benefical for these patients (Leblanc et al [2], Marnitz et al [3]). In our case, the patient underwent robotic-assisted single-port laparoscopy using the da Vinci Single-Site platform. The abdominal cavity was insufflated from a 3-cm umblical incision, and a 5-lumen single port was inserted. Then, an 8.5-mm 3-dimensional camera was inserted through the port, and for dissection and

  12. Sutured clear corneal incision: wound apposition and permeability to bacterial-sized particles.

    Science.gov (United States)

    May, William N; Castro-Combs, Juan; Kashiwabuchi, Renata T; Tattiyakul, Woranart; Qureshi-Said, Saima; Hirai, Flavio; Behrens, Ashley

    2013-03-01

    To determine the effects of single radial or horizontal suture placement in 2-step clear corneal incision (CCI) wound apposition and permeability to particles of India ink. Five fresh human globes were included. Two 25-gauge needles connected to a saline solution bag and to a digital manometer were inserted through the limbus, 120 degrees apart from each other. Four 2-step CCIs (2.75 mm wide and 3 mm length) were constructed in each cornea. Incisions were divided into 3 groups: single radial suture (SRS), single horizontal suture (SHS), and unsutured group. Optical coherence tomography (OCT) was performed before and after suture placement. With a preset 10 mm Hg intraocular pressure (IOP), India ink was applied to the incision site and a standardized sudden IOP fluctuation was induced. OCT and superficial images were recorded before and after suture placement. India ink inflow and internal and external CCI gapping were outlined and measured by planimeter. The area and linear distance of India ink inflow after pressure challenge in all study groups were higher when compared with pre-pressure measurements; however, this increase was significant in the SRS and SHS groups (P < 0.05). Additionally, SRS placement significantly increased inner wound gapping (P = 0.018), and SHS significantly widened outer wound gape (P = 0.02). Well-constructed unsutured 2-step CCI seems to be more efficient at preventing bacterial-sized particles inflow during sudden changes in IOP, and it seems to offer better wound apposition as assessed by OCT.

  13. From incision to infill: What a Late Quaternary valley system records?

    Science.gov (United States)

    Maselli, V.; Asioli, A.; Trincardi, F.; Ceregato, A.; Rizzetto, F.; Taviani, M.

    2014-12-01

    Erosional sequence boundaries and incised valleys buried in modern continental shelves represent the response of alluvial and coastal systems to Quaternary sea level oscillations. The study of the processes leading to valley incision reveals, at both regional and global scales, the influence of tectonics and eustatism on the evolution of fluvial landforms in coastal plains, while the sedimentary infill of the valley may represents one of the best archives to investigate past environmental changes. Although the time registered in the stratigraphic record represents only a small portion of the geological history, informations about the processes governing the evolution of past landscapes can be quantified by looking to erosional surfaces, where much of the time is condensed. The Manfredonia Incised Valley (southern Adriatic Sea), is a very interesting case of valley as it formed during a single episode of incision related to the last glacial sea level fall and was completely filled during the post-glacial sea level rise. The inverse-funnel shape of the incision, and its confinement toward the mid-inner shelf reveal the impact of the step-wise sea level fall on preexisting coastal morphologies, in particular during the MIS5-4 and MIS3-2 transitions. The 45 m thick sedimentary succession filling the valley recorded the post-glacial sea level rise, as revealed by the upward transition from fluvial to shallow-marine deposits, and the impact of base level and high-frequency climate change on river to coastal systems. The upper 15 m of infill, in particular, consist of multiple bayhead delta progradations occurred synchronously to the formation of sapropel S1, and represent the very-shallow water equivalent of the cm-thick sapropel layers accumulated offshore in the deeper southern Adriatic basin.

  14. Influence of Incision Location on Transmitter Loss, Healing, Incision Lengths, Suture Retention, and Growth of Juvenile Chinook Salmon

    Energy Technology Data Exchange (ETDEWEB)

    Panther, Jennifer L.; Brown, Richard S.; Gaulke, Greggory L.; Woodley, Christa M.; Deters, Katherine A.

    2010-05-11

    In this study, conducted by Pacific Northwest National Laboratory for the U.S. Army Corps of Engineers, Portland District, we measured differences in survival and growth, incision openness, transmitter loss, wound healing, and erythema among abdominal incisions on the linea alba, lateral and parallel to the linea alba (muscle-cutting), and following the underlying muscle fibers (muscle-sparing). A total of 936 juvenile Chinook salmon were implanted with both Juvenile Salmon Acoustic Tracking System transmitters (0.43 g dry) and passive integrated transponder tags. Fish were held at 12°C (n = 468) or 20°C (n = 468) and examined once weekly over 98 days. We found survival and growth did not differ among incision groups or between temperature treatment groups. Incisions on the linea alba had less openness than muscle-cutting and muscle-sparing incisions during the first 14 days when fish were held at 12°C or 20°C. Transmitter loss was not different among incision locations by day 28 when fish were held at 12°C or 20°C. However, incisions on the linea alba had greater transmitter loss than muscle-cutting and muscle-sparing incisions by day 98 at 12°C. Results for wound closure and erythema differed among temperature groups. Results from our study will be used to improve fish-tagging procedures for future studies using acoustic or radio transmitters.

  15. Use of laparoscopy in trauma at a level II trauma center.

    Science.gov (United States)

    Barzana, Daniel C; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W

    2011-01-01

    Enthusiasm for the use of laparoscopy in trauma has not rivaled that for general surgery. The purpose of this study was to evaluate our experience with laparoscopy at a level II trauma center. A retrospective review of all trauma patients undergoing diagnostic or therapeutic laparoscopy was performed from January 2004 to July 2010. Laparoscopy was performed in 16 patients during the study period. The average age was 35 years. Injuries included left diaphragm in 4 patients, mesenteric injury in 2, and vaginal laceration, liver laceration, small bowel injury, renal laceration, urethral/pelvic, and colon injury in 1 patient each. Diagnostic laparoscopy was performed in 11 patients (69%) with 3 patients requiring conversion to an open procedure. Successful therapeutic laparoscopy was performed in 5 patients for repair of isolated diaphragm injuries (2), a small bowel injury, a colon injury, and placement of a suprapubic bladder catheter. Average length of stay was 5.6 days (range, 0 to 23), and 75% of patients were discharged home. Morbidity rate was 13% with no mortalities or missed injuries. Laparoscopy is a seldom-used modality at our trauma center; however, it may play a role in a select subset of patients.

  16. Large Conization and Laparoendoscopic Single-Port Pelvic Lymphadenectomy in Early-Stage Cervical Cancer for Fertility Preservation

    Directory of Open Access Journals (Sweden)

    Polat Dursun

    2013-01-01

    Full Text Available Fertility preservation in early-stage cervical cancer is a hot topic in gynecologic oncology. Although radical vaginal trachelectomy (RVT is suggested as a fertility preserving approach, there are some serious concerns like cervical stenosis, second trimester loss, preterm delivery in survivors, and lack of residual tumor in the majority of the surgical specimens. Therefore, less radical surgical operations have been proposed in early-stage cervical carcinomas. On the other hand, single-incision laparoscopic surgery (SILS is an evolving endoscopic approach for minimal access surgery. In this report, we present a case with early-stage cervical cancer who wishes to preserve fertility. We successfully performed single-port pelvic lymphadenectomy and large conization to preserve fertility potential of the patient. We think that combination of less radical approach like conization and single-port pelvic lymphadenectomy might be less minimally invasive and is still an effective surgical approach in well-selected cases with cervical carcinomas. Incorporation of single-port laparoscopy into the minimally invasive fertility sparing management of the cervical cancer will improve patients outcome with less complications and better cosmesis. Further studies are needed to reach a clear conclusion.

  17. Assessment of corneal astigmatism following frown and straight incision forms in sutureless manual small incision cataract surgery

    Directory of Open Access Journals (Sweden)

    Amedo AO

    2016-04-01

    Full Text Available Angela Ofeibea Amedo, Kwadwo Amoah, Nana Yaa Koomson, David Ben Kumah, Eugene Appenteng Osae Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Abstract: To investigate which of two tunnel incision forms (frown versus straight in sutureless manual small incision cataract surgery creates more corneal astigmatism. Sixty eyes of 60 patients who had consented to undergo cataract surgery and to partake in this study were followed from baseline through >12-week postoperative period. Values of preoperative and postoperative corneal astigmatism for the 60 eyes, measured with a Bausch and Lomb keratometer, were extracted from the patients’ cataract surgery records. Residual astigmatism was computed as the difference between preoperative and postoperative keratometry readings. Visual acuity was assessed during the preoperative period and at each postoperative visit with a Snellen chart at 6 m. Fifty eyes of 50 patients were successfully followed-up on. Overall, the mean residual astigmatism was 0.75±0.12 diopters. The differences in mean residual astigmatism between the two different incision groups were statistically significant (t [48]=6.33, P<0.05; frown incision group recorded 1.00±0.12 diopters, whereas the straight incision group recorded 0.50±0.12 diopters. No significant difference was observed between male and female groups (t [48]=0.24, P>0.05. Residual corneal astigmatism in the frown incision group was significantly higher than in the straight incision group. Fisher’s exact test did not reveal a significant association between incision forms and visual acuity during the entire postoperative period (P>0.05. Keywords: cataract, residual corneal astigmatism, frown incision, straight incision

  18. Development and validation of a theoretical test in basic laparoscopy

    DEFF Research Database (Denmark)

    Strandbygaard, Jeanett; Maagaard, Mathilde; Larsen, Christian Rifbjerg

    2012-01-01

    conversational interviews with experts in laparoscopy. The subsequent relevance of the test questions was evaluated using the Delphi method involving regional chief physicians. Construct validity was tested by comparing test results from three groups with expected different clinical competence and knowledge...... levels: senior medical students, first-year residents, and chief physicians. RESULTS: The four conversational interviews resulted in the development of 47 test questions, which were narrowed down to 37 test questions after two Delphi rounds involving 12 chief physicians. Significant differences were...... found between the test scores from the senior medical students (n = 14) and the first-year residents (n = 52) (median test scores, 18 vs. 24, respectively; p = 0.001), and between the first-year residents and the chief physicians (n = 12) (median test scores, 24 vs. 33, respectively; p = 0...

  19. Robot-assisted laparoscopy for infertility treatment: current views.

    Science.gov (United States)

    Carbonnel, Marie; Goetgheluck, Julie; Frati, Albane; Even, Marc; Ayoubi, Jean Marc

    2014-03-01

    To determine the interest of using robotic laparoscopic surgery in the management of female infertility, we reviewed our own activity and searched the Medline database for publications on robotic technology in infertility surgery, with the use of the following search words: robotic laparoscopy, tubal anastomosis, myomectomy, deep infiltrating endometriosis, and adnexal surgery. Robot-assisted laparoscopic surgery has seen rapid progression over the past few years. It has been mostly used for myomectomy, proximal tubal reanastomosis, and deep endometriosis surgery. Despite its increased range of indications, no randomized control studies are available. The place of robotic surgery in the management of infertility remains undetermined. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  20. Laparoscopy and ultrasound examination in women with acute pelvic pain

    DEFF Research Database (Denmark)

    Mikkelsen, A L; Felding, C

    1990-01-01

    The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women...... had ultrasound examination performed. This investigation showed to be helpful especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did...... not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic...

  1. Technique of Intravesical Laparoscopy for Ureteric Reimplantation to Treat VUR

    Directory of Open Access Journals (Sweden)

    Atul A. Thakre

    2008-01-01

    Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as 0.4 to 1.8% among the pediatric population. In children with urinary tract infection, the prevalence is typically from 30–50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of presenting our surgical technique: laparoscopic intravesical ureteric reimplantation is to highlight the use of laparoscopy to perform ureteric reimplantation for the management of pediatric VUR.

  2. The concept of laparoscopy-assisted pancreatobiliary EUS (LAP-EUS).

    Science.gov (United States)

    Ramesh, Jayapal; Christein, John; Varadarajulu, Shyam

    2013-05-01

    While laparoscopy-assisted endoscopic retrograde cholangiopancreatography can be performed for the diagnosis and management of pancreaticobiliary diseases in patients with Roux-en-Y (RY) anatomy; the technical feasibility of performing laparoscopy-assisted endoscopic ultrasound (EUS) is unknown. In this report, we describe the technique for performing laparoscopy-assisted EUS in two patients with RY gastric bypass anatomy who presented with obstructive jaundice, abnormal liver function tests, and dilated biliary tree. While the examination was normal in one patient, EUS-guided fine needle aspiration of pancreatic head mass revealed adenocarcinoma in the other. Laparoscopic assisted EUS examination including FNA is feasible in Roux-en-Y surgical anatomy.

  3. Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Fader Amanda

    2011-01-01

    Full Text Available Review Objective: To review the recent developments and published literature on laparoendoscopic single-site (LESS surgery in gynaecology. Recent Findings: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript. Conclusions: LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.

  4. Re-laparoscopy in the diagnosis and treatment of postoperative complications following laparoscopic colorectal surgery.

    LENUS (Irish Health Repository)

    O'Riordan, J M

    2013-08-01

    Laparoscopic colorectal surgery has increasingly become the standard of care in the management of both benign and malignant colorectal disease. We herein describe our experience with laparoscopy in the management of complications following laparoscopic colorectal surgery.

  5. Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases

    NARCIS (Netherlands)

    N.D. Kannekens-Bouvy (Nicole); R.L. Marquet (Richard); H.J. Bonjer (Jaap); J. Jeekel (Hans)

    1996-01-01

    textabstractOBJECTIVE: A tumor model in the rat was used to study peritoneal tumor growth and abdominal wall metastases after carbon dioxide (CO2) pneumoperitoneum, gasless laparoscopy, and laparotomy. SUMMARY BACKGROUND DATA: The role of laparoscopic resection of

  6. Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia

    NARCIS (Netherlands)

    Hulscher, J. B.; Nieveen van Dijkum, E. J.; de Wit, L. T.; van Delden, O. M.; van Lanschot, J. J.; Obertop, H.; Gouma, D. J.

    2000-01-01

    OBJECTIVE: To investigate the role of diagnostic laparoscopy and laparoscopic ultrasonography in the staging of carcinoma of the gastric cardia that is involving the distal oesophagus. DESIGN: Retrospective consecutive case series. SETTING: Tertiary care centre, The Netherlands. SUBJECTS: 48

  7. Laparoscopy decreases the laparotomy rate for hemodynamically stable patients with blunt hollow viscus and mesenteric injuries.

    Science.gov (United States)

    Lin, Heng-Fu; Chen, Ying-Da; Lin, Keng-Li; Wu, Meng Che; Wu, Cheng Yi; Chen, Shyr-Chyr

    2015-08-01

    The aim of this study was to evaluate the effect of laparoscopy on patients with blunt hollow viscus and mesenteric injuries (BHVMIs). Hemodynamically stable patients with BHVMIs were diagnosed using computed tomography and serial examinations. Patients admitted from July 1, 1999 to June 30, 2006 underwent exploratory laparotomy (group A), and those admitted from January 1, 2007 to December 31, 2013 received laparoscopy (group B). There were 62 patients in group A, and 59 patients in group B. There were no significant differences in demographic characteristics, injury severity score, and injuries requiring surgical intervention between the groups (all, P > .05). Patients in group B had a shorter hospital stay (mean 11.0 vs 17.6 days, P laparoscopy to laparotomy in group B was 8.5%, compared with a 100% laparotomy rate in group A (P Laparoscopy is feasible and safe for hemodynamically stable patients with BHVMIs. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Training of European urology residents in laparoscopy: results of a pan-European survey

    NARCIS (Netherlands)

    Furriel, Frederico T. G.; Laguna, Maria P.; Figueiredo, Arnaldo J. C.; Nunes, Pedro T. C.; Rassweiler, Jens J.

    2013-01-01

    To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments. A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during

  9. Cyclic steps incised on experimental bedrock

    Science.gov (United States)

    Yokokawa, M.; Kyogoku, A.; Kotera, A.; Izumi, N.

    2013-12-01

    the step shape has been predicted by the mathematical model (Izumi et al., 2012). Among three cases of sediment supply: 1 g/sec, 3 g/sec, and 6 g/sec with fixed water discharge (52 g/sec), the erosion rate was maximized in the cases of the sediment supply of 3 g/sec both in the cement-sand-water ratios of 2:150:50 and 3:150:50. The erosion rate is higher in the case of the moderate amount of sediment supply rather than in the case of the largest amount of sediment supply in which the alluvial cover effect inhibited erosion. This result is consistent with that observed in previous studies (Sklar & Dietrich, 2004; Johnson & Whipple, 2010). References Izumi, N., Yokokawa, M. & Parker G. 2012. Cyclic step morphology formed on bedrock. Annual Journal of Hydraulic Engineering 68(4) : I_955-I_960. Johnson, J.P.L. & Whipple, K.X. 2010. Evaluating the controls of shear stress, sediment supply, alluvial cover, and channel morphology on experimental bedrock incision rate. Journal of Geophysical Research 115, F02018, doi:10.1029/2009JF001335. Sklar, L.S. & Dietrich, W.E. 2004. A mechanistic model for river incision into bedrock by sultating bedload. Water Resources Re-search 40, W06301, doi:10.1029/2003WR002496.

