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Sample records for single-incision laparoscopic intraperitoneal

  1. 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.

  2. Single-incision total laparoscopic hysterectomy

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    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.

  3. Single incision laparoscopic colorectal resection: Our experience

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    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.

  4. 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.

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

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    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.

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

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    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.

  7. Current Status of Single-incision Laparoscopic Surgery

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    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....

  8. 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.

  9. 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

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

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    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

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

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    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.

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

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    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.

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

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    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.

  14. 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.

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

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    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.

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

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    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.

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

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    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. 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.

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

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    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.

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

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    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.

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

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    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.

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

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    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.

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

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    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...

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

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    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

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. [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.

  8. 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.

  9. 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.

  10. 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...

  11. 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.

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

    Science.gov (United States)

    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

  13. 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.

  14. 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.

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

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    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.

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

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    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.

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

    Science.gov (United States)

    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.

  19. 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

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    Chee Wei Tay

    2013-01-01

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

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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.

  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. 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.

  12. 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.

  13. "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

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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...

  2. 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.

  3. 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.

  4. 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

  5. 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.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  8. 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.

  9. [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

  10. 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.

  11. Safe Veress Needle Intraperitoneal Placement and Safer Laparoscopic Entry.

    Science.gov (United States)

    Vilos, George; Vilos, Angelos; Jacob, George P; Abu-Rafea, Basim; Ternamian, Artin

    2018-02-06

    Fifty percent of laparoscopic bowel and vascular injuries occur at the time of entry. These serious complications can lead to significant morbidity and even mortality. This video demonstrates 3 techniques that have been developed to minimize the risk of these injuries during entry. Step-by-step description of 3 techniques that can be used as a highly reliable and safe method of obtaining intraperitoneal entry during laparoscopy. Caudal displacement of the umbilicus before insertion of the veress needle allows for a median displacement of 6 cm between the site of entry and the common iliac vessels. An entry pressure of less than 9 mm Hg is suggestive of successful intraperitoneal entry. The left upper quadrant should be used in specific cases instead of the umbilicus as the point of entry for the veress needle. The use of a visualized trocarless cannula instead of a conventional primary trocar for entry after insufflation allows for real-time recognition of injury and converts linear penetrating force to radial torque. These 3 techniques can help decrease the risk and improve intraoperative recognition of serious bowel and vascular injuries during laparoscopy. Copyright © 2018 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-06-01

    new single-incision slings. The definition of a single-incision sling is "a sling that does not involve either a retropubic or transobturator passage of the tape or trocar and involves only a single vaginal incision (i.e. no exit wounds in the groin or lower abdomen)." Three review authors assessed the methodological quality of potentially eligible trials and independently extracted data from the individual trials. We identified 31 trials involving 3290 women. Some methodological flaws were observed in some trials; a summary of these is given in the 'Risk of bias in included studies' section.No studies compared single-incision slings versus no treatment, conservative treatment, colposuspension, laparoscopic procedures or traditional sub-urethral slings. Also no data on the comparison of single-incision slings versus retropubic mid-urethral slings (top-down approach) were available, but the review authors believe this did not affect the overall comparison versus retropubic mid-urethral slings.The types of single-incision slings included in this review were TVT-Secur (Gynecare), MiniArc (American Medical Systems, Minnetonka, MN, USA), Ajust (C.R. Bard, Inc.,Covington, GA, USA), Needleless (Mayumana Healthcare, Lisse, The Netherlands), Ophira (Promedon, Cordoba, Argentina), Tissue Fixation System (TFS PTY Ltd, Sydney, Australia) and CureMesh (D.Med. Co., Inc., Seoul, Korea).Women were more likely to remain incontinent after surgery with single-incision slings than with retropubic slings such as tension-free vaginal tape (TVT(TM)) (121/292, 41% vs 72/281, 26%; risk ratio (RR) 2.08, 95% confidence interval (CI) 1.04 to 4.14). Duration of the operation was slightly shorter for single-incision slings but with higher risk of de novo urgency (RR 2.39, 95% CI 1.25 to 4.56). Four of five studies in the comparison included TVT-Secur as the single-incision sling.Single-incision slings resulted in higher incontinence rates compared with inside-out transobturator slings (30% vs 11

  13. Effect of intraperitoneal and incisional port site lidocaine on pain relief after gynecological laparoscopic surgery: A randomized controlled study

    Directory of Open Access Journals (Sweden)

    Nahla W. Shady

    2018-03-01

    Conclusions: This study clearly depicts that incisional and intraperitoneal infiltration of lidocaine is an easy, safe, inexpensive, and noninvasive method that provides good analgesia during the early post-operative period and also provides early recovery from laparoscopic surgery.

  14. Is Palliative Laparoscopic Hyperthermic Intraperitoneal Chemotherapy Effective in Patients with Malignant Hemorrhagic Ascites?

    Science.gov (United States)

    de Mestier, Louis; Volet, Julien; Scaglia, Elodie; Msika, Simon; Kianmanesh, Reza; Bouché, Olivier

    2012-01-01

    Malignant hemorrhagic ascites may complicate the terminal evolution of digestive cancers with peritoneal carcinomatosis. It has a bad influence on prognosis and may severely impair patients’ quality of life. Palliative laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) has been proposed to treat debilitating malignant ascites. Two cases of peritoneal carcinomatosis causing hemorrhagic ascites and severe anemia that needed iterative blood transfusions are reported. These patients were treated by laparoscopic HIPEC (mitomycin C and cisplatin with an inflow temperature of 43°C), resulting in cessation of peritoneal bleeding. No postoperative complication or relapse of ascites occurred during the following months. No more blood transfusion was needed. Laparoscopic HIPEC might be an effective and safe therapeutic option to consider in patients with malignant hemorrhagic ascites. PMID:22679405

  15. Laparoscopic appendectomy for perforated appendicitis in children: Is intraperitoneal drainage necessary?

    Directory of Open Access Journals (Sweden)

    Mithat Günaydın

    2015-09-01

    Full Text Available Objective: In this study, our aim is to evaluate the necessity of intraperitoneal drainage in perforated appendicitis. Methods: 510 pediatric patients [246 laparoscopic (LA and 264 open (OA] underwent appendectomy between 2007 and 2014. 275 of them were perforated appendicitis (106 LA, 169 OA. The patients were retrospectively evaluated in terms of age, sex, symptoms, length of hospital stay (LOHS, antibiotherapy, postoperative nasogastric tube placement and intraperitoneal drainage, follow-up period, intraoperative and postoperative complications. Results: Statistically significant differences were observed between laparoscopic perforated appendicitis (71 male, 35 female; median 9.5 years and open perforated appendicitis (108 male, 61 female; median 9 years groups in terms of placement of nasogastric tube (102/106 vs.169/169 (p=0.021, length of hospital stay (1.67± 0.11 days vs. 2.34± 0.09 days (p<0.001, intraperitoneal drainage (32/106 vs. 138/169, (p<0.001, duration of intraperitoneal drainage (1.66± 0.28 vs. 4.21± 0.2 days and LOHS (5.82± 0.3 vs. 4.23± 0.6 days respectively (p <0.001. There was no significant difference between the two groups in terms of development of intra-abdominal abscess (10/106 vs. 9/169, (p=0.144, surgical site infection (2/106 vs. 8/169, (p=0.187 and development of adhesive intestinal obstruction (1/106 vs. 9/169 (p=0.053. Conclusion: Laparoscopic access reduces the necessity for drainage and shortens duration of nasogastric tube and length of hospital stay. J Clin Exp Invest 2015; 6 (3: 224-227

  16. Hybrid NOTES transvaginal intraperitoneal onlay mesh in abdominal wall hernias: an alternative to traditional laparoscopic procedures.

    Science.gov (United States)

    Descloux, Alexandre; Pohle, Sebastian; Nocito, Antonio; Keerl, Andreas

    2015-12-01

    Abdominal wall hernias are increasingly treated by laparoscopic placement of an intraperitoneal onlay mesh (IPOM). We present an alternative technique for women: the laparoscopic-assisted transvaginal IPOM. Before surgery, all patients underwent a gynecological examination. The patients agreed to IPOM repair via a transvaginal approach, and written informed consent for surgery was obtained. Pneumoperitoneum was established with a Veress needle at the umbilicus. This access was subsequently dilated to 5 mm (VersaStep), and a 5-mm laparoscope was inserted. Under laparoscopic view, the transvaginal trocars (12-mm VersaStep and 5-mm flexible accesses) were safely inserted after lifting the uterus with a uterus manipulator. After preparation of the falciform ligament, the ligamentum teres and the preperitoneal fat, a lightweight composite mesh was introduced through the transvaginal access and fixed with absorbable tacks using the double-crown technique. From September 2011 to December 2012, we performed six laparoscopic-assisted transvaginal IPOM procedures (one epigastric, three umbilical, two combined epigastric and umbilical hernias; all were primary hernias). In the initial phase, only patients with small or medium primary abdominal wall hernia were selected (max. 3 cm diameter). Median hospital stay was 3 days (range 2-6 days). One minor complication occurred perioperatively (second-degree skin burn to the labia majora). At 1-year follow-up, we identified one recurrence in a high-risk patient with a body mass index higher than 35 kg/m(2). No infection and no mortality were observed. Although no final conclusion can be made regarding the presumed non-inferiority of this technique in terms of recurrence and mesh infection compared with traditional laparoscopic IPOM, laparoscopic-assisted transvaginal IPOM is a feasible alternative to treat abdominal wall hernias.

  17. Intraperitoneal Hydrocortisone plus Bupivacaine versus Bupivacaine alone for Pain Relief after Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Mahesh Sharma

    2016-11-01

    Full Text Available Introduction: Laparoscopic cholecystectomy has been the gold standard in the treatment of gallstones since last decades. Beside several benefits of laparoscopic cholecystectomy compared with open surgery, postoperative pain is still a frequent melancholy.  Hence, pain management is utmost regarding patients' comfort. The main objective of the study was to compare the effect of intraperitoneal hydrocortisone plus bupivacaine with bupivacaine alone on pain relief following laparoscopic cholecystectomy.   Methods: A randomized study was conducted from December 2015 to August 2015 that included 100 patients aged 20 to 60 years of both genders who were found to have symptomatic gallstones and were scheduled for elective laparoscopic cholecystectomy at Lumbini Medical College. Patients randomly received 100 mg hydrocortisone plus 100 mg bupivacaine in 200 ml normal saline (group A or 100 mg bupivacaine in 200 ml normal saline (group B into the peritoneum. Post-operative abdominal and shoulder pain were evaluated using Visual Analog Score (VAS. The patients were also followed up for postoperative analgesic requirements, and recovery variables. Data were collected, tabulated and analyzed statistically using SPSS version 19.   Results: Total number of patients in this study were 100. Age and gender among both groups were comparable. VAS scores for pain was significantly lower for group A as compared to group B at 0, 2, 4, 6, 12, and 24 hours. Time of oral intake in hrs for liquids and solids was statistically significant in Group A compared to Group B. Rescue analgesic requirement was also significantly low in Group A compared to Group B. Hospital stay in both group were comparable.   Conclusion: Combination of hydrocortisone plus bupivacaine can relieve pain after laparoscopic cholecystectomy better compared to bupivacaine alone when administered intraperitoneally.

  18. 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 ...

  19. Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for refractory malignant ascites in patients unsuitable for cytoreductive surgery.

    Science.gov (United States)

    Valle, S J; Alzahrani, N A; Alzahrani, S E; Liauw, W; Morris, D L

    2015-11-01

    Malignant ascites (MA) is the abnormal accumulation of fluid in the peritoneal cavity of patients with intraperitoneal dissemination of their disease and is associated with a short life expectancy. The most common clinical feature is a progressive increase of abdominal distention resulting in pain, discomfort, anorexia and dyspnoea. Currently, no treatment is established standard of care due to limited efficacy or considerable toxicity. The objective was to examine the efficacy of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliation of refractory MA in patients who were unsuitable for cytoreductive surgery. From May 2009 to June 2015, 12 patients with MA due to their peritoneal malignancy were treated with laparoscopic HIPEC. The time between operation and repeat paracentesis, in-hospital data, and the proportion of patients that did not require repeat paracentesis was analyzed. One patient (8%) was admitted to ICU for 1 day. The mean operating time and hospital stay was 149.3 min (range 79-185) and 4.6 days (range 2-11) respectively. Neither high-grade morbidity nor mortality was observed. The median OS was 57 days. In our experience, a complete and definitive disappearance of MA was observed in 83% of patients. Two patients (17%) developed recurrent MA 124 days and 283 days post-HIPEC. Laparoscopic HIPEC is a beneficial treatment for the management and palliation of refractory MA and results in an excellent clinical and radiological resolution in patients with a complete resolution observed in selected patients. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  20. Efficacy of port-site and intraperitoneal application of bupivacaine in reducing early post-laparoscopic cholecystectomy pain

    International Nuclear Information System (INIS)

    Ahmad, J.; Khan, Z.A.; Khan, A.

    2015-01-01

    The aim of this study was to assess the analgesic efficacy of Bupivacaine application at port-site and intraperitoneal infiltration in patients with laparoscopic cholecystectomy. Study Design: Randomized Controlled Clinical Trial. Place and Duration: The study was conducted at Rehman Medical Institute (RMI) Peshawar, Pakistan from June 2009 to June 2012. Materials and Methods: Patients who underwent elective laparoscopic cholecystectomy during the study period were included in the study. Eighty patients were randomized into two groups, study group and control group. The study group received 40 ml of 0.25% bupivacaine intraoperatively as intraperitoneal infiltration and local infiltration at the port sites. Pain assessment was done using visual analogue pain score (VAS) of 0-10 at fixed intervals during the first 24 hours post surgery. Results: The mean VAS score in the study group was less as compared to the control group throughout the 24 hours assessment period, however this difference was statistically significant (p<0.001) only during the first three assessments at 1 hour, 4 hours and 8 hours post surgery. The analgesia requirement was also significantly (p<0.001) decreased in the study group. Conclusion: Port site and intraperitoneal application of local anesthetic bupivacaine significantly reduced pain during the first 8 hours post surgery and total analgesia requirement was also significantly reduced. It is a simple and easily applicable technique which increases patient comfort and can be safely used to decrease post operative pain in patients undergoing laparoscopic cholecystectomy. (author)

  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. Laparoscopic intraperitoneal mesh fixation with fibrin sealant (Tisseel((R))) vs. titanium tacks: a randomised controlled experimental study in pigs

    DEFF Research Database (Denmark)

    Eriksen, J.R.; Bech, J.I.; Linnemann, D.

    2008-01-01

    ) test). There was no significant difference in the formation of fibrosis or inflammation between the different meshes or fixation methods. All samples showed significant foreign-body reaction with giant cells. CONCLUSION: Our results suggest that the laparoscopic fixation of an intraperitoneal mesh...... chronic) pain after LVHR. Therefore, non-invasive and patient-friendly mesh fixation methods must be considered. The present study was designed to investigate the technical applicability, safety and effect of Tisseel((R)) for intraperitoneal mesh fixation. METHODS: Nine 40-kg Danish Landrace female pigs...... and the mesh-tissue samples were tested for strength of ingrowth (peel test), adhesion formation, mesh shrinkage and examined for histological alterations. RESULTS: No meshes were displaced from their initial position at autopsy, but we observed two cases of mesh folding that could have resulted in hernia...

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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

  5. 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.

  6. Intraperitoneal injection of Bupivacaine and Lidocaine in reducing postoperative pain in gynecologic laparoscopic surgeries: a comparative study

    Directory of Open Access Journals (Sweden)

    Alleyassin A

    2007-08-01

    Full Text Available Background: As less invasive surgical procedures, such as laparoscopy, become more common, patients can go home soon after the surgery. However, some pain is accompanied by such procedures due to peritoneal stretching, diaphragmatic irritation, or, to a lesser extent, abdominal puncture. It is important to reduce the level of pain to the point that narcotics are not necessary. The administration of opioids for pain after abdominal surgeries is common. The receptors involved seem to be susceptible to blockade with low-dose local anesthesia, although this is subject to some controversy. In this study, we assess and compare the effectiveness of intraperitoneal Bupivacaine and Lidocaine in pain reduction after diagnostic gynecologic laparoscopy in infertility patients. Methods: In this randomized clinical trial, 150 patients admitted to Dr. Shariati Hospital for diagnostic gynecologic laparoscopy were entered into three randomized groups. Group B received Bupivacaine after the diagnostic laparoscopic procedure, group L received Lidocaine and group C, the control group, received a placebo after the surgery, all administered intraperi- toneally. Postsurgerical pain was assessed using the numeric visual analogue scale at 6 and 24 hours after surgery. Results: In group B, the pain scores at 6 and 24 hours after surgery were significantly less than those of group L. Conclusions: Administration of Bupivacaine after diagnostic gynecologic laparoscopic procedures is more effective in pain control than Lidocaine. The effect of this drug is temporary, yet it significantly decreases early postoperative pain, reducing the need for additional postoperative analgesics. Furthermore, the time at which patients can be discharged from the hospital is significantly reduced.

  7. Sewing machine technique for laparoscopic mesh fixation in intra-peritoneal on-lay mesh.

    Science.gov (United States)

    Dastoor, Khojasteh Sam; Balsara, Kaiomarz P; Gazi, Asif Y

    2018-01-01

    : Mesh fixation in laparoscopic ventral hernia is accomplished using tacks or tacks with transfascial sutures. This is a painful operation and the pain is believed to be more due to transfascial sutures. We describe a method of transfascial suturing which fixes the mesh securely and probably causes less pain. : Up to six ports may be necessary, three on each side. A suitable-sized mesh is used and fixed with tacks all around. A 20G spinal needle is passed from the skin through one corner of the mesh. A 0 prolene suture is passed through into the peritoneum. With the prolene within, the needle is withdrawn above the anterior rectus sheath and passed again at an angle into the abdomen just outside the mesh. A loop of prolene is thus created which is tied under vision using intra-corporeal knotting. : This method gives a secure mesh fixation and causes less pain than conventional methods. This technique is easy to learn but needs expertise in intra-corporeal knotting.

  8. 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.

  9. 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)

  10. A prospective randomised controlled study for evaluation of high-volume low-concentration intraperitoneal bupivacaine for post-laparoscopic cholecystectomy analgesia

    Directory of Open Access Journals (Sweden)

    Shruti Jain

    2018-01-01

    Full Text Available Background and Aims: Low-volume high-concentration bupivacaine irrigation of the peritoneal cavity has been reported to be ineffective for short-term analgesia after laparoscopic cholecystectomy (LC. This study was conducted to evaluate the effectiveness of intraperitoneal instillation of high-volume low-concentration bupivacaine for post-operative analgesia in LC. Methods: Sixty patients undergoing LC were included in this prospective, double-blind, randomised study. Patients were divided into two (n = 30 groups. In Group S, intraperitoneal irrigation was done with 500 ml of normal saline. In Group B, 20 ml of 0.5% (100 mg bupivacaine was added to 480 ml of normal saline for intraperitoneal irrigation during and after surgery. Post-operative pain was assessed by numeric pain rating scale (NRS at fixed time intervals. Duration of analgesia (DOA, total rescue analgesic requirement (intravenous tramadol, presence of shoulder pain, nausea and vomiting were recorded for the initial 24 h post-operatively. Results: Mean DOA in Group S was 0.06 ± 0.172 h (3.6 ± 10.32 min and that in Group B was 19.35 ± 8.64 h (P = 0.000. Cumulative requirement of rescue analgesic in 24 h in Group S was 123.33 ± 43.01 mg and that in Group B was 23.33 ± 43.01 mg (P = 0.000. There was no significant difference in incidence of shoulder pain, nausea and vomiting between the groups. Conclusion: High-volume low-concentration of intraperitoneal bupivacaine significantly increases post-operative DOA and reduces opioid requirement after LC.

  11. Unresectable gastric cancer with gastric outlet obstruction and distant metastasis responding to intraperitoneal and folfox chemotherapy after palliative laparoscopic gastrojejunostomy: report of a case

    Science.gov (United States)

    2010-01-01

    Background Gastric outlet obstruction (GOO) caused by unresectable gastric cancer is a challenging aspect of patient care. There have been no reports involving patients with obstructing gastric cancer and several incurable factors curatively treated by multimodal treatments. Case presentation We report a case of 55-year-old man who was diagnosed with a poorly differentiated adenocarcinoma in the pre-pyloric antrum with GOO by gastroscopy. An abdominal computed tomography (CT) scan revealed thickening of the gastric wall and adjacent fat infiltration, and a large amount of food in the stomach suggesting a passage disturbance, enlarged lymph nodes along the common hepatic and left gastric arteries, and multiple hepatic metastases. The serum carcinoembryonic antigen (CEA) level was 343 ng/ml and the carbohydrate antigen (CA) 19-9 level was within normal limits. The patient underwent a laparoscopic gastrojejunostomy for palliation of the GOO. On the 3rd and 12th days after surgery, he received intraperitoneal chemotherapy with 40 mg of docetaxel and 150 mg of carboplatin. Simultaneously, combined chemotherapy with 85 mg/m2 of oxaliplatin for the 1st day and 600 mg/m2 of 5-FU for 2 days (FOLFOX regimen) was administered from the 8th post-operative day. After completion of nine courses of FOLFOX, the patient achieved a complete response (CR) with complete disappearance of the primary tumor and the metastatic foci. He underwent a radical subtotal gastrectomy with D3 lymph node dissection 4 months after the initial palliative surgery. The pathologic results revealed no residual primary tumor and no lymph node metastasis in 43 dissected lymph nodes. He has maintained a CR for 18 months since the last operation. Conclusion Combination chemotherapy with systemic and intraperitoneal chemotherapy following laparoscopic bypass surgery showed marked efficacy in the treatment for unresectable advanced gastric cancer with GOO. PMID:21167074

  12. Unresectable gastric cancer with gastric outlet obstruction and distant metastasis responding to intraperitoneal and folfox chemotherapy after palliative laparoscopic gastrojejunostomy: report of a case

    Directory of Open Access Journals (Sweden)

    Park Joong-Min

    2010-12-01

    Full Text Available Abstract Background Gastric outlet obstruction (GOO caused by unresectable gastric cancer is a challenging aspect of patient care. There have been no reports involving patients with obstructing gastric cancer and several incurable factors curatively treated by multimodal treatments. Case presentation We report a case of 55-year-old man who was diagnosed with a poorly differentiated adenocarcinoma in the pre-pyloric antrum with GOO by gastroscopy. An abdominal computed tomography (CT scan revealed thickening of the gastric wall and adjacent fat infiltration, and a large amount of food in the stomach suggesting a passage disturbance, enlarged lymph nodes along the common hepatic and left gastric arteries, and multiple hepatic metastases. The serum carcinoembryonic antigen (CEA level was 343 ng/ml and the carbohydrate antigen (CA 19-9 level was within normal limits. The patient underwent a laparoscopic gastrojejunostomy for palliation of the GOO. On the 3rd and 12th days after surgery, he received intraperitoneal chemotherapy with 40 mg of docetaxel and 150 mg of carboplatin. Simultaneously, combined chemotherapy with 85 mg/m2 of oxaliplatin for the 1st day and 600 mg/m2 of 5-FU for 2 days (FOLFOX regimen was administered from the 8th post-operative day. After completion of nine courses of FOLFOX, the patient achieved a complete response (CR with complete disappearance of the primary tumor and the metastatic foci. He underwent a radical subtotal gastrectomy with D3 lymph node dissection 4 months after the initial palliative surgery. The pathologic results revealed no residual primary tumor and no lymph node metastasis in 43 dissected lymph nodes. He has maintained a CR for 18 months since the last operation. Conclusion Combination chemotherapy with systemic and intraperitoneal chemotherapy following laparoscopic bypass surgery showed marked efficacy in the treatment for unresectable advanced gastric cancer with GOO.

  13. 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.

  14. Randomized controlled study of intraincisional infiltration versus intraperitoneal instillation of standardized dose of ropivacaine 0.2% in post-laparoscopic cholecystectomy pain: Do we really need high doses of local anesthetics-time to rethink!

    Science.gov (United States)

    Kaushal-Deep, Singh Mathuria; Anees, Afzal; Khan, Shehtaj; Khan, Mohammad Amanullah; Lodhi, Mehershree

    2018-01-16

    Earlier studies done to compare the efficacy of use of local anesthetics at intraperitoneal location versus intraincisional use had utilized equal amount of drugs at the two locations, usually 10-20 ml. Using this large amount of drug in the small space of intraincisional location as compared to similar amount of drug in large intraperitoneal space created an inadvertent bias in favor of patients receiving the drug intraincisionally so these patients naturally experienced less pain. To conduct a randomized, triple-blind, placebo-controlled study by standardizing dose of local anesthetic, to compare the effectiveness of intraperitoneal against intraincisional use of ropivacaine 0.2% for post-laparoscopic cholecystectomy pain relief. 294 patients underwent elective 4-port laparoscopic cholecystectomy. Patients were triple blindly randomized. All patients received ~ 23 ml of solution, of which 20 ml was given intraperitoneally (1 ml/cm; 16 ml along right hemi-dome and 4 ml in gall bladder fossa) and ~ 3 ml intraincisionally (1 ml/cm of length of incision). Solution was either normal saline or drug (0.2% ropivacaine) depending on the group [controls (n = 86), intraperitoneal group (n = 100), and intraincisional group (n = 108)]. 5 different pain scales were used for assessment of overall pain. Pain scores were assessed at 5 points of time. Patients in intraincisional group showed significantly less overall pain and rescue analgesia requirement (p  0.05); and shoulder pain was significantly less in intraperitoneal group (p < 0.05). The intraincisional use of injection ropivacaine at its minimum concentration of 0.2% in minimal doses of 1 ml/cm at the end of procedure provides significantly more post-operative analgesia as compared to intraperitoneal group and controls. However, for controlling shoulder pain, the use of intraperitoneal ropivacaine is desirable.

  15. 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.

  16. 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

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

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    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

  18. Impact of obesity on surgical outcome after single-incision laparoscopic cholecystectomy

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    Toru Obuchi

    2018-01-01

    Conclusion: Our findings show that obesity, intended as a BMI ≥30 kg/m2, does not have an adverse impact on the technical difficulty and post-operative outcomes of SILC. Obesity-related comorbidities did not increase the risks for SILC.

  19. 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.

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

    Science.gov (United States)

    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.

  1. 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...

  2. 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 .

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Pre-emptive intraperitoneal local anaesthesia: an effective method in immediate post-operative pain management and metabolic stress response in laparoscopic appendicectomy, a randomized, double-blinded, placebo-controlled study.

    Science.gov (United States)

    Thanapal, Mohana Raj; Tata, Mahadevan D; Tan, Ann J; Subramaniam, Thiruselvi; Tong, Jenny M G; Palayan, Kandasami; Rampal, Sanjay; Gurunathan, Ramesh

    2014-01-01

    Although laparoscopic surgeries are associated with reduced surgical stress response and shortened post-operative recovery, intense pain and high analgesia requirements in the immediate post-operative period are often the chief complaints. The aim of this study was to evaluate the effect of pre-emptive intraperitoneal local anaesthetic drugs on post-operative pain management and metabolic stress response in laparoscopic appendicectomy. The method used was a randomized double-blinded placebo-controlled study. Patients with clinical diagnosis of acute appendicitis who fulfil the criteria, were taken into this study. Primary outcomes investigated were consumption of patient-controlled analgesia during the immediate post-operative period (first 6 h) and subsequent 18 h as well as serum cortisol sampling. Total of 120 patients were recruited into three different treatment groups (placebo, ropivacaine, levobupivacaine). In order to maintain visual analogue score of 0-1 during the immediate post-operative period, patients in the placebo group required significantly (P metabolic stress response of the body. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  8. Laparoscopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperitoneal Gore-Tex mesh: prospective study and review of the literature.

    Science.gov (United States)

    Aura, Tamer; Habib, Elias; Mekkaoui, Mrine; Brassier, Didier; Elhadad, Andre

    2002-08-01

    Recurrence rates after repair of incisional and ventral hernias range from 18% to 52%. Prosthetic open repair has decreased this rate, but the wide fascial dissection it requires increases the complication rate. Laparoscopic repair is a safe and effective alternative. A prospective study was performed including 86 patients (63 women and 23 men) with a mean age of 54 years (range 29-79 years) having incisional or ventral hernias who underwent laparoscopic repair in our institution between July 1994 and October 2001. The majority of the patients were obese with a mean body mass index of 31.7 kg/m2. The abdominal wall defect size ranged from 2 X 1 cm to 20 X 13 cm. In all cases, a Gore-Tex mesh (Dual Mesh, W.L. Gore & Associates, Flagstaff, AZ, USA) was used in sizes ranging from 10 X 15 cm to 20 X 30 cm. Nineteen repairs were performed for recurrent hernias (12 incisional and 7 ventral). The mean operative time was 110.3 minutes (range 50-240 minutes). There was one open conversion (1.2%), one intraoperative complication (1.2%), and no deaths. There were no wound or mesh infections. Immediate postoperative complications occurred in 9 patients (10.6%) and late complications occurred in 16 patients (18.8%). The average hospital stay was 4.8 days (range 2-19 days). During a mean follow-up of 37 months (range 6-73 months), there were 6 hernia recurrences (7%). Laparoscopic repair of incisional hernia and ventral hernia appears to be safe, especially with the use of Gore-Tex mesh, and is proving to be effective as it decreases pain, complications, hospital stay, and recurrences.

  9. 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.

  10. 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

  11. Comparison of efficacy of intraperitoneal instillation of bupivacaine ...

    African Journals Online (AJOL)

    Comparison of efficacy of intraperitoneal instillation of bupivacaine alone with bupivacaine – fentanyl and bupivacaine –tramadol combination for alleviation of post-operative pain following laparoscopic cholecystectomy: a randomized prospective study.

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

    Science.gov (United States)

    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.

  13. 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.

  14. 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.

  15. Administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia pós-operatória em colecistectomias videolaparoscópicas Administración intraperitoneal de la mezcla con exceso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia postoperatoria en colecistectomías videolaparoscópicas Intraperitoneal administration of 50% enantiomeric excess (S75-R25 bupivacaine in postoperative analgesia of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    João Batista Santos Garcia

    2007-08-01

    40 pacientes sometidos a colecistectomía videolaparoscópica divididos en dos grupos: GI (n = 20 que recibió 80 mL de solución de bupivacaína S75-R25 a 0,125% intraperitoneal al final de la operación; y GII (n = 20 que recibió 80 mL de solución fisiológica a 0,9%. Los dos grupos recibieron 40 mg de tenoxican y 30 mg.kg-1 de dipirona, por vía venosa, poco antes del final de la operación. La analgesia en el postoperatorio (PO se hizo con tramadol. Se evaluaron las puntuaciones de dolor en reposo, al sentarse y en la maniobra de Valsalva, según la escala numérica al despertar y 2, 4, 8, 12 y 24 horas en el PO; la presencia de dolor en el hombro; el tiempo para la primera solicitación del analgésico y su consumo acumulativo. RESULTADOS: Hubo una diferencia estadística significativa entre los puntajes de dolor a las 12 horas en el PO con el paciente en reposo (GI BACKGROUND AND OBJECTIVES: The analgesic effect of intraperitoneal administration of local anesthetics after laparoscopic cholecystectomy is a controversial issue, and the results described vary from considerable pain relief to little reduction in pain. The objective of this study was to evaluate the efficacy of the intraperitoneal administration of 50% enantiomeric excess bupivacaine (S75-R25 for the postoperative pain relief of laparoscopic cholecystectomy. METHODS: A randomized, double blind, placebo controlled study was conducted with 40 patients undergoing laparoscopic cholecystectomy, who were divided in two groups: GI (n = 20 received 80 mL of intraperitoneal 0,125% S75-R25 bupivacaine at the end of the procedure; and GII (n = 20 received 80 mL of intraperitoneal normal saline. Both groups received 40 mg of tenoxicam and 30 mg.kg-1 of intravenous dypirone shortly before the end of the surgery. Tramadol was used for postoperative analgesia (PO. Pain scores were evaluated at rest, sitting up, and during the Valsalva maneuver, according to a numeric scale upon waking up and 2, 4, 8, 12, and 24

  16. 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.

  17. 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.

  18. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair.

    Science.gov (United States)

    Yang, George Pei Cheung

    2017-05-01

    Laparoscopic repair for ventral and incisional hernias was first reported in the early 1990s. It uses intraperitoneal only mesh placement to achieve a tension-free repair of the hernia. However, in recent years, there has been greater concern about long-term complication involving intraperitoneal mesh placement. Many case reports and case series have found evidence of mesh adhesion, mesh fistulation, and mesh migration into hollow organs including the esophagus, small bowel, and large bowel, resulting in various major acute abdominal events. Subsequent management of these complications may require major surgery that is technically demanding and difficult; in such cases, laparotomy and bowel resection have often been performed. Because of these significant, but not common, adverse events, many surgeons favor open sublay repair for ventral and incisional hernias. Investigators are therefore searching for a laparoscopic approach for ventral and incisional hernias that might overcome the mesh-induced visceral complications seen after intraperitoneal only mesh placement repair. Laparoscopic preperitoneal onlay mesh is one such approach. This article will explore the fundamental of intraperitoneal only mesh placement and its problems, the currently available peritoneal visceral-compatible meshes, and upcoming developments in laparoscopic ventral and incisional hernia repair. The technical details of preperitoneal onlay mesh, as well as its potential advantages and disadvantages, will also be discussed. © 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  19. FIRST SINGLE-PORT LAPAROSCOPIC PANCREATECTOMY IN BRAZIL

    Directory of Open Access Journals (Sweden)

    Marcel Autran Cesar MACHADO

    2013-12-01

    Full Text Available Context Pancreatic surgery is an extremely challenging field, and the management of pancreatic diseases continues to evolve. In the past decade, minimal access surgery is moving towards minimizing the surgical trauma by reducing numbers and size of the port. In the last few years, a novel technique with a single-incision laparoscopic approach has been described for several laparoscopic procedures. Objectives We present a single-port laparoscopic spleen-preserving distal pancreatectomy. To our knowledge, this is the first single-port pancreatic resection in Brazil and Latin America. Methods A 33-year-old woman with neuroendocrine tumor underwent spleen-preserving distal pancreatectomy via single-port approach. A single-incision advanced access platform with gelatin cap, self-retaining sleeve and wound protector was used. Results Operative time was 174 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. Conclusions Single-port laparoscopic spleen-preserving distal pancreatectomy is feasible and can be safely performed in specialized centers by skilled laparoscopic surgeons.

  20. Recent technological advancements in laparoscopic surgical instruments

    Science.gov (United States)

    Subido, Edwin D. C.; Pacis, Danica Mitch M.; Bugtai, Nilo T.

    2018-02-01

    Laparoscopy was a progressive step to advancing surgical procedures as it minimised the scars left on the body after surgery, compared to traditional open surgery. Many years later, single-incision laparoscopic surgery (SILS) was created where, instead of having multiple incisions, only one incision is made or multiple small incisions in one location. SILS, or laparoendoscopic single-site surgery (LESS), may produce lesser scars but drawbacks for the surgeons are still present. This paper aims to present related literature of the recent technological developments in laparoscopic tools and procedure particularly in the vision system, handheld instruments. Tech advances in LESS will also be shown. Furthermore, this review intends to give an update on what has been going on in the surgical robot market and state which companies are interested and are developing robotic systems for commercial use to challenge Intuitive Surgical's da Vinci Surgical System that currently dominates the market.

  1. 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.

  2. Systemic Toxicity of Intraperitoneal Vancomycin

    OpenAIRE

    Kumar, Teerath; Teo, Iris; McCormick, Brendan B.

    2016-01-01

    Intraperitoneal vancomycin is used for empiric treatment of peritoneal dialysis peritonitis. It is dosed intermittently and a high systemic concentration is often achieved. Despite this, there are very few reports of systemic toxicity from intraperitoneal vancomycin. We report the course of a patient who developed a drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after three weeks of intraperitoneal vancomycin. We review the literature and conclude that this is the firs...

  3. 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

  4. Implementation and usefulness of single access laparoscopic segmental and total colectomy.

    LENUS (Irish Health Repository)

    Baig, Muhammad N

    2012-02-06

    Aim:  Single access laparoscopic surgery is a recent vogue in the field of minimally invasive colorectal surgery. While selected series have indicated feasibility, we prospectively examined its usefulness for resectional surgery in routine practice. Method:  All patients undergoing laparoscopic colorectal resection over a twelve month period were considered for a single access approach by a single surgical team in a university hospital. This utilised a \\'Glove\\' port via a 3-5 cm periumbilical or stomal site incision with standard rigid laparoscopic instruments then being used. Results:  Of 74 planned laparoscopic colorectal resections, 35 (47%) were performed by this single incision laparoscopic modality without disruption of theatre list efficiency or surgical training obligations. The mean (range) age and BMI of these 25 consecutive right sided resections, 8 total colectomies (7 urgent operations) and 2 anterior resections was 58 (22-82) years and 23.9 (18.6-36.2) kg\\/m(2) respectively. The modal postoperative day of discharge was 4. For right sided resections, the mean (range) post-op stay in those undergoing surgery for benign disease was 4, while for those undergoing operation for neoplasia (n=18, mean age 71 years) it was 5.8 days and the average lymph node harvest was 13. Use of the glove port reduced trocar cost by 58% (€60\\/£53) by allowing use of trocar sleeves alone without obturators. Conclusion:  Single incision laparoscopic surgery is an effective option for abdominal surgery and seems especially suited for laparoscopic-assisted right sided colonic resections. The Glove port technique facilitates procedural frequency and familiarity and proves economically favourable.

  5. 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.

  6. 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.

  7. 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.

  8. 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).

  9. Single access laparoscopic cholecystectomy: technique without the need for special materials and with better ergonomics

    Directory of Open Access Journals (Sweden)

    Marco Aurélio Lameirão Pinto

    Full Text Available The authors describe a surgical technique which allows, without increasing costs, to perform laparoscopic cholecystectomy with a single incision, without using specific materials and with better surgical ergonomics. The technique consists of a longitudinal umbilical incision, navel detachment, use of a permanent 10mm trocar and two clamps directly and bilaterally through the aponeurosis without the use of 5mm trocars, transcutaneous gallbladder repair with straight needle cotton suture, ligation with unabsorbable suture and umbilical incision for the specimen extraction. The presented technique enables the procedure with conventional and permanent materials, improving surgical ergonomics, with safety and aesthetic advantages.

  10. 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.

  11. 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.

  12. Intraperitoneal explosion following gastric perforation

    OpenAIRE

    K. Mansfield, Scott; Roderick Borrowdale, Roderick Borrowdale

    2017-01-01

    The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.

  13. Intraperitoneal explosion following gastric perforation.

    Science.gov (United States)

    Mansfield, Scott K; Borrowdale, Roderick

    2014-04-01

    The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring. Copyright © 2012. Published by Elsevier B.V.

  14. Intraperitoneal explosion following gastric perforation

    Directory of Open Access Journals (Sweden)

    Scott K. Mansfield

    2014-04-01

    Full Text Available The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.

  15. Laparoscopic Appendectomy.

    Science.gov (United States)

    1992-04-14

    since it can be used across the cecum. I see decreased post -operative convalescence as being the greatest benefit of laparoscopic appendectomy...with laparoscopic cholecystectomies , this surgical approach has distinct advantages over the traditional appendectomy. Benefits include decrease in...and a sterile dressing. Patients receive three peri- operative doses of a second generation cephalosporin and are given a clear liquid diet as

  16. Intraperitoneal pressure in peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Vicente Pérez Díaz

    2017-11-01

    Full Text Available The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal dialysis units. This review aims to disseminate the usefulness of measuring intraperitoneal pressure. This measurement is performed in supine before initiating the drain of a manual exchange with “Y” system, by raising the drain bag and measuring from the mid-axillary line the height of the liquid column that rises from the patient. With typical values of 10–16 cm H2O, intraperitoneal pressure should never exceed 18 cm H2O. With basal values that depend on body mass index, it increases 1–3 cm H2O/L of intraperitoneal volume, and varies with posture and physical activity. Its increase causes discomfort, sleep and breathing disturbances, and has been linked to the occurrence of leaks, hernias, hydrothorax, gastro-esophageal reflux and enteric peritonitis. Less known and valued is its ability to decrease the effectiveness of dialysis significantly counteracting ultrafiltration and decreasing solute clearance to a smaller degree. Because of its easy measurement and potential utility, should be monitored in case of ultrafiltration failure to rule out its eventual contribution in some patients. Although not yet mentioned in the clinical practice guidelines for PD, its clear benefits justify its inclusion among the periodic measurements to consider for prescribing and monitoring peritoneal dialysis. Resumen: La medida de la presión intraperitoneal en diálisis peritoneal es muy sencilla y aporta claros beneficios terapéuticos. Sin embargo, su monitorización todavía no se ha generalizado en las unidades de diálisis peritoneal de adultos. Esta revisión pretende divulgar su conocimiento y la utilidad de su medida. Se realiza en decúbito antes de iniciar el drenaje de un intercambio manual con bolsa en Y, elevando la bolsa de

  17. Laparoscopic herniorrhaphy.

    Science.gov (United States)

    Swanstrom, L L

    1996-06-01

    There is little doubt that laparoscopic herniorrhaphy has assumed a place in the pantheon of hernia repair. There is also little doubt that further work needs to be done to determine the exact role that laparoscopic hernia repair should play in the surgical armamentarium. Hernias have been surgically treated since the early Greeks. In contrast, laparoscopic hernia repair has a history of only 6 years. Even within that short time, laparoscopic hernia repair techniques have not remained unchanged. This is obviously a technique in evolution, as indicated by the abandonment of early repairs ("plug and mesh" and IPOM) and the gradual gain in pre-eminence of the TEP repair. During the same time frame, surgery itself has evolved into a discipline more concerned with cost-effectiveness, outcomes, and "consumer acceptance." Confluence of these two developments has led to a situation in which traditional concerns regarding surgical procedures (i.e., recurrence rates or complication rates) assume less of a role than cost-effectiveness, learnability, marketability, and medical-legal considerations. No surgeon, whether practicing in a academic setting or a private practice, is exempt from these pressures. Laparoscopic hernia repair therefore seems to fit into a very specialized niche. In our community, the majority of general surgeons are only too happy to not do laparoscopic hernia repairs. On the other hand, in our experience, certain indications do seem to cry out for a laparoscopic approach. At our own center we have found that laparoscopic repairs can indeed be effective, and even cost-effective, under specific circumstances. These include completing a minimal learning curve, utilizing the properitoneal approach, minimizing the use of reusable instruments, using dissecting balloons as a time-saving device, and very specific patient selection criteria. At present these include patients with bilateral inguinal hernias on clinical examination, patients with recurrent

  18. Comparison between single and three portal laparoscopic splenectomy in dogs

    Directory of Open Access Journals (Sweden)

    Khalaj Alireza

    2012-09-01

    Full Text Available Abstract Background Single incision laparoscopic surgery (SILS is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS with three portal (Conventional laparoscopic splenectomy in dogs. Mongrel dogs (n = 18, weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional. The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Results All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P  Conclusion This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional for splenectomy in dog.

  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. Pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter: a single institution experience.

    Science.gov (United States)

    Fu, Weijun; Zhang, Xu; Zhang, Xiaoyi; Zhang, Peng; Gao, Jiangping; Dong, Jun; Chen, Guangfu; Xu, Axiang; Ma, Xin; Li, Hongzhao; Shi, Lixin

    2014-01-01

    To report our experience of pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter, seven patients (one bilateral) with symptomatic congenital megaureter underwent pure laparoscopic or robot-assisted laparoscopic surgery. The megaureter was exposed at the level of the blood vessel and was isolated to the bladder narrow area. Extreme ureter trim and submucosal tunnel encapsulation or papillary implantations and anti-reflux ureter bladder anastomosis were performed intraperitoneally by pure laparoscopic or robot-assisted laparoscopic surgery. The clinical data of seven patients after operation were analyzed, including the operation time, intraoperative complications, intraoperative bleeding volumes, postoperative complications, postoperative hospitalization time and pathological results. All of the patients were followed. The operation was successfully performed in seven patients. The mean operation times for pure laparoscopic surgery and robotic-assistant laparoscopic surgery were 175 (range: 150-220) and 187 (range: 170-205) min, respectively, and the mean operative blood loss volumes were 20 (range: 10-30) and 28.75 (range: 15-20) ml, respectively. There were no intraoperative complications. The postoperative drainage time was 5 (range: 4-6) and 5.75 (range: 5-6) d, respectively, and the indwelling catheter time was 6.33 (range: 4-8) d and 7 (range: 7-7) d, respectively. The postoperative hospitalization time was 7.67 (range: 7-8) d and 8 (range: 7-10) d, respectively. There was no obvious pain, no secondary bleeding and no urine leakage after the operation. Postoperative pathology reports revealed chronic urothelial mucosa inflammation. The follow-up results confirmed that all patients were relieved of their symptoms. Both pure laparoscopic and robot-assisted laparoscopic surgery using different anti-reflux ureter bladder anastomoses are safe and effective approaches in the minimally invasive treatment of congenital

  1. [Postoperative intraperitoneal complications in colon cancer surgery].

    Science.gov (United States)

    Erokhina, E A; Topuzov, É G; Topuzov, É É

    2014-01-01

    The authors studied the clinical characteristics and terms of the development of postoperative intraperitoneal complications in patients undergoing colon cancer surgery. It was stated, that the diversity of clinical data depended on complication characteristics. Results of investigation allowed defining of the most dangerous terms of intraperitoneal complications and risk factors.

  2. Training value of laparoscopic colorectal videos on the World Wide Web: a pilot study on the educational quality of laparoscopic right hemicolectomy videos.

