Abo, Carole; Roman, Horace
The strengths of surgical laparoscopy compared to laparotomy include shorter hospitalization, reduction in post-operative pain and adhesions, and better cosmetic outcomes. Since 2008, Single Port Access Laparoscopy (SPAL) has been used in order to offer additional cosmetic benefits and to further reduce post-operative morbidity. The aim of this study was to assess the feasibility of a subtotal hysterectomy using SPAL technique, as well as the benefits and the limitations of this technique. Retrospective series of 15 women managed between September 2010 and February 2013 at our university tertiary referral center by subtotal hysterectomy using SPAL technique for benign pathologies. Twelve of the 15 procedures were performed by SPAL alone. Three conversions to classic laparoscopy were required for a large uterus (1 case) or major pelvic adhesions (2 cases). Postoperative complications were a bladder injury, a subumbilical hematoma and transcervical fragmentation of a uterus with a low-grade sarcoma. Mean operative time was 85.4 minutes (50-170). Postoperative hospitalization was of 2 days in average. The rate of patient satisfaction at 16-month follow-up was 9.2/10. Subtotal hysterectomy using SPAL technique is safe and feasible. Successful procedure requires accurate selection of patients taking into account main limitations, such as uterus weight, patient's BMI and abdominal surgical history. Notwithstanding, SPAL technique can be seen as technical progress. Celsius.
Sofie AF Fransen
Full Text Available Introduction: Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy. Materials And Methods: An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy. Results: A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population. Conclusion: Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for
Fransen, Sofie Af; Broeders, Epm; Stassen, Lps; Bouvy, Nd
Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy. An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years) were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy. A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population. Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for the safety and feasibility of this new surgical technique needs to be obtained
Qi, Jin-Chun; Xue, Wen-Yong; Li, Suo-Lin; Lu, Bao-Sai; Jia, Jiang-Hua; Zhang, Yan-Ping; DU, Lei; Li, Meng; Li, Wei
To compare the clinical effect of transumbilical single-port laparoscopy combined with improved double hernia needles with that of traditional open surgery in the treatment of hydrocele in children. We retrospectively analyzed 35 cases (54 sides) of pediatric hydrocele treated by transumbilical single-port laparoscopy combined with improved double hernia needles (laparoscopy group). We recorded the operation time, intraoperative blood loss, hospital stay, scrotal edema, and postoperative complications and compared them with those of another 46 cases (58 sides) treated by traditional open surgery (open surgery group) during the same period. The laparoscopy group showed a significantly shorter operation time, less intraoperative blood loss, milder scrotal edema, and fewer hospital days than the open surgery group (all P0.05). Subcutaneous emphysema developed in 2 patients in the laparoscopy group, which disappeared after 1－3 days of oxygen inhalation and other symptomatic treatment, while scrotal hematoma occurred in 1 and incision fat liquefaction in 2 patients in the open surgery group 3 days postoperatively, which healed after debridement suture and daily dressing, respectively. The patients were followed up for 3－6 months, which revealed no late complications in the laparoscopy group but 1 case of unilateral recurrence and 2 cases of offside recurrence in the open surgery group, all cured by laparoscopic internal ring ligation. Transumbilical single-port laparoscopy combined with improved double hernia needles is superior to traditional open surgery for the treatment of pediatric hydrocele and therefore deserves clinical generalization.
Moulton, Laura; Jernigan, Amelia M; Carr, Caitlin; Freeman, Lindsey; Escobar, Pedro F; Michener, Chad M
Single-port laparoscopy has gained popularity within minimally invasive gynecologic surgery for its feasibility, cosmetic outcomes, and safety. However, within gynecologic oncology, there are limited data regarding short-term adverse outcomes and long-term hernia risk in patients undergoing single-port laparoscopic surgery. The objective of the study was to describe short-term outcomes and hernia rates in patients after single-port laparoscopy in a gynecologic oncology practice. A retrospective, single-institution study was performed for patients who underwent single-port laparoscopy from 2009 to 2015. A univariate analysis was performed with χ 2 tests and Student t tests; Kaplan-Meier and Cox proportional hazards determined time to hernia development. A total of 898 patients underwent 908 surgeries with a median follow-up of 37.2 months. The mean age and body mass index were 55.7 years and 29.6 kg/m 2 , respectively. The majority were white (87.9%) and American Society of Anesthesiologists class II/III (95.5%). The majority of patients underwent surgery for adnexal masses (36.9%) and endometrial hyperplasia/cancer (37.3%). Most women underwent hysterectomy (62.7%) and removal of 1 or both fallopian tubes and/or ovaries (86%). Rate of adverse outcomes within 30 days, including reoperation (0.1%), intraoperative injury (1.4%), intensive care unit admission (0.4%), venous thromboembolism (0.3%), and blood transfusion, were low (0.8%). The rate of urinary tract infection was 2.8%; higher body mass index (P = .02), longer operative time (P = .02), smoking (P = .01), hysterectomy (P = .01), and cystoscopy (P = .02) increased the risk. The rate of incisional cellulitis was 3.5%. Increased estimated blood loss (P = .03) and endometrial cancer (P = .02) were independent predictors of incisional cellulitis. The rate for surgical readmissions was 3.4%; higher estimated blood loss (P = .03), longer operative time (P = .02), chemotherapy alone (P = .03), and
Angioni, S; Mais, V; Pontis, A; Peiretti, M; Nappi, L
•Single port access laparoscopy may be suggested for prophylactic salpingectomy in BRCA carriers.•Diode laser salpingectomy could preserve ovarian function as it can cut and coagulate with extreme precision and minimal thermal damage.
Carvello, M.; de Groof, E. J.; de Buck van Overstraeten, A.; Sacchi, M.; Wolthuis, A. M.; Buskens, C. J.; D'Hoore, A.; Bemelman, W. A.; Spinelli, A.
AimSingle port (SP) ileocaecal resection (ICR) is an established technique but there are no large studies comparing SP and multi-port (MP) laparoscopic surgery in Crohn's disease (CD). The aim of this study was to compare postoperative pain scores and analgesia requirements after SP and MP
Gracia, Meritxell; Sisó, Cristian; Martínez-Zamora, M Àngels; Sarmiento, Laura; Lozano, Francisco; Arias, Maria Teresa; Beltrán, Joan; Balasch, Juan; Carmona, Francisco
To evaluate systemic markers of immune and stress responses after bilateral adnexectomy performed using 2 different laparoscopic techniques in pigs. Prospective comparative study (Canadian Task Force classification II-2). University teaching hospital, research hospital, and tertiary care center. Twenty female Yorkshire pigs undergoing laparoscopic surgery. Animals underwent bilateral salpingo-oophorectomy (ovary and fallopian tube extraction), performed via conventional laparoscopy (n = 10) or the single-port access approach (n = 10). Injury provokes an acute-phase response, primarily produced by cytokines. The inflammatory response has been well described for major surgery and for conventional laparoscopy; however, little information is currently available for single-port laparoscopy, and none in the gynecologic field. This is the first study to compare serum cytokine interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) concentrations at baseline and in the early postoperative period (2, 4, and 20 hours) after bilateral salpingo-oophorectomy performed via conventional laparoscopy (n = 10) or single-port access (n = 10) in a porcine model. The stress response was measured using glucose and cortisol concentrations and the animals' response to surgery via a 6-category observation-based behavior test. Both IL-6 and TNF-α concentrations peaked at 4 hours after surgery, and were significantly lower in the single-port access group (p = .02) than in the conventional laparoscopy group (p = .02). In addition, in the single-port access group, concentrations of stress markers were slightly lower at all intervals recorded and were statistically significant at 2 hours after the operation for glucose concentration (mean [SD], 164.50 [26.73] mg/dL for conventional laparoscopy vs 86.50 [17.93] mg/dL for single-port access; p = .02). Evidence of improved inflammatory and stress responses was recorded in the minimally invasive single-port group. More clinical
Full Text Available Michael Wassef, David Y Lee, Jun L Levine, Ronald E Ross, Hamza Guend, Catherine Vandepitte, Admir Hadzic, Julio TeixeiraDepartment of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USAPurpose: The transversus abdominis plane (TAP block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS scores.Patients and methods: After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL, a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups.Results: Sensory block ranged from T5–L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04 within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4–10 after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSG surgery
Bo Sung Yoon
Conclusion: SPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.
Peretti, V; Chereau, E; Lambaudie, E; Greco, F; Butarelli, M; Jauffret, C; Rua-Ribeiro, S; Houvenaeghel, G
Carry out a preliminary study comparing postoperative pain and intraoperative and postoperative complications between micro-laparoscopy and laparoscopic monotrocart non-oncological adnexal surgery. All patients should benefit from a benign adnexal surgery were included prospectively from February to May 2014. The insufflation pressure, infiltration of trocar holes with a local anesthetic, postoperative analgesics were prescribed standardized. Operative and postoperative complications, type and length of hospital stay as well as EVA and analgesic consumption were recorded. Nine patients were included in monotrocart group versus 7 in the micro-laparoscopy group. There were no differences in operative and postoperative complications, the type and length of hospital stay, as well as cosmetics satisfaction. However, there was a significant difference in the VAS to D2 (2.15 vs. 4.08, P=0.04) and analgesic consumption at D0 (P=0.04), D1 (P=0.04), D2 (P=0.02) and D3 (P=0.01), for the benefit of micro-laparoscopy. Despite an enrollment of patients low, micro-laparoscopy appears to have a significant advantage over the monotrocart laparoscopy for postoperative pain in benign adnexal surgery. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Evaluation of Patient Satisfaction Using the EORTC IN-PATSAT32 Questionnaire and Surgical Outcome in Single-Port Surgery for Benign Adnexal Disease: Observational Comparison with Traditional Laparoscopy
Full Text Available Laparoscopic surgery has been demonstrated as a valid approach in almost all gynaecologic procedures including malignant diseases. Benefits of the minimally invasive approach over traditional open surgery have been well demonstrated in terms of minimal perioperative morbidity and reduced postoperative pain and hospital stay duration, with consequent quick postoperative recovery (Medeiros et al. (2009. Single-port surgery resurfaced in gynaecology surgery in recent years and renewed interest among other surgeons and within the industry to develop this field (Podolsky et al. (2009. Patient satisfaction is emerging as an increasingly important measure of quality which represents a complex entity that is dependent on patient demographics, comorbidities, disease, and, to a large extent, patient expectations (Tomlinson and Ko (2006. It can be broadly thought to refer to all relevant experiences and processes associated with health care delivery (Jackson et al. (2001. In this study we aim to compare single-port surgery (SPS with conventional laparoscopy in terms of patient satisfaction using the EORTC IN-PATSAT32 questionnaire. We also evaluate the main surgical outcomes of both minimally invasive approaches.
Full Text Available The recently developed minimally invasive techniques of ovariohysterectomy (OVH have been studied in dogs in order to optimize their benefits and decrease risks to the patients. The purpose of this study was to compare surgical time, complications and technical difficulties of transvaginal total-NOTES, single-port laparoscopic-assisted and conventional OVH in bitches. Twelve bitches were submitted to total-NOTES (NOTES group, while 13 underwent single-port laparoscopic-assisted (SPLA group and 15 were submitted to conventional OVH (OPEN group. Intra-operative period was divided into 7 stages: (1 access to abdominal cavity; (2 pneumoperitoneum; approach to the right (3 and left (4 ovarian pedicle and uterine body (5; (6 abdominal or vaginal synthesis, performed in 6 out of 12 patients of NOTES; (7 inoperative time. Overall and stages operative times, intra and postoperative complications and technical difficulties were compared among groups. Mean overall surgical time in NOTES (25.7±6.8 minutes and SPLA (23.1±4.0 minutes groups were shorter than in the OPEN group (34.0±6.4 minutes (P<0.05. The intraoperative stage that required the longest time was the approach to the uterine body in the NOTES group and abdominal and cutaneous sutures in the OPEN group. There was no difference regarding the rates of complications. Major complications included postoperative bleeding requiring reoperation in a bitch in the OPEN group, while minor complications included mild vaginal discharge in four patients in the NOTES group and seroma in three bitches in the SPLA group. In conclusion, total-NOTES and SPLA OVH were less time-consuming then conventional OVH in bitches. All techniques presented complications, which were properly managed.
... may suggest that they be removed with laparoscopy. • Ectopic pregnancy —Laparoscopy may be done to remove an ectopic pregnancy. • Pelvic floor disorders —Laparoscopic surgery can be used ...
Jeremy R Huddy
Full Text Available Introduction: Experience has allowed increasingly complex procedures to be undertaken by single port surgery. We describe a technique for single port Billroth I gastrectomy with a hand-sewn intracorporeal anastomosis in the resection of a benign tumour diagnosed incidentally on a background of cholelithiasis. Materials and Methods: Single port Billroth I gastrectomy and cholecystectomy was performed using a transumbilical quadport. Flexible tipped camera and straight conventional instruments were used throughout the procedure. The stomach was mobilised including a limited lymph node dissection and resection margins in the proximal antrum and duodenum were divided with a flexible tipped laparoscopic stapler. The lesser curve was reconstructed and an intracorporal hand sewn two layer end-to-end anastomosis was performed using unidirectional barbed sutures. Intraoperative endoscopy confirmed the anastomosis to be patent without leak. Results: Enteral feed was started on the day of surgery, increasing to a full diet by day 6. Analgesic requirements were a patient-controlled analgesia morphine pump for 4 postoperative days and paracetamol for 6 days. There were no postoperative complications and the patient was discharged on the eighth day. Histology confirmed gastric submucosal lipoma. Discussion: As technology improves more complex procedures are possible by single port laparoscopic surgery. In this case, flexible tipped cameras and unidirectional barbed sutures have facilitated an intracorporal hand-sewn two layer end-to-end anastomosis. Experience will allow such techniques to become mainstream.
Bulut, O; Aslak, K K; Rosenstock, S
Although conventional laparoscopic surgery is less traumatic than open surgery, it does cause tissue trauma and multiple scar formation. The size and number of ports determine the extent of the trauma. Single-port laparoscopic surgery is assumed to minimize and perhaps eliminate the potential adv...... adverse effects of conventional laparoscopy. The aim of this study was to examine short-term outcomes of single-port laparoscopic surgery for rectal cancer....
Gomes, Mariano Tamura Vieira; Machado, Andréa Maria Novaes; Podgaec, Sérgio; Barison, Gustavo Anderman Silva
this technique in elective hysterectomy and other gynecological procedures in the future, as described in large reference centers of advanced surgery worldwide. Specifically, in gynecological practice, existing evidence on the use of robot-assisted, single-port surgery seems promising, and although it is not indicated in all cases, it should be considered as a surgical option. Nonetheless, further randomized and controlled clinical studies are necessary to establish the preeminence of robot-assisted, single-port surgery versus single-incision and conventional laparoscopy.
Conclusions : Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.