  10. Analisis Strategi Pemasaran Produk Laparoscopy di Rumah Sakit PKU Muhammadiyah YOGYAKARTA

    OpenAIRE

    Mudayana, Ahmad Ahid

    2010-01-01

    Background : Complexity of hospital marketing strategy that have social function needed research to analyses marketing strategy have been applied by PKU Muhammadiyah Yogyakarta hospital, especially to promote Laparoscopy Product. Marketing strategy of the segmentation, targeting and positioning. The aim of the research to analyses marketing strategy of PKU Muhammadiyah Yogyakarta to promote Laparoscopy product.Method : This was descriptive research using qualitative method. The subject was di...

  11. The value of laparoscopy in the management of the impalpable cryptorchid testis.

    Science.gov (United States)

    Rappe, B J; Zandberg, A R; De Vries, J D; Froeling, F M; Debruyne, F M

    1992-01-01

    From January 1981 till October 1991, 47 diagnostic laparoscopies were performed in 50 impalpable testicles. In total, 28 intra-abdominal testes were found. In 14 cases no testes were found, but a deferential duct and vessels were seen. In 7 cases the diagnosis of testicular agenesia was made. One laparoscopy was a technical failure. We bring our results of this safe and reliable procedure, and discuss our management. A review of treatment options for intra-abdominal testes is given.

  12. Yield of Staging Laparoscopy and Lavage Cytology for Radiologically Occult Peritoneal Carcinomatosis of Gastric Cancer.

    Science.gov (United States)

    Ikoma, Naruhiko; Blum, Mariela; Chiang, Yi-Ju; Estrella, Jeannelyn S; Roy-Chowdhuri, Sinchita; Fournier, Keith; Mansfield, Paul; Ajani, Jaffer A; Badgwell, Brian D

    2016-12-01

    This study aimed to identify the yield of staging laparoscopy with peritoneal lavage cytology for gastric cancer patients and to track it over time. The medical records of patients with gastric or gastroesophageal adenocarcinoma who underwent pretreatment staging laparoscopy at the authors' institution from 1995 to 2012 were reviewed. The yield of laparoscopy was defined as the proportion of patients who had positive findings on laparoscopy, including those with macroscopic carcinomatosis, positive cytology, or other clinically important findings. To compare the yield of laparoscopy over time, the patients were divided into three 6-year ranges based on the date of diagnosis. Associations between clinicopathologic factors and peritoneal disease were examined using uni- and multivariate analyses. The study included 711 patients. Among these patients, 43.5 % had gastroesophageal junction tumors, 72.9 % had poorly differentiated adenocarcinoma, and 53 % had signet ring cell morphology. Endoscopic ultrasound had most commonly identified T3 (83.9 %) and N-positive (66.4 %) tumors. At laparoscopy, 148 (20.8 %) patients had been found to have macroscopic peritoneal carcinomatosis. Among 514 macroscopically negative patients who underwent peritoneal lavage cytologic analysis, 68 (13.2 %) had positive cytology results for malignancy. The total laparoscopy yield was 36 %, which did not change over time (p = 0.58). Multivariate analysis demonstrated that positive cytology or carcinomatosis was associated with poorly differentiated histology, linitis plastica, and equivocal computed tomography findings. Laparoscopy remains a useful staging procedure to evaluate for peritoneal spread when treatment or surgery is considered, even with the current availability of high-quality imaging.

  13. Impact of laparoscopy for diagnosis and treatment in patients with disorders of sex development.

    Science.gov (United States)

    Moriya, K; Morita, K; Mitsui, T; Kitta, T; Nakamura, M; Kon, M; Nonomura, K

    2014-10-01

    To review laparoscopy in patients with disorders of sex development (DSD) in order to clarify its usefulness in diagnosis, devising subsequent therapeutic strategies and managing patients with various conditions. Between April 1992 and December 2012, 29 laparoscopic surgeries were performed in 25 DSD patients. Among them, ten were diagnostic laparoscopy including gonadal biopsy, and 19 were therapeutic laparoscopy. Surgical procedures and complications were evaluated. For diagnostic laparoscopy, laparoscopic gonadal biopsy was performed in three patients. Inspection, with or without open gonadal biopsy, was performed on four out of seven patients with 46XY DSD or mixed gonadal dysgenesis (MGD). Additional surgery was planned and performed based on diagnostic laparoscopic findings in six out of seven patients. In the three patients with ovotesticular DSD, the gonadal pathology was diagnosed as: testis/ovary in one, testis/ovotestis in one and ovary/ovotestis in one--this was from the laparoscopic inspection and/or gonadal biopsy. However, the final diagnoses were bilateral ovotestis in two patients and ovary/ovotestis in one patient. For therapeutic laparoscopy, surgical procedures were: gonadectomy in 17 patients (bilateral in 13, unilateral in three, partial in two); hysterectomy in two patients; orchiopexy in one; and sigmoid vaginoplasty in one patient (included multiple procedures). There were no severe perioperative complications. In the four patients with a history of diagnostic laparoscopy, no severe intra-abdominal adhesions that would disturb therapeutic laparoscopic surgery were observed. While diagnostic laparoscopy was helpful in devising a therapeutic surgical strategy in most of the patients with DSD who were suspected as having complex gonadal status or Müllerian duct derivatives, attention must be paid to precisely diagnosing the gonadal status in ovotesticular DSD. On the other hand, therapeutic laparoscopic surgeries were valuable procedures in

  14. Comparison of hysterosalpingography and laparoscopy in the evaluation of infertile women

    International Nuclear Information System (INIS)

    Sakar, Mehmet N.; Atay, Ahmet E.; Gul, T.; Celik, Y.

    2008-01-01

    Objective was to compare tuboperitoneal factors of infertile women hysterosalpingography (HSG) and laparoscopy. In this cohort study, 82 infertile cases were evaluated retrospectively by laparoscopy, 3 months subsequent to HSG in the Department of Gynecology and Obstetrics, Medical School of Dicle University, Diyarbakir, Turkey between March 2004 and April 2006. The findings of HSG and laparoscopy were compared. Out of 82 infertile women, pathological findings were observed in 45.1% by HSG and 54.9% had no pathological findings. On laparoscopic evaluation, however, pathological findings were observed in 65.85% and 34.15% had no pathological findings. The pathological findings were detected by laparoscopy in 20 of the 45(44.4%) patients who had had no pathological findings by HSG and no pathological findings were detected by laparoscopy in 3 of the 37 (8.1%) patients who had pathological findings by HSG. Laparoscopy revealed no pathological findings in 6 of 35 patients who had tubal pathology by HSG. The sensitivity of HSG was 63%, specificity was 89.3% and positive predictive value was 92% with a 55% predictive value and the accuracy ratio was 72%. Laparoscopy is a superior method for the result of tubal and pelvic pathologies in the evaluation of infertility. However, HSG is a more economical and elementary method suitable for evaluation of endometrial and tubal pathologies and laparoscopy is an appropriate method for examining the external part of tubae, fimbriae, the relation of tuba and ovary, endometriosis, adhesions, tuberculosis and other pathologies. Therefore, these 2 methods are not alternative but complementary. (author)

  15. A skin abscess model for teaching incision and drainage procedures.

    Science.gov (United States)

    Fitch, Michael T; Manthey, David E; McGinnis, Henderson D; Nicks, Bret A; Pariyadath, Manoj

    2008-07-03

    Skin and soft tissue infections are increasingly prevalent clinical problems, and it is important for health care practitioners to be well trained in how to treat skin abscesses. A realistic model of abscess incision and drainage will allow trainees to learn and practice this basic physician procedure. We developed a realistic model of skin abscess formation to demonstrate the technique of incision and drainage for educational purposes. The creation of this model is described in detail in this report. This model has been successfully used to develop and disseminate a multimedia video production for teaching this medical procedure. Clinical faculty and resident physicians find this model to be a realistic method for demonstrating abscess incision and drainage. This manuscript provides a detailed description of our model of abscess incision and drainage for medical education. Clinical educators can incorporate this model into skills labs or demonstrations for teaching this basic procedure.

  16. A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    L Snyman

    2017-03-01

    Full Text Available Background. Ruptured ectopic pregnancy (REP is a common gynaecological emergency in resource-poor settings, where laparotomy is the standard treatment despite laparoscopic surgery being regarded as the optimal treatment. There is a lack of prospective randomised data comparing laparoscopic surgery with laparotomy in the surgical management of women with REP. Objective. To compare operative laparoscopy with laparotomy in women with REP. Methods. This was a randomised parallel study. One hundred and forty women with suspected REP were randomised to undergo operative laparoscopy or laparotomy. The outcome measures were operating time, hospital stay, pain scores and analgesic requirements, blood transfusion, time to return to work, and time to full recovery. Results. Operating time was significantly longer in the laparoscopy group (67.3 v. 30.5 minutes, p<0.001. Duration of hospital stay, pain scores and need for analgesia were significantly less in the laparoscopy group. Women in this group returned to work 8 days earlier and their time to full recovery was significantly shorter compared with those in the laparotomy group. Significantly more women undergoing laparotomy required blood transfusion than women in the laparoscopy group. In the latter group, 14.5% of women required blood transfusion compared with 26.5% in the laparotomy group (p=0.01. Conclusion. Operative laparoscopy in women treated for REP is feasible in a resource-poor setting and is associated with significantly less morbidity and a quicker return to economic activity.

  17. THE ROLE OF LAPAROSCOPY IN DISCOVERING THE CAUSES OF CHRONIC PELVIC PAIN

    Directory of Open Access Journals (Sweden)

    Jadranka Domazet Fink

    2003-12-01

    Full Text Available Background. The aim of this study was to assess the share of organic changes in patients with chronic pelvic pain (CPP as well as evaluate the need for invasive CPP diagnostics – laparoscopy.Methods. The data for the analysis were gathered retrospectively from the descriptions of 287 CPP patients who were treated at the Clinic of Gynaecology in Ljubljana from 1993 to 1999. In this analysis the share of laparoscopically established organic causes of CPP was assessed and the findings of invasive (laparoscopy and non-invasive diagnostics (clinical status and ultrasound were compared.Results. Out of 287 patients, 272 underwent laparoscopy, 7 underwent laparotomy while 8 were only observed. As regards organic CPP causes, an organic cause was established in 70.7% patients through laparoscopy. The most frequently observed phenomena were adhesions, namely in 97 (35.7% patients, endometriosis in 68 (25.0% and pelvic varices in 29 (10% patients.By comparing the results of invasive and non-invasive diagnostics it was established that up to three times more organic changes – a possible cause of CPP – can be discovered through laparoscopy than through the use of non-invasive diagnostics methods.Conclusions. Laparoscopy is considered to be the most reliable method of diagnostics and detection of organic causes of CPP. An adequate psychological treatment within a multidisciplinary approach is necessary in patients in whom an organic cause of CPP can not be discovered in their genital tract.

  18. Laparoscopy improves clinical outcome of gastrointestinal fistula caused by Crohn's disease.

    Science.gov (United States)

    Ren, Jianan; Liu, Song; Wang, Gefei; Gu, Guosheng; Ren, Huajian; Hong, Zhiwu; Li, Jieshou

    2016-01-01

    Benefits of laparoscopic surgery in the management of gastrointestinal fistula caused by Crohn disease need to be fully elucidated. We conducted this retrospective study to investigate the safety and feasibility and emphasize the advantages of laparoscopy compared with that of laparotomy for patients with gastrointestinal fistula caused by Crohn disease. A total of 1213 patients with gastrointestinal fistula in our center were screened, and 318 qualified patients were enrolled and divided into laparoscopy (n = 122) and laparotomy (n = 196) groups. Postoperative complications, length of hospital stay, systemic stress responses to surgery, postoperative mortality, and economic burden were collected and compared. A total of 125 laparoscopic interventions were performed with a conversion rate of 20.0%. Fifteen versus 84 postoperative complications were obtained in laparoscopy and laparotomy groups, respectively (P = 0.0033). Total hospitalization was 22.7 d and 38.0 d in laparoscopy and laparotomy groups, respectively (P laparoscopy was significantly lower than that to laparotomy. Reduced postoperative mortality (P = 0.0292) and postoperative cost (P = 0.0292) were observed in laparoscopy instead of laparotomy group. Laparoscopic approach is safe and feasible and could improve clinical outcome in gastrointestinal fistula patients with Crohn disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Laparoscopy Versus Laparotomy in the Treatment of High-Risk Endometrial Cancer

    Science.gov (United States)

    Gao, Huiqiao; Zhang, Zhenyu

    2015-01-01

    Abstract The aim of this study was to compare the long-term safety and efficacy of laparoscopic surgery and laparotomy for high-risk endometrial cancer (EC). A retrospective analysis based on our decade of clinical data of patients with high-risk EC who were comprehensively surgically staged by laparotomy or laparoscopy was performed. The surgical outcomes were compared between different approaches using propensity score matching (PSM). Eighty-one pairs of patients from the initial 220 enrolled ones were matched by PSM. The mean operative time is similar between laparotomy and laparoscopy groups (258 minutes vs. 253 minutes). The laparoscopy cohort has less blood loss (107 mL vs.414 mL, P laparoscopy (16.4) were significant less than that dissected by laparotomy (21.9). The 5- and 10-year survival rate for laparotomy were 89.2% and 75.8% compared with 85.3% and 85.3% for the laparoscopy. There was no significant difference in overall survival (P = 0.97). Laparoscopy is as effective as laparotomy in the long term and can be safely carried out in patients with high-risk EC for surgery treatment. PMID:26222865

  20. Morphodynamic Model of Submarine Canyon Incision by Sandblasting

    Science.gov (United States)

    Zhang, L.; Parker, G.; Izumi, N.; Cartigny, M.; Li, T.; Wang, G.

    2017-12-01

    Submarine canyons are carved by turbidity currents under the deep sea. As opposed to subaerial canyons, the relevant processes are not easy to observe directly. Turbidity currents are bottom-hugging sediment gravity flows of that can incise or deposit on the seafloor to create submarine canyons or fans. The triggers of turbidity currents can be storms, edge waves, internal waves, canyon wall sapping, delta failure, breaching and hyperpycnal flows. The formation and evolution mechanisms of submarine canyons are similar to those of subaerial canyons, but have substantial differences. For example, sandblasting, rather than wear due to colliding gravel clasts is more likely to be the mechanism of bedrock incision. Submarine canyons incise downward, and often develop meander bends and levees within the canyon, so defining "fairways". Here we propose a simple model for canyon incision. The starting point of our model is the Macro Roughness Saltation Abrasion Alluviation model of Zhang et al. [2015], designed for bedrock incision by gravel clasts in mixed bedrock-alluvial rivers. We adapt this formulation to consider sandblasting as a means of wear. We use a layer-averaged model for turbidity current dynamics. The current contains a mixture of mud, which helps drive the flow but which does not cause incision, and sand, which is the agent of incision. We show that the model can successfully model channel downcutting, and indeed illustrate the early formation of net incisional cyclic steps, i.e. upstream-migrating undulations on the bed associated with transcritical (in the Froude sense) flow. These steps can be expected to abet the process of incision.

  1. Vertical compared with transverse incisions in abdominal surgery

    DEFF Research Database (Denmark)

    Grantcharov, T P; Rosenberg, J

    2001-01-01

    . SETTING: Teaching hospital, Denmark. SUBJECTS: Patients undergoing open abdominal operations. INTERVENTIONS: For some of the variables (burst abdomen and incisional hernia) it was considered adequate to include retrospective studies. Studies were identified through Medline, Cochrane library, Embase...... with fewer complications (pain, burst abdomen, and pulmonary morbidity) and there is lower incidence of late incisional hernia after transverse compared with vertical laparotomy. A midline incision is still the incision of choice in conditions that require rapid intra-abdominal entry (such as trauma...

  2. Diathermy versus scalpel incisions for open cholecystectomy comparative study

    International Nuclear Information System (INIS)

    Ali, M.A.; Niazi, W.A.K.

    2014-01-01

    The aim of the study was to make a comparison between skin incisions made with electrocautery versus scalpel in terms of their safety, efficacy and post-operative complications. Design: A randomized controlled study. Setting: The study was conducted in Combined Military Hospital (CMH) Kharian, Pakistan airforce (PAF) Hospital Sargodha. Duration of Study: May 2008 to August 2011. Patients and Methods: Ninety seven patients who underwent open cholecystectomy were randomly divided into two groups on the basis of the use of electrocautery versus steel scalpel for making skin incision and sub-cutaneous tissue dissection. Parameters recorded were, time taken from skin incision to full incising of the peritoneum, length of the wound, amount of blood loss during this step of surgery in each group. Post-operative pain scoring using visual analogue scale was done. Wound complications such as infection, haematoma/seroma and dehiscence were noted too. One month of follow up was recorded in each group. Subsequently a comparison of these findings was done. Results: Incision time (sec/cm/sub 2/) was longer in scalpel group than in diathermy group (p = 0.001), whereas, incision blood loss (ml/cm/sub 2/) was significantly less in diathermy group than in scalpel group (p = 0.03). There was no difference in post-operative pain perception as delineated by visual pain analogue scoring system between the two groups (p = 0.57). Post-operative wound complications and the final healing of wound at 01 month of follow-up were almost similar in both groups. Conclusion: Electrocautery may be used safely without any untoward complication in making skin incision and sub-cutaneous tissue dissection with an advantage of reduced incision time and and less blood loss. (author)

  3. High-power diode laser in the circumvestibular incision for Le Fort I osteotomy in orthognathic surgery: a prospective case series study.