    Science.gov (United States)

    Celentano, V; Browning, M; Hitchins, C; Giglio, M C; Coleman, M G

    2017-11-01

    Instructive laparoscopy videos with appropriate exposition could be ideal for initial training in laparoscopic surgery, but unfortunately there are no guidelines for annotating these videos or agreed methods to measure the educational content and the safety of the procedure presented. Aim of this study is to systematically search the World Wide Web to determine the availability of laparoscopic colorectal surgery videos and to objectively establish their potential training value. A search for laparoscopic right hemicolectomy videos was performed on the three most used English language web search engines Google.com, Bing.com, and Yahoo.com; moreover, a survey among 25 local trainees was performed to identify additional websites for inclusion. All laparoscopic right hemicolectomy videos with an English language title were included. Videos of open surgery, single incision laparoscopic surgery, robotic, and hand-assisted surgery were excluded. The safety of the demonstrated procedure was assessed with a validated competency assessment tool specifically designed for laparoscopic colorectal surgery and data on the educational content of the video were extracted. Thirty-one websites were identified and 182 surgical videos were included. One hundred and seventy-three videos (95%) detailed the year of publication; this demonstrated a significant increase in the number of videos published per year from 2009. Characteristics of the patient were rarely presented, only 10 videos (5.4%) reported operating time and only 6 videos (3.2%) reported 30-day morbidity; 34 videos (18.6%) underwent a peer-review process prior to publication. Formal case presentation, the presence of audio narration, the use of diagrams, and snapshots and a step-by-step approach are all characteristics of peer-reviewed videos but no significant difference was found in the safety of the procedure. Laparoscopic videos can be a useful adjunct to operative training. There is a large and increasing amount of

  3. Laparoscopic pyeloplasty.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-01-01

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

  4. Abdominal wall fibromatosis associated with previous laparoscopic hernia repair.

    Science.gov (United States)

    Brown, S B F; MacDuff, E; O'Dwyer, P J

    2013-10-01

    Two cases of desmoid-type fibromatosis developing after laparoscopic hernia repair are described: one in a young male 3 years after laparoscopic umbilical hernia repair and the other in a young female 1 year after laparoscopic incisional hernia repair. The male patient presented with a slowly enlarging non-tender firm abdominal wall mass; the female patient had similar findings. Excision biopsy in the male and core biopsy in the female were consistent with fibromatosis. The young male patient underwent resection of the fibromatosis, and the female patient has been managed conservatively. These are the first documented cases of fibromatosis developing after laparoscopic hernia surgery. Whilst the safety of hernia meshes has been assessed in animal studies, it may be that more detailed study of intraperitoneal placement of these meshes is required.

  5. Laparoscopic Choledochoduodenostomy.

    Science.gov (United States)

    Cuendis-Velázquez, Adolfo; E Trejo-Ávila, Mario; Rosales-Castañeda, Enrique; Cárdenas-Lailson, Eduardo; E Rojano-Rodríguez, Martin; Romero-Loera, Sujey; A Sanjuan-Martínez, Carlos; Moreno-Portillo, Mucio

    Today's options for biliary bypass procedures, for difficult choledocholithiasis, range from open surgery to laparo-endoscopic hybrid procedures. The aim of this study was to analyze the outcomes of patients with difficult choledocholithiasis treated with laparoscopic choledochoduodenostomy. We performed a prospective observational study from March 2011 to June 2016. We included patients with difficult common bile duct stones (recurrent or unresolved by ERCP) in which a biliary bypass procedure was required. We performed a laparoscopic bile duct exploration with choledochoduodenostomy and intraoperative cholangioscopy. A total of 19 patients were included. We found female predominance (78.9%), advanced mean age (72.4±12 years) and multiple comorbidities. Most patients with previous episodes of choledocholitiasis or cholangitis, mode 1 (min-max: 1-7). Mean common bile duct diameter 24.9±7mm. Mean operative time 218.5±74min, estimated blood loss 150 (30-600)mL, resume of oral intake 3.2±1 days, postoperative length of stay 4.9±2 days. We found a median of 18 (12-32) months of follow-up. All patients with normalization of liver enzymes during follow-up. One patient presented with sump syndrome and one patient died due to nosocomial pneumonia. Laparoscopic choledochoduodenostomy with intraoperative cholangioscopy seems to be safe and effective treatment for patients with difficult common bile duct stones no resolved by endoscopic procedures. This procedure is a good option for patients with advanced age and multiple comorbidities. We offer all the advantages of minimally invasive surgery to these patients. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. 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.

  7. 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

  8. Laparoscopic Splenectomy

    International Nuclear Information System (INIS)

    Javed, I.; Malik, A. A.; Khan, A.; Shamim, R.; Allahnawaz, A.; Ayaaz, M.

    2014-01-01

    Patients undergoing laparoscopic splenectomy were observed for their postoperative recovery and development of complications. It was a retrospective analysis done at Services Hospital and National Hospital and Medical Center, Lahore, from January 2010 to December 2012. A total of 13 patients underwent laparoscopic splenectomy and were included in the study. Patients were followed for their postoperative recovery and development of any complications. The median age of patients was 19 years ranging from 13 to 69 years. Accessory spleens were removed in 3 patients. Mean operating time was 158 minutes. One operation had to be converted to open because of uncontrolled hemorrhage. Six patients experienced postoperative complications including unexplained hyperpyrexia (n=2), pleural effusion (n=4) and prolonged pain > 48 hours (n=1). No deaths or infections were seen. Seven out of 8 patients with idiopathic thrombocytopenic purpura developed a positive immediate response to the splenectomy, defined as a platelet count greater than 100 x 109/L after the surgery, which was maintained without medical therapy. Mean hospital stay was 5.5 days. Average time to return to activity was 15 days. All patients were followed for 6 months and no follow-up complications were noted. (author)

  9. Adnexal Masses Treated Using a Combination of the SILS Port and Noncurved Straight Laparoscopic Instruments: Turkish Experience and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Polat Dursun

    2013-01-01

    Full Text Available Objective. To report our experience treating adnexal masses using a combination of the SILS port and straight nonroticulating laparoscopic instruments. Study Design. This prospective feasibility study included 14 women with symptomatic and persistent adnexal masses. Removal of adnexal masses via single-incision laparoscopic surgery using a combination of the SILS port and straight nonroticulating laparoscopic instruments was performed. Results. All of the patients had symptomatic complex adnexal masses. Mean age of the patients was 38.4 years (range: 21–61 years and mean duration of surgery was 71 min (range: 45–130 min. All surgeries were performed using nonroticulating straight laparoscopic instruments. Mean tumor diameter was 6 cm (range: 5–12 cm. All patient pathology reports were benign. None of the patients converted to laparotomy. All the patients were discharged on postoperative d1. Postoperatively, all the patients were satisfied with their incision and cosmetic results. Conclusion. All 14 patients were successfully treated using standard, straight nonroticulating laparoscopic instruments via the SILS port. This procedure can reduce the cost of treatment, which may eventually lead to more widespread use of the SILS port approach. Furthermore, concomitant surgical procedures are possible using this approach. However, properly designed comparative studies with single port and classic laparoscopic surgery are urgently needed.

  10. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Amir Abu Zikry

    2011-01-01

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

  11. Intraperitoneal stone migration during percutaneos nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Akif Diri

    2014-12-01

    Full Text Available Percutaneos nephrolithotomy (PNL is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL.

  12. Adjuvant Bidirectional Chemotherapy Using an Intraperitoneal Port

    Directory of Open Access Journals (Sweden)

    Paul H. Sugarbaker

    2012-01-01

    Full Text Available Cytoreductive surgery (CRS and hyperthermic intraperitoneal chemotherapy (HIPEC have been established as treatment options for patients with peritoneal metastases or peritoneal mesothelioma. However, this novel treatment strategy remains associated with a large percentage of local-regional treatment failures. These treatment failures are attributed to the inadequacy of HIPEC to maintain a surgical complete response. Management strategies to supplement CRS and HIPEC are indicated. A simplified approach to the intraoperative placement of an intraperitoneal port for adjuvant bidirectional chemotherapy (ABC was devised. Four different chemotherapy treatment plans were utilized depending upon the primary site of the malignancy. Thirty-one consecutive patients with an intraoperative placement of the intraperitoneal port were available for study. The incidence of adverse events that caused an early discontinuation of the bidirectional chemotherapy occurred in 75% of the 8 patients who had an incomplete cytoreduction and in 0% of patients who had a complete cytoreduction. All of the patients who had complete cytoreduction completed at least 5 of the scheduled 6 bidirectional chemotherapy treatments. Adjuvant bidirectional chemotherapy is possible following a major cytoreductive surgical procedure using a simplified method of intraoperative intraperitoneal port placement.

  13. Comparison between single and three portal laparoscopic splenectomy in dogs

    Science.gov (United States)

    2012-01-01

    Background Single incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n = 18), weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Results All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min) and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P hernia formation and dehiscence up to one month after surgery. Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches. Conclusion This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional) for splenectomy in dog. PMID:22963734

  14. Laparoscopic Spine Surgery

    Science.gov (United States)

    ... Global Affairs and Humanitarian Efforts Log In Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Laparoscopic Spine Surgery Your spine surgeon has determined that you ...

  15. Laparoscopic Spleen Removal (Splenectomy)

    Science.gov (United States)

    ... Affairs and Humanitarian Efforts Login Laparoscopic Spleen Removal (Splenectomy) Patient Information from SAGES Download PDF Find a ... are suspected. What are the Advantages of Laparoscopic Splenectomy? Individual results may vary depending on your overall ...

  16. [Laparoscopic hysterectomy and training].

    Science.gov (United States)

    Tomov, S; Gorchev, G

    2012-01-01

    Mastering and perception of laparoscopic hysterectomy by gynecologists is a slow process because of the learners' insufficient experience and inadequate training, lack of hospital equipment and the low levels of reimbursement. Analysing science literature data and their own 7-year experience (2004-2011), the authors suggest a training program for laparoscopic gynecological surgery. The process of education for laparoscopic hysterectomy implementation has to be performed at highly specialized centers by highly qualified specialists in accordance with strict principles and strict sequence. After mastering all the laparoscopic approaches to hysterectomy, laparoscopic hysterectomy has to be a method of choice among the methods used by the contemporary gynecologic surgeon.

  17. A suicide involving intraperitoneal injection of pentobarbital.

    Science.gov (United States)

    Hangartner, Sarah; Steiner, Jasmin; Dussy, Franz; Moeckli, Regula; Gerlach, Kathrin; Briellmann, Thomas

    2016-09-01

    We present an unusual case of suicide by intraperitoneal injection of pentobarbital, an overdose of zolpidem and the intake of diazepam, ethanol and other psychoactive substances. The autopsy and specimen collection were conducted in a 10 to 18 h postmortem interval. The toxicological analysis revealed a significantly higher pentobarbital concentration in femoral blood compared to cardiac blood (36 vs. 15 mg/L). On the contrary, zolpidem and diazepam concentrations in cardiac blood (2700 and 590 µg/L) were found to be significantly higher than in femoral blood (1500 and 230 µg/L). These findings point to a postmortem redistribution with a distinct gradient from areas of high drug concentrations in the gastrointestinal tract (zolpidem and diazepam) and the injection site (pentobarbital) to peripheral tissue. Ethanol concentration was 0.95 ‰ which amplified the CNS depression. The choice of this unusual suicide method was associated with the deceased's former job as a veterinarian's assistant. In veterinary medicine, the intraperitoneal injection of a lethal dose of pentobarbital is quite commonly performed to euthanise small animals. Intraperitoneal injection is rare as route of administration in humans.

  18. Characterisation and Safety of Intraperitoneal Perioperative Administration of Antibacterial Agents

    DEFF Research Database (Denmark)

    Fonnes, Siv; Holzknecht, Barbara Juliane; Arpi, Magnus

    2017-01-01

    Background Intraperitoneal drug administration applies treatment at the site of diseases with gynaecological, urological, or gastrointestinal origin. The objective of this systematic review was to investigate perioperative intraperitoneal administration of antibacterial agents to characterise...... event was discomfort or pain during administration, especially with use of oxytetracycline. Conclusion At least 12 different classes of antibacterial agents have been administered intraperitoneally during or after surgery as prophylaxis or treatment of intraabdominal infections. Intraperitoneal...... administration seems safe although use of oxytetracycline may cause discomfort or pain....

  19. Impact of laparoscopic surgery on stress responses, immunofunction, and risk of infectious complications

    DEFF Research Database (Denmark)

    Kehlet, H; Nielsen, Hans Jørgen

    1998-01-01

    a reduction in wound complications, whereas the sparse data on intraperitoneal infections and sepsis are not conclusive. Thus, laparoscopic surgery modifies the injury response and reduces the risk of infectious complications. If integrated into an accelerated rehabilitation program, further improvement may...

  20. Hand-assisted laparoscopic splenectomy

    NARCIS (Netherlands)

    Bemelman, W. A.; de Wit, L. T.; Busch, O. R.; Gouma, D. J.

    2000-01-01

    Laparoscopic splenectomy is performed routinely in patients with small and moderately enlarged spleens at specialized centers. Large spleens are difficult to handle laparoscopically and hand-assisted laparoscopic splenectomy might facilitate the procedure through enhanced vascular control, easier

  1. 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

  2. Laparoscopic splenectomy: Current concepts

    Science.gov (United States)

    Misiakos, Evangelos P; Bagias, George; Liakakos, Theodore; Machairas, Anastasios

    2017-01-01

    Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes. PMID:28979707

  3. Sealed Orifice Laparoscopic or Endoscopic (SOLE) Surgery: technology and technique convergence for next-step colorectal surgery.

    LENUS (Irish Health Repository)

    Cahill, R A

    2012-02-01

    The new avenue of minimally invasive surgery, referred to as single-incision\\/access laparoscopy, is often presented as an alternative to standard multiport approaches, whereas in fact it is more usefully perceived as a complementary modality. The emergence of the technique can be of greater use both to patients and to the colorectal specialty if its principles can be merged into next-stage evolution by synergy with more conventional practice. In particular, rather than device specificity, what is needed is convergence of capability that can be applied by the same surgeon in differing scenarios depending on the individualized patient and disease characteristics. We detail here the global applicability of a simple access device construct that allows the provision of simple and complex single-port laparoscopy as well as contributing to multiport laparoscopic and transanal resections in a manner that is reliable, reproducible, ergonomical and economical.

  4. The Impact of 0.9% NaCl on Mesothelial Cells After Intraperitoneal Lavage During Surgical Procedures.

    Science.gov (United States)

    Cwaliński, Jarosław; Bręborowicz, Andrzej; Połubińska, Alicja

    2016-01-01

    Normal saline gained wide popularity in abdominal surgery as a basic compound used in intraoperative drainage of the peritoneal cavity. However, recent studies have revealed that saline solution is not quite biocompatible with the intraperitoneal enviroment and may promote peritoneal adhesions. The aim of the study was to evaluate the function and viability of human mesothelial cells cultured in vitro in 0.9% NaCl solution from intraperitoneal lavage carried out during laparoscopic cholecytectomies. The study included 40 consecutive patients suffering from gallstones who underwent laparoscopic cholecystectomy. Fluid was collected after intraperitoneal lavage during the surgical procedures. The samples obtained were used as a medium for in vitro incubation of primary human mesothelial cells. After 24 h the synthesis of interleukin 6 (IL-6), plasminogen activator inhibitor (PAI) and tissue plasminogen activator (tPA), as well as the index of cell proliferation were assessed in all the experimental groups. All the mesothelium cell cultures treated with fluid samples obtained ex vivo were characterized by elevated levels of IL-6. The highest concentrations of PAI-1 were found in groups of cells exposed to fluid with bile; similarly, tPA synthesis was extremely elevated in groups treaded with fluid containing bile and small amounts of hemolyzed blood. In contrast, cell proliferation was exceedingly high in 2 groups of cells placed in a standard culture medium and in 0.9% NaCl solution. Normal saline introduced into the abdominal cavity modifies the biological and physicochemical conditions of the intraperitoneal environment. The impact of 0.9% NaCl on mesothelial cells is manifested in destabilized tissue regeneration, which supposedly initiates adhesion formation.

  5. Principles of safe abdominal entry in laparoscopic gynecologic surgery

    Directory of Open Access Journals (Sweden)

    Jongrak Thepsuwan

    2013-11-01

    Full Text Available Laparoscopic gynecologic surgery has been widely used with a range of benefits. However, there are complications that are related to the abdominal entry process. Serious complications are gastrointestinal tract and major blood vessel injuries. This review introduces the recent available literature to prevent and eliminate the laparoscopic entry complications. The open entry technique is associated with a significant reduction of failed entry, compared to the closed entry technique; however there is no difference in the incidence of visceral or vascular injury. Laparoscopic entry by the left upper abdomen (i.e., Palmer's point or the middle upper abdomen (i.e., the Lee-Huang point could be considered in patients with suspected periumbilical adhesions or a history of umbilical hernia, or after three failed attempts of insufflation at the umbilicus. The Lee-Huang point has its own benefit for the operative laparoscopy in large pelvic pathologies and gynecology malignancy cases. The angle of Veress needle insertion varies from 45° in nonobese women to 90° in extraordinarily obese women. The high intra-peritoneal pressure entries, which range from 20 mmHg to 25 mmHg, minimize the risk of vascular injury. Therefore, this will not adversely affect the cardiopulmonary function in healthy women. The Veress intraperitoneal pressure (<10 mmHg is a reliable indicator of correct intraperitoneal placement of the Veress needle. The elevation of anterior abdominal wall for placement of a Veress needle increases the risks of failed entry and shows no advantage in regard to vascular or visceral complications. Surgeons should continue to increase their knowledge of anatomy, their training, and their experience to decrease laparoscopic complications.

  6. CT evaluation of the intraperitoneal fluid distribution

    Energy Technology Data Exchange (ETDEWEB)

    Wojtowicz, J.; Rzymski, K.; Czarnecki, R.

    1982-07-01

    The intraperitoneal distribution of fluid and its detectability with a CT scanning were investigated in 13 patients during infusion of dialysate for peritoneal dialysis. An ascending pattern of spread i.e. from the lesser pelvis through the inframesocolic compartment to the supramesocolic compartment prevailed. Accumulation of fluid in the perihepatic space and in Morison's pouch as a function of fluid volume is at best approximated by a parabolic curve. Fifty to two hundred fifty ml. of fluid were detectable with a CT scanning in supine position in the majority of cases within the perihepatic space and Morison's pouch. The lowest amount of fluid detectable in the peritoneal cavity - 25 ml. was found between the anterior abdominal wall and bowel loops in right decubitus.

  7. SILS: Is It Cost- and Time-Effective Compared to Standard Pediatric Laparoscopic Surgery?

    Science.gov (United States)

    Islam, Saidul; Adams, Stephen D; Mahomed, Anies A

    2012-01-01

    The aim of the study was to review our experience with single-incision laparoscopic surgery (SILS) and to compare costs and operative time to standard laparoscopic surgery (SLS). A prospectively collected database of operative times and costs was analysed for the years 2008-2011. SILS cases were compared to standard laparoscopy on a procedure-matched basis. Patient demographics, on-table time and consumable costs were collated. Descriptive statistics and Mann-Whitney U-test were utilized with SPSS for windows. Analysis of the data demonstrate that neither consumable costs nor operative time were significantly different in each group. Comparing operative costs, SILS appendicectomy, nephrectomy/heminephrectomy, and ovarian cystectomy/oophorectomy showed cost benefit over SLS (£397 versus £467; £942 versus £1127; £394 versus £495). A trend toward higher cost for SILS Palomo procedure is noted (£734 versus £400). Operative time for SILS appendicectomy, nephrectomy/heminephrectomy, and Palomo was lower compared to SLS (60 versus 103 minutes[mins.]; 130 versus 60 mins.; 60 versus 80 mins.). In conclusion, SILS appears to be cost-effective for the common pediatric surgical operations. There is no significant difference in operating time in this series, but small sample size is a limiting factor. Studies with larger numbers will be necessary to validate these initial observations.

  8. Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience.

    Science.gov (United States)

    Nagendran, Myura; Toon, Clare D; Davidson, Brian R; Gurusamy, Kurinchi Selvan

    2014-01-17

    taken for task completion was significantly shorter in the box trainer group than the control group (8 trials; 249 participants; SMD -0.48 seconds; 95% CI -0.74 to -0.22). Compared with the control group, the box trainer group also had lower error score (3 trials; 69 participants; SMD -0.69; 95% CI -1.21 to -0.17), better accuracy score (3 trials; 73 participants; SMD 0.67; 95% CI 0.18 to 1.17), and better composite performance scores (SMD 0.65; 95% CI 0.42 to 0.88). Three trials reported movement distance but could not be meta-analysed as they were not in a format for meta-analysis. There was significantly lower movement distance in the box model training compared with no training in one trial, and there were no significant differences in the movement distance between the two groups in the other two trials. None of the remaining secondary outcomes such as mortality and morbidity were reported in the trials when animal models were used for assessment of training, error in movements, and trainee satisfaction. Different methods of box training: One trial (36 participants) found significantly shorter time taken to complete the task when box training was performed using a simple cardboard box trainer compared with the standard pelvic trainer (SMD -3.79 seconds; 95% CI -4.92 to -2.65). There was no significant difference in the time taken to complete the task in the remaining three comparisons (reverse alignment versus forward alignment box training; box trainer suturing versus box trainer drills; and single incision versus multiport box model training). There were no significant differences in the error score between the two groups in any of the comparisons (box trainer suturing versus box trainer drills; single incision versus multiport box model training; Z-maze box training versus U-maze box training). The only trial that reported accuracy score found significantly higher accuracy score with Z-maze box training than U-maze box training (1 trial; 16 participants; SMD 1

  9. [Laparoscopic treatment of ovarian cysts. Indications, techniques, results. Apropos of 650 cases].

    Science.gov (United States)

    Bruhat, M A; Mage, G; Bagory, G; Canis, M; Pouly, J L; Wattiez, A; Chapron, C; Laberge, P

    1991-01-01

    Laparoscopic management of annexes is now accepted as alternative to classical management by laparotomy. However, a careful pre-operative evaluation, including clinical and ultrasonographic examination is of ut most importance in order to exclude malignant lesion which should be treated by laparotomy. The laparoscopic treatment includes several procedures: intra-peritoneal cystectomy, extra-abdominal cystectomy, oaphorectomy and adnexectomy. These procedures and used according to the laparoscopic diagnosis. About 652 cases managed by laparoscopy, we can concluded: laparoscopic diagnosis of benign lesion is reliable (positive predictive value 100%); most of benign ovarian cysts can be treated by laparoscopy, from 89 to 97% of the benign adnexal cysts; complications are uncommon (8 cases out of 616 patients); the recurrence risk appears to be low (only 2.7% in patients treated for a non endometriotic adnexal cysts).

  10. Cannabinoid Disposition After Human Intraperitoneal Use: An Insight Into Intraperitoneal Pharmacokinetic Properties in Metastatic Cancer.

    Science.gov (United States)

    Lucas, Catherine J; Galettis, Peter; Song, Shuzhen; Solowij, Nadia; Reuter, Stephanie E; Schneider, Jennifer; Martin, Jennifer H

    2018-01-06

    Medicinal cannabis is prescribed under the provision of a controlled drug in the Australian Poisons Standard. However, multiple laws must be navigated in order for patients to obtain access and imported products can be expensive. Dose-response information for both efficacy and toxicity pertaining to medicinal cannabis is lacking. The pharmacokinetic properties of cannabis administered by traditional routes has been described but to date, there is no literature on the pharmacokinetic properties of an intraperitoneal cannabinoid emulsion. A cachectic 56-year-old female with stage IV ovarian cancer and peritoneal metastases presented to hospital with fevers, abdominal distension and severe pain, vomiting, anorexia, dehydration and confusion. The patient reported receiving an intraperitoneal injection, purported to contain 12 g of mixed cannabinoid (administered by a deregistered medical practitioner) two days prior to presentation. Additionally, cannabis oil oral capsules were administered in the hours prior to hospital admission. THC concentrations were consistent with the clinical state but not with the known pharmacokinetic properties of cannabis nor of intraperitoneal absorption. THC concentrations at the time of presentation were predicted to be ~60 ng/mL. Evidence suggests that blood THC concentrations >5 ng/mL are associated with substantial cognitive and psychomotor impairment. The predicted time for concentrations to drop pharmacokinetic properties of the case suggest that there is a large amount unknown about cannabis pharmacokinetic properties. The pharmacokinetic properties of a large amount of a lipid soluble compound given intraperitoneally gave insights into the absorption and distribution of cannabinoids, particularly in the setting of metastatic malignancy. Copyright © 2018 Elsevier HS Journals, Inc. All rights reserved.

  11. In vivo efficacy of oral and intraperitoneal administration of extracts ...

    African Journals Online (AJOL)

    In vivo efficacy of oral and intraperitoneal administration of extracts of Warburgia ugandensis (Canellaceae) in experimental treatment of old world cutaneous leishmaniasis caused by Leishmania major .

  12. Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil

    2013-01-01

    instillation (IPI) of saline and local anesthesia (LA) to minimize SP. METHODS: A search of the literature was conducted using PubMed and Excerpta Medica Database (EMBASE). Eligibility criteria were: randomized clinical trials (RCT) evaluating IPI of saline and/or LA to minimize incidence or severity of SP...

  13. Laparoscopic total pancreatectomy

    Science.gov (United States)

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

    2017-01-01

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

  14. Incidence of leukopenia after intraperitoneal vs combined intravenous/intraperitoneal chemotherapy in pseudomyxoma peritonei.

    Science.gov (United States)

    Horvath, Philipp; Beckert, Stefan; Struller, Florian; Königsrainer, Alfred; Königsrainer, Ingmar

    2016-08-06

    To investigate the clinical impact of post-hyperthermic intraperitoneal chemotherapy (HIPEC) leukopenia, intraperitoneal and combined intravenous/intraperitoneal drug administrations were compared. Two patient cohorts were retrospectively analyzed regarding the incidence of postoperative leukopenia. The first cohort (n = 32) received Mitomycin C (MMC)-based HIPEC intraperitoneally (35 mg/m² for 90 min) and the second cohort (n = 10) received a bi-directional therapy consisting of oxaliplatin (OX) (300 mg/m(2) for 30 min) intraperitoneally and 5-fluorouracil (5-FU) 400 mg/m² plus folinic acid 20 mg/m² intravenously. The following data were collected retrospectively: Age, sex, length of operation, length of hospital stay, amount of resection including extent of peritonectomy, peritoneal cancer index, CC (completeness of cytoreduction)-status and leukocyte-count before cytoreductive surgery (CRS) and HIPEC, on days 3, 7 and 14 after CRS and HIPEC. HIPEC leukopenia was defined as Leukopenia occurred statistically more often in the MMC than in the OX/5-FU-group (10/32 vs 0/10; P = 0.042). Leukopenia set-on was on day 7 after CRS and MMC-HIPEC and lasted for two to three days. Three patients (33%) required medical treatment. Patients affected by leukopenia were predominantly female (7/10 patients) and older than 50 years (8/10 patients). The length of hospital stay tended to be higher in the MMC-group without reaching statistical significance (22.5 ± 11 vs 16.5 ± 3.5 d). Length of operation (08:54 ± 01:44 vs 09:48 ± 02:28 h) were comparable between patients with and without postoperative leukopenia. Prior history of systemic chemotherapy did not trigger post-HIPEC leukopenia. Occurrence of leucopenia did not trigger surgical site infections, intraabdominal abscess formations, hospital-acquired pneumonia or anastomotic insufficiencies. Surgeons must be aware that there is a higher incidence of postoperative leukopenia in MMC-based HIPEC protocols primarily

  15. Laparoscopic Thal versus laparoscopic Nissen fundoplication in ...

    African Journals Online (AJOL)

    12 Esposito C, Montupet P, van der Zee D, Settimi A, Paye-Jaouen A, Centonze. A, Bax NK. Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc 2006; 20:855–858. 13 van der Zee DC, Arends NJ, Bax NM.

  16. Intraperitoneal treatment with darbepoetin for children on peritoneal dialysis.

    NARCIS (Netherlands)

    Rijk, Y.; Raaijmakers, R.; Kar, N.C.A.J. van de; Schroder, C.

    2007-01-01

    To determine the efficacy and safety of intraperitoneal administration of darbepoetin in children with renal anemia on peritoneal dialysis, we conducted a single-arm, retrospective, two-centre study in which children were treated with intraperitoneal darbepoetin at the end of nightly intermittent

  17. Laparoscopic Ventral Hernia Repair

    Science.gov (United States)

    ... heavy straining, aging, obesity, injury or following an infection at that site following surgery. They can occur immediately following surgery ... overall condition. Common advantages may include: Less post-operative ... wound infections Are You a Candidate for Laparoscopic Ventral Hernia ...

  18. Gallbladder removal - laparoscopic

    Science.gov (United States)

    ... Gallbladder anatomy Laparoscopic surgery - series References Jackson PG, Evans SRT. Biliary system. In: Townsend CM Jr, Beauchamp ... A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among ...

  19. Laparoscopic adrenalectomy: Surgical techniques

    Directory of Open Access Journals (Sweden)

    Matthew J Mellon

    2008-01-01

    Full Text Available Since its first description in 1992, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time and improved patient satisfaction are widely accepted. However, as this procedure becomes more widespread, critical steps of the operation must be maintained to ensure expected outcomes and success. This article reviews the surgical techniques for the laparoscopic adrenalectomy.

  20. Laparoscopic stoma creation.

    Science.gov (United States)

    Olmi, Stefano; Croce, Enrico; Magnone, Stefano; Mastropasqua, Emanuele

    2003-01-01

    Laparoscopic creation of an intestinal stoma may be preferable to an open operation. We report here our experience with faecal diversions. From April 1992 to April 2003 we performed 55 procedures (23 end colostomies for Miles operations; 21 end colostomies for Hartman procedures; 9 loop colostomies and 3 loop ileostomies). In 45 cases the procedure was completed laparoscopically. Ten (18%) of the cases required conversion due to bulky tumours (6 pts), obesity (2 pts) and adhesions (2 pts). The indications for diversions were rectovaginal fistula (1 pt), anastomosis leakage (1 pt), unresectable rectal cancer (21), rectal cancer resectable by Miles operation (20 pts). The two ileostomies were constructed to protect colo-anal anastomoses. The average duration of surgery was 50 minutes (range: 20-100) and 200 minutes in the case of Miles operations. The average postoperative hospital stay was 3 days (range: 2-5) and 7 days (range: 6-9) after a Miles operation. The demand for analgesics was far lower than with traditional surgery and did not continue after postoperative day two. We had no intraoperative complications. There was no mortality. During the follow-up period all the stomas have functioned well but a prolapse occurred in one case (2.6%). The laparoscopic creation of intestinal stomas is safe, feasible and effective and can be performed with a low morbidity rate. Stoma construction is the simplest of all laparoscopic procedures because it requires little dissection and only minimal mesenteric handling. The length of the procedure is longer in patients who have had prior surgery, but prior surgery is not a contraindication and a laparotomy can be avoided in the majority of patients. Patients who are obstructed or have significant bowel dilation are less prone to damage with laparoscopic procedures. In addition to the benefits of laparoscopic techniques for the patients, a laparoscopic colostomy may be ideal for the surgeon as a basic, initial step in the

  1. Spontaneous Bladder Perforation in an Infant Neurogenic Bladder: Laparoscopic Management

    Directory of Open Access Journals (Sweden)

    Daniel Cabezalí Barbancho

    2013-01-01

    Full Text Available Spontaneous bladder perforation is an uncommon event in childhood. It is usually associated with bladder augmentation. We are presenting a case of bladder rupture in an infant with neurogenic bladder without prior bladder surgery. Three days after lipomyelomeningocele excision the patient showed signs and symptoms of acute abdomen. The ultrasound exploration revealed significant amount of intraperitoneal free fluid and therefore a laparoscopic exploration was performed. A posterior bladder rupture was diagnosed and repaired laparoscopically. Currently, being 3 years old, she keeps successfully dry with clean intermittent catheterization. Neurogenic bladder voiding function can change at any time of its evolution and lead to complications. Early diagnosis of spontaneous bladder rupture is of paramount importance, so it is essential to think about it in the differential diagnosis of acute abdomen.

  2. 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.

  3. The Optimal Approach for Laparoscopic Adrenalectomy through Mono Port regarding Left or Right Sides: A Comparative Study

    Directory of Open Access Journals (Sweden)

    Wooseok Byon

    2014-01-01

    Full Text Available Introduction. Several studies have shown the feasibility and safety of both transperitoneal and posterior retroperitoneal approaches for single incision laparoscopic adrenalectomy, but none have compared the outcomes according to the left- or right-sided location of the adrenal glands. Materials and Methods. From 2009 to 2013, 89 patients who received LAMP (laparoscopic adrenalectomy through mono port were analyzed. The surgical outcomes attained using the transperitoneal approach (TPA and posterior retroperitoneal approach (PRA were analyzed and compared. Results and Discussion. On the right side, no significant differences were found between the LAMP-TPA and LAMP-PRA groups in terms of patient characteristics and clinicopathological data. However, outcomes differed in which LAMP-PRA group had a statistically significant shorter mean operative time (84.13 ± 41.47 min versus 116.84 ± 33.17 min; P=0.038, time of first oral intake (1.00 ± 0.00 days versus 1.21 ± 0.42 days; P=0.042, and length of hospitalization (2.17 ± 0.389 days versus 3.68 ± 1.38 days; P≤0.001, whereas in left-sided adrenalectomies LAMP-TPA had a statistically significant shorter mean operative time (83.85 ± 27.72 min versus 110.95 ± 29.31 min; P=0.002. Conclusions. We report that LAMP-PRA is more appropriate for right-sided laparoscopic adrenalectomies due to anatomical characteristics and better surgical outcomes. For left-sided laparoscopic adrenalectomies, however, we propose LAMP-TPA as a more suitable method.

  4. Correcting Reflux Laparoscopically

    Directory of Open Access Journals (Sweden)

    Eric C Poulin

    1998-01-01

    Full Text Available Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication (Nissen because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery.

  5. [The main aspects of vesical risk in intraperitoneal surgery].

    Science.gov (United States)

    Tode, V; Voinea, F; Marin, O

    2001-01-01

    They are described the main aspects of vezical risk in intraperitoneal surgery: subembilical celiostomy, haernios surgery, rectal surgery, gynecological surgery. It is shown few aspects of our experience in the treatment of haernias, vesicovaginal fistules secondary to total hysterectomy.

  6. Behandling af peritoneal karcinose med laparoskopisk intraperitoneal kemoterapi under tryk

    DEFF Research Database (Denmark)

    Graversen, Martin; Pfeiffer, Per; Mortensen, Michael Bau

    2016-01-01

    Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new treatment option in patients with peritoneal carcinomatosis (PC). PIPAC has proven efficacious in the treatment of PC from ovarian, colon and gastric cancer. PIPAC has a favourable profile regarding safety for patients and occupati......Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new treatment option in patients with peritoneal carcinomatosis (PC). PIPAC has proven efficacious in the treatment of PC from ovarian, colon and gastric cancer. PIPAC has a favourable profile regarding safety for patients...

  7. "Knotless" laparoscopic extraperitoneal adenomectomy.

    Science.gov (United States)

    Garcia-Segui, A; Verges, A; Galán-Llopis, J A; Garcia-Tello, A; Ramón de Fata, F; Angulo, J C

    2015-03-01

    Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation. A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision. The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor. "Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Laparoscopic Conversion of Sleeve Gastrectomy to Gastric Bypass for Super-Obesity (BMI ≥ 50 kg/m²) and Incisional Hernia: a Video Report.

    Science.gov (United States)

    Thereaux, Jérémie; Roche, Charles; Bail, Jean-Pierre

    2016-01-01

    Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed procedure for morbid obesity in France. However, in case of de novo gastroesophageal reflux disease or of insufficient weight loss, LSG could be converted in rare cases to laparoscopic Roux-en-Y gastric bypass (LRYGB). In case of voluminous incisional hernia (IH) associated, this procedure could be technically challenging, especially in cases of super-obesity (body mass index (BMI) ≥50 kg/m2). Furthermore, IH should be repaired in order to avoid life-threatening post-operative small bowel obstruction. We present the case of a 30-year-old woman (125 kg, 1.55 m) with a BMI of 52.1 kg/m2. She was referred to our tertiary care center for weight regain (Nadir 100 kg), 4 years after a LSG was performed for super-super obesity (BMI = 68.7 kg/m2). She also had a history of epigastric IH (single-incision LSG; diameter = 10 cm). The strategy adopted was to repair hernia with raphy. In case of hernia recurrence and of sustainable weight loss, use of prothetic mesh would be mandatory in the future. In this multimedia video, we present a step-by-step laparoscopic conversion of sleeve gastrectomy to LRYGB for super-obesity (BMI ≥50 kg/m2) and incisional hernia. Laparoscopic procedure included adhesiolysis, dissection, and resection of the low part of the remnant stomach, gastro-jejunal circular anastomosis, and closure of aponeurosis defect. Incisional hernia and morbid obesity are often entangled problems. Revisional procedure of bariatric surgery with incisional hernia associated should be performed laparoscopically.

  9. Formation of adhesion after intraperitoneal application of TiMesh: experimental study on a rodent model.

    Science.gov (United States)

    Delibegovic, Samir; Koluh, Anhel; Cickusic, Elmir; Katica, Muhamed; Mustedanagic, Jasminka; Krupic, Ferid

    2016-10-01

    After laparoscopic repair of an incisive hernia, intraperitoneal prosthetic mesh, as a foreign material, is a strong stimulus for the development of adhesion, which may be the cause of serious complications. This experimental study compared three different meshes and their ability to prevent the formation of adhesion and shrinkage. Ninety rats were divided randomly into three groups: in Group 1 Proceed mesh was implanted, in Group 2 Ultrapro mesh was implanted, and in Group 3 TiMesh was implanted. Mesh samples were fixed as an intraabdominal mesh in the upper part of the abdomen. Ten animals from each group were sacrificed on days 7, 28 and 60 post-surgery. After opening the abdomen, the formation of adhesion was assessed according to the Surgical Membrane Study Group (SMSG) score, the percentage of shrinkage of the mesh was established and inflammatory reaction scored. The SMSG score for adhesion was statistically significantly higher on all the postoperative days in the Proceed and Ultrapro mesh groups than in the TiMesh group which caused milder inflammatory reaction on 60th day than others meshes. The size of the mesh after 7 days was statistically significantly smaller in the Proceed and Ultrapro groups than in the TiMesh group, but after 60 days it was statistically significantly larger than in the TiMesh group. The least formation of adhesion was noted in the TiMesh group, in which the highest level of shrinkage was noticed after 28 and 60 days. TiMesh has advantages over the other meshes studied, but a larger size mesh may be recommended for intraperitoneal application.

  10. LAPAROSCOPIC ADENOMECTOMY (PRELIMINARY RESULTS

    Directory of Open Access Journals (Sweden)

    A. Yu. Seroukhov

    2016-01-01

    Full Text Available Bladder outlet obstruction due to benign prostatic hyperplasia (BPH remains one of the most common problems of men in the advanced age group. Open prostatectomy for patients with large BPH is still the standard treatment recommended by the European Association of Urology and is performed quiet often. Disadvantages of this method of treatment are significant surgical trauma and high rate of perioperative complications . Laparoscopic modification of simple prostatectomy presents a worthy minimal invasive alternative to open surgical treatment of BPH. From November 2014 to December 2015, laparoscopic adenomectomy was performed for 16 patients. 7 (43.5% patients had transperitoneal (TP and 9 (56.25% patients had extraperitoneal (EP laparoscopic simple prostatectomy. None of the cases required conversion . All patients were discharged in satisfactory condition with complete restoration of free micturation. Laparoscopic prostatectomy as a method of surgical treatment for BPH can be easily reproducible. It can be adopted as a routine urological practice for large-sized BPH with the aim of minimizing operative trauma and achieving short hospital stay.

  11. Training in laparoscopic urology

    NARCIS (Netherlands)

    Laguna, Ma Pilar; de Reijke, Theodorus M.; Wijkstra, Hessel; de la Rosette, Jean

    2006-01-01

    PURPOSE OF REVIEW: Training in laparoscopy has become an important issue in the current surgical scenario. In this overview we aim to update the current knowledge in the field of laparoscopic urological training and to highlight the potential dangers of using simulation for accreditation and

  12. Laparoscopic and robotic nephroureterectomy

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Berg, Kasper Drimer; Thamsborg, Andreas Key Milan

    2017-01-01

    nephroureterectomy between January 2008 and December 2014 was conducted. Outcome measures were OS and CSM. RESULTS: In total, 298 patients underwent robot-assisted or laparoscopic radical nephroureterectomy with a final histological diagnosis of UTUC. LND was performed in 46 (15.4%). One hundred and seventy...

  13. Laparoscopic hemi-splenectomy

    NARCIS (Netherlands)

    de Pastena, Matteo; Nijkamp, Maarten W.; van Gulik, Thomas G.; Busch, Olivier R.; Hermanides, H. S.; Besselink, Marc G.

    2018-01-01

    Laparoscopic splenectomy is now established as a safe and feasible procedure. However, it remains associated with some short- and long-term postoperative complications, especially infectious complications. To our knowledge, this is the first report (with video) focusing on the safety and feasibility

  14. Recent advances in laparoscopic surgery.

    Science.gov (United States)

    Lee, Wei-Jei; Chan, Chien-Pin; Wang, Bing-Yen

    2013-02-01

    Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%-0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence-based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  15. Feasibility and Safety of Pressurized Intraperitoneal Aerosol Chemotherapy for Peritoneal Carcinomatosis: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Martin Hübner

    2017-01-01

    Full Text Available Background. Pressurized intraperitoneal aerosol chemotherapy (PIPAC has been introduced as a novel repeatable treatment for peritoneal carcinomatosis. The available evidence from the pioneer center suggests good tolerance and high response rates, but independent confirmation is needed. A single-center cohort was analyzed one year after implementation for feasibility and safety. Methods. PIPAC was started in January 2015, and every patient was entered into a prospective database. This retrospective analysis included all consecutive patients operated until April 2016 with emphasis on surgical feasibility and early postoperative outcomes. Results. Forty-two patients (M : F = 8 : 34, median age 66 (59–73 years with 91 PIPAC procedures in total (4×: 1,  3×: 17,  2×: 12, and  1×: 12 were analyzed. Abdominal accessibility rate was 95% (42/44; laparoscopic access was not feasible in 2 patients with previous HIPEC. Median initial peritoneal carcinomatosis index (PCI was 10 (IQR 5–17. Median operation time was 94 min (89–108 with no learning curve observed. One PIPAC application was postponed due to intraoperative intestinal lesion. Overall morbidity was 9% with 7 minor complications (Clavien I-II and one PIPAC-unrelated postoperative mortality. Median postoperative hospital stay was 3 days (2-3. Conclusion. Repetitive PIPAC is feasible in most patients with refractory carcinomatosis of various origins. Intraoperative complications and postoperative morbidity rates were low. This encourages prospective studies assessing oncological efficacy.

  16. Sex differences in laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Thesbjerg, Simon E; Harboe, Kirstine Moll; Bardram, Linda

    2010-01-01

    Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relations...... the relationship of gender to conversion rate and length of hospital stay after laparoscopic cholecystectomy in a national cohort of patients....

  17. Hernia inguinal laparoscopic surgery

    International Nuclear Information System (INIS)

    Morelli Brum, R. . E mail: raulmorelli@hotmail.com

    2005-01-01

    The purpose of this paper is to enhance treatment of inguinal hernia through a bibliographic study of its main complications and the analysis of a retrospective series of laparoscopic restorations performed by the author in the same private medical care center. From December 1994 through July 2003, ninety-nine patients were operated in 108 procedures.The technique employed was trans-abdominal peritoneal (TAPP)Follow-up covered over 2 years in 80% of patients with a relapse of 2.8%. Main morbidity was neuralgia due to a nerve being trapped, which fact required re-intervention.There was no mortality.The conclusion arrived at is that it is and excellent technique which requires a long learning curve and its main indication would be relapse of conventional surgery, bilateralism, coexistence with another laparoscopic abdominal pathology and doubts concerning contra lateral hernia

  18. Laparoscopic specimen retrieval bags.

    Science.gov (United States)

    Smorgick, Noam

    2014-10-01

    Specimen retrieval bags have long been used in laparoscopic gynecologic surgery for contained removal of adnexal cysts and masses. More recently, the concerns regarding spread of malignant cells during mechanical morcellation of myoma have led to an additional use of specimen retrieval bags for contained "in-bag" morcellation. This review will discuss the indications for use retrieval bags in gynecologic endoscopy, and describe the different specimen bags available to date.

  19. Peritonitis: laparoscopic approach

    Directory of Open Access Journals (Sweden)

    Agresta Ferdinando

    2006-03-01

    Full Text Available Abstract Background Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment – exploration to identify the causative pathology and performance of an appropriate operation – can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution. Methods From January 1992 and January 2002 a total of 935 patients (mean age 42.3 ± 17.2 years underwent emergent and/or urgent surgery. Among them, 602 (64.3% were operated on laparoscopically (of whom 112 -18.7% – with peritonitis, according to the presence of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than two previous major abdominal surgeries or massive bowel distension were not treated Laparoscopically. Peritonitis was not considered contraindication to Laparoscopy. Results The conversion rate was 23.2% in patients with peritonitis and was mainly due to the presence of dense intra-abdominal adhesions. Major complications ranged as high as 5.3% with a postoperative mortality of 1.7%. A definitive diagnosis was accomplished in 85.7% (96 pat. of cases, and 90.6% (87 of these patients were treated successfully by Laparoscopy. Conclusion Even if limited by its retrospective feature, the present experience let us to consider the Laparoscopic approach to abdominal peritonitis emergencies a safe and effective as conventional surgery, with a higher diagnostic yield and allows for lesser trauma and a more rapid postoperative recovery. Such features make Laparoscopy a challenging alternative to open surgery in the management algorithm for abdominal

  20. Complications of continuous intraperitoneal insulin infusion with an implantable pump

    NARCIS (Netherlands)

    van Dijk, Peter R; Logtenberg, Susan J. J.; Groenier, Klaas H; Haveman, Jan Willem; Kleefstra, Nanno; Bilo, Henk J. G.