Iacoponi, Sara; De Santiago, Javier; Diestro, Maria D; Hernandez, Alicia; Zapardiel, Ignacio
The aim of this study was to evaluate the feasibility and the safety of single-port extraperitoneal laparoscopic para-aortic lymphadenectomy for patients with gynecologic cancer. From July 2012 to January 2013, a total of 7 patients with gynecologic cancer underwent a laparoscopic pelvic and para-aortic lymphadenectomy with a single-port device. An extraperitoneal approach was performed for para-aortic lymphadenectomy using only one 2.5-cm incision on the left side. In 6 patients, additionally, hysterectomy and pelvic lymphadenectomy with conventional laparoscopy were performed to complete the treatment. Aortic dissection was complete in all cases without complications. The median age of the patients was 63 years (range, 48-78 years), and the median patient body mass index was 31 kg/m(2) (range, 19-38 kg/m(2)). The median number of para-aortic nodes was 17 (range, 10-25); the median operative time was 204 minutes (range, 120-300 minutes). The median hospital stay was 4 days (range, 3-6 days). No patient encountered postoperative complications. This study demonstrates the feasibility of single-port laparoscopic extraperitoneal para-aortic lymphadenectomy.
van der Linden, Yoen T. Kim
Nowadays laparoscopic surgery is the standard procedure for many abdominal diseases. Compared with open surgery, laparoscopic surgery offers several advantages, such as reduction of postoperative pain, faster postoperative recovery and shorter admission times to the hospital. The continuous drive to
de Armas, Ismael A Salas; Garcia, Isabella; Pimpalwar, Ashwin
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
Gungor, Mete; Takmaz, Ozguc; Afsar, Selim; Ozbasli, Esra; Gundogan, Savas
To report the feasibility of bulky pelvic lymph node resection with robotic-assisted single-port laparoscopy in a patient with cervical cancer before chemoradiation therapy. Resection of pelvic bulky lymph nodes with a narrated video of da Vinci single-port platform surgery (Intuitive Surgical, Sunnyvale, CA) (Canadian Task Force classification III). Although not enough evidence exists to reveal that single-site surgery is better than traditional endoscopic surgery, several studies have suggested that single-site robotic surgery has certain advantages such as less postoperative analgesic use, shorter hospital stay, and quicker recovery. Furthermore, robotic single-site surgery has evolved single-site procedures. Compared with the single-port laparoendoscopic procedure, the robotic-assisted single-port laparoscopic procedure offers some advantages to minimally invasive surgery such as greater dexterity, 3-dimensional visualization, and fewer instrument clashes. These advantages make robotic single-port surgery more preferable; nevertheless, the lack of articulating instruments and the low quality of optical exposure are still challenges. Robotic single-port pelvic lymphadenectomy was first described by Tateo et al  in an endometrial carcinoma patient. We present a robotic single-port pelvic bulky lymph node resection in an advanced cervical cancer patient. Even though current data are controversial about removing bulky lymph nodes in patients with advanced cervical cancer, some studies have recommended that debulking of tumor-involved lymph nodes before chemoradiation may be benefical for these patients (Leblanc et al , Marnitz et al ). In our case, the patient underwent robotic-assisted single-port laparoscopy using the da Vinci Single-Site platform. The abdominal cavity was insufflated from a 3-cm umblical incision, and a 5-lumen single port was inserted. Then, an 8.5-mm 3-dimensional camera was inserted through the port, and for dissection and
Celioscopy; Band-aid surgery; Pelviscopy; Gynecologic laparoscopy; Exploratory laparoscopy - gynecologic ... such as appendectomy , removing lymph nodes) After the laparoscopy, the carbon dioxide gas is released, and the ...
Dávila, Fausto; Tsin, Daniel; González, Gloria; Dávila, M Ruth; Lemus, José; Dávila, Ulises
The usefulness of percutaneous needles (PN) to replace traditional assistance ports in mini-invasive techniques with a single port is analyzed and their feasibility for conducting a single port laparoscopic cholecystectomy (SPLC) is demonstrated. A retrospective, linear and descriptive study covering 2,431 patients with a diagnosis of acute and non-acute gallbladder disease has been conducted. The patients underwent a single port laparoscopic cholecystectomy using some type of PNs, replacing the assisting ports used in traditional laparoscopic cholecystechtomy (TLC). Based on the progressive use of PNs-reins (R), hooked needles (HN) and passing suture needles (PSN)-to carry out the SPLC technique, 3 groups have been established: A, B and C. The results were compared using a Student T test, odds ratio and CI and were analyzed by means of the SPSS software v. 13.0. The use of PNs showed an increased feasibility for the laparoscopic procedure, as they were included in the surgical technique. The R were useful when carrying out the SPLC in 78% of the cases and when the HK were added, the results increased to 88%. When using the 3 types (R, HN and PSN), the results increased by 96%. Statistical significance was obtained with these values: chi 2=67.13 and P<.001; odds ratio and 95% CI became significant when comparing the B/C, A/C, and A-B/C groups. The PNs, replacing the assisting ports in laparoscopy, make it possible to attain a feasibility of the process in 96% of the cases. This percentage was similar to what is achieved with the TLC, which places the one port laparoscopy surgery technique as an advantageous and economic alternative. This application of the PNs could be made extensive to other single-port techniques, with a multi-valve platform and natural orifice surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.
Hompes, R; Lindsey, I; Jones, O M; Guy, R; Cunningham, C; Mortensen, N J; Cahill, R A
The cost associated with single-port laparoscopic access devices may limit utilisation of single-port laparoscopic surgery by colorectal surgeons. This paper describes a simple and cheap access modality that has facilitated the widespread adoption of single-port technology in our practice both as a stand-alone procedure and as a useful adjunct to traditional multiport techniques. A surgical glove port is constructed by applying a standard glove onto the rim of the wound protector/retractor used during laparoscopic resectional colorectal surgery. To illustrate its usefulness, we present our total experience to date and highlight a selection of patients presenting for a range of elective colorectal surgery procedures. The surgical glove port allowed successful completion of 25 single-port laparoscopic procedures (including laparoscopic adhesiolysis, ileo-rectal anastomosis, right hemicolectomy, total colectomy and low anterior resection) and has been used as an adjunct in over 80 additional multiport procedures (including refashioning of a colorectal anastomosis made after specimen extraction during a standard multiport laparoscopic anterior resection). This simple, efficient device can allow use of single-port laparoscopy in a broader spectrum of patients either in isolation or in combination with multiport surgery than may be otherwise possible for economic reasons. By separating issues of cost from utility, the usefulness of the technical advance inherent within single-port laparoscopy for colorectal surgery can be better appreciated. We endorse the creative innovation inherent in this approach as surgical practice continues to evolve for ever greater patient benefit.
Full Text Available Stefano Angioni,1 Alessandro Pontis,1 Federica Sedda,1 Theodoros Zampetoglou,2 Vito Cela,3 Liliana Mereu,4 Pietro Litta51Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; 2Obstetrics and Gynecology, Iaso Thessalia Hospital, Larissa, Greece; 3Department of Obstetrics and Gynecology, University of Pisa, Pisa, 4Ospedale S Chiara, Trento, 5Department of Obstetrics and Gynecology, University of Padua, Padua, ItalyAbstract: Bilateral salpingo-oophorectomy (BSO in carriers of BRCA1 and BRCA2 mutations is widely recommended as part of a risk-reduction strategy for ovarian or breast cancer due to an underlying genetic predisposition. BSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. BSO may be performed via a minimally invasive approach with the use of three to four 5 mm and/or 12 mm ports inserted through a skin incision. To further reduce the morbidity associated with the placement of multiple port sites and to improve cosmetic outcomes, single-port laparoscopy has been developed with a single access point from the umbilicus. The purpose of this study was to evaluate the surgical outcomes associated with reducing the risks of salpingo-oophorectomy performed in a single port, while comparing multiport laparoscopy in women with a high risk for ovarian cancer. Single-port laparoscopy–BSO is feasible and safe, with favorable surgical and cosmetic outcomes when compared to conventional laparoscopy.Keywords: prophylactic salpingectomy, single-port access laparoscopy, BRCA carriers
Nam, Eun Ji; Kim, Sang Wun; Lee, Maria; Yim, Ga Won; Paek, Ji Heum; Lee, San Hui; Kim, Sunghoon; Kim, Jae Hoon; Kim, Jae Wook; Kim, Young Tae
Objective To evaluate the feasibility of robotic single-port transumbilical total hysterectomy using a home-made surgical glove port system. Methods We retrospectively reviewed the medical records of patients who underwent robotic single-port transumbilical total hysterectomy between January 2010 and July 2010. All surgical procedures were performed through a single 3-4-cm umbilical incision, with a multi-channel system consisting of a wound retractor, a surgical glove, and two 10/12-mm and t...
Single port laparoscopy is a relatively new niche in the expanding spectrum of minimal access surgery for colorectal disease. To date the published experience has predominantly focused on planned operations for neoplasia in the elective setting. It seems probable however that the benefits of minimal abdominal wounding will be greatest among those patients with the highest risk of impaired wound healing. Combining this with the impression of improved cosmesis suggests that (the mostly young) patients with inflammatory bowel disease needing urgent operation are the most likely to appreciate and benefit from the extraoperative effort. The extension of single port surgery to the acute setting and for debilitated individuals is therefore a likely next step advance in broadening the category of patients for whom it represents a real benefit and ultimately aid in focusing by selection the subgroups for whom this technique is best suited and most appropriate. We describe here our approach (including routine use of a surgical glove port) to patients presenting for urgent colorectal operation for benign disease. As provision of specialized approaches regardless of timing or mode of presentation is a defining component of any specialty service, this concept will soon be more fully elucidated and established.
Morales-Conde, Salvador; Del Agua, Isaías Alarcón; Moreno, Antonio Barranco; Macías, María Socas
Laparoscopic approach is the gold standard for surgical treatment of morbid obesity. The single-port (SP) approach has been demonstrated to be a safe and effective technique for the treatment of morbid obesity in several case control studies. Compare conventional multiport laparoscopy (LAP) with an SP approach for the treatment of morbid obesity using sleeve gastrectomy in terms of postoperative pain using a visual analog scale (VAS) 0-100, surgical outcome, weight loss, and aesthetical satisfaction at 6 months after surgery. University Hospital, Spain. Randomized, controlled pilot study. The trial enrolled patients suitable for bariatric surgery, with a body mass index lower than 50 kg/m 2 and xiphoumbilical distance lower than 25 cm. Patients were randomly assigned to receive LAP or SP sleeve gastrectomy. A total of 30 patients were enrolled; 15 were assigned to LAP group and 15 to SP group. No patients were lost during follow-up. Baseline characteristics were similar in both groups. A significantly higher level of pain during movement was noted for the patients in the LAP group on the first (mean VAS 49.3±12.2 versus 34.1±8.9, P = .046) and second days (mean VAS 35.9±10.2 versus 22.1±7.9, P = .044) but not the third day (mean VAS 20.1±5.2 versus 34.12.9 ±4.3, P = .620). No differences regarding pain at rest, operative time, complications, or weight loss at 6 months were observed. Higher aesthetical satisfaction was noticed in SP group. In selected patients, SP surgery presented less postoperative pain in sleeve gastrectomy compared with the conventional laparoscopic approach with similar surgical results. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Paul Anthony Karam
Full Text Available Transumbilical laparoscopic assisted appendectomy combines laparoscopic single port dissection with open appendectomy after exteriorization of the appendix through the port site. Compared to the conventional three-port approach, this technique provides an alternative with excellent cosmetic outcome. We developed a safe and effective technique to perform an intracorporeal single port appendectomy, using the same laparoscope employed in the extracorporeal procedure. Retrospective review of 71 consecutively performed intracorporeal single port appendectomies and 30 conventional three-port appendectomies in children 6 to 17 years of age. A straight 10-mm Storz telescope with inbuilt 6 mm working channel is used to dissect the appendix, combined with one port-less 2.3 mm percutaneous grasper. Polymer WECK® hem-o-lock® clips are applied to seal the base of the appendix and the appendiceal vessels. No intraoperative complications were reported with the hybrid intracorporeal single port appendectomy or three-port appendectomy. There were two post-operative complications in the group treated with the single port hybrid technique: one intra-abdominal abscess and one surgical site infection. Groups did not differ in age, weight, and types of appendicitis. Operative times were shorter for the hybrid technique (70 vs 79 minutes but did not differ significantly (P=0.19. This modified technique to a previously described single port extracorporeal appendectomy is easy to master and implement. It provides exposure similar to a three-port laparoscopic appendectomy, while maintaining virtually scarless results and potentially reduces the risk for surgical site infections compared to the extracorporeal technique.
Full Text Available Fertility preservation in early-stage cervical cancer is a hot topic in gynecologic oncology. Although radical vaginal trachelectomy (RVT is suggested as a fertility preserving approach, there are some serious concerns like cervical stenosis, second trimester loss, preterm delivery in survivors, and lack of residual tumor in the majority of the surgical specimens. Therefore, less radical surgical operations have been proposed in early-stage cervical carcinomas. On the other hand, single-incision laparoscopic surgery (SILS is an evolving endoscopic approach for minimal access surgery. In this report, we present a case with early-stage cervical cancer who wishes to preserve fertility. We successfully performed single-port pelvic lymphadenectomy and large conization to preserve fertility potential of the patient. We think that combination of less radical approach like conization and single-port pelvic lymphadenectomy might be less minimally invasive and is still an effective surgical approach in well-selected cases with cervical carcinomas. Incorporation of single-port laparoscopy into the minimally invasive fertility sparing management of the cervical cancer will improve patients outcome with less complications and better cosmesis. Further studies are needed to reach a clear conclusion.
Lukovich, Peter; Sionov, Valery Ben; Kakucs, Timea
Lately single-port surgery is becoming a widespread procedure, but it is more difficult than conventional laparoscopy owing to the lack of triangulation. Although, these operations are also possible with standard laparoscopic instruments, curved instruments are being developed. The aims of the study were to identify the effect of training on a box trainer in single-port setting on the quality of acquired skills, and transferred with the straight and curved instruments for the basic laparoscopic tasks, and highlight the importance of a special laparoscopic training curriculum. A prospective study on a box trainer in single-port setting was conducted using 2 groups. Each group performed 2 tasks on the box trainer in single-port setting. Group-S used conventional straight laparoscopic instruments, and Group-C used curved laparoscopic instruments. Learning curves were obtained by daily measurements recorded in 7-day sessions. On the last day, the 2 groups changed instruments between each other. 1st Department of Surgery, Semmelweis University of Medicine from Budapest, Hungary, a university teaching hospital. In all, 20 fifth-year medical students were randomized into 2 groups. None of them had any laparoscopic or endoscopic experience. Participation was voluntary. Although Group-S performed all tasks significantly faster than Group-C on the first day, the difference proved to be nonsignificant on the last day. All participants achieved significantly shorter task completion time on the last day than on the first day, regardless of the instrument they used. Group-S showed improvement of 63.5%, and Group-C 69.0% improvement by the end of the session. After swapping the instruments, Group-S reached significantly higher task completion time with curved instruments, whereas Group-C showed further progression of 8.9% with straight instruments. Training with curved instruments in a single-port setting allows for a better acquisition of skills in a shorter period. For this
Marcel Autran Cesar MACHADO
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.
Lolle, Ida; Rosenstock, Steffen; Bulut, Orhan
INTRODUCTION: Single-port laparoscopic surgery (SPLS) for colonic disease has been widely described, whereas data for SPLS rectal resection are sparse. This review aimed to evaluate the feasibility, safety and complication profile of SPLS for rectal diseases. METHODS: A systematic literature search...
... cavity. These complications could lead to immediate open surgery ( laparotomy ). Diagnostic laparoscopy may not be possible if you have a swollen bowel, fluid in the abdomen (ascites), or you have had a past surgery.
Singh, Satwinder; Cheung, Jo L. K.; Sreedhar, Biji; Hoa, Xuyen Dai; Ng, Hoi Pang; Yeung, Chung Kwong
In this paper, a novel robot-assisted platform for single-port minimally invasive surgery is presented. A miniaturized seven degrees of freedom (dof) fully internalized in-vivo actuated robotic arm is designed. Due to in-vivo actuation, the system has a smaller footprint and can generate 20 N of gripping force. The complete work envelop of the robotic arms is 252 mm × 192 mm × 322 m. With the assistance of the cannula-swivel system, the robotic arms can also be re-positioned and have multi-quadrant reachability without any additional incision. Surgical tasks, such as lifting, gripping suturing and knot tying that are commonly used in a standard surgical procedure, were performed to verify the dexterity of the robotic arms. A single-port trans-abdominal cholecystectomy in a porcine model was successfully performed to further validate its functionality.
Nerup, Nikolaj; Rosenstock, Steffen; Bulut, Orhan
BACKGROUND: Within the last two decades, surgical treatment of colorectal cancer has changed dramatically from large abdominal incisions to minimal access surgery. In the recent years, single port (SP) surgery has spawned from conventional laparoscopic surgery. The purpose of this study was to co......BACKGROUND: Within the last two decades, surgical treatment of colorectal cancer has changed dramatically from large abdominal incisions to minimal access surgery. In the recent years, single port (SP) surgery has spawned from conventional laparoscopic surgery. The purpose of this study...... was to compare conventional with SP laparoscopic abdominoperineal resection (LAPR) for rectal cancer. PATIENTS AND METHODS: This was a single-center non-randomised retrospective comparative study of prospectively collected data on 53 patients who underwent abdominoperineal resection for low rectal cancer; 41...