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    Jaeger, Filipe; Chiavaioli, Gustavo Marques; de Toledo, Guilherme Lacerda; Freire-Maia, Belini; Amaral, Marcio Bruno Figueiredo; Mesquita, Ricardo Alves

    2018-01-01

    The incisions during orthognathic surgery are classically performed with conventional scalpel or electrocautery. Considering that the high-power diode laser surgery may provide advantages when compared to conventional incision techniques, the current study aimed to present a prospective case series of patients submitted to circumvestibular incision for Le Fort I osteotomy. Ten patients with dentofacial deformities who underwent to rapid assisted maxillary expansion or bimaxillary orthognathic surgery were enrolled in the study. All incisions were performed by a single surgeon using an 808-nm diode laser, with an optical fiber of 600 μm, at a power of 2.5 W, in a continuous-wave mode. The performance of the incision was evaluated by incision velocity, bleeding, edema, secondary infection, clinical healing, and pain. The velocity of the incision ranged from 0.10 to 0.20 mm/s (mean 0.13 ± 0.03 mm/s). Considering bleeding during the soft tissue incision, all surgeries were classified as absent bleeding. All patients presented a clinical healing of the surgical wound in a period that range from 3 to 5 weeks and experienced swelling during the follow-up period. On average, approximately 50% of the swelling had resolved after the third postoperative week, and 28.8% of swelling remained after 2 months after the surgery. The pain decreased after 2 and 3 days, and 90.0% of the patients reported no pain after 7 postoperative days. High-power diode laser is effective and safety during circumvestibular incisions for Le Fort I osteotomy in orthognathic surgery decreasing bleeding, surgery time, pain, and edema after orthognathic surgery.

  4. Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation

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    Ricardo Hideki Yanasse

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL reconstruction using a single band. METHODS: A prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients or two incisions (group 2: 20 patients. The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm were evaluated. RESULTS: The positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p 0.05. Group 2 had better results from the pivot-shift maneuver (p < 0.05. CONCLUSION: The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.

  5. Chicken and porcine models for training in laparoscopy and robotics.

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    Ganpule, Arvind; Chhabra, Jaspreet Singh; Desai, Mahesh

    2015-03-01

    To review the most recent literature and contemporary role of the use of porcine and chicken models in laparoscopic and robotic simulation exercises, for training and skill assessment. There are multiple types of the simulators which include mechanical, virtual reality, hybrid simulators and animal models. The recent literature has seen insurgence of several of such simulators, specifically the animate ones comprising porcine and chicken models. The different training models reported have evolved from generalized and simpler, to a more task dedicated and complex versions. Unlike in the past, the recent publications include analysis of these models incorporating different measures of validity assessment. On account of the natural tissue properties inherent to these porcine and chicken models, they are proving to be instrumental in acquisition of higher surgical skills such as dissection, suturing and use of energy sources, all of which are required in real-time clinical scenarios be it laparoscopy or robotic-assisted procedures. In-vivo training in the animal model continues to be, perhaps, the most sophisticated training method before resorting to real-time surgery.

  6. Port-Site Metastasis of Uterine Carcinosarcoma after Laparoscopy.

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    Tan, Zhen; Li, Ang; Chen, Long; Xu, XiaoWen; Fu, ChuanGang

    2017-11-01

    We report a case of port-site metastasis after laparoscopic surgery for early stage uterine carcinosarcoma (UCS) and review the related literature. A 53-year-old woman with suspected uterine malignance underwent a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, infra-colic omentectomy, and pelvic lymphadenectomy resulting pathologically in a stage IA UCS. Twelve months later she developed a palpable abdominal-wall mass at the trocar site without other synchronous metastases. A mass resection was performed and it was pathologically diagnosed with port-site metastasis of UCS. When performing surgery for UCS, specimens should be carefully removed in case small pieces of the occult disseminated metastatic tissues are trapped between the outer surface of the trocar sleeve and the abdominal wall incisional canal. Despite the low incidence, a laparotomy might be considered rather than laparoscopy to prevent port-site metastasis and more gynecological oncology clinical practices might be relevant to the management of port-site metastasis. © 2017 The Korean Academy of Medical Sciences.

  7. "Spaghetti Maneuver": A useful tool in pediatric laparoscopy - Our experience

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    Antonio Marte

    2011-01-01

    Full Text Available Aims: The laparoscopic "Spaghetti Maneuver" consists in holding an organ by its extremity with a grasper and rolling it up around the tool to keep the organ stable and facilitate its traction within a small space. We describe our experience with the "Spaghetti Maneuver" in some minimally invasive procedures. Materials and Methods: We successfully adopted this technique in 13 patients (5F : 8M aged between 6 and 14 years (average age, 10 on whom we performed 7 appendectomies, 2 ureteral reimplantation and 4 cholecystectomies. In all cases, after the first steps, the appendix, the gallbladder and the ureter were rolled around the grasper and easily isolated; hemostasis was thus induced and the organ was mobilized until removal during cholecystectomy and appendectomy, and before the reimplantation in case of ureteral reimplantation. Results: We found that this technique facilitated significantly the acts of holding, isolating and removing, when necessary, the structures involved, which remained constantly within the visual field of the operator. This allowed a very ergonomic work setting, overcoming the problem of the "blind" zone, which represents a dangerous and invisible area out of the operator′s control during laparoscopy. Moreover the isolation maneuvers resulted easier and reduced operating time. Conclusion: We think that this technique is easy to perform and very useful, because it facilitates the dissection of these organs, by harmonizing and stabilizing the force of traction exercised.

  8. Laparoscopy in the management of pediatric vesicoureteral reflux

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    Atul A Thakre

    2007-01-01

    Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.

  9. Management of Ovarian Dermoid Cysts by Laparoscopy Compared With Laparotomy

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    Pang Liyi

    1996-01-01

    Full Text Available Thirty patients with ovarian dermoid cysts removed by laparoscopic surgery were compared with 42 patients with ovarian dermoid cysts removed by laparotomy, with respect to the selection criteria, surgical procedures, operating time, intraoperative and postoperative complications, blood loss, and hospital stay. Although the operating time for unilateral cystectomy, unilateral salpingo-oophorectomy, and bilateral cystectomy performed by laparoscopic surgery was longer (120.3 ± 43.7 min, mean ± SD than those for the same procedures performed by laparotomy (73.9 ± 21.6 min, p < 0.01, we observed a learning curve with a remarkable declining tendency (linear regression model, p < 0.01. At the end of this study, the times taken for laparoscopic procedures were almost the same as those for laparotomy. Less blood loss (18.2 ± 1.7 ml versus 105.9 ± 84.3 ml, p < 0.01 and shorter hospital stay (5.9 ± 1.9 days versus 12.0 ± 2.9 days, p < 0.01 were also found to be advantages of laparoscopic surgery. This article discusses the technical procedures of laparoscopic surgery. The efficiency and safety of operative laparoscopy as an alternative access route for the management of ovarian dermoid cysts were recognized. We stress that strict criteria for selection of patients should always be followed and the necessity of retraining schedules for gynecologists and nursing staff in the speciality of laparoscopic surgery.

  10. Laparoscopy and peritoneal cytology: important prognostic tools to guide treatment selection in gastric adenocarcinoma.

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    Tourani, Saam S; Cabalag, Carlos; Link, Emma; Chan, Steven T F; Duong, Cuong P

    2015-01-01

    Previous studies have suggested that patients with occult peritoneal metastases not seen on preoperative imaging have poor prognosis. In this study, we aim to evaluate the utility and impact of staging laparoscopy and peritoneal cytology in patients with gastric adenocarcinoma. A retrospective analysis of patients with gastric adenocarcinoma managed at two major metropolitan hospitals in Melbourne, Australia, between January 1999 and July 2010 was undertaken. The main outcome measures were the number of patients in whom laparoscopy and/or peritoneal cytology changed treatment intent, and the overall survival of patients with occult metastases detected by laparoscopy/cytology. Staging laparoscopy as an independent procedure was performed in 74.3% (148/199) of patients who had neither unequivocal metastases (M1) on preoperative imaging nor early T1 disease on endoscopic ultrasound. Laparoscopy/cytology detected occult metastases in 38 (25.6%) patients (27 macroscopic M1 and 11 microscopic M1 with positive peritoneal cytology only), leading to change in the treatment intent in 37 cases. The median overall survivals of patients with metastatic disease detected at staging laparoscopy (8.3 months, 95% confidence interval (CI) 5.4-16.5) or on peritoneal cytology (4.9 months, 95% CI 4.2-48) were as poor as those with M1 disease seen on preoperative imaging (6.7 months, 95% CI 4.2-8.9), P = 0.97. Laparoscopy and peritoneal cytology add incremental value to modern imaging in the staging of gastric adenocarcinomas by detecting occult metastatic disease. Their utility needs to be optimized to allow better treatment selection for gastric cancer patients. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

  11. Pragmatic staging of oesophageal cancer using decision theory involving selective endoscopic ultrasonography, PET and laparoscopy.

    Science.gov (United States)

    Findlay, J M; Bradley, K M; Maile, E J; Braden, B; Maw, J; Phillips-Hughes, J; Gillies, R S; Maynard, N D; Middleton, M R

    2015-11-01

    Following CT, guidelines for staging oesophageal and gastro-oesophageal junction (GOJ) cancer recommend endoscopic ultrasonography (EUS), PET-CT and laparoscopy for T3-T4 GOJ tumours. These recommendations are based on generic utilities, but it is unclear whether the test risk outweighs the potential benefit for some patients. This study sought to quantify investigation risks, benefits and utilities, in order to develop pragmatic, personalized staging recommendations. All patients with a histological diagnosis of oesophageal or GOJ cancer staged between May 2006 and July 2013 comprised a development set; those staged from July 2013 to July 2014 formed the prospective validation set. Probability thresholds of altering management were calculated and predictive factors identified. Algorithms and models (decision tree analysis, logistic regression, artificial neural networks) were validated internally and independently. Some 953 patients were staged following CT, by [(18) F]fluorodeoxyglucose PET-CT (918), EUS (798) and laparoscopy (458). Of these patients, 829 comprised the development set (800 PET-CT, 698 EUS, 397 laparoscopy) and 124 the validation set (118 PET-CT, 100 EUS, 61 laparoscopy). EUS utility in the 71.8 per cent of patients with T2-T4a disease on CT was minimal (0.4 per cent), its risk exceeding benefit. EUS was moderately accurate for pT1 N0 disease. A number of factors predicted metastases on PET-CT and laparoscopy, although none could inform an algorithm. PET-CT altered management in 23.0 per cent, and laparoscopy in 7.1 per cent, including those with T2 and distal oesophageal tumours. Although EUS provided additional information on T and N category, its risk outweighed potential benefit in patients with T2-T4a disease on CT. Laparoscopy seemed justified for distal oesophageal tumours of T2 or greater. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  12. Neighborhood Variation in the Utilization of Laparoscopy for the Treatment of Colon Cancer.

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    Doumouras, Aristithes G; Saleh, Fady; Eskicioglu, Cagla; Amin, Nalin; Cadeddu, Margherita; Hong, Dennis

    2016-08-01

    The rates of laparoscopic colectomy for colon cancer have steadily increased since its inception. Laparoscopic colectomy currently accounts for a third of colectomy procedures in the United States, but little is known regarding the spatial pattern of the utilization of laparoscopy for colon cancer. This study evaluated the utilization of laparoscopy for colon cancer at the neighborhood level in Ontario. Retrospective analysis of prospectively collected data was performed. This study was conducted at all hospitals in the province of Ontario. This population-based study included all patients aged ≥18 who received an elective colectomy for colon cancer from April 2008 until March 2012 in the province of Ontario. The primary outcome measure was the neighborhood rates of laparoscopy. Overall, 9,969 patients underwent surgery, and the cluster analysis identified 74 cold-spot neighborhoods, representing 1.8 million people, or 14% of the population. In the multivariate analysis, patients from rural neighborhoods were less than half as likely to receive laparoscopy, OR 0.44 (95% CI, 0.24-0.84; p = 0.012). Additionally, having a minimally invasive surgery fellowship training facility within the same administrative health region as the neighborhood made it more than 23 times as likely to be a hot spot, OR 25.88 (95% CI, 12.15-55.11; p laparoscopy. Patient case mix could affect laparoscopy use. This study identified an unequal utilization of laparoscopy for colon cancer within Ontario with rural neighborhoods experiencing low rates of laparoscopic colectomy, whereas neighborhoods in the same administrative region as minimally invasive surgery training centers experienced increased utilization. Further study into the causes of this variation in resource allocation is needed to identify ways to improve more efficient spread of knowledge and technical skills advancement.

  13. Fluorescence laparoscopy imaging of pancreatic tumor progression in an orthotopic mouse model

    Science.gov (United States)

    Tran Cao, Hop S.; Kaushal, Sharmeela; Lee, Claudia; Snyder, Cynthia S.; Thompson, Kari J.; Horgan, Santiago; Talamini, Mark A.; Hoffman, Robert M.

    2010-01-01

    Background The use of fluorescent proteins to label tumors is revolutionizing cancer research, enabling imaging of both primary and metastatic lesions, which is important for diagnosis, staging, and therapy. This report describes the use of fluorescence laparoscopy to image green fluorescent protein (GFP)-expressing tumors in an orthotopic mouse model of human pancreatic cancer. Methods The orthotopic mouse model of human pancreatic cancer was established by injecting GFP-expressing MiaPaCa-2 human pancreatic cancer cells into the pancreas of 6-week-old female athymic mice. On postoperative day 14, diagnostic laparoscopy using both white and fluorescent light was performed. A standard laparoscopic system was modified by placing a 480-nm short-pass excitation filter between the light cable and the laparoscope in addition to using a 2-mm-thick emission filter. A camera was used that allowed variable exposure time and gain setting. For mouse laparoscopy, a 3-mm 0° laparoscope was used. The mouse’s abdomen was gently insufflated to 2 mm Hg via a 22-gauge angiocatheter. After laparoscopy, the animals were sacrificed, and the tumors were collected and processed for histologic review. The experiments were performed in triplicate. Results Fluorescence laparoscopy enabled rapid imaging of the brightly fluorescent tumor in the pancreatic body. Use of the proper filters enabled simultaneous visualization of the tumor and the surrounding structures with minimal autofluorescence. Fluorescence laparoscopy thus allowed exact localization of the tumor, eliminating the need to switch back and forth between white and fluorescence lighting, under which the background usually is so darkened that it is difficult to maintain spatial orientation. Conclusion The use of fluorescence laparoscopy permits the facile, real-time imaging and localization of tumors labeled with fluorescent proteins. The results described in this report should have important clinical potential. PMID:20533064

  14. Three-dimensional versus two-dimensional vision in laparoscopy: a systematic review.

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    Sørensen, Stine Maya Dreier; Savran, Mona Meral; Konge, Lars; Bjerrum, Flemming

    2016-01-01

    Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. The search was accomplished in accordance with the PRISMA guidelines using the PubMed, EMBASE, and The Cochrane Library electronic databases. No language or year of publication restrictions was applied. Data extracted were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction. Three hundred and forty articles were screened for eligibility, and 31 RCTs were included in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71%) showed a reduction in performance time, and 12 out of 19 (63%) showed a significant reduction in error when using 3D compared to 2D. Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.

  15. Staging laparoscopy improves treatment decision-making for advanced gastric cancer.

    Science.gov (United States)

    Hu, Yan-Feng; Deng, Zhen-Wei; Liu, Hao; Mou, Ting-Yu; Chen, Tao; Lu, Xin; Wang, Da; Yu, Jiang; Li, Guo-Xin

    2016-02-07

    To evaluate the clinical value of staging laparoscopy in treatment decision-making for advanced gastric cancer (GC). Clinical data of 582 patients with advanced GC were retrospectively analyzed. All patients underwent staging laparoscopy. The strength of agreement between computed tomography (CT) stage, endoscopic ultrasound (EUS) stage, laparoscopic stage, and final stage were determined by weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. A χ(2) test was used to analyze the correlation between peritoneal metastasis or positive cytology and clinical characteristics. Among the 582 patients, the distributions of pathological T classifications were T2/3 (153, 26.3%), T4a (262, 45.0%), and T4b (167, 28.7%). Treatment plans for 211 (36.3%) patients were changed after staging laparoscopy was performed. Two (10.5%) of 19 patients in M1 regained the opportunity for potential radical resection by staging laparoscopy. Unnecessary laparotomy was avoided in 71 (12.2%) patients. The strength of agreement between preoperative T stage and final T stage was in almost perfect agreement (Kw = 0.838; 95% confidence interval (CI): 0.803-0.872; P laparoscopy; compared with CT and EUS, which was in fair agreement. The strength of agreement between preoperative M stage and final M stage was in almost perfect agreement (Kw = 0.990; 95% CI: 0.977-1.000; P laparoscopy; compared with CT, which was in slight agreement. Multivariate analysis revealed that tumor size (≥ 40 mm), depth of tumor invasion (T4b), and Borrmann type (III or IV) were significantly correlated with either peritoneal metastasis or positive cytology. The best performance in diagnosing P-positive was obtained when two or three risk factors existed. Staging laparoscopy can improve treatment decision-making for advanced GC and decrease unnecessary exploratory laparotomy.