    2012-01-01

    AIM: To monitor the course of continuous intraperitoneal insulin infusion (CIPII) and to gain more insight into possible complications. METHODS: A retrospective, longitudinal observational cohort study in patients with type 1 diabetes mellitus (T1DM) was performed. Only patients with "brittle" T1DM

  1. Continuous intraperitoneal insulin infusion in patients with 'brittle' diabetes

    DEFF Research Database (Denmark)

    DeVries, J H; Eskes, S A; Snoek, Frank J

    2002-01-01

    AIMS: To evaluate the effects of continuous intraperitoneal insulin infusion (CIPII) using implantable pumps on glycaemic control and duration of hospital stay in poorly controlled 'brittle' Dutch diabetes patients, and to assess their current quality of life. METHODS: Thirty-three patients were...

  2. The role of intraperitoneally administered vitamin C during ...

    African Journals Online (AJOL)

    The effects of daily intraperitoneally administered doses of 100 mg/kg bd. wt. vitamin C on levels of some endogenous antioxidants as well as hepatic and renal function were investigated in a group of rabbits infected with a strain of Trypanosoma congolense (strain number: BS2/TC /SP28/P4). Values of parameters ...

  3. Effects of intraperitoneal nitroglycerin on the strength and healing ...

    African Journals Online (AJOL)

    Background: Ischemic conditions in the intestine result in deterioration of anastomosis healing process. In this study, our aim was to evaluate the possible effects of intraperitoneal nitroglycerin on the intestinal anastomosis healing and anastomosis burst pressures in rats with ischemia and reperfusion injury (I/R). Materials ...

  4. Laparoscopic donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Gupta Nitin

    2005-01-01

    Full Text Available Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN, by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.

  5. Laparoscopic radical trachelectomy.

    Science.gov (United States)

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

    2012-01-01

    The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.

  6. 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

  7. Sex differences in laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Thesbjerg, Simon E; Harboe, Kirstine Moll; Bardram, Linda

    2010-01-01

    Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relations...

  8. Virtual reality and laparoscopic surgery.

    Science.gov (United States)

    Coleman, J; Nduka, C C; Darzi, A

    1994-12-01

    The nature of laparoscopic surgery makes it likely to benefit from current and future developments in virtual reality and telepresence technology. High-definition screens, three-dimensional sensory feedback and remote dextrous manipulation will be the next major developments in laparoscopic surgery. Simulators may be used in surgical training and in the evaluation of surgical capability.

  9. Laparoscopic common bile duct exploration.

    Science.gov (United States)

    Shuchleib, S; Chousleb, A; Mondragon, A; Torices, E; Licona, A; Cervantes, J

    1999-07-01

    Since the introduction of laparoscopic cholecystectomy, the management of common bile duct (CBD) stones has undergone significant change. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is now routinely done in cases where the diagnosis of choledocholithiasis is suspected preoperatively, with clearance of the bile ducts before laparoscopic cholecystectomy. Intraoperative discovery of CBD stones by cholangiography represents a challenge to the surgeon, who must make a decision about when to perform laparoscopic CBD exploration, convert to open surgery, or send the patient for ERCP during the postoperative period. Because ERCP has a definite failure rate, laparoscopic CBD exploration can be a treatment option. Among 2500 laparoscopic cholecystectomies done by our group from January 1991 to June 1997, 50 patients (2%) underwent laparoscopic CBD exploration, 13 by the transcystic technique and 37 by choledocotomy, with a conversion rate of 8% and a hospital stay of 4.3 days. One patient died from complicated pancreatitis following ERCP and unsuccessful extraction of a CBD stone. We obtained our goal of a CBD free of stones in 92% of the cases. We conclude that laparoscopic CBD exploration is an effective method for treating choledocolithiasis that allows management of this pathology in one stage, although it requires advanced laparoscopic skills and adequate equipment.

  10. Immunotherapeutic modulation of intraperitoneal adhesions by Asparagus racemosus.

    Directory of Open Access Journals (Sweden)

    Rege N

    1989-10-01

    Full Text Available The hypothesis that macrophages appear to play a pivotal role in the development of intraperitoneal adhesions and that modulation of macrophage activity, therefore, is likely to provide a tool for prevention of adhesions, was tested in the present study. Effect of Asparagus racemosus, an indigenous agent with immunostimulant properties, was evaluated in an animal model of intraperitoneal adhesions induced by caecal rubbing. Animals were sacrificed 15 days following surgery. The peritoneal macrophages were collected to assess their activity. At the same time, peritoneal cavity was examined for the presence of adhesions, which were graded. A significant decrease was observed in the adhesion scores attained by animals receiving Asparagus racemosus. This was associated with significant increase in the activity of macrophages (70.1 +/- 2.52, compared to that in surgical controls (53.77 +/- 10.8. These findings support our hypothesis and provide a novel approach for the prevention and management of post-operative adhesions.

  11. [Nursing care for ovarian cancer patients with intraperitoneal chemotherapy].

    Science.gov (United States)

    Lu, Yu-Ying; Chou, Ju-Fen; Tsao, Lee-Ing; Liang, Shu-Yuan; Wu, Shu-Fang

    2015-02-01

    Ovarian cancer, known as a "silent killer", is the leading cause of gynecologic cancer death. Standard treatments for ovarian cancer are debulking surgery combined with platinum chemotherapy drugs to prolong the survival of patients. According to clinical trials run by the American Society of Gynecologic Oncology, patients who received intraperitoneal (IP) chemotherapy survived longer on average than patients who received intravenous chemotherapy alone. Thus, intraperitoneal chemotherapy is a new potential approach for treating ovarian cancer patients. However, the toxicities and undesirable complications of IP chemotherapy are the major challenges of this treatment approach. This article helps nurses recognize the toxicities and complications of IP chemotherapy and may be used as reference for future revisions to patient care guidelines.

  12. Laparoscopic rectosigmoid flap vaginoplasty.

    Science.gov (United States)

    Kim, Seok Kwun; Jeong, Jae Oo; Kwon, Yong Seok; Lee, Keun Cheol; Park, Ki Jae; Jung, Ghapjoong

    2011-09-01

    Various methods have been developed for vaginoplasty, of which the rectosigmoid flap has its own advantages including sufficient increase in the vaginal length and lower incidence of complications such as contracture or strain after vaginoplasty. Laparoscopic operation can greatly minimise the abdominal scar associated with laparotomy and allow cosmetically superior outcomes. Its minimally invasive procedure can also achieve rapid recovery and shorten the duration of hospital stay. Twelve patients (age range 18-40 years) had vaginoplasty using the rectosigmoid colon. We evaluated the ecological changes of the neovagina from the change of pH in the neovagina, culture of the normal flora, and vaginal wall biopsy taken 6 to 12 months postoperatively. Details of sexual activity were also examined. No patient from interviews developed vaginal narrowing as a result of the contracture that caused painful intercourse, or had smelly discharge or spontaneous bleeding from the vagina. Laparoscopic procedures may need only five-openings of 1-1.5 cm in diameter. Mean operating time was 130 minutes (IQR, 113-140) and duration of hospital stay 8.5 days (IQR, 7-11). Twelve months postoperatively the intravaginal pH was about 6. In one case, the histological test showed that the original columnar cell of the intestinal mucosa had been transformed to stratified squamous cell tissue. The key to the vaginoplasty is that it should give functional satisfaction and a minimal rate of complications. The laparoscopic rectosigmoid flap technique of vaginoplasty allowed less morbidity and excellent aesthetic and functional postoperative outcomes.

  13. Laparoscopic Heller's cardiomyotomy.

    LENUS (Irish Health Repository)

    Doodnath, R

    2012-02-01

    Achalasia is a rare motility disorder which causes failure of relaxation of the lower oesophageal sphincter (LES) and is thought to affect 0.31\\/100,000 children per year in Ireland. The classic presentation is difficulty swallowing and vomiting undigested food, and children can often present with chest pain. In some instances, these symptoms can lead to considerable weight loss. In this report, we present 2 cases of patients with achalasia who have also been the first 2 cases of laparoscopic Heller\\'s cardiomyotomy performed in children in the Republic of Ireland.

  14. Laparoscopic CBD Exploration.

    Science.gov (United States)

    Savita, K S; Bhartia, Vishnu K

    2010-10-01

    Laparoscopic CBD exploration (LCBDE) is a cost effective, efficient and minimally invasive method of treating choledocholithiasis. Laparoscopic Surgery for common bile duct stones (CBDS) was first described in 1991, Petelin (Surg Endosc 17:1705-1715, 2003). The surgical technique has evolved since then and several studies have concluded that Laparoscopic common bile duct exploration(LCBDE) procedures are superior to sequential endolaparoscopic treatment in terms of both clinical and economical outcomes, Cuschieri et al. (Surg Endosc 13:952-957, 1999), Rhodes et al. (Lancet 351:159-161, 1998). We started doing LCBDE in 1998.Our experience with LCBDE from 1998 to 2004 has been published, Gupta and Bhartia (Indian J Surg 67:94-99, 2005). Here we present our series from January 2005 to March 2009. In a retrospective study from January 2005 to March 2009, we performed 3060 laparoscopic cholecystectomies, out of which 342 patients underwent intraoperative cholangiogram and 158 patients eventually had CBD exploration. 6 patients were converted to open due to presence of multiple stones and 2 patients were converted because of difficulty in defining Calots triangle; 42 patients underwent transcystic clearance, 106 patients had choledochotomy, 20 patients had primary closure of CBD whereas in 86 patients CBD was closed over T-tube; 2 patients had incomplete stone clearance and underwent postoperative ERCP. Choledochoduodenosotomy was done in 2 patients. Patients were followed regularly at six monthly intervals with a range of six months to three years of follow-up. There were no major complications like bile leak or pancreatitis. 8 patients had port-site minor infection which settled with conservative treatment. There were no cases of retained stones or intraabdominal infection. The mean length of hospital stay was 3 days (range 2-8 days). LCBDE remains an efficient, safe, cost-effective method of treating CBDS. Primary closure of choledochotomy in select patients is a

  15. Nosocomial rapidly growing mycobacterial infections following laparoscopic surgery: CT imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Volpato, Richard [Cassiano Antonio de Moraes University Hospital, Department of Diagnostic Radiology, Vitoria, ES (Brazil); Campi de Castro, Claudio [University of Sao Paulo Medical School, Department of Radiology, Cerqueira Cesar, Sao Paulo (Brazil); Hadad, David Jamil [Cassiano Antonio de Moraes University Hospital, Nucleo de Doencas Infecciosas, Department of Internal Medicine, Vitoria, ES (Brazil); Silva Souza Ribeiro, Flavya da [Laboratorio de Patologia PAT, Department of Diagnostic Radiology, Unit 1473, Vitoria, ES (Brazil); Filho, Ezequiel Leal [UNIMED Diagnostico, Department of Diagnostic Radiology, Unit 1473, Vitoria, ES (Brazil); Marcal, Leonardo P. [The University of Texas M D Anderson Cancer Center, Department of Diagnostic Radiology, Unit 1473, Houston, TX (United States)

    2015-09-15

    To identify the distribution and frequency of computed tomography (CT) findings in patients with nosocomial rapidly growing mycobacterial (RGM) infection after laparoscopic surgery. A descriptive retrospective study in patients with RGM infection after laparoscopic surgery who underwent CT imaging prior to initiation of therapy. The images were analyzed by two radiologists in consensus, who evaluated the skin/subcutaneous tissues, the abdominal wall, and intraperitoneal region separately. The patterns of involvement were tabulated as: densification, collections, nodules (≥1.0 cm), small nodules (<1.0 cm), pseudocavitated nodules, and small pseudocavitated nodules. Twenty-six patients met the established criteria. The subcutaneous findings were: densification (88.5 %), small nodules (61.5 %), small pseudocavitated nodules (23.1 %), nodules (38.5 %), pseudocavitated nodules (15.4 %), and collections (26.9 %). The findings in the abdominal wall were: densification (61.5 %), pseudocavitated nodules (3.8 %), and collections (15.4 %). The intraperitoneal findings were: densification (46.1 %), small nodules (42.3 %), nodules (15.4 %), and collections (11.5 %). Subcutaneous CT findings in descending order of frequency were: densification, small nodules, nodules, small pseudocavitated nodules, pseudocavitated nodules, and collections. The musculo-fascial plane CT findings were: densification, collections, and pseudocavitated nodules. The intraperitoneal CT findings were: densification, small nodules, nodules, and collections. (orig.)

  16. Nosocomial rapidly growing mycobacterial infections following laparoscopic surgery: CT imaging findings

    International Nuclear Information System (INIS)

    Volpato, Richard; Campi de Castro, Claudio; Hadad, David Jamil; Silva Souza Ribeiro, Flavya da; Filho, Ezequiel Leal; Marcal, Leonardo P.

    2015-01-01

    To identify the distribution and frequency of computed tomography (CT) findings in patients with nosocomial rapidly growing mycobacterial (RGM) infection after laparoscopic surgery. A descriptive retrospective study in patients with RGM infection after laparoscopic surgery who underwent CT imaging prior to initiation of therapy. The images were analyzed by two radiologists in consensus, who evaluated the skin/subcutaneous tissues, the abdominal wall, and intraperitoneal region separately. The patterns of involvement were tabulated as: densification, collections, nodules (≥1.0 cm), small nodules (<1.0 cm), pseudocavitated nodules, and small pseudocavitated nodules. Twenty-six patients met the established criteria. The subcutaneous findings were: densification (88.5 %), small nodules (61.5 %), small pseudocavitated nodules (23.1 %), nodules (38.5 %), pseudocavitated nodules (15.4 %), and collections (26.9 %). The findings in the abdominal wall were: densification (61.5 %), pseudocavitated nodules (3.8 %), and collections (15.4 %). The intraperitoneal findings were: densification (46.1 %), small nodules (42.3 %), nodules (15.4 %), and collections (11.5 %). Subcutaneous CT findings in descending order of frequency were: densification, small nodules, nodules, small pseudocavitated nodules, pseudocavitated nodules, and collections. The musculo-fascial plane CT findings were: densification, collections, and pseudocavitated nodules. The intraperitoneal CT findings were: densification, small nodules, nodules, and collections. (orig.)

  17. Comparison of Giemsa Staining, Intraperitoneal Injection and Oral

    Directory of Open Access Journals (Sweden)

    Sajad Rashidi

    2014-02-01

    Full Text Available Background: Toxoplasma gondii is one of the most common protozoan parasites in humans and animals in all countries of the world. The aim of this study was to detect Toxoplasma parasite in the brain of wild rats in Tehran using smear preparation, Giemsa staining, Intraperitoneal injection and oral administration to Souri mice. Materials and Methods: Forty rats were collected from different areas of Tehran. Smears were prepared from rat brains on glass slides and stained using Giemsa. In the second method, a cell suspension was prepared from rat brain and was given orally and injected intraperitoneally into Souri mice. In peritoneal method, peritoneum of the mice was examined for parasites. In oral method, the titer of Toxoplasma antibody in sera of Souri mice was determined using Toxoplasma IgG antibody kit and anti-mouse conjugate of Sigma company. Results: All results were negative in Giemsa staining method. In the second method, the results were negative and no parasites were observed in peritoneum of Souri mice. In oral administration method, after ingestion of suspensions by Souri mice and measuring the IgG titer, 50% of them showed a positive titer after one month. Conclusion: In detection of Toxoplasma gondii, the method of smear preparation on glass slides followed by Giemsa staining, and intraperitoneal injection of brain suspensions to Souri mice are of less value in comparison with oral administration of suspensions and determining the titer of IgG in sera of Souri mice.

  18. Intraperitoneal fluid collection: CT characteristics in determining the causes

    International Nuclear Information System (INIS)

    Kim, Mi Young; Suh, Chang Hae; Chung, Won Kyun; Kim, Chong Soo; Choi, Ki Chul

    1995-01-01

    Abdominal CT scans in patients with intraperitoneal fluid were retrospectively studied to identify characteristic features useful for differential diagnosis of various causes. One hundred and seventy patients with intraperitoneal fluid collection were classified as categories of hepatic disease, carcinomatosis, and infectious disease. We analyzed sites of fluid collection, the presence of peritoneal thickening, omental and mesenteric fat infiltration, and lymph node enlargement. Intraperitoneal fluid was present in subhepatic space, subphrenic space, paracolic gutter, mesentery, and fossa of the gallbladder in decreasing order of frequency. Fluid in the gallbladder fossa was the most frequent in hepatic disease. The fluid collection in subhepatic and subphrenic space was less frequent in infectious disease. Peritoneal thickening was noted in infectious diseases, and carcinomatosis. Omental fat infiltration and enlarged lymph nodes were the most frequent in carcinomatosis (58% and 44%, respectively), whereas, mesenteric fat infiltration and enlarged lymph nodes were the most common in infectious diseases (61%, and 26%, respectively). The location of peritoneal fluid collection showed some lesion specific characteristics, and CT features of fat infiltration and enlarged lymph nodes of peritoneum, omentum, and mesentery were helpful for differential diagnosis between carcinomatosis and infectious diseases

  19. Serial Changes of the Splenic Volume after Traumatic Intraperitoneal Hemorrhage

    International Nuclear Information System (INIS)

    Park, Hyun Jin; Lee, Young Hwan; Jung, Kyung Jae

    2010-01-01

    We wanted to evaluate the serial changes of the splenic volume in patients with traumatic intraperitoneal hemorrhage. 20 consecutive patients with traumatic intraperitoneal hemorrhage and who underwent initial CT, early follow-up CT within 30 days and late follow- up CT examinations thereafter were included in this study. The volume of the spleen on each CT examination was measured and the relative splenic volume (RSV) on the initial and early follow-CT examinations was calculated on the basis of the splenic volume on the late follow-up CT. The hemoperitoneum score was calculated on the basis of the size of the intraperitoneal hemorrhage. The average RSVs of the initial and early follow-up CT were 62.0% and 133.3%, respectively, and all the patients showed an increase of the splenic and relative splenic volumes on the early follow-up CT, as compared with those on the initial CT. Initial splenic contraction was seen in 18 patients (90.0%) and early splenomegaly was seen in 14 patients (70.0%). Patients with initial splenic contraction and early splenomegaly were the most common (12 patient, 60.0%). Initial physiologic splenic contraction was seen in most of the patients with hemoperitoneum, and thereafter early splenomegaly was commonly seen before normalization of the splenic volume

  20. A novel prototype 3/5 laparoscopic needle driver: A validation study with conventional laparoscopic needle driver

    Directory of Open Access Journals (Sweden)

    Arvind P Ganpule

    2018-01-01

    Conclusion: The expert laparoscopic surgeons as well as novice laparoscopic surgeons performed laparoscopic suturing faster and with more ease while using the prototype 3/5 laparoscopic needle holder.

  1. Intraperitoneal microdialysis in the postoperative surveillance of infants undergoing surgery for congenital abdominal wall defect

    DEFF Research Database (Denmark)

    Risby, Kirsten; Pedersen, Mark Ellebæk; Jakobsen, Marianne S

    2015-01-01

    PURPOSE: This study aims to investigate the safety and clinical implication of intraperitoneal microdialysis (MD) in newborns operated on for congenital abdominal wall defect. PATIENTS AND METHODS: 13 infants underwent intraperitoneal microdialysis (9 with gastroschisis and 4 with omphalocele). MD...

  2. Mini-laparoscopic versus laparoscopic approach to appendectomy

    Directory of Open Access Journals (Sweden)

    Kercher Kent W

    2001-10-01

    Full Text Available Abstract Background The purpose of this clinical study is to evaluate the feasibility of using 2-mm laparoscopic instruments to perform an appendectomy in patients with clinically suspected acute appendicitis and compare the outcome of this mini-laparoscopic or "needlescopic" approach to the conventional laparoscopic appendectomy. Methods Two groups of patients undergoing appendectomy over 24 months were studied. In the first group, needlescopic appendectomy was performed in 15 patients by surgeons specializing in advanced laparoscopy. These patients were compared with the second or control group that included 21 consecutive patients who underwent laparoscopic appendectomy. We compared the patients' demographic data, operative findings, complications, postoperative pain medicine requirements, length of hospital stay, and recovery variables. Differences were considered statistically significant at a p-value Results Patient demographics, history of previous abdominal surgery, and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. No postoperative morbidity or mortality occurred in either group. The needlescopic group had a significantly shorter mean operative time (p = 0.02, reduced postoperative narcotics requirements (p = 0.05, shorter hospital stay (p = 0.04, and quicker return to work (p = 0.03 when compared with the laparoscopic group. Conclusions We conclude that the needlescopic technique is a safe and effective approach to appendectomy. When performed by experienced laparoscopic surgeons, the needlescopic technique results in significantly shorter postoperative convalescence and a prompt recovery.

  3. Laparoscopic treatment of perforated appendicitis

    Science.gov (United States)

    Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

    2014-01-01

    The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

  4. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

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

    2010-01-01

    %). There was no difference in postoperative complications between the two groups (10 versus 14%), and no anastomotic leaks. The total mortality was 2% as one patient died postoperatively after an open operation. CONCLUSION: It is possible for trained laparoscopic colorectal surgeons to perform laparoscopic reversal...... of all patients who underwent reversal of a colostomy after a primary Hartmann's procedure during the period May 2005 to December 2008 were reviewed retrospectively in a case-control study. RESULTS: A total of 43 patients were included. Twenty-one had a laparoscopic and 22 an open procedure. The two...... groups matched with regard to age, sex, American Society of Anestheologists (ASA) score, body mass index and indication for Hartmann's operation. A significantly longer operation time was found for laparoscopic than for open surgery (median 285 versus 158 minutes, p

  5. Laparoscopic adrenalectomy: Single centre experience.

    LENUS (Irish Health Repository)

    O'Farrell, N J

    2012-02-01

    BACKGROUND: Laparoscopic adrenalectomy is an attractive alternative to the traditional open approach in the surgical excision of an adrenal gland. It has replaced open adrenalectomy in our institution and we review our experience to date. METHODS: All cases of laparoscopic adrenalectomies in our hospital over eight years (from 2001 to May 2009) were retrospectively reviewed. Patient demographics, diagnosis, length of hospital stay, histology and all operative and post-operative details were evaluated. RESULTS: Fifty-five laparoscopic adrenalectomies (LA) were performed on 51 patients over eight years. The mean age was 48 years (Range 16-86 years) with the male: female ratio 1:2. Twenty-three cases had a right adrenalectomy, 24 had a left adrenalectomy and the remaining four patients had bilateral adrenalectomies. 91% were successfully completed laparoscopically with five converted to an open approach. Adenomas (functional and non functional) were the leading indication for LA, followed by phaeochromocytomas. Other indications for LA included Cushing\\'s disease, adrenal malignancies and rarer pathologies. There was one mortality from necrotising pancreatitis following a left adrenalectomy for severe Cushing\\'s disease, with subsequent death 10 days later. CONCLUSION: Laparoscopic adrenalectomy is effective for the treatment of adrenal tumours, fulfilling the criteria for the ideal minimally invasive procedure. It has replaced the traditional open approach in our centre and is a safe and effective alternative. However, in the case of severe Cushing\\'s disease, laparoscopic adrenalectomy has the potential for significant adverse outcomes and mortality.

  6. Liquid Paraffin vs Hyaluronic Acid in Preventing Intraperitoneal Adhesions.

    Science.gov (United States)

    Kataria, Hanish; Singh, Vinod Prem

    2017-12-01

    Adhesion formation after abdominal and pelvic operations remains a challenging problem. Role of adjuvant barriers have been studied but there is no comparative study between liquid paraffin and hyaluronic acid as a barrier method. Hence, we planned to compare the effectiveness of 0.4 % hyaluronic acid and liquid paraffin in the prevention of postoperative intraperitoneal adhesions in rats. This prospective, randomized and controlled study was conducted in 60 adult Wistar albino rats. Surgical trauma by caecal abrasion and 1 g talcum powder was used in the rat model to induce adhesion formation. After trauma, 3 ml normal saline was instilled in the peritoneal cavity in control group ( n  = 20), 3 ml liquid paraffin was instilled in experimental group A ( n  = 20) and 3 ml 0.4 % hyaluronic acid was instilled in experimental group B ( n  = 20). Two weeks after laparotomy, repeat laparotomy was performed and the adhesions were scored according to Zuhlke classification. Liquid paraffin and hyaluronic acid both reduce the extent and grade of adhesions both macroscopically ( p  = 0.018, p  = 0.017) and microscopically ( p  = 0.019, p  = 0.019) respectively. Although there was significant reduction in adhesions by hyaluronic acid at certain specific sites as compared with liquid paraffin, its overall effectiveness in preventing postoperative intraperitoneal adhesions is not significantly different from liquid paraffin ( p  = 0.092, p  = 0.193) respectively. The presence of liquid paraffin and hyaluronic acid in the peritoneal cavity reduce postoperative intraperitoneal adhesions significantly in rats. However, there is no overall significant difference in the effectiveness of two groups. Dosage and safety of these chemicals in human beings remains to be established.

  7. Impact of laparoscopic surgery on stress responses, immunofunction, and risk of infectious complications

    DEFF Research Database (Denmark)

    Kehlet, H; Nielsen, Hans Jørgen

    1998-01-01

    to a reduced inflammatory response (C-reactive protein and interleukin-6), a reduced immunomodulatory response, improvement in pulmonary function, and less hypoxemia, whereas classic endocrine metabolic responses are less influenced or not influenced compared with similar open operation. The clinical......Open laparotomy is followed by profound changes in endocrine metabolic function and various host defense mechanisms, impaired pulmonary function, and hypoxemia, all of which may be important for the development of postoperative infectious complications. Laparoscopic surgery, however, leads...... a reduction in wound complications, whereas the sparse data on intraperitoneal infections and sepsis are not conclusive. Thus, laparoscopic surgery modifies the injury response and reduces the risk of infectious complications. If integrated into an accelerated rehabilitation program, further improvement may...

  8. Hypotonic intraperitoneal cisplatin chemotherapy for peritoneal carcinomatosis in mice.

    OpenAIRE

    Kondo, A.; Maeta, M.; Oka, A.; Tsujitani, S.; Ikeguchi, M.; Kaibara, N.

    1996-01-01

    The intraperitoneal (i.p.) administration of cisplatin (CDDP) is one of the most effective therapies for cancers that are confined to the abdominal cavity. However, the effect of fluid osmolarity on the therapeutic efficacy of i.p. administration of CDDP has not been well established. In the current study, hypotonic (154 mosmol 1-1), isotonic (308 mosmol 1-1) and hypertonic (616 mosmol 1-1) solutions of CDDP were prepared for an evaluation of their therapeutic efficacy in an experimental syst...

  9. Sleep after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    1996-01-01

    The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration...... of opioids. There were no significant changes in the total time awake or the number of arousals on the postoperative night compared with the night before operation. During the postoperative night, we found a decrease (P = 0.02) in slow wave sleep (SWS) with a corresponding increase in stage 2 sleep (P = 0.......01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative...

  10. Ambulatory laparoscopic fundoplication.

    Science.gov (United States)

    Milford, M A; Paluch, T A

    1997-12-01

    Increasingly larger series of laparoscopic fundoplications (LF) are being reported. A well-documented advantage of the laparoscopic approach is shortened hospital stay. Most centers report typical lengths of stay (LOS) for LF of 2-3 days. Our success with LF with a LOS of 1 day led to an attempt at performing LF on an ambulatory basis. Sixty-one consecutive patients with appropriate criteria for LF underwent surgery at our institution. Patients were counseled by the authors as to the usual postop course and progression of diet. All patients received preemptive analgesia (PEA) consisting of perioperative ketorolac and preincisional local infiltration with bupivicaine. Anesthetic management included induction with propofol, high-dose inhalational anesthetics, minimizing administration of parenteral narcotics, and avoidance of reversal of neuromuscular blockade. Immediate postop pain management included parenteral ketorolac and oral hydro- or oxycodone. All patients were given oral fluids and soft solids after transfer from the recovery room to the postoperative observation unit. Two patients were excluded from ambulatory consideration due to excessive driving distance from our hospital. Another two were hospitalized for observation after experiencing intraoperative technical problems. Of 57 patients in whom same-day discharge was attempted, there were three failures requiring overnight hospitalization: All were due to pain and nausea; one patient also suffered transient urinary retention. There were no adverse outcomes related to early discharge, and there were no readmissions. One patient returned to the emergency room after delayed development of urinary retention. Median time from conclusion of operation to discharge was less than 5 h. No patients expressed dissatisfaction with early discharge on follow-up interview. LF can be safely performed as an ambulatory procedure. Analgesic and anesthetic management should be tailored to minimize nausea and provide adequate

  11. Pain characteristics after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette A; Strandfelt, Pernille; Rosenberg, Jacob

    2011-01-01

    Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study...

  12. Deep Neuromuscular Blockade Improves Laparoscopic Surgical Conditions

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Herring, W Joseph; Blobner, Manfred

    2017-01-01

    INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecys...

  13. Laparoscopic supracervical hysterectomy and uterine morcellation ...

    African Journals Online (AJOL)

    2015-02-23

    Feb 23, 2015 ... sites completely healed and histology result confirmed. Leiomyoma Uteri. Discussion. Advances in hysterectomy range from laparoscopic‑assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), LSCH and more recently robotic. TLH. Literature on laparoscopic hysterectomy in Nigeria.

  14. What's new in intraperitoneal test on Kevlar (asbestos substitute)?

    Science.gov (United States)

    Brinkmann, O A; Müller, K M

    1989-09-01

    The intraperitoneal test is a suitable experimental method for studying the different patterns of morphological reaction to foreign body substances of various kinds and concentrations as well as their transport within and elimination from the organism, Kevlar fibres are synthetic aromatic polyamid (aramid) fibres which, investigated by means of the intraperitoneal test in Wistar rats, show distinct pathogenetic reaction patterns: 1. In the early stage after application, the formation of multinucleated giant cells with phagocytosis of the amber-coloured Kevlar fibres, and an inflammatory reaction are foremost features. 2. The typical feature of the second stage is the development of granulomas with central necrosis indicating the cytotoxic nature of Kevlar fibres. 3. The third stage is dominated by the mesenchymal activation with capsular structures of collagenous fibres. Besides granulomatous foci, a slight submesothelial fibrosis is observed. 4. Fragments of Kevlar fibres are drained through lymphatic pathways and stored in lymph nodes where they lead to inflammatory reactions. 5. The reactive granulomatous changes in the greater omentum of rats are accompanied by proliferative mesothelial changes which, in one cases, even led to the development of a multilocular mesothelioma.

  15. Active protection against rotavirus infection of mice following intraperitoneal immunization.

    Science.gov (United States)

    McNeal, M M; Sheridan, J F; Ward, R L

    1992-11-01

    Active immunity to rotavirus has been demonstrated following oral inoculation with live virus but little is known about the effects of parenteral immunization. In this study, adult mice were immunized by intraperitoneal (ip) inoculation with live rotaviruses and later orally challenged with murine rotavirus (EDIM) to measure active immunity against infection. Three doses of EDIM (8 micrograms/dose) given intraperitoneally (ip) provided full protection against EDIM infection, whether administered with or without Freund's adjuvant. Only partial protection was found when the quantity of immunogen was reduced to protection of all mice. Significant protection was also observed after inoculation with one or three doses (2 micrograms/dose) of heterologous rotaviruses. Protection provided by the heterologous strains did not correlate with neutralizing antibody to EDIM, which indicated that neutralizing antibody to the challenge virus was not required for protection. uv-Inactivated EDIM also provided significant protection against EDIM, thus demonstrating that viral replication was not required for protection. These results suggest that parenteral immunization may be an effective method to vaccinate against rotavirus disease.

  16. Deep Neuromuscular Blockade Improves Laparoscopic Surgical Conditions

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Herring, W Joseph; Blobner, Manfred

    2017-01-01

    INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecys......INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic...

  17. Laparoscopic intraperitoneal mesh fixation with fibrin sealant (Tisseel®) vs. titanium tacks: a randomised controlled experimental study in pigs

    DEFF Research Database (Denmark)

    Eriksen, J.R.; Bech, Jakob Ilsted; Linnemann, D.

    2008-01-01

    .002). There was no difference in the grade of adhesions (%) between fixation methods (p = 0.794) or different mesh types (p = 0.296). In the same fashion, there was no difference in the strength of adhesions (grades 0-4) between the two fixation methods or different mesh types (p>0.5, chi(2) test). There was no significant...

  18. Symptomatic outcome after laparoscopic cholecystectomy.

    Science.gov (United States)

    Niranjan, B; Chumber, S; Kriplani, A K

    2000-01-01

    Patients with gallstones often present with multiple complaints. We wanted to study the major complaints of our patients undergoing laparoscopic cholecystectomy and the symptomatic relief afforded by the operation. We studied 113 patients with symptomatic gallstone disease who underwent laparoscopic cholecystectomy in a single surgical unit. Patients with proven common bile duct stones, obstructive jaundice, cholangitis, present or past associated abdominal pathology or cholecystoenteric fistula were excluded from the study. The mean follow up period was 18 months (range 10-22 months). A detailed account of the symptoms of gallstones, length of post-operative stay, persistence of symptoms, development of fresh symptoms and resumption of fat containing diet were assessed. The male to female ratio was 1:4. Common presenting symptoms were abdominal pain (96%), flatulence or feeling of fullness of abdomen (85%), heartburn (66%), belching (62%), sour eructation (52%), vomiting (48%) and nausea (45%). Mean postoperative hospital stay was 28 hours (range 9-68 hours). Biliary pain was relieved in 99% of patients after laparoscopic cholecystectomy (p cholecystectomy. Fresh symptoms that developed after laparoscopic cholecystectomy were heart-burn (6%), belching (3.5%), sour eructation (1%) and vomiting (0.5%). Post-cholecystectomy post-prandial diarrhoea occurred in 20% of the patients. The patients' appreciation of a satisfactory cosmetic result of operation scars was 100 percent. Fifteen female patients (13.5%) complained of increased weight gain of more than 5 kg after laparoscopic cholecystectomy [(p > 0.05; not significant (NS)]. Laparoscopic cholecystectomy significantly relieved symptoms of gall stone disease. Biliary pain, nausea, vomiting and sour eructations had better outcome compared to belching, flatulence and heartburn, which are also relieved in majority. Postcholecystectomy post-prandial diarrhea was a significant new symptom after cholecystectomy. Pre

  19. Laparoscopic Elective Colonic Operation and Concomitant ...

    African Journals Online (AJOL)

    extracorporeal bowel resection and anastomosis after laparoscopic anterior resection. Another possibility that could be used in this case would be a laparoscopic transabdominal preperitoneal repair (TAPP) associated with laparoscopic anterior resection. Anyway, the presented case shows that a full preoperative surgical ...

  20. Laparoscopic Appendectomy in a Developing African Country ...

    African Journals Online (AJOL)

    Background: The wide spread introduction of laparoscopic surgery to surgical practice in Nigeria is a relatively new development. The benefits of laparoscopic appendicectomy are controversial. Laparoscopic appendicectomy (LA) has always generated controversy due to its cost and time consuming nature and the multiple ...

  1. CELL RESPONSE TO INTRAPERITONEAL PDMS/HAP COMPOSITE IMPLANT

    Directory of Open Access Journals (Sweden)

    Perica Vasiljević

    2005-07-01

    Full Text Available Siloxane polimers have been widely used in biomedicine and pharmacy due to their biocompatibility. Hydroxyapatite (HAp is a natural constituent of bones, and therefore widely used in maxillofacial and orthopedic surgery. HAp itself is amorphous and without elasticity, so its characteristics can be improved when combined with organic polymers. We evaluated the interaction of cells and composites made of polydimethylsiloxane (PDMS and HAp by scanning electron microscopy (SEM 10 days after their intraperitoneal implantation into Balb/c mice. Two composites which were different in the quantity of HAp were analyzed. Both of them showed high adhesive characteristics for different cell types. The erythrocytes in cell clusters could be seen on the surface of the composite with higher quantity of HAp.

  2. Neutron-Activatable Nanoparticles for Intraperitoneal Radiation Therapy.

    Science.gov (United States)

    Hargrove, Derek; Lu, Xiuling

    2017-01-01

    Intraperitoneal internal radiation therapy is a cancer treatment option that is employed in situations where surgical resection, systemic chemotherapy, and external beam radiotherapy are not amenable for patients. However, exposure of noncancerous tissues to radiation continues to be a hindrance to safe and effective treatment of patients. In addition, reducing prolonged radiation exposure of personnel during preparation of internal radiation therapy agents makes their manufacture complicated and hazardous. Developments in nanotechnology have provided a platform for targeted treatments that combine dual imaging and treatment capabilities all in one package, while also being robust enough to withstand the intense stresses faced during neutron activation. Here, we describe a method for synthesizing neutron activatable mesoporous silica nanoparticles for use in radiotherapy of metastatic peritoneal cancers while limiting personal exposure to radioactive materials, limiting the leakage of radioactive isotopes caused by nanoparticle degradation during neutron activation, and increasing cancer tissue specificity of radiation.

  3. [Terminological and classification aspects of laparoscopic hysterectomies].

    Science.gov (United States)

    Tomov, S; Gorchev, G; Tzvetkov, Ch; Iliev, S; Gincheva, D

    2012-01-01

    There is a great variety of terms and concepts describing laparoscopic hysterectomy in scientific literature. The term "laparoscopic hysterectomy" includes different operations where the laparoscope is used as an aid for a hysterectomy. The first classifications related to hysterectomy laparoscopic procedures were suggested by Munro and Parker (1993) Johns and Diamonds (1994) and Garry et al. (1994). Based on them is the American Association of Gynecologic Laparoscopists (AAGL) classification of 2000. Reich defined basic terms easy to use in clinical practice. The elaboration of a suitable classification system describing the size of laparoscopic intervention in hysterectomy is a prerequisite for an adequate comparison of the results of scientific researches.

  4. Efficacy of intramuscular and intraperitoneal deferoxamine for aluminum chelation.

    Science.gov (United States)

    Molitoris, B A; Alfrey, P S; Miller, N L; Hasbargen, J A; Kaehney, W D; Alfrey, A C; Smith, B J

    1987-04-01

    As intravenous administration of deferoxamine is difficult in home dialysis patients we set out to determine the efficacy of intramuscular (i.m.) and intraperitoneal (i.p.) deferoxamine for removal of aluminum. Patients with serum aluminum levels greater than 90 micrograms/liter were studied in a paired fashion with each patient serving as their own control. Serum and peritoneal fluid aluminum were determined using flameless atomic absorption. In hemodialysis patients 2 g of intravenous deferoxamine increased serum aluminum from 124.7 +/- 32.4 to 415 +/- 192.4 micrograms/liter. One g of deferoxamine given intravenously or intramuscularly resulted in 76.8 +/- 35.3% and 70.4 +/- 23.2%, respectively, of the 2 g i.v. response. The rate at which serum aluminum increased following i.v. deferoxamine infusion was biphasic, with an initial rapid phase lasting 139 minutes followed by a much slower phase. The volume of distribution of aluminum following deferoxamine administration was 12.6 +/- 1.61 and the half life (t1/2) for aluminum removal during hemodialysis was 9.0 +/- 2.0 hours. The increase in serum aluminum following deferoxamine was not due to chelation of erythrocyte aluminum as erythrocyte aluminum remained constant over 24 hours. In patients on continuous ambulatory peritoneal dialysis, 2 g intravenous deferoxamine resulted in the removal of 560 +/- 267 micrograms of aluminum over 24 hours while 2 g deferoxamine given intraperitoneally gave 91 +/- 13% of the intravenous response. Aluminum clearance over 48 hours was twice that for 24 hours for both i.v. and i.p. deferoxamine.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Dysphagia after laparoscopic Nissen fundoplication

    DEFF Research Database (Denmark)

    Funch-Jensen, Peter; Jacobsen, Bo

    2007-01-01

    OBJECTIVE: To investigate the frequency and severity of dysphagia during the first 8 weeks after laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. So far, there have been no studies reporting data on day-to-day occurrence of dysphagia after laparoscopic fundoplication...... in a consecutive series of patients. This may explain why the frequency of dysphagia varies greatly in the literature (4-100%). MATERIAL AND METHODS: Forty consecutive patients, undergoing elective laparoscopic Nissen fundoplication, completed a standard dysphagia registration diary each day during the first 8...... weeks after surgery. Patients who preoperatively had suffered from dysphagia were excluded. Thus, none of the patients had dysphagia in the 2-month period before surgery. Ten patients undergoing elective cholecystectomy served as controls. Data were quantified, and a score value of 4 or more...

  6. Laparoscopic surgery in colorectal cancer

    International Nuclear Information System (INIS)

    Bressler Hernandez, Norlan; Martinez Perez, Elliot; Fernandez Rodriguez, Leopoldo; Torres Core, Ramiro

    2011-01-01

    In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as oncologically equivalent to conventional open surgery. The advantages of laparoscopic surgery have translated into smaller incisions and shorter recovery. Since the advent of laparoscopy, surgeons have been fueled to develop less invasive operative methods as feasible alternatives to traditional procedures. As techniques evolved and technology advanced, laparoscopy became more widely accepted and is now more commonly used in many institutions. Recently, a trend toward less invasive surgery, driven by patient and surgeon alike, has been a major objective for many institutions because of the ability of laparoscopic surgery to reduce postoperative pain, achieve a quicker recovery time, and improve cosmetic outcomes. Although still evolving, traditional laparoscopy has served as a foundation for even further refinements in the minimally invasive approach and as a result, more advanced equipment and newer techniques have arisen

  7. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  8. Laparoscopic Partial Hepatectomy: Animal Experiments

    Directory of Open Access Journals (Sweden)

    Haruhiro Inoue

    1995-01-01

    Full Text Available As a first step in firmly establishing laparoscopic hepatectomy, we introduce a porcine model of laparoscopic partial hepatectomy. This procedure has been successfully performed under the normal-pressure or low-pressure pneumoperitoneum condition supported by the full-thickness abdominal wall lifting technique. An ultrasonic dissector combined with electrocautery, newly developed by Olympus Optical Corporation (Japan was effectively utilized in facilitating safe and smooth incisions into the liver parenchyma. Although indications for this procedure seem to be limited only to peripheral lesions and not to central lesions, clinical application of this method may be useful for some patients in the near future.

  9. Laparoscopic ultrasound and gastric cancer

    Science.gov (United States)

    Dixon, T. Michael; Vu, Huan

    2001-05-01

    The management of gastrointestinal malignancies continues to evolve with the latest available therapeutic and diagnostic modalities. There are currently two driving forces in the management of these cancers: the benefits of minimally invasive surgery so thoroughly demonstrated by laparoscopic surgery, and the shift toward neoadjuvant chemotherapy for upper gastrointestinal cancers. In order to match the appropriate treatment to the disease, accurate staging is imperative. No technological advances have combined these two needs as much as laparascopic ultrasound to evaluate the liver and peritoneal cavity. We present a concise review of the latest application of laparoscopic ultrasound in management of gastrointestinal malignancy.

  10. Magnetically assisted intraperitoneal drug delivery for cancer chemotherapy.

    Science.gov (United States)

    Shamsi, Milad; Sedaghatkish, Amir; Dejam, Morteza; Saghafian, Mohsen; Mohammadi, Mehdi; Sanati-Nezhad, Amir

    2018-11-01

    Intraperitoneal (IP) chemotherapy has revived hopes during the past few years for the management of peritoneal disseminations of digestive and gynecological cancers. Nevertheless, a poor drug penetration is one key drawback of IP chemotherapy since peritoneal neoplasms are notoriously resistant to drug penetration. Recent preclinical studies have focused on targeting the aberrant tumor microenvironment to improve intratumoral drug transport. However, tumor stroma targeting therapies have limited therapeutic windows and show variable outcomes across different cohort of patients. Therefore, the development of new strategies for improving the efficacy of IP chemotherapy is a certain need. In this work, we propose a new magnetically assisted strategy to elevate drug penetration into peritoneal tumor nodules and improve IP chemotherapy. A computational model was developed to assess the feasibility and predictability of the proposed active drug delivery method. The key tumor pathophysiology, including a spatially heterogeneous construct of leaky vasculature, nonfunctional lymphatics, and dense extracellular matrix (ECM), was reconstructed in silico. The transport of intraperitoneally injected magnetic nanoparticles (MNPs) inside tumors was simulated and compared with the transport of free cytotoxic agents. Our results on magnetically assisted delivery showed an order of magnitude increase in the final intratumoral concentration of drug-coated MNPs with respect to free cytotoxic agents. The intermediate MNPs with the radius range of 200-300 nm yield optimal magnetic drug targeting (MDT) performance in 5-10 mm tumors while the MDT performance remains essentially the same over a large particle radius range of 100-500 nm for a 1 mm radius small tumor. The success of MDT in larger tumors (5-10 mm in radius) was found to be markedly dependent on the choice of magnet strength and tumor-magnet distance while these two parameters were less of a concern in small tumors

  11. EAMJ Dec. Laparoscopic.indd

    African Journals Online (AJOL)

    2008-12-12

    Dec 12, 2008 ... A case of an acute abdomen secondary to a ruptured spleen managed laparoscopically is presented. ... cavity was done. No surgical intervention was done as the adherent clot was found to be providing tamponade with no active bleeding evidenced. A ... splenic rupture in complicated malaria is poorly.