Sulz, Michael C; Zerz, Andreas; Sagmeister, Markus; Roll, Thomas; Meyenberger, Christa
Few data are available regarding patients' perceptions of new cholecystectomy (CC) techniques, in the context of the patients' risk behaviours. We investigated patients' preferences for transgastric pure natural orifice translumenal endoscopic surgery (NOTES; transgastric NCC) and rigid-hybrid transvaginal NOTES CC (tvNCC) compared with the standard laparoscopic CC (SL-CC), and patients' risk behaviours. A total of 140 inpatients scheduled for elective laparoscopic CC were enrolled in this prospective single-centre study, from January 2009 to January 2010. Patients judged the potential advantages and disadvantages of transgastric NCC and tvNCC compared with SL-CC. The individual's risk behaviour was analysed by means of the validated 40-item Domain-Specific Risk Attitude Scale (DOSPERT). Of the 140 recruited patients, 57 (65% females; mean age 51.5 years) were analysed. Twenty-five percent of males opted for transgastric NCC and 75% opted for SL-CC. Among females, 10.8%, 37.8% and 51.4% opted for transgastric NCC, tvNCC and SL-CC, respectively. Faster convalescence was graded as the primary potential advantage of transgastric NCC, whereas the potential risk of long-term stomach injuries was considered a primary disadvantage. Females graded the reduction of hospital-acquired morbidity as the primary advantage of tvNCC. The risk assessment showed significantly more risk-taking behaviour in the recreational domain of life among patients who opted for innovative surgical techniques than among those opting for conventional surgery. Transgastric NCC is rarely accepted by females but accepted by a quarter of males. Females consider rigid-hybrid tvNCC and SL-CC similarly attractive. Despite promising new techniques, three-quarters of male and one half of female patients still prefer the standard laparoscopic CC.
All the case notes of patients that had diagnostic laparoscopy during the stated period were retrieved and analyzed. Results: A total of 975 gynaecological ... The mean duration of hospital stay was 1.9 ±0.9days, making our laparoscopy, therefore, not completely an outpatient procedure. Conclusion: Diagnostic laparoscopy ...
Lolle, Ida; Rosenstock, Steffen; Bulut, Orhan
INTRODUCTION: Single-port laparoscopic surgery (SPLS) for colonic disease has been widely described, whereas data for SPLS rectal resection are sparse. This review aimed to evaluate the feasibility, safety and complication profile of SPLS for rectal diseases. METHODS: A systematic literature search.......5%. Length of hospital stay was 1-16 days. No 30-day mortality was reported. CONCLUSION: Short-term results suggest that SPLS for rectal disease is feasible and safe with an acceptable complication rate when performed by experienced surgeons in selected patients. Oncological safety and the possible benefits......-term oncological outcome and early complication profile. RESULTS: No randomised studies or controlled clinical studies were identified. All studies were case series or case reports. Only five studies included more than ten patients operated with SPLS, comprising a total of 120 patients. These studies formed...
Lolle, Ida; Rosenstock, Steffen; Bulut, Orhan
.5%. Length of hospital stay was 1-16 days. No 30-day mortality was reported. CONCLUSION: Short-term results suggest that SPLS for rectal disease is feasible and safe with an acceptable complication rate when performed by experienced surgeons in selected patients. Oncological safety and the possible benefits......INTRODUCTION: Single-port laparoscopic surgery (SPLS) for colonic disease has been widely described, whereas data for SPLS rectal resection are sparse. This review aimed to evaluate the feasibility, safety and complication profile of SPLS for rectal diseases. METHODS: A systematic literature search...... of PubMed and Embase was performed in September 2013 according to the PRISMA guidelines. Original reports on the use of SPLS in high and low anterior resection, Hartmann's operation and abdominoperineal resection were included. Outcome measures were intra-operative details and complications, short...
Conway, Nathan E; Romanelli, John R; Bush, Ron W; Seymour, Neal E
Single-port laparoscopic surgery imposes unique psychomotor challenges. We used surgical simulation to define performance differences between surgeons with and without single-port clinical experience and examined whether a short course of training resulted in improved performance. Study participants were assigned to 3 groups: resident group (RES), experienced laparoscopic surgeons with (SP) and without (LAP) prior single-port laparoscopic experience. Participants performed the Fundamentals of Laparoscopic Surgery precision cutting task on a ProMIS trainer through conventional ports or with articulating instruments via a SILS Port (Covidien, Inc). Two iterations of each method were performed. Then, 6 residents performed 10 successive single-port iterations to assess the effect of practice on task performance. The SP group had faster task times for both laparoscopic (P = .0486) and single-port (P = .0238) methods. The LAP group had longer path lengths for the single-port task than for the laparoscopic task (P = .03). The RES group was slower (P = .0019), with longer path length (P = .0010) but with greater smoothness (P = .0186) on the single-port task than the conventional laparoscopic task. Resident performance task time (P = .005) and smoothness (P = .045) improved with successive iterations. Our data show that surgeons with clinical single-port surgery experience perform a simulated single-port surgical task better than inexperienced single-port surgeons. Furthermore, this performance is comparable to that achieved with conventional laparoscopic techniques. Performance of residents declined dramatically when confronted with the challenges of the single-port task but improved with practice. These results suggest a role for lab-based single-port training.
Wang, Zhifeng; Xu, Le; Chen, Zhi; Yao, Cong; Su, Zexuan
The purpose of the study is to introduce our experience of a modified single-port minilaparoscopic technique for the treatment of pediatric hydrocele. Between June 2008 and May 2012, 279 boys (115 communicating hydrocele and 164 "non-communicating" hydrocele, diagnosis based on preoperative physical examination and scrotal ultrasound) underwent the modified single-port minilaparoscopic repair in our institution. During surgery, a 3-mm laparoscope was inserted into the abdomen through a mini-umbilical incision. The hydrocele sac orifice was closed by an extraperitoneal purse-string suture placed around the internal ring with an ordinary taper needle and an endoclose needle. Of all the 279 patients, 16 (5.7 %) were found to have a potential patent processus vaginalis (PPV) on the contralateral side. Of the 164 boys diagnosed with "non-communicating" hydrocele preoperatively, 5 (3.0 %) had no PPV identified in laparoscope and the other 159 (97.0 %) had PPV actually. A total of 274 single-port minilaparoscopic procedures were performed, and all cases were successful without serious complications. The mean operative time was 19.5 and 24.8 min for unilateral and bilateral operations, respectively. Postoperative complications were noted in 4 cases, 2 (0.7 %) patients with scrotal edema, 1 (0.4 %) patient experienced an umbilical hernia, and 1 (0.4 %) patient with suture site abscess. During a median follow-up period of 9 months (range 6-24 months), postoperative hydrocele recurrence was seen in 2 patients (0.7 %). This modified single-port minilaparoscopic technique is a safe, effective, and reliable procedure for pediatric hydroceles.
Weiss, Helmut; Zorron, R; Vestweber, K-H
patients undergoing single-port colorectal surgery were enrolled from 11 European centres between March 2010 and March 2014. Data were analysed to assess patient-, technique- and procedure-dependent parameters. A validated sex-adjusted risk chart was developed for prediction of single-port colorectal......BACKGROUND: The international multicentre registry ECSPECT (European Consensus of Single Port Expertise in Colorectal Treatment) was established to evaluate the general feasibility and safety of single-port colorectal surgery with regard to preoperative risk assessment. METHODS: Consecutive...
.... The doctrine on single port management is still evolving and not entirely written. With clearly defined responsibilities and accepted doctrine, our ability to support geographic commanders greatly improves...
Shrestha, J; Saha, R
Laparoscopy has a great role in early and effective diagnosis and treatment of ectopic pregnancy. This study was carried out to evaluate the feasibility and role of laparoscopy in diagnosis and treatment of ectopic pregnancy. This is a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital from April 2009 to March 2011. All the women who underwent laparoscopy for ectopic pregnancy or diagnosed as ectopic pregnancy during laparoscopy done for other diagnosis were included. Data were collected by interviewing patients, operating surgeons, reviewing charts and operative notes and following up patients. There were 42 cases of ectopic pregnancy during study period, of whom 16 (38.1%) underwent laparoscopy. Preoperative diagnosis of ectopic pregnancy was confirmed clinically in 6 (37.5%) patients, who underwent laparoscopy as an operative procedure. In the remaining 6 (37.5%), laparoscopy was performed as a diagnostic procedure as clinical diagnosis was doubtful; two cases of negative laparoscopy was noted. Incidental diagnosis of ectopic pregnancy was made in another 4 (25%) patients who had undergone laparoscopy for other pre operative diagnosis. All the patients were surgically managed by laparoscopy without converting it to laparotomy. There were no intraoperative or postoperative complications except for primary port infection in few (25%). Therefore, laparoscopy has a significant role in the diagnosis of ectopic pregnancy and operative laparoscopy is a safe approach with minimal complications.
Angelou, Anastasios; Skarmoutsos, Athanasios; Margonis, Georgios A; Moris, Demetrios; Tsigris, Christos; Pikoulis, Emmanouil
Minimally invasive techniques are used more and more frequently. Since conventional laparoscopic approach has been the gold standard, surgeons in their effort to further reduce the invasiveness of conventional laparoscopic cholecystectomy have adopted Single Incision approach. The widespread adoption of robotics has led to the inevitable hybridization of robotic technology with laparoendoscopic single-site surgery (LESS). As a result, employment of the da Vinci surgical system may allow greater surgical maneuverability, improving ergonomics. A review of the English literature was conducted to evaluate all robotic single port cholecystectomy performed till today. Demographic data, operative parameters, postoperative outcomes and materials used for the operation were collected and assessed. A total of 12 studies, including 501 patients were analyzed. Demographics and clinical characteristics of the patients was heterogeneous, but in most studies a mean BMI port cholecystectomy is a safe and feasible alternative to conventional multiport laparoscopic or manual robotic approach. However, current data do not suggest a superiority of robotic SILC over other established methods.
Full Text Available Objective To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB. Materials and Methods Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample. Results SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31. Conclusion SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy.
Estupinam, Oscar; Oliveira, André Lacerda de Abreu; Antunes, Fernanda; Galvão, Manoel; Phillips, Henrique; Scheffer, Jussara Peters; Rios, Marcelo; Zorron, Ricardo
To perform technically the laparoscopic sleeve gastrectomy (LSG) using a unique Intragastric Single Port (IGSG) in animal swine model, evidencing an effective and safe procedure, optimizing the conventional technique. IGSG was performed in 4 minipigs, using a percutaneous intragastric single port located in the pre-pyloric region. The gastric stapling of the greater curvature started from the pre-pyloric region towards the angle of His by Endo GIA™ system and the specimen was removed through the single port. In the postoperative day 30, the animals were sacrificed and submitted to autopsy. All procedures were performed without conversion, and all survived 30 days. The mean operative time was 42 min. During the perioperative period no complications were observed during invagination and stapling. No postoperative complications occurred. Post-mortem examination showed no leaks or infectious complications. Intragastric Single Port is a feasible procedure that may be a suitable alternative technique of sleeve gastrectomy for the treatment of morbid obesity.
Bulut, O; Aslak, K K; Levic, K
BACKGROUND: Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim...... of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances. METHODS: Patients with non-metastasized rectal cancer were prospectively randomized...... to single-port (n = 20) or conventional laparoscopic rectal surgery (n = 20). Postoperative pain was assessed at rest, at coughing and during mobilization, with a numeric pain ranking score and was recorded at 6 h after the operation and subsequently every morning daily for 4 days. Levels of C...
Rao, Prashanth P.; Bhagwat, Sonali M.; Rane, Abhay; Rao, Pradeep P.
Introduction. Laparoscopic cholecystectomy has become the gold standard for symptomatic cholelithiasis 1. Traditionally done through four ports, three and two port surgeries have been described. We present a novel technique of single port cholecystectomy using the R-PortR (Advanced Surgical Concepts). Materials and methods. The R-PortR is a Tri-port that allows the ingress of three 5 mm instruments through a single port. Twenty patients with symptomatic cholelithiasis were subjected to single...
Bulut, Orhan; Nielsen, Claus B; Jespersen, Niels
Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined.......Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined....
Camps Lasa, Judith; Cugat Andorrà, Esteban; Herrero Fonollosa, Eric; García Domingo, María Isabel; Sánchez Martínez, Raquel; Vargas Pierola, Harold; Rodríguez Campos, Aurora
New technological advances have enabled the development of single-port laparoscopic surgery. This approach began with cholecystectomy and subsequently with other abdominal surgeries. However, few publications on laparoscopic liver surgery have described the use of complete single-port access. We present our initial experience of a single-port laparoscopic hepatectomy. Between May 2012 and December 2013, 5 single-port laparoscopic hepatectomies were performed: one for benign disease and four for colorectal liver metastases. The lesions were approached through a 3-5 cm right supraumbilical incision using a single-port access device. All the lesions were located in hepatic segments II or III. Four left lateral sectorectomies and one left hepatectomy were performed. Median operative time was 135 min. No cases were converted to conventional laparoscopic or open surgery. The oral intake began at 18 h. There were no postoperative complications and no patients required blood transfusion. The median hospital stay was 3 days. The degree of satisfaction was very good in 4 cases and good in one. Patients resumed their normal daily activities at 8 days. Single-port laparoscopic hepatectomy is safe and feasible in selected cases and may reduce surgical aggression and offer better cosmetic results. Comparative studies are needed to determine the real advantages of this approach. Copyright © 2014 AEC. Published by Elsevier Espana. All rights reserved.
Full Text Available Abstract Acute abdominal pain is a leading symptom in many surgical emergency patients. Laparoscopy allows for accurate diagnosis and immediate therapy of many intraabdominal pathologies. The guidelines of the EAES (European Association for Endoscopic Surgery provides scientifically founded recommendations about the role of laparoscopy in the different situations. Generally, laparoscopy is well suited for the therapy of the majority of diseases that cause acute abdominal pain.
Arezzo, Alberto; Passera, Roberto; Bullano, Alberto; Mintz, Yoav; Kedar, Asaf; Boni, Luigi; Cassinotti, Elisa; Rosati, Riccardo; Fumagalli Romario, Uberto; Sorrentino, Mario; Brizzolari, Marco; Di Lorenzo, Nicola; Gaspari, Achille Lucio; Andreone, Dario; De Stefani, Elena; Navarra, Giuseppe; Lazzara, Salvatore; Degiuli, Maurizio; Shishin, Kirill; Khatkov, Igor; Kazakov, Ivan; Schrittwieser, Rudolf; Carus, Thomas; Corradi, Alessio; Sitzman, Guenther; Lacy, Antonio; Uranues, Selman; Szold, Amir; Morino, Mario
Single-port laparoscopic surgery as an alternative to conventional laparoscopic cholecystectomy for benign disease has not yet been accepted as a standard procedure. The aim of the multi-port versus single-port cholecystectomy trial was to compare morbidity rates after single-access (SPC) and standard laparoscopy (MPC). This non-inferiority phase 3 trial was conducted at 20 hospital surgical departments in six countries. At each centre, patients were randomly assigned to undergo either SPC or MPC. The primary outcome was overall morbidity within 60 days after surgery. Analysis was by intention to treat. The study was registered with ClinicalTrials.gov (NCT01104727). The study was conducted between April 2011 and May 2015. A total of 600 patients were randomly assigned to receive either SPC (n = 297) or MPC (n = 303) and were eligible for data analysis. Postsurgical complications within 60 days were recorded in 13 patients (4.7 %) in the SPC group and in 16 (6.1 %) in the MPC group (P = 0.468); however, single-access procedures took longer [70 min (range 25-265) vs. 55 min (range 22-185); P < 0.001]. There were no significant differences in hospital length of stay or pain VAS scores between the two groups. An incisional hernia developed within 1 year in six patients in the SPC group and in three in the MPC group (P = 0.331). Patients were more satisfied with aesthetic results after SPC, whereas surgeons rated the aesthetic results higher after MPC. No difference in quality of life scores, as measured by the gastrointestinal quality of life index at 60 days after surgery, was observed between the two groups. In selected patients undergoing cholecystectomy for benign gallbladder disease, SPC is non-inferior to MPC in terms of safety but it entails a longer operative time. Possible concerns about a higher risk of incisional hernia following SPC do not appear to be justified. Patient satisfaction with aesthetic results was greater after SPC than after
Kim, Ho Goon; Ryu, Seong Yeob; Kim, Dong Yi
Recently, minimize incisions has led to a reduction in the number of ports, and has led to transumbilical single-port surgery. We evaluated the treatment result of single-port, intragastric, full thickness resections for gastric SMTs. In addition, we introduce a novel intracorporeal knot tying method. From August 2010 to March 2011, five patients underwent single-port intragastric, full thickness gastric wedge resections. After performing a gastrostomy, a single port was inserted into the stomach. After full thickness resection, the defect in the gastric wall was sutured by full thickness interrupted suture and a new knot tying technique. The mean operative time was 129 ± 21.0 min and the mean mass size was 3.0±0.6 cm. There were two very low-risk GISTs, 2 leiomyomas, and 1 carcinoid. The post-operative course was uneventful in all patients. The mean hospital stay was 7.2±1.2 days. Single-port intra-gastric full thickness resection with novel intracorporeal knot tying method is feasible and safe. novel intracorporeal knot tying method is a very useful knot tying method. We expect the application of novel intracorporeal knot tying method to be diverse and broad.