  16. Strict Criteria for Selection of Laparoscopy for Women with Adnexal Mass

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    Sallum, Luis Felipe; Sarian, Luis Otávio; Bastos, Joana Fróes Bragança; Derchain, Sophie

    2014-01-01

    Objectives: We compared the indication of laparoscopy for treatment of adnexal masses based on the risk scores and tumor diameters with the indication based on gynecology-oncologists' experience. Methods: This was a prospective study of 174 women who underwent surgery for adnexal tumors (116 laparotomies, 58 laparoscopies). The surgeries begun and completed by laparoscopy, with benign pathologic diagnosis, were considered successful. Laparoscopic surgeries that required conversion to laparotomy, led to a malignant diagnosis, or facilitated cyst rupture were considered failures. Two groups were defined for laparoscopy indication: (1) absence of American College of Obstetrics and Gynecology (ACOG) guideline for referral of high-risk adnexal masses criteria (ACOG negative) associated with 3 different tumor sizes (10, 12, and 14 cm); and (2) Index of Risk of Malignancy (IRM) with cutoffs at 100, 200, and 300, associated with the same 3 tumor sizes. Both groups were compared with the indication based on the surgeon's experience to verify whether the selection based on strict rules would improve the rate of successful laparoscopy. Results: ACOG-negative and tumors ≤10 cm and IRM with a cutoff at 300 points and tumors ≤10cm resulted in the same best performance (78% success = 38/49 laparoscopies). However, compared with the results of the gynecology-oncologists' experience, those were not statistically significant. Discussion: The selection of patients with adnexal mass to laparoscopy by the use of the ACOG guideline or IRM associated with tumor diameter had similar performance as the experience of gynecology-oncologists. Both methods are reproducible and easy to apply to all women with adnexal masses and could be used by general gynecologists to select women for laparoscopic surgery; however, referral to a gynecology-oncologist is advisable when there is any doubt. PMID:25392617

  17. Effects of two different incision phacoemulsification on corneal astigmatism

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    Lu Huo

    2014-12-01

    Full Text Available AIM:To compare the effect of different incision in corneal astigmatism after phacoemulsification. METHODS: Totally 88 cases(122 eyeswith pure cataract were randomly divided into two groups. Forty cases(60 eyeswere clarity corneal incision in group A, and 48 cases(62 eyeswere sclera tunnel incision in group B. Mean corneal astigmatism, surgically induced astigmatism(SIA, uncorrected visual acuity(UCVAand best correct vision acuity(BCVAwere observed in pre- and post-operation at 1d; 1wk; 1mo.RESULTS: The mean astigmatism had statistically significant difference between two groups at 1d; 1wk; 1mo after operation(PPP>0.05. UCVA≥0.5 and BCVA≥0.8 had statistically significant difference at 1d; 1wk(PP>0.05.CONCLUSION: Phacoemulsification with scleral tunnel incision remove combined intraocular lens(IOLimplantation has small changes to corneal astigmatism. By selecting personalized corneal incision according to the corneal topography might be more beneficial.

  18. Small incision removal of nylon foil orbital implants.

    Science.gov (United States)

    Liu, Catherine Y; Vemuri, Swapna; Tao, Jeremiah P

    2015-01-01

    To describe a small incision technique for the removal of a nylon foil orbital wall implant. The authors retrospectively reviewed the charts of 9 patients who underwent a minimally invasive anterior orbitotomy for nylon foil explantation. Indications for removal and surgical technique, including size of orbitotomy incision and extent of orbital dissection, were recorded. Motility, globe position, strabismus pre- and post procedure, and complications were also assessed. Photographs, videos, and postoperative imaging were included, when available. The indications for removal were adjacent sinusitis (4 cases), undesirable implant position (3), orbital abscess (1), and adjacent orbital emphysema (1). The removal technique was associated with no changes in motility, globe position, or strabismus postprocedure. The average incision size was 1.1 cm, and the procedure was rapid, usually seconds once the anterior aspect of the implant was exposed and grasped with a hemostat. The dissection in all cases was to the anterior aspect of the implant without a need for deep orbital manipulation. The authors demonstrate through video that the implant folds to exit through a small incision. No adverse events were noted. Nasal endoscopy and radiography demonstrated a fibrous capsule that maintained orbital structure and support. Thin nylon foil implant can be explanted safely and efficiently through a very small incision. The orbit maintains structure and configuration postexplantation in this series.

  19. External defibrillation failure due to antimicrobial incise drape.

    Science.gov (United States)

    Barbara, David W; Dietz, Niki M; White, Roger D; Pochettino, Alberto; Nuttall, Gregory A

    2013-09-01

    Antimicrobial incise drapes adhere to a patient's skin during surgery in an attempt to reduce surgical infections. We describe a patient undergoing repeated aortic valve replacement who experienced sudden ventricular fibrillation before median sternotomy. External defibrillation was unsuccessful on multiple attempts using several defibrillators. On removal of the incise drape from the patient's chest, external defibrillation was immediately successful. Increased transthoracic impedance can be caused by multiple factors and may prevent defibrillation. To our knowledge, this is the first reported case of an antimicrobial incise drape preventing defibrillation. If external defibrillation, cardioversion, or pacing is indicated intraoperatively, we recommend prompt removal of the antimicrobial incise drapes before electrode placement if the drapes overlay the intended pad position. Since this case, our institutional practice has now changed to placement of 2 external adhesive defibrillator electrodes onto the patient's skin lateral to the surgical field before incise drape application to allow for defibrillation. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  20. Early clinical outcomes after small incision lenticule extraction surgery (SMILE).

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    Recchioni, Alberto; Hartwig, Andreas; Dermott, Jay; Vaswani, Sundeep; Bhatt, Jay; Morris, Robert; O'Donnell, Clare

    2018-02-01

    Dry eye is known to impact on clinical outcomes after laser vision correction and the use of a newer 'all femtosecond laser' surgical approach may be associated with less impact on the ocular surface post-operatively. The purpose of this study was to evaluate the early clinical outcomes and tear instability after the first small incision lenticule extraction (SMILE) cases undertaken by three surgeons at a single site in the UK. Retrospective audit. Seventy-one eyes of 37 patients underwent SMILE surgery using the Zeiss VisuMax laser system (Carl Zeiss Meditec, Germany). Uncorrected and corrected distance visual acuity, spherical equivalent refraction, fluorescein enhanced tear break up time, simulated keratometry and complications were evaluated pre- and post-operatively where applicable. The study population consisted of 21 males and 16 females. The mean±standard deviation age was 33±8years. The results showed that 100% of eyes achieved 20/40 or better and 88% achieved 20/20 or better uncorrected distance visual acuity. The spherical equivalent refraction after surgery was within ±0.50D in 82% of eyes at three months. There was no significant difference in tear break up time from pre-operative levels at three months. Complications were infrequent. This early data from surgeons' first SMILE procedures suggest SMILE provides good outcomes in terms of refractive predictability and visual acuity with minimal impact on the tear film. Longitudinal research will further improve our understanding of the longer-term impact of SMILE on clinical outcomes, ocular surface metrics and patient reported outcomes. Copyright © 2017. Published by Elsevier Ltd.

  1. LEARNING CURVES OF LAPAROSCOPY – BARRIERS TO ADOPTION: A MNJIO EXPERIENCE!

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    Ramesh Maturi

    2016-06-01

    Full Text Available BACKGROUND Laparoscopy has been a new entry in the field of surgery with an active history of around just two decades. Today, it is in a position to challenge the conventional surgery which is in use since ages. It is making rapid inroads into various disciplines of surgery. Rapid improvements in optics, along with improvements in energy devices and mechanical stapling devices gave a fillip to acceptance of laparoscopy by the majority of surgeons. Also accumulating data and evidence has started influencing the sceptical, mobilising them to jump into the bandwagon. Barriers to adoption of new techniques, resistance to learning are common to human nature and it is necessary to have a systematic overview of the issues that might crop, so as to be prepared to overcome the problems of accepting laparoscopy into established centres of surgery. AIMS This publication is a reflection of our experience, our trials and tribulations in taking forward the laparoscopy program at our institution. This publication will give an overview of the steps involved in initiation of laparoscopy and aspires to be a source of answers, for day-to-day issues that crop during the process of learning laparoscopy. METHODS AND MATERIALS Just the way, executing laparoscopic surgery is a team effort, incorporating laparoscopy program in an institution is also a team effort where the members of team extend beyond the operating room. Involvement and co-operation of individuals across departments is a must along with benevolent seniors and a proactive administration. So we collated data by interviewing all the stakeholders of laparoscopy program, analysed observations of the faculty from the operating room and reviewed literature on the world wide web. Opinions of the administrators about their perceptions and the issues faced by the junior staff of the department were taken into consideration. Patients were interviewed before and after laparoscopic surgery. CONCLUSIONS Success at

  2. Costs of Robotic-Assisted Versus Traditional Laparoscopy in Endometrial Cancer.

    Science.gov (United States)

    Vuorinen, Riikka-Liisa K; Mäenpää, Minna M; Nieminen, Kari; Tomás, Eija I; Luukkaala, Tiina H; Auvinen, Anssi; Mäenpää, Johanna U

    2017-10-01

    The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.

  3. The clinical efficacy of laparoscopy combined with choledochoscopy for cholelithiasis and choledocholithiasis.

    Science.gov (United States)

    Qiu, W; Sun, X-D; Wang, G-Y; Zhang, P; Du, X-H; Lv, G-Y

    2015-10-01

    To compare and analyze the clinical efficacy of laparoscopy combined with choledochoscopy, and laparoscopy combined with duodenoscopy, for cholelithiasis and choledocholithiasis. A total of 105 patients with cholelithiasis and choledocholithiasis from our hospital, from January 2014 to January 2015, were enrolled in this study. All patients weren given primary treatment. After obtaining consent from our hospital Ethics Committee and the patients, all 10529 cases were divided into two groups according to their time of admission. The observation group consisted of 59 cases and the control group consisted of 46 cases. The control group were treated by laparoscopy combined with duodenoscopy (cholecystectomy +ERCP+calculi extraction with an endoscope) and the observation group were treated by laparoscopy combined with choledochoscopy. We then compared the clinical efficacy between the two groups of patients. The success rate of the first surgery in the observation group, was higher than that in the control group. The time of surgery and intra-operative blood loss of the observation group were less than the control group. The differences had statistical significance p choledocholithiasis. Its treatment outcomes might be superior to laparoscopy combined with duodenoscopy.

  4. Staging laparoscopy leads to rapid induction of chemotherapy for unresectable pancreatobiliary cancers.

    Science.gov (United States)

    Hashimoto, Daisuke; Chikamoto, Akira; Sakata, Kazuya; Nakagawa, Shigeki; Hayashi, Hiromitsu; Ohmuraya, Masaki; Hirota, Masahiko; Yoshida, Naoya; Beppu, Toru; Baba, Hideo

    2015-02-01

    Preoperatively evaluating the resectability of pancreatobiliary cancers is difficult. The aim of this study was to investigate the benefit of staging laparoscopy in unresectable pancreatobiliary cancers. Between 2010 and 2013, 25 patients with pancreatobiliary cancers underwent staging laparoscopy after conventional tumor staging; they were compared with 10 patients who had unresectable or metastatic tumors that were found during laparotomy. Staging laparoscopy did not show unresectable factors in 11 patients, and resections were performed in these patients. Unresectable factors were found in other 14 patients who underwent staging laparoscopy. In these patients, chemotherapy was started after median postoperative day 3 (range, 2-10 days). This period was significantly longer in patients who received unnecessary laparotomy; chemotherapy was started after median postoperative day 11 (range, 6-15 days). These results suggest that staging laparoscopy, while avoiding laparotomy with unsuccessful resection, can lead to rapid induction of chemotherapy for unresectable pancreatobiliary cancers. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  5. Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer.

    Science.gov (United States)

    van de Vrie, Roelien; van Meurs, Hannah S; Rutten, Marianne J; Naaktgeboren, Christiana A; Opmeer, Brent C; Gaarenstroom, Katja N; van Gorp, Toon; Ter Brugge, Henk G; Hofhuis, Ward; Schreuder, Henk W R; Arts, Henriette J G; Zusterzeel, Petra L M; Pijnenborg, Johanna M A; van Haaften, Maarten; Engelen, Mirjam J A; Boss, Erik A; Vos, M Caroline; Gerestein, Kees G; Schutter, Eltjo M J; Kenter, Gemma G; Bossuyt, Patrick M M; Mol, Ben Willem; Buist, Marrije R

    2017-09-01

    To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility=0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € -80 per patient (95% CI -470 to 300)). Findings were consistent across various sensitivity analyses. In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Laparotomy and laparoscopy diversely affect macrophage-associated antimicrobial activity in a murine model

    Science.gov (United States)

    2013-01-01

    Background Surgical intervention-related trauma contributes largely to the development of postoperative immunosuppression, with reduced resistance to secondary bacterial infection. This study compared the impact of laparotomy versus laparoscopy on macrophage-associated bactericidal ability and examined whether laparotomy renders the host more susceptible to microbial infection. Results BALB/c mice were randomized into control, laparotomy, and laparoscopy groups. Laparotomy, but not laparoscopy, significantly downregulated CR3 expression on macrophages, diminished macrophage-induced uptake and phagocytosis of E. coli and S. aureus, and impaired macrophage-mediated intracellular bacterial killing. Consistent with this, mice that underwent laparotomy displayed substantially higher bacterial counts in the blood and visceral organs as well as a significantly enhanced mortality rate following bacterial infection, whereas mice subjected to laparoscopy did not show any defects in their bacterial clearance. Conclusion Laparotomy has an adverse effect on host innate immunity against microbial infection by impairing macrophage-mediated phagocytosis and killing of the invaded bacteria. By contrast, laparoscopy appears to preserve macrophage-associated bactericidal ability, thus alleviating the development of postoperative immunosuppression. PMID:23786397

  7. Quality of life in patients affected by endometrial cancer: comparison among laparotomy, laparoscopy and vaginal approach.

    Science.gov (United States)

    Berretta, Roberto; Gizzo, Salvatore; Noventa, Marco; Marrazzo, Vivienne; Franchi, Laura; Migliavacca, Costanza; Michela, Monica; Merisio, Carla; Modena, Alberto Bacchi; Patrelli, Tito Silvio

    2015-07-01

    The aim of this study is to verify if the surgical approach (laparoscopy/laparotomy/vaginal) in stage-I endometrial cancer treatment, may have effects on intra- and post-operative outcomes and on the patient's quality of life. The study group consisted of patients with histological diagnosis of type-I endometrial adenocarcinoma, stage-I. They were divided into three groups according to surgical approach chosen (laparotomic/laparoscopic/vaginal). Every patient answered a telephone health survey (SF-36) at 30 and 180 days post-surgery. Surgical-operating times, hospitalization length and short/long-term complications after surgery were also compared. The SF-36 survey revealed a better performance status in patients who underwent laparoscopy as compared to those who received laparotomy or vaginal surgery. We found significantly better results considering General Health, Physical Functioning, Role-Physical and Bodily Pain in the laparoscopy group after 30 and 180 days. Patients who underwent laparoscopy had significantly shorter hospitalization and less post-operative complications even if laparoscopy required significantly longer surgical-operating times compared to vaginal surgery. Our data confirm the superiority of the laparoscopic approach respect to the laparotomic and vaginal ones both in term of hospitalization length and post-operative complications.

  8. Rectosigmoid endometriosis: Comparison between CT water enema and video laparoscopy

    International Nuclear Information System (INIS)

    Stabile Ianora, A.A.; Moschetta, M.; Lorusso, F.; Lattarulo, S.; Telegrafo, M.; Rella, L.; Scardapane, A.

    2013-01-01

    Aim: To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard. Materials and methods: Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement. Results: In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84). Conclusion: Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated

  9. Efficacy of virtual computerized tomography laparoscopy for retroperitoneoscopic nephrectomy

    International Nuclear Information System (INIS)

    Shigeta, Masanobu; Kadonishi, Yuichi; Yasumoto, Hiroaki; Mita, Koji; Usui, Tsuguru; Marukawa, Kazushi

    2004-01-01

    Retroperitoneoscopic nephrectomy is less invasive than open nephrectomy, and is an alternative surgical procedure for renal tumors and upper urothelial tumors. We evaluated the efficacy of virtual computerized tomography laparoscopy (VCTL) as a navigator for retroperitoneoscopic nephrectomy to ascertain the correct anatomy of the renal hilum pre-operatively under the retroperitoneoscopic view. Seventy-three kidneys with localized renal tumors (n=44), upper urothelial tumors (n=23), or benign renal disease (n=6) underwent multidetector-row CT. VCTL was carried out by the volume-rendered technique. The findings were compared with those of real retroperitoneoscopy. After the operation, each operator scored 1 to 5 in evaluating the usefulness of virtual retroperitoneoscopy (score 5 indicated very useful). The percentages of renal arteries depicted by VCTL compared with those noted during real surgery were 93% for kidneys with renal tumors, 100% for upper urothelial tumors and 83% for benign renal disease. Two renal arteries of 2 kidneys were not detected by virtual imaging. These were about 1 mm in diameter and directly branched from the aorta, however retroperitoneoscopic nephrectomy was performed uneventfully. VCTL depicted all the renal veins. The anatomy of the renal hilum seen on VCTL and real retroperitoneoscopy was identical, without the minor angle deviation caused by drawing the kidney during the operation. The average score for the usefulness of VCTL was 4.1, ranging from 3 to 5. The accurate surgical anatomy of the renal hilum could be predicted in almost all patients pre-operatively. VCTL is an excellent navigator for retroperitoneoscopic nephrectomy. (author)

  10. Sharp compared with blunt fascial incision at cesarean delivery

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Hare, Kristine J; Krebs, Lone

    2014-01-01

    OBJECTIVE: To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control. STUDY DESIGN: Women undergoing primary cesarean delivery (n=34) were randomized...... to side distribution of sharp or blunt incision of the fascia (sharp right and blunt left or blunt right and sharp left) and followed three months postoperatively. The primary outcome was patient preference for the right or left side of the scar 3 months postoperatively and modeled by polytomous logistic...... difference was found in patient preference with regard to sharp or blunt incision of the fascia, nor was there a significant difference in postoperative pain scores. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: www.clinicaltrials.org;NCT01297725....