  12. Errors and complications in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Liviu Drăghici

    2017-05-01

    Full Text Available Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during 1994-2014. We wanted to identify evolution trends in complications of laparoscopic surgery, analyzing the dynamic of errors occurred in all patients with laparoscopic procedures. Results. We recorded 26847 laparoscopic interventions with a total of 427 intra-or postoperative complications that required 160 conversions and 267 reinterventions to resolve inconsistencies. The average frequency of occurrence of complications was 15.9‰ (15.9 of 1,000 cases. In the period under review it was a good momentum of laparoscopic procedures in our department. Number of minimally invasive interventions increased almost 10 times, from 266 cases operated laparoscopically in 1995 to 2638 cases in 2008. Annual growth of the number of laparoscopic procedures has surpassed the number of complications. Conclusions. Laborious work of laparoscopic surgery and a specialized centre with well-trained team of surgeons provide premises for a good performance even in the assimilation of new and difficult procedures.

  13. Laparoscopic repair for vesicouterine fistulae

    Directory of Open Access Journals (Sweden)

    Rafael A. Maioli

    2015-10-01

    Full Text Available ABSTRACT Objective: The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a cesarean delivery. The obstetric team implemented conservative management, including Foley catheter insertion, for 2 weeks. She subsequently developed intermittent hematuria and cystitis. The urology team was consulted 15 days after cesarean delivery. Cystoscopy indicated an ulcerated lesion in the bladder dome of approximately 1.0cm in size. Hysterosalpingography and a pelvic computed tomography scan indicated a fistula. Materials and Methods: Laparoscopic repair was performed 30 days after the cesarean delivery. The patient was placed in the lithotomy position while also in an extreme Trendelenburg position. Pneumoperitoneum was established using a Veress needle in the midline infra-umbilical region, and a primary 11-mm port was inserted. Another 11-mm port was inserted exactly between the left superior iliac spine and the umbilicus. Two other 5-mm ports were established under laparoscopic guidance in the iliac fossa on both sides. The omental adhesions in the pelvis were carefully released and the peritoneum between the bladder and uterus was incised via cautery. Limited cystotomy was performed, and the specific sites of the fistula and the ureteral meatus were identified; thereafter, the posterior bladder wall was adequately mobilized away from the uterus. The uterine rent was then closed using single 3/0Vicryl sutures and two-layer watertight closure of the urinary bladder was achieved by using 3/0Vicryl sutures. An omental flap was mobilized and inserted between the uterus and the urinary bladder, and was fixed using two 3/0Vicryl sutures, followed by tube drain insertion. Results: The operative time was 140 min, whereas the blood loss was 100ml. The patient was discharged 3 days after surgery, and the catheter was removed 12 days after surgery

  14. Repeated Intraperitoneal alpha-Radioimmunotherapy of Ovarian Cancer in Mice

    DEFF Research Database (Denmark)

    Elgqvist, Jörgen; Andersson, Håkan; Jensen, Holger

    2010-01-01

    The aim of this study was to investigate the therapeutic efficacy of alpha-radioimmunotherapy of ovarian cancer in mice using different fractionated treatment regimens. The study was performed using the monoclonal antibody MX35 F(ab')(2) labeled with the alpha-particle emitter (211)At. Methods....... Nude mice were intraperitoneally inoculated with ~1 x 10(7) cells of the cell line NIH:OVCAR-3. Four weeks later 6 groups of animals were given 400 kBq (211)At-MX35 F(ab')(2) as a single or as a repeated treatment of up to 6 times (n = 18 in each group). The fractionated treatments were given every...... seventh day. Control animals were treated with unlabeled MX35 F(ab')(2) (n = 12). Eight weeks posttreatment the animals were sacrificed and the presence of macro- and microscopic tumors and ascites was determined. Results. The tumor-free fractions (TFFs) of the animals, defined as the fraction of animals...

  15. Serum Antibodies Protect against Intraperitoneal Challenge with Enterotoxigenic Escherichia coli

    Directory of Open Access Journals (Sweden)

    Xinghong Yang

    2011-01-01

    Full Text Available To assess whether anticolonization factor antigen I (CFA/I fimbriae antibodies (Abs from enterotoxigenic Escherichia coli (ETEC can protect against various routes of challenge, BALB/c mice were immunized with a live attenuated Salmonella vaccine vector expressing CFA/I fimbriae. Vaccinated mice elicited elevated systemic IgG and mucosal IgA Abs, unlike mice immunized with the empty Salmonella vector. Mice were challenged with wild-type ETEC by the oral, intranasal (i.n., and intraperitoneal (i.p. routes. Naïve mice did not succumb to oral challenge, but did to i.n. challenge, as did immunized mice; however, vaccinated mice were protected against i.p. ETEC challenge. Two intramuscular (i.m. immunizations with CFA/I fimbriae without adjuvant conferred 100% protection against i.p. ETEC challenge, while a single 30 μg dose conferred 88% protection. Bactericidal assays showed that ETEC is highly sensitive to anti-CFA/I sera. These results suggest that parenteral immunization with purified CFA/I fimbriae can induce protective Abs and may represent an alternative method to elicit protective Abs for passive immunity to ETEC.

  16. Peritoneal Nebulization of Ropivacaine during Laparoscopic Cholecystectomy: Dose Finding and Pharmacokinetic Study

    Directory of Open Access Journals (Sweden)

    Massimo Allegri

    2017-01-01

    Full Text Available Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain and morphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150 mg of ropivacaine 1% by peritoneal nebulization through a nebulizer. Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50 mg of ropivacaine had the same effect of 100 or 150 mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05. Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P>0.05. Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

  17. Laparoscopic management of a drain site evisceration of the vermiform appendix, a case report.

    Science.gov (United States)

    Tidjane, Anisse; Tabeti, Benali; Boudjenan Serradj, Nabil; Bensafir, Salim; Ikhlef, Nacim; Benmaarouf, Noureddine

    2018-01-01

    Peritoneal cavity drainage is not riskless and several publications reported drain induced complications. However, till this day, abdominal drainage is still a subject of divergence between necessity and usual operative practice. We describe in this publication an exceptional complication of drainage, which is the drain site evisceration of the appendix. We report the case of a 47-years-old patient, initially operated for perforated ulcer peritonitis, in whom an evisceration occured 48h after the removal of an intraperitoneal drain placed in the Douglas pouch, the physical examination predicated the presence of a herniated omentum fringe, as a precaution a laparoscopic exploration was performed and revealed that the eviscerated organ was the vermiform appendix, then a two trocars appendectomy was performed and the orifice of the evisceration was safely closed. Since the first description in 1995, only seven cases were reported in the literature, we propose a new management of the drain site evisceration of the appendix, including laparoscopic exploration, and both side control of the drain site defect closure, our technique seems safer. The laparoscopic approaches must have a place in the management of the drain site eviscerations. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  18. Errors and complications in laparoscopic surgery

    OpenAIRE

    Liviu Drăghici; Mircea Lițescu; Rubin Munteanu; Constantin Pătru; Carmen L. Gorgan; Radu Mirică; Isabela Drăghici

    2017-01-01

    Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during...

  19. Laparoscopic colectomy for transverse colon carcinoma.

    Science.gov (United States)

    Zmora, O; Bar-Dayan, A; Khaikin, M; Lebeydev, A; Shabtai, M; Ayalon, A; Rosin, D

    2010-03-01

    Laparoscopic resection of transverse colon carcinoma is technically demanding and was excluded from most of the large trials of laparoscopic colectomy. The aim of this study was to assess the safety, feasibility, and outcome of laparoscopic resection of carcinoma of the transverse colon. A retrospective review was performed to identify patients who underwent laparoscopic resection of transverse colon carcinoma. These patients were compared to patients who had laparoscopic resection for right and sigmoid colon carcinoma. In addition, they were compared to a historical series of patients who underwent open resection for transverse colon cancer. A total of 22 patients underwent laparoscopic resection for transverse colon carcinoma. Sixty-eight patients operated for right colon cancer and 64 operated for sigmoid colon cancer served as comparison groups. Twenty-four patients were identified for the historical open group. Intraoperative complications occurred in 4.5% of patients with transverse colon cancer compared to 5.9% (P = 1.0) and 7.8% (P = 1.0) of patients with right and sigmoid colon cancer, respectively. The early postoperative complication rate was 45, 50 (P = 1.0), and 37.5% (P = 0.22) in the three groups, respectively. Conversion was required in 1 (5%) patient in the laparoscopic transverse colon group. The conversion rate and late complications were not significantly different in the three groups. There was no significant difference in the number of lymph nodes harvested in the laparoscopic and open groups. Operative time was significantly longer in the laparoscopic transverse colectomy group when compared to all other groups (P = 0.001, 0.008, and transverse colectomy, respectively). The results of laparoscopic colon resection for transverse colon carcinoma are comparable to the results of laparoscopic resection of right or sigmoid colon cancer and open resection of transverse colon carcinoma. These results suggest that laparoscopic resection of transverse

  20. Mesenteric vein thrombosis following laparoscopic appendectomy

    OpenAIRE

    Jamie Harris; Brian Blackwood; Srikumar Pillai; Bill Chiu

    2014-01-01

    Mesenteric vein thrombosis is an uncommon complication following laparoscopic surgery. A review of the literature has shown that there is a higher incidence of thrombosis following laparoscopic bariatric procedures, including the gastric sleeve procedure and roux-en-y gastric bypass surgery. Additionally, pylephlebitis, thrombosis of portal or mesenteric veins, has been described following perforated appendicitis. However no report has described mesenteric vein thrombosis following laparoscop...

  1. Intraperitoneal implantation of life-long telemetry transmitters in otariids

    Directory of Open Access Journals (Sweden)

    Haulena Martin

    2008-12-01

    Full Text Available Abstract Background Pinnipeds, including many endangered and declining species, are inaccessible and difficult to monitor for extended periods using externally attached telemetry devices that are shed during the annual molt. Archival satellite transmitters were implanted intraperitoneally into four rehabilitated California sea lions (Zalophus californianus and 15 wild juvenile Steller sea lions (Eumetopias jubatus to determine the viability of this surgical technique for the deployment of long-term telemetry devices in otariids. The life history transmitters record information throughout the life of the host and transmit data to orbiting satellites after extrusion following death of the host. Results Surgeries were performed under isoflurane anesthesia and single (n = 4 or dual (n = 15 transmitters were inserted into the ventrocaudal abdominal cavity via an 8.5 to 12 cm incision along the ventral midline between the umbilicus and pubic symphysis or preputial opening. Surgeries lasted 90 minutes (SD = 8 for the 19 sea lions. All animals recovered well and were released into the wild after extended monitoring periods from 27 to 69 days at two captive animal facilities. Minimum post-implant survival was determined via post-release tracking using externally attached satellite transmitters or via opportunistic re-sighting for mean durations of 73.7 days (SE = 9.0, Z. californianus and 223.6 days (SE = 71.5, E. jubatus. Conclusion The low morbidity and zero mortality encountered during captive observation and post-release tracking periods confirm the viability of this surgical technique for the implantation of long-term telemetry devices in otariids.

  2. Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair

    DEFF Research Database (Denmark)

    Baker, J J; Öberg, S; Andresen, K

    2018-01-01

    BACKGROUND: Ventral hernia repairs are common and have high recurrence rates. They are usually repaired laparoscopically with an intraperitoneal mesh, which can be fixed in various ways. The aim was to evaluate the recurrence rates for the different fixation techniques. METHODS: This systematic...... review included studies with human adults with a ventral hernia repaired with an intraperitoneal onlay mesh. The outcome was recurrence at least 6 months after operation. Cohort studies with 50 or more participants and all RCTs were included. PubMed, Embase and the Cochrane Library were searched on 22...... September 2016. RCTs were assessed with the Cochrane risk-of-bias assessment tool and cohort studies with the Newcastle-Ottawa scale. Studies comparing fixation techniques were included in a network meta-analysis, which allowed comparison of more than two fixation techniques. RESULTS: Fifty-one studies...

  3. Laparoscopic radical prostatectomy: a review

    Directory of Open Access Journals (Sweden)

    Pierluigi Bove

    2009-04-01

    Full Text Available INTRODUCTION: We offer an overview of the intra-, peri- and postoperative outcomes of laparoscopic radical prostatectomy (LRP with the endpoint to evaluate potential advantages of this approach. MATERIAL AND METHODS: We conducted an extensive Medline literature search (search terms “laparoscopic radical prostatectomy” and “radical prostatectomy” from 1990 until 2007. Only full-length English language articles identified during this search were considered for this analysis. A preference was given to the articles with large series with more than 100 patients. All pertinent articles concerning localized prostate cancer were reviewed. CONCLUSION:Pure LRP has shown to be feasible and reproducible but it is difficult to learn. Potential advantages over open surgery have to be confirmed by longer-term follow-up and adequately designed clinical studies.

  4. Laparoscopic revolution in bariatric surgery

    OpenAIRE

    Sundbom, Magnus

    2014-01-01

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techn...

  5. Laparoscopic pancreatectomy: Indications and outcomes

    Science.gov (United States)

    Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

    2014-01-01

    The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons’ experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. PMID:25339811

  6. Laparoscopic liver resection with radiofrequency.

    Science.gov (United States)

    Croce, E; Olmi, S; Bertolini, A; Erba, L; Magnone, S

    2003-01-01

    In this report, the feasibility, efficacy and safety of laparoscopic liver resection with radiofrequency has been evaluated in a small series of patients. From January 1993 to May 2002 we carried out 7 laparoscopic liver resections (3 men and 4 women), five of which were for benign pathology and two for metastases from colorectal cancer. In four of the above resections we used an argon coagulator; the last three were accomplished by means of a radiofrequency instrument. We had no perioperative or postoperative complications in this small series of patients. There were no deaths. Perioperative blood loss was of 120 mL (range 80-200) and the procedure took about 90 minutes (range 80-110). Hospitalization was of 4 days and pain was adequately controlled by 2 mL of Toradol twice a day. We think that the advantages of laparoscopic techniques together with the efficacy of the radiofrequency instrument in hepatic surgery will allow the diffusion of this method and its extension to safe execution of major resections.

  7. Effect of Intraperitoneal Bupivacaine on Postoperative Pain in the Gynecologic Oncology Patient.

    Science.gov (United States)

    Rivard, Colleen; Vogel, Rachel Isaksson; Teoh, Deanna

    2015-01-01

    To evaluate if the administration of intraperitoneal bupivacaine decreased postoperative pain in patients undergoing minimally invasive gynecologic and gynecologic cancer surgery. Retrospective cohort study (Canadian Task Force classification II-3). University-based gynecologic oncology practice operating at a tertiary medical center. All patients on the gynecologic oncology service undergoing minimally invasive surgery between September 2011 and June 2013. Starting August 2012, intraperitoneal administration of .25% bupivacaine was added to all minimally invasive surgeries. These patients were compared with historical control subjects who had surgery between September 2011 and July 2012 but did not receive intraperitoneal bupivacaine. One-hundred thirty patients were included in the study. The patients who received intraperitoneal bupivacaine had lower median narcotic use on the day of surgery and the first postoperative day compared with those who did not receive intraperitoneal bupivacaine (day 0: 7.0 mg morphine equivalents vs 11.0 mg, p = .007; day 1: .3 mg vs 1.7 mg, p = .0002). The median patient-reported pain scores were lower on the day of surgery in the intraperitoneal bupivacaine group (2.7 vs 3.2, p = .05) CONCLUSIONS: The administration of intraperitoneal bupivacaine was associated with improved postoperative pain control in patients undergoing minimally invasive gynecologic and gynecologic cancer surgery and should be further evaluated in a prospective study. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  8. 21 CFR 884.1720 - Gynecologic laparoscope and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gynecologic laparoscope and accessories. 884.1720... Devices § 884.1720 Gynecologic laparoscope and accessories. (a) Identification. A gynecologic laparoscope...) Class II (performance standards). (2) Class I for gynecologic laparoscope accessories that are not part...

  9. Pioneering Laparoscopic General Surgery in Nigeria | Misauno ...

    African Journals Online (AJOL)

    Background: Laparoscopic Surgery has revolutionized surgical operations due to its unique advantages of a shorter hospital stay, minimal surgical trauma and a better cosmetic outcome. There are a few reports from Nigeria reporting laparoscopic surgery in gynaecology. To the best of our knowledge, there has been no ...

  10. Laparoscopic partial nephrectomy for endophytic hilar tumors

    DEFF Research Database (Denmark)

    Di Pierro, G B; Tartaglia, N; Aresu, L

    2014-01-01

    To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients.......To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients....

  11. Portal vein thrombosis following laparoscopic gastric plication

    Science.gov (United States)

    Rikabi, S; Chang, A; Durkin, N; Ramar, S

    2017-01-01

    Portal vein thrombosis (PVT) following laparoscopic surgery including Roux-en-Y bypass, sleeve gastrectomy and Nissen’s fundoplication is a rare but recognised complication. Laparoscopic gastric plication in a new procedure that is popular in some parts of the world. We report a case of a patient suffering PVT as a complication of this surgery. PMID:27652795

  12. Laparoscopic versus open appendectomy in children with ...

    African Journals Online (AJOL)

    Introduction: Acute appendicitis represents one of the most common causes of urgent surgical interventions in pediatric age group. With the advances in minimal invasive surgery laparoscopic appendectomy (LA) has been introduced as a suitable line of treatment. We compare between laparoscopic and conventional open ...

  13. Force feedback and basic laparoscopic skills

    NARCIS (Netherlands)

    Chmarra, M.K.; Dankelman, J.; Van den Dobbelsteen, J.J.; Jansen, F.W.

    2008-01-01

    Background - Not much is known about the exact role offorce feedback in laparoscopy. This study aimed to determine whether force feedback influences movements of instruments during training in laparoscopic tasks and whether force feedback is required for training in basic laparoscopic force

  14. Day-case laparoscopic Nissen fundoplication.

    LENUS (Irish Health Repository)

    Khan, S A

    2012-01-01

    For day-case laparoscopic surgery to be successful, patient selection is of the utmost importance. This study aimed to assess the feasibility of day-case laparoscopic Nissen fundoplication and to identify factors that may lead to readmission and overstay.

  15. Paediatric laparoscopic orchidopexy as a novel mentorship ...

    African Journals Online (AJOL)

    Paediatric laparoscopic orchidopexy as a novel mentorship: Training model. ... V Gupta, SK Yadav, E Dean, P Vincent, F Walid, A Al Said ... The aim of this study was to review experience as a mentor in training laparoscopic skills through condensed training programme based on high volume low risk procedure of pediatric ...

  16. [Laparoscopic vs opened appendicovesicostomy in pediatric patients].

    Science.gov (United States)

    Landa-Juárez, Sergio; Montes de Oca-Muñoz, Lorena Elizabeth; Castillo-Fernández, Ana María; de la Cruz-Yañez, Hermilo; García-Hernández, Carlos; Andraca-Dumit, Roxona

    2014-01-01

    Appendicovesicostomy is commonly employed to facilitate drainage of urine through the catheter. Due to the tendency to less invasive procedures for the treatment of patients with neurogenic bladder, laparoscopy has been used as an alternative to open surgery, with the immediate advantages of postoperative recovery, shorter postoperative ileus, better cosmetic results, lower postoperative pain and early reintegration into everyday life. Compare the results of laparoscopic procedure with open appendicovesicostomy. We conducted an observational, analytical, longitudinal, ambispective cohort study, which included patients from 6-16 years of age diagnosed with neurogenic bladder, operated through laparoscopic and open appendicovesicostomy from January 2009 to June 2013. Information was obtained from clinical records. Six patients were operated laparoscopically and 14 by open approach. Surgical time was longer and statistically significant in the laparoscopic group with a median of 330 min (300-360 min) compared to open procedure of 255 min (180-360 min). Seven patients had complications in the open group and only one in the laparoscopic group. The difference in the dose of analgesics and time of use was statistically significant in favor of the laparoscopic group. The degree of urinary continence through the stoma was higher for laparoscopic (100%) compared to the open procedure (64%). In neurogenic bladder with urodynamic bladder capacity and leak point pressure bladder within acceptable values, laparoscopic appendicovesicostomy was a better alternative.

  17. Portal vein thrombosis following laparoscopic gastric plication

    OpenAIRE

    Som, R; Rikabi, S; Chang, A; Durkin, N; Ramar, S

    2017-01-01

    Portal vein thrombosis (PVT) following laparoscopic surgery including Roux-en-Y bypass, sleeve gastrectomy and Nissen’s fundoplication is a rare but recognised complication. Laparoscopic gastric plication in a new procedure that is popular in some parts of the world. We report a case of a patient suffering PVT as a complication of this surgery.

  18. Coagulation and fibrinolysis during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rahr, H B; Fabrin, K; Larsen, J F

    1999-01-01

    Laparoscopic surgery appears to be less traumatic to the patient than open surgery, but its influence upon coagulation and fibrinolysis is incompletely elucidated. Our aim was to measure markers of coagulation and fibrinolysis before, during. and after laparoscopic cholecystectomy (LC). Blood...

  19. Laparoscopic myomectomy for infertile patients with intramural ...

    African Journals Online (AJOL)

    Background. The safety of laparoscopic myomectomy has been questioned, especially in the case of fibroids. Objectives. To assess the safety of laparoscopic myomectomy for intramural fibroids and study the subsequent effect on fertility. Methods and settings. A retrospective study of a tertiary endoscopic centre ...

  20. Laparoscopic assisted vaginal hysterectomy for benign uterine ...

    African Journals Online (AJOL)

    Objective: To determine the acceptability and outcome of laparoscopic assisted vaginal hysterectomy at the Aga Khan Hospital, Nairobi. Design: A retrospective case analysis. Subjects: Two hundrend and twenty nine cases of laparoscopic assisted hysterectomy were undertaken at various hospitals in the presence of the ...

  1. Generalized peritonitis caused by spontaneous intraperitoneal rupture of the urinary bladder.

    Science.gov (United States)

    Tabaru, A; Endou, M; Miura, Y; Otsuki, M

    1996-11-01

    We report a case of generalized peritonitis caused by spontaneous intraperitoneal rupture of the urinary bladder. A 74-year-old female was admitted with abdominal pain and biochemical findings of acute renal failure (ARF). She had recently complained of macrohematuria. She had a past history of radiotherapy for uterine cervical cancer and Parkinson's disease treated with levodopa and amantadine. We diagnosed this case as intraperitoneal rupture of the bladder by cystogram. Biochemical findings of ARF might have resulted from urine reabsorption. Intraperitoneal rupture of the bladder should be considered in all cases of peritonitis, especially in patients with urological symptoms and features of ARF.

  2. Music experience influences laparoscopic skills performance.

    Science.gov (United States)

    Boyd, Tanner; Jung, Inkyung; Van Sickle, Kent; Schwesinger, Wayne; Michalek, Joel; Bingener, Juliane

    2008-01-01

    Music education affects the mathematical and visuo-spatial skills of school-age children. Visuo-spatial abilities have a significant effect on laparoscopic suturing performance. We hypothesize that prior music experience influences the performance of laparoscopic suturing tasks. Thirty novices observed a laparoscopic suturing task video. Each performed 3 timed suturing task trials. Demographics were recorded. A repeated measures linear mixed model was used to examine the effects of prior music experience on suturing task time. Twelve women and 18 men completed the tasks. When adjusted for video game experience, participants who currently played an instrument performed significantly faster than those who did not (Pmusic experience on the laparoscopic suturing abilities of surgical novices. The visuo-spatial abilities used in laparoscopic suturing may be enhanced in those involved in playing an instrument.

  3. Laparoscopic Transcystic Common Bile Duct Exploration: Advantages over Laparoscopic Choledochotomy.

    Directory of Open Access Journals (Sweden)

    Qian Feng

    Full Text Available The ideal treatment for choledocholithiasis should be simple, readily available, reliable, minimally invasive and cost-effective for patients. We performed this study to compare the benefits and drawbacks of different laparoscopic approaches (transcystic and choledochotomy for removal of common bile duct stones.A systematic search was implemented for relevant literature using Cochrane, PubMed, Ovid Medline, EMBASE and Wanfang databases. Both the fixed-effects and random-effects models were used to calculate the odds ratio (OR or the mean difference (MD with 95% confidence interval (CI for this study.The meta-analysis included 18 trials involving 2,782 patients. There were no statistically significant differences between laparoscopic choledochotomy for common bile duct exploration (LCCBDE (n = 1,222 and laparoscopic transcystic common bile duct exploration (LTCBDE (n = 1,560 regarding stone clearance (OR 0.73, 95% CI 0.50-1.07; P = 0.11, conversion to other procedures (OR 0.62, 95% CI 0.21-1.79; P = 0.38, total morbidity (OR 1.65, 95% CI 0.92-2.96; P = 0.09, operative time (MD 12.34, 95% CI -0.10-24.78; P = 0.05, and blood loss (MD 1.95, 95% CI -9.56-13.46; P = 0.74. However, the LTCBDE group showed significantly better results for biliary morbidity (OR 4.25, 95% CI 2.30-7.85; P<0.001, hospital stay (MD 2.52, 95% CI 1.29-3.75; P<0.001, and hospital expenses (MD 0.30, 95% CI 0.23-0.37; P<0.001 than the LCCBDE group.LTCBDE is safer than LCCBDE, and is the ideal treatment for common bile duct stones.

  4. PHOTODYNAMIC THERAPY OF THE CANINE PERITONEUM - NORMAL TISSUE-RESPONSE TO INTRAPERITONEAL AND INTRAVENOUS PHOTOFRIN FOLLOWED BY 630NM LIGHT

    NARCIS (Netherlands)

    TOCHNER, Z; MITCHELL, JB; HOEKSTRA, HJ; SMITH, P; DELUCA, AM; BARNES, M; HARRINGTON, F; MANYAK, M; RUSSO, D; RUSSO, A

    1991-01-01

    A toxicity study was performed in a canine model to explore the feasibility of using intraperitoneal photodynamic therapy for patients with peritoneal carcinomatosis. Dogs received 1.25 mg/kg Photofrin II both intravenously (48 hours) and intraperitoneally (2 hours) before intraperitoneal light

  5. Experimental intraperitoneal injection of alcohol in rats: Peritoneal findings and histopathology

    Directory of Open Access Journals (Sweden)

    Hyun Sin In

    2014-01-01

    Conclusion: An intraperitoneal injection of alcohol in rats caused peritoneal inflammation or fibrosis during the first 2 weeks. However, these peritoneal abnormalities were short-lived and had completely disappeared after 3 weeks.

  6. Biodistribution of Intraperitoneally-administered {sup 125}I-labeled IgG in Mouse

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sooyong; Dho, So Hee; Cho, Eunha; Lee, Soyoung; Jung, Sunghee; Lim, Jaecheong [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-10-15

    The use of radiolabeled antibodies is one of the most effective strategies to diagnose and treat cancers. However, it is hindered by the relatively low delivery to tumors following intravenous administration, in particular, cancers in peritoneal cavity. Intraperitoneal administration of radiolabeled antibodies results in significantly higher exposure to the peritoneal cavity than does intravenous administration. Therefore, intraperitoneal administration of the radiolabeled antibodies can be more effective to diagnose and treat cancers in peritoneal cavity such as ovarian and colonic cancers. This study was performed to determine the biodistribution pattern of intraperitoneally-administered radiolabeled antibodies. The {sup 125}I-labeled IgG was rapidly absorbed into the blood and organs, and the radioactivities were dropped in 24 hr p.i. These results suggest that the intraperitoneal administration of the radiolabeled antibodies can be an effective way to treat diseases in the peritoneal cavity.

  7. Bowel injury following gynecological laparoscopic surgery.

    African Journals Online (AJOL)

    ular having midline scar), severe endometriosis, and com- plicated pelvic pathology should ... intra-peritoneal adhesions.13 However, previous splenec- tomy and splenomegaly might be .... Figure 4: Ultrasound appearance of significant intra-peritoneal free air using a linear probe (10-12 MHZ). There is a hyper-echogenic ...

  8. Continuous intraperitoneal insulin infusion in the treatment of type 1 diabetes mellitus: Glycaemia and beyond

    OpenAIRE

    van Dijk, Peter R.

    2015-01-01

    Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is a last-resort treatment option for selected patients with type 1 diabetes mellitus (T1DM). As compared to the most commonly used forms of insulin administration -injections and an externally placed pump- which deliver insulin in the subcutaneous (SC) tissue, CIPII delivers the insulin in the intraperitoneal space. CIPII using an implantable pump is an unique treatment which has been available for more than 30 year...

  9. Pathology Report for Intraperitoneal Sodium Dichromate Exposure in Rats, Protocol No. 15-002-3

    Science.gov (United States)

    2015-12-08

    Toxicological Study No. S.0035303-15, March 2016 Toxicology Portfolio Division of Toxicologic Pathology Pathology Report for Intraperitoneal Sodium...distribution unlimited. Specialty: 500C, Toxicity Tests GOOD LABORATORY PRACTICE COMPLIANCE STATEMENT This pathology investigation was conducted in...3 Pathology Report for Intraperitoneal Sodium Dichromate Exposure in Rats 8 December 2015 1 Summary 1.1 Purpose The U.S. Army Center for Environmental

  10. Robotic assisted laparoscopic augmentation ileocystoplasty

    Directory of Open Access Journals (Sweden)

    Peter A. Caputo

    Full Text Available ABSTRACT Introduction: Augmentation ileocystoplasty is a common treatment in adults with low capacity bladders due to neurogenic bladder dysfunction. We describe here our technique for robotic assisted laparoscopic augmentation ileocystoplasty in an adult with a low capacity bladder due to neurogenic bladder dysfunction. Materials and Methods: The patient is a 35 years-old man with neurogenic bladder due to a C6 spinal cord injury in 2004. Cystometrogram shows a maximum capacity of 96cc and Pdet at maximum capacity of 97cmH2O. He manages his bladder with intermittent catheterization and experiences multiple episodes of incontinence between catheterizations. He experiences severe autonomic dysreflexia symptoms with indwelling urethral catheter. He has previously failed non operative management options of his bladder dysfunction. Our surgical technique utilizes 6 trocars, of note a 12mm assistant trocar is placed 1cm superior to the pubic symphysis, and this trocar is solely used to pass a laparoscopic stapler to facilitate the excision of the ileal segment and the enteric anastomosis. Surgical steps include: development of the space of Retzius/dropping the bladder; opening the bladder from the anterior to posterior bladder neck; excision of a segment of ileum; enteric anastomosis; detubularizing the ileal segment; suturing the ileal segment to the incised bladder edge. Results: The surgery had no intraoperative complications. Operative time was 286 minutes (4.8 hours. Estimated blood loss was 50cc. Length of hospital stay was 8 days. He did experience a postoperative complication on hospital day 3 of hematemesis, which did not require blood transfusion. Cystometrogram at 22 days post operatively showed a maximum bladder capacity of 165cc with a Pdet at maximum capacity of 10cmH2O. Conclusions: As surgeon comfort and experience with robotic assisted surgery grows, robotic surgery can successfully be applied to less frequently performed procedures

  11. The efficacy of intraperitoneal saline infusion for percutaneous radiofrequency ablation for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Park, Soo Young; Tak, Won Young; Jeon, Seong Woo; Cho, Chang Min; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan

    2010-01-01

    Objective: To evaluated the efficacy and safety of radiofrequency ablation (RFA) with intraperitoneal saline infusion. Background: Ultrasound-guided RFA is not always feasible due to the tumor location, possible adjacent tissue damage or poor sonographic identification. Patients and methods: Ultrasound-guided RFA with intraperitoneal saline infusion was performed in 116 patients between June 2001 and March 2008. Results: The overall technical feasibility of the intraperitoneal saline infusions was 90.5% (105 patients). The purposes of the intraperitoneal saline infusion were achieved in 100 patients (86.2%) by visualizing the tumor located in hepatic dome (47 patients), prevent adjacent organ damage (42 patients) and withdrawing overlying omentum (10 patients). Complete ablation of tumor was accomplished in 102 patients (87.9%). Complications associated with the treatment occurred in seven patients (6.0%). There was no case of adverse event directly related to intraperitoneal saline infusion. Conclusions: Intraperitoneal saline infusion is an effective and safe procedure that can be used to overcome the current limitations of ultrasound-guided RFA.

  12. A Recommended Laparoscopic Procedure for Implantation of Microcapsules in the Peritoneal Cavity of Non-human Primates

    Science.gov (United States)

    Qi, Meirigeng; Lacik, Igor; Kolláriková, Gabriela; Strand, Berit L; Formo, Kjetil; Wang, Yong; Marchese, Enza; Mendoza-Elias, Joshua E.; Kinzer, Katie P.; Gatti, Francesca; Paushter, Daniel; Patel, Sonny; Oberholzer, Jose

    2013-01-01

    Background The anatomical spatial distribution of microencapsulated islets transplanted into the peritoneal cavity of large animals remains a relatively unexplored area of study. In this study, we developed a new implantation approach using laparoscopy in order to avoid microcapsule amalgamation. This approach constitutes a clinically relevant method, which can be used to evaluate the distribution and in vivo biocompatibility of various types of transplanted microcapsules in the future. Materials and Methods Two healthy baboons were implanted intraperitoneally with microencapsulated islets through mini-laparotomy and observed at 76 days after implantation. Nine baboons underwent laparoscopic implantation of approximately 80,000 empty microcapsules. Microcapsule distribution was observed by laparoscopic camera during and after implantation at 1, 2, and 4 weeks. At each time point, microcapsules were retrieved and evaluated with brightfield microscopy and histological analysis. Results Mini-laparotomic implantation resulted in microcapusle aggregation in both baboons. In contrast, laparoscopic implantation resulted in even distribution of microcapsules throughout the peritoneum without sedimentation to the Douglas space in all animals. In 8 out of 9 animals, retrieved microcapsules were evenly distributed in the peritoneal cavity and presented with no pericapsular overgrowth and easily washed out during laparoscopic procedure. The one exception was attributed to microcapsule contamination with blood from the abdominal wall following trocar insertion. Conclusions Laparoscopic implantation of microcapsules in non-human primates can be successfully performed and prevents microcapsule aggregation. Given the current widespread clinical application of laparoscopy, we propose that this presented laparoscopy technique could be applied in future clinical trials of microencapsulated islet transplantation. PMID:21435661

  13. Total laparoscopic Roux-en-Y cholangiojejunostomy for the treatment of biliary disease.

    Science.gov (United States)

    Chen, Dexing; Zhu, Andong; Zhang, Zhibo

    2013-01-01

    bile leakage and were treated from 1 week to approximately 1 month with abdominal drainage. Postoperative intraperitoneal hemorrhage and stress ulcer of the stomach occurred in 2 patients with biliary tract injury combined with obstructive jaundice. One with intraperitoneal hemorrhage was cured by another laparoscopic surgery. The other patient was cured after 2 days of abdominal drainage, antacids, and hemostatic drug therapy. The follow-up duration of 95 patients was 4 to 93 months (average, 48.3 months). The follow-up rate was 92.2% (95/103). Patients with cancer died of metastasis or cachexia during 14-month follow-up with no postoperative complication. Reflux cholangitis occurred in 3 patients 2, 3, and 5 years after the operation, respectively. No anastomotic stricture or other complication was found in other patients during the follow-up. TLRCJS is the best and first choice for patients with biliary tract diseases that need biliary-jejunal anastomosis. But it is essential that the surgeon has proficiency in laparoscopic surgeries.

  14. Cholecystoenteric Fistule and Laparoscopic Repair

    Directory of Open Access Journals (Sweden)

    Temel Bulut

    2014-03-01

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

  15. Laparoscopic management of abdominal cocoon

    Directory of Open Access Journals (Sweden)

    Makam Ramesh

    2008-01-01

    Full Text Available "Peritonitis fibrosa incapsulata", first described in 1907, is a condition characterized by encasement of the bowel with a thick fibrous membrane. This condition was renamed as "abdominal cocoon" in 1978. It presents as small bowel obstruction clinically. 35 cases of abdominal cocoon have been reported in the literature over the last three decades. Abdominal cocoon is more common in adolescent girls from tropical countries. Various etiologies have been described, including tubercular. It is treated surgically by releasing the entrapped bowel. We report a laparoscopic experience of tubercular abdominal cocoon and review the literature.

  16. Splenic artery embolization using contour emboli before laparoscopic or laparoscopically assisted splenectomy.

    Science.gov (United States)

    Iwase, Kazuhiro; Higaki, Jun; Yoon, Hyung-Eun; Mikata, Shoki; Miyazaki, Minoru; Nishitani, Akiko; Hori, Shinichi; Kamiike, Wataru

    2002-10-01

    The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy.

  17. Parastomal Hernia Repair with a 3D Funnel Intraperitoneal Mesh Device and Same-Sided Stoma Relocation: Results of 56 Cases.

    Science.gov (United States)

    Fischer, Ines; Wundsam, Helwig; Mitteregger, Martin; Köhler, Gernot

    2017-12-01

    Parastomal hernias (PSHs) are a common and challenging issue. In previous studies, three-dimensional (3D) funnel mesh devices have been used successfully for the repair of PSHs. We performed an analysis of prospectively collected data of patients who underwent a same-sided stoma reposition with 3D funnel-shaped mesh augmentation in intraperitoneal (IPOM) position at our department between the years of 2012 and 2015. Primary outcome parameters were intra- and postoperative surgical complications and recurrence rate during the follow-up period. Fifty-six patients could be included in this analysis. PSH repair was performed in 89.3% as elective surgery and in 73% in laparoscopic technique. A concomitant incisional hernia (EHS type 2 and 4) was found in 50% and repaired in a single-step procedure with PSH. Major postoperative complications requiring redo surgery (Clavien-Dindo ≥3b) were identified in 8.9% (5/56). Overall recurrence rate was 12.5% (7/56). Median follow-up time was 38 months, and a 1-year follow-up rate of 96.4% was reached. PSH repair with 3D funnel mesh in IPOM technique is safe, efficient and easy to perform in laparoscopic and open surgical approaches providing advantageous results compared to other techniques. Furthermore, simultaneous detection and treatment of concomitant incisional hernias has shown favorable. However, the mesh funnel distends and becomes shortened encasing a bulky bowel mesentery and further shrinkage happens eccentric. Changing mesh construction according to lengthening the funnel could possibly lead to reduction in recurrence.

  18. Laparoscopic ureterocalicostomy in pigs - experimental study

    Directory of Open Access Journals (Sweden)

    Paulo Fernando de Oliveira Caldas

    2015-07-01

    Full Text Available This study aimed to evaluated laparoscopic ureterocalicostomy as treatment of experimental ureteropelvic junction (UPJ obstruction in pigs. Ten male Large White pigs weighting approximately 28.4 (±1.43 kg were used in the current study. The UPJ obstruction was created laparoscopically by double-clipping of the left ureter. After 14 days the animals underwent laparoscopic ureterocalicostomy f The animals were sacrificed for subsequent retrograde pyelography in order to assess the anastomotic patency on the 28th day. The laparoscopic procedure for experimental obstruction of UPJ was successfully performed in all animals, as well as the laparoscopic ureterocalicostomy. There was intestinal iatrogenic injury in one animal. Satisfactory UPJ patency was noted in 75% of the animals. There was no stenosis of the proximal anastomosis between the ureter and the lower pole of the kidney in 37.5%, mild stenosis in 37.5% and severe stenosis in 25% of the animals. The laparoscopic approach for reestablishment he urinary flow by ureterocalicostomy was feasible in the porcine model. The ascending pyelography revealed satisfactory results of the laparoscopic ureterocalicostomy

  19. Laparoscopic Cholecystectomy in Chronic Calculus Cholecystitis

    Directory of Open Access Journals (Sweden)

    Prakash Sapkota

    2013-12-01

    Full Text Available Introduction: Laparoscopic cholecystectomy has clearly become the choice over open cholecystectomy in the treatment of hepatobiliary disease since its introduction by Mouret in 1987. This study evaluates a series of patients with chronic calculus cholecystitis who were treated with laparoscopic and open cholecystectomy and assesses the outcomes of both techniques. Objective: To evaluate the efficacy of laparoscopic vs open cholecystectomy in chronic calculus cholecystitis and establish the out-comes of this treatment modality at Lumbini Medical College and Teaching Hospital. Methods: This was a retrospective analysis over a one-year period (January 1, 2012 to December 31, 2012, per-formed by single surgeon at Lumbini Medical College and Teaching Hospital located midwest of Nepal. 166 patients underwent surgical treatment for chronic calculus cholecystitis. Patients included were only chronic calculus cholecystitis proven histopathologocally and the rest were excluded. Data was collected which included patients demographics, medical history, presentation, complications, conversion rates from laparoscopic. cholecystectomy to open cholecystectomy, operative and postoperative time. Results: Patients treated with laparoscopic cholecystectomy for chronic calculus cholecystitis had shorter operating times and length of stay compared to patients treated with open cholecystectomy for chronic calculus cholecystitis. Conversion rates were 3.54% in chronic calculus cholecystitis during the study period. Complications were also lower in patients who underwent laparoscopic cholecystectomy versus open cholecystectomy for cholelithiasis. Conclusions: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for chronic calculus cholecystitis.

  20. Laparoscopic repair of postoperative perineal hernia.

    LENUS (Irish Health Repository)

    Ryan, Stephen

    2010-01-01

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

  1. An audit of laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Khan, S.; Oonwala, Z.G.

    2006-01-01

    To evaluate the outcome of Laparoscopic Cholecystectomy in Gall stone disease, critically analyzing the complication rate, morbidity and mortality rate. All patients (>12 years) with cholelithiasis were included in this study. Patients with common bile duct dilatation (>8mm) or stones, or gall bladder mass or jaundice, and those declared unfit for anaesthesia were excluded. The detailed data of all the cases was compiled and analyzed. Out of the total of 1345 patients operated during the study period, 1234 (91.75%) were females and 111 (8.25%) males; their ages ranged from 12 to 89 years, majority were in the age bracket of 30-50 years. Our conversion rate was 6.4%. Nine (0.67%) patients developed bleeding from the port site, 30 (2.23%) port site infection, 43 (3.20%) umbilical port hernia, two bile ducty injury and one colonic injury. There was no mortality in this series. Laparoscopic Cholecystectomy is a safe and effective treatment for Cholelithiasis. (author)

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

    Directory of Open Access Journals (Sweden)

    Fernanda O. de Carvalho

    2014-04-01

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

  3. Transperitoneal versus retroperitoneal laparoscopic pyeloplasty in children: Randomized clinical trial.

    Science.gov (United States)

    Badawy, Haytham; Zoaier, Amr; Ghoneim, Tamer; Hanno, Ahmed

    2015-06-01

    Laparoscopic pyeloplasty achieves good cosmetic and functional outcomes. Both transperitoneal and retroperitoneal approaches are used. No single study to date has compared the two approaches in a prospective randomized design. We present a prospective randomized comparison between both approaches in children in a trial to define which technique is better with regard to multiple factors including operative time, hospital stay, recovery of bowel movement, analgesic requirement and complication rate. In the period from June 2010 to September 2012, 38 children (25 boys and 13 girls) were operated laparoscopically. Children were randomized into Group I (19 children) operated by the transperitoneal approach, and Group II (19 children) operated by the retroperitoneal approach. Both groups were compared as regards to the operative time, anesthetic changes, and postoperative recovery. A minimum sample size required was calculated to be 19 for each arm based on previous studies of laparoscopic pyeloplasty, using a mean difference in operative time = 40 min, effect size = 0.95, an alpha of 0.05 and power 80% and an online sample size calculator. Statistical analysis was performed using SPSS software using the Fischer exact test, chi square test and Mann-Whitney U test. The operative time was the primary endpoint for comparison between both approaches. Our series is the first in the literature that compares in a prospective randomized design the transperitoneal and retroperitoneal laparoscopic pyeloplasty in children. Shouma et al. is the only prospective randomized study to compare both techniques in adult pyeloplasty. They had a significantly shorter operative time in the transperitoneal group however, the author in the discussion mentioned that he was at the start of the learning curve for retroperitonoscopic pyeloplasty when he conducted his study, which affected the result of the operative time. Hence, as mentioned above, we stressed the importance of a single surgeon

  4. Acceptable outcome after laparoscopic appendectomy in children

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  5. Anesthesia related complications of laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Qureshi, F.A.

    2003-01-01

    Objective: To determine the incidence of intraoperative anesthesia-related complications of laparoscopic cholecystectomy. Results: One hundred patients with male to female ratio of 1:8.09 in the age range of 20-80 years (mean 39 years) underwent general anesthesia for laparoscopic cholecystectomy. The duration of operation in 94 laparoscopic cholecystectomy was from 20 to 80 minutes (mean 60.63 minutes). The incidence of intraoperative hypotension was 9%. Four percent of the patients developed arrhythmias. Increase in end-tidal-carbon dioxide (ETCO/sub 2/) was observed in 3% of cases. Conversion rate to open cholecystectomy was 6%. Damage to intraabdominal vessels with trocar insertion occurred in 1% of cases. Conclusion: Although laparoscopic cholecystectomy has major surgical and anesthetic advantages, there are anesthesia related complications requiring specific anesthetic interventions to improve patients outcome without compromising their safety. (author)

  6. Radiologic investigation after laparoscopic inguinal hernia repair

    Energy Technology Data Exchange (ETDEWEB)

    Larmark, Martin; Ekberg, Olle [Department of Diagnostic Radiology, Malmoe University Hospital, 205 02, Malmoe (Sweden); Montgomery, Agneta [Department of Surgery, Malmoe University Hospital, 205 02, Malmoe (Sweden)

    2003-12-01

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

  7. Laparoscopic cystogastrostomy in the management of pancreatic ...

    African Journals Online (AJOL)

    Abstract. Pancreatic pseudocysts develop following acute or chronic pancreatitis. Majority of the cases resolve spontaneously but some persist beyond six weeks. Active management of pancreatic pseudocysts involves draining of the fluid collection through open surgery, endoscopically, laparoscopically or percutaneously.