The aim of this study was to demonstrate the feasibility of a total hysterectomy performed entirely by transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Conventional, reusable laparoscopic instruments were used, inserted through an inexpensive, self-constructed single-port device. Ten total vaginal NOTES hysterectomies (TVNHs) were performed by a single surgeon. The self-constructed single-port device was made by assembling a surgical glove, a wound protector or modified laryngeal mask airway, 1 reusable 10-mm trocar, and 4 reusable 5-mm trocars. This gloveport was inserted into the vagina to create a pneumovagina. The conventional steps of a vaginal hysterectomy were followed, but performed endoscopically with standard reusable endoscopic instruments. The patient and perioperative data were analyzed. No conversion to standard laparoscopy or laparotomy was necessary in any of the 10 patients who underwent a TVNH. Mean operation time was 97 min (range: 60-120); mean drop in hemoglobin level was 1.5 g/dL (range: 0.5-2.4). There were no operative complications, and postoperative pain scores were very low. This first report on a small number of patients demonstrates that TVNH is possible. By incorporating the advantages of endoscopic surgery, TVNH broadens the indications for vaginal hysterectomy and helps overcome its limitations. At the same time, the NOTES approach avoids abdominal wall wounds and trocar-related complications. TVNH is feasible, even when performed with reusable, conventional laparoscopic instruments. This frugally innovative technique also enables surgeons to perform hysterectomies by vNOTES in low resource settings. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
Lauritsen, Morten; Bulut, O
Single-port access (SPA) laparoscopic surgery is emerging as an alternative to conventional laparoscopic and open surgery, although its benefits still have to be determined. We present the case of a 87-year-old woman who underwent abdominoperineal resection (APR) with SPA. The abdominal part...
Horeman, Tim; Sun, Siyu; Tuijthof, Gabrielle J. M.; Jansen, Frank William; Meijerink, Jeroen W. J. H. J.; Dankelman, Jenny
Laparoscopic single-port (SP) surgery uses only a single entry point for all instruments. The approach of SP has been applied in multiple laparoscopic disciplines owing to its improved cosmetic result. However, in SP surgery, instrument movements are further restricted, resulting in increased
Levic, Katarina; Bulut, Orhan
BACKGROUND: Single-port laparoscopic surgery (SPLS) has evolved as an alternative method to conventional laparoscopic surgery (CLS). The aim of this study is to evaluate the results of SPLS compared to CLS in the treatment of rectal cancer. MATERIAL AND METHODS: Prospectively collected data...
Choi, Byung Jo; Jeong, Won Jun; Kim, Say-June; Lee, Sang Chul
To report our experience with solo-surgeon, single-port laparoscopic anterior resection (solo SPAR) for sigmoid colon cancer. Data from sigmoid colon cancer patients who underwent anterior resections (ARs) using the single-port, solo surgery technique (n = 31) or the conventional single-port laparoscopic technique (n = 45), between January 2011 and July 2016, were retrospectively analyzed. In the solo surgeries, making the transumbilical incision into the peritoneal cavity was facilitated through the use of a self-retaining retractor system. After establishing a single port through the umbilicus, an adjustable mechanical camera holder replaced the human scope assistant. Patient and tumor characteristics and operative, pathologic, and postoperative outcomes were compared. The operative times and estimated blood losses were similar for the patients in both treatment groups. In addition, most of the postoperative variables were comparable between the two groups, including postoperative complications and hospital stays. In the solo SPAR group, comparable lymph nodes were attained, and sufficient proximal and distal cut margins were obtained. The difference in the proximal cut margin significantly favored the solo SPAR, compared with the conventional AR group (P = .000). This study shows that solo SPAR, using a passive camera system, is safe and feasible for use in sigmoid colon cancer surgery, if performed by an experienced laparoscopic surgeon. In addition to reducing the need for a surgical assistant, the oncologic requirements, including adequate margins and sufficient lymph node harvesting, could be fulfilled. Further evaluations, including prospective randomized studies, are warranted.
Tei, Mitsuyoshi; Suzuki, Yozo; Wakasugi, Masaki; Akamatsu, Hiroki
To compare the perioperative and short-term oncological outcomes of patients who underwent single-port surgery (SPS) with those of patients who underwent multi-port surgery (MPS) for transverse colon cancer. The records of consecutive patients who underwent SPS (n = 75) or MPS (n = 41) for transverse colon cancer in our department between January, 2008 and December, 2015 were analyzed retrospectively. Operative times were significantly shorter in the SPS group than in the MPS group (185 vs. 195 min, respectively; P = 0.043). There were no significant differences in operative procedures, blood loss, or extent of lymph node dissection. The rate of postoperative complications was similar in both groups, but the length of hospital stay was significantly shorter in the single-port group than in the multi-port group (8 vs. 11 days, respectively; P transverse colon cancer.
Henrique Neubarth Phillips
Full Text Available Background: Single-port unilateral axillary thyroidectomy has great potential to become a valid alternative technique for thyroid surgery. We tested the technique in a study on live animals and cadavers to evaluate the feasibility and reproducibility of the procedure. Materials and Methods: Institutional review board (IRB approval was obtained in our university by the Council of Ethics for the study in surviving animals and cadavers. Subtotal thyroidectomy using unilateral axillary single port was performed in five dogs and five cadavers. Performing incision in the axillary fossa, a disposable single port was inserted. The dissection progressed for creating a subcutaneous tunnel to the subplatysmal region; after opening the platysma muscle and separation of the strap muscles, the thyroid gland was identified. After key anatomical landmarks were identified, the dissection was started at the upper pole towards the bottom, and to the isthmus. Specimens were extracted intact through the tunnel. Clinical and laboratorial observations of the experimental study in a 15-day follow-up and intraoperative data were documented. Results: All surgeries were performed in five animals which survived 15 days without postoperative complications. In the surgeries successfully performed in five cadavers, anatomical landmarks were recognised and intraoperative dissection of recurrent nerves and parathyroid glands was performed. Mean operative time was 64 min (46-85 min in animals and 123 min (110-140 min in cadavers, with a good cosmetic outcome since the incision was situated in the axillary fold. Conclusion: The technique of single-port axillary unilateral thyroidectomy was feasible and reproducible in the cadavers and animal survival study, suggesting the procedure as an alternative to minimally invasive surgery of the neck.
Full Text Available Background: In 1990, Ramirez introduced a new procedure to close abdominal wall hernia (AWH, called "components separation technique (CST". Thanks to endoscopy, surgical repair possibilities have risen, reducing the operative trauma and preserving vascular and neuronal anatomical structures. This report aims to describe a single port endoscopic approach for CST to repair the abdominal wall of a patient undergoing surgery for abdominal aneurysm and already subject to placement of a mesh for AWH. Methods: We performed endoscopic-assisted CST, using a single-port access with a gasless technique. Conclusion: CST is a useful procedure to close large abdominal wall incisional hernia avoiding the use of mesh, notably under contamination, when prosthetic material use is contraindicated. The endoscopic-assisted CST produces same results than the conventional open separation technique and also minimised tissue trauma that ensures blood supply and prevents postoperative wounds complications. The described single port method was found to be safe and effective to close large midline abdominal hernias when a primary open or laparoscopic closure is not feasible or when patients have been previously treated with abdominal meshes.
Abdominal laparoscopy is a useful aid in diagnosing disease or trauma in the abdominal cavity with less scarring than ... as liver and pancreatic resections may begin with laparoscopy to exclude the presence of additional tumors (metastatic ...
Considering how much attention people lavish on the technologies of writing--scroll, codex, print, screen--it's striking how little they pay to the technologies for digesting and regurgitating it. One way or another, there's no sector of the modern world that is not saturated with note-taking--the bureaucracy, the liberal professions, the…
Monkhouse, S J W; Court, E L; Beard, L A; Bunni, J; Burgess, P
This study was designed to assess the satisfaction or otherwise of a proportion of the U.K. population who have undergone standard four-port laparoscopic cholecystectomy within the past 18 months. The results should indicate whether there is potential demand for a new, improved approach to surgery. Patients who underwent laparoscopic cholecystectomy between October 2008 and October 2009 in two geographically separated general hospitals were identified from hospital databases. Notes were reviewed to confirm the technique and lack of conversion to an open procedure. Those who had immediate complications were excluded. A telephone questionnaire was conducted to answer questions related to long-term cosmetic and general satisfaction of the current procedure. Of the patients surveyed, 93% were happy or extremely happy with the current procedure, 48% experienced some wound-related issues (pain, infection), and 65% of those were at the umbilicus (a possible reflection of location and retrieval site for gallbladder). Cosmesis was rated less important than hospital cleanliness and experience of the surgeon. Overall satisfaction was high with the existing technique. The high rate of umbilical wound problems is an issue that will not be eradicated by introduction of single-port laparoscopic surgery.
distal pancreatectomy has been advised. Laparoscopy has been successfully used both in acute and delayed distal pancreatectomies following trauma. It has been reported that magnification obtained through laparoscopic camera allows excellent identification of vessels and dissection of pancreas from splenic artery and ...
Ozden, Burcu Celet; Agcaoglu, Orhan; Kecer, Mustafa; Ozmen, Vahit; Muslumanoglu, Mahmut; Igci, Abdullah
Abstract Purpose: Single-incision videoendoscopic surgery has recently become popular as a result of the ongoing search for less invasive procedures. The aim of this study was to evaluate the safety and efficacy of endoscopic single-port nipple-sparing mastectomy, axillary lymphadenectomy, and immediate reconstruction in patients with breast cancer. Patients and Methods: From May 14, 2012 through January 23, 2013, 10 patients underwent videoendoscopic single-port nipple-sparing mastectomy and axillary dissection via a single, limited incision and immediate prosthetic reconstruction. Patient charts were reviewed, and demographic data, operative time, complications and pathology results were analyzed. Results: In all patients, videoendoscopic surgery was performed successfully. Of 10 patients, 7 were diagnosed as having invasive ductal carcinoma, 2 had a ductal carcinoma in situ, and 1 underwent bilateral prophylactic mastectomy. The weight of the resected gland was 300–650 g, with a mean of 420 g. There were no operative complications, and the mean operative time was 250 minutes (range, 160–330 minutes). One-stage reconstruction with implants was performed on 4 patients, whereas expanders were placed in the remaining 6. Surgical margins of all cases were pathologically negative, and there were no recurrences observed during the early follow-up period. Conclusions: Videoendoscopic single-port nipple-sparing mastectomy is technically feasible even in larger breasts, enabling immediate reconstruction with good cosmetic outcomes. However, further studies with larger clinical series and long-term follow-up are required to compare the safety and efficacy of the technique with those of the standard nipple-sparing mastectomy. PMID:24401140
Mota Filho, Francisco Hidelbrando Alves; Sávio, Luis Felipe; Sakata, Rafael Eiji; Ivanovic, Renato Fidelis; da Silva, Marco Antonio Nunes; Maia, Ronaldo; Passerotti, Carlo
Robot-Assisted Single Site Radical Nephrectomy (RASS-RN) has been reported by surgeons in Europe and United States (1-3). To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America. A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected. Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using na 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis. Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2). Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision. RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology. Copyright® by the International Brazilian Journal of Urology.
Francisco Hidelbrando Alves Mota Filho
Full Text Available ABSTRACT Introduction Robot-Assisted Single Site Radical Nephrectomy (RASS-RN has been reported by surgeons in Europe and United States (1–3. To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America. Case A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected. Results Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3 cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using an 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis. Discussion Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2. Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision. Conclusion RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology.
Şendağ, Fatih; Peker, Nuri; Aydeniz, Elif Ganime; Akdemir, Ali; Gündoğan, Savaş
To present the feasibility of single-port laparoscopic surgery at patients with deep infiltrating endometriosis. Step by step explanation of the surgery using videos (Canadian Task Force classification III-c). Single-port laparoscopic surgery is an emerging technique and an option for improving the benefits of laparoscopic surgery. The goals of single-port laparoscopic surgery is to further enhance the cosmetic benefits of minimally invasive surgery and minimize the potential risk and morbidity associated with multiport surgery [1,2]. This procedure is not without challenges, however, such as instrument crowding and clashing, ergonomic difficulties, loss of instrument triangulation, and the need for advanced laparoscopic skills [1,2]. Despite these challenges, technical advances in optics and instrumentation have led to the widespread use of single-port laparoscopic surgery to treat such gynecologic disorders as endometriosis, uterine myomas, and cancers [2,3]. A 42-year-old woman was admitted to our clinic with a complaint of chronic pelvic pain dysmenorrhea and deep dyspareunia. Her medical history revealed a cesarean section delivery and a diagnosis of endometriosis. Despite treatment of her endometriosis with dienogest, there has been no decline at her complaints. Ultrasound examination performed at admission revealed a 6 × 6 cm right adnexal mass compatible with endometrioma, with a normal left ovary and uterus. Rectovaginal examination detected no endometriotic nodules. Although all treatment options were explained and discussed and laparoscopic excision of right ovarian endometrioma was recommended, the patient strongly desired removal of the uterus and the ovaries to avoid recurrence of endometriosis and related complaints. Thus, laparoscopic hysterectomy and bilateral salpingo-oophorectomy were planned. Under general anesthesia and endotracheal intubation, the patient was placed in low lithotomy position with the arms tucked. An orogastric tube and a
Full Text Available Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previouslaparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.
Full Text Available Background: Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive - from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital. Materials and Methods: Prospective review of 37 hernias in 31 children (29 male and 2 female (8 months - 13 years performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV, complications, and cosmesis. Results: Sixteen right (52%, 14 left (45% and 1 bilateral hernia (3% were repaired. Five unilateral hernias (16.66%, all left, had a contralateral PPV that was repaired (P = 0.033. Mean operative time for a unilateral and bilateral repair were 13.20 (8-25 and 20.66 min (17 -27 min respectively. Only one of the repairs (2.7% recurred and another had a post operative hydrocoele (2.7%. One case (2.7% needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries. Conclusion: Single port laparoscopic inguinal hernia repair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The
Full Text Available A novel direction of arrival (DOA estimation technique that uses the conventional multiple-signal classification (MUSIC algorithm with periodic signals is applied to a single-port smart antenna. Results show that the proposed method gives a high-resolution (1 degree DOA estimation in an uncorrelated signal environment. The novelty lies in that the MUSIC algorithm is applied to a simplified antenna configuration. Only 1 analogue-to-digital converter (ADC is used in this antenna, which features low power consumption, low cost, and ease of fabrication. Modifications to the conventional MUSIC algorithm do not bring much additional complexity. The proposed technique is also free from the negative influence by the mutual coupling among antenna elements. Therefore, it offers an economical way to extensively implement smart antennas into the existing wireless mobile communications systems, especially at the power consumption limited mobile terminals such as laptops in wireless networks.
Borges, Marisa de Carvalho; Takeuti, Tharsus Dias; Terra, Guilherme Azevedo; Ribeiro, Betânia Maria; Rodrigues-Júnior, Virmondes; Crema, Eduardo
Surgical trauma triggers an important postoperative stress response characterized by significantly elevated levels of cytokines, an event that can favor the emergence of immune disorders which lead to disturbances in the patient's body defense. The magnitude of postoperative stress is related to the degree of surgical trauma. To evaluate the expression of pro-inflammatory (TNF-α, IFN-γ, IL-1β, and IL-17) and anti-inflammatory (IL-4) cytokines in patients submitted to conventional and single-port laparoscopic cholecystectomy before and 24 h after surgery. Forty women with symptomatic cholelithiasis, ranging in age from 18 to 70 years, participated in the study. The patients were divided into two groups: 21 submitted to conventional laparoscopic cholecystectomy and 19 to single-port laparoscopic cholecystectomy. Evaluation of the immune response showed no significant difference in IFN-γ and IL-1β levels between the groups or time points analyzed. With respect to TNF-α and IL-4, serum levels below the detection limit (10 pg/ml) were observed in the two groups and at the time points analyzed. Significantly higher postoperative expression of IL-17A was detected in patients submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels (p=0.0094). Significant postoperative expression of IL-17 was observed in the group submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels, indicating that surgical stress in this group was higher compared to the conventional laparoscopic cholecystectomy. O trauma cirúrgico induz resposta de estresse pós-operatório significativo, evidenciado pelos níveis elevados de citocinas, podendo favorecer o surgimento de distúrbios imunológicos. A magnitude de estresse está relacionada ao grau do trauma cirúrgico. Avaliar a expressão das citocinas pró-inflamatórias (TNF-α, IFN-γ, IL-1β, IL-17) e da anti-inflamatória (IL-4) no pré e pós-operatório de pacientes
Islam, M.A.; Julyk, J.L.; Weiner, E.O.