  11. The problem of insufficient incisal display: a case presentation.

    Science.gov (United States)

    Castillo, Rodrigo

    2010-01-01

    Enhancement of facial beauty is one of the primary elective goals of patients seeking dental care. Frequently, improvements in natural beauty can be expected to follow restoration of ideal relationships between the denture and the facial soft tissues. A very important feature in a youthful appearance is the incisal tooth display; the amount of maxillary incisal exposure gradually decreases with age, accompanied by a gradual increase in mandibular incisal exposure. However, this problem could be present in young people where the effects of age should not be apparent yet. There are some other factors that could accelerate this process. The present case illustrates the improvement and rejuvenation of an unesthetic young smile through restorative treatment.

  12. Giant Nasolabial Cyst Treated Using Neumann Incision: Case Report

    Directory of Open Access Journals (Sweden)

    Ordones, Alexandre Beraldo

    2013-09-01

    Full Text Available Introduction: A nasolabial cyst is an ectodermal development cyst. It presents as a fullness of canine fossa, nasal ala, or vestibule of the nose. It is rare and usually small. Treatment consists of complete surgical excision or transnasal endoscopic marsupialization. Objective: To describe a giant nasolabial cyst case treated using Neumann incision. Case Report: A 37-year-old man was referred to the otolaryngology department with nasal obstruction and nasal deformity. Computed tomography showed a nasal cystic lesion 4 × 4.5 × 5 cm wide. Surgical excision using Neumann incision was performed. Discussion: Neumann incision provides wide access to the nasal cavity and may be useful in nasolabial cyst treatment.

  13. Force modeling for incision surgery into tissue with haptic application

    Science.gov (United States)

    Kim, Pyunghwa; Kim, Soomin; Choi, Seung-Hyun; Oh, Jong-Seok; Choi, Seung-Bok

    2015-04-01

    This paper presents a novel force modeling for an incision surgery into tissue and its haptic application for a surgeon. During the robot-assisted incision surgery, it is highly urgent to develop the haptic system for realizing sense of touch in the surgical area because surgeons cannot sense sensations. To achieve this goal, the force modeling related to reaction force of biological tissue is proposed in the perspective on energy. The force model describes reaction force focused on the elastic feature of tissue during the incision surgery. Furthermore, the force is realized using calculated information from the model by haptic device using magnetorheological fluid (MRF). The performance of realized force that is controlled by PID controller with open loop control is evaluated.

  14. Minimizing surgical skin incision scars with a latex surgical glove.

    Science.gov (United States)

    Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun

    2013-04-01

    The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  15. Small incision transcutaneous levator aponeurotic repair for blepharoptosis.

    Science.gov (United States)

    Baroody, Michael; Holds, John B; Sakamoto, Douglas K; Vick, Valerie L; Hartstein, Morris E

    2004-06-01

    Patients presenting with blepharoptosis due to disinsertion or thinning of the levator aponeurosis require surgical repair. A minimally invasive approach directed specifically at the levator aponeurotic anatomic defect may provide benefits to the patient. Proposed advantages of a small eyelid incision (8-13 mm) include less local anesthetic and tissue distortion, less ecchymosis and edema, decreased operative times, a shortened recovery period, and improved surgical results. We describe our results with the use of a small incision ptosis repair in select patients. A retrospective chart review between January 2000 and September 2001 included 91 patients and 118 eyelids with blepharoptosis due to aponeurotic disinsertion, corrected by a minimally invasive approach. The small incision technique comprised levator aponeurotic resection and advancement. Pre- and postoperative upper eyelid marginal reflex distances (MRD1), eyelid contour, need for reoperation, and complications (overcorrection, undercorrection, hematoma, and infection) were recorded. The average preoperative MRD1 measured 0.5 +/- 1.1 mm, with a range of -2.0 to 2.5 mm. The average postoperative MRD1 measured 2.6 +/- 0.8 mm, with a range of 1 to 5.5 mm (P < 0.0001). Of the 118 eyelids corrected by a small incision technique, there were 4 overcorrections, 3 undercorrections, 1 failure, 1 postoperative ptosis procedure of the contralateral upper eyelid secondary to Hering's law ptosis, and 4 patients requesting surgical treatment of dermatochalasis. No symptomatic dry eye, exposure keratopathy, or other complication resulted in association with the overcorrections. No contour abnormalities, infections, hematomas, or other complications were noted. Our experience suggests that utilization of a small skin incision is safe, precise, and efficient and allows for more rapid recovery from surgery. The authors note a decreased incidence of reoperation and postoperative complaints compared with historical larger-incision

  16. Two-incision laparoscopic appendectomy for a severe hemophilia A child patient with coagulation factor VII deficiency: Case report and review of literature.

    Science.gov (United States)

    He, Jin Peng; Feng, Jie Xiong

    2017-10-01

    The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time. An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting. He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency. Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy. The patient had an uneventful recovery. It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment.

  17. Cervical and incisal marginal discrepancy in ceramic laminate veneering materials: A SEM analysis

    Directory of Open Access Journals (Sweden)

    Hemalatha Ranganathan

    2017-01-01

    Full Text Available Context: Marginal discrepancy influenced by the choice of processing material used for the ceramic laminate veneers needs to be explored further for better clinical application. Aims: This study aimed to evaluate the amount of cervical and incisal marginal discrepancy associated with different ceramic laminate veneering materials. Settings and Design: This was an experimental, single-blinded, in vitro trial. Subjects and Methods: Ten central incisors were prepared for laminate veneers with 2 mm uniform reduction and heavy chamfer finish line. Ceramic laminate veneers fabricated over the prepared teeth using four different processing materials were categorized into four groups as Group I - aluminous porcelain veneers, Group II - lithium disilicate ceramic veneers, Group III - lithium disilicate-leucite-based veneers, Group IV - zirconia-based ceramic veneers. The cervical and incisal marginal discrepancy was measured using a scanning electron microscope. Statistical Analysis Used: ANOVA and post hoc Tukey honest significant difference (HSD tests were used for statistical analysis. Results: The cervical and incisal marginal discrepancy for four groups was Group I - 114.6 ± 4.3 μm, 132.5 ± 6.5 μm, Group II - 86.1 ± 6.3 μm, 105.4 ± 5.3 μm, Group III - 71.4 ± 4.4 μm, 91.3 ± 4.7 μm, and Group IV - 123.1 ± 4.1 μm, 142.0 ± 5.4 μm. ANOVA and post hoc Tukey HSD tests observed a statistically significant difference between the four test specimens with regard to cervical marginal discrepancy. The cervical and incisal marginal discrepancy scored F = 243.408, P < 0.001 and F = 180.844, P < 0.001, respectively. Conclusion: This study concluded veneers fabricated using leucite reinforced lithium disilicate exhibited the least marginal discrepancy followed by lithium disilicate ceramic, aluminous porcelain, and zirconia-based ceramics. The marginal discrepancy was more in the incisal region than in the cervical region in all the groups.

  18. Better outcome from arthroscopic partial meniscectomy than skin incisions only?

    DEFF Research Database (Denmark)

    Roos, Ewa M; Hare, Kristoffer Borbjerg; Nielsen, Sabrina Mai

    2018-01-01

    . In total, nine participants experienced 11 adverse events; six in the surgery group and three in the skin-incisions-only group. CONCLUSION: We found greater improvement from arthroscopic partial meniscectomy compared with skin incisions only at 2 years, with the statistical uncertainty of the between......-group difference including what could be considered clinically relevant. Because of the study being underpowered, nearly half in the sham group being non-blinded and one-third crossing over to surgery, the results cannot be generalised to the greater patient population. TRIAL REGISTRATION NUMBER: NCT01264991....

  19. Ultrasonic diagnosis and transurethral incision of ureterocele with hydronephrosis

    DEFF Research Database (Denmark)

    Waaddegaard, P; Miskowiak, J; Stage, P

    1991-01-01

    In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography is advantage......In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography...

  20. Meta-analysis of the effectiveness of surgical scalpel or diathermy in making abdominal skin incisions.

    LENUS (Irish Health Repository)

    Ahmad, Nasir Zaheer

    2012-02-01

    BACKGROUND: Surgical scalpels are traditionally used to make skin incisions. Diathermy incisions on contrary are less popular among the surgeons. The aim of this meta-analysis was to compare the effectiveness of both techniques and address the common fallacies about diathermy incisions. METHODS: A literature search of MEDLINE and Cochrane databases was done, using the keywords diathermy, cold scalpel, and incisions. Eleven clinical trials comparing both methods of making skin incisions were selected for meta-analysis. The end points compared included postoperative wound infection, pain in first 24 hours after surgery, time taken to complete the incisions, and incision-related blood loss. RESULTS: Postoperative wound infection rate was comparable in both techniques (P = 0.147, odds ratio = 1.257 and 95% CI = 0.923-1.711). Postoperative pain was significantly less with diathermy incisions in first 24 hours (P = 0.031, weighted mean difference = 0.852 and 95% CI = 0.076-1.628). Similarly, the time taken to complete the incision and incision-related blood loss was significantly less with diathermy incisions (95% CI = 0.245-0.502 and 0.548-1.020, respectively). CONCLUSION: Diathermy incisions are equally prone to get wound infection, as do the incisions made with scalpel. Furthermore, lower incidence of early postoperative pain, swiftness of the technique, and a reduced blood loss are the encouraging facts supporting routine use of diathermy for abdominal skin incisions after taking careful precautions.

  1. Infiltration of bupivacaine local anesthetic to trocar insertion sites after laparoscopy: a randomized, double-blind, stratified, and controlled trial.

    Science.gov (United States)

    Tam, Teresa; Harkins, Gerald; Wegrzyniak, Lindsey; Ehrgood, Suzanne; Kunselman, Allen; Davies, Matthew

    2014-01-01

    To determine if injection of local anesthetic into trocar insertion sites after laparoscopy improves postoperative pain. A prospective, 2-arm, randomized, double-blind, stratified, and controlled trial (Canadian Task Force classification I). A university-based teaching hospital. This study was performed on women who had a laparoscopic gynecologic procedure for benign indications from March 2013 to June 2013. One hundred thirty-five subjects were stratified by chronic pelvic pain or no chronic pelvic pain. Chronic pelvic pain was defined as pelvic pain occurring for 6 months or more in duration. Randomization was performed for this trial, with 68 receiving a bupivacaine block and 67 receiving no bupivacaine block. Of the 71 patients with chronic pelvic pain, 35 patients were in group 1 (i.e., bupivacaine block) and 36 patients were in group 2 (i.e., no bupivacaine block). After the laparoscopic surgery was completed, the trocar incision sites were closed. For subjects randomized to receive a local anesthesia block, bupivacaine (0.25%) was injected. Incisions 8 mm or greater were injected with 10 mL 0.25% bupivacaine. Incisions 5 mm or less were infiltrated with 5 mL. Injecting the local anesthetic through all preperitoneal layers provided a full-thickness local injection. Group 2 did not receive a local injection. At the preoperative suite, the nurses gauged the patient's pain using the Numeric Rating Scale. This score was used as the baseline pain level with which the postoperative pain scores were compared. The primary objective was to measure changes in pain scores, from preoperative to postoperative time frames of 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days postoperatively. These score changes were measured as the main objective. Secondary objectives include estimated blood loss, operating time, length of hospital stay, and histopathologic diagnosis. The hospital personnel caring for the patient during the preoperative and postoperative course

  2. Evolution of virtual CT laparoscopy for preoperative imaging in laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Uchida, Masafumi; Ishibashi, Masatoshi; Nishimura, Hiroshi; Hayabuchi, Naofumi [Kurume Univ., Fukuoka (Japan). School of Medicine

    2002-06-01

    The purpose of this study was to determine the feasibility of virtual endoscopy, named as ''virtual CT laparoscopy'', in the hepatobiliary system prior to laparoscopic cholecystectomy. We applied this technique to 28 patients suspected of having biliary disease. These images were compared and analyzed qualitatively based on visualization of the structures critical to operative cholangiography and surgical findings. Twenty-four patients, who underwent laparoscopic cholecystectomy, were evaluated as follows: the common bile duct and the hepatic duct were adequately visualized in 23 (96%) of the 24 patients, the cystic duct in 21 (88%), the gallbladder opacification in 20 (83%), the liver inferior surface in 20 (83%). Four patients had anatomic variations detected virtual CT laparoscopy and were proven by operative cholangiography and surgical findings. We emphasize that our new technique may contribute to the laparoscopy during surgery as the aid of understanding of anatomical structures in these organs. (author)

  3. Cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy

    Directory of Open Access Journals (Sweden)

    Shu S

    2015-08-01

    Full Text Available Shan-rong Shu, Xin Luo, Zhi-xin Wang, Yu-hong Yao Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, HuangPu Road West, Guangzhou, People’s Republic of China Abstract: Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient. Keywords: cesarean scar pregnancy, laparoscopy, curettage and aspiration 

  4. Laparoscopy training in surgical education: the utility of incorporating a structured preclinical laparoscopy course into the traditional apprenticeship method.

    Science.gov (United States)

    De Win, Gunter; Van Bruwaene, Siska; Aggarwal, Rajesh; Crea, Nicola; Zhang, Zhewen; De Ridder, Dirk; Miserez, Marc

    2013-01-01

    To investigate whether preclinical laparoscopy training offers a benefit over standard apprenticeship training and apprenticeship training in combination with simulation training. This randomized controlled trial consisted of 3 groups of first-year surgical registrars receiving a different teaching method in laparoscopic surgery. The KU LEUVEN Faculty of Medicine is the largest medical faculty in Belgium. Thirty final-year medical students starting a general surgical career in the next academic year. Thirty final-year medical students were randomized into 3 groups, which differed in the way they were exposed to laparoscopic simulation training but were comparable in regard to ambidexterity, sex, age, and laparoscopic psychomotoric skills. The control group received only clinical training during surgical residentship, whereas the interval group received clinical training in combination with simulation training. The registrars were allowed to do deliberate practice. The Centre for Surgical Technologies Preclinical Training Programme (CST PTP) group received a preclinical simulation course during the final year as medical students, but was not exposed to any extra simulation training during surgical residentship. At the beginning of surgical residentship and 6 months later, all subjects performed a standardized suturing task and a laparoscopic cholecystectomy in a POP Trainer. All procedures were recorded together with time and motion tracking parameters. All videos were scored by a blinded observer using global rating scales. At baseline the 3 groups were comparable. At 6 months, for suturing, the CST PTP group was better than both the other groups with respect to time, checklist, and amount of movements. The interval group was better than the control group on only the time and checklist score. For the cholecystectomy evaluation, there was a statistical difference between the CST PTP study group and both other groups on all evaluation scales in favor of the CST PTP

  5. Two-dimensional versus three-dimensional laparoscopy in surgical efficacy: a systematic review and meta-analysis.

    Science.gov (United States)

    Cheng, Ji; Gao, Jinbo; Shuai, Xiaoming; Wang, Guobin; Tao, Kaixiong

    2016-10-25

    Laparoscopy is a revolutionary technique in modern surgery. However, the comparative efficacy between two-dimensional laparoscopy and three-dimensional laparoscopy remains in uncertainty. Therefore we performed this systematic review and meta-analysis in order to seek for answers. Databases of PubMed, Web of Science, EMBASE and Cochrane Library were carefully screened. Clinical trials comparing two-dimensional versus three-dimensional laparoscopy were included for pooled analysis. Observational and randomized trials were methodologically appraised by Newcastle-Ottawa Scale and Revised Jadad's Scale respectively. Subgroup analyses were additionally conducted to clarify the potential confounding elements. Outcome stability was examined by sensitivity analysis, and publication bias was analyzed by Begg's test and Egger's test. 21 trials were screened out from the preliminary 3126 records. All included studies were high-quality in methodology, except for Bilgen 2013 and Ruan 2015. Three-dimensional laparoscopy was superior to two-dimensional laparoscopy in terms of surgical time (P analysis. Although Begg's test (P = 0.215) and Egger's test (P = 0.003) revealed that there was publication bias across included studies, Trim-and-Fill method confirmed that the results remained stable. Three-dimensional laparoscopy is a preferably surgical option against two-dimensional laparoscopy due to its better surgical efficacy.