  8. Laparoscopic RFA with splenectomy for hepatocellular carcinoma.

    Science.gov (United States)

    Hu, Kunpeng; Lei, Purun; Yao, Zhicheng; Wang, Chenhu; Wang, Qingliang; Xu, Shilei; Xiong, Zhiyong; Huang, He; Xu, Ruiyun; Deng, Meihai; Liu, Bo

    2016-07-27

    The treatment of hepatocellular carcinoma (HCC) is complicated and challenging because of the frequent presence of cirrhosis. Therefore, we propose a novel surgical approach to minimize the invasiveness and risk in patients with HCC, hypersplenism, and esophagogastric varices. This was a retrospective study carried out in 25 patients with HCC and hypersplenism and who underwent simultaneous laparoscopic-guided radio-frequency ablation and laparoscopic splenectomy with endoscopic variceal ligation. Tumor size was restricted to a single nodule of splenectomy. Laparoscopic-guided radio-frequency ablation with laparoscopic splenectomy and endoscopic variceal ligation could be an available technique for patients with HCC <3 cm, hypersplenism, and esophagogastric varices. This approach may help to minimize the surgical risks and results in a fast increase in platelet counts with an acceptable rate of complications.

  9. Laparoscopic surgery for early endometrial cancer

    DEFF Research Database (Denmark)

    Bennich, Gitte; Rudnicki, M.; Lassen, P. D.

    2016-01-01

    IntroductionThe purpose of the present study was to evaluate learning curves and short-term outcomes following laparoscopic surgery for early endometrial cancer in women of different body mass index (BMI) classes. Material and methodsData from 227 women planned for laparoscopic surgery for presumed...... stage I endometrial cancer were collected retrospectively from a Danish gynecologic oncology unit. Surgery included laparoscopic hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy (PLA). ResultsMedian length of operations was 60 min (range, 30-197) and 120 min (range...... peri- and postoperative outcomes were independent of BMI classes. ConclusionsOur data suggest that laparoscopic surgery for early endometrial cancer is feasible and safe. With increasing surgeon's experience there is a significant decrease in operative time and increase in the number of lymph nodes...

  10. Optimising intraperitoneal gentamicin dosing in peritoneal dialysis patients with peritonitis (GIPD study

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    Lipman Jeffrey

    2009-12-01

    Full Text Available Abstract Background Antibiotics are preferentially delivered via the peritoneal route to treat peritonitis, a major complication of peritoneal dialysis (PD, so that maximal concentrations are delivered at the site of infection. However, drugs administered intraperitoneally can be absorbed into the systemic circulation. Drugs excreted by the kidneys accumulate in PD patients, increasing the risk of toxicity. The aim of this study is to examine a model of gentamicin pharmacokinetics and to develop an intraperitoneal drug dosing regime that maximises bacterial killing and minimises toxicity. Methods/Design This is an observational pharmacokinetic study of consecutive PD patients presenting to the Royal Brisbane and Women's Hospital with PD peritonitis and who meet the inclusion criteria. Participants will be allocated to either group 1, if anuric as defined by urine output less than 100 ml/day, or group 2: if non-anuric, as defined by urine output more than 100 ml/day. Recruitment will be limited to 15 participants in each group. Gentamicin dosing will be based on the present Royal Brisbane & Women's Hospital guidelines, which reflect the current International Society for Peritoneal Dialysis Peritonitis Treatment Recommendations. The primary endpoint is to describe the pharmacokinetics of gentamicin administered intraperitoneally in PD patients with peritonitis based on serial blood and dialysate drug levels. Discussion The study will develop improved dosing recommendations for intraperitoneally administered gentamicin in PD patients with peritonitis. This will guide clinicians and pharmacists in selecting the most appropriate dosing regime of intraperitoneal gentamicin to treat peritonitis. Trial Registration ACTRN12609000446268

  11. Status Epilepticus due to Intraperitoneal Injection of Vehicle Containing Propylene Glycol in Sprague Dawley Rats

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    Evon S. Ereifej

    2017-01-01

    Full Text Available Published reports of status epilepticus due to intraperitoneal injection containing propylene glycol in rats are sparse. In fact, there are no reports specifying a maximum safe dose of propylene glycol through intraperitoneal administration. We report here a case of unexpected seizures in Sprague Dawley rats after receiving an intraperitoneal injection containing propylene glycol. Nine-week-old, 225–250 gram male rats were reported to experience tremor progressing to seizures within minutes after given injections of resveratrol (30 mg/kg dissolved in a 40 : 60 propylene glycol/corn oil vehicle solution by direct intraperitoneal (IP slow bolus injection or via a preplaced intraperitoneal catheter. The World Health Organization suggests a maximum dose of 25 mg/kg/day of propylene glycol taken orally and no more than 25 mg/dL in blood serum, whereas the animals used in our study got a calculated maximum 0.52 g/kg (25 times lower dose. Blood tests from the seizing rat support a diagnosis of hemolysis and lactic acidosis which may have led to the seizures, all of which appeared to be a consequence of the propylene glycol administration. These findings are consistent with oral and intravenous administration of propylene glycol toxicity as previously reported in other species, including humans. To our knowledge, this report represents the first published case of status epilepticus due to an IP injection containing propylene glycol.

  12. Status Epilepticus due to Intraperitoneal Injection of Vehicle Containing Propylene Glycol in Sprague Dawley Rats.

    Science.gov (United States)

    Ereifej, Evon S; Meade, Seth M; Smith, Cara S; Chen, Keying; Kleinman, Nanette; Capadona, Jeffrey R

    2017-01-01

    Published reports of status epilepticus due to intraperitoneal injection containing propylene glycol in rats are sparse. In fact, there are no reports specifying a maximum safe dose of propylene glycol through intraperitoneal administration. We report here a case of unexpected seizures in Sprague Dawley rats after receiving an intraperitoneal injection containing propylene glycol. Nine-week-old, 225-250 gram male rats were reported to experience tremor progressing to seizures within minutes after given injections of resveratrol (30 mg/kg) dissolved in a 40 : 60 propylene glycol/corn oil vehicle solution by direct intraperitoneal (IP) slow bolus injection or via a preplaced intraperitoneal catheter. The World Health Organization suggests a maximum dose of 25 mg/kg/day of propylene glycol taken orally and no more than 25 mg/dL in blood serum, whereas the animals used in our study got a calculated maximum 0.52 g/kg (25 times lower dose). Blood tests from the seizing rat support a diagnosis of hemolysis and lactic acidosis which may have led to the seizures, all of which appeared to be a consequence of the propylene glycol administration. These findings are consistent with oral and intravenous administration of propylene glycol toxicity as previously reported in other species, including humans. To our knowledge, this report represents the first published case of status epilepticus due to an IP injection containing propylene glycol.

  13. Adjuvant Bidirectional Chemotherapy with Intraperitoneal Pemetrexed Combined with Intravenous Cisplatin for Diffuse Malignant Peritoneal Mesothelioma

    Directory of Open Access Journals (Sweden)

    Lana Bijelic

    2012-01-01

    Full Text Available Cytoreductive surgery (CRS with heated intraoperative intraperitoneal chemotherapy (HIPEC has emerged as optimal treatment for diffuse malignant peritoneal mesothelioma (DMPM showing median survivals of 36–92 months. However, recurrences occur frequently even in patients undergoing optimal cytreduction and are often confined to the abdomen. We initiated a Phase II study of adjuvant intraperitoneal pemetrexed combined with intravenous cisplatin for patients undergoing CRS and HIPEC for DMPM. The treatment consisted of pemetrexed 500 mg/m2 intraperitoneally and cisplatin 50 mg/m2 intravenously given simultaneously on day 1 of every 21 day cycle for 6 cycles. The primary endpoint of the study was treatment related toxicity. From July 2007 until July 2009 ten patients were enrolled. Nine of 10 completed all 6 cycles of adjuvant treatment per protocol. The most common toxicities were fatigue, nausea and abdominal pain grade 1 or 2. There was one grade 3 toxicity consisting of a catheter infection. The median survival for all 10 patients was 33.5 months. Pharmacokinetic analysis of intraperitoneal pemetrexed showed a peritoneal to plasma area under the curve ratio of 70. Our study shows that adjuvant intravenous cisplatin and intraperitoneal pemetrexed can be used following CRS and HIPEC for DMPM with low morbidity.

  14. Laparoscopic liver resection for intrahepatic cholangiocarcinoma.

    Science.gov (United States)

    Uy, Billy James; Han, Ho-Seong; Yoon, Yoo-Seok; Cho, Jai Young

    2015-04-01

    Reports on laparoscopic liver resection for intrahepatic cholangiocarcinoma are still scarce. With increased experience in laparoscopic liver resection, its application to intrahepatic cholangiocarcinoma can now be considered. Our aim is to determine the feasibility and safety of laparoscopic liver resection for intrahepatic cholangiocarcinoma and to analyze its clinical and oncologic outcomes. Among the 84 patients with intrahepatic cholangiocarcinoma operated on from March 2004 to April 2012, 37 patients with a T-stage of 2b or less were included in the study. Eleven patients underwent laparoscopic liver resection, and 26 underwent open liver resection. Treatment and survival outcomes were analyzed. Intraoperative blood loss was significantly greater in the open group (P=.024), but with no difference in the blood transfusion requirement between groups (P=.074), and no operative mortality occurred. The median operative time, postoperative resection margin, and length of hospital stay were comparable between groups (P=.111, P=.125, and P=.077, respectively). Four (36.4%) patients in the laparoscopic group developed recurrence compared with 12 (46.2%) patients in the open group (P=.583). After a median follow-up of 17 months, the 3- and 5-year overall survival rates were 77.9% and 77.9%, respectively, in the laparoscopic group compared with 66.2% and 66.2%, respectively, in the open group (P=.7). There was also no significant difference in the 3- and 5-year disease-free survival rates for the laparoscopic group at 56.2% and 56.2%, respectively, versus the open group at 39.4% and 39.4%, respectively (P=.688). Laparoscopic liver resection for intrahepatic cholangiocarcinoma is technically safe with survival outcome comparable to that of open liver resection in selected cases.

  15. OUTCOME FOLLOWING OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY

    OpenAIRE

    Anmol; Lakshminarayan; Manohar; Avadhani Geeta; Abinash

    2014-01-01

    : Laparoscopic cholecystectomy has rapidly become established as the popular alternative to open cholecystectomy, but it should have a safety profile similar to or better than that of open procedure. The aim of this study was to compare conventional cholecystectomy and laparoscopic cholecystectomy with respect to duration of procedure, complications, postoperative pain, analgesic requirement, antibiotic requirement, resumption of normal diet and period of hospital stay.50 ...

  16. Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

    Science.gov (United States)

    Huang, Gregory S; Chance, Elisha A; Hileman, Barbara M; Emerick, Eric S; Gianetti, Emily A

    2017-01-01

    No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.

  17. Cost-effective method for laparoscopic choledochotomy.

    Science.gov (United States)

    Griniatsos, John; Karvounis, Evangelos; Arbuckle, James; Isla, Alberto-Martinez

    2005-01-01

    Recent reports have noted that postoperative complications following open or laparoscopic choledochotomy for common bile duct (CBD) exploration are mainly related to the T-tube presence, and that there has been no trend of decrease in the laparoscopic era. Laparoscopic endobiliary stent placement with primary closure of the CBD has been proposed as a safe and effective alternative to T-tube placement. Between January 1999 and January 2003, 53 consecutive patients suffering from proven choledocholithiasis underwent laparoscopic common bile exploration (LCBDE) via choledochotomy. In the early period, a T-tube was placed at the end of the procedure (group A, n = 32) while, from June 2001 onwards, laparoscopic biliary stent placement and primary CBD closure were chosen as the drainage method (group B, n = 21). Six patients developed T-tube-related complications postoperatively. Univariate analysis revealed statistically significant lower morbidity rate and shorter postoperative hospital stay for the stent group. Although not statistically significant, a median saving of 780 UK pounds per patient was observed in the stent group. Biliary endoprosthesis placement following laparoscopic choledochotomy avoids the well-known complications of a T-tube, leading to a shorter postoperative hospital stay. The method is safe and effective and it should also be considered as cost-effective compared to T-tube placement. Further studies are required in order to document cost-effectiveness of the method.

  18. [Value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen].

    Science.gov (United States)

    Cai, Jian-liang; Zhang, Yi; Sun, Guo-feng; Li, Ning-chen; Zhang, Xiang-hua; Na, Yan-qun

    2012-12-01

    To investigate the value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen. After finishing the virtual reality training of basic laparoscopic skills, 26 catechumen were divided randomly into 2 groups, one group undertook advanced laparoscopic skill (suture technique) training with laparoscopic virtual reality simulator (virtual group), another used laparoscopic box trainer (box group). Using our homemade simulations, before grouping and after training, every trainee performed nephropyeloureterostomy under laparoscopy, the running time, anastomosis quality and proficiency were recorded and assessed. For virtual group, the running time, anastomosis quality and proficiency scores before grouping were (98 ± 11) minutes, 3.20 ± 0.41, 3.47 ± 0.64, respectively, after training were (53 ± 8) minutes, 6.87 ± 0.74, 6.33 ± 0.82, respectively, all the differences were statistically significant (all P training were (52 ± 9) minutes, 6.08 ± 0.90, 6.33 ± 0.78, respectively, all the differences also were statistically significant (all P training, the running time and proficiency scores of virtual group were similar to box group (all P > 0.05), however, anstomosis quality scores in virtual group were higher than in box group (P = 0.02). The laparoscopic virtual reality simulator is better than traditional box trainer in advanced laparoscopic suture ability training of catechumen.

  19. Prediction of Hemodynamic Reactivity during Sevoflurane Remifentanyl Anesthesia for Laparoscopic Cholecystectomy Using Analgesia Nociception Index

    Directory of Open Access Journals (Sweden)

    Ali Şefik Köprülü

    2016-12-01

    Full Text Available Aim: Pneumoperitoneum may cause serious side effects in high-risk patients during laparoscopic cholecystectomy. Perioperative analgesic sufficiency has been measured by the Analgesia Nociception index (ANI in recent years. We examine the possibility of predicting hemodynamic reactivity by observing sudden changes in ANI during operation. Methods: In this retrospective study, recorded hemodynamic parameters (including heart rate, systolic/ diastolic blood pressure values and ANI values, before and after intubation, nasogastric tube application, intraperitoneal gas insufflation, and surgical incision in 31 patients who were applied laparoscopic cholecystectomy were compared by paired t-test. Additionally, an increment or decrement of 20% in ANI and 15% in hemodynamic parameters with respect to basal observation values were called “sudden changes”. Correlation of these parameters with sudden changes in ANI values was examined either. Results: There was a statistically significant difference in parameters after premedication and intubation. After induction, a statistically significant decrement was detected only in heart rate and systolic/diastolic blood pressure values. There was no significant change after nasogastric tube insertion. During pneumoperitoneum and surgical incision, there was no change in heart rate and systolic/diastolic blood pressure values, but a statistically significant decrement was observed in ANI. No correlation was detected between sudden changes in ANI values and hemodynamic parameters. Conclusion: We assume that use of ANI in analgesia evaluation under general anesthesia at perioperative period is suitable, however, it is not reliable in predicting hemodynamic interaction.

  20. Delayed pneumothorax after laparoscopic sigmoid colectomy in a patient without underlying lung disease

    Directory of Open Access Journals (Sweden)

    Richie K Huynh

    2014-10-01

    Full Text Available We present an unusual case of a delayed pneumothorax occurring approximately 72 h post-operatively in a patient without any underlying lung disease who had undergone laparoscopic sigmoid colon resection. The patient was in her mid-40s with a body mass index of 28.0 and had no history of smoking. Her spontaneous pneumothorax manifested without any precipitating events or complications during recovery. There was no evidence of any infectious process. There were no central line attempts and all ports were placed intra-peritoneally, and there was no evidence of any subcutaneous emphysema. One possible mechanism of injury that we propose is barotrauma from an extended period of time in Trendelenburg position. Notably, the only abnormal finding throughout the entire post-operative period preceding the delayed pneumothorax was a PO 2 desaturation the day before. This case highlights the necessity to examine and investigate any desaturation post-operatively and deliberate its possible significance. Furthermore, it demonstrates that, even during a normal recovery period for a patient without any underlying lung disease or risk factors, spontaneous pneumothorax could still develop in a delayed fashion multiple days post-operatively from a laparoscopic procedure.

  1. Computational modeling of abdominal hernia laparoscopic repair with a surgical mesh.

    Science.gov (United States)

    Todros, Silvia; Pachera, Paola; Baldan, Nicola; Pavan, Piero G; Pianigiani, Silvia; Merigliano, Stefano; Natali, Arturo N

    2018-01-01

    Although new techniques and prostheses have been introduced in ventral hernia surgery, abdominal hernia repair still presents complications, such as recurrence, pain, and discomfort. Thus, this work implements a computational method aimed at evaluating biomechanical aspects of the abdominal hernia laparoscopic repair, which can support clinical research tailored to hernia surgery. A virtual solid model of the abdominal wall is obtained from MRI scans of a healthy subject. The mechanical behavior of muscular and fascial tissues is described by constitutive formulations with specific parameters. A defect is introduced to reproduce an incisional hernia. Laparoscopic repair is mimicked via intraperitoneal positioning of a surgical mesh. Numerical analyses are performed to evaluate the mechanical response of the abdominal wall in healthy, herniated and post-surgery configurations, considering physiological intra-abdominal pressures. During the deformation of the abdominal wall at increasing pressures, a percentage displacement increment up to 6% is found in the herniated condition, while the mechanical behavior of the repaired abdomen is similar to the healthy one. In the pressure range between 8 mmHg and 55 mmHg, the herniated abdomen shows an incremental stiffness differing of 7% with respect to the healthy condition, while the post-surgery condition shows an increase of the incremental stiffness up to 58%. This computational approach may be exploited to investigate different aspects of abdominal wall surgical repair, including mesh mechanical characteristics and positioning. Numerical modeling offers a helpful support for selecting the best-fitting prosthesis for customize pre-surgery planning.

  2. Laparoscopic splenectomy using conventional instruments

    Directory of Open Access Journals (Sweden)

    Dalvi A

    2005-01-01

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

  3. Laparoscopic diverticulectomy: A systemised technique.

    Science.gov (United States)

    Servera, A; Benejam, J; Pons, J; García-Miralles, R; Hernández, Y

    2016-12-01

    To present an original technique for laparoscopic vesical diverticulectomy without the need for dissecting the diverticular wall, thereby making the procedure safe and significantly simpler. Four patients were operated on between September 2014 and April 2016. The diagnosis was made by ultrasonography in all cases, and the study included blood and urine analyses with urine cultures, urine cytology, contrast-enhanced CT scans, prostate symptom questionnaire (International Prostate Symptom Score), flowmetry and cystoscopy. One case required transurethral prostate resection in a first time. The mean age of the patients was 64 years (range: 56-71). The mean diverticulum size was 4cm (range: 3-6). The location was retrotrigonal in all cases, on the left side in 2 cases, right retromeatic in 1 case and near the midline in 1 case. The mean surgical time was 146min (range, 120-180), shortening for each new case. There were no significant bleeding, complications or conversion to open surgery in any of the cases. The postoperative period had no incidences. The hospital stay was 3 days in 3 cases and 48h in the other case (mean, 3.5 days). The catheter was withdrawn in the outpatient clinic at 14 days. The initial experience with the technique described above shows it to be safe and reproducible, with results similar to other current laparoscopic techniques. Avoiding the dissection of the diverticular wall significantly reduces the technical difficulty of the procedure. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Acute Cholecystitis and Laparoscopic Cholecystectomy

    Science.gov (United States)

    Sharma, Neeta

    2002-01-01

    Objective: To determine whether laparoscopic cholecystectomy (LC) should be the procedure of choice in treating acute cholecystitis. Method: A prospective study was conducted over a 4 1/2-year period. There were 187 patients with acute cholecystitis out of 1020 patients with gallbladder disease who required cholecystectomy. These patients were divided into three groups based on the time interval between the onset of pain and the time patients sought medical attention: Group 1, 7 days. All the patients underwent LC after a comprehensive preoperative workup. The parameters analyzed included operating time, hospital stay, and conversion rate. The comparison was made among the various groups and with those who had elective LC. Results: One hundred twenty patients (64.17%) presented for treatment within 3 to 7 days of the onset of an attack. Empyema of the gallbladder was seen in 106 (56.68%) patients and phlegmon of the gallbladder in 42 (22.46%) patients. Group 3 patients had an operative time of 56.2 min as opposed to 18.5 min in Group 1 and 17.5 min in the elective LC group. The conversion rate in Group 3 was 19.5% versus 3.8% in Group 1 and 3.48% in the elective LC group. The complication rate was 7.3% in Group 3, 3.8% in Group 1, and 3.7% in the elective LC group. Conclusion: Acute cholecystitis is better managed by laparoscopic cholecystectomy, except in the patients presenting with a gallbladder phlegmon later than 7 days after the onset of the attack. PMID:12002300

  5. Cardiopulmonary function and laparoscopic cholecystectomy.

    Science.gov (United States)

    Wahba, R W; Béïque, F; Kleiman, S J

    1995-01-01

    This review analyzes the literature dealing with cardiopulmonary function during and pulmonary function following laparoscopic cholecystectomy in order to describe the patterns of changes in these functions and the mechanisms involved as well as to identify areas of concern and lacunae in our knowledge. Information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth, and Can J Anaesth. The principal findings were that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance. In the next few minutes there is partial restoration of cardiac index and resistance but blood pressure and heart rate do not change. The pattern is the result of the interaction between increased abdominal pressure, neurohumoral responses and absorbed CO2. Pulmonary function changes are characterized by reduced compliance without large alterations in PaO2, but tissue oxygenation can be adversely affected due to reduced O2 delivery. A major difficulty in maintaining normocarbia is due to the abdominal distention reducing pulmonary compliance and to CO2 absorption. End tidal CO2 tension is not a reliable index of PaCO2, particularly in ASA III-IV patients. The pattern of lung function following LC is characterized by a transient reduction in lung volumes and capacities with a restrictive breathing pattern and the loss of the abdominal contribution to breathing. Atelectasis also occurs. These changes are qualitatively similar to but of a lesser magnitude than those following "open" abdominal operations. It is concluded that the changes in cardiopulmonary function during laparoscopic upper abdominal surgery lead us to suggest judicious invasive monitoring and careful interpretation in ASA III-IV patients. Lung function following extensive procedures in sick patients has not been

  6. Quantifying rates of glucose production in vivo following an intraperitoneal tracer bolus.

    Science.gov (United States)

    Wang, Sheng-Ping; Zhou, Dan; Yao, Zuliang; Satapati, Santhosh; Chen, Ying; Daurio, Natalie A; Petrov, Aleksandr; Shen, Xiaolan; Metzger, Daniel; Yin, Wu; Nawrocki, Andrea R; Eiermann, George J; Hwa, Joyce; Fancourt, Craig; Miller, Corin; Herath, Kithsiri; Roddy, Thomas P; Slipetz, Deborah; Erion, Mark D; Previs, Stephen F; Kelley, David E

    2016-12-01

    Aberrant regulation of glucose production makes a critical contribution to the impaired glycemic control that is observed in type 2 diabetes. Although isotopic tracer methods have proven to be informative in quantifying the magnitude of such alterations, it is presumed that one must rely on venous access to administer glucose tracers which therein presents obstacles for the routine application of tracer methods in rodent models. Since intraperitoneal injections are readily used to deliver glucose challenges and/or dose potential therapeutics, we hypothesized that this route could also be used to administer a glucose tracer. The ability to then reliably estimate glucose flux would require attention toward setting a schedule for collecting samples and choosing a distribution volume. For example, glucose production can be calculated by multiplying the fractional turnover rate by the pool size. We have taken a step-wise approach to examine the potential of using an intraperitoneal tracer administration in rat and mouse models. First, we compared the kinetics of [U- 13 C]glucose following either an intravenous or an intraperitoneal injection. Second, we tested whether the intraperitoneal method could detect a pharmacological manipulation of glucose production. Finally, we contrasted a potential application of the intraperitoneal method against the glucose-insulin clamp. We conclude that it is possible to 1) quantify glucose production using an intraperitoneal injection of tracer and 2) derive a "glucose production index" by coupling estimates of basal glucose production with measurements of fasting insulin concentration; this yields a proxy for clamp-derived assessments of insulin sensitivity of endogenous production. Copyright © 2016 the American Physiological Society.

  7. Intraperitoneal Vancomycin Plus Either Oral Moxifloxacin or Intraperitoneal Ceftazidime for the Treatment of Peritoneal Dialysis-Related Peritonitis: A Randomized Controlled Pilot Study.

    Science.gov (United States)

    Xu, Rong; Yang, Zhikai; Qu, Zhen; Wang, Huan; Tian, Xue; Johnson, David W; Dong, Jie

    2017-07-01

    Intraperitoneal administration of antibiotics is recommended as a first treatment for managing peritoneal dialysis (PD)-related peritonitis. However, the efficacy of oral administration of quinolones has not been well studied. Randomized controlled pilot study. 80 eligible patients with PD-related peritonitis from Peking University First Hospital (40 in each arm). Intraperitoneal vancomycin, 1g, every 5 days plus oral moxifloxacin, 400mg, every day (treatment group) versus intraperitoneal vancomycin, 1g, every 5 days plus intraperitoneal ceftazidime, 1g, every day (control group). The primary end point was complete resolution of peritonitis, and secondary end points were primary or secondary treatment failure. PD effluent white blood cell count. Baseline demographic and clinical characteristics of the 2 groups were comparable. There were 24 and 22 Gram-positive organisms, 6 and 7 Gram-negative organisms, 9 and 10 culture-negative samples, and 1 and 1 fungal sample in the treatment and control groups, respectively. Complete resolution of peritonitis was achieved in 78% and 80% of cases in the treatment and control groups, respectively (OR, 0.86; 95% CI, 0.30-2.52; P=0.8). There were 3 and 1 cases of relapse in the treatment and control groups, respectively. Primary and secondary treatment failure rates were not significantly different (33% vs 20% and 10% vs 13%, respectively). In each group, there was 1 peritonitis-related death and 6 transfers to hemodialysis therapy. During the 3-month follow-up period, 7 and 3 successive episodes of peritonitis occurred in the treatment and control groups, respectively. Only 2 adverse drug reactions (mild nausea and mild rash, respectively) were observed in the 2 groups. Sample size was relatively small and the eligibility ratio was low. Also, the number of peritonitis episodes was low, limiting the power to detect a difference between groups. This pilot study suggests that intraperitoneal vancomycin with oral moxifloxacin is a

  8. Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Rosenberg Jacob

    2011-08-01

    Full Text Available Abstract Background Perforated diverticulitis is a condition associated with substantial morbidity. Recently published reports suggest that laparoscopic lavage has fewer complications and shorter hospital stay. So far no randomised study has published any results. Methods DILALA is a Scandinavian, randomised trial, comparing laparoscopic lavage (LL to the traditional Hartmann's Procedure (HP. Primary endpoint is the number of re-operations within 12 months. Secondary endpoints consist of mortality, quality of life (QoL, re-admission, health economy assessment and permanent stoma. Patients are included when surgery is required. A laparoscopy is performed and if Hinchey grade III is diagnosed the patient is included and randomised 1:1, to either LL or HP. Patients undergoing LL receive > 3L of saline intraperitoneally, placement of pelvic drain and continued antibiotics. Follow-up is scheduled 6-12 weeks, 6 months and 12 months. A QoL-form is filled out on discharge, 6- and 12 months. Inclusion is set to 80 patients (40+40. Discussion HP is associated with a high rate of complication. Not only does the primary operation entail complications, but also subsequent surgery is associated with a high morbidity. Thus the combined risk of treatment for the patient is high. The aim of the DILALA trial is to evaluate if laparoscopic lavage is a safe, minimally invasive method for patients with perforated diverticulitis Hinchey grade III, resulting in fewer re-operations, decreased morbidity, mortality, costs and increased quality of life. Trial registration British registry (ISRCTN for clinical trials ISRCTN82208287http://www.controlled-trials.com/ISRCTN82208287

  9. Augmented versus virtual reality laparoscopic simulation: what is the difference? A comparison of the ProMIS augmented reality laparoscopic simulator versus LapSim virtual reality laparoscopic simulator

    NARCIS (Netherlands)

    Botden, Sanne M. B. I.; Buzink, Sonja N.; Schijven, Marlies P.; Jakimowicz, Jack J.

    2007-01-01

    BACKGROUND: Virtual reality (VR) is an emerging new modality for laparoscopic skills training; however, most simulators lack realistic haptic feedback. Augmented reality (AR) is a new laparoscopic simulation system offering a combination of physical objects and VR simulation. Laparoscopic

  10. Time-action analysis of instrument positioners in laparoscopic cholecystectomy

    NARCIS (Netherlands)

    den Boer, K. T.; Bruijn, M.; Jaspers, J. E.; Stassen, L. P. S.; Erp, W. F. M.; Jansen, A.; Go, P. M. N. Y. H.; Dankelman, J.; Gouma, D. J.

    2002-01-01

    BACKGROUND: Instrument positioners can position and lock a laparoscopic instrument. This study uses time-action analysis to evaluate objectively whether IPs can substitute for a surgical assistant efficiently and safely. METHODS: In four hospitals, 78 laparoscopic cholecystectomies were randomly

  11. Laparoscopic Appendectomy and Cholecystectomy During Pregnancy: Six Case Reports

    Science.gov (United States)

    Thomas, Stephen J.

    1998-01-01

    Background: Pregnancy was once considered a contraindication to laparoscopic cholecystectomy and appendectomy. The progression of laparoscopic techniques has resulted in a continued reassessment of laparoscopic procedures during pregnancy. There still exists some controversy as to the safety of laparoscopic procedures during pregnancy. This paper reviews our series of six pregnant patients treated laparoscopically for appendicitis and cholecystitis. Methods: Charts were reviewed of all pregnant patients who underwent laparoscopic cholecystectomy or appendectomy at St Clare's Hospital Schenectady, New York between 1992 and 1996. Six patients were identified. Patients and obstetricians were contacted to investigate the results of the pregnancy. Results: All patients and fetuses survived the procedure. Two patients delivered prematurely but remote from the operative procedure. All infants were healthy postpartum. One patient underwent an elective abortion as she had planned. The abortion was remote from the surgical procedure. Conclusion: Our series adds to the growing evidence that laparoscopic cholecystectomy and laparoscopic appendectomy can be performed safely during pregnancy. PMID:9876709

  12. Laparoscopic versus open splenectomy in children with benign ...

    African Journals Online (AJOL)

    2017-06-28

    Jun 28, 2017 ... Thalassemia was present in 36 cases, idiopathic thrombocytopenic purpura ... hemoglobinopathies) and extracellular defects particu- larly autoimmune .... Thalassemia. 2. 2. Spherocytosis. 1. 0. ITP, idiopathic thrombocytopenic purpura; LS, laparoscopic splenectomy;. OS, open splenectomy. Laparoscopic ...

  13. Robot-assisted laparoscopic surgery of the infrarenal aorta

    NARCIS (Netherlands)

    Diks, J.; Nio, D.; Jongkind, V.; Cuesta, M.; Rauwerda, J.; Wisselink, W.

    2007-01-01

    Background Recently introduced robot-assisted laparoscopic surgery (RALS) facilitates endoscopic surgical manipulation and thereby reduces the learning curve for (advanced) laparoscopic surgery. We present our learning curve with RALS for aortobifemoral bypass grafting as a treatment for

  14. Two-port Laparoscopic-assisted Appendicectomy Under Local ...

    African Journals Online (AJOL)

    Key words: Laparoscopic appendicectomy, laparoscopic- assisted appendicectomy, local anesthesia, monitored anesthesia care. Departments of Anesthesiology, and 1General Surgery,. Institute of Medical Sciences, Banaras Hindu University,. Varanasi, Uttar Pradesh, India. Address for correspondence: Dr. V. K. Shukla,.

  15. Metabolism and distribution of guanosine given intraperitoneally: implications for spinal cord injury.

    Science.gov (United States)

    Jiang, Shucui; Fischione, Gemma; Giuliani, Patricia; Guiliani, Patricia; Romano, Silvia; Caciagli, Francesco; Di Iorio, Patrizia; Diiorio, Patrizia

    2008-06-01

    Intraperitoneal administration of guanosine to rats with chronic spinal cord injury stimulates remyelination and functional recovery. If guanosine produced its effects in the nervous system, it should enter it and elevate endogenous concentrations. [(3)H]-guanosine (8 mg/kg) was administered intraperitoneally to rats and its distribution and concentration in different sites determined. Guanosine rapidly entered all tissues; its concentration peaked at about 15 minutes except in adipose tissue and CNS where it continued to rise for 30 minutes. Its chief metabolic product in all sites was guanine with over twice as much guanine as guanosine present in CNS after 30 minutes.

  16. Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model

    NARCIS (Netherlands)

    Schreinemacher, M. H. F.; Emans, P. J.; Gijbels, M. J. J.; Greve, J.-W. M.; Beets, G. L.; Bouvy, N. D.

    2009-01-01

    In laparoscopic ventral hernia repair a mesh is placed in direct contact with the viscera, often leading to substantial adhesions. In this experimental study the ability of different coated and uncoated meshes to attenuate adhesion formation was examined. Six commercially available meshes were

  17. Same-day discharge after laparoscopic hysterectomy.

    Science.gov (United States)

    Perron-Burdick, Misa; Yamamoto, Miya; Zaritsky, Eve

    2011-05-01

    To estimate readmission rates and emergency care use by patients discharged home the same day after laparoscopic hysterectomy. This was a retrospective case series of patients discharged home the same-day after total or supracervical laparoscopic hysterectomy in a managed care setting. Chart reviews were performed for outcomes of interest which included readmission rates, emergency visits, and surgical and demographic characteristics. The two hysterectomy groups were compared using χ² tests for categorical variables and t tests or Wilcoxon rank-sum tests for continuously measured variables. One-thousand fifteen laparoscopic hysterectomies were performed during the 3-year study period. Fifty-two percent (n=527) of the patients were discharged home the same-day; of those, 46% (n=240) had total laparoscopic hysterectomies and 54% (n=287) had supracervical. Cumulative readmission rates were 0.6%, 3.6%, and 4.0% at 48 hours, 3 months, and 12 months, respectively. The most common readmission diagnoses included abdominal incision infection, cuff dehiscence, and vaginal bleeding. Less than 4% of patients presented for emergency care within 48 or 72 hours, most commonly for nausea or vomiting, pain, and urinary retention. Median uterine weight was 155 g, median blood loss was 70 mL, and median surgical time was 150 minutes. There was no difference in readmission rates or emergency visits for the total compared with the supracervical laparoscopic hysterectomy group. Same-day discharge after laparoscopic hysterectomy is associated with low readmission rates and minimal emergency visits in the immediate postoperative period. Same-day discharge may be a safe option for healthy patients undergoing uncomplicated laparoscopic hysterectomy.

  18. Day case laparoscopic cholecystectomy in Sudan | Ibnouf | Sudan ...

    African Journals Online (AJOL)

    Day case laparoscopic cholecystectomy in Sudan. MAM Ibnouf, Mohamed Mahmoud, Yosif A Abdulgadir, Ali A Salama, El Tayb El Amri. Abstract. Background: Laparoscopic surgery faces lots of constraints in the less developing countries. The aim: To audit day-case laparoscopic cholecystectomy in our set up in Sudan.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  20. The value of laparoscopic classifications in decision on definitive ...

    African Journals Online (AJOL)

    The value of laparoscopic classifications in decision on definitive surgery in patients with nonpalpable testes: our ... present our clinical experience with the laparoscopic approach in patients with nonpalpable testes (NPTs) and .... decision making during the procedure. Gatti and. Ostlie [3] have pointed out that laparoscopic ...

  1. Experience with laparoscopic surgery at the Aga Khan Hospital ...

    African Journals Online (AJOL)

    Objective: To outline the experience of laparoscopic surgery at the Aga Khan Hospital, Nairobi, and to determine the acceptability and outcome of the various procedures undertaken laparoscopically. Design: A retrospective case analysis. Subjects: Four hundred and seventy eight cases of laparoscopic surgery were ...

  2. Laparoscopic diagnostic findings in atypical intestinal malrotation in ...

    African Journals Online (AJOL)

    We present our experience with laparoscopic management of atypical presentations of intestinal malrotation in children, describing laparoscopic findings in these ... Thirty-six patients (90%) were found to have definite laparoscopic findings in the form of markedly dilated stomach and first part of duodenum, ectopic site of ...

  3. A COMPARATIVE STUDY OF LAPAROSCOPIC VERSUS OPEN CHOLECYSTECTOMY

    OpenAIRE

    Gopal Rao; Suryanarayana; Srinivas; Satish

    2015-01-01

    The model era of Laparoscopic Surgery has evoked remarkable changes in approaches to surgical diseases. The trend toward minimal access surgery (MAS) has prompted General surgeons to scrutinize nearly all operations for possible convention to Laparoscopic techniques. AIM OF THE STUDY : Our aim of the study is to compare Laparoscopic Cholecystectomy with that of open cholecystectomy. MATERIALS AND METHODS : ...

  4. Image acquisition in laparoscopic and endoscopic surgery

    Science.gov (United States)

    Gill, Brijesh S.; Georgeson, Keith E.; Hardin, William D., Jr.

    1995-04-01

    Laparoscopic and endoscopic surgery rely uniquely on high quality display of acquired images, but a multitude of problems plague the researcher who attempts to reproduce such images for educational purposes. Some of these are intrinsic limitations of current laparoscopic/endoscopic visualization systems, while others are artifacts solely of the process used to acquire and reproduce such images. Whatever the genesis of these problems, a glance at current literature will reveal the extent to which endoscopy suffers from an inability to reproduce what the surgeon sees during a procedure. The major intrinsic limitation to the acquisition of high-quality still images from laparoscopic procedures lies in the inability to couple directly a camera to the laparoscope. While many systems have this capability, this is useful mostly for otolaryngologists, who do not maintain a sterile field around their scopes. For procedures in which a sterile field must be maintained, one trial method has been to use a beam splitter to send light both to the still camera and the digital video camera. This is no solution, however, since this results in low quality still images as well as a degradation of the image that the surgeon must use to operate, something no surgeon tolerates lightly. Researchers thus must currently rely on other methods for producing images from a laparoscopic procedure. Most manufacturers provide an optional slide or print maker that provides a hardcopy output from the processed composite video signal. The results achieved from such devices are marginal, to say the least. This leaves only one avenue for possible image production, the videotape record of an endoscopic or laparoscopic operation. Video frame grabbing is at least a problem to which industry has applied considerable time and effort to solving. Our own experience with computerized enhancement of videotape frames has been very promising. Computer enhancement allows the researcher to correct several of the

  5. Intraperitoneal chemotherapy in the management of ovarian cancer: focus on carboplatin

    Directory of Open Access Journals (Sweden)

    Maurie Markman

    2009-02-01

    Full Text Available Maurie MarkmanUniversity of Texas MD Anderson Cancer Center, Houston, Texas, USAAbstract: Both pre-clinical studies and phase 1–2 clinical trials have provided strong support for the potential role of regional drug delivery in the management of epithelial ovarian cancer, a disease process whose major manifestations remain largely localized to the peritoneal cavity in the majority of individuals with this malignancy. The results of 3 phase 3 randomized trials have revealed the favorable impact of primary cisplatin-based intraperitoneal chemotherapy in women who initiate drug treatment with small-volume residual ovarian cancer following an attempt at optimal surgical cytoreduction. Concerns have been raised regarding the toxicity of regional treatment, particularly the side-effect profile associated with cisplatin. One rational approach to improving the tolerability of intraperitoneal chemotherapy is to substitute carboplatin for cisplatin. This review discusses the rationale for and data supporting regional treatment of epithelial ovarian cancer, and highlights the potential role for intraperitoneal carboplatin in this clinical setting.Keywords: ovarian cancer, intraperitoneal chemotherapy, cisplatin, carboplatin

  6. Comparison of Mucosal, Subcutaneous and Intraperitoneal Routes of Rat Leptospira Infection.

    Directory of Open Access Journals (Sweden)

    Anne-Laure Zilber

    2016-03-01

    Full Text Available Leptospirosis is a zoonosis found worldwide that is caused by a spirochete. The main reservoirs of Leptospira, which presents an asymptomatic infection, are wild rodents, including the brown rat (Rattus norvegicus. Experimental studies of the mechanisms of its renal colonization in rats have previously used an intraperitoneal inoculation route. However, knowledge of rat-rat transmission requires the use of a natural route of inoculation, such as a mucosal or subcutaneous route. We investigated for the first time the effects of subcutaneous and mucosal inoculation routes compared to the reference intraperitoneal route during Leptospira infection in adult rats. Infection characteristics were studied using Leptospira renal isolation, serology, and molecular and histological analyses. Leptospira infection was asymptomatic using each inoculation route, and caused similar antibody production regardless of renal colonization. The observed renal colonization rates were 8 out of 8 rats, 5 out of 8 rats and 1 out of 8 rats for the intraperitoneal, mucosal and subcutaneous inoculation routes, respectively. Thus, among the natural infection routes studied, mucosal inoculation was more efficient for renal colonization associated with urinary excretion than the subcutaneous route and induced a slower-progressing infection than the intraperitoneal route. These results can facilitate understanding of the infection modalities in rats, unlike the epidemiological studies conducted in wild rats. Future studies of other natural inoculation routes in rat models will increase our knowledge of rat-rat disease transmission and allow the investigation of infection kinetics.

  7. Surgical aspects and complications of continuous intraperitoneal insulin infusion with an implantable pump

    NARCIS (Netherlands)

    Haveman, Jan Willem; Logtenberg, Susan J. J.; Kleefstra, Nanne; Groenier, Klaas H.; Bilo, Henk J. G.; Blomme, Adri M.

    Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is safe and effective in selected subjects with diabetes. Our aim was to assess surgical experience and complications with CIPII. We performed a retrospective longitudinal observational cohort study of patients that started

  8. Continuous intraperitoneal insulin infusion in the treatment of type 1 diabetes mellitus : Glycaemia and beyond

    NARCIS (Netherlands)

    van Dijk, Peter R.

    2015-01-01

    Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is a last-resort treatment option for selected patients with type 1 diabetes mellitus (T1DM). As compared to the most commonly used forms of insulin administration -injections and an externally placed pump- which deliver

  9. Improved Glycemic Control With Intraperitoneal Versus Subcutaneous Insulin in Type 1 Diabetes A randomized controlled trial

    NARCIS (Netherlands)

    Logtenberg, Susan J.; Kleefstra, Nanne; Houweling, Sebastiaan T.; Groenier, Klaas H.; Gans, Reinold O.; van Ballegooie, Evert; Bilo, Henk J.

    OBJECTIVE - Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump has been available for the past 25 years. CIPII, with its specific pharmacodynamic properties, may be a viable treatment alternative to improve glycemic control in patients with type I diabetes for whom other

  10. Systematic review: continuous intraperitoneal insulin infusion with implantable insulin pumps for diabetes mellitus

    NARCIS (Netherlands)

    Spaan, Nienke; Teplova, Alina; Stam, Gerrit; Spaan, Jos; Lucas, Cees

    2014-01-01

    Continuous intraperitoneal insulin infusion (CIPII) with implantable insulin pumps (IIPs) is a treatment option for diabetes, which is not widely utilized nor freely accessible in clinical practice. The aim of this study was to summarize available evidence on use of IIPs for CIPII for diabetes

  11. Intraperitoneal tenoxicam to prevent abdominal adhesion formation in a rat peritonitis model.

    Science.gov (United States)

    Ezberci, Fikret; Bulbuloglu, Ertan; Ciragil, Pinar; Gul, Mustafa; Kurutas, Ergul Belge; Bozkurt, Serdar; Kale, I Taner

    2006-01-01

    We investigated the effects of intraperitoneal tenoxicam on the development of postoperative intra-abdominal adhesions and oxidative stress in a model of bacterial peritonitis. Bacterial peritonitis was induced in 24 rats by cecal ligation and puncture. The rats were randomly assigned to one of three groups. Group 1 (n = 8) received 2 ml saline intraperitoneally, group 2 (n = 8) received 2 ml (0.5 mg/kg) tenoxicam (Oksamen) intraperitoneally, and group 3 (n = 8) was a control, which did not receive any injection. All animals were killed 14 days later so we could assess the adhesion score and measure anastomotic bursting pressures. Tissue antioxidant levels were measured in 1-g tissue samples taken from the abdominal wall. The adhesion score was significantly lower in the tenoxicam group than in the saline and control groups. The anastomotic bursting pressures were higher in the saline and tenoxicam groups than in the control group. The catalase (CAT) levels were higher in the saline and tenoxicam groups than in the control group. The malondialdehyde (MDH) levels were higher in the saline group than in the tenoxicam and control groups. Intraperitoneal tenoxicam inhibited the formation of postoperative intra-abdominal adhesions without compromising wound healing in this bacterial peritonitis rat model. Tenoxicam also decreased the oxidative stress during peritonitis.