Jumper connectors are used in the Hanford site for remotely connecting jumper pipe lines in the radioactive zones. The jumper pipes are used for transporting radioactive fluids and hazardous chemicals. This report evaluates the adequacy and the integrity of the 2-, 3-, and 4-in. single-port integral seal block (ISB) jumper connector assemblies, as well as the three-way 2-in. configuration. The evaluation considers limiting forces from the piping to the nozzle. A stress evaluation of the jumper components (hook, hook pin, operating screw, nozzle and nozzle flange, and block) under operational (pressure, thermal, dead weight, and axial torquing of the jumper) and seismic loading is addressed in the report
Birck, Malene Muusfeldt; Vegge, Andreas; Moesgaard, S G
Oral dosing by gavage is often used to test compounds in minipigs. This method is also used for certain nutritional studies that require exact dosing. This procedure may be stressful for the animal and requires the assistance of more than one technician. We investigated whether a gastrostomy tube...... it was evident that the catheter had entered the stomach in the fundus region in 11/12 of the animals. In one animal the catheter had entered the antrum region. None of the animals developed leakage or clinically detectable reactions to the gastrostomy tube. Histopathologically, only discrete changes were...... observed. Single port laparoscopic tube gastrostomy with a locking pigtail catheter is safe, simple and reliable and is an appropriate alternative to, for example, percutaneous endoscopic gastrostomy, when long-term enteral delivery of pharmacological or nutritional compounds is needed. The use...
Islam, M A; Julyk, J L; Weiner, E O [ICF Kaiser Hanford Co., Richland, WA (United States)
Jumper connectors are used in the Hanford site for remotely connecting jumper pipe lines in the radioactive zones. The jumper pipes are used for transporting radioactive fluids and hazardous chemicals. This report evaluates the adequacy and the integrity of the 2-, 3-, and 4-in. single-port integral seal block (ISB) jumper connector assemblies, as well as the three-way 2-in. configuration. The evaluation considers limiting forces from the piping to the nozzle. A stress evaluation of the jumper components (hook, hook pin, operating screw, nozzle and nozzle flange, and block) under operational (pressure, thermal, dead weight, and axial torquing of the jumper) and seismic loading is addressed in the report.
Zhang, Chi; Hu, Xinhua
Metamaterials are engineered materials which exhibit fascinating properties unreachable by traditional materials. Here, we report on the design, fabrication, and experimental characterization of a three-dimensional single-port labyrinthine acoustic metamaterial. By using curled perforations with one end closed and with appropriate loss inside, the metamaterial can perfectly absorb airborne sounds in a low-frequency band. Both the position and the relative width of the band can be tuned flexibly. A trade-off is uncovered between the relative absorption bandwidth and thickness of the metamaterial. When the relative absorption bandwidth is as high as 51%, the requirement of deep-subwavelength thickness (0.07 λ ) can still be satisfied. We emphasize that the perfect absorption with large tunability in relative bandwidth (from 9% to >180 % ) was not attainable previously and may find applications ranging from noise reduction to sound imaging.
Kobayashi, Yo; Sekiguchi, Yuta; Tomono, Yu; Watanabe, Hiroki; Toyoda, Kazutaka; Konishi, Kozo; Tomikawa, Morimasa; Ieiri, Satoshi; Tanoue, Kazuo; Hashizume, Makoto; Fujie, Masaktsu G
Recently, a robotic system was developed to assist Single Port Endoscopic Surgery (SPS). However, the existing system required a manual change of vision field, hindering the surgical task and increasing the degrees of freedom (DOFs) of the manipulator. We proposed a surgical robot for SPS with dynamic vision field control, the endoscope view being manipulated by a master controller. The prototype robot consisted of a positioning and sheath manipulator (6 DOF) for vision field control, and dual tool tissue manipulators (gripping: 5DOF, cautery: 3DOF). Feasibility of the robot was demonstrated in vitro. The "cut and vision field control" (using tool manipulators) is suitable for precise cutting tasks in risky areas while a "cut by vision field control" (using a vision field control manipulator) is effective for rapid macro cutting of tissues. A resection task was accomplished using a combination of both methods.
Villalobos Mori, Rafael; Escoll Rufino, Jordi; Herrerías González, Fernando; Mias Carballal, M Carmen; Escartin Arias, Alfredo; Olsina Kissler, Jorge Juan
Laparoscopic appendectomy is probably the technique of choice in acute appendicitis. Single port laparoscopic surgery (SILS) has been proposed as an alternative technique. The objective of this study is to compare the safety and efficacy of SILS against conventional laparoscopic appendectomy (LA). From January 2011 to September 2012, 120 patients with acute appendicitis were prospectively randomized; 60 for SILS and 60 for LA. Patients between 15 to 65 years were selected, with onset of symptoms less than 48h. We compared BMI, surgery time, start of oral intake, hospital stay, postoperative pain, pathology and costs. The median age, BMI, sex and time of onset of symptoms to diagnosis were similar. There were no statistically significant differences in the operative time, start of oral intake or hospital stay. There was a significant difference in postoperative pain being higher in SILS (4±1.3) than in LA (3.3±0.5) with a P=.004. Flemonous appendicitis predominated in both groups in a similar percentage. A total of 3 cases with intra-abdominal abscess (SILS 2, LA 1) required readmission and resolved spontaneously with intravenous antibiotic treatment. One case of SILS required assistance by a 5mm trocar in the RLC for drainage placement. The cost was higher in SILS due the single port device. SILS appendectomy is safe, effective and has similar results to LA in selected patients, and although the cost is greater, the long term results will determine the future of this technique. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.
Felix C. Blanco
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.
Park, Jae Hyun; Kim, Soo Young; Lee, Cho-Rok; Park, Seulkee; Jeong, Jun Soo; Kang, Sang-Wook; Jeong, Jong Ju; Nam, Kee-Hyun; Chung, Woong Youn; Park, Cheong Soo
Posterior retroperitoneoscopic adrenalectomy (PRA) has several benefits compared with transperitoneal adrenalectomy in that it is safe and has a short learning curve. In addition, it provides direct short access to the target organ, prevents irritation to the intraperitoneal space, and does not require retraction of adjacent organs.1 (-) 3 We have performed several cases of robot-assisted PRA using single-port access for small adrenal tumors. This multimedia article introduces the detailed methods and preliminary results of this procedure. Five patients underwent single-port robot-assisted PRA between March 2010 and June 2011 at our institution. During the procedure, patients were placed in a prone jackknife position with their hip joints bent at a right angle (Fig. 1). A 3 cm transverse skin incision was made just below the lowest tip of the 12th rib (Fig. 2), and the Glove port (Nelis, Kyung-gi, Korea) was placed through the skin incision while maintaining pneumoretroperitoneum (Fig. 3). CO2 was then insufflated to a pressure of 18 mm Hg to create an adequate working space. A 10 mm robotic camera with a 30-degree up view was placed at the center of the incision through the most cephalic portion of the Glove port. A Maryland dissector or Prograsp forceps (Intuitive Surgical, Inc., Sunnyvale, CA) was placed on the medial side of the incision, and Harmonic curved shears (Intuitive Surgical) were placed on the lateral side of the incision (Fig. 4). Using the Maryland dissector and the harmonic curved shears, the Gerota fascia is opened, perinephric fat is dissected, and the kidney upper pole is mobilized to expose the adrenal gland (Fig. 5). Gland dissection starts with lower margin detachment from the upper kidney pole in a lateral to medial direction (Fig. 6). After dissecting the adrenal gland from surrounding adipose tissue and medial isolation of the adrenal central vein, the vessel is ligated with a 5 mm hemolock clip (Fig. 7). Patient
Uranues, Selman; Popa, Dorin Eugen; Diaconescu, Bogdan; Schrittwieser, Rudolph
If morbidity and mortality are to be reduced in patients with penetrating abdominal trauma, first priority goes to prompt and accurate determination of peritoneal penetration and identification of the need for surgery. In this setting, laparoscopy may have an important impact on the rate of negative or non-therapeutic laparotomies. We analyzed indications and patient selection criteria for laparoscopy in penetrating trauma along with outcomes. The analysis focused on identification of peritoneal penetration and injuries to the diaphragm, small intestine, and mesentery. Results from the early phase of laparoscopy were compared with those from recent decades with more advanced laparoscopic equipment and instruments and more experienced surgeons. A systematic review of the role of laparoscopy in penetrating abdominal trauma shows a sensitivity ranging from 66.7 to 100%, specificity from 33.3 to 100% and accuracy from 50 to 100%. Publications from the 1990s found trauma laparoscopy to be inadequate for detecting intestinal injuries and so to lead to missed injuries. Twenty-three of the 50 studies including the most recent ones report sensitivity, specificity, and accuracy of 100%. Laparoscopy is more cost effective than negative laparotomy. Laparoscopy can be performed safely and effectively on stable patients with penetrating abdominal trauma. The most important advantages are reduction of morbidity, accuracy in detecting diaphragmatic and intestinal injuries, and elimination of prolonged hospitalization for observation, so reducing the length of stay and increasing cost effectiveness.
Crouzet, Sebastien; Haber, Georges-Pascal; White, Wesley M; Kamoi, Kazumi; Goel, Raj K; Kaouk, Jihad H
To present our initial operative experience in which single-port-light endoscopic robot-assisted reconstructive and extirpative urological surgery was performed by one surgeon, using a pig model. This pilot study was conducted in male farm pigs to determine the feasibility and safety of single-port, single-surgeon urological surgery. All pigs had a general anaesthetic and were placed in the flank position. A 2-cm umbilical incision was made, through which a single port was placed and pneumoperitoneum obtained. An operative laparoscope was introduced and securely held using a novel low-profile robot under foot and/or voice control. Using articulating instruments, each pig had bilateral reconstructive and extirpative renal surgery. Salient intraoperative and postmortem data were recorded. Results were analysed statistically to determine if outcomes improved with surgeon experience. Five male farm pigs underwent bilateral partial nephrectomy and bilateral pyeloplasty before a completion bilateral radical nephrectomy. There were no intraoperative complications and there was no need for additional ports to be placed. The mean (range) operative duration for partial nephrectomy, pyeloplasty, and nephrectomy were 120 (100-150), 110 (95-130) and 20 (15-30) min, respectively. The mean (range) estimated blood loss for all procedures was 240 (200-280) mL. The preparation time decreased with increasing number of cases (P = 0.002). The combination of a single-port, a robotic endoscope holder and articulated instruments operated by one surgeon is feasible. With a single-port access, the robot allows more room to the surgeon than an assistant.
Imkamp, Florian; Herrmann, Thomas R W; Stolzenburg, Jens U; Rassweiler, Jens; Sulser, Tullio; Zimmermann, Uwe; Dziuba, Sebastian; Kuczyk, Markus A; Burchardt, Martin
Laparoscopy introduction has dramatically changed urology. Novel techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES), might also have substantial influence. This 2012 survey evaluated present laparoscopy use, its appraisal among urologic surgeons, laparoscopy training, and use of new techniques. Results were compared to the previous surveys, demonstrating the 10-year development of laparoscopy. A detailed questionnaire regarding demographic data, laparoscopy use, attitudes concerning laparoscopy, and novel techniques was send to 424 departments in Germany, Austria, and Switzerland. Procedures performed in 25 indications were quantitatively evaluated. The response rate was 63 % (269). Eighty-six percent of the respondents reported performing laparoscopy, compared to 54 % in 2002. Only 16 % expected economic advantages with laparoscopy, whereas 67 % expected shorter hospitalization. Seventy percent of responders anticipated comparable functional and oncological results between laparoscopic procedures and open surgery. Slow learning curves (81 %) and insufficient training facilities (32 %) were reported to impair laparoscopic surgery. On average, laparoscopic and non-laparoscopic surgical teams consisted of 2.5 and 3.5 members, respectively. LESS procedures were performed at 15 % of institutions. Twenty-two percent of respondents considered NOTES techniques valuable for future urology. Few indications (laparoscopic prostatectomies or nephrectomies) were performed frequently in specialized centers, and the rapidly increasing procedure numbers observed between 2002 and 2007 had dropped to a mild accretion. The results demonstrate broad acceptance of laparoscopy in German urologic surgery, depict the need for structured training facilities, and indicate limited impact of novel techniques (LESS and NOTES). The survey demonstrates the 10-year development of urologic laparoscopy and the broad acceptance
Angioni, Stefano; Pontis, Alessandro; Pisanu, Adolfo; Mereu, Liliana; Roman, Horace
The objective was to evaluate the perioperative outcomes, safety, and patient acceptance of single-port access laparoscopic subtotal hysterectomy (SPAL-SH) in comparison with conventional multiport access laparoscopic subtotal hysterectomy (MPAL-SH). Case-control study. Canadian Task Force Classification II-2. The study was conducted at university hospitals in Cagliari, Italy, and Rouen, France. Sixty-one women with metrorrhagia, abnormal uterine bleeding with uterine myomas, or symptomatic adenomyosis were included in the study. Thirty-one patients underwent SPAL-SH, and 30 patients underwent conventional MPAL-SH. We analyzed the data to compare the outcomes of SPAL-SH versus MPAL-SH. Patients in the SPAL-SH group had longer operative times than those in the MPAL-SH group (p < .001) but shorter hospital stays (p < .001). Postoperative pain immediately after surgery, after 6 hours, and after 24 hours were lower in the SPAL-SH group (p < .001). The SPAL-SH group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p < .01). We conclude that SPAL-SH is a feasible and safe alternative to standard MPAL-SH in selected patients. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. In addition, SPAL-SH has a definite benefit in relation to body image and cosmesis. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
Kandil, Emad; Noureldine, Salem I; Saggi, Bob; Buell, Joseph F
Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery. A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated. A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21-68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10-200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered. Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.
Bai, Weibang; Cao, Qixin; Leng, Chuntao; Cao, Yang; Fujie, Masakatsu G; Pan, Tiewen
Research into robotic systems for single port surgery (SPS) has become widespread around the world in recent years. A new robot arm system for SPS was developed, but its positioning platform and other hardware components were not efficient. Special features of the developed surgical robot system make good teleoperation with safety and efficiency difficult. A robot arm is combined and used as new positioning platform, and the remote center motion is realized by a new method using active motion control. A new mapping strategy based on kinematics computation and a novel optimal coordinated control strategy based on real-time approaching to a defined anthropopathic criterion configuration that is referred to the customary ease state of human arms and especially the configuration of boxers' habitual preparation posture are developed. The hardware components, control architecture, control system, and mapping strategy of the robotic system has been updated. A novel optimal coordinated control strategy is proposed and tested. The new robot system can be more dexterous, intelligent, convenient and safer for preoperative positioning and intraoperative adjustment. The mapping strategy can achieve good following and representation for the slave manipulator arms. And the proposed novel control strategy can enable them to complete tasks with higher maneuverability, lower possibility of self-interference and singularity free while teleoperating. Copyright © 2017 John Wiley & Sons, Ltd.
Mori, Hirohito; Kobayashi, Nobuya; Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Chiyo, Taiga; Ayaki, Maki; Nagase, Takashi; Masaki, Tsutomu
To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or not. Two dogs (11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port. We are sure of great feasibility of endoscopic cholecystectomy via single port for human.
Kim, Min Kyung; Kim, Jeong Jin; Choi, Joong Sub; Eom, Jeong Min; Lee, Jung Hun
To investigate the feasibility and safety of single port laparoscopic surgery (SP-LS) for ectopic pregnancy, irrespective of type of ectopic pregnancy and hemodynamic stability. A prospective case-control study of 106 women who underwent SP-LS or conventional LS for a suspected ectopic pregnancy was performed at a university teaching hospital from January 2009 to March 2012. Twenty-six women underwent SP-LS (SP-LS group) and 80 women underwent conventional LS (conventional LS group). There were no statistical differences between the groups in terms of demographic characteristics, operating time, hemoglobin change, return of bowel activity, hospital stay or complication rate. There were no cases of additional trocar use or conversion to laparotomy. Of five women with heterotopic pregnancy, one underwent SP-LS, and three underwent conventional LS for tubal pregnancy, which all resulted in vaginal delivery without obstetric complication; one woman received SP-LS for cornual pregnancy and had an ongoing pregnancy. SP-LS for ectopic pregnancy is feasible and safe regardless of the type of ectopic pregnancy and hemodynamic stability. However, further work is needed to confirm this conclusion and to demonstrate any advantage of SP-LS for ectopic pregnancy. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.