  6. Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

    Science.gov (United States)

    Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

    2014-08-01

    Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P general surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in

  7. ROLE OF DIAGNOSTIC LAPAROSCOPY IN EVALUATION AND TREATMENT OF CHRONIC ABDOMINAL PAIN IN CHILDREN.

    Science.gov (United States)

    Talat, Nabila; Afzal, Muhammad; Ahmad, Sarfraz; Rasool, Naima; Wasti, Arsalan Raza; Saleem, Muhammad

    2016-01-01

    Chronic abdominal Pain in children is a very common cause of hospital admission. Many of them are discharged without a diagnosis even after battery of investigations. Laparoscopy plays a significant role in diagnosis and management of many causes of acute and chronic abdominal pain. The purpose of this study was to determine the efficacy of laparoscopy as an efficient diagnostic and management tool in children with chronic abdominal pain. A descriptive, prospective case series was collected in the department of Paediatric surgery Mayo's Hospital Lahore, over the period of 5 years between Jan 2007-Dec 2013. The data of consecutive 50 patients, who were admitted in the department with the diagnosis of chronic abdominal pain, was recorded. All patients who had 2-3 admissions in hospital for last 2 months and failed to establish a definitive diagnosis after clinical examination and base line investigations underwent laparoscopy. The details of associated symptoms, finding of laparoscopy, laparoscopic procedures done, definitive diagnosis, histopathology, complications and relief of symptoms were collected and analysed and results were evaluated using SPSS-17. Out of 50 patients studies, 27/50 (54%) were male, 23/50 (46%) were female. Age ranged from 2-12 years, with the mean age of 7.24 year. Tuberculosis abdomen, adhesions, mesenteric lymphadenitis, appendicitis and cholecystitis were the final diagnosis. Five abdomens were found normal on laparoscopy. Complete pain relief was achieved in 30/50 (60%), reduced intensity of pain was gained in 12/50 (24%) cases while 16% (8/50) still complained of pain. Laparoscopy is an efficient diagnostic and treatment tool in children with chronic unexplained abdominal pain. It avoids serial examinations; prolong admission, battery of investigations and unnecessary surgeries.

  8. SHOULD DIAGNOSTIC HYSTEROSCOPY BE A ROUTINE PROCEDURE DURING DIAGNOSTIC LAPAROSCOPY IN INFERTILE WOMEN?

    Science.gov (United States)

    Godinjak, Zulfo; Idrizbegović, Edin

    2008-01-01

    The aim of this study was to clarify the role of simultaneous combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility. In a retrospective study, 360 infertile women underwent complete fertility evaluation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of the routine infertility evaluation. Laparoscopy and hysteroscopy were successful in 360 patients. Bilateral tubes were blocked in 18 (5%) and unilateral tubal occlusion were in 30 (8,33%) of patients. Pelvic adhesions were revealed in 40 (11,11%), and myomas in 42 (11,65%) out of that 31 (8,6%) were revealed by laparoscopy and 11 (3,05%) by hysteroscopy. Endometrial polyps were revealed in 26 (7,22%) and Syndrome Asherman in 3(0,83%) of patients. Uterine anomaly was found in 19 (5,27%) of cases and out of that septate uterus in 7 (37,15%), bicornuate uterus in 5 (26,31%), arcuate uterus in 4 (21,26%) and uterus unicornu cum cornu rudimentario in 3 (15,27%) of uterine anomalies. Endometriosis was found in 51 (14,16%), dermoid cysts in 8 (2,22%) and in 16 (4,44%) functional cysts of patients. Also, Fitz-Hugh- Curtis syndrome was revealed in 23 (6,11%) of our patients. Laparoscopy and hysteroscopy play very important role as diagnostic tools in the infertility women. Combined diagnostic simultaneous laparoscopy and hysteroscopy should be performed in all infertile patients before the treatment. PMID:18318671

  9. Comparison of robotic-assisted and conventional laparoscopy in the management of adnexal masses.

    Science.gov (United States)

    El Khouly, N I; Barr, R L; Kim, B B; Jeng, C J; Nagarsheth, N P; Fishman, D A; Nezhat, F R; Gretz, H F; Chuang, L T

    2014-01-01

    To compare the outcome of robotic-assisted laparoscopy vs conventional laparoscopy in the management of ovarian masses. Retrospective cohort (Canadian Task Force classification II-3). Academic medical centre in the northeast United States. Retrospective medical record review of 71 consecutive patients with presumed benign ovarian masses. Robotic-assisted laparoscopy in 30 patients with presumed benign ovarian masses was compared with conventional laparoscopy in 41 patients. Operative outcomes including operative time, estimated blood loss, length of hospital stay, and complications were recorded. Standard statistical analysis was used to compare the outcomes in the 2 groups. Mean (SD) operative time in the robotic group was 1.95 (0.63) hours, which was significantly longer than in the conventional laparoscopic group, 1.28 (0.83) hours (p = .04). Estimated blood loss in the robotic group was 74.52 (56.23) mL, which was not significantly different from that in the conventional laparoscopic group, 55.97 (49.18) mL. There were no significant differences in length of hospital stay between the robotic and conventional laparoscopic groups: 1.20 (0.78) days and 1.48 (0.63). Conversion to laparotomy was not necessary in either group of patients. Intraoperative and postoperative complications were similar between the 2 groups. Robotic-assisted laparoscopy is a safe and efficient technique for management of various types of ovarian masses. However, conventional laparoscopy is preferred for management of ovarian masses because of shorter operative time. Prospective studies are needed to evaluate the outcomes of robotic-assisted laparoscopic management of benign and malignant ovarian neoplasms. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  10. Prognostic Impact of Port-Site Metastasis After Diagnostic Laparoscopy for Epithelial Ovarian Cancer.

    Science.gov (United States)

    Ataseven, Beyhan; Grimm, Christoph; Harter, Philipp; Heikaus, Sebastian; Heitz, Florian; Traut, Alexander; Prader, Sonia; Kahl, Annett; Schneider, Stefanie; Kurzeder, Christian; du Bois, Andreas

    2016-12-01

    This study was designed to evaluate the prevalence, morbidity, and prognostic impact of port-site metastasis (PSM) in patients with epithelial ovarian cancer (EOC) undergoing laparoscopy before subsequent primary debulking surgery (PDS). All consecutive patients treated between 2000 and 2014, who had a laparoscopy followed by PDS, were extracted from our prospectively maintained database. All patients with histological examination of port-sites were included in this unicentric exploratory analysis. A total of 250 (25.5 %) of 982 patients with EOC underwent laparoscopy before PDS. Port-site resection was performed in those 214 (85.6 %) patients in whom a complete or almost complete resection with residuals ≤1 cm was achieved. Median interval between laparoscopy and PDS was 25 days. PSM was detected in 100 of 214 patients (46.7 %). Risk factors for PSM were higher tumor stage (odds ratio [OR] 13.5, 95 % confidence interval [CI] 2.9-62.0, p = 0.04), positive lymph node status (OR 3.0, 95 % CI 1.3-6.7, p = 0.009), and ascites >500 mL (OR 3.9, 95 % CI 1.5-10.0, p = 0.005). Wound healing disorders and postoperative morbidity were significantly higher in patients with PSM (Clavien-Dindo Classification grade 3-5: 41.0 vs. 14.9 %, p laparoscopy in EOC patients is considerably high. PSM had no impact on survival; however, PSM were associated with more postoperative complications and a higher surgical treatment burden. This should be balanced with the expected benefit when laparoscopy is considered for the management of EOC.

  11. Recurrence of Endometrioma Following Conservative Ovarian Endometrioma Cystectomy: Laparoscopy versus Laparotomy.

    Science.gov (United States)

    Tanprasertkul, Chamnan; Patumanond, Jayanton; Manusook, Sakol; Suwannarurk, Komsun; Somprasit, Charintip; Sreshthaputra, Opas; Vutyavanich, Teeraporn

    2015-04-01

    To investigate the recurrence rate and disease-free interval between laparoscopy versus laparotomy for the conservative surgery of endometrioma. A retrospective cohort study was conducted. The medical records of reproductive women who underwent conservative ovarian cystectomy surgery (laparoscopy or laparotomy) for endometrioma at Thammasat University Hospital were retrieved. The patients were followed through 24 months to evaluate the recurrence of endometrioma. Propensity scoring was used to adjust for confounding by indication and confounding by contraindication. Model for competing time to event was used in analysis. One hundred and twenty-eight and 114 patients were enrolled in laparoscopy and laparotomy groups, respectively. Mean age and body weight in laparotomy group were statistically higher than those in the other group were. Mean height and body mass index were, however not statistically different in either groups. In addition, the stage of disease and bilaterality in both groups were comparable. Diameter ofendometrioma in laparotomy group was significantly larger than that in laparoscopy group (7.0 ± 2.5 vs. 6.2 ± 1.8 cm, respectively; p = 0.004). After adjusting for propensity scoring, the endometrioma recurrence rate was significantly higher in laparoscopy group as compared to laparotomy group (27.3% vs. 14.9%, respectively; p = 0.02). However, the cumulative rate of pregnancy after surgery was not statistically different (4.7% vs. 4.4%, respectively; p = 1.0). The present study has demonstrated that the surgical technique has a strong impact on the recurrence or disease-free interval. Laparoscopy might not eradicate the disease pathology as effectively as open laparotomy in some situations, such as in cases with complexity of disease.

  12. Role of staging laparoscopy in the stratification of patients with perihilar cholangiocarcinoma.

    Science.gov (United States)

    Bird, N; Elmasry, M; Jones, R; Elniel, M; Kelly, M; Palmer, D; Fenwick, S; Poston, G; Malik, H

    2017-03-01

    Cholangiocarcinoma is a rare cancer with a poor prognosis. Radical surgical resection is the only option for curative treatment. Optimal determination of resectability is required so that patients can be stratified into operative or chemotherapeutic treatment cohorts in an accurate and time-efficient manner. Staging laparoscopy is utilized to determine the presence of radiologically occult disease that would preclude further surgical treatment. The aim of this study was to analyse the utility of staging laparoscopy in a contemporary cohort of patients with perihilar cholangiocarcinoma. Patients diagnosed with potentially resectable perihilar cholangiocarcinoma between January 2010 and April 2015 were analysed retrospectively from a prospective database linked to UK Hospital Episode Statistics data. Patients with distal cholangiocarcinoma and gallbladder cancer were excluded from analysis. A total of 431 patients with perihilar cholangiocarcinoma were referred for assessment of potential resection at a supraregional referral centre. Some 116 patients with potentially resectable disease subsequently underwent surgical assessment. The cohort demonstrated an all-cause yield of staging laparoscopy for unresectable disease of 27·2 per cent (31 of 114). The sensitivity for detection of peritoneal disease was 71 per cent (15 of 21; P laparoscopy was 66 per cent (31 of 47) with a positive predictive value of progress to resection of 81 per cent (69 of 85). Neither the Bismuth-Corlette nor the Memorial Sloan Kettering Cancer Center preoperative scoring system was contingent with cause of unresectability at staging laparoscopy (P = 0·462 and P = 0·280 respectively). In the present cohort, staging laparoscopy proved useful in determining the presence of radiologically occult metastatic disease in perihilar cholangiocarcinoma. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  13. Cost-effectiveness analysis of robotic-assisted laparoscopy for newly diagnosed uterine cancers

    Science.gov (United States)

    Leitao, Mario M; Bartashnik, Aleksandra; Wagner, Isaac; Lee, Stephen J; Caroline, Ari; Hoskins, William J; Thaler, Howard T; Abu-Rustum, Nadeem R; Sonoda, Yukio; Brown, Carol L; Jewell, Elizabeth L; Barakat, Richard R; Gardner, Ginger J

    2015-01-01

    Objective We assessed the direct costs of 3 surgical approaches in uterine cancer and the cost impact of incorporating robot-assisted surgery. Methods A cost system that allocates the actual cost of resources used to treat each patient, as opposed to borrowing cost data from a billing system, was used to determine direct costs for patients who underwent surgery for uterine cancer from 2009–2010. These costs included all aspects of surgical care up to 6 months after discharge. Total amortized direct costs (AC) included the capital cost of 3 dual console DaVinci Si platforms with 5 years of service contracts. Non-amortized costs (NAC) were also calculated (excluded capital costs). Modeling was performed to estimate the mean cost of surgical care for patients presenting with endometrial cancer from 2007–2010 Results Of 436 cases (132 laparoscopic, 262 robotic, 42 laparotomy), total mean AC/case was $20,489 (laparoscopy), $23,646 (robot), and $24,642 (laparotomy) (P<0.05 [robot vs laparoscopy]; P=0.6 [robot vs laparotomy]). Total NAC/case was $20,289, $20,467, and $24,433, respectively (P=0.9 [robot vs laparoscopy]; P=0.03 [robot vs laparotomy]). The planned surgical approach in 2007 was laparoscopy-68%, robot-8%, and laparotomy-24% compared to 26%, 64%, and 9%, respectively, in 2010 (P<0.001). The modeled mean AC/case was $21,738 in 2007 and $22,678 in 2010 (+$940). NAC was $21,298 in 2007 and $20,573 in 2010 (−$725). Conclusion Laparoscopy is least expensive when including capital acquisition costs. Laparoscopy and robotic surgery are comparable if upfront costs are excluded. There is cost neutralization with the robot when it helps decrease laparotomy rates. PMID:24785856

  14. History of Laparoscopy Surgery: Particularities about its Introduction and Development in Cuba

    OpenAIRE

    Pérez Martínez, Caridad de Jesús; Universidad de Ciencias Médicas de La Habana

    2016-01-01

    Minimal access surgery has been a true revolution in the field of surgery, especially in general surgery, with the apparition of laparoscopy surgery. In this article has been made a bibliographic research with one main purpose: To describe the antecedents, origins, and development of the minimal access surgery and laparoscopy surgery in Cuba and around the world. Recent publications have been consulted, and, finally, we counting with thirty bibliographic references. A relevant conclusion has ...

  15. Self-expandable metallic stent placement plus laparoscopy for acute malignant colorectal obstruction

    Science.gov (United States)

    Zhou, Jia-Min; Yao, Li-Qing; Xu, Jian-Min; Xu, Mei-Dong; Zhou, Ping-Hong; Chen, Wei-Feng; Shi, Qiang; Ren, Zhong; Chen, Tao; Zhong, Yun-Shi

    2013-01-01

    AIM: To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer (CRC) patients with acute colorectal obstruction (ACO). METHODS: From April 2008 to April 2012, surgery-related parameters, complications, overall survival (OS), and disease-free survival (DFS) of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent (SEMS) placement followed by one-stage open (n = 58) or laparoscopic resection (n = 16) were evaluated retrospectively. The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics. RESULTS: The characteristics of patients among these groups were comparable. The rate of conversion to open surgery was 12.5% in the stent-laparoscopy group. Bowel function recovery and postoperative hospital stay were significantly shorter (3.3 ± 0.9 d vs 4.2 ± 1.5 d and 6.7 ± 1.1 d vs 9.5 ± 6.7 d, P = 0.016 and P = 0.005), and surgical time was significantly longer (152.1 ± 44.4 min vs 127.4 ± 38.4 min, P = 0.045) in the stent-laparoscopy group than in the stent-open group. Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group. There were no significant differences in the interval between stenting and surgery, intraoperative blood loss, OS, and DFS between the two stent groups. Compared with those in the stent-laparoscopy group, all surgery-related parameters, complications, OS, and DFS in the control group were comparable. CONCLUSION: The stent-laparoscopy approach is a feasible, rapid, and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis. PMID:24023495

  16. Postoperative Outcomes among Pediatric and Adolescent Patients Undergoing Minilaparotomy vs Laparoscopy in the Management of Adnexal Lesions.

    Science.gov (United States)

    Trotman, Gylynthia; Foley, Christine; Taylor, Janelle; DeSale, Sameer; Gomez-Lobo, Veronica

    2017-12-01

    To compare institutional experience in postoperative recovery in children and adolescents who undergo laparoscopy vs minilaparotomy in the management of benign adnexal cystic lesions. Retrospective cohort study. Tertiary care children's hospital. Patients ages 6-21 years who underwent surgical management for benign adnexal lesions. Comparison of surgery times, size of lesions, pain scores, and patient length of stay after minilaparotomy vs laparoscopy. Forty-four patients were identified. Of those, 59% (n = 26) had a laparoscopic procedure and 41% (n = 18) underwent minilaparotomy. Patients who underwent minilaparotomy were more likely to have a larger adnexal mass than those in the laparoscopy group with a median size of 15.5 cm vs 6.0 cm, respectively (P laparoscopy. The minilaparotomy approach should be considered when laparoscopy is limited. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Incised plate urethroplasty in perineal and perineo-scrotal ...

    African Journals Online (AJOL)

    Objective: The ideal replacement of the urethra is the urethra itself. However, when the urethra is not available, flaps or tubes are used as substitutes in hypospadias repair. The urethral plate, when preserved, is an excellent tool for tubularization and urethral reconstruction. Tubularized incise plate (TIP) repair has become ...

  18. Versatility of tubularized incised plate urethroplasty in the ...

    African Journals Online (AJOL)

    Background: The outcomes of urethroplasty in the management of different types of hypospadias have continued to improve since the introduction of the tubularized incised plate (TIP) urethroplasty (Snodgrass method). The aim of this study was to evaluate the feasibility and applicability of TIP urethroplasty in the ...

  19. Feasibility of a tubularised incised-plate urethroplasty with double ...

    African Journals Online (AJOL)

    Background: Reoperation for failed hypospadias has been considered to be seriously problematic. The dense fibrotic tissue causes difficulties in wound healing and increases the rate of complications. The tubularised incised-plate urethroplasty (TIPU) method has become a preferred method for all varieties of hypospadias ...

  20. Tubularized Incised Plate (TIP) Urethroplasty: Extended Use in ...

    African Journals Online (AJOL)

    Objective: Recently, tubularized incised plate (TIP) urethroplasty (Snodgrass repair) has gained popularity for the primary repair of distal and proximal hypospadias. This study was carried out to evaluate TIP urethroplasty in the repair of failed and complicated hypospadias cases. Patients and Methods: This study was ...

  1. Combined use of Mathieu and incised plate technique (Snodgrass ...

    African Journals Online (AJOL)

    Objectives: To evaluate the results and complications after combined use of Mathieu and incised plate technique for management of distal hypospadias in older children. Patients and methods: A total of 33 patients with primary distal penile hypospadias were operated upon using the Mathieu technique combined with deep ...