  12. Methylene blue 1% solution on the prevention of intraperitoneal adhesion formation in a dog model

    Directory of Open Access Journals (Sweden)

    Marco Augusto Machado Silva

    Full Text Available Intraperitoneal adhesions usually are formed after abdominal surgeries and may cause technical difficulties during surgical intervention, chronic abdominal pain and severe obstructions of the gastrointestinal tract. The current study aimed to evaluate the efficacy of methylene blue (MB 1% solution on the prevention of intraperitoneal postsurgical adhesion formation in a canine surgical trauma model. Twenty bitches were submitted to falciform ligament resection, omentectomy, ovariohysterectomy and scarification of a colonic segment. Prior to abdominal closure, 10 bitches received 1mg kg-1 MB intraperitoneally (MB group and 10 bitches received no treatment (control group, CT. On the 15th postoperative day the bitches were submitted to laparoscopy to assess adhesions. The mean adhesion scores were 13.9 (±5.6 for MB group and 20.5 (±6.4 for the CT group (P=0,043. In conclusion, the 1% MB solution was efficient on the prevention of intraperitoneal postoperative adhesion formation in bitches, especially those involving the colonic serosa.

  13. Intraperitoneal microdialysis in the postoperative surveillance after surgery for necrotizing enterocolitis

    DEFF Research Database (Denmark)

    Pedersen, Mark E; Dahl, Marianne; Qvist, Niels

    2011-01-01

    BACKGROUND/PURPOSE: The aim of the present pilot study was to evaluate the safety and clinical application of intraperitoneal microdialysis (MD) in preterm infants operated on for necrotizing enterocolitis (NEC). METHODS: Fourteen infants underwent MD. Two were excluded from analysis: 1 because...

  14. Comparison of Mucosal, Subcutaneous and Intraperitoneal Routes of Rat Leptospira Infection

    Science.gov (United States)

    Zilber, Anne-Laure; Belli, Patrick; Grezel, Delphine; Artois, Marc; Kodjo, Angeli; Djelouadji, Zoheira

    2016-01-01

    Leptospirosis is a zoonosis found worldwide that is caused by a spirochete. The main reservoirs of Leptospira, which presents an asymptomatic infection, are wild rodents, including the brown rat (Rattus norvegicus). Experimental studies of the mechanisms of its renal colonization in rats have previously used an intraperitoneal inoculation route. However, knowledge of rat-rat transmission requires the use of a natural route of inoculation, such as a mucosal or subcutaneous route. We investigated for the first time the effects of subcutaneous and mucosal inoculation routes compared to the reference intraperitoneal route during Leptospira infection in adult rats. Infection characteristics were studied using Leptospira renal isolation, serology, and molecular and histological analyses. Leptospira infection was asymptomatic using each inoculation route, and caused similar antibody production regardless of renal colonization. The observed renal colonization rates were 8 out of 8 rats, 5 out of 8 rats and 1 out of 8 rats for the intraperitoneal, mucosal and subcutaneous inoculation routes, respectively. Thus, among the natural infection routes studied, mucosal inoculation was more efficient for renal colonization associated with urinary excretion than the subcutaneous route and induced a slower-progressing infection than the intraperitoneal route. These results can facilitate understanding of the infection modalities in rats, unlike the epidemiological studies conducted in wild rats. Future studies of other natural inoculation routes in rat models will increase our knowledge of rat-rat disease transmission and allow the investigation of infection kinetics. PMID:27031867

  15. Intraperitoneal Paclitaxel Is Useful as Adjuvant Chemotherapy for Advanced Gastric Cancer with Serosal Exposure

    Directory of Open Access Journals (Sweden)

    Joji Kitayama

    2014-01-01

    Full Text Available Background: Intraperitoneal administration of paclitaxel (PTX can elicit a marked clinical response in peritoneal metastases of gastric cancer. Methods: In this study, we retrospectively analyzed the clinical outcome of 17 patients who underwent R0 resection with D2 dissection for advanced gastric cancer with macroscopic serosal exposure and received intraperitoneal PTX as adjuvant therapy. Results: A pathological study revealed that the depth of invasion of the primary tumor was pT4a or pT4b in 10 cases, and that the pN stage was more than pN2 in 8 cases. Genetic analysis of peritoneal lavage fluid was performed in 14 cases, all of which were positive for carcinoembryonic antigen mRNA. In these patients, PTX was intraperitoneally administered at 20-60 mg/m2 with oral S-1 for 3-36 months after surgery. In a median follow-up period of 66 months, recurrence occurred in the liver and peritoneum in 2 (11.7% and 1 (5.9% patients, respectively, and no nodal recurrence was observed. Five-year overall survival and disease-free survival were 88.2 and 82.3%, respectively. Conclusion: Since these patients are considered to be a high-risk group for peritoneal recurrence, this result strongly suggests that adjuvant chemotherapy including intraperitoneal PTX is a promising protocol to improve the outcome of patients with advanced gastric cancer with serosal exposure.

  16. Laparoscopic and mini-invasive surgery.

    Science.gov (United States)

    Pugliese, Raffaele; Maggioni, Dario; Costanzi, Andrea; Ferrari, Giovanni; Gualtierotti, Monica

    2012-01-01

    JGCA Gastric Cancer Treatment Guidelines (2004) include Laparoscopic Assisted Distal Gastrectomy (LADG) within the chapter of modified surgery. A metanalysis published in 2010 shows that LADG is significantly superior to Open Distal Gastrectomy (ODG) if comparing short term outcomes. Oncologic results prove to be comparable to ODG by one RCT and 2 retrospective studies. Little evidence is available on Laparoscopic Total Gastrectomy and concerns are raised about long-term oncologic outcomes. Laparoscopic Subtotal Gastrectomy is carried out with 4 to 5 ports in the periumbilical region (Hasson trocar for laparoscope) and upper quadrants. After exploration of the abdominal cavity surgical steps include coloepiploic detachment, omentectomy, dissection of the gastrocolic ligament, division of the left gastroepiploic vessels, division of right gastroepiploic vessels, division of pyloric vessels. The duodenum is transected with a linear stapler. Incision of the lesser omentum and dissection of the hepatoduodenal ligament allows completion of D2 lymphadenectomy. The 4/5ths of the stomach are transected starting from the greater curve at the junction of left and right gastroepiploic arcades by linear stapler. Roux-en-Y loop reconstruction is performed through a stapled side-to-side gastro-jejunal anastomosis and a side-to-side jejuno-jejunal anastomosis. Reconstruction after Laparoscopic Total Gastrectomy is performed preferably by a side-to-side esophago-jejunal anastomosis according to Orringer. A robotic assisted approach adds precision on lymphadenectomy and reconstructive techniques.

  17. Laparoscopic diagnosis and treatment of nonpalpable testis

    Directory of Open Access Journals (Sweden)

    Francisco T. Denes

    2008-06-01

    Full Text Available INTRODUCTION: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are nonpalpable. In these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. MATERIALS AND METHODS: We present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. Forty-six patients (51.1% had intra-abdominal gonads. In 25 testicles of 19 patients, we performed a two stage laparoscopic Fowler-Stephens orchiopexy. The other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. RESULTS: We obtained an overall 88% success rate with the 2 stage Fowler-Stephens approach and only 33% rate success using one stage Fowler-Stephens surgery with primary vascular ligature. There was no intraoperative complication in our group of patients. In the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. Hospital stay and convalescence were brief. CONCLUSIONS: In pediatric age group, the laparoscopic approach is safe and feasible. Furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our Department.

  18. Transperitoneal laparoscopic live donor nephrectomy: Current status

    Directory of Open Access Journals (Sweden)

    A Srivastava

    2007-01-01

    Full Text Available Renal transplantation is the treatment of choice for a suitable patient with end stage renal disease. Unfortunately, the supply of donor organs is greatly exceeded by demand. In many countries the use of kidneys from living donors has been widely adopted as a partial solution. Traditionally donor nephrectomy has been performed via a open flank incision however with some morbidity like pain and a loin scar. Currently, the donor nephrectomy is increasingly being performed laparoscopically with the objective of reducing the morbidity. It is also hoped that this will lead to increasing acceptance of living donation. The first minimally invasive living donor nephrectomy was carried out in 1995 at the Johns Hopkins Medical Center and since then many centers have undertaken laparoscopic living donor nephrectomy. The laparoscopic approach substantially reduces the donor morbidity and wound related problems associated with open nephrectomy. The laparoscopic techniques thus have the potential to increase the number of living kidney donors. The present article attempts to review the safety and efficacy of transperitoneal laparoscopic donor nephrectomy.

  19. Laparoscopic simulation for all: two affordable, upgradable, and easy-to-build laparoscopic trainers.

    Science.gov (United States)

    Smith, Matthew D; Norris, Joseph M; Kishikova, Lyudmila; Smith, David P

    2013-01-01

    Laparoscopic surgery has established itself as the approach of choice for a multitude of operations in general, urological, and gynecological surgery. A number of factors make performing laparoscopic surgery technically demanding, and as such it is crucial that surgical trainees hone their skills safely on trainers before operating on patients. These can be highly expensive. Here, we describe a novel and upgradable approach to constructing an affordable laparoscopic trainer. A pattern was produced to build an upgradable laparoscopic trainer for less than $100. The basic model was constructed from an opaque plastic crate with plywood base, 2 trocars, and 2 pairs of disposable laparoscopic instruments. A laptop, a light emitting diode (LED), and a fixed webcam were utilized to visualize the box interior. An enhanced version was also created, as an optional upgrade to the basic model, featuring a neoprene-trocar interface and a simulated mobile laparoscope. The described setup allowed trainees to gain familiarity with laparoscopic techniques, beginning with simple manipulation and then progressing through to more relevant procedures. Novices began by moving easy-to-grasp objects between containers and then attempting more challenging manipulations such as stacking sugar cubes, excising simulated lesions, threading circular mints onto cotton, and ligating fastened drinking straws. These techniques have introduced the necessity of careful instrument placement and have increased trainees' dexterity with laparoscopy. Here, we have outlined an upgradable and affordable alternative laparoscopic trainer that has given many trainees crucial experience with laparoscopic techniques, allowing them to safely improve their manual skill and confidence. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Jennings Jason

    2010-01-01

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

  1. Laparoscopic revolution in bariatric surgery.

    Science.gov (United States)

    Sundbom, Magnus

    2014-11-07

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21(st) century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.

  2. Penrose Drain Migration After Laparoscopic Surgery

    Directory of Open Access Journals (Sweden)

    Pazouki AbdolReza

    2009-05-01

    Full Text Available Laparoscopy has made a revolution in surgical procedures and treatment of various diseases but its complications are still under investigation. Intra-abdominal visceral and vessel injuries, trocar site hernia, and leaving foreign bodies into the peritoneal cavity are among some laparoscopic surgery complications. This is a rare report of Penrose drain migration following incomplete laparoscopic Fundoplication surgery. The patient was a 47- year- old woman, who was a candidate for Touplet Fundoplication via laparoscopic approach due to refractory gastro-esophageal reflux disease (GERD. While wrapping a Penrose drain around the esophagus, the patient had a cardiorespiratory arrest. Attempts to remove the Penrose drain were unsuccessful and the surgical procedure was terminated due to patient's condition. Four months later, after a long period of dysphagia and abdominal pain, the Penrose drain was defecated via rectum.

  3. A laparoscopic approach to CBD stones.

    Science.gov (United States)

    Khanzada, Zubair; Morgan, Richard

    2013-12-01

    : This study aimed to evaluate single-stage surgical (laparoscopic or open) approach to the management of common bile duct (CBD) stones, as treatment of choice. Prospectively collected data to assess outcomes of CBD clearance, morbidity, mortality, and hospital stay, and compared with published data. Successful clearance of CBD stones was achieved in 96% cases, laparoscopic exploration successful in 83%. Retained stones were found in 4% cases and another 5% developed postoperative complications. Common length of stay in hospital was 2 days, although mean stay was 4 days. Seventy-three percent of cases were elective, 27% were emergencies. Conversion rate to open surgery was 14%, which was mainly in emergency cases. Postoperative mortality was 1.2%, not directly related to the procedure. Good outcomes can be achieved, comparing favorably with those of other modalities, when laparoscopic bile duct exploration is chosen as treatment for CBD stones; the best results can be anticipated in elective patients.

  4. Factors leading to conversion in laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Iqbal, P.; Saddique, M.; Baloch, T.A.

    2008-01-01

    To determine the reasons for conversion of Laparoscopic Cholecystectomy to open surgery in our setup. Detailed history, physical examination and investigations were carried out. Patients were operated by a senior surgeon. Cases that required conversion from Laparoscopic to open surgery were analyzed and the factors responsible for such conversion were studied. Out of 340 patients 32 (9.4%) required conversion to open procedure. Factors responsible for these conversion were dense adhesions in 8(2.4%), empyema gall bladder in 4(1.2%), contracted gall bladder in 3(0.9%), haemorrhage in 3(0.9%), and CBD injury and carcinoma gall bladder in 2(0.6%) each. Instrument failure and repeated power breakdowns with backup failure were also recognized as important factors responsible for 10(2.9%) conversions. Conversion of Laparoscopic to open procedure may be life saving in difficult situations. Conversion rate can be reduced by addressing the preventable factors. (author)

  5. Intraperitoneal immunoconjugates

    International Nuclear Information System (INIS)

    Griffin, T.W.; Collins, J.; Bokhari, F.; Stochl, M.; Brill, A.B.; Ito, T.; Emond, G.; Sands, H.

    1990-01-01

    Intracavitary instillation of radioantibodies has been proposed as therapy for anatomically confined malignant disease. To evaluate this therapeutic strategy, a monoclonal antibody reactive with human transferrin receptor (7D3) was evaluated for localization in a human malignant mesothelioma transplanted i.p. in athymic nude mice. This antibody was purified and labeled with 131I, 125I, or 111In. Radiolabeled antibody was administered i.p. or i.v. to tumor-bearing mice. Three h after injection, the percentage of injected dose/g (ID/g) of tumor was higher in free-floating ascites tumor cells (31.0%/g tumor cell pellet) after i.p. injection than after i.v. injection (12.0%). However, localization of radiolabel in i.p. solid tumors was similar (5.37% ID/g i.p. versus 4.73% of ID/g i.v.), and by 24 h both routes of administration produced similar localization of radiolabel in both free-floating ascites cells and solid tumors. In contrast, uptake of radiolabel into liver, kidney, and to a lesser extent bone and bone marrow, was less with i.p. than with i.v. administration. In clinical studies with 111In and 90Y antibodies administered i.p. to patients with ovarian cancer, confined biodistribution of the radioantibody was again seen, although interpatient variability of rate of egress of the radiolabel was documented. Therefore, both preclinical and clinical data indicate that i.p. therapy with immunoconjugates may be advantageous for cancer confined to the peritoneal cavity. This advantage stems primarily from reduced localization of isotope in organs of catabolism or toxicity (liver, kidney, bone, and bone marrow), rather than greatly increased levels of isotope in tumor. Unresolved problems include degree of antibody penetration into solid tumors, microdosimetry, and radioantibody effectiveness for tumor killing

  6. Nintendo Wii video-gaming ability predicts laparoscopic skill.

    Science.gov (United States)

    Badurdeen, Shiraz; Abdul-Samad, Omar; Story, Giles; Wilson, Clare; Down, Sue; Harris, Adrian

    2010-08-01

    Studies using conventional consoles have suggested a possible link between video-gaming and laparoscopic skill. The authors hypothesized that the Nintendo Wii, with its motion-sensing interface, would provide a better model for laparoscopic tasks. This study investigated the relationship between Nintendo Wii skill, prior gaming experience, and laparoscopic skill. In this study, 20 participants who had minimal experience with either laparoscopic surgery or Nintendo Wii performed three tasks on a Webcam-based laparoscopic simulator and were assessed on three games on the Wii. The participants completed a questionnaire assessing prior gaming experience. The score for each of the three Wii games correlated positively with the laparoscopic score (r = 0.78, 0.63, 0.77; P effect of prior gaming experience showed a significant positive correlation between the Wii score and the laparoscopic score (r = 0.713; P positively with the laparoscopic score (r = 0.578; P < 0.01), but no significant difference in the laparoscopic score was observed when the participants in the top tertile of experience were compared with those in the bottom tertile (P = 0.26). The study findings suggest a skill overlap between the Nintendo Wii and basic laparoscopic tasks. Surgical candidates with advanced Nintendo Wii ability may possess higher baseline laparoscopic ability.

  7. PRINCIPLES OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY

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    Tomaž Benedik

    2003-12-01

    Full Text Available Background. After more than decade of routine use of laparoscopic cholecystectomy for treatment of symptomatic gallbladder stones, the incidence of biliary injuries, which are potentially life threatening and cause prolonged hospitalization and major morbidity, seems to be increased in laparoscopic cholecystectomy compared with open operation. Injury rate was from some reports 2.5 to 4 times higher than with open operation. There are many proposed classifications of types of biliary injuries.The most frequent direct causes of laparoscopic biliary injury are misidentification of the common bile duct, cautery injuries to the bile duct and improper application of clips to the cystic duct.Conclusions. To avoid misidentification of ducts one should conclusively identify cystic duct and artery, the structures to be divide, in every laparoscopic cholecystectomy. To achieve that goal, Calot’s triangle must be dissected free of fat and fibrous – tissue and the lower end of the gallbladder must be dissected of the liver bed. The only two structures entering the gallbladder should be visible – cystic duct and artery. With avoidance of blind application of cautery and clips to control bleeding one should avoid injury of bile duct. Low cautery settings should be used in portal dissections to prevent arc.With meticulous care in dissection and conclusive identification of cystic duct and artery we can prevent injuries of bile duct, which still have impermissible high incidence. In the article 504 laparoscopic cholecystectomies performed at the Department of abdominal surgery in BPD in 2002 were analysed. We follow priciples of safety in laparoscopic cholecystectomy. There were no biliary injuries reports.

  8. 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.

  9. Laparoscopic management of large ureteral fibroepithelial polyp.

    Science.gov (United States)

    Kijvikai, Kittinut; Maynes, Lincoln J; Herrell, S Duke

    2007-08-01

    Fibroepithelial polyps of the ureter are rare benign mesothelial tumors. Most polyps are small; however, very rare large polyps have also been reported. Currently, most investigators encourage endoscopic management in these patients. Nevertheless, endoscopic resection can be difficult in patients with a long or large polypoid lesion. We describe our experience and laparoscopic technique for treatment of a symptomatic 42-year-old woman who presented with a 17-cm-long fibroepithelial polyp in the proximal ureter associated with ureteral obstruction. To our knowledge, this is the first reported case of laparoscopic management of a large ureteral fibroepithelial polyp.

  10. Laparoscopic retrieval of impacted Dormia basket

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2017-01-01

    Full Text Available For choledocholithiasis, endoscopic management is the first line of treatment. Both Dormia basket and balloon catheter are used to retrieve common bile duct (CBD stones. Here we present a case of impaction of the Dormia basket during an endoscopic procedure. The patient was managed through laparoscopic choledochotomy, and the basket was found to be impacted with a common bile stone of size 18 mm. The stone was disengaged from the basket and, by holding the tip of the basket, was removed through one of the laparoscopic ports.

  11. Laparoscopic repair of abdominal incisional hernia

    Science.gov (United States)

    Yang, Xue-Fei

    2016-01-01

    Abdominal incisional hernia is a common complication after open abdominal operations. Laparoscopic procedures have obvious mini-invasive advantages for surgical treatment of abdominal incisional hernia, especially to cases with big hernia defect. Laparoscopic repair of incisional hernia has routine mode but the actual operations will be various according to the condition of every hernia. Key points of these operations include design of the position of trocars, closure of defects and fixation of meshes. The details of these issues and experiences of perioperative evaluation and treatment will be talked about in this article. PMID:27761446

  12. [Intraoperative complications during performance of laparoscopic cholecystectomy].

    Science.gov (United States)

    Honchar, M H; Hlushchuk, O M

    2012-02-01

    During 10-year period (2001-2010) in the clinic there were operated on 3648 patients, suffering cholelithic disease. Most frequent intraoperative complications, especially in an acute calculous cholecystitis, were: hemorrhage from the bed of gallbladder and its artery, bile leakage, common biliary duct and internal organs damage. A casuistic case was depicted--the rubber tube migration from the wound into the intestinal lumen and its exile per vias naturalis. The authors consider, that aiming to warn the operative complications during performance of laparoscopic cholecystectomy, the operation must be performed by surgeons, experienced in laparoscopic surgery.

  13. Mesenteric vein thrombosis following laparoscopic appendectomy

    Directory of Open Access Journals (Sweden)

    Jamie Harris

    2014-11-01

    Full Text Available Mesenteric vein thrombosis is an uncommon complication following laparoscopic surgery. A review of the literature has shown that there is a higher incidence of thrombosis following laparoscopic bariatric procedures, including the gastric sleeve procedure and roux-en-y gastric bypass surgery. Additionally, pylephlebitis, thrombosis of portal or mesenteric veins, has been described following perforated appendicitis. However no report has described mesenteric vein thrombosis following laparoscopy for nonperforated appendicitis in the pediatric population. The cause of this thrombosis is hypothesized to be secondary to venous stasis secondary to insufflation during laparoscopy.

  14. Laparoscopic Splenectomy in Patients With Spleen Injuries.

    Science.gov (United States)

    Ermolov, Aleksander S; Tlibekova, Margarita A; Yartsev, Peter A; Guliaev, Andrey A; Rogal, Mikhail M; Samsonov, Vladimir T; Levitsky, Vladislav D; Chernysh, Oleg A

    2015-12-01

    Spleen injury appears in 10% to 30% of abdominal trauma patients. Mortality among the patients in the last 20 years remains high (6% to 7%) and shows no tendency to decline. Nowadays nonoperative management is widely accepted management of patients with low-grade spleen injury, whereas management of patients with high-grade spleen injury (III and higher) is not so obvious. There are 3 methods exist in treatment of such patients: conservative (with or without angioembolization), spleen-preserving operations, and splenectomy. Today laparoscopic splenectomy is not a widely used operation and only few studies reported about successful use of laparoscopic splenectomy in patients with spleen injury.The aim of the study was to determine indications and contraindications for laparoscopic splenectomy in abdominal trauma patients and to analyze results of the operations. The study involved 42 patients with spleen injury grade III who were admitted in our institute in the years of 2010 to 2014. The patients were divided in 2 groups. Laparoscopic splenectomy was performed in 23 patients (group I) and "traditional" splenectomy was carried out in 19 patients (group II). There was no difference in the demographic data and trauma severity between the 2 groups. Noninvasive investigations, such as laboratory investigations, serial abdominal ultrasound examinations, x-ray in multiple views, and computed tomography had been performed before the decision about necessity of an operation was made. Patients after laparoscopic operations had better recovering conditions compared with patients with the same injury after "traditional" splenectomy. Neither surgery-related complications nor mortalities were registered in both groups. Laparoscopic splenectomy was more time-consuming operation than "traditional" splenectomy. We suggest that as experience of laparoscopic splenectomy is gained the operation time will be reduced. Laparoscopic splenectomy is a safe feasible operation in patients

  15. Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia.

    Science.gov (United States)

    Rodriguez-Acevedo, Omar; Elstner, Kristen E; Jacombs, Anita S W; Read, John W; Martins, Rodrigo Tomazini; Arduini, Fernando; Wehrhahm, Michael; Craft, Colette; Cosman, Peter H; Dardano, Anthony N; Ibrahim, Nabeel

    2018-02-01

    Operative management of complex ventral hernia still remains a significant challenge for surgeons. Closure of large defects in the unprepared abdomen has serious pathophysiological consequences due to chronic contraction and retraction of the lateral abdominal wall muscles. We report outcomes of 56 consecutive patients who had preoperative Botulinum toxin A (BTA) abdominal wall relaxation facilitating closure and repair. This was a prospective observational study of 56 patients who underwent ultrasound-guided BTA into the lateral abdominal oblique muscles prior to elective ventral hernia repair between November 2012 and January 2017. Serial non-contrast abdominal CT imaging was performed to evaluate changes in lateral oblique muscle length and thickness. All hernias were repaired laparoscopically, or laparoscopic-open-laparoscopic (LOL) using intraperitoneal onlay mesh. 56 patients received BTA injections at predetermined sites to the lateral oblique muscles, which were well tolerated. Mean patient age was 59.7 years, and mean BMI was 30.9 kg/m 2 (range 21.8-54.0). Maximum defect size was 24 × 27 cm. A subset of 18 patients underwent preoperative pneumoperitoneum as an adjunct procedure. A comparison of pre-BTA to post-BTA imaging demonstrated an increase in mean lateral abdominal wall length from 16.1 cm to 20.1 cm per side, a mean gain of 4.0 cm/side (range 1.0-11.7 cm/side) (p LOL primary closure was achieved in all cases, with no clinical evidence of raised intra-abdominal pressures. One patient presented with a new fascial defect 26 months post-operative. Preoperative BTA to the lateral abdominal wall muscles is a safe and effective technique for the preparation of patients prior to operative management of complex ventral hernias. BTA temporary flaccid paralysis relaxes, elongates and thins the chronically contracted abdominal musculature. This in turn reduces lateral traction forces facilitating laparoscopic repair and fascial closure of large

  16. Laparoscopic treatment of UPJ obstruction in ectopic pelvic kidneys in children

    Directory of Open Access Journals (Sweden)

    A. Marte

    2012-10-01

    Full Text Available Aims: to assess the feasibility and safety of a laparoscopic approach to uPJ obstruction (uPJo in ectopic pelvic kidneys. Material and Methods: in a retrospective analysis we selected 14 children, aged 6months to 17 years, 12 males, 2 females, who had been treated in our department between January 2004 and June 2011. 9 patients presented ureteropelvic junction obstruction (in 3 cases pelvic stones coexisted with normal/moderately reduced (≥25% relative function at radionuclide scan (MAg3, 3 nonfunctioning kidneys associated or not to hypertension, 2 congenital hypo-dysplastic kidneys. the evaluation of each patient involved the medical history, ultrasound examination, VCug, MAg3 diuresis renogram and Mri in some cases. of the patients presenting uPJo, 5 underwent dismembered pyeloplasty with pyelolithotomy, if required, and 4 pelvic derotation with straightening of the uretero-pelvic junction. A previous cystoscopic placement of a double J stent was utilized. this facilitated the identification and dissection around the pelvis. With the patient in trendelenburg position we utilized an umbilical trocar and two trocar in the right and left iliac fossae; an additional trocar, when required, was inserted more cephalad on the midclavear line contralaterally to the lesion. the derotation of ureteropelvic junction was obtained by freeing the kidney’s lower pole and by placing intraperitoneally the junction protected with a double J stent. this was obtained by suturing the peritoneum behind the ureteropelvic junction resulting in a forward rotation of the major axis of the kidney and a straightening of the junction. the 5 patients presenting nonfunctioning ectopic kidneys underwent laparoscopic nephrectomy. While the removal of congenital hypoplasic kidneys resulted easy, the removal of nonfunctioning kidneys was more difficult due to their complex vascular situation and for the embryonic disposition. Results: the operating time varied between 40 to

  17. Massive splenomegaly in children: laparoscopic versus open splenectomy.

    Science.gov (United States)

    Hassan, Mohamed E; Al Ali, Khalid

    2014-01-01

    Laparoscopic splenectomy for massive splenomegaly is still a controversial procedure as compared with open splenectomy. We aimed to compare the feasibility of laparoscopic splenectomy versus open splenectomy for massive splenomegaly from different surgical aspects in children. The data of children aged splenectomy for hematologic disorders were retrospectively reviewed in 2 pediatric surgery centers from June 2004 until July 2012. The study included 32 patients, 12 who underwent laparoscopic splenectomy versus 20 who underwent open splenectomy. The mean ages were 8.5 years and 8 years in the laparoscopic splenectomy group and open splenectomy group, respectively. The mean operative time was 180 minutes for laparoscopic splenectomy and 120 minutes for open splenectomy. The conversion rate was 8%. The mean amount of intraoperative blood loss was 60 mL in the laparoscopic splenectomy group versus 110 mL in the open splenectomy group. Postoperative atelectasis developed in 2 cases in the open splenectomy group (10%) and 1 case in the laparoscopic splenectomy group (8%). Oral feeding postoperatively resumed at a mean of 7.5 hours in the laparoscopic splenectomy group versus 30 hours in the open splenectomy group. The mean hospital stay was 36 hours in the laparoscopic splenectomy group versus 96 hours in the open splenectomy group. Postoperative pain was less in the laparoscopic splenectomy group. Laparoscopic splenectomy for massive splenomegaly in children is safe and feasible. Although the operative time was significantly greater in the laparoscopic splenectomy group, laparoscopic splenectomy was associated with statistically significantly less pain, less blood loss, better recovery, and shorter hospital stay. Laparoscopic splenectomy for pediatric hematologic disorders should be the gold-standard approach regardless of the size of the spleen.

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Laparoscopic nephrectomy in live donor

    Directory of Open Access Journals (Sweden)

    Mitre Anuar I.

    2004-01-01

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

  20. [Laparoscopic skills training -- novel methods].

    Science.gov (United States)

    Fábry, György; Haidegger, Tamás

    2013-05-12

    Simulation for skill training has a long history in surgery. Initially, surgeons practiced on animals or human cadavers, which is costly and raises ethical questions. Emerging hygienic requirements lead to the development of "artificial" phantoms, on which suturing, anastomoses and other elements of the procedure could be practiced on. Similarly, in minimal invasive surgery surgeons need extensive practice to learn the correct techniques, and to acquire sufficient skills. Laparoscopy requires specific training devices, ranging from animal models to virtual reality simulators. This work focused on physical simulators, development of affordable phantoms and adjoin tasks for a personal laparoscopic training box. Authors described five new tasks that were added to the classical curriculum. The tasks included leading the line, ligation, preparation-ligation, leading a string and camera handling. Data was were derived from a trial with 30 participants. They were categorized into 3 groups: laymen, general practitioner residents (non-surgeons) and surgery residents. Subjective assessment of the new tasks was performed using a 20-points questionnaire (NASA Task Load Index). Participants were asked about the usefulness, mental, physical, temporal demand, performance, effort and frustration. Accomplishment time was also recorded for each task (as well as the number or errors, where applicable). In addition, 10 consecutive task execution sessions were recorded, and in some cases, users' performance was tracked over a follow-up period of several days. Participants considered the tasks suitable and relevant for education, and also approved them for self-education purposes. The three groups showed statistically significant differences in performance, based on their average completion time. The follow-up studies showed continuous progress in the completion of individual tasks.

  1. Day case laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Hamid Abboudi

    2017-10-01

    Full Text Available Background: To evaluate the feasibility of performing laparoscopic radical prostatectomy (LRP as a day case procedure while maintaining patient satisfaction and safety. Herein we report our experience, selection criteria, and discharge criteria for day case LRP. Methods: We performed a prospective study with 32 patients undergoing extraperitoneal LRP. These patients were counselled before the procedure that they would go home the same evening of the procedure. Pain scores and quality of life data were recorded day 1 postoperatively via a telephone consultation. The patients underwent routine blood tests on day 2 and an outpatient review on day 7 and regularly thereafter via an assigned key worker. Socio-demographic data, comorbidities, and outcomes were collected for analysis. Results: All patients were successfully discharged the same day of surgery. Mean patient age was 62 years with a mean body mass index of 25. Mean operative time was 147 minutes, and estimated blood loss was 101 ml. Three patients were treated for post operative urinary tract infections; two patients developed infected lymphoceles which required percutaneous drainage and one patient required re-catheterisation due to a burst catheter balloon. Of these six complications four patients required re-admission. Post-operative pain, nausea and vomiting were low whilst patient satisfaction scores were unanimously high in all patients surveyed. Conclusions: The early experience with extraperitoneal LRP as a same day surgery is promising although patients who are at high risk of lymphocele should be excluded. Preoperative patient counselling and selection is paramount. Patient satisfaction is not adversely affected by the shortened stay. Surgeon experience, a well-motivated patient, meticulous attention to detail through an integrated pathway, a multidisciplinary team and adequate postoperative assessment are essential.

  2. Sonographic evidence of intraperitoneal fluid: An experimental study and its clinical implications

    International Nuclear Information System (INIS)

    Dinkel, E.; Lehnart, R.; Troeger, J.; Peters, H.; Dittrich, M.

    1984-01-01

    In order to evaluate the sensitivity of ultrasound to intraperitoneal fluid, such as ascites or blood, an experimental study was performed in the pig. Various amounts of fluid were injected into the peritoneal cavity to investigate distribution and diagnostic criteria in different positions. As little as 10 ml of fluid was visualized around the urinary bladder in an upright position. In the supine position, 20 ml could be detected around the bladder and below the diaphragm. The injection of 60 ml resulted in a pattern of free-floating bowel loops. The sonographic findings of fluid distribution were correlated to radiological and contrast studies. A different amounts of fluid produce characteristic sonographic patterns, an approximate estimation of the intraperitoneal fluid volume can be made. (orig.)

  3. [Intraperitoneal and intrathoracic administration of hydroxyapatite-carboplatin (HAp-CBDCA)].

    Science.gov (United States)

    Mohri, N; Mizuno, I; Akamo, Y; Takeyama, H; Manabe, T

    1999-10-01

    We have investigated the efficacy of intraperitoneal or intrathoracic administration of hydroxyapatite particles (HAp) loaded carboplatin (CBDCA). HAp-CBDCA (HAp; 200 mg, CBDCA; 4 mg) was administered intraperitoneally to rats with peritoneal carcinomatosis. The area under the curve of the ascitic platinum (Pt) increased significantly with rats given HAp-CBDCA, and the omental Pt levels in the HAp-CBDCA group remained higher and longer. Additionally, the HAp-CBDCA group showed a trend toward longer survival when compared with the CBDCA alone group. In clinical use, HAp-CBDCA (HAp; 5 g, CBDCA; 150 mg) was administered intrathoracically to a patient who had undergone esophagectomy. The Pt in serum was detected until 7 days after administration of HAp-CBDCA.

  4. An overview of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for the anesthesiologist.

    Science.gov (United States)

    Webb, Christopher Allen-John; Weyker, Paul David; Moitra, Vivek K; Raker, Richard K

    2013-04-01

    Anesthesiologists face several perioperative challenges when patients need cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion. To adequately care for these patients, anesthesiologists must understand the goals and objectives of the operation in addition to having a basic knowledge of the chemotherapeutic drugs that are frequently used. Optimal anesthetic management of patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion requires control of a complex interplay of physiologic mechanisms, including hyperthermia, abdominal hypertension, electrolyte abnormalities, coagulopathies, increased cardiac index, oxygen consumption, and decreased systemic vascular resistance. As this surgery continues to gain popularity among oncologic surgeons, further studies that clearly define the chemistry, pharmacokinetics, pharmacodynamics, and end points of efficacy need to be performed to elucidate optimal perioperative management.

  5. Effect of hyaluronic acid on postoperative intraperitoneal adhesion formation in the rat model

    Energy Technology Data Exchange (ETDEWEB)

    Urman, B.; Gomel, V.; Jetha, N. (Department of Obstetrics and Gynecology, University of British Columbia, Vancouver (Canada))

    1991-09-01

    The aim of this study was to determine the effectiveness of hyaluronic acid solution in preventing intraperitoneal (IP) adhesions. The study design was prospective, randomized and blinded and involved 83 rats. Measured serosal injury was inflicted using a CO2 laser on the right uterine horn of the rat. Animals randomized to groups 1 and 2 received either 0.4% hyaluronic acid or its diluent phosphate-buffered saline (PBS) intraperitoneally before and after the injury. In groups 3 and 4, the same solutions were used only after the injury. Postoperative adhesions were assessed at second-look laparotomy. Histologic assessment of the fresh laser injury was carried out on uteri pretreated with hyaluronic acid, PBS, or nothing. Pretreatment with hyaluronic acid was associated with a significant reduction in postoperative adhesions and a significantly decreased crater depth. Hyaluronic acid appears to reduce postoperative IP adhesion formation by coating the serosal surfaces and decreasing the extent of initial tissue injury.

  6. Intraperitoneal injection of technetium-99m sulfur colloid in visualization of a peritoneo-vaginalis connection

    International Nuclear Information System (INIS)

    Ducassou, D.; Vuillemin, L.; Wone, C.; Ragnaud, J.M.; Brendel, A.J.

    1984-01-01

    Ten minutes after an intraperitoneal infusion of Tc-99m sulfur colloid, a gamma camera was used to obtain anterior abdominal views. This visualized a peritoneo-scrotal communication in an 80-yr-old patient. He had developed extensive edema of the genitals and lower limbs after about 6 wk of continuous ambulatory peritoneal dialysis. At operation the communication was confirmed and closed. A repeat test verified the success of operation

  7. Intraperitoneal injection of technetium-99m sulfur colloid in visualization of a peritoneo-vaginalis connection

    Energy Technology Data Exchange (ETDEWEB)

    Ducassou, D.; Vuillemin, L.; Wone, C.; Ragnaud, J.M.; Brendel, A.J.

    1984-01-01

    Ten minutes after an intraperitoneal infusion of Tc-99m sulfur colloid, a gamma camera was used to obtain anterior abdominal views. This visualized a peritoneo-scrotal communication in an 80-yr-old patient. He had developed extensive edema of the genitals and lower limbs after about 6 wk of continuous ambulatory peritoneal dialysis. At operation the communication was confirmed and closed. A repeat test verified the success of operation.

  8. ASPECTOS CLÍNICOS DA INFUSÃO INTRAPERITONEAL EM BOVINOS

    Directory of Open Access Journals (Sweden)

    Wilmar Sachetin Marçal

    2015-12-01

    Full Text Available The maintenance and the proper concentration of ions are essential for homeostasis in animals. Some diseases such as hypocalcemia, hypoglycemia, diarrhea among others, commonly affect cattle, leading to eletrolute an acid base imbalances. Fluid therapy is done as a therapeutic method. This paper is intended to evaluate the use of intraperitoneal administrations of crystalloid solutions and other drugs as an effective and safe way for rehydration therapy of the sick animals.

  9. Successful Laparoscopic Removal of an Ingested Toothbrush

    African Journals Online (AJOL)

    Successful Laparoscopic Removal of an Ingested Toothbrush. Karim Jamal, Shalin Shaunak1, Sarandeep Kalsi2, Dhiren Nehra3. INTRODUCTION. Most ingested foreign bodies will pass through the gastrointestinal tract without any problems. On the other hand long, slender objects such as a toothbrush will rarely be able ...

  10. Laparoscopically assisted pyeloplasty for ureteropelvic junction ...

    African Journals Online (AJOL)

    instrument is necessary. The use of a robot may overcome such limitations, as the learning curve is quicker and less laparoscopic skills are required [9]. A similar procedure of video-assisted retroperitoneoscopic approach was published by Lima and Ruggeri [10] and more recently by Caione et al. [11]. Both techniques ap-.

  11. Laparoscopic esophagomyotomy in children: is routine ...

    African Journals Online (AJOL)

    Purpose Laparoscopic esophagomyotomy (LE) with or without fundoplication has been described as a modality for the treatment of achalasia in children. Our aim is to evaluate the safety and efficacy of LE without fundoplication in the management of achalasia in children. Patients and methods A retrospective review of the.

  12. Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A ...

    African Journals Online (AJOL)

    ... collection (P - 0.04), and abdominal scar due to previous abdominal surgery (P ‑ 0.009) were found statistically significant in predicting difficult LC. Conclusion: The proposed scoring system is reliable with a sensitivity of 76.47% and specificity of 100%. Keywords: Difficult, laparoscopic cholecystectomy, prediction, scoring ...

  13. EDITORIAL LAPAROSCOPIC APPENDICECTOMY For a surgeon to ...

    African Journals Online (AJOL)

    hi-tech

    takes longer and costs more. This opinion is shared by. Germans (3): “there were no differences in post operative analgesia, resumption of oral intake, or morbidity, but laparoscopic appendicectomy is associated with longer operating times and increased cost”; Americans (4)say that: “differences in outcome between open ...

  14. Laparoscopic Bladder -Conserving Surgery: Case Series

    African Journals Online (AJOL)

    (for endometriosis, vesico-vaginal fistula, embedded ovarian remnants) and unintentional cystotomies for several years (11). Robotic assisted laparoscopic partial cystectomy has also been done and especially in the treatment of urachal adenocarcinoma with an excellent outcome. (5). A group from Brazil has published the ...

  15. Laparoscopic cholecystectomy in adult cystic fibrosis.

    LENUS (Irish Health Repository)

    McGrath, D S

    2012-02-03

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

  16. Understanding perceptual boundaries in laparoscopic surgery.

    Science.gov (United States)

    Lamata, Pablo; Gomez, Enrique J; Hernández, Félix Lamata; Oltra Pastor, Alfonso; Sanchez-Margallo, Francisco Miquel; Del Pozo Guerrero, Francisco

    2008-03-01

    Human perceptual capabilities related to the laparoscopic interaction paradigm are not well known. Its study is important for the design of virtual reality simulators, and for the specification of augmented reality applications that overcome current limitations and provide a supersensing to the surgeon. As part of this work, this article addresses the study of laparoscopic pulling forces. Two definitions are proposed to focalize the problem: the perceptual fidelity boundary, limit of human perceptual capabilities, and the Utile fidelity boundary, that encapsulates the perceived aspects actually used by surgeons to guide an operation. The study is then aimed to define the perceptual fidelity boundary of laparoscopic pulling forces. This is approached with an experimental design in which surgeons assess the resistance against pulling of four different tissues, which are characterized with both in vivo interaction forces and ex vivo tissue biomechanical properties. A logarithmic law of tissue consistency perception is found comparing subjective valorizations with objective parameters. A model of this perception is developed identifying what the main parameters are: the grade of fixation of the organ, the tissue stiffness, the amount of tissue bitten, and the organ mass being pulled. These results are a clear requirement analysis for the force feedback algorithm of a virtual reality laparoscopic simulator. Finally, some discussion is raised about the suitability of augmented reality applications around this surgical gesture.

  17. Laparoscopic Conservative Management Of A Spontaneously ...

    African Journals Online (AJOL)

    A case of an acute abdomen secondary to a ruptured spleen managed laparoscopically is presented. Laparoscopy is currently widely used for the initial diagnosis and management of such cases as an alternative to laparotomy due to the numerous advantages of the minimal access techniques. With widespread availability ...

  18. Pneumodilation versus laparoscopic Heller's myotomy for achalasia

    LENUS (Irish Health Repository)

    Slattery, E

    2011-08-04

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

  19. Laparoscopic right hemicolectomy for intestinal intussuception.

    LENUS (Irish Health Repository)

    Kiernan, F

    2012-09-01

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

  20. Laparoscopic ultrasonography for abdominal tumor staging

    NARCIS (Netherlands)

    van Delden, O. M.; de Wit, L. T.; Nieveen van Dijkum, E. J.; Reeders, J. W.; Gouma, D. J.

    1998-01-01

    In recent years, laparoscopic ultrasonography has been introduced as an adjunct to diagnostic laparoscopy for staging of tumors of the upper gastrointestinal tract, liver, biliary tree, and pancreas. It has proved feasible to visualize most anatomic structures in the upper abdomen consistently and

  1. Neuromuscular blockade during laparoscopic ventral herniotomy

    DEFF Research Database (Denmark)

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

    2015-01-01

    INTRODUCTION: Laparoscopic herniotomy is the preferred technique for some ventral hernias. Several factors may influence the surgical conditions, one being the depth of neuromuscular blockade (NMB) applied. We hypothesised that deep neuromuscular blockade defined as a post-tetanic count below eight...

  2. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines...... analgesic treatment in LRYGB surgery....

  3. Comparing laparoscopic appendectomy to open appendectomy in ...

    African Journals Online (AJOL)

    Background: The objective of the study was to compare the outcomes of patients with generalised purulent peritonitis from complicated appendicitis diagnosed intraoperatively who were managed laparoscopically to those managed via the open approach in a single institution. Methods: Data were collected from all cases ...

  4. Carbon dioxide embolism during laparoscopic cholecystectomy.

    Science.gov (United States)

    Moskop, R J; Lubarsky, D A

    1994-03-01

    We present a 38-year-old woman with cholelithiasis having laparoscopic cholecystectomy. After two attempts of abdominal insufflation using CO2 and a Verres needle, the patient had symptoms consistent with a venous gas embolism. The patient was treated quickly and recovered without sequelae. Surgery was continued, and inspection of the liver showed two Verres needle puncture wounds.

  5. Laparoscopic Cystogastrostomy in the Management of Pancreatic ...

    African Journals Online (AJOL)

    Experience. From a Tertiary Centre. Surgical Endoscopy. 2007;21(12):2262–67. 6. Eom BW, Jang JY, Lee SE, et al. Clinical Outcomes. Compared Between Laparoscopic and Open Distal. Pancreatectomy. 2008;22(5):1334-38. 7. Gumaste VV, Aron ...

  6. Zero ischemia laparoscopic partial thulium laser nephrectomy.

    LENUS (Irish Health Repository)

    Thomas, Arun Z

    2013-11-01

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

  7. [Laparoscopic choledochoduodenostomy as an optional treatment choledocholithiasis].

    Science.gov (United States)

    Aguirre-Olmedo, Itzé; Cuendis-Velázquez, Adolfo; Morales-Chávez, Carlos Ernesto; Torres-Ruiz, María Fernanda; Rojano-Rodríguez, Martín Edgardo; Cárdenas-Lailson, Luis Eduardo

    2013-01-01

    Choledochoduodenostomy is indicated for unsolved choledocholithiasis and biliary malignant or benign stenosis. This surgical procedure has been feared for its potential complications. This article shows our initial experience with this laparo-endoscopic approach. We performed laparoscopic choledochoduodenoastomy in seven elderly patients with recurrent or unsolved choledocholithiasis. Additionally, laparo-endoscopic extraction of gallstones was performed in necessary cases. We gathered and analyzed the demographic data, diagnostic proofs and follow up of the patients. Average age of patients was 71 years, with 57.1% of women in our population. Main omorbidities of our patients included obesity in 71.4%, diabetes mellitus type 2 in 57.4%, and arterial hypertension in 42.85%. Patients had in average 2.7 previous episodes of choledocholithiasis and/or cholangitis and the average diameter of the removed stones was 22.6 mm. Average follow-up was 155 days (range 28 to 420). Laparoscopic chooledochoduodenostomy has proved to be safe, effective and be superior to open surgery, as long as an appropriate selection of patients is performed and surgeons with experience on laparoscopic techniques are available. All these factors reduce the long-term complications with which this surgical procedure has been related. Laparoscopic choledochoduodenostomy is an option for the definitive surgical treatment of "difficult choledocholithiasis" in elderly patients with multiple comorbidities; it also offers the advantages of the minimally invasive approaches.