Park, Sue Yeon; Kim, Kye Hyun; Yuk, Jin-Sung; Ji, Hyun Young; Lee, Jung Hun
To compare postoperative cosmetic outcomes according to different umbilical closure methods after single port laparoscopic surgery (SP-LS). A total of 138 women who were scheduled to receive elective SP-LS were randomized to undergo closure of the umbilical incision with either a subcutaneous suture only without subcuticular skin suture (case group, n=68) or both a subcutaneous suture and subcuticular skin suture (control group, n=70) after fascial closure. At postoperative months 1 and 3, the umbilical scar was evaluated using the Vancouver scar scale (VSS), the patient and observer scar assessment scale, and a visual analog scale (VAS). Overall satisfaction with scar cosmesis and surgery was assessed with the VAS. There was no significant difference in the clinical characteristics and operative data between the groups. The objective and subjective scar assessments and the overall satisfaction with scar cosmesis were not different between the groups. In the control group, four (5.7%) women experienced wound discharge and were treated with conservative treatments and delayed closure. In women who completed the first and second assessments, the changes in the scar assessment and overall satisfaction with the scar according to time after surgery were not different in either group, but the patient scar assessment scale in both groups and the VSS in the case group improved. After SP-LS, the approximation of the fascia and subcutaneous layer seems to be enough for the closure of an umbilical incision. Skin closure with subcuticular sutures did not improve the postoperative cosmetic outcomes and might lead to impaired wound healing. However, large randomized trials with various closure techniques and materials are needed to confirm this finding. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Caronia, Francesco Paolo; Fiorelli, Alfonso; Arrigo, Ettore; Trovato, Sebastiano; Santini, Mario; Monte, Attilio Ignazio Lo
Video-assisted thoracoscopy is become a widely accepted approach for the resection of anterior mediastinal masses, including thymoma. The current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paresthesia, and length of hospitalization. Herein, we reported an extended resection of thymoma in a patient with myasthenia gravis through an uniportal bilateral thoracoscopic approach. A 74 years old woman with myasthenia gravis was referred to our attention for management of a 3.5 cm, well capsulate, thymoma. All laboratory and cardio-pulmonary tests were within normal; thus, she was scheduled for thymoma resection through an uniportal bilateral thoracoscopic approach. Under general anaesthesia and selective intubation, the patient was placed in a 60° right lateral decubitus. A 3 cm skin incision was performed in the fourth right intercostal space and, through that a 30° video-camera and working instruments were inserted without rib spreading. After complete dissection of the thymus and mediastinal fat, the contralateral pleura was opened, and, through that the specimen was pushed into the left pleural cavity. Then, the patient was placed in the left lateral decubitus. Similarly to the right side procedure, a 3-cm incision was performed in the fourth left intercostal space to complete thymic dissection and retrieve the specimen. No intraoperative and post-operative complications were found. The patient was discharged four days later. Pathological examination revealed a type A thymoma (Masaoka stage I). No recurrence was found at 18 months of follow-up CONCLUSIONS: Bilateral single-port thoracoscopy is an available procedure for management of thymoma associated with myasthenia gravis. The less post-operative pain, the reduction of hospital stay and the better esthetic results are all potential advantages of this approach over traditional technique. Obviously, our impression should be
Roh, Se-gon; Lee, Younbaek; Lee, Jongwon; Ha, Taesin; Sang, Taejun; Moon, Kyung-Won; Lee, Minhyong; Choi, Jung-yun
An innovative single-port surgical robot has recently been developed by the Samsung Advanced Institute of Technology (SAIT). The robot can reach various surgical sites inside the abdominal cavity from a single incision on the body. It has two 7-DOF surgical tools, a 3-DOF endoscope, a flexible hyper-redundant 6-DOF guide tube, and a 6-DOF manipulator. This paper primarily focuses on the manipulator, called a slave arm, which is capable of setting the location of a Remote Center Motion (RCM) point. Because the surgical tools can explore the abdominal area through a small incision point when the RCM point is aligned with the incision area, the RCM mechanism is an integral part of the manipulator for single-port surgery. The mechanical feature, operational principle, control method, and the system architecture of the slave arm are introduced in this paper. In addition, manipulation experiments conducted validate its efficacy.
Jiang, Zhi-Wei; Zhang, Shu; Wang, Gang; Zhao, Kun; Liu, Jiang; Ning, Li; Li, Jieshou
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.
Francesco Paolo Caronia
Full Text Available Abstract Background Video-assisted thoracoscopy is become a widely accepted approach for the resection of anterior mediastinal masses, including thymoma. The current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paresthesia, and length of hospitalization. Herein, we reported an extended resection of thymoma in a patient with myasthenia gravis through an uniportal bilateral thoracoscopic approach. Case presentation A 74 years old woman with myasthenia gravis was referred to our attention for management of a 3.5 cm, well capsulate, thymoma. All laboratory and cardio-pulmonary tests were within normal; thus, she was scheduled for thymoma resection through an uniportal bilateral thoracoscopic approach. Under general anaesthesia and selective intubation, the patient was placed in a 60° right lateral decubitus. A 3 cm skin incision was performed in the fourth right intercostal space and, through that a 30° video-camera and working instruments were inserted without rib spreading. After complete dissection of the thymus and mediastinal fat, the contralateral pleura was opened, and, through that the specimen was pushed into the left pleural cavity. Then, the patient was placed in the left lateral decubitus. Similarly to the right side procedure, a 3-cm incision was performed in the fourth left intercostal space to complete thymic dissection and retrieve the specimen. No intraoperative and post-operative complications were found. The patient was discharged four days later. Pathological examination revealed a type A thymoma (Masaoka stage I. No recurrence was found at 18 months of follow-up Conclusions Bilateral single-port thoracoscopy is an available procedure for management of thymoma associated with myasthenia gravis. The less post-operative pain, the reduction of hospital stay and the better esthetic results are all potential advantages of this approach over
van Dijk, A. H.; Lamberts, M.; van Laarhoven, C. J. H. M.; Drenth, J. P. H.; Boermeester, M. A.; de Reuver, P. R.
Gallstone disease is one of the most common problems in the gastroenterology and is associated with significant morbidity. It may present as stones in the gallbladder (cholecystolithiasis) or in the common bile duct (choledocholithiasis). At the end of the 1980s laparoscopy was introduced and first
Ibrahim, Mohsen; Menna, Cecilia; Andreetti, Claudio; Ciccone, Anna Maria; D'Andrilli, Antonio; Maurizi, Giulio; Poggi, Camilla; Vanni, Camilla; Venuta, Federico; Rendina, Erino Angelo
OBJECTIVES Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. METHODS From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). RESULTS The mean postoperative follow-up period was 12.5 (range: 1–24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome. CONCLUSIONS Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis. PMID:23442937
Background Primary palmar and/or axillary focal hyperhidrosis is a frequent disorder characterized by excessive sweating beyond physiological needs, often leading to a substantial impairment of quality of life. Over the years several minimally invasive surgical treatments have been described, however results vary, and due to a lack of uniform surgical approach, technique and nomenclature are often difficult to compare. In this prospective study we sought to evaluate the safety and effectiveness of our standardized technique of single-port, one-stage bilateral thoracoscopic sympathicotomy. Methods On a prospective basis a hundred consecutive patients with severe or intolerable primary hyperhidrosis underwent one-stage bilateral single-port thoracoscopic sympathicotomy. Primary outcome was measured in pre- vs. post-operative Hyperhidrosis Disease Severity Scale scores. Location and extend of compensatory hyperhidrosis, and satisfaction with the procedure were registered. Results A significant reduction in mean Hyperhidrosis Disease Severity Scale score (3.69 ± 0.47 preoperatively vs. 1.06 ± 0.34 postoperatively) (p 80% reduction in sweat production was achieved. Compensatory hyperhidrosis was seen in 27 patients (27%). It was rated as mild by 21 patients (78%) and as moderate by 6 (22%) of these patients. No severe compensatory hyperhidrosis was reported. Major complications, such as intraoperative bleeding, infections, and Horner’s syndrome were not observed. Conclusions Highly selective sympathicotomy at well-defined levels with a one-stage bilateral single-port transaxillary thoracoscopic approach is a save procedure, with excellent and reproducible immediate results in the treatment of primary palmar and/or axillary hyperhidrosis. PMID:24279511
Martin-Ucar, Antonio E; Aragon, Javier; Bolufer Nadal, Sergio; Galvez Munoz, Carlos; Luo, Qigang; Perez Mendez, Itzel; Sihoe, Alan D L; Socci, Laura
Competency in video-assisted thoracoscopic (VATS) lobectomy is estimated to be reached after the surgeon completes 50 cases. We wanted to explore the impact of competency in performing multiport VATS lobectomies on completing the needed number of single-port VATS. In a retrospective multicentre study, 6 individual surgeons (3 with previous competency in multiport VATS lobectomy and 3 without) submitted their first 50 cases of single-port VATS lobectomies. Extended and sublobar resections were excluded. Pre-, peri- and postoperative data were compared between the groups of surgeons. Chi-square and Wilcoxon's rank tests were used. The less experienced surgeons had previously attended dedicated training courses and visited with experts. A total of 300 cases were included [150 in Group A (surgeons with previous experience performing multiport VATS) and 150 in Group B (surgeons without extensive experience performing multiport VATS)]. Surgeons in Group B performed significantly more elective open lobectomies during their learning curve period than surgeons of Group A (58 vs 1). Patients in Group B were older and had more risk factors. There were 3 in-hospital deaths (respiratory failure, sepsis and fatal stroke). There were no differences between the groups in operative time, intensive care unit admissions, hospital stay, total complications, tumour size or number of N2 stations explored. Only the duration of intercostal drainage (2 vs 3 days, 0.012), incidence of respiratory tract infections (1% vs 7%, P = 0.002) and conversion rates (4% vs 12%, P = 0.018) were better in Group A. Patients characteristics played a role in the development of respiratory infections and longer drainage times but not in the need for conversion. Overall, postoperative outcomes during the learning curve period for single-port VATS lobectomies are not noticeably affected by previous multiport VATS experience. Less experienced surgeons were more selective in order to achieve
Levic, Katarina; Donatsky, Anders Meller; Bulut, Orhan
INTRODUCTION: Conventional laparoscopic surgery is the treatment of choice for many abdominal procedures. To further reduce surgical trauma, new minimal invasive procedures such as single-port laparoscopic surgery (SPLS) and robotic assisted laparoscopic surgery (RALS) have emerged. The aim...... of this study was to compare the early results of SPLS versus RALS in the treatment of rectal cancer. METHODS: We performed a retrospective analysis of prospectively collected data on patients who had undergone SPLS (n = 36) or RALS (n = 56) in the period between 2010 and 2012. Operative and short...
V. N Klymenko
Full Text Available Aim and methods. In this paper, a comparative analysis of the results obtained in the performance of single-port laparoscopic surgery (SILS and the traditional four-port laparoscopic cholecystectomy was presented. Average duration of surgery, intra and postoperative complications, duration of pain, hyperthermia, a cosmetic effect were assessed and compared. Results. SILS technique reduces the duration and intensity of post-operative discomfort associated with pain in the wound; achieve early almost complete physical and social adaptation, and return to the normal rhythm of life; get the best cosmetic result.
Navez, Benoit; Navez, Julie
Laparoscopy has become a routine procedure in the management of acute abdominal disease and can be considered both an excellent therapeutic and additional diagnostic tool in selected cases. However, a high level of expertise in laparoscopic and emergency surgery is required. Hemodynamic instability, huge abdominal distension, fecal peritonitis and perforated cancer are relative contraindications for the laparoscopic approach. In recent years, abdominal emergencies have increasingly been managed successfully by laparoscopy. In acute appendicitis, acute cholecystitis and perforated peptic ulcer, randomized controlled trials have proven that the laparoscopic approach is as safe and as effective as open surgery, with fewer complications and a quicker postoperative recovery. Other indications such as blunt and penetrating trauma to the abdomen, small bowel occlusion and perforated diverticular disease are under debate, indicating that more randomized controlled trials comparing laparoscopic and open surgery are still necessary. Copyright © 2013 Elsevier Ltd. All rights reserved.
van Dijk, A H; Lamberts, M; van Laarhoven, C J H M; Drenth, J P H; Boermeester, M A; de Reuver, P R
Gallstone disease is one of the most common problems in the gastroenterology and is associated with significant morbidity. It may present as stones in the gallbladder (cholecystolithiasis) or in the common bile duct (choledocholithiasis). At the end of the 1980s laparoscopy was introduced and first laparoscopic cholecystectomy was performed in 1985. The laparoscopic technique for removing the gallbladder is the current treatment of choice, although indications for open surgery exist. To perform laparoscopic cholecystectomy as safe as possible multiple safety measures were developed. The gold standard for diagnosing and removing common bile duct stones is Endoscopic Retrograde Cholangiopancreatography (ERCP). The surgical treatment option for choledocholithiasis is laparoscopic cholecystectomy with common bile duct exploration. If experience is not available, than ERCP followed by elective cholecystectomy is by far the best therapeutic modality. The present review will discuss the use, benefits and drawbacks of laparoscopy in patients with cholecystolithiasis and choledocholithiasis. Copyright © 2013 Elsevier Ltd. All rights reserved.
Fergo, Charlotte; Burcharth, Jakob; Pommergaard, Hans-Christian
BACKGROUND: This systematic review investigates newer generation 3-dimensional (3D) laparoscopy vs 2-dimensional (2D) laparoscopy in terms of error rating, performance time, and subjective assessment as early comparisons have shown contradictory results due to technological shortcomings. DATA...
Fransson, Boel A; Grubb, Tamara L; Perez, Tania E; Flores, Krystina; Gay, John M
To compare intraoperative physiologic variables and post-operative pain associated with lift laparoscopy and conventional capnoperitoneum laparoscopy. Prospective randomized case controlled study. Healthy dogs (n = 30). Dogs having laparoscopic ovariohysterectomy were randomly assigned to lift laparoscopy (n = 14) or capnoperitoneum (16) laparoscopy. Physiologic variables measured intraoperatively were documented. Postoperatively, pain response was assessed in a blinded fashion using the short Glasgow pain scale and von Frey filament aesthesiometry. Lift laparoscopy was associated with less frequency of hypercapnia, required less anesthetic gas, and was not more time-consuming or painful than capnoperitoneum laparoscopy. Lift laparoscopy is a feasible alternative to capnoperitoneum laparoscopy, especially in dogs where pressurized capnoperitoneum is not desired. © Copyright 2014 by The American College of Veterinary Surgeons.
Full Text Available The many benefits of laparoscopy, including smaller incision, reduced length of hospital stay and more rapid return to normal function, have seen its popularity grow in recent years. With concurrent improvements in non-surgical cancer management the importance of accurate staging is becoming increasingly important. There are two main applications of laparoscopic surgery in managing hepato-pancreatico-biliary (HPB malignancy: accurate staging of disease and resection. We aim to summarize the use of laparoscopy in these contexts. The role of staging laparoscopy has become routine in certain cancers, in particular T staged, locally advanced gastric cancer, hilar cholangiocarcinoma and non-Hodgkin's lymphoma. For other cancers, in particular colorectal, laparoscopy has now become the gold standard management for resection such that there is no role for stand-alone staging laparoscopy. In HPB cancers, although staging laparoscopy may play a role, with ever improving radiology, its role remains controversial.
Arumugam, Prabhu; Balarajah, Vickna; Watt, Jennifer; Abraham, Ajit T; Bhattacharya, Satyajit; Kocher, Hemant M
The many benefits of laparoscopy, including smaller incision, reduced length of hospital stay and more rapid return to normal function, have seen its popularity grow in recent years. With concurrent improvements in non-surgical cancer management the importance of accurate staging is becoming increasingly important. There are two main applications of laparoscopic surgery in managing hepato-pancreatico-biliary (HPB) malignancy: accurate staging of disease and resection. We aim to summarize the use of laparoscopy in these contexts. The role of staging laparoscopy has become routine in certain cancers, in particular T staged, locally advanced gastric cancer, hilar cholangiocarcinoma and non-Hodgkin's lymphoma. For other cancers, in particular colorectal, laparoscopy has now become the gold standard management for resection such that there is no role for stand-alone staging laparoscopy. In HPB cancers, although staging laparoscopy may play a role, with ever improving radiology, its role remains controversial.