  2. Tubularized incised plate urethroplasty repair in adult hypospadias ...

    African Journals Online (AJOL)

    Objective: Most studies published in the literature report on the results of tubularized incised plate urethroplasty (TIPU) for hypospadias repair in children. Hence, the objective of this study was to evaluate the results of TIPU repair in adults. Patients and methods: The records of 60 adult patients with primary hypospadias ...

  3. Incised plate urethroplasty in perineal and perineo-scrotal ...

    African Journals Online (AJOL)

    A. Bhat

    Abstract. Objective: The ideal replacement of the urethra is the urethra itself. However, when the urethra is not available, flaps or tubes are used as substitutes in hypospadias repair. The urethral plate, when preserved, is an excellent tool for tubularization and urethral reconstruction. Tubularized incise plate (TIP) repair.

  4. Tubularized incised plate technique for recurrent hypospadias: a ...

    African Journals Online (AJOL)

    Annals of Pediatric Surgery 2012, 8:80–85. Keywords: recurrent hypospadias, salvage hypospadias, tubularized incised plate. aDepartment of Surgery, Division of Pediatric and Plastic Surgery, Faculty of. Medicine, Suez Canal University, Ismailia and bDepartment of Surgery, Faculty of. Medicine, Menoufia University ...

  5. a comparative study between manual small incision cataract surgery ...

    African Journals Online (AJOL)

    ... October 2012 to October 2014 for cataract surgery were followed up for 6 weeks after surgery. They were divided into two groups based on the type of surgical procedure opted by the patients. Group A consisted of 50 patients who underwent Manual Small Incision Cataract. Surgery with rigid Polymethyl Methacrylate IOL ...

  6. Anastomosis Procedure through an Inguinal Hernia Incision in ...

    African Journals Online (AJOL)

    was laparoscopically transected by a stapler. A 4 cm skin incision was then made in the left inguinal region and carried down to the peritoneum through the hernia sac [Figure 1]. Bowel resection was performed extracorporeally, and an anvil was placed at the proximal end of the colon, over a purse-string suture. [Figure 2].

  7. rubularised Incised Plate Hypospadias Urethroplasty In A Regional ...

    African Journals Online (AJOL)

    1t the Coast Province General Hospital in Mombasa. Xenya and in some private hospitals, nearby. junction. Artificial erection test is done to check for residual chordee20. Residual penile curvature is corrected by dorsal tunica albuginea plication8. - The glans wings are mobilized laterally. A midline relaxing incision is made ...

  8. Treatment of pharyngocutaneous fistula acquired from incisions and ...

    African Journals Online (AJOL)

    Treatment of pharyngocutaneous fistula acquired from incisions and drainage of deep neck space abscess in a patient with occult third branchial anomaly. ... We did surgical exploration to excise and close the fistula but only succeeded at the second attempt. Conclusion: We conclude that branchial apparatus anomaly ...

  9. Better outcome from arthroscopic partial meniscectomy than skin incisions only?

    DEFF Research Database (Denmark)

    Roos, Ewa M; Hare, Kristoffer Borbjerg; Nielsen, Sabrina Mai

    2018-01-01

    OBJECTIVE: Compare arthroscopic partial meniscectomy to a true sham intervention. METHODS: Sham-controlled superiority trial performed in three county hospitals in Denmark comparing arthroscopic partial meniscectomy to skin incisions only in patients aged 35-55 years with persistent knee pain and...

  10. Feasibility of reduced port surgery applying Higuchi's transverse incision

    Directory of Open Access Journals (Sweden)

    Kazu Ueda

    2017-02-01

    Conclusion: We reported novel forms of reduced port surgery applying Higuchi's transverse incision. It was suggested that these procedures are relatively simple, but ensure the same safety and efficacy as conventional methods. We intend to increase the number of cases and examine safety, efficacy, and patient satisfaction for these procedures.

  11. Short communication Combined use of Mathieu and incised plate ...

    African Journals Online (AJOL)

    Objectives: To evaluate the results and complications after combined use of Mathieu and incised plate technique for management of distal hypospadias in older children. Patients and methods: A total of 33 patients with primary distal penile hypospadias were operated upon using the Mathieu technique combined with deep ...

  12. Topical‑intracameral anesthesia in manual small incision cataract ...

    African Journals Online (AJOL)

    Background: Cataract remains a leading cause of blindness worldwide. Manual small incision cataract surgery (MSICS) is currently practiced as the technique of choice in Sub‑Saharan Africa to reduce the backlog of cataract blindness. Optimal pain control during surgery remains a challenge to cataract surgeons. Aim: To ...

  13. Visual Outcome after Small Incision Cataract Surgery in ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to determine the visual outcome of patients who had manual small incision cataract surgery in a high volume secondary eye hospital in southwestern Nigeria, and to identify reasons for poor outcome. Methodology: This is an observational descriptive, longitudinal study of consecutive ...

  14. Ankle fusion using a 2-incision, 3-screw technique

    NARCIS (Netherlands)

    Hendrickx, R. P. M.; Kerkhoffs, G. M. M. J.; Stufkens, S. A. S.; van Dijk, C. N.; Marti, R. K.

    2011-01-01

    Reliable fusion and optimal correction of the alignment of the ankle joint using a 2-incision, 3-screw technique. Symptomatic osteoarthritis of the ankle joint after insufficient other treatment, severe deformity of the osteoarthritic ankle joint, or salvation procedure after failed arthroplasty.

  15. DOES CONJUNCTIVAL INCISION INFLUENCE MEDIAL RECTUS MUSCLE RECESSIONS?

    Directory of Open Access Journals (Sweden)

    Galina G. Dimitrova

    2015-09-01

    Full Text Available Purpose: To evaluate the role of conjunctival incision in medial rectus muscle recessions as surgical treatment of choice in esotropia. Methods: The study included 200 patients (370 eyes, operated on for esotropia in the period of 2000-2014. 170 of them (340 eyes underwent bilateral medial rectus muscle recessions and 30- unilateral medial rectus muscle recession for various forms of alternating/alternated esotropia. We compared the effect (Δ/mm recession of fornix and limbal approach. Diagnostic, surgical and statistical methods were used. Results: Limbal incision was performed on 110 patients (55,3% and fornix approach was done in 89 cases (44,7%. The mean effect corrected prism diopters for each mm of recession (Δ/mm differed significantly in the two groups, being bigger in cases with fornix incision (p<0,001 . Conclusion: The type of conjunctival incision in medial rectus muscle recessions have an influence not only on the cosmetic appearance, but also on the functional result. This is especially true for large recessions.

  16. Treatment of bilateral mammary ptosis and pectus excavatum through the same incision in one surgical stage

    Directory of Open Access Journals (Sweden)

    Fernando Passos Rocha

    Full Text Available CONTEXT: Congenital deformities of the anterior thoracic wall are characterized by unusual development of the costal cartilages. All these medical conditions are frequently associated with a variety of breast deformities. Several surgical techniques have been described for correcting them, going from sternochondroplasty to, nowadays, minimally invasive techniques and silicone prosthesis implantation. CASE REPORT: The present article reports the case of a young female patient who presented bilateral mammary ptosis and moderate pectus excavatum that caused a protrusion between the eighth and the tenth ribs and consequent esthetic disharmony. The proposed surgical treatment included not only subglandular breast implants of polyurethane, but also resection of part of the rib cartilage and a bone segment from the eighth, ninth and tenth ribs by means of a single submammary incision in order to make the scar minimally visible. Correction through a single incision benefited the patient and provided an excellent esthetic result. CONCLUSIONS: The techniques used to repair bilateral mammary ptosis and pectus excavatum by plastic and thoracic surgery teams, respectively, have been shown to be efficient for correcting both deformities. An excellent esthetic and functional result was obtained, with consequent reestablishment of the patient's self-esteem.

  17. The anterolateral incision for pilon fracture surgery: an anatomic study of cutaneous blood supply.

    Science.gov (United States)

    Fisher, Brent E; Nathan, Senthil T; Acland, Robert D; Roberts, Craig S

    2011-06-01

    The purpose of this study was to examine the blood supply to the adjacent skin and its vulnerability to anterolateral tibial plating performed with fibular plating through a single surgical incision. Ten lightly embalmed cadaver legs without a history of lower extremity trauma or surgery with a mean age of 71 years (range, 57 to 87 years) were used for this investigation. Each specimen was injected with a commercially available silicone compound through the popliteal artery. The left leg was plated through a modified extensile Böhler approach and the right leg served as the control. Each leg was anatomically dissected. All measurements were taken using a digital caliper by a single investigator. A mean of 93 (range, 4 to 17) perforating arteries were present and in the proximity of the fibula plate. Our findings suggest the potential for iatrogenic soft tissue breakdown along the posterior border of the anterolateral surgical incision in this procedure as a result of compromised blood supply to the skin.

  18. Simplified bone-anchored hearing aid insertion using a linear incision without soft tissue reduction.

    Science.gov (United States)

    Husseman, J; Szudek, J; Monksfield, P; Power, D; O'Leary, S; Briggs, R

    2013-07-01

    Numerous techniques have been described to manage the skin and other soft tissues during bone-anchored hearing aid insertion. Previously, generally accepted techniques have sometimes led to distressing alopecia and soft tissue defects. Now, some surgeons are rejecting the originally described split skin flap in favour of a less invasive approach. To investigate bone-anchored hearing aid placement utilising a single, linear incision with either no or minimal underlying soft tissue reduction. Thirty-four adults were prospectively enrolled to undergo single-stage bone-anchored hearing aid placement with this modified technique. A small, linear incision was used at the standard position and carried down through the periosteum. Standard technique was then followed with placement of an extended length abutment. Patients were reviewed regularly to assess wound healing, including evaluation with Holgers' scale. Only 14.7 per cent of patients had a reaction score of 2 or higher. Most complications were limited to minor skin reactions that settled with silver nitrate cautery and/or antibiotics. None required revision surgery for tissue overgrowth, and there were no implant failures. Our results suggest this to be a simple and effective insertion technique with favourable cosmesis and patient satisfaction.

  19. Laparoendoscopic single-site gastric bands versus standard multiport gastric bands: a comparison of technical learning curve measured by surgical time.

    Science.gov (United States)

    Gawart, Matthew; Dupitron, Sabine; Lutfi, Rami

    2012-03-01

    We aimed to evaluate our learning curve comparing surgical time of laparoendoscopic single-site (LESS) banding with multiport laparoscopy. We performed a retrospective analysis of prospectively collected data comparing our first 48 LESS bands with our first 50 multiport laparoscopic bands at our institution. We then compared the first 24 LESS bands with the last 24 bands. The average body mass index for the LESS group was significantly lower than for the laparoscopic group (43.19 vs 48.3; P < .0001). The surgical time was much faster toward the second half of our experience performing the LESS procedure (85.34 vs 68.8; P = .0055). LESS banding took significantly longer than our early traditional laparoscopic adjustable gastric banding (76.85 vs 64.4; P = .0015). We conclude that in experienced hands, single-incision banding is feasible and safe to perform. Long-term data are needed to prove that LESS banding is as good a surgery as traditional laparoscopic surgery. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Incisional hernia after upper abdominal surgery: A randomised controlled trial of midline versus transverse incision

    NARCIS (Netherlands)

    J.A. Halm (Jens); H. Lip (Harm); P.I.M. Schmitz (Paul); J. Jeekel (Hans)

    2009-01-01

    textabstractObjectives: To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Summary background data: Incisional hernias after midline

  1. Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device

    Directory of Open Access Journals (Sweden)

    Deepak Dubey

    2011-01-01

    Conclusions : Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.

  2. Two Late Pleistocene climate-driven incision/aggradation rhythms in the middle Dnieper River basin, west-central Russian Plain

    Science.gov (United States)

    Panin, Andrei; Adamiec, Grzegorz; Buylaert, Jan-Pieter; Matlakhova, Ekaterina; Moska, Piotr; Novenko, Elena

    2017-06-01

    In valleys of the River Seim and its tributaries in the middle Dnieper basin (west-central Russian Plain), two low terraces (T1, 10-16 m, and T0, 5-7 m above the river) and a floodplain (2-4 m) with characteristic large and small palaeochannels exist. A range of field and laboratory techniques was applied and ∼30 new numerical ages (OSL and 14C dates) were obtained to establish a chronology of incision and aggradation events that resulted in the current valley morphology. Two full incision/aggradation rhythms and one additional aggradation phase from the previous rhythm were recognized in the Late Pleistocene - Holocene climate cycle. The following events were detected. (1) Late MIS 5 - early MIS 4: aggradation of Terrace T1 following the deep incision at the end of MIS 6. (2) Late MIS 4 (40-30 ka): incision into Terrace T1 below the present-day river, formation of the main scarp in the bottom of the valley between Terrace T1 and Terrace T0/Floodplain levels. (3) MIS 2: aggradation of Terrace T0, lateral migrations of a shallow braided channel located few meters above the present-day river since ∼25 ka through the LGM. (4) 18-13 ka: incision into Terrace T0 below the modern river. Multiple-thread channels concentrated in a single flow that at some places formed large meanders. In the period 15-13 ka, high floods that rose above the present-day floods left large levees and overbank loams on Terrace T0. (5) Younger Dryas - Holocene transition: aggradation up to the modern channel level, transformation of large Late Glacial to small Holocene meanders. The established incision/aggradation rhythms are believed to be manifested over the Central Russian Plain outside the influence of ice sheets in the north and base level changes in the south. The two-phase deepening of the valley occurred in the last quarter of the last glacial epoch but can not be attributed directly to the glacial-interglacial transition. Both the detected incision events correspond to relatively

  3. Evaluation of the appendix during diagnostic laparoscopy, the laparoscopic appendicitis score : a pilot study

    NARCIS (Netherlands)

    Hamminga, Jenneke T. H.; Hofker, H. Sijbrand; Broens, Paul M. A.; Kluin, Philip M.; Heineman, Erik; Haveman, Jan Willem

    Diagnostic laparoscopy is the ultimate diagnostic tool to evaluate the appendix. Still, according to the literature, this strategy results in a negative appendectomy rate of approximately 12-18 % and associated morbidity. Laparoscopic criteria for determining appendicitis are lacking. The goal of

  4. Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Stefansson, T. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery]|[Univ. Hospital, Uppsala (Sweden). Dept. of Epidemiology; Nyman, R. [Univ. Hospital, Uppsala (Sweden). Dept. of Diagnostic Radiology; Nilsson, S. [Univ. Hospital, Uppsala (Sweden). Dept. of Diagnostic Radiology; Ekbom, A. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery]|[Univ. Hospital, Uppsala (Sweden). Dept. of Epidemiology; Paahlman, L. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery

    1997-03-01

    Purpose: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP)) in diagnosing diverticulitis of the sigmoid colon. Material and Methods: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. Results: Fity-two patients were found to have sigmoid diverticulitis: 20 patients by lanparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. Conclusion: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be rule out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis. (orig.).

  5. Laparoscopy for the management of early-stage endometrial cancer: from experimental to standard of care.

    Science.gov (United States)

    Acholonu, Uchenna C; Chang-Jackson, Shao-Chun R; Radjabi, A Reza; Nezhat, Farr R

    2012-01-01

    We performed a search of PUBMED and MEDLINE for articles concerning surgical management of early stage endometrial cancer from 1950 to 2011. From the articles collected we extracted data such as estimated blood loss, operating room time, complications, conversion to laparotomy, and length of hospital stay. Forty-seven relevant sources were analyzed. The patients in the laparoscopy group had less blood loss, fewer complications, longer operating room times, and a shorter length of stay. Lymph node count was similar in both groups. Although obesity is not a contraindication to laparoscopy, it does lead to a higher conversion rate. Route of surgical treatment had no impact on recurrence or survival. Robotic surgery has significant advantages over laparotomy, but advantages over laparoscopy are not as distinct. Laparoscopic hysterectomy offers several advantages over laparotomy. These advantages relate to improvements in patient care with comparable clinical outcome. After careful analysis we believe laparoscopy should be the standard of care for surgical management of early stage endometrial cancer. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

  6. IMPLEMENTING LAPAROSCOPY IN BRAZIL'S NATIONAL PUBLIC HEALTH SYSTEM: THE BARIATRIC SURGEONS' POINT OF VIEW

    Science.gov (United States)

    SUSSENBACH, Samanta; SILVA, Everton N; PUFAL, Milene Amarante; ROSSONI, Carina; CASAGRANDE, Daniela Schaan; PADOIN, Alexandre Vontobel; MOTTIN, Cláudio Corá

    2014-01-01

    Background Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. Aim 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. Methods A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. Results From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. Conclusion 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy. PMID:25409964

  7. Laparoscopy May Have a Role in the Drainage of Liver Abscess ...

    African Journals Online (AJOL)

    image‑guided percutaneous aspiration or drainage in addition to systemic antimicrobial agents became the standard of ... Indications for surgical drainage have now been limited to cases of failure of percutaneous .... Figure 1: Drainage catheter (chest tube) passed percutaneously into the abscess cavity during laparoscopy ...

  8. Intraoperative sentinel lymph node detection by vital dye through laparoscopy or laparotomy in early endometrial cancer.