  8. Successful Laparoscopic Removal of an Ingested Toothbrush ...

    African Journals Online (AJOL)

    Successful Laparoscopic Removal of an Ingested Toothbrush. K Jamal, S Shaunak, S Kalsi, D Nehra. Abstract. Most ingested foreign bodies will pass through the gastrointestinal tract without any problems. On the other hand long, slender objects such as a toothbrush will rarely be able to negotiate the angulated and fixed ...

  9. Laparoscopic splenectomy: Consensus and debatable points | Bani ...

    African Journals Online (AJOL)

    Introduction. The emergence of minimally invasive techniques has broadened interest in splenectomy for a variety of haematological illnesses. Laparoscopic splenectomy (LS) is currently considered the gold standard for the treatment of various haematological disorders. Purpose. The literature was reviewed to highlight ...

  10. Laparoscopic Surgery in Very Acute Cholecystitis

    Science.gov (United States)

    Invernizzi, Rocco; Prezzati, Francesco

    2002-01-01

    The objective of this study was to demonstrate the safety and feasibility of laparoscopic cholecystectomy in empyematous or gangrenous cholecystitis. During the period from August 1998 to April 2000, we operated laparoscopically on 64 patients, without any selection, in which we established, preoperatively or intraoperatively, the diagnosis of empyematous or gangrenous cholecystitis using clinical criteria (fever, leukocytosis, persistent pain, abdominal tenderness or guarding), echographic findings and intraoperative or pathological aspects of the gallbladder. The operations were performed by experienced surgeons skillful in advanced laparoscopic procedure. We concluded successfully 59 operations. The five conversions were due to dense adhesions because of previous gastric surgery in 3 cases, to the lack of recognizing the anatomy of the biliary tree in one case and to a choledoco-duodenal fistula in the last case. No mortality and a very low morbidity with a short hospital stay, were noted in our study. We consider patients with very acute cholecystitis to be candidates for a laparoscopic approach. PMID:12113421

  11. Bowel injury following gynecological laparoscopic surgery | Elbiss ...

    African Journals Online (AJOL)

    The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed. Conclusion: Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and ...

  12. Laparoscopic nephrectomy: analysis of 34 patients

    Directory of Open Access Journals (Sweden)

    Domingos André Luís Alonso

    2003-01-01

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

  13. Laparoscopic Treatment of Intestinal Malrotation in Children

    NARCIS (Netherlands)

    Ooms, N.; Matthyssens, L.E.; Draaisma, J.M.T.; Blaauw, I. de; Wijnen, M.H.

    2016-01-01

    Purpose Intestinal malrotation is a congenital intestinal rotation anomaly, which can be treated by either laparotomy or laparoscopy. Our hypothesis is that laparoscopic treatment leads to less small bowel obstruction because of the fewer adhesions in comparison to laparotomy, without increasing the

  14. Laparoscopic Retrieval Of Perforated Intrauterine Device ...

    African Journals Online (AJOL)

    We present a case of successful laparoscopic retrieval of a perforated intrauterine device (Lippes loop). The Lippes loop was inserted after manual intrauterine adhesiolysis as a treatment of uterine synaechia presenting as secondary amenorrhoea of 20 months duration. The uterine perforation in this patient did not occur at ...

  15. Transperitoneal laparoscopic ureteric reimplantation for lower ...

    African Journals Online (AJOL)

    V. Singh

    2016-07-21

    Jul 21, 2016 ... Buttressing by detrusor muscle was done for cre- ation of anti-reflux mechanism by taking 3–4 interrupted sutures for. Table 1. Indications for laparoscopic ureteric reimplanation. Lower ureteric stricture. Ureterovaginal fistula. Pelvic surgeries (like hystrectomy and pelvic mass excision). Ureterolithotomy.

  16. Varicocoelectomy in adolescents: Laparoscopic versus open high ...

    African Journals Online (AJOL)

    Background: Treatment of varicocoele is aimed at eliminating the retrograde reflux of venous blood through the internal spermatic veins. The purpose of this investigation was to compare laparoscopic varicocoelectomy (LV) with open high ligation technique in the adolescent population. Materials and Methods: We ...

  17. Neuromuscular blockade during laparoscopic ventral herniotomy

    DEFF Research Database (Denmark)

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

    2015-01-01

    INTRODUCTION: Laparoscopic herniotomy is the preferred technique for some ventral hernias. Several factors may influence the surgical conditions, one being the depth of neuromuscular blockade (NMB) applied. We hypothesised that deep neuromuscular blockade defined as a post-tetanic count below eig...

  18. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-02-01

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

  19. Outcomes in laparoscopic cholecystectomy in a resource ...

    African Journals Online (AJOL)

    Background: Laparoscopic cholecystectomy (LC) is a common surgical procedure performed for symptomatic gallstones. There is a trend towards early cholecystectomy for patients with acute cholecystitis who present timeously. Local inflammation has been identified as a risk factor for bile duct injuries. This study sought to ...

  20. [25 years of laparoscopic surgery in Spain].

    Science.gov (United States)

    Moreno-Sanz, Carlos; Tenías-Burillo, Jose María; Morales-Conde, Salvador; Balague-Ponz, Carmen; Díaz-Luis, Hermógenes; Enriquez-Valens, Pablo; Manuel-Palazuelos, Juan Carlos; Martínez-Cortijo, Sagrario; Olsina-Kissler, Jorge; Socas-Macias, María; Toledano-Trincado, Miguel; Vidal-Pérez, Oscar; Noguera-Aguilar, Juan Francisco; Salvador-Sanchís, José Luis; Feliu-Pala, Xavier; Targarona-Soler, Eduard M

    2014-04-01

    The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  1. ureteric perforation following laparoscopic assisted vaginal

    African Journals Online (AJOL)

    2011-03-03

    Mar 3, 2011 ... Ureteric injury is one of the most common complications of hysterectomy, both in open and laparoscopic and is a source of serious morbidity. Laparoscopy carries a higher risk because of increased use of electro-surgery close to the ureter when securing the uterine artery and it is more likely to be ...

  2. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2012-02-01

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

  3. Single versus multimodality training basic laparoscopic skills

    NARCIS (Netherlands)

    Brinkman, W.M.; Havermans, S.Y.; Buzink, S.N.; Botden, S.M.B.I.; Jakimowicz, J.J.; Schoot, B.C.

    2012-01-01

    Introduction - Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality

  4. Combined Laparoscopic and Cystoscopic Retrieval of Forgotten ...

    African Journals Online (AJOL)

    cavity with calculus formation around the tail and thread of the IUCD in the urinary bladder causing recurrent urinary tract infection. This “Collar Stud” effect made either cystoscopic or laparoscopic retrieval alone unsuccessful necessitating a combined approach. This case report highlights the need for a combined.

  5. Laparoscopic Pelvic Floor Repair Using Polypropylene Mesh

    Directory of Open Access Journals (Sweden)

    Shih-Shien Weng

    2008-09-01

    Conclusion: Laparoscopic pelvic floor repair using a single piece of polypropylene mesh combined with uterosacral ligament suspension appears to be a feasible procedure for the treatment of advanced vaginal vault prolapse and enterocele. Fewer mesh erosions and postoperative pain syndromes were seen in patients who had no previous pelvic floor reconstructive surgery.

  6. Laparoscopic radical trachelectomy: technique, feasibility, and outcomes.

    Science.gov (United States)

    Saadi, José Martín; Perrotta, Myriam; Orti, Roberto; Salvo, Gloria; Giavedoni, María Eugenia; Gogorza, Sebastían; Testa, Roberto

    2015-01-01

    Our objectives are to describe our surgical technique for laparoscopic radical trachelectomy, to evaluate its feasibility, and to present the perioperative results at Hospital Italiano de Buenos Aires, Argentina. We analyzed 4 patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer between December 2011 and May 2013. Four patients were included in this study. Total laparoscopic radical trachelectomy was performed in all cases. The mean age was 26 years (range, 19-32 years), the mean body mass index was 21 (range, 18-23), and the mean length of hospital stay was 33 hours (range, 24-36 hours). The mean operative time was 225 minutes (range, 210-240 minutes), and no complications were reported. During the postoperative period, only 1 patient presented with left vulvar edema, which resolved spontaneously. The pelvic and parametrial lymph nodes, as well as the vaginal cuff and cervical resection margins, were negative for malignancy in all cases. On average, 18 pelvic lymph nodes (range, 15-20) were removed. The tumor stage was IB in all 4 patients, and the mean tumor size was 17 mm (range, 12-31 mm). No patient required conversion to laparotomy. We consider laparoscopic radical trachelectomy, performed by trained surgeons, a feasible and safe therapeutic option as a fertility-sparing surgical technique, with good perioperative outcomes for women with early-stage cervical cancer with a desire to preserve their fertility. Minimally invasive surgery provides the widely known benefits of this type of approach.

  7. [Laparoscopic Heller myotomy for esophageal achalasia].

    Science.gov (United States)

    Ibáñez, Luis; Butte, Jean Michel; Pimentel, Fernando; Escalona, Alex; Pérez, Gustavo; Crovari, Fernando; Guzmán, Sergio; Llanos, Osvaldo

    2007-04-01

    Achalasia is characterized by an incomplete relaxation of the lower esophageal sphincter. The best treatment is surgical and the laparoscopic approach may have good results. To assess the results of laparoscopic Heller myotomy among patients with achalasia. Prospective study of patients subjected to a laparoscopic Heller myotomy between 1995 and 2004. Clinical features, early and late operative results were assessed. Twenty seven patients aged 12 to 74 years (12 females) were operated. All had disphagia lasting for a mean of 32 months. Mean lower esophageal sphincter pressure ranged from 18 to 85 mmHg. Eight patients received other treatments prior to surgery but symptoms persisted or reappeared. The preoperative clinical score was 7. No patient died and no procedure had to be converted to open surgery. In a follow up of 21 to 131 months, all patients are satisfied with the surgical results and the postoperative clinical score is 1. Only one patient with a mega esophagus maintained a clinical score of six. In this series of patients, laparoscopic Heller myotomy was an effective and safe treatment for esophageal achalasia.

  8. Preliminary Experience with Laparoscopic Cholecystectomy in a ...

    African Journals Online (AJOL)

    Our protocol of patient selection eliminated the need for intraoperative common bile duct exploration which requires expensive instruments. However, to sustain laparoscopic surgery it is pertinent to ensure an activity based costing system which will not make it arbitrarily too expensive for the general population. Keywords: ...

  9. Safe laparoscopic colorectal surgery performed by trainees

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  10. Defining a learning curve for laparoscopic cardiomyotomy.

    Science.gov (United States)

    Grotenhuis, Brechtje A; Wijnhoven, Bas P L; Jamieson, Glyn G; Devitt, Peter G; Bessell, Justin R; Watson, David I

    2008-08-01

    This study was designed to determine whether there is a learning curve for laparoscopic cardiomyotomy for the treatment of achalasia. All patients who underwent a primary laparoscopic cardiomyotomy for achalasia between 1992 and 2006 in our hospitals were identified from a prospective database. The institutional and the individual surgeon's learning experiences were assessed based on operative and clinical outcome parameters. The outcomes of cardiomyotomies performed by consultant surgeons versus supervised trainees also were compared. A total of 186 patients met the inclusion criteria; 144 procedures were undertaken by consultant surgeons and 42 by a surgical trainee. The length of operation decreased after the first ten cases in both the institutional and each individual experience. The rate of conversion to open surgery also was significantly higher in the first 20 cases performed. Intraoperative complications, overall satisfaction with the outcome, reoperation rate, and postoperative dysphagia were not associated with the institutional or the surgeon's operative experience. Although the length of the operation was greater for surgical trainees (93 versus 79 minutes; p learning curve for laparoscopic cardiomyotomy for achalasia can be defined. The clinical outcome for laparoscopic cardiomyotomy does not differ between supervised surgical trainees and consultant surgeons.

  11. Bowel injury following gynecological laparoscopic surgery.

    African Journals Online (AJOL)

    Abstract. Background: Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication. Methods: We performed a narrative review on bowel ...

  12. Wound Complications Following Laparoscopic Surgery in a ...

    African Journals Online (AJOL)

    enthusiasm and has been able to sustain routine practice of laparoscopy in general surgery.[3‑5] Still, there exist some ... [6] Postoperatively, infections and its sequelae, hernia formation and port site metastasis are commonly ... Objectives: The aim was to observe the rate and types of complications attending laparoscopic ...

  13. Knowledge and Perception of Laparoscopic Surgery among ...

    African Journals Online (AJOL)

    user

    Conclusion: There is a need for public health education in the region to drive this relatively new frontier of surgery to improve our practice and encourage indigenous innovations. INTRODUCTION. Minimal access surgery (Laparoscopic surgery) is prospected as the future of surgery. It offers the benefits of reduced morbidity, ...

  14. The optimal mechanical efficiency of laparoscopic forceps

    NARCIS (Netherlands)

    Heijnsdijk, E. A. M.; Pasdeloup, A.; Dankelman, J.; Gouma, D. J.

    2004-01-01

    Background Laparoscopic forceps have a large amount of friction in the mechanism, leading to a limited mechanical efficiency, which impairs the pinch force feedback. The advantage of a small amount of friction is that it is easier to maintain a constant pinch force on the tissue. Therefore, to

  15. Percutaneous Drainage of 300 Intraperitoneal Abscesses with Long-Term Follow-Up

    International Nuclear Information System (INIS)

    Akinci, Devrim; Akhan, Okan; Ozmen, Mustafa N.; Karabulut, Nevzat; Ozkan, Orhan; Cil, Barbaros E.; Karcaaltincaba, Musturay

    2005-01-01

    The purpose of the study was to evaluate the efficacy of percutaneous drainage of intraperitoneal abscesses with attention to recurrence and failure rates. A retrospective analysis of percutaneous treatment of 300 intraperitoneal abscesses in 255 patients (147 male, 108 female; average age: 38 years; range: 40 days to 90 years) for whom at least 1-year follow-up data were available was performed. Abscesses were drained with fluoroscopic, sonographic, or computed tomographic guidance. Nine abscesses were drained by simple aspiration; catheter drainage either by Seldinger or trocar technique was used in the remaining 291 abscesses with 6F to 14 F catheters. Initial cure and failure rates were 68% (203/300) and 12% (36/300), respectively. Sixty-one abscesses (20%) were either palliated or temporized. The recurrence rate was 4% (12/300) and nine of them were cured by recatheterization, whereas three of them were treated by medication or surgery. The overall success and failure rates were 91% (273/300) and 9% (27/300), respectively, with temporized, palliated, and recatheterized recurred abscesses. The 30-day mortality rate was 3.1% (8/255). The mean duration of catheterization was 13 days. Intraperitoneal abscesses with safe access routes should be drained percutaneously because of high success and low morbidity, mortality, and recurrence rates

  16. [Intraperitoneal photodynamic therapy for peritoneal metastasis of epithelial ovarian cancer. Limits and future prospects].

    Science.gov (United States)

    Azaïs, H; Mordon, S; Collinet, P

    2017-04-01

    High peritoneal recurrence rate in advanced epithelial ovarian cancer after complete macroscopic cytoreductive surgery and platinum-based chemotherapy, raises the issue of peritoneal microscopic disease management and requires the development of additional locoregional treatment strategies. Photodynamic therapy is an effective treatment already applied in other medical and surgical indications. After administration of a photosensitizer which accumulates in cancer cells, illumination with a light of adequate wavelength may induce photochemical reaction between photosensitizer and tissue oxygen which lead to reactive oxygen species production and cytotoxic phenomenon. Photodynamic therapy's ability to treat superficial lesions disseminated on large area makes it an excellent candidate to insure destruction of microscopic peritoneal metastases in addition to macroscopic cytoreductive surgery in order to decrease peritoneal recurrence rate. Development of intraperitoneal photodynamic therapy has been limited by its poor tolerance related to the lack of specificity of photosensitizers and the location of the metastases in proximity to adjacent intraperitoneal organs. Our aim is to review clinical data concerning intraperitoneal photodynamic therapy and epithelial ovarian cancer to identify the limits of this strategy and to provide solutions which may be applied to solve these barriers and enable safe and effective treatment. Targeted photosensitizers and innovative illumination solutions are mandatory to continue research in this field and to consider the feasibility of clinical trials. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  17. The use of intraperitoneal xenon for early diagnosis of acute mesenteric ischemia

    International Nuclear Information System (INIS)

    Gharagozloo, F.; Bulkley, G.B.; Zuidema, G.D.; O'Mara, C.S.; Alderson, P.O.

    1984-01-01

    We evaluated the technique of intraperitoneal use of xenon Xe 133, previously described for the diagnosis of early intestinal strangulation obstruction in rats and dogs, for the recognition of acute mesenteric vascular occlusion in these animals. 133 Xe was injected intraperitoneally into five groups of six rats: control, sham operation, superior mesenteric artery (SMA) ligation, superior mesenteric vein ligation, and portal vein ligation. Residual gamma-activity was monitored by external counting and camera imaging. At 30 minutes after injection, the activity was significantly higher in the rats from the three groups with vascular ligation than in the control and sham operation animals (P less than 0.001). gamma-Camera images reflected these findings, with positive images only in the rats that underwent vascular ligation. ''Blinded'' readings of the 30 sets of scans confirmed the diagnostic accuracy of the images. Results were essentially the same in a second series of experiments in eight control dogs and six dogs with balloon occlusion of the SMA. Concentrations of isotope in ischemic intestine ranged from 10(3) to 10(5) times the levels in adjacent normal bowel. These levels and the positive images appeared early, prior to the development of tissue necrosis. The intraperitoneal use of 133 Xe therefore continues to show promise for the recognition of patients with early intestinal ischemia

  18. The use of intraperitoneal xenon for early diagnosis of acute mesenteric ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Gharagozloo, F.; Bulkley, G.B.; Zuidema, G.D.; O' Mara, C.S.; Alderson, P.O.

    1984-04-01

    We evaluated the technique of intraperitoneal use of xenon Xe 133, previously described for the diagnosis of early intestinal strangulation obstruction in rats and dogs, for the recognition of acute mesenteric vascular occlusion in these animals. /sup 133/Xe was injected intraperitoneally into five groups of six rats: control, sham operation, superior mesenteric artery (SMA) ligation, superior mesenteric vein ligation, and portal vein ligation. Residual gamma-activity was monitored by external counting and camera imaging. At 30 minutes after injection, the activity was significantly higher in the rats from the three groups with vascular ligation than in the control and sham operation animals (P less than 0.001). gamma-Camera images reflected these findings, with positive images only in the rats that underwent vascular ligation. ''Blinded'' readings of the 30 sets of scans confirmed the diagnostic accuracy of the images. Results were essentially the same in a second series of experiments in eight control dogs and six dogs with balloon occlusion of the SMA. Concentrations of isotope in ischemic intestine ranged from 10(3) to 10(5) times the levels in adjacent normal bowel. These levels and the positive images appeared early, prior to the development of tissue necrosis. The intraperitoneal use of /sup 133/Xe therefore continues to show promise for the recognition of patients with early intestinal ischemia.

  19. Home within 24 hours of laparoscopic hysterectomy.

    Science.gov (United States)

    Chou, D C; Rosen, D M; Cario, G M; Carlton, M A; Lam, A M; Chapman, M; Johns, C

    1999-05-01

    We assessed the feasibility of safe discharge home within 24 hours following laparoscopic hysterectomy in 30 patients who met the inclusion criteria and consented to be enrolled in the study group. Patients were admitted on the day of their surgery with the expectation of discharge within 24 hours. Appropriate home nursing follow-up and phone contact by the surgical team were organized preoperatively. Inclusion criteria were: age 30-65 years, absence of any major medical history that would require prolonged hospitalization, availability of home support for the first 48 hours after discharge and presence of a working telephone line and an address within the area of the Community Home Nursing service. All 30 operative procedures were completed without incident. Six patients underwent total laparoscopic hysterectomy (TLH) (all the procedures of hysterectomy being performed laparoscopically including the suturing of uterine arteries, colpotomy and closure of the vaginal vault. The uterus was removed vaginally) and 24 patients underwent laparoscopic hysterectomy (LH) (this techniques differs from TLH in that the colpotomy was performed laparoscopically but the uterosacral ligaments were divided vaginally and the vault also was closed vaginally after the uterus was removed vaginally). The average operating time was 115 minutes (range 85-150 minutes) and the average blood loss was 97 mL (20-250 mL). There were no intraoperative complications, no requirement for transfusion and no readmission to hospital for any of the patients in the study. Postoperative complications were minor (umbilical cellulitis (1), intestinal colic (1)) and both were treated with resolution of the symptoms. Ninety per cent of patients in the study were discharged within 24 hours of their surgery, the average duration of stay being 22.9 hours (20-24 hours). Three patients were not fit for discharge at 24 hours postoperatively due to general lethargy, migraine and nausea; their average discharge time

  20. Safety Evaluation of Laparoscopic Sleeve Gastrectomy Compared with Two Procedures of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Adjustable Gastric Banding for Individuals with Morbid Obesity: A Systemic Review

    OpenAIRE

    F Arabi Basharic; A Olyaee Manesh; M Ranjbar Ezzatabadi; R Goudarzi; SM Shiryazdi; M Arab zozani; MR Mobini Zade

    2015-01-01

    Introduction: Laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are the most common bariatric surgery procedures. Therefore, this study aims to compare the safety of the newer procedure of Laparoscopic sleeve gastrectomy compared to Laparoscopic Roux-en-Y gastric bypass and Laparoscopic adjustable gastric bonding. Method: A systematic review was conducted on the most important and most relevant search data bases, including Cochrane library, Pubmed, Ovid Med...

  1. Laparoscopic Cholecystectomy by Sectorisation of Port Sites

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    Sindhu, M. A.; Haq, I.; Rehman, S.

    2013-01-01

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

  2. Port Site Infections After Laparoscopic Cholecystectomy

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    Mumtaz KH Al-Naser

    2017-06-01

    Full Text Available Background: Port site infection (PSI is an infrequent surgical site infection that complicates laparoscopic surgery but has a considerable influence in the overall outcome of laparoscopic cholecystectomy. The aim of this study was to evaluate factors that influence PSI after laparoscopic cholecystectomies and to analyze which of these factors can be modified to avoid PSI in a trail to achieve maximum laparoscopic advantages. Methods: A prospective descriptive qualitative study conducted on patients who underwent laparoscopic cholecystectomies. Swabs were taken for culture & sensitivity in all patients who developed PSI. Exploration under general anaesthesia, for patients, had deep surgical site infections and wound debridement was done, excisional biopsies had been taken for histopathological studies, and tissue samples for polymerase chain reaction for detection of mycobacterium tuberculosis was done. All patients were followed up for six months postoperatively. Factors as gender, site of infected port, type of microorganism, acute versus chronic cholecystitis, type of infection (superficial or deep infection and intraoperative spillage of stones, bile or pus were analyzed in our sample. Results: Port site infection rate was recorded in 40/889 procedures (4.5%, higher rates were observed in male patients 8/89 (8.9%, in acute cholecystitis 13/125 (10.4%, when spillage of bile, stones or pus occurred 24/80 (30%, and at epigastric port 32/40 (80%. Most of the PSI were superficial infections 77.5% with non-specific microorganism 34/40 (85%. Conclusion: There is a significant association of port site infection with spillage of bile, stones, or pus, with the port of gallbladder extraction and with acute cholecystitis. Especial consideration should be taken in chronic deep surgical site infection as mycobacterium tuberculosis could be the cause. Most of the PSIs are superficial and more common in males.

  3. The Comparison of Open and Laparoscopic Appendectomy: Is There any Outcome Difference Between Non-Complicated and Complicated Appendicitis?

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    Ünal Bıçakcı

    2011-09-01

    Full Text Available Objective: The assessment of laparoscopic appendectomy (LA and open appendectomy (OA in patients with noncomplicated (NCA and complicated appendicitis (CA was aimed for. Material and Methods: Of 279 patients with appendectomy, 135 had NCA (48.3% (49 underwent LA (86M, 49F, median 9 years and144 had CA (51.7% (23 underwent LA (98M, 46F, median 11 years. Outcome measures: Wound infection (WI, intraabdominal abscess (IA, postoperative ileus (PI, requirement of reoperation (RO, time of surgery (TOS, length of stay (LOS, duration of postoperative pain (PP, nasogastric tube (NT, intraperitoneal drainage (ID were recorded.Results: Between OA and LA groups, there was no statistical significance in WI(3/86 vs 0/49, IA(2/86 vs 0/49, RO(2/86 vs 2/49, and PI rate (1/86 vs 2/49 in NCA group (p>0.05. The LOS(3±1.4 vs 4±1.3, NT (1.2±0.9 vs 1.8±0.6 days and PP(0.9±0.9 vs 2.3±1.1 days were lower in LA than OA (p0.05. In CA, patients with LA had less WI(0/23 vs 18/121 (p<0.05. NT (2±0.8 vs 2.7±1.5, PP (2.1±1.2 vs 3.2±1.5 and ID (3.1±2.3 vs 4.4±1.4 were lower in LA than OA (p<0.05.Conclusion: Laparoscopic appendectomy decreases wound infection, nasogastric tube duration, intraperitoneal drainage and pain in complicated appendicitis. The Laporoscopic approach is superior in complicated and noncomplicated appendicitis.

  4. Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair.

    Science.gov (United States)

    Baker, J J; Öberg, S; Andresen, K; Klausen, T W; Rosenberg, J

    2018-01-01

    Ventral hernia repairs are common and have high recurrence rates. They are usually repaired laparoscopically with an intraperitoneal mesh, which can be fixed in various ways. The aim was to evaluate the recurrence rates for the different fixation techniques. This systematic review included studies with human adults with a ventral hernia repaired with an intraperitoneal onlay mesh. The outcome was recurrence at least 6 months after operation. Cohort studies with 50 or more participants and all RCTs were included. PubMed, Embase and the Cochrane Library were searched on 22 September 2016. RCTs were assessed with the Cochrane risk-of-bias assessment tool and cohort studies with the Newcastle-Ottawa scale. Studies comparing fixation techniques were included in a network meta-analysis, which allowed comparison of more than two fixation techniques. Fifty-one studies with a total of 6553 participants were included. The overall crude recurrence rates with the various fixation techniques were: absorbable tacks, 17·5 per cent (2 treatment groups); absorbable tacks with sutures, 0·7 per cent (3); permanent tacks, 7·7 per cent (20); permanent tacks with sutures, 6·0 per cent (25); and sutures, 1·5 per cent (6). Six studies were included in a network meta-analysis, which favoured fixation with sutures. Although statistical significance was not achieved, there was a 93 per cent chance of sutures being better than one of the other methods. Both crude recurrence rates and the network meta-analysis favoured fixation with sutures during laparoscopic ventral hernia repair. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  5. Impact of intra-operative intraperitoneal chemotherapy on organ/space surgical site infection in patients with gastric cancer.

    Science.gov (United States)

    Liu, X; Duan, X; Xu, J; Jin, Q; Chen, F; Wang, P; Yang, Y; Tang, X

    2015-11-01

    Various risk factors for surgical site infection (SSI) have been identified such as age, overweight, duration of surgery, blood loss, etc. Intraperitoneal chemotherapy during surgery is a common procedure in patients with gastric cancer, yet its impact on SSI has not been evaluated. To evaluate whether intra-operative intraperitoneal chemotherapy is a key risk factor for organ/space SSI in patients with gastric cancer. All patients with gastric cancer who underwent surgery at the Department of Gastrointestinal Surgery between January 2008 and December 2013 were studied. The organ/space SSI rates were compared between patients who received intra-operative intraperitoneal chemotherapy and patients who did not receive intra-operative intraperitoneal chemotherapy, and the risk factors for organ/space SSI were analysed by univariate and multi-variate regression analyses. The microbial causes of organ/space SSI were also identified. Of the eligible 845 patients, 356 received intra-operative intraperitoneal chemotherapy, and the organ/space SSI rate was higher in these patients compared with patients who did not receive intra-operative intraperitoneal chemotherapy (9.01% vs 3.88%; P = 0.002). Univariate analysis confirmed the significance of this finding (odds ratio 2.443; P = 0.003). As a result, hospital stay was increased in patients who received intra-operative intraperitoneal chemotherapy {mean 20.91 days [95% confidence interval (CI) 19.76-22.06] vs 29.72 days (95% CI 25.46-33.99); P = 0.000}. The results also suggested that intra-operative intraperitoneal chemotherapy may be associated with more Gram-negative bacterial infections. Intra-operative intraperitoneal chemotherapy is a significant risk factor for organ/space SSI in patients with gastric cancer. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  6. A novel prototype 3/5 laparoscopic needle driver: A validation study with conventional laparoscopic needle driver.

    Science.gov (United States)

    Ganpule, Arvind P; Deshmukh, Chaitanya S; Joshi, Tanmay

    2018-01-01

    The challenges in laparoscopic suturing include need to expertise to suture. Laparoscopic needle holder is a" key" instrument to accomplish this arduous task. The objective of this new invention was to develop a laparoscopic needle holder which would be adapted to avoid any wobble (with a shaft diameter same as a 5mm port), ensure accurate and dexterous suturing not just in adult patients but pediatric patients alike (with a short shaft diameter) and finally ensure seamless throw of knots with a narrow tip configuration. We did an initial evaluation to evaluate the validity of the prototype needle holder and its impact on laparoscopic suturing skills by experienced laparoscopic surgeons and novice laparoscopic Surgeons. Both the groups of surgeons performed two tasks. The first task was to grasp the needle and position it in an angle deemed ideal for suturing. The second task was to pass suture through two fixed points and make a single square knot. At the end of the tasks each participant was asked to complete a 5- point Likert's scale questionnaire (8 items; 4 items of handling and 4 items of suturing) rating each needle holder. In expert group, the mean time to complete task 1 was shorter with prototype 3/5 laparoscopic needle holder (11.8 sec Vs 20.8 sec). The mean time to complete task 2 was also shorter with prototype 3/5 laparoscopic needle holder (103.2 sec Vs 153.2 sec). In novice group, mean time to complete both the task was shorter with prototype 3/5 laparoscopic needle holder. The expert laparoscopic surgeons as well as novice laparoscopic surgeons performed laparoscopic suturing faster and with more ease while using the prototype 3/5 laparoscopic needle holder.

  7. Effect of a laparoscopic instrument with rotatable handle piece on biomechanical stress during laparoscopic procedures.

    Science.gov (United States)

    Steinhilber, Benjamin; Seibt, Robert; Reiff, Florian; Rieger, Monika A; Kraemer, Bernhard; Rothmund, Ralf

    2016-01-01

    To investigate the effect of a pistol grip laparoscopic instrument with a rotatable handle piece (rot-HP) on biomechanical stress and precision as well as a possible interaction between the instrument and working height (WH). Biomechanical stress induced by laparoscopic surgery (LS) is associated with work-related upper limb musculoskeletal disorders in surgeons. Ergonomic handle designs of laparoscopic instruments may reduce the risk of musculoskeletal disorders. Without LS experience, 57 healthy subjects (30 women; 27 men, median age: 26) were observed while performing a laparoscopic exercise. Subjects had to pick up coloured pins and place them into a colour-coded wooden set-up inside a pelvitrainer. The exercise was performed at two WHs using the rot-HP and a standard laparoscopic (fixed) handle piece in randomized sequence. Biomechanical stress was monitored via surface electromyography (sEMG) on fife muscles from the upper limb and shoulder region. Further, the wrist angle (palmar and dorsi flexion) and posture of the dominant upper arm were recorded. Precision was assessed using the number of validly placed pins and process time. sEMG parameters and upper arm postures indicated no differences in biomechanical stress related to either laparoscopic handle piece. The higher WH was associated with higher trapezius and deltoid activity and elevated arm postures (p stress in the shoulder or lower arm muscles. However, wrist angle position may be optimized without affecting precision. Long-term effects of the rot-HP on preventing complaints of the upper extremity should be evaluated. Low WH is recommended to reduce biomechanical stress in the shoulder during laparoscopic surgery.

  8. Feasibility of Reduced Port Laparoscopic Colectomy for Colon Cancer.

    Science.gov (United States)

    Tsutsumi, Soichi; Morita, Hiroki; Fujii, Takaaki; Suto, Toshinaga; Yajima, Reina; Takada, Takahiro; Asao, Takayuki; Kuwano, Hiroyuki

    2015-06-01

    Reduced port laparoscopic surgery has recently emerged as a method to improve the cosmetic results of conventional laparoscopic surgery. We reported our technique of reduced port laparoscopic colectomy using 3-port and short-time outcomes. Between 2005 and 2012, we performed 161 reduced port laparoscopic colectomies using the 3-port technique. Data analyzed in-cluded age, gender, body mass index (BMI), duration of surgery, number of harvested lymph nodes, and duration of hospital stay. All of the cases were successfully performed using the 3-port procedure. The median durations of surgery and postoperative hospital stay were 140 mm (range 75-463 mm) and 9 days (range 5-38 days), respectively. No mortality was associated with this technique. Reduced port laparoscopic colectomy is feasible and may have advantages over conventional laparoscopic colectomy.

  9. Laparoscopic treatment of complex small bowel obstruction: is it safe?

    Science.gov (United States)

    Pearl, Jonathan P; Marks, Jeffrey M; Hardacre, Jeffrey M; Ponsky, Jeffrey L; Delaney, Conor P; Rosen, Michael J

    2008-06-01

    Laparoscopic treatment of small bowel obstruction has many reported advantages, yet it is infrequently performed. Criticisms include reduced working space, difficult abdominal access, and bowel injury. The experience with laparoscopic treatment of small bowel obstruction to determine its safety has been reviewed. Nineteen patients underwent laparoscopic treatment of small bowel obstruction. A cut-down technique was used for abdominal access and avoided manipulation of dilated bowel. The average number of prior operations was 1.4. The average size of maximally dilated bowel was 3.5 cm, including 6 patients whose diameter was greater than 4 cm. Laparoscopic treatment was successful in 16 patients; 3 patients required laparotomy. There were no complications from abdominal access and no iatrogenic bowel injuries. This series demonstrated that abdominal access and relief of bowel obstruction can be safely performed laparoscopically in patients with complex small bowel obstruction. Neither massively dilated bowel nor multiple previous abdominal operations precluded safe conduct of the operation laparoscopically.

  10. Force model for laparoscopic graspers: implications for virtual simulator design.

    Science.gov (United States)

    Susmitha Wils, K; Devasahayam, Suresh R; Manivannan, M; Mathew, George

    2017-04-01

    Laparoscopic graspers limit haptic perception, which in turn leads to tissue damage. Using virtual simulators to train surgeons in handling these instruments would ensure safer grasp. The design of a laparoscopic virtual simulator with force feedback depends on effective implementation of the grasper force model. To develop a laparoscopic grasper tip force model theoretically from grasper mechanics and validate the same experimentally during laparoscopic pinching. We developed a force model for double and single jaw action graspers using grasper mechanics. For experimental validation, the handle angle and the forces at the tip and the handle of the instrumented graspers during laparoscopic pinching of porcine abdominal tissues were measured. The intra-class correlation coefficient (ICC) between experimental and calculated tip force was calculated. Excellent ICC (ICC ≥0.8, pvirtual simulator with force feedback and also for better ergonomic design of laparoscopic graspers.

  11. Robot assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor

    Directory of Open Access Journals (Sweden)

    Prem Nath Dogra

    2013-01-01

    Full Text Available The treatment options in clinical stage I nonseminomatous germ cell tumor (NSGCT of testis are either surveillance, chemotherapy or retroperitoneal lymph node dissection (RPLND. While open RPLND still serves as the gold standard, laparoscopic and robot assisted laparoscopic approaches are gaining popularity. In this report, we share our experience and technique of robot assisted laparoscopic RPLND in a patient with clinical stage Ib NSGCT of testis.

  12. Laparoscopic Resection of Cesarean Scar Ectopic Pregnancy.

    Science.gov (United States)

    Ades, Alex; Parghi, Sneha

    To demonstrate a technique for the laparoscopic surgical management of cesarean section scar ectopic pregnancy. Step-by-step presentation of the procedure using video (Canadian Task Force classification III). Cesarean section scar ectopic pregnancy is a rare form of ectopic pregnancy with an incidence ranging from 1:1800 to 1:2216. Over the last decade, the incidence seems to be on the rise with increasing rates of cesarean deliveries and early use of Doppler ultrasound. These pregnancies can lead to life-threatening hemorrhage, uterine rupture, and hysterectomy if not managed promptly. Local or systemic methotrexate therapy has been used successfully but can result in prolonged hospitalization, requires long-term follow-up, and in some cases treatment can fail. In the hands of a trained operator, laparoscopic resection can be performed to manage this type of pregnancy. Consent was obtained from the patient, and exemption was granted from the local Internal Review Board (The Womens' Hospital, Parkville). In this video we describe our technique for laparoscopic management of a cesarean scar ectopic pregnancy. We present the case of a 34-year-old G4P2T1 with the finding of a live 8-week pregnancy embedded in the cesarean section scar. The patient had undergone 2 previous uncomplicated cesarean sections at term. On presentation her β-human chorionic gonadotropin (β-hCG) level was 52 405 IU/L. She was initially managed with an intragestational sac injection of potassium chloride and methotrexate, followed by 4 doses of intramuscular methotrexate. Despite these conservative measures, the level of β-hCG did not adequately fall and an ultrasound showed a persistent 4-cm mass. A decision was made to proceed with surgical treatment in the form of a laparoscopic resection of the ectopic pregnancy. The surgery was uneventful, and the patient was discharged home within 24 hours of her procedure. Her serial β-hCG levels were followed until complete resolution

  13. Effectiveness of box trainers in laparoscopic training

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    Dhariwal Anender

    2007-01-01

    Full Text Available Rationale and Objectives: Various devices are used to aid in the education of laparoscopic skills ranging from simple box trainers to sophisticated virtual reality trainers. Virtual reality system is an advanced and effective training method, however it is yet to be adopted in India due to its cost and the advanced technology required for it. Therefore, box trainers are being used to train laparoscopic skills. Hence this study was undertaken to assess the overall effectiveness of the box-training course. Study Procedure: The study was conducted during six-day laparoscopic skills training workshops held during 2006. Twenty five surgeons; age range of 26 to 45 years, of either sex, who had not performed laparoscopic surgery before; attending the workshop were evaluated. Each participant was given a list of tasks to perform before beginning the box-training course on day one and was evaluated quantitatively by rating the successful completion of each test. Evaluation began when the subject placed the first tool into the cannula and ended with task completion. Two evaluation methods used to score the subject, including a global rating scale and a task-specific checklist. After the subject completed all sessions of the workshop, they were asked to perform the same tasks and were evaluated in the same manner. For each task completed by the subjects, the difference in the scores between the second and first runs were calculated and interpreted as an improvement as a percentage of the initial score. Statistical Analysis: Wilcoxon matched-paired signed-ranks test was applied to find out the statistical significance of the results obtained. Results: The mean percentage improvement in scores for both the tasks, using global rating scale, was 44.5% + 6.930 (Mean + SD. For task 1, using the global rating scale mean percentage improvement was 49.4% + 7.948 (Mean + SD. For task 2, mean percentage improvement using global rating scale was 39.6% + 10.4 (Mean

  14. Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis--the role of routine abdominal drainage.

    Science.gov (United States)

    Allemann, Pierre; Probst, Herve; Demartines, Nicolas; Schäfer, Markus

    2011-01-01

    Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis. This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay. Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.

  15. Laparoscopic redo fundoplication for intrathoracic migration of wrap

    Directory of Open Access Journals (Sweden)

    Maheshkumar G

    2007-01-01

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

  16. Development of a compact laparoscope manipulator (P-arm).

    Science.gov (United States)

    Sekimoto, Mitsugu; Nishikawa, Atsushi; Taniguchi, Kazuhiro; Takiguchi, Shuji; Miyazaki, Fumio; Doki, Yuichiro; Mori, Masaki

    2009-11-01

    Laparoscope manipulating robots are useful for maintaining a stable view during a laparoscopic operation and as a substitute for the surgeon who controls the laparoscope. However, there are several problems to be solved. A large apparatus sometimes interferes with the surgeon. The setting and repositioning is awkward. Furthermore, the initial and maintenance costs are expensive. This study was designed to develop a new laparoscope manipulating robot to overcome those problems. We developed a compact robot applicable for various types of laparoscopic surgery with less expensive materials. The robot was evaluated by performing an in vitro laparoscopic cholecystectomy using extracted swine organs. Then, the availability of the robot to various operations was validated by performing a laparoscopic cholecystectomy, anterior resection of the rectum, and distal gastrectomy using a living swine. The reliability of the system was tested by long-time continuous running. A compact and lightweight laparoscope manipulating robot by the name of P-arm was developed. The surgical time of an in vitro laparoscopic cholecystectomy with and without the P-arm was not different. The three types of operations were accomplished successfully. During the entire procedure, the P-arm worked without trouble and did not interfere with the surgeons. Continuous 8-h operating tests were performed three times and neither discontinuance nor trouble occurred with the system. The P-arm worked steadily for various swine operations, without interfering with surgeon's work.

  17. Results of laparoscopic versus open abdominal and incisional hernia repair.

    Science.gov (United States)

    Olmi, Stefano; Magnone, Stefano; Erba, Luigi; Bertolini, Aimone; Croce, Enrico

    2005-01-01

    Incisional hernia is a frequent complication of abdominal surgery. The object of this study was to confirm the safety, efficacy, and feasibility of laparoscopic treatment of abdominal wall defects. Fifty consecutive laparoscopic abdominal and incisional hernia repairs from September 2001 to May 2003 were compared with 50 open anterior repairs. The 2 groups were not different for age, body mass index, or American Society of Anaesthesiologists scores. Mean operative time was 59 minutes for the laparoscopic group, 164.5 minutes for the open group. Mean hernia diameter was 10.6 cm for the laparoscopic group, 10.5 cm for the open group. Mean length of stay was 2.1 days for the laparoscopic group, 8.1 days for the open group. Complications occurred in 16% of the laparoscopic and 50% of open group. Median follow-up was 9.0 months for the laparoscopic group, 24.5 months for the open group. Recurrence rates were 2% for laparoscopic group and 0% for the open group. Results for laparoscopic abdominal and incisional hernia repair seem to be superior to results for open repair in terms of operative time, length of stay, wound infection, major complications, and overall hospital reimbursement.

  18. Laparoscopic Harvest of the Rectus Abdominis for Perineal Reconstruction

    Directory of Open Access Journals (Sweden)

    Nneamaka Agochukwu, MD

    2017-11-01

    Full Text Available Summary:. The rectus abdominis is a workhorse flap for perineal reconstruction, in particular after abdominoperineal resection (APR. Laparoscopic and robotic techniques for abdominoperineal surgery are becoming more common. The open harvest of the rectus abdominis negates the advantages of these minimally invasive approaches. (Sentence relating to advantages of laparoscopic rectus deleted here. We present our early experience with laparoscopic harvest of the rectus muscle for perineal reconstruction. Three laparoscopic unilateral rectus abdominis muscle harvests were performed for perineal reconstruction following minimally invasive colorectal and urological procedures. The 2 patients who underwent APR also had planned external perineal skin reconstruction with local flaps. (Sentence deleted here to shorten abstract. All rectus muscle harvests were performed laparoscopically. Two were for perineal reconstruction following laparoscopic APR, and 1 was for anterior vaginal wall reconstruction. This was done with 4 ports positioned on the contralateral abdomen. The average laparoscopic harvest time was 60–90 minutes. The rectus muscle remained viable in all cases. One patient developed partial necrosis of a posterior thigh fasciocutaneous flap after cancer recurrence. There were no pelvic abscesses, or abdominal wall hernias. Laparoscopic harvest of the rectus appears to be a cost-effective, reliable, and reproducible procedure for perineal with minimal donor-site morbidity. Larger clinical studies are needed to further establish the efficacy and advantages of the laparoscopic rectus for perineal reconstruction.

  19. Intraperitoneal administration of the globular adiponectin gene ameliorates diabetic nephropathy in Wistar rats.

    Science.gov (United States)

    Yuan, Fang; Liu, Ying-Hong; Liu, Fu-You; Peng, You-Ming; Tian, Jun-Wei

    2014-06-01

    The present study investigated the potential effects of the long-term expression of exogenous adiponectin (ADPN) on normal and diabetic kidneys. Type 2 diabetes mellitus models were induced by high-lipid and high-sucrose feeding plus intraperitoneal injection of streptozotocin. The recombinant plasmid pIRES2-EGFP-gAd, which is able to co-express globular ADPN (gAd) and enhanced green fluorescent protein (EGFP), was intraperitoneally injected into rat models mediated by Lipofectamine. In total, 32 Wistar rats were randomly assigned into four groups: the normal control group, the diabetes group, the diabetes group treated with pIRES2-EGFP-gAd and the diabetes group treated with pIRES2-EGFP. After 12 weeks, serum biochemistry and urine albumin levels were measured. The kidneys were collected to assess the generation of reactive oxygen species (ROS) and the renal pathological changes were observed by light microcopy. The protein expression of endothelial nitric oxide synthase (eNOS), transforming growth factor-β1 (TGF-β1) and phosphorylated adenosine monophosphate-activated protein kinase (p-AMPK) were determined by an immunohistochemical staining method and western blot analysis. Intraperitoneal injection of the human gAd gene via Lipofectamine resulted in abundant ADPN protein in the kidney. In the diabetic rats, the delivery of the exogenous gAd gene ameliorated the progression of diabetic nephropathy (DN). ADPN attenuated urine albumin excretion in the diabetic rats. ADPN also mitigated glomerular mesangial expansion, reduced the generation of ROS and prevented interstitial fibrosis. In addition, the expression of gAd inhibited the renal expression of TGF-β1, promoted the protein expression of eNOS and activated the opening of the AMPK signaling pathway in the renal tissues of the diabetic rats. Despite the effects of ADPN on DN being controversial, these observations indicate that the supplementation of ADPN is beneficial in ameliorating DN in rats.