Full Text Available Abstract Background Emerging attempts have been made to reduce operative trauma and improve cosmetic results of laparoscopic cholecystectomy. There is a trend towards minimizing the number of incisions such as natural transluminal endoscopic surgery (NOTES and single-port laparoscopic cholecystectomy (SPLC. Many retrospective case series propose excellent cosmesis and reduced pain in SPLC. As the latter has been confirmed in a randomized controlled trial, patient's satisfaction on cosmesis is still controversially debated. Methods/Design The SPOCC trial is a prospective, multi-center, double blinded, randomized controlled study comparing SPLC with 4-port conventional laparoscopic cholecystectomy (4PLC in elective surgery. The hypothesis and primary objective is that patients undergoing SPLC will have a better outcome in cosmesis and body image 12 weeks after surgery. This primary endpoint is assessed using a validated 8-item multiple choice type questionnaire on cosmesis and body image. The secondary endpoint has three entities: the quality of life 12 weeks after surgery assessed by the validated Short-Form-36 Health Survey questionnaire, postoperative pain assessed by a visual analogue scale and the use of analgesics. Operative time, surgeon's experience with SPLC and 4PLC, use of additional ports, conversion to 4PLC or open cholecystectomy, length of stay, costs, time of work as well as intra- and postoperative complications are further aspects of the secondary endpoint. Patients are randomly assigned either to SPLC or to 4PLC. Patients as well as treating physicians, nurses and assessors are blinded until the 7th postoperative day. Sample size calculation performed by estimating a difference of cosmesis of 20% (alpha = 0.05 and beta = 0.90, drop out rate of 10% resulted in a number of 55 randomized patients per arm. Discussion The SPOCC-trial is a prospective, multi-center, double-blind, randomized controlled study to assess cosmesis and body
Abdominoperineal resection (APR) of anorectal cancers after neoadjuvant chemoradiotherapy may incur significant perineal morbidity. While vertical rectus abdominis muscle (V-RAM) flaps can fill the pelvic resection space with health tissue, their use has previously been described predominantly in association with laparotomy. Here, we describe a means of combination laparoscopic APR with V-RAM flap reconstruction that allows structural preservation of the entire abdominal wall throughout the oncological resection and of the deep parietal layers after V-RAM donation. Furthermore, a single port access device used at the end colostomy site allows a second senior surgeon assist with an additional two working instruments for the purpose of improved pelvic tissue retraction, especially useful in obese patients.
Bertolaccini, Luca; Viti, Andrea; Terzi, Alberto
Single-port access video-assisted thoracic surgery (VATS), a technique progressively developed from the standard three-port approach in minimally invasive surgery, offers ergonomic advantages but also new challenges for the surgeon. We compared the ergonomics of three-port versus single-port VATS. Posture analysis of surgeons was evaluated during 100 consecutive VATS wedge resections (50 triportal vs. 50 uniportal). Technically demanding procedures (major lung resection) were excluded. Operating table height, monitor height, distance and inclination were adjusted according to operator preference. Body posture was assessed by measuring head-trunk axial rotation and head flexion. Perceived physical strain was self-evaluated on the Borg Category Ratio (CR-10) scale. Mental workload was assessed with the National Aeronautics Space Administration-Task Load indeX (NASA-TLX), a multidimensional tool that rates workloads on six scales (mental, physical and temporal demand; effort; performance; frustration). All procedures were completed without complications. Head-trunk axial rotation was significantly reduced and neck flexion significantly improved in uniportal VATS. Viewing direction significantly declined (p = 0.01), body posture as measured on the Borg CR-10 scale was perceived as more stressful and the NASA-TLX score for overall workload was higher (p = 0.04) during triportal VATS. The NASA-TLX score for frustration was higher with uniportal VATS (p = 0.02), but the score for physical demand was higher in triportal VATS (p = 0.006). The surgeon can maintain a more neutral body posture during uniportal VATS by standing straight and facing the monitor with only minimal neck extension/rotation; however, frustration is greater than with triportal VATS.
Xiang, Yang; Hu, Jiasheng; Jiang, Huilin
Minimally invasive surgery (MIS) has contributed significantly to patient care by reducing the morbidity associated with more invasive procedures. MIS procedures have become standard treatment for gallbladder disease and some abdominal malignancies. The imaging system has played a major role in the evolving field of minimally invasive surgery (MIS). The image need to have good resolution, large magnification, especially, the image need to have depth cue at the same time the image have no flicker and suit brightness. The video stereo-laparoscopy system can meet the demand of the doctors. This paper introduces the 3d video laparoscopy has those characteristic, field frequency: 100Hz, the depth space: 150mm, resolution: 10pl/mm. The work principle of the system is introduced in detail, and the optical system and time-division stereo-display system are described briefly in this paper. The system has focusing image lens, it can image on the CCD chip, the optical signal can change the video signal, and through A/D switch of the image processing system become the digital signal, then display the polarized image on the screen of the monitor through the liquid crystal shutters. The doctors with the polarized glasses can watch the 3D image without flicker of the tissue or organ. The 3D video laparoscope system has apply in the MIS field and praised by doctors. Contrast to the traditional 2D video laparoscopy system, it has some merit such as reducing the time of surgery, reducing the problem of surgery and the trained time.
Keller, R; Kleemann, M; Hildebrand, P; Roblick, U J; Bruch, H-P
Acute abdomen is not a disease in itself but a description of a complex of symptoms combined with severe abdominal pain developed within a time frame of less than 24 h. All strategies for the management of acute abdomen underline the need for an interdisciplinary approach to diagnosis and therapy. This requires focused and intelligent use of efficient diagnostic procedures. Diagnostic laparoscopy may be a key to solving the diagnostic dilemma of unspecific acute abdomen. Furthermore, it allows not only direct inspection of the abdominal cavity but also surgical intervention, if needed. In particular the rate of negative laparotomies can be reduced.
Conclusion: A significant degree of desaturation occurs during gynaecologic laparoscopy under pentazocine and diazepam sedation. It is recommended that oxygen should be administered to all patients during the procedure. Key Words: Gynaecological Laparoscopy, Sedation, Hypoxaemia. [Trop J Obstet Gynaecol, 2002, ...
Pu, Qingfan; Zhang, Chuanrong; Huang, Zhenfeng; Zeng, Yu
Laparoscopy has been proposed for the management of recurrent hepatolithiasis, but no comparative study of its relative efficacy versus laparotomy has been performed, and the patient selection criteria for laparoscopy are not clear. This study aimed to investigate the therapeutic effect of laparoscopy versus laparotomy for repeated hepatolithiasis and to highlight how to select patients best suited for laparoscopy. We performed a cohort study of 94 patients who underwent laparotomy or laparoscopy for recurrent hepatolithiasis between January 2010 and May 2014. The clinical data of 53 patients who underwent open biliary exploration (laparotomy group) and 41 patients who underwent laparoscopic biliary exploration (laparoscopy group) for recurrent hepatolithiasis were retrospectively analyzed and compared. Intestinal adhesions to the porta hepatis occurred in 62 (66%) patients. There was no difference in operating time between the two groups. In comparing the laparoscopic group versus the laparotomy group, the intraoperative blood loss was less (P = .001), the incidence of postoperative ascites (9.8 vs. 30.2%, P = .016) and/or pleural effusion (7.3 vs. 28.3%, P = .010) was lower, and the stone clearance rates were comparable. Wound morbidity appeared peculiarly in 15 (28.3%) patients among the laparotomy group. The postoperative hospital stay in the laparoscopy group was shorter than that in the laparotomy group (P = .000). Laparoscopy is a safe and effective treatment for recurrent hepatolithiasis patients who are scheduled for bile duct exploration.
Nezhat, Camran R; Stevens, Amanda; Balassiano, Erika; Soliemannjad, Rose
To compare robotic-assisted laparoscopy with conventional laparoscopy for treatment of advanced stage endometriosis insofar as operative time, estimated blood loss, complication rate, and length of hospital stay. Retrospective cohort study (Canadian Task Force classification II2). All procedures were performed by one surgeon between January 2004 and July 2012. Data was collected via chart review. Tertiary referral center for treatment of endometriosis. Four hundred twenty women with advanced endometriosis. Fertility-sparing surgery to treat advanced endometriosis, either via conventional or robotic-assisted laparoscopy. Patient demographic data, operative time, estimated blood loss, complication rate, and length of hospital stay were compared between the 2 groups. Two hundred seventy-three patients underwent conventional laparoscopy and 147 patients underwent robotic-assisted laparoscopy for fertility-sparing treatment of advanced stage endometriosis. Patients in both groups had similar characteristics insofar as age, body mass index, and previous abdominal surgeries. There were no significant differences in blood loss or complication rate between the 2 groups. Mean operative time in the conventional laparoscopy group was 135 minutes (range, 115-156 minutes), and in the robotic-assisted laparoscopy group was 196 minutes (range, 185-209 minutes), with a mean difference in operative time of 61 minutes (p laparoscopy group. Most patients who underwent conventional laparoscopy were discharged to home on the day of surgery. Of 273 patients in the conventional laparoscopy group, only 63 remained in the hospital overnight, and all 147 patients in the robotic-assisted laparoscopy group were discharged on postoperative day 1. Conventional laparoscopy and robotic-assisted laparoscopy are excellent methods for treatment of advanced stages of endometriosis. However, use of the robotic platform may increase operative time and might also be associated with longer hospital stay
M. C. Smaldone
Full Text Available The spectrum of laparoscopic surgery in children has undergone a dramatic evolution. Initially used as a diagnostic modality for many pediatric urologists, complex as well as reconstructive procedures are now being performed laparoscopically. Laparoscopic orchiopexy and nephrectomy are well established and are being performed at many centers. Laparoscopic partial nephrectomy, adrenalectomy, and dismembered pyeloplasty series have reported shortened hospital stays and operative times that are comparable to that of open techniques or are decreasing with experience. The initial experiences with laparoscopic ureteral reimplantation and laparoscopic-assisted bladder reconstructive surgery have been described, reporting encouraging results with regards to feasibility, hospital stay, and cosmetic outcome. This report will provide a directed review of the literature to establish the current indications for laparoscopy in pediatric urologic surgery.
Stanowski, Edward; Domaniecki, Janusz
The application of laser light and laparoscopy attenuates operative trauma owing to the use of small incisions for introducing the trochars necessary for conveying the surgical instruments and fiber optics which allow for precise cutting and coagulation of small vessels under control of the image on a TV monitor. The present, most remarkable development of laparoscopic surgery is due to the fascination of physicians and patients by this procedure. The method enables the physician to operate with great precision and to take advantage of the most recent attainments of electronics and laser technique, as well as of his own ability. The patients profit by attenuation of postoperative pain, limitation of the probability of infection, reduced blood loss, decreased number of postoperative complications, shortening of the hospitalization period, and rapid return to physical fitness and work.
Friedrich, Daniel T; Scheithauer, Marc O; Greve, Jens; Duvvuri, Uma; Sommer, Fabian; Hoffmann, Thomas K; Schuler, Patrick J
Transoral surgery of the larynx is commonly performed with a rigid laryngoscope, a microscope, and a laser. We investigated the potential utility of a flexible, single-port, robot-assisted and physician-controlled endoscopic system to enable easy, transoral surgical access to the larynx. Transoral laryngeal surgery was performed in human cadavers (n = 4) using the Flex System and compatible flexible instruments. Anatomical landmarks were identified, and mock surgical procedures were performed. Standard laryngeal surgical procedures were completed successfully in a human cadaver model. The built-in HD digital camera enabled high-quality visualization of the larynx. Epiglottectomy, as well as posterior cordectomy, were performed by laser and radio-frequency resection. The flexible design of the compatible tools enabled a nontraumatic approach. The Flex System has the potential to improve surgical access to the larynx, especially in patients with challenging anatomy. The associated flexible instruments enabled completion of surgical procedures in the larynx in a human cadaveric model. Further clinical studies, as well as the development of supplemental technology and tools, are recommended for future clinical applications. © The Author(s) 2015.
Ko, Jennifer K Y; Li, Raymond H W; Cheung, Vincent Y T
To compare the proficiency and preference of physicians in performing standard tasks in a box trainer using 2-dimensional (2D) versus 3-dimensional (3D) laparoscopy. Prospective randomized controlled trial. Prospective, randomized controlled trial (Canadian Task Force classification I). Tertiary care teaching hospital. Thirty physicians from the Department of Obstetrics and Gynecology. Participants were randomly assigned to perform a set of 3 to 4 tasks in a pelvic trainer using 2D laparoscopy first and then 3D laparoscopy, and vice versa. The time taken to complete the tasks and side effects experienced were noted. Participants were asked to complete a modified Global Operative Assessment of Laparoscopic Skills (GOALS) form at the end of their tasks to evaluate their experiences and to assess their own proficiency with both visual modalities. The time taken for peg transfer, duct cannulation, and suturing was significantly faster using 3D laparoscopy compared with 2D laparoscopy. There were no significant differences in the time taken for pattern cutting with both visual modalities. Participants experienced more dizziness using 3D laparoscopy (6.9% vs 37.9%; p = .004). The GOALS self-evaluation score was significantly higher for 3D compared with 2D laparoscopy. After the study, 11 of 29 (37.9%) participants preferred 2D, 16 of 29 (55.2%) preferred 3D, and 1 of 29 (8.3%) had no preference. Although 3D laparoscopy scored higher on self-evaluation and was preferred by more participants, it only gave better objective performance in the completion of some selected tasks by participants with intermediate skill levels and was associated with more dizziness. Further studies are needed to determine the value of 3D laparoscopy, especially when used in the clinical setting. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
Konarzewska, J.; Bianek-Bodzak, A.; Mielcarek, P.; Kobierski, J.
Background: Despite dynamic development of diagnostic imaging methods and endoscopic procedures, X-ray hysterosalpingography remains the basic diagnostic procedure when anatomical cause of infertility is suspected. The aim of the study was to assess the correlation between HSG results and laparoscopy findings, especially in infertile women with normal results of hysterosalpingography. Material/Methods: The results of HSG and laparoscopies performed between 2002 and 2005 years in 53 infertile women were analyzed retrospectively. The indication for HSG was primary infertility in 44 cases and secondary infertility in 9 cases.Results: The result of HSG was normal in 51%. Pathological findings were observed in 49% of HSG and in 93% of laparoscopies. The most common pathological findings observed during laparoscopy were tubal occlusion (26% cases) and endometriosis (25% cases). Polycystic ovaries and myomas were observed in 20% of the performed laparoscopies. HSG and laparoscopy yield consistent results in evaluation of tubal patency (p < 0.001). Conclusions: HSG remains the method of first choice in the diagnostics of uterine malformations and tubal diseases as causes of infertility. When mechanical factors of female infertility are suspected, HSG allows the optimal choice of more invasive procedure. (authors)
Alemayehu, Hanna; Stringel, Gustavo; Lo, Irene J; Golden, Jamie; Pandya, Samir; McBride, Whitney; Muensterer, Oliver
Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the management of Meckel diverticulum is established. We reviewed our experience with complicated cases of Meckel diverticulum in children managed with laparoscopy. A 15-year retrospective chart review revealed 14 cases of complicated Meckel diverticulum managed with laparoscopy. Incidentally found Meckel diverticulum and cases done by laparotomy were excluded. Ages varied from 2 years to 16 years old. There were 10 males and four females. Eight cases had small bowel obstruction; of those, three had extensive intestinal gangrene. Four cases had significant rectal bleeding, three had acute diverticulitis, and two had intussusception caused by the diverticulum. Eleven cases were treated with laparoscopic Meckel diverticulectomy and three with laparoscopic-assisted bowel resection because of extensive gangrene of the intestine. Two of the three cases with significant intestinal gangrene returned several weeks later with small bowel obstruction secondary to adhesions. They were successfully managed with laparoscopic lysis of adhesions. There were no other complications. Laparoscopy is safe and effective in the management of complicated Meckel diverticulum in children. Most cases can be managed with simple diverticulectomy. Laparoscopy is useful when the diagnosis is uncertain. When extensive gangrene is present, laparoscopy can help to mobilize the intestine and evaluate the degree of damage, irrigate and cleanse the peritoneal cavity, and minimize the incision necessary to accomplish the bowel resection.
Springborg, Henrik; Istre, Olav
potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark, in which 40 patients have been treated for benign gynecologic conditions......LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique, however, its large-scale adoption awaits results of prospective randomized controlled studies confirming...