    Science.gov (United States)

    Mais, Valerio; Peiretti, Michele; Gargiulo, Tigellio; Parodo, Giuseppina; Cirronis, Maria Giuseppina; Melis, Gian Benedetto

    2010-04-01

    Recent studies reported the feasibility of intraoperative lymphatic mapping in women with endometrial cancer but none of these studies compared the sentinel lymph nodes (SLNs) detection rates obtainable through laparoscopy or laparotomy. The purpose of this study was to address this issue. Thirty-four patients with clinical stage I-II endometrial cancer were enrolled in this prospective comparative trial. Four milliliters of Patent Blue Violet were injected into the cervix after the induction of general anesthesia. The assessment of SLNs was done in 17 patients through laparoscopy and in 17 patients through laparotomy as first step of systematic pelvic lymphadenectomy. Both SLNs and non-SLNs were evaluated for micrometastases. The SLNs detection rate was significantly higher (82%) for laparoscopy than for laparotomy (41%; P = 0.008). Pelvic lymph node metastases were present in 6 out of 34 patients (18%) but only 3 (50%) of these patients were correctly identified. SLNs detection rate is significantly higher through laparoscopy than through laparotomy after vital dye pericervical injection but intraoperative vital dye pericervical injection is not reliable as part of standard care for predicting lymphatic spread in women with early stage endometrial cancer. (c) 2010 Wiley-Liss, Inc.

  9. Laparoscopy-promising tool for improvement of reproductive efficiency of small ruminants

    Directory of Open Access Journals (Sweden)

    Dovenski Toni

    2012-01-01

    Full Text Available Assisted reproductive technologies are used to accelerate genetic gain and improve reproductive performances in farm animals, including small ruminants. This technologies include estrous synchronization, artifi cial insemination (AI using fresh, frozen or sexed semen, embryo transfer (ET using in vivo or in vitro produced embryos, and more advanced - cloning and production of transgenic animals. Diagnostic procedures, such as ultrasonography and laparoscopy, have been used as additional tools for monitoring the ovarian response to superovulatory treatment in donor animals as well as for AI and collection and transfer of embryos. The use of laparoscopy for assisted reproduction techniques in Macedonia commenced in the early 90’s, with the acquisition of a set of ,,Karl Storz” equipment. After the adoption of the required routine, our group has completed several scientifi c projects where laparoscopy was used for intrauterine inseminations as well as for recovery and transfer of embryos in both sheep andgoats. In the following period our group endeavored into introduction of laparoscopic insemination in the routine farm practice. Ovine intrauterine/intracornual insemination by frozen-thawed semen resulted with pregnancy rates of 45% and 60%, when AI was performed out of season and during the breeding season, respectively. In goats, this percentage occasionally peaked at 85%. The aim of this article is to review the status of implementation of laparoscopy in Assisted Reproduction Technologies (ART of small ruminants and to present our experience in this field.

  10. Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy

    International Nuclear Information System (INIS)

    Stefansson, T.; Univ. Hospital, Uppsala; Nyman, R.; Nilsson, S.; Ekbom, A.; Univ. Hospital, Uppsala; Paahlman, L.

    1997-01-01

    Purpose: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP)) in diagnosing diverticulitis of the sigmoid colon. Material and Methods: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. Results: Fity-two patients were found to have sigmoid diverticulitis: 20 patients by lanparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. Conclusion: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be rule out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis. (orig.)

  11. [Laparoscopy in the examination of patients with non-palpable undescended testis].

    Science.gov (United States)

    Iunusov, M Iu; Ugarov, B A; Ten, S L

    1991-01-01

    Diagnostic laparoscopy was performed in 28 patients at the age of from 5 to 32 years. The endoscopic semiotics of the inguinal and intraabdominal retention, testicular agenesia were studied. Laparoscopic and intraoperative diagnoses coincided in all the cases. No complications were observed.

  12. Laparoscopy Can Safely Be Performed in Frail Patients Undergoing Colon Resection for Cancer.

    Science.gov (United States)

    Ho, Be; Lewis, Aaron; Paz, I Benjamin

    2017-10-01

    The present study aims to evaluate the role of laparoscopy in frail patients undergoing colorectal surgery for colorectal cancer. A review of the 2011 to 2014 American College of Surgeons National Surgical Quality Improvement Program database was performed to identify frail patients (using a frailty index), who underwent resection for colorectal cancer. Univariable and multivariable analyses were performed to evaluate 30-day mortality and Clavien-Dindo grade IV (CD-IV) complications. A total of 52,087 patients with colorectal cancer were identified, of which frailty accounted for 2.63 per cent (index score ≥5). Patients above the age 85 were considered frail 6.8 per cent of the time and accounted for 24.5 per cent of patients with frailty. Laparoscopic surgery was performed in 32.9 and 53.1 per cent of patients with and without frailty (P < 0.001). Patients with frailty were less likely to die within 30 days of surgery if younger (P = 0.004), performed electively (P < 0.001), or laparoscopically (P < 0.001). On multivariate analysis, laparoscopy and elective surgery were associated with better perioperative survival; whereas, older age, male sex, and tobacco use were associated with 30-day mortality. Laparoscopy and lower body mass index were associated with fewer Clavien-Dindo grade IV complications. Although laparoscopy is performed less commonly in the frail, this study indicated better perioperative outcomes for patients undergoing elective surgery who were <85 years old.

  13. Hybrid (laparoscopy + stent) treatment of celiac trunk compression syndrome (Dunbar syndrome, median arcuate ligament syndrome (MALS)).

    Science.gov (United States)

    Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Majda, Kaja; Gutowski, Piotr

    2016-01-01

    Celiac trunk (CT) compression syndrome caused by the median arcuate ligament (MAL) is a rarely diagnosed disease because of its nonspecific symptoms, which cause a delay in the correct diagnosis. Intestinal ischemia occurs, which causes symptoms of abdominal angina. One method of treatment for this disease is surgical release of the CT - the intersection of the MAL. Laparoscopy is the first step of the hybrid technique combined with percutaneous angioplasty and stenting of the CT. To demonstrate the usefulness and advantages of the laparoscopic approach in the treatment of Dunbar syndrome. Between 2013 and 2016 in the General and Minimally Invasive Surgery Department of the Medical Sciences Faculty of the University of Warmia and Mazury in Olsztyn, 6 laparoscopic procedures were performed because of median arcuate ligament syndrome. During the laparoscopy the MAL was cut with a harmonic scalpel. One month after laparoscopy 5 patients had Doppler percutaneous angioplasty of the CT with stent implantation in the Vascular Surgery Department in Pomeranian Medical University in Szczecin. In one case, there was a conversion of laparoscopic surgery to open due to unmanageable intraoperative bleeding. In one case, postoperative ultrasound examination of the abdominal cavity demonstrated the presence of a large hematoma in the retroperitoneal space. All patients reported relief of symptoms in the first days after the operation. The hybrid method, combining laparoscopy and angioplasty, seems to be a long-term solution, which increases the comfort of the patient, brings the opportunity for normal functioning and minimizes the risk of restenosis.

  14. Laparoscopy May Have a Role in the Drainage of Liver Abscess ...

    African Journals Online (AJOL)

    Laparoscopy May Have a Role in the Drainage of. Liver Abscess: Early Experience at Owerri, Nigeria. Christopher N Ekwunife, Ogechukwu Okorie1, Ogechukwu Nwobe. Departments of Surgery and 1Anaesthesia, Federal Medical Centre, Owerri, Nigeria. ABSTRACT. Background: Image‑guided percutaneous drainage ...

  15. Comparison of Laparoscopy and Laparotomy in Surgical Staging of Apparent Early Ovarian Cancer

    Science.gov (United States)

    Lu, Qi; Qu, Hong; Liu, Chongdong; Wang, Shuzhen; Zhang, Zhiqiang; Zhang, Zhenyu

    2016-01-01

    Abstract The aim of this study was to compare the safety and morbidity of laparoscopic versus laparotomic comprehensive staging of apparent early stage ovarian cancer. In this retrospective study, the outcomes of patients with apparent stage I ovarian cancer who underwent laparoscopic or laparotomic comprehensive surgical staging from January 2002 to January 2014 were evaluated. The long-term survival of patients with early ovarian cancer was compared. Forty-two patients were treated by laparoscopy, and 50 were treated by laparotomy. The median operative time was 200 minutes in the laparoscopy group and 240 minutes in the laparotomy group (P >0.05). The median length of hospital stay was 3 days in the laparoscopy group and 7 days in the laparotomy group (P laparoscopy and laparotomy groups. Laparoscopic and laparotomic comprehensive staging of early ovarian cancer were similar in terms of staging adequacy, accuracy and survival rate. Laparoscopic staging was associated with a significantly reduced hospital stay. Prospective randomized trials are required to evaluate the overall oncologic outcomes. PMID:27196468

  16. Role of laparoscopy and ultrasound in the management of “impalpable testis” in children

    Directory of Open Access Journals (Sweden)

    Iskandar Rahardjo Budianto

    2014-10-01

    Conclusions: Laparoscopy is superior to ultrasound in the management of impalpable testes when high-resolution ultrasound is not available during the diagnostic process, with respect to both the sensitivity of localizing the testis and being more time and cost effective.

  17. Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy.

    Science.gov (United States)

    Magrina, Javier F; Cetta, Rachel L; Chang, Yu-Hui; Guevara, Gregory; Magtibay, Paul M

    2013-05-01

    Analysis of perioperative outcomes and survival of patients with recurrent ovarian cancer undergoing secondary cytoreduction by robotics, laparoscopy, or laparotomy. Retrospective analysis of 52 selected patients with recurrent ovarian cancer undergoing secondary cytoreduction by laparoscopy (9), laparotomy (33) or robotics (10) between January 2006 and December 2010. Comparison was made by a total of 21 factors including age, BMI, number of previous surgeries, tumor type and grade, number of procedures, and 15 types of procedures performed at secondary cytoreduction. For all patients, the mean operating time was 213.8 min, mean blood loss 657.4 ml; and mean hospital stay 7.5 days. Complete debulking was achieved in 75% of patients. Postoperative complications were noted in 36.5% of patients. Overall and progression-free survival at 3-years were 58.8% and 34.1%, respectively. Laparoscopy and robotics had reduced blood loss and hospital stay, while no differences were observed among the three groups for operating time, complications, complete debulking, and survival. Selected patients with recurrent ovarian cancer benefit from a laparoscopic or robotic secondary cytoreduction without compromising survival. Robotics and laparoscopy provide similar perioperative outcomes, and reduced blood loss and shorter hospital stay as compared to laparotomy. Laparotomy seems preferable for patients with widespread peritoneal implants, multiple sites of recurrence, and/or extensive adhesions. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. The role of laparoscopy in the management of urachal anomalies in ...

    African Journals Online (AJOL)

    Objectives Management for urachal anomalies (UAs) is controversial. Although traditional treatment of UAs has been surgical excision, recent literature report also a conservative approach. We reviewed our experience to define the role of laparoscopy in the management of UAs in children. Patients and methods From July ...

  19. Functional and aesthetic results of various lip-splitting incisions: A clinical analysis of 60 cases.

    Science.gov (United States)

    Rapidis, A D; Valsamis, S; Anterriotis, D A; Skouteris, C A

    2001-11-01

    This study retrospectively evaluated the functional and aesthetic results of various types of lip-splitting incisions in a group of patients in whom this approach was used to treat intraoral tumors. Between 1992 and 1998, 87 consecutive patients were subjected to either mandibulotomy or mandibulectomy using a lip-splitting incision. During this period, 4 types of incisions were sequentially used: straight midline incision, lateral lip-splitting incision, midline splitting with extension around the contour of the chin, and the chevron chin-contour incision. Sixty patients with a follow-up of at least 6 months were included in the study. The patients were asked to answer a questionnaire regarding the degree of satisfaction with the cosmetic result of the procedure and were clinically assessed for sensory and functional impairment resulting from the incision. The remaining 27 patients were lost to follow-up or had died of their disease. The lateral lip-splitting incision caused the fewest postoperative problems in patients subjected to either mandibulotomy or mandibulectomy. The best overall results were achieved by the chevron-chin contour incision. The incision that followed the contour of the chin and the straight midline incision showed less satisfactory results. The chevron chin-contour incision, along with meticulous soft tissue closure, produces the best aesthetic and functional results. Copyright 2001 American Association of Oral and Maxillofacial Surgeons

  20. Comparison of Robotic Surgery with Laparoscopy and Laparotomy for Treatment of Endometrial Cancer: A Meta-Analysis

    Science.gov (United States)

    Ran, Longke; Jin, Jing; Xu, Yan; Bu, Youquan; Song, Fangzhou

    2014-01-01

    Purpose To compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis. Methods The MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT), number of complications, length of hospital stay (LOHS), estimated blood loss (EBL), number of transfusions, total lymph nodes harvested (TLNH), and number of conversions. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated using either a fixed-effects or random-effects model. Results Twenty-two studies were included in the meta-analysis. These studies involved a total of 4420 patients, 3403 of whom underwent both robotic surgery and laparoscopy and 1017 of whom underwent both robotic surgery and laparotomy. The EBL (p = 0.01) and number of conversions (p = 0.0008) were significantly lower and the number of complications (plaparoscopy. The OT, LOHS, number of transfusions, and TLNH showed no significant differences between robotic surgery and laparoscopy. The number of complications (plaparoscopy and laparotomy for patients with endometrial cancer. Robotic surgery is associated with significantly lower EBL than both laparoscopy and laparotomy; fewer conversions but more complications than laparoscopy; and shorter LOHS, fewer complications, and fewer transfusions but a longer OT than laparoscopy. Further studies are required. PMID:25259856

  1. Intrauterine synechiae after myomectomy; laparotomy versus laparoscopy: Non-randomized interventional trial

    Science.gov (United States)

    Asgari, Zahra; Hafizi, Leili; Hosseini, Rayhaneh; Javaheri, Atiyeh; Rastad, Hathis

    2015-01-01

    Background: Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion (synechiae). Objective: To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy. Materials and Methods: In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran’s Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups. Results: Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma’s size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02). Conclusion: With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae. PMID:26000007

  2. Laparoscopy has a therapeutic role in the management of abdominal trauma: A matched-pair analysis.

    Science.gov (United States)

    Chakravartty, Saurav; Sarma, Diwakar R; Noor, Muhammad; Panagiotopoulos, Spyros; Patel, Ameet G

    2017-08-01

    Laparoscopy is increasingly utilised as a diagnostic tool in management of abdominal trauma; however its role in therapeutic intervention remains unexplored. The aim of this study is to compare laparoscopy with laparotomy in the treatment of abdominal trauma in haemodynamically stable patients. A review of patients undergoing surgery for abdominal trauma between January 2004-2014 identified 25 patients who underwent laparoscopy for therapeutic intervention (TL). This group was matched with 25 similar patients undergoing laparotomy (LT). Matching of the two cohorts was based on patient characteristics, severity of injuries, haemodynamic compromise and radiological findings. Peri-operative outcomes were compared. Patient characteristics were similar in TL and LT patients for age (median 33 vs. 26 years), gender distribution and clinical presentation. Injury severity score was also similar with a median of 16 in both groups (major trauma = ISS>15, normal range 0-75). Types of injuries included; hollow viscus [bowel repair = 10 (TL) vs. 16 (LT)] and solid organs [5(TL) vs. 2 (LT)]. Median operating time was similar in both groups; 105(TL) compared to 98 (LT) minutes. Post-operative complications (1 vs. 10, p = 0.02), analgesia requirements, specifically opiate use (34 vs. 136 morphine equivalents, p = 0.002) and hospital stay (4 vs. 9 days, p = 0.03) were significantly lower in the laparoscopy group. Abdominal trauma in haemodynamically stable patients can be managed effectively and safely with laparoscopy by experienced surgeons. Major benefits may include lower morbidity, reduced pain, and shorter length of hospital stay. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  3. Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis.

    Science.gov (United States)

    Ran, Longke; Jin, Jing; Xu, Yan; Bu, Youquan; Song, Fangzhou

    2014-01-01

    To compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis. The MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT), number of complications, length of hospital stay (LOHS), estimated blood loss (EBL), number of transfusions, total lymph nodes harvested (TLNH), and number of conversions. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated using either a fixed-effects or random-effects model. Twenty-two studies were included in the meta-analysis. These studies involved a total of 4420 patients, 3403 of whom underwent both robotic surgery and laparoscopy and 1017 of whom underwent both robotic surgery and laparotomy. The EBL (p = 0.01) and number of conversions (p = 0.0008) were significantly lower and the number of complications (psurgery than in laparoscopy. The OT, LOHS, number of transfusions, and TLNH showed no significant differences between robotic surgery and laparoscopy. The number of complications (psurgery than in laparotomy. The TLNH showed no significant difference between robotic surgery and laparotomy. Robotic surgery is generally safer and more reliable than laparoscopy and laparotomy for patients with endometrial cancer. Robotic surgery is associated with significantly lower EBL than both laparoscopy and laparotomy; fewer conversions but more complications than laparoscopy; and shorter LOHS, fewer complications, and fewer transfusions but a longer OT than laparoscopy. Further studies are required.

  4. Two-dimensional versus three-dimensional laparoscopy: evaluation of physicians' performance and preference using a pelvic trainer.

    Science.gov (United States)

    Ko, Jennifer K Y; Li, Raymond H W; Cheung, Vincent Y T

    2015-01-01

    To compare the proficiency and preference of physicians in performing standard tasks in a box trainer using 2-dimensional (2D) versus 3-dimensional (3D) laparoscopy. Prospective randomized controlled trial. Prospective, randomized controlled trial (Canadian Task Force classification I). Tertiary care teaching hospital. Thirty physicians from the Department of Obstetrics and Gynecology. Participants were randomly assigned to perform a set of 3 to 4 tasks in a pelvic trainer using 2D