  20. Complete intraperitoneal displacement of a double J stent: a first case

    Directory of Open Access Journals (Sweden)

    Filippo Maria Turri

    2015-03-01

    Full Text Available Objectives: Ureteral double-J stents are known to migrate proximally and distally within the urinary tract, while perforation and stent displacement are uncommon. Possible mechanisms of displacement are either original malpositioning with ureteral perforation or subsequent fistula and erosion of the excretory system, due to infection or long permanence of the device. We present the unique case of complete intraperitoneal stent migration in a 59-year-old caucasian male without evidence of urinary fistula at the moment of diagnosis, so far an unreported complication. Materials and Methods: Eight months after the placement of a double-J stent for lower right ureteral stricture at a district hospital, the patient came at our observation for urosepsis and hydro-uretero-nephrosis. A CT scan demonstrated intraperitoneal migration of the stent outside the urinary tract. Cystoscopy failed to visualize the lower extremity of the stent, a percutaneous nephrostomy was placed to drain the urinary system and the stent was removed through a small abdominal incision on the right lower quadrant. Results: In our case we presume that during the positioning manoeuvre the guide wire perforated simultaneously the lower ureteral wall and the pelvic peritoneum, and that once the upper end of the stent was coiled, the lower extremity was also attracted intraperitoneally. The lack of pain due to the spinal lesion concurred to this unusual complication. Conclusions: We must be aware that ureteral double J stents may be found displaced even inside the peritoneal cavity, and that the use of retrograde pyelography during placement is of paramount importance to exclude misplacement of an apparently normally coiled upper extremity of the stent.

  1. intraperitoneal infiltration of ropivacaine for post-operative analgesia in open cholecystectomy

    International Nuclear Information System (INIS)

    Ahmed, A.; Ahmed, M.

    2017-01-01

    Objective: To assess the role of Intraperitoneal infiltration of Ropivacaine for post-op analgesia in open cholecystectomy in a low resource setting. Study Design: Randomized controlled trial. Place and Duration of Study: Study was conducted at department of Anesthesia, Scouts Hospital Chitral, from Jul 2014 to Jun 2016. Material and Methods: After taking approval from hospital ethical committee, total 126 patients were divided randomly in two groups. Group I (study group) was given intraperitoneal ropivacaine and group II (control group) was given routine standard analgesia. After complete recovery, pain was measure on VAS score (1-10) at 1 hour, 6 hour and 24 hour in all patients. Patients having pain score of 4 or more were managed with nalbuphine 5 mg IV bolus. Data was analyzed by SPSS version 16. Results: The comparison of pain score (after 1, 6and 24 hours of surgery), showed that study group had significantly (p-value<0.05) less mean pain score as compared with placebo group. Significant rate of nausea/vomiting was observed (p-value<0.05) higher (62%) in placebo group as compared with (38%) in study group. Statistically there was no significant difference (p-value>0.05) between groups on the basis of mean age (47.89 ± 8.56 vs. 48.75 ± 9.36), gender (Females 70% vs. 68%), duration of the surgery (88.54 ± 12.34 minutes vs. 91.70 ± 13.50 minutes) and American society of anesthesiologist (ASA) grades in study and placebo group patients respectively. Conclusion: Intraperitoneal ropivacaine infiltration helped in reducing the post op pain significantly in open cholecystectomy. (author)

  2. Acute effect of oral, intraperitoneal, and intravenous 1 alpha-hydroxycholecalciferol on markers of bone metabolism

    DEFF Research Database (Denmark)

    Joffe, P; Ladefoged, S D; Cintin, C

    1994-01-01

    ,25-(OH)2D3 was measured. DESIGN: Single doses of 1 alpha-OHD3 (80 ng/kg body wt) were given in randomized cross-over fashion, orally, intraperitoneally (i.p.) and intravenously (i.v.) on three occasions. Blood was sampled at 0, 1, 6, 12, and 24 h after administration of 1 alpha-OHD3. MAIN RESULTS......: Following oral administration of 1 alpha-OHD3, a decrease in serum alkaline phosphatase was seen when levels at 1 and 6 h were compared to baseline (P trend in serum Ca2+ throughout the study (P

  3. Ny behandling af peritoneal karcinose fra kolorektal cancer. Cytoreduktiv kirurgi og hyperterm intraperitoneal kemoterapi

    DEFF Research Database (Denmark)

    Iversen, Lene Hjerrild; Rasmussen, Peter C; Laurberg, Søren

    2007-01-01

    Peritoneal carcinomatosis (PC) is commonly seen in colorectal cancer and is uniformly fatal. Cytoreductive surgery (CS) combined with hyperthermic intraperitoneal chemotherapy (HIIC) is a new treatment in strictly selected patients with PC. CS includes peritonectomy procedures and resection...... of infiltrated viscera leaving no macroscopic tumor thicker than 2.5 mm behind. Peritoneal perfusion with mitomycin C at a temperature of 40 degrees -41 degrees C is performed at the end of surgery. The postoperative morbidity and mortality rates are 20%-30% and 4%-8% respectively. Median survival is 1-2 years...

  4. Evaluation of effects on the peritoneum after intraperitoneal α-radioimmunotherapy with (211)At

    DEFF Research Database (Denmark)

    Cederkrantz, Elin; Angenete, Eva; Bäck, Tom

    2012-01-01

    The introduction of the short-lived α-emitter (211)At to intraperitoneal radioimmunotherapy has raised the issue of the tolerance dose of the peritoneum. The short range of the α-particles (70 μm) and the short half-life (7.21 h) of the nuclide yield a dose distribution in which the peritoneum......-ethylenediamine tetraacetic acid, was measured for evaluation of the small solute transport capacity of the peritoneal membrane. The macroscopic status of the peritoneum and the mesenteric windows was documented when the mice were sacrificed. Biopsies of the peritoneum were taken for morphology and immunohistochemical...

  5. Duration and degree of radioprotection by WR-2721 in mice following intraperitoneal, intramuscular and subcutaneous administration

    International Nuclear Information System (INIS)

    Kuna, P.

    1983-01-01

    An intramuscular dose of 300 mg S-2-(3-aminopropylamino)-ethyl-phosphothioic acid (WR-2721) per kg body weight, applied 15-120 minutes before whole-body #betta# irradiation, protected mice significantly from radiation death. The protective dose was 35% of the acute toxic dose. After intraperitoneal and subcutaneous injection, resp., the same protective dose was effective within a 90 minute interval. According to the LD/sub 50/30/ the most effective radioprotective dose in mice was 300 mg WR-2721/kg, applied intramuscularly

  6. LAPAROSCOPIC NEPHRECTOMY USING RADIOFREQUENCY THERMAL ABLATION

    Directory of Open Access Journals (Sweden)

    B. Ya. Alekseev

    2012-01-01

    Full Text Available The wide use of current diagnostic techniques, such as ultrasound study, computed tomography, and magnetic resonance imaging, has led to significantly increased detection rates for disease in its early stages. This gave rise to a change in the standards for the treatment of locally advanced renal cell carcinoma (RCC. Laparoscopic nephrectomy (LN has recently become the standard treatment of locally advanced RCC in the clinics having much experience with laparoscopic surgery. The chief drawback of LN is difficulties in maintaining intraoperative hemostasis and a need for creating renal tissue ischemia. The paper gives the intermediate results of application of the new procedure of LN using radiofrequency thermal ablation in patients with non-ischemic early-stage RCC.

  7. Laparoscopic pyloroplasty for perforated peptic ulcer.

    Science.gov (United States)

    Grišin, Edvard; Mikalauskas, Saulius; Poškus, Tomas; Jotautas, Valdemaras; Strupas, Kęstutis

    2017-09-01

    Peptic ulcer is a common disease affecting millions of people every year. Despite improved understanding and treatment of the disease, the number of patients admitted with duodenal peptic ulcer perforation has not decreased. Deaths from peptic ulcer disease overcome other common emergency situations. Laparoscopic repair of the perforated peptic ulcer (PPU) is the gold standard approach for simple perforation. However, in patients with large perforated chronic ulcers laparotomy with pyloroplasty is the standard treatment. It is generally accepted to perform open surgery in PPU emergencies because of the greater knowledge and experience gathered over the past decades and less potential harm for the patient or surgical complications. We present a case of successful laparoscopic pyloroplasty of a perforated duodenal ulcer with stenosis.

  8. Acute complicated diverticulitis managed by laparoscopic lavage

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2009-01-01

    PURPOSE: The classic surgical treatment of acute complicated sigmoid diverticulitis with peritonitis is often a two-stage operation with colon resection and a temporary stoma. This approach is associated with high mortality and morbidity and the reversal of the stoma is in many cases not performed...... because of concurrent diseases and age. Recently, several studies have experimented with laparoscopic lavage as a treatment of acute complicated diverticulitis. The aim of this review was to give an overview of the literature for this new approach and to determine the safety compared with Hartmann...... searched. RESULTS: Eight studies met the inclusion criteria and reported 213 patients with acute complicated diverticulitis managed by laparoscopic lavage. None of these studies were randomized. The patients' mean age was 59 years and most patients had Hinchey Grade 3 disease. All patients were treated...

  9. Haptic rendering for VR laparoscopic surgery simulation.

    Science.gov (United States)

    McColl, Ryan; Brown, Ian; Seligman, Cory; Lim, Fabian; Alsaraira, Amer

    2006-03-01

    This project concerns the application of haptic feedback to a VR laparoscopic surgery simulator. Haptic attributes such as mass, friction, elasticity, roughness and viscosity are individually modeled, validated and applied to the existing visual simulation created by researchers at Monash University. Haptic feedback is an essential element in an immersive and realistic virtual reality laparoscopic training simulator. The haptic system must display stable, continuous and realistic multi-dimensional force feedback, and its inclusion should enhance the simulators training capability. Stability is a recurring concern throughout haptic history, and will be tackled with the implementation of a stable control algorithm and a passive environment model. Haptic force feedback modeling, systems implementation and validation studies form the principal areas of new work associated with this project.

  10. Evolution and current challenges of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    XU Dahua.

    2013-03-01

    Full Text Available Since its introduction at the end of the 20th century, laparoscopic cholecystectomy has evolved into a safe and convenient minimally invasive surgical method, which is now the gold standard therapy for cholelithiasis worldwide. Physicians have continued to improve upon the procedure, creating methods that further minimize the related scarring and pain, such as the laproendoscopic single-site cholecystectomy and the gasless-lift laparoscopy. Additionally, the primary challenge of limited operative space in these procedures remains a key feature requiring improvement. In this review, the development and progression of laparoscopic cholecystectomy over the past 26 years is discussed, highlighting the current advantages and disadvantages that need to be addressed by practicing physicians to maximize the clinical value of this important therapy.

  11. Sepsis from dropped clips at laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hussain, Sarwat E-mail: sarwathussain@hotmail.com

    2001-12-01

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

  12. Impaired postural stability after laparoscopic surgery

    DEFF Research Database (Denmark)

    Eskildsen, K Z; Staehr-Rye, A K; Rasmussen, L S

    2015-01-01

    BACKGROUND: Early postoperative mobilisation may reduce patient morbidity and improve hospital efficiency by accelerated discharge. The aim of this study was to measure postural stability early after laparoscopic surgery in order to assess how early it is safe to mobilise and discharge patients....... METHODS: We included 25 women undergoing outpatient gynaecological laparoscopic surgery in the study. Patients received standardised anaesthesia with propofol, remifentanil and rocuronium. Postural stability was assessed preoperatively, at 30 min after tracheal extubation, and at discharge from the post......-anaesthesia care unit using a force platform where sway area, mean sway and sway velocity were determined. The assessments were done with eyes closed and with eyes open. The primary outcome was the change in sway area with eyes closed 30 min after extubation. Data are reported as median (25-75% range). RESULTS...

  13. [Laparoscopic cleavage in splenic symptomatic cyst].

    Science.gov (United States)

    Fernández-López, Antonio-José; Candel-Arenas, Marifé; González-Valverde, Francisco-Miguel; Luján-Martínez, Delia; Medina-Manuel, Esther; Albarracín Marín-Blázquez, Antonio

    2017-12-01

    Splenic cysts are rare diseases that are diagnosed incidentally during imaging studies. When cysts are recognized, surgical treatment is recommended adapted to the particular case, depending on the size and location of the cyst and the age of the patient in order to avoid dangerous complications such as spleen rupture or cyst infection with abscess. We report 2patients with symptomatic splenic epidermoid cyst treated by laparoscopic cleavage. Laparoscopic cleavage is a surgical option for splenic cyst, with the goal of reducing postoperative complications while preserving splenic function. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  14. Sepsis from dropped clips at laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Hussain, Sarwat

    2001-01-01

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

  15. Effect of exposure routes on the relationships of lethal toxicity to rats from oral, intravenous, intraperitoneal and intramuscular routes.

    Science.gov (United States)

    Ning, Zhong H; Long, Shuang; Zhou, Yuan Y; Peng, Zi Y; Sun, Yi N; Chen, Si W; Su, Li M; Zhao, Yuan H

    2015-11-01

    The lethal toxicity values (log 1/LD(50)) of 527 aliphatic and aromatic compounds in oral, intravenous, intramuscular and intraperitoneal routes were used to investigate the relationships of log 1/LD(50) from different exposure routes. Regression analysis shows that the log 1/LD(50) values are well correlated between intravenous and intraperitoneal or intramuscular injections. However, the correlations between oral and intravenous or intraperitoneal routes are relatively poor. Comparison of the average residuals indicates that intravenous injection is the most sensitive exposure route and oral administration is the least sensitive exposure route. This is attributed to the difference in kinetic process of toxicity testing. The toxic effect of a chemical can be similar or significantly different between exposure routes, depending on the absorption rates of chemicals into blood. Inclusion of hydrophobic parameter and fractions of ionic forms can improve the correlations between intravenous and intraperitoneal or oral routes, but not between intraperitoneal and oral routes. This is due to the differences of absorption rate in different exposure environments from different routes. Several factors, such as experimental uncertainty, metabolism and toxic kinetics, can affect the correlations between intravenous and intraperitoneal or oral routes. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. A rare late complication of laparoscopic cholecystectomy

    OpenAIRE

    Little, Mhairi; Munipalle, Phanibhushana C; Nugud, Omar

    2013-01-01

    An 86-year-old woman presented three years after laparoscopic cholecystectomy with right upper quadrant pain and raised inflammatory markers. Liver function tests were normal; however, a previous ultrasound scan suggested a common bile duct stone so she was treated for cholangitis secondary to choledocholithiasis. Repeat ultrasound scan again showed a common bile duct (CBD) stone and also a subdiaphragmatic abscess. CT scan confirmed the abscess, associated with a surgical clip from her previ...

  17. Laparoscopic right colon resection with intracorporeal anastomosis.

    Science.gov (United States)

    Chang, Karen; Fakhoury, Mathew; Barnajian, Moshe; Tarta, Cristi; Bergamaschi, Roberto

    2013-05-01

    This study was performed to evaluate short-term clinical outcomes of laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon. This was a retrospective study of selected patients who underwent laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon for tumors or Crohn's disease by a single surgeon from July 2002 through June 2012. Data were retrieved from an Institutional Review Board-approved database. Study end point was postoperative adverse events, including mortality, complications, reoperations, and readmissions at 30 days. Antiperistaltic side-to-side anastomoses were fashioned laparoscopically with a 60-mm-long stapler cartridge and enterocolotomy was hand-sewn intracorporeally in two layers. Values were expressed as medians (ranges) for continuous variables. There were 243 patients (143 females) aged 61 (range = 19-96) years, with body mass index of 29 (18-43) kg/m(2) and ASA 1:2:3:4 of 52:110:77:4; 30 % had previous abdominal surgery and 38 % had a preexisting comorbidity. There were 84 ileocolic resections with ileo ascending anastomosis and 159 right colectomies with ileotransverse anastomosis. Operating time was 135 (60-220) min. Estimated blood loss was 50 (10-600) ml. Specimen extraction site incision length was 4.1 (3-4.4) cm. Conversion rate was 3 % and there was no mortality at 30 days, 15 complications (6.2 %), and 8 reoperations (3.3 %). Readmission rate was 8.7 %. Length of stay was 4 (2-32) days. Pathology confirmed Crohn's disease in 84 patients, adenocarcinoma in 152, and other tumors in 7 patients. Laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon resulted in a favorable outcome in selected patients with Crohn's disease or tumors of the right colon.

  18. Laparoscopic left colon resection for diverticular disease.

    Science.gov (United States)

    Trebuchet, G; Lechaux, D; Lecalve, J L

    2002-01-01

    The aim of this study was to review our experience with laparoscopic sigmoid colectomy for diverticular disease. All patients presenting with acute or chronic diverticulitis, obstruction, abscess, or fistula were included. Symptomatic diverticular disease was the main surgical indication (95%). Between March 1992 and August 1999 170 consecutive patients underwent surgery. Of these, 21 patients (12%) had significant obesity, with body mass index (BMI) greater than 30. The average length of surgery was 141 +/- 36 min. In 163 patients (96%), the procedure was performed solely with the laparoscope. The nasogastric tube was removed on postoperative day 2 +/- 1.9, and oral feeding was started on postoperative day 3.4 +/- 2.1. The average length of hospital stay after surgery was 8.5 +/- 3.7 days. During the first postoperative month, there were no deaths. However, 11 patients (6.5%) had surgical complications: 5 anastomotic leaks (2.9%), 1 intraabdominal abscess (0.6%), and 3 wound infections (1.7%). There were four reinterventions (2.4%), with two diverting colostomies. Secondarily, 10 anastomotic stenoses (5.9%) were observed. Eight patients required a reintervention: seven anastomotic resections by open laparotomy and one terminal colostomy. Seven patients (4.1%) reported retrograde ejaculation, and one reported impotence. The feasibility of the laparoscopic approach to diverticular disease is established with a conversion rate of 4%, a low incidence of acute septic complications (5.3%), and a mortality rate of 0%. Therefore, laparoscopic sigmoid colectomy has become our procedure of choice in the treatment of diverticular disease.

  19. Laparoscopic tubal sterilization reversal and fertility outcomes

    Directory of Open Access Journals (Sweden)

    K Jayakrishnan

    2011-01-01

    Full Text Available Purpose: The purpose of the study was two-fold. Firstly it was to assess the suitability for tubal recanalization and factors predicting successful laparoscopic recanalization. Secondly, it was to analyze the fertility outcomes and factors affecting the pregnancy rate following laparoscopic tubal recanalization. Materials and Methods: A retrospective chart review of prospectively followed-up 29 women at a tertiary care center seeking tubal sterilization reversal between May 2005 and February 2010 were included. Results: In 14 (48.3% women unilateral tubes were suitable and in only 3 women (10.3% bilateral tubes were suitable. All cases with laparoscopic tubal sterilization were suitable, whereas all cases with fimbriectomy were unsuitable for recanalization. In 6 (20.7% cases salphingostomy was performed as an alternative procedure to tubal reanastomosis. The overall pregnancy rate was 58.8%. In cases with sterilization by Pomeroy′s method, 4 out of 10 (40% conceived, whereas for laparoscopic tubal ligation cases 6 out of 7 (85.7% conceived (P=0.32. None of the patients with final tubal length <5 cm conceived (P=0.03. Comparing the age at recanalization, in women ≤30 years, 71.4% conceived, as compared with 50% when age of women was more than 30 years (P=0.37. Conclusions: The important factors determining the success of recanalization are technique of sterilization and the remaining length of the tube after recanalization. The gynecologist must use an effective technique of sterilization to minimize the failure rates, but at the same time, which causes minimal trauma, and aim at preserving the length of the tube so that reversal is more likely to be successful, should the patient′s circumstances change.

  20. Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Chigot, Valerie; Dubois, Josee; Lallier, Michel; Alvarez, Fernando

    2003-01-01

    The authors describe a hepatic pseudoaneurysm following laparoscopic cholecystectomy in a child. It arose from a hepatic artery that was ligated during surgery and was supplied by collaterals from the superior right branch. Because of the risk of hepatic infarction and recanalization of the pseudoaneurysm by new collaterals, the authors decided not to occlude the superior right branch, but to embolize the aneurysm itself with cyanoacrylate. Since the intra-arterial approach was not feasible, a transhepatic puncture was successfully performed. (orig.)

  1. Improved Image-Guided Laparoscopic Prostatectomy

    Science.gov (United States)

    2013-07-01

    sensitivity of intraoperative ultrasonography in detecting colorectal liver metastases in the modern era. Ann Surg Oncol 2010;17: 2756-63. 17. Leven J...uncorrelated; USE can identify hypoechoic lesions, but also echogenic or isoechoic cancers that classic gray-scale ultrasonography cannot...a new integrated ultrasonography (US) device with the da Vinci Surgical System for laparoscopic visualization (same LAPUS probe as in Figure 3

  2. Laparoscopic retrieval of an unusual foreign body

    Directory of Open Access Journals (Sweden)

    Binay Kumar Shukla

    2014-01-01

    Full Text Available Ingestion of foreign body is a serious problem commonly encountered in our clinical practice. Most of them pass spontaneously, whereas in others endoscopic or surgical intervention is required because of complications or non-passage from the gastrointestinal tract. We present here a case of teaspoon ingestion, which did not pass spontaneously. Laparoscopic retrieval of teaspoon was done from mid jejunum after enterotomy and the patient recovered uneventfully. Right intervention at the right time is of paramount importance.

  3. Urologic surgery laparoscopic access: vascular complications.

    Science.gov (United States)

    Branco, Anibal Wood

    2017-01-01

    Vascular injury in accidental punctures may occur in large abdominal vessels, it is known that 76% of injuries occur during the development of pneumoperitoneum. The aim of this video is to demonstrate two cases of vascular injury occurring during access in laparoscopic urologic surgery. The first case presents a 60-year old female patient with a 3cm tumor in the superior pole of the right kidney who underwent a laparoscopic partial nephrectomy. After the Verres needle insertion, output of blood was verified. During the evaluation of the cavity, a significant hematoma in the inferior vena cava was noticed. After the dissection, a lesion in the inferior vena cava was identified and controlled with a prolene suture, the estimated bloos loss was 300ml. The second case presents a 42-year old female live donor patient who had her right kidney selected to laparoscopic live donor nephrectomy. After the insertion of the first trocar, during the introduction of the 10mm scope, an active bleeding from the mesentery was noticed. The right colon was dissected and an inferior vena cava perforation was identified; a prolene suture was used to control the bleeding, the estimated blood loss was 200mL, in both cases the patients had no previous abdominal surgery. Urologists must be aware of this uncommon, serious, and potentially lethal complication. Once recognized and in the hands of experienced surgeons, some lesions may be repaired laparoscopically. Whenever in doubt, the best alternative is the immediate conversion to open surgery to minimize morbidity and mortality. Copyright® by the International Brazilian Journal of Urology.

  4. Improved Image-Guided Laparoscopic Prostatectomy

    Science.gov (United States)

    2012-08-01

    associated with loss of blood and lengthy recovery times. Laparoscopic radical prostatectomies ( LRP ) have a very steep learning curve, lack 3-D...algorithm on the presented data set , as well as on new ex-vivo and in-vivo tissue data. 5. CONCLUSION We proposed and successfully implemented an...loop generating assistive motion for tissue palpation. A command terminal on the central workstation allows the user to set the amplitude and frequency

  5. Laparoscopic cholecystectomy perioperative management: an update

    Directory of Open Access Journals (Sweden)

    Sellbrant I

    2015-07-01

    Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic

  6. The benefits of being a video gamer in laparoscopic surgery.

    Science.gov (United States)

    Sammut, Matthew; Sammut, Mark; Andrejevic, Predrag

    2017-09-01

    Video games are mainly considered to be of entertainment value in our society. Laparoscopic surgery and video games are activities similarly requiring eye-hand and visual-spatial skills. Previous studies have not conclusively shown a positive correlation between video game experience and improved ability to accomplish visual-spatial tasks in laparoscopic surgery. This study was an attempt to investigate this relationship. The aim of the study was to investigate whether previous video gaming experience affects the baseline performance on a laparoscopic simulator trainer. Newly qualified medical officers with minimal experience in laparoscopic surgery were invited to participate in the study and assigned to the following groups: gamers (n = 20) and non-gamers (n = 20). Analysis included participants' demographic data and baseline video gaming experience. Laparoscopic skills were assessed using a laparoscopic simulator trainer. There were no significant demographic differences between the two groups. Each participant performed three laparoscopic tasks and mean scores between the two groups were compared. The gamer group had statistically significant better results in maintaining the laparoscopic camera horizon ± 15° (p value = 0.009), in the complex ball manipulation accuracy rates (p value = 0.024) and completed the complex laparoscopic simulator task in a significantly shorter time period (p value = 0.001). Although prior video gaming experience correlated with better results, there were no significant differences for camera accuracy rates (p value = 0.074) and in a two-handed laparoscopic exercise task accuracy rates (p value = 0.092). The results show that previous video-gaming experience improved the baseline performance in laparoscopic simulator skills. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  7. [Celioscopic treatment of inguinal hernias by intraperitoneal patch of ePTFE according to Spaw. Preliminary results of a prospective study of 162 hernioplasties in 135 patients. Groupe CHIC (Cure des hernies inquinocrurales sous coelioscopie)].

    Science.gov (United States)

    Gillion, J F; Elhadad, A; Balique, J G; Begin, G F; Fourtanier, G

    1994-01-01

    Spaw's (original and modified) was technique evaluated in a prospective, multicentre study: from november 1992 to september 1993, 162 intraperitoneal laparoscopic herniorraphies were carried out in 135 patients for recurrent hernias or for hernias associated with a high risk of recurrence. Three needed an open procedure. Three early complications (2 periprosthetic hematomas, 1 microscopic bladder injury) were treated by another laparoscopy; a bowel loop retained in a trocar orifice was reintegrated under local anesthesia; dysesthesias of the lateral cutaneous nerve of the thigh in 1 patient and nonspecific parietal pain in 2 patients resolved within three weeks. Three seromas resolved after only one percutaneous aspiration. The mean post operative pain, evaluated by a visual analogic scale graduated from 1 to 10 was 1.8 (0 to 6) at D1, 05 (0 to 2) at D2 and the mean duration of analgesic requirments was 1.7 (0 to 15) days. The mean hospital stay was 2 (1 to 17) days for unilateral herniorraphies and the mean time to return to work or normal activity was 10 (2 to 44) days, even in heavy workers (35 patients). All patients were reviewed. The mean follow-up was 4 (1 to 10) months. Two complications needed further laparoscopic treatment: 1 recurrence at the internal edge of the patch, easily restapled with a stronger stapler, 1 bowel adhesion between patch and bladder revealed by pain without obstruction. The recurrence rate was 0.6% (1/162). The conversion rate was 2% (3/162) and the overall morbidity was 7.5% (12/162), decreasing respectively to 0 and 4% after the learning curve. This study confirms that Spaw's technique and its variant are feasible, and allows us to continue this study, and suggest these techniques would be useful in the treatment of some recurrent inguinal hernias.

  8. [Complicated acute apendicitis. Open versus laparoscopic surgery].

    Science.gov (United States)

    Gil Piedra, Francisco; Morales García, Dieter; Bernal Marco, José Manuel; Llorca Díaz, Javier; Marton Bedia, Paula; Naranjo Gómez, Angel

    2008-06-01

    Although laparoscopy has become the standard approach in other procedures, this technique is not generally accepted for acute appendicitis, especially if it is complicated due reports on the increase in intra-abdominal abscesses. The purpose of this study was to evaluate the morbidity in a group of patients diagnosed with complicated apendicitis (gangrenous or perforated) who had undergone open or laparoscopic appendectomy. We prospectively studied 107 patients who had undergone appendectomy for complicated appendicitis over a two year period. Mean operation time, mean hospital stay and morbidity, such as wound infection and intra-abdominal abscess were evaluated. In the group with gangrenous appendicitis morbidity was significantly lower in laparoscopic appendectomy group (p = 0.014). Wound infection was significantly higher in the open appendectomy group (p = 0.041), and there were no significant differences in intra-abdominal abscesses (p = 0.471). In the perforated appendicitis group overall morbidity (p = 0.046) and wound infection (p = 0.004) was significantly higher in the open appendectomy group. There were no significant differences in intra-abdominal abscesses (p = 0.612). These results suggest that laparoscopic appendectomy for complicated appendicitis is a safe procedure that may prove to have significant clinical advantages over conventional surgery.

  9. Laparoscopic versus open resection for sigmoid diverticulitis.

    Science.gov (United States)

    Abraha, Iosief; Binda, Gian A; Montedori, Alessandro; Arezzo, Alberto; Cirocchi, Roberto

    2017-11-25

    Diverticular disease is a common condition in Western industrialised countries. Most individuals remain asymptomatic throughout life; however, 25% experience acute diverticulitis. The standard treatment for acute diverticulitis is open surgery. Laparoscopic surgery - a minimal-access procedure - offers an alternative approach to open surgery, as it is characterised by reduced operative stress that may translate into shorter hospitalisation and more rapid recovery, as well as improved quality of life. To evaluate the effectiveness of laparoscopic surgical resection compared with open surgical resection for individuals with acute sigmoid diverticulitis. We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 2) in the Cochrane Library; Ovid MEDLINE (1946 to 23 February 2017); Ovid Embase (1974 to 23 February 2017); clinicaltrials.gov (February 2017); and the World Health Organization (WHO) International Clinical Trials Registry (February 2017). We reviewed the bibliographies of identified trials to search for additional studies. We included randomised controlled trials comparing elective or emergency laparoscopic sigmoid resection versus open surgical resection for acute sigmoid diverticulitis. Two review authors independently selected studies, assessed the domains of risk of bias from each included trial, and extracted data. For dichotomous outcomes, we calculated risk ratios (RRs) with 95% confidence intervals (CIs). For continuous outcomes, we planned to calculate mean differences (MDs) with 95% CIs for outcomes such as hospital stay, and standardised mean differences (SMDs) with 95% CIs for quality of life and global rating scales, if researchers used different scales. Three trials with 392 participants met the inclusion criteria. Studies were conducted in three European countries (Switzerland, Netherlands, and Germany). The median age of participants ranged from 62 to 66 years; 53% to 64% were

  10. Cheledochal cyst resection and laparoscopic hepaticoduodenostomy

    Directory of Open Access Journals (Sweden)

    Jiménez Urueta Pedro Salvador

    2014-07-01

    Full Text Available Background. Choledochal cyst is a rare abnormality. Its esti- mated incidence is of 1:100,000 to 150,000 live births. Todani et al. in 1981 reported the main objection for performing a simpler procedure, i.e., hepaticoduodenostomy, has been the risk of an “ascending cholangitis”. This hazard, however, seems to be exaggerated. Methods: A laparoscopic procedure was performed in 8 consecutive patients with choledochal cyst between January 2010 and Septem- ber 2012; 6 females and 2 males mean age was 8 years. Results. Abdominal pain was the main symptom in everyone, jaundice in 1 patient and a palpable mass in 3 patients. Lapa- roscopic surgical treatment was complete resection of the cyst with cholecystectomy and hepaticoduodenostomy laparoscopy in every patient. Discussion and conclusion. A laparoscopic approach to chole- dochal cyst resection and hepaticoduodenostomy is feasible and safe. The hepaticoduodenal anastomosis may confer additional benefits over hepaticojejunostomy in the setting of a laparoscopic approach. The creation of a single anastomosis can decrease operative time and anesthetic exposure.

  11. LAPAROSCOPIC GASTRECTOMY WITH LONGMIRE’S PROCEDURE

    Directory of Open Access Journals (Sweden)

    R. A. Zubkov

    2016-01-01

    Full Text Available The arm of the research. To develop a way to perform the laparoscopic total gastrectomy with jejunal interposition (Longmire’s procedure.Material and methods. The study presents the technology of laparoscopic total gastrectomy with a lymph node dissection D1α and jejunal interposition. After removal of the gaster with the tumor through a mini-laparotomy (2 inch, the jejunum was cut approximately45 cm distally to the ligament of Treitz. A circular stapler was used to perform an esophago-jejunostomy with Roux-en-Y reconstruction using a standard technology. The second stage is forming a segment of the small intestine for jejunal interposition. The third stage is entering the head of the circular stapling apparatus into the stump of the duodenum on a probe retrogradely through the afferent loop of the small intestine. The fourth stage is stapled anastomosis between a free segment of the jejunum and the duodenum with the circular stapler. The procedure is finalized with hand-sewn anastomosis between the afferent and efferent loops of the small intestine.Results. The presented technology was used to perform surgery on one patient. The increase in operative time did not lead to increased intraoperative blood loss and longer post-operative bed-days. After 1 year the patient shows no evidence of a tumor progression, manifestations of reflux esophagitis, and dumping syndrome. Conclusion. The proposed technology allows laparoscopic total gastrectomy with jejunal interposition via a mini-invasive technology. 

  12. Laparoscopic radical prostatectomy in the canine model.

    Science.gov (United States)

    Price, D T; Chari, R S; Neighbors, J D; Eubanks, S; Schuessler, W W; Preminger, G M

    1996-12-01

    The purpose of this study was to determine the feasibility of performing laparoscopic radical prostatectomy in a canine model. Laparoscopic radical prostatectomy was performed on six adult male canines. A new endoscopic needle driver was used to construct a secure vesicourethral anastomosis. Average operative time required to complete the procedure was 304 min (range 270-345 min). Dissection of the prostate gland took an average of 67 min (range 35-90 min), and construction of the vesicourethral anastomosis took 154 min (rage 80-240 min). There were no intraoperative complications and only one postoperative complication (anastomotic leak). Five of the six animals recovered uneventfully from the procedure, and their foley catheters were removed 10-14 days postoperatively after a retrograde cystourethrogram demonstrated an intact vesicourethral anastomosis. Four (80%) of the surviving animals were clinically continent within 10 days after catheter removal. Post mortem examination confirmed that the vesicourethral anastomosis was intact with no evidence of urine extravasation. These data demonstrate the feasibility of laparoscopic radical prostatectomy in a canine model, and suggest that additional work with this technique should be continued to develop its potential clinical application.

  13. Laparoscopic cholecystectomy versus open cholecystectomy in children.

    Science.gov (United States)

    Ruangtrakool, Ravit; Mungnirandr, Akkrapol; Laohapensang, Mongkol; Sathornkich, Chana

    2002-02-01

    Laparoscopic cholecystectomy (LC) is well accepted as the standard cholecystectomy only in adult patients. However, the advantages of LC over open cholecystectomy have never been proved in pediatric patients because the number of pediatric cholecystectomies is limited as well as the faster ability of pediatric patients to resume their normal activity. Retrospective study of 42 pediatric cholecystectomies (laparoscopic cholecystectomy (n = 8) (LCs), open cholecystectomy alone (n = 8) (OCs) and open cholecystectomy concomitant with splenectomy (n = 26)(OCs + S)) done in Siriraj University Hospital, Bangkok, Thailand between 1992 and 2000 was conducted. Statistical comparison revealed that LC was superior to OC in regard to diet resumption. LCs resumed soft diet on 1.38 days, whereas OCs and OCs + S could resume soft diet on 3.38 and 3.35 days respectively. The average length of hospitalization following LCs was significantly shorter than OCs' and OCs + S' ones (3.00 vs 8.38 and 4.85 days respectively). There was no morbidity and mortality in LCs, whereas two OCs and three OCs + S had complications. In this preliminary study, laparoscopic cholecystectomy is a preferred method of cholecystectomy in children because it has a shorter post-operative interval of diet resumption and shortens hospitalization with minimal morbidity. However, this study has a limited number of patients and further study is still required to conclude the benefits of LC.

  14. Randomized clinical trial of laparoscopic ultrasonography before laparoscopic colorectal cancer resection

    DEFF Research Database (Denmark)

    Ellebaek, S B; Fristrup, C W; Hovendal, C

    2017-01-01

    BACKGROUND: Intraoperative ultrasonography during open surgery for colorectal cancer may be useful for the detection of unrecognized liver metastases. Laparoscopic ultrasonography (LUS) for the detection of unrecognized liver metastasis has not been studied in a randomized trial. This RCT tested...... the hypothesis that LUS would change the TNM stage and treatment strategy. METHODS: Patients with colorectal cancer and no known metastases were randomized (1 : 1) to laparoscopic examination (control or laparoscopy plus LUS) in three Danish centres. Neither participants nor staff were blinded to the group...

  15. Intraperitoneal Gemcitabine Chemotherapy Treatment for Patients with Resected Pancreatic Cancer: Rationale and Report of Early Data

    Directory of Open Access Journals (Sweden)

    Paul H. Sugarbaker

    2011-01-01

    Full Text Available Currently, the surgical management of pancreas cancer is recognized around the world as inadequate. Despite a potentially curative R0 resection, long-term survival is rare. There is a strong rationale for the use of chemotherapy in the operating room to reduce local-regional of recurrent/progressive disease. Gemcitabine monotherapy administered by an intraperitoneal route in the operating room with hyperthermia and then for long-term treatment postoperatively has a pharmacologic basis in that the exposure of peritoneal surfaces to intraperitoneal gemcitabine is approximately 200–500 times the exposure that occurs within the plasma. A standardized treatment with intraoperative and long-term chemotherapy that is well tolerated would greatly facilitate further improvements in pancreas cancer treatment and may lead the way to an evolution of more successful treatment strategies of this dread disease. The aim of this paper is to present the early data on a protocol in progress in patients with resected pancreatic cancer.

  16. Experimental intraperitoneal infusion of OK-432 in rats: Evaluation of peritoneal complications and pathology

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Wook [Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of); Kim, Hak Jin, E-mail: hakjink@pusan.ac.k [Department of Radiology, Pusan National University Hospital, Pusan National University College of Medicine, Medical Research Institute, Busan (Korea, Republic of); Lee, Jun Woo [Department of Radiology, Pusan National University Hospital, Pusan National University College of Medicine, Medical Research Institute, Busan (Korea, Republic of)

    2010-06-15

    Purpose: OK-432 is known to be a potent sclerosant of cystic lesions. The purpose of this study was to evaluate both its safety and pathologic effects after the infusion of OK-432 into the peritoneal cavity of rats. Materials and methods: Twenty male rats were used in this study. Twelve rats were infused intraperitoneally with 0.2 Klinishe Einheit of OK-432 melted in 2 mL of normal saline (group 1: the treated group); four rats each were infused intraperitoneally with 0.5 mL of 99% ethanol (group 2) and normal saline (group 3), and served as the control groups. An abdominal ultrasonographic examination was performed both before and after the infusions in all rats. Three rats in group 1 and one rat in each of groups 2 and 3 were sacrificed each week following the infusion. Gross and microscopic evaluations of the peritoneum and abdominal cavity were performed on each rat. Results: In group 1, the abdomen was clear on gross inspection and the peritoneum was unremarkable on microscopic examination. In group 2, mild-to-moderate peritoneal adhesions were revealed grossly, and inflammation and fibrosis of the peritoneum were demonstrated microscopically. In group 3, no specific abnormalities were noted on gross or microscopic examinations. Conclusion: Leakage or abnormal infusion of OK-432 solution into the peritoneal cavity during sclerotherapy of intra-abdominal or retroperitoneal cystic lesions does not result in any significant complications.

  17. Experimental intraperitoneal infusion of OK-432 in rats: Evaluation of peritoneal complications and pathology

    International Nuclear Information System (INIS)

    Kim, Dong Wook; Kim, Hak Jin; Lee, Jun Woo

    2010-01-01

    Purpose: OK-432 is known to be a potent sclerosant of cystic lesions. The purpose of this study was to evaluate both its safety and pathologic effects after the infusion of OK-432 into the peritoneal cavity of rats. Materials and methods: Twenty male rats were used in this study. Twelve rats were infused intraperitoneally with 0.2 Klinishe Einheit of OK-432 melted in 2 mL of normal saline (group 1: the treated group); four rats each were infused intraperitoneally with 0.5 mL of 99% ethanol (group 2) and normal saline (group 3), and served as the control groups. An abdominal ultrasonographic examination was performed both before and after the infusions in all rats. Three rats in group 1 and one rat in each of groups 2 and 3 were sacrificed each week following the infusion. Gross and microscopic evaluations of the peritoneum and abdominal cavity were performed on each rat. Results: In group 1, the abdomen was clear on gross inspection and the peritoneum was unremarkable on microscopic examination. In group 2, mild-to-moderate peritoneal adhesions were revealed grossly, and inflammation and fibrosis of the peritoneum were demonstrated microscopically. In group 3, no specific abnormalities were noted on gross or microscopic examinations. Conclusion: Leakage or abnormal infusion of OK-432 solution into the peritoneal cavity during sclerotherapy of intra-abdominal or retroperitoneal cystic lesions does not result in any significant complications.

  18. Current status and future prospects of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) clinical trials in ovarian cancer.

    Science.gov (United States)

    Cowan, Renee A; O'Cearbhaill, Roisin E; Zivanovic, Oliver; Chi, Dennis S

    2017-08-01

    The natural history of advanced-stage epithelial ovarian cancer is one of clinical remission after surgery and platinum/taxane-based intravenous (IV) and/or intraperitoneal (IP) chemotherapy followed by early or late recurrence in the majority of patients. Prevention of progression and recurrence remains a major hurdle in the management of ovarian cancer. Recently, many investigators have evaluated the use of normothermic and hyperthermic intraoperative IP drug delivery as a management strategy. This is a narrative review of the current status of clinical trials of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in ovarian cancer and the future directions for this treatment strategy. The existing studies on HIPEC in patients with epithelial ovarian cancer are mostly retrospective in nature, are heterogeneous with regards to combined inclusion of primary and recurrent disease and lack unbiased data. Until data are available from evidence-based trials, it is reasonable to conclude that surgical cytoreduction and HIPEC is a rational and interesting, though still investigative, approach in the management of epithelial ovarian cancer, whose use should be employed within prospective clinical trials.

  19. Non-specific immune response of bullfrog Rana catesbeiana to intraperitoneal injection of bacterium Aeromonas hydrophila

    Science.gov (United States)

    Zhang, Junjie; Zou, Wenzheng; Yan, Qingpi

    2008-08-01

    Non-specific immune response of bullfrog Rana catesbeiana to pathogenic Aeromonas hydrophila was studied to 60 individuals in two groups. Each bullfrog in bacterium-injected group was injected intraperitoneally (i.p.) with 0.2 ml bacterial suspension at a density of 5.2 × 106 CFU/ml, while each one in control group injected i.p. with 0.2 ml sterile saline solution (0.85%, w/v). Three bullfrogs in both groups were sampled at 0, 1, 3, 7, 11, 15 and 20 days post-injection (dpi) for the evaluation of non-specific immune parameters. It was observed that intraperitoneal injection of A. hydrophila significantly increased the number of leucocytes and that of NBT-positive cells in peripheral blood. Significant increases in serum bactericidal activity and serum acid phosphatase activity were also observed in the bacterium-injected frogs when compared with those in the control group. However, a significant reduction was detected in vitro in phagocytosis activity of peripheral blood phagocytes. No significant difference in changes in the number of peripheral erythrocytes, serum superoxide dismutase (SOD) activity, and lysozyme activity was detected between the two groups. It is suggested that bullfrogs may produce a series of non-specific immune reactions in response to the A. hydrophila infection.

  20. Intraperitoneal administration of chitosan/DsiRNA nanoparticles targeting TNFα prevents radiation-induced fibrosis

    International Nuclear Information System (INIS)

    Nawroth, Isabel; Alsner, Jan; Behlke, Mark A.; Besenbacher, Flemming; Overgaard, Jens; Howard, Kenneth A.; Kjems, Jorgen

    2010-01-01

    Background and purpose: One of the most common and dose-limiting long-term adverse effects of radiation therapy is radiation-induced fibrosis (RIF), which is characterized by restricted tissue flexibility, reduced compliance or strictures, pain and in severe cases, ulceration and necrosis. Several strategies have been proposed to ameliorate RIF but presently no effective one is available. Recent studies have reported that tumor necrosis factor-α (TNFα) plays a role in fibrogenesis. Material and methods: Male CDF1 mice were radiated with a single dose of 45 Gy. Chitosan/DsiRNA nanoparticles targeting TNFα were intraperitoneal injected and late radiation-induced fibrosis (RIF) was assessed using a modification of the leg contracture model. Additionally, the effect of these nanoparticles on tumor growth and tumor control probability in the absence of radiation was examined in a C3H mammary carcinoma model. Results: We show in this work, that targeting TNFα in macrophages by intraperitoneal administration of chitosan/DsiRNA nanoparticles completely prevented radiation-induced fibrosis in CDF1 mice without revealing any cytotoxic side-effects after a long-term administration. Furthermore, such TNFα targeting was selective without any significant influence on tumor growth or irradiation-related tumor control probability. Conclusion: This nanoparticle-based RNAi approach represents a novel approach to prevent RIF with potential application to improve clinical radiation therapeutic strategies.