Seyed Vahid Hosseini
Full Text Available Background: In recent years, laparoscopic sleeve gastrectomy (LSG has become more acceptable for obese patients. Single-port sleeve gastrectomy (SPSG is more popular since each abdominal incision carries the risk of bleeding, hernia, and internal organ injury as well as exponentially affecting cosmesis. This cross-sectional study aimed at comparing multi-port sleeve gastrectomy (MPSG and SPSG in terms of their early results and complications. Methods: Out of129 obese patients candidated for LSG, 102 patients were assigned to 2 groups of SPSG and MPSG. Complications and demographic data such as body mass index (BMI, age, gender, operation time, and hospital stay were measured. All surgeries were carried out between2013 and 2015 in Shiraz, Iran. Data analysis was performed using SPSS, version 16 for Windows (SPSS Inc., Chicago, IL. The continuous and categorical variables were compared using the Student t-test and the Chi-square test or the Fisher exact test, respectively. Results: The patients’ data from both groups were similar in terms of age, intraoperative and postoperative bleeding volume, and length of hospital stay. Mean BMI was 42.8±0.7 in the SPSG group and 45.3±1.2 in the MPSG group. Duration of surgery was significantly lower in the SPSG group (P<0.001. Only 1 patient from the SPSG group and 5 patients from the MPSG group had bleeding as an early complication. Conclusion: The differences in each complication between the groups were not statistically significant. SPSG seems to be safe and is the same as MPSG in terms of major postoperative complications. Trial Registration Number: IRCT201512229936N12
Müller, Verena; Fikatas, Panagiotis; Gül, Safak; Noesser, Maximilian; Fuehrer, Kirs Ten; Sauer, Igor; Pratschke, Johann; Zorron, Ricardo
Bariatric surgery is currently the most effective method to ameliorate co-morbidities as consequence of morbidly obese patients with BMI over 35 kg/m2. Endoscopic techniques have been developed to treat patients with mild obesity and ameliorate comorbidities, but endoscopic skills are needed, beside the costs of the devices. To report a new technique for internal gastric plication using an intragastric single port device in an experimental swine model. Twenty experiments using fresh pig cadaver stomachs in a laparoscopic trainer were performed. The procedure was performed as follow in ten pigs: 1) volume measure; 2) insufflation of the stomach with CO2; 3) extroversion of the stomach through the simulator and installation of the single port device (Gelpoint Applied Mini) through a gastrotomy close to the pylorus; 4) performance of four intragastric handsewn 4-point sutures with Prolene 2-0, from the gastric fundus to the antrum; 5) after the performance, the residual volume was measured. Sleeve gastrectomy was also performed in further ten pigs and pre- and post-procedure gastric volume were measured. The internal gastric plication technique was performed successfully in the ten swine experiments. The mean procedure time was 27±4 min. It produced a reduction of gastric volume of a mean of 51%, and sleeve gastrectomy, a mean of 90% in this swine model. The internal gastric plication technique using an intragastric single port device required few skills to perform, had low operative time and achieved good reduction (51%) of gastric volume in an in vitro experimental model. A cirurgia bariátrica é atualmente o método mais efetivo para melhorar as co-morbidades decorrentes da obesidade mórbida com IMC acima de 35 kg/m2. Técnicas endoscópicas foram desenvolvidas para tratar pacientes com obesidade leve e melhorar as comorbidades, mas habilidades endoscópicas são necessárias, além dos custos. Relatar uma nova técnica para a plicatura gástrica interna
Li, Caiwei; Xu, Meiqing; Xu, Guangwen; Xiong, Ran; Wu, Hanran; Xie, Mingran
Through the comparative analysis of the acute and chronic pain postoperative between the single port and triple port video-assisted thoracic surgery to seek the better method which can reduce the incidence of acute and chronic pain in patients with lung cancer. Data of 232 patients who underwent single port -VATS (n=131) or triple port VATS (n=101) for non-small cell lung cancer (NSCLC) on January 1, 2016 to June 30, 2017 in our hospital were analyzed. The clinical and operative data were assessed, numeric rating scale (NRS) was used to evaluate the mean pain score on the 1th, 2th, 3th, 7th, 14th days, 3th months and 6th months postoperative. Both groups were similar in clinical characteristics, there were no perioperative death in two groups. In the 1th, 2th, 7th, 14th days and 3th, 6th months postoperative, the NRS score of the single port group was superior, and the difference was significant compared with the triple port (P0.05). Univariate and multivariate analysis of the occurrence on the chronic pain showed that the operation time, surgical procedure and the 14th NRS score were risk factors for chronic pain (Pport thoracoscopic surgery has an advantage in the incidence of acute and chronic pain in patients with non-small cell lung cancer. Shorter operative time can reduce the occurrence of chronic pain. The 14th day NRS score is a risk factor for chronic pain postoperative.
Rakesh Y Sinha
Full Text Available The largest challenge for laparoscopic surgeons is the eye–hand coordination within a three-dimensional (3D scene observed on a 2D display. The 2D view on flat screen laparoscopy is cerebrally intensive. The loss of binocular vision on a 2D display causes visual misperceptions, mainly loss of depth perception and adds to the surgeon's fatigue. This compromises the safety of laparoscopy. The 3D high-definition view with great depth perception and tactile feedback makes laparoscopic surgery more acceptable, safe and cost-effective. It improves surgical precision and hand–eye coordination, conventional and all straight stick instruments can be used, capital expenditure is less and recurring cost and annual maintenance cost are less. In this article, we have discussed the physics of 3D laparoscopy, principles of depth perception, and the different kinds of 3D systems available for laparoscopy. We have also discussed our experience of using 3D laparoscopy in over 2000 surgeries in the last 4 years.
Rieder, Erwin; Martinec, Danny V; Cassera, Maria A; Goers, Trudie A; Dunst, Christy M; Swanstrom, Lee L
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.
Mol, B. W.; Swart, P.; Bossuyt, P. M.; van der Veen, F.
OBJECTIVE: To determine the prognostic significance of laparoscopy results for fertility outcome. STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and laparoscopy for subfertility in our department between May 1985 and November 1987 were identified from medical records. The impact
El Hachem, Lena; Acholonu, Uchenna C; Nezhat, Farr R
To compare postoperative pain after conventional laparoscopic and robotically assisted laparoscopic surgery in gynecology. This is a prospective nonrandomized analysis of patients undergoing conventional laparoscopy or robotically assisted laparoscopy in a university-affiliated hospital between March 2011 and March 2012. Postoperative pain was measured using the Numeric Rating Scale and the narcotic use converted to morphine sulfate equivalents. The primary outcome was the Numeric Rating Scale pain score obtained on the first postoperative day. One hundred ten patients were enrolled; 91 were included in the statistical analysis. Both groups were similar with regard to race, history of abdominopelvic surgeries, psychiatric history, and substance abuse. Patients undergoing robotically assisted laparoscopy were 6 years older and had a body mass index 6 points higher. Median length of hospital stay for conventional laparoscopy and robotically assisted laparoscopy was 2 days and 3 days, respectively (P<.001); median to being off narcotics was 4 days and 4.5 days, respectively (P=.336); and median return to normal activities was 13 days and 21 days, respectively (P=.021). There were no significant differences in mean Numeric Rating Scale pain scores over time (P=.499) or mean narcotic requirements (P=.393) between groups. Robotically assisted laparoscopy is equivalent to conventional laparoscopy in terms of subjective and objective measures of postoperative pain.
Khunda, S; Ghanima, K Y
With reference to your correspondence (September 27, p. 764, and December 27, p. 760) regarding laparoscopy explosion hazards with nitrous oxide, in our experience this is not substantiated. In the last 18 months we have done some 123 laparoscopies in the Medical City Hospital, Baghdad. We have done 16 sterilizations by tubal diathermy and not fewer than 12 cases where biopsies were taken from ovaries in case of tuberculosis or for other reasons, where diathermy was used. In all our laparoscopy procedures we always used nitrous oxide gas because carbon dioxide cylinders are difficult to otain. We did not have any incident of explosion, and most of our patients stayed in hospital not more than 24 hours postoperatively, during which time no complications were reported. None of these cases was readmitted for any complications. It seems to us that the hazard of explosion with nitrous oxide is more theoretical than real.
Magrina, Javier F; Cetta, Rachel L; Chang, Yu-Hui; Guevara, Gregory; Magtibay, Paul M
Analysis of perioperative outcomes and survival of patients with recurrent ovarian cancer undergoing secondary cytoreduction by robotics, laparoscopy, or laparotomy. Retrospective analysis of 52 selected patients with recurrent ovarian cancer undergoing secondary cytoreduction by laparoscopy (9), laparotomy (33) or robotics (10) between January 2006 and December 2010. Comparison was made by a total of 21 factors including age, BMI, number of previous surgeries, tumor type and grade, number of procedures, and 15 types of procedures performed at secondary cytoreduction. For all patients, the mean operating time was 213.8 min, mean blood loss 657.4 ml; and mean hospital stay 7.5 days. Complete debulking was achieved in 75% of patients. Postoperative complications were noted in 36.5% of patients. Overall and progression-free survival at 3-years were 58.8% and 34.1%, respectively. Laparoscopy and robotics had reduced blood loss and hospital stay, while no differences were observed among the three groups for operating time, complications, complete debulking, and survival. Selected patients with recurrent ovarian cancer benefit from a laparoscopic or robotic secondary cytoreduction without compromising survival. Robotics and laparoscopy provide similar perioperative outcomes, and reduced blood loss and shorter hospital stay as compared to laparotomy. Laparotomy seems preferable for patients with widespread peritoneal implants, multiple sites of recurrence, and/or extensive adhesions. Copyright © 2013 Elsevier Inc. All rights reserved.
Feb 27, 2012 ... Diagnostic laparoscopy for gynecological indications is safe and wider application of this modern ... JI Ikechebelu. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, and Life Fertility. Centre .... The hemorrhage would have been controlled or control attempted ...
Introduction: The objectives were to assess the diagnostic value of hysterosalpingography (HSG) with laparoscopy as gold standard in the evaluation of tubal patency and pelvic adhesions in women suffering from infertility. Methods: We conducted a comparative cross sectional study on 208 medical files of infertile women ...
Kavic, Suzanne M.
Background: Adhesions commonly result from abdominal and pelvic surgical procedures and may result in intestinal obstruction, infertility, chronic pain, or complicate subsequent operations. Laparoscopy produces less peritoneal trauma than does conventional laparotomy and may result in decreased adhesion formation. We present a review of the available data on laparoscopy and adhesion formation, as well as laparoscopic adhesiolysis. We also review current adjuvant techniques that may be used by practicing laparoscopists to prevent adhesion formation. Database: A Medline search using “adhesions,” “adhesiolysis,” and “laparoscopy” as key words was performed for English-language articles. Further references were obtained through cross-referencing the bibliography cited in each work. Discussion: The majority of studies indicate that laparoscopy may reduce postoperative adhesion formation relative to laparotomy. However, laparoscopy by itself does not appear to eliminate adhesions completely. A variety of adjuvant materials are available to surgeons, and the most recent investigation has demonstrated significant potential for intraperitoneal barriers. Newer technologies continue to evolve and should result in clinically relevant reductions in adhesion formation. PMID:12113430
van der Voort, M.; Heijnsdijk, E. A. M.; Gouma, D. J.
Background: Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury. Methods: The review was carried out using the MeSH browser within
Jimenez, Angel Martin; Aguilar, Jose-Francisco Noguera
Operative laparoscopy has progressed rapidly in recent years, and this alternative to the conventional approach for abdominal surgery has allowed the description of new planes, spaces, and anatomic references as a result of the artificial rupture of the "anatomical continuum". Magnified laparoscopic views and the ability to deeply explore anatomic…
Context: Diagnostic laparoscopy is an endoscopy procedure, which has become indispensable in the evaluation of the female reproductive organs especially in infertility. Aim: Experience with conversion to open laparotomy is presented and ways of averting this complication are discussed. Settings and Design: A ...
Abdullah, Muhammad Tariq; Waqar, Shahzad Hussain; Zahid, Muhammad Abdul
Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients.
Ades, Alex; Dobromilsky, Kim C; Cheung, King T; Umstad, Mark P
To evaluate the obstetric outcome, surgical morbidity, and pre-abdominal cerclage characteristics of women undergoing transabdominal cerclage (TAC) via laparotomy or laparoscopy. Prospective cohort study (Canadian Task Force classification II-2). University hospital. Between 2007 and 2014, 51 patients underwent laparoscopic abdominal cervical cerclage to treat cervical incompetence. These women were compared with a historical cohort of 18 patients who underwent the same procedure via laparotomy between 1995 and 2011. All of the women had a diagnosis of cervical incompetence based on previous obstetric history and/or a short or absent cervix. The fetal survival rate postcerclage was 100% in the laparotomy group (n = 30 pregnancies) and 98% in the laparoscopy group (n = 54 pregnancies). There were no perioperative pregnancy losses in either group. The median gestation age was 36.9 weeks (range: 35.0-37.3) in the laparotomy group and 37.0 weeks (range: 34.7-38.0) in the laparoscopy group. Complications were recorded in 4 (22%) cases from the laparotomy group and 1 (2%) of the laparoscopies; however, the types of complications might not be comparable between groups. There were no conversions to laparotomy in the laparoscopy group. Pre-TAC median gestational age in the laparotomy group was 24.0 weeks (range: 20.0-25.1) with 19 (57.6%) previous pregnancies occurring after transvaginal cervical cerclage placement. The corresponding laparoscopy pre-TAC median gestational age was 22.0 weeks (range 19.0-34.0) with 40 (40%) previous pregnancies having a transvaginal cerclage. Before the TAC, women in the laparotomy group had lost 25 babies, and 63 babies were lost in the laparoscopy group. After TAC, these numbers were 0 and 1. Our findings show that transabdominal cervical cerclage placed laparoscopically appears to be as effective as TAC placed via laparotomy. Neither approach was associated with serious or long-term complications. Because of this finding, the approach
Korkmaz, Mevlit; Güvenç, B Haluk
Laparoscopy has been widely used in surgical practice in pediatric age, and many techniques for laparoscopic hernia repair have been described till now. In this study, we compared two laparoscopic techniques performed by two surgeons; each surgeon practicing only one of the two techniques. A retrospective analysis was performed on the surgical charts, enrolling 71 patients with uncomplicated inguinal hernia. Patients were divided into two groups according to the type of surgery: (Group A, 24 patients aged 2 months-8 years) laparoscopic percutaneous internal ring suturing technique and (Group B, 47 patients aged 35 days-12 years) three-port mini-laparoscopic technique. The hernia sac was ligated at the level of internal ring, using nonabsorbable 4/0-3/0 suture. Any unexpected contralateral opening was repaired in the same manner for both groups. Follow-up period was 4 months-2 years and 9 months-8 years, respectively. Operative time and complications were analyzed. Operation time (19.58 ± 7.06 minutes versus 35.87 ± 10.34 minutes, P < .001) was shorter in the percutaneous repair group. However, when subdivided by unilateral and bilateral presentation, only unilateral operative time was shorter compared to three-port group. There were no recurrences in Group A, while two recurrences occurred in Group B during the learning curve period. A contralateral opening accompanied the presenting unilateral hernia in 3 cases for Group A and 16 for Group B. One patient had to be converted open resulting from epigastric vessel injury, and postop hydrocele formation was seen in another in Group A. No intraoperative complications were seen in Group B. The overall experience shows that laparoscopic repair is a reliable approach regardless of the chosen technique. Percutaneous repair seems to be a less invasive method with shorter operative time, but it is not free of complications according to this series.
Kobaek-Larsen, Morten; Rud, Lene; Østergaard-Sørensen, Finn
Metastatic disease to the liver is one of the major factors determining the outcome of colonic resection with curative interventions in human patients. Therefore, animal models for studies of liver metastasis have been developed. Humane endpoints are needed for the evaluation of the animal...... impression of the metastases was obtained. We suggest, as a new humane endpoint, that one animal should only have 1-2 separately growing metastases, each of a maximum size of 10 mm(2). In future, the method has to be developed further to measure the size of the metastases in a more quantitatively precise...... manner. Although the animal has to be anaesthetized each time, laparoscopy is considered a minor surgical procedure as only two small puncture wounds are made through the abdominal wall. Because laparoscopy offers a direct view of the hidden tumours and their sizes, as well as of possible complications...
Sundbom, M; Hedberg, J
One by one, minimally invasive alternatives to established gastrointestinal procedures have become clinical routine. We have studied the use of laparoscopy in four common procedures-cholecystectomy, appendectomy, reflux surgery, and bariatric surgery-as well as in major resectional gastrointestinal surgery in Sweden. The National Patient Registry was used to identify all in-hospital procedures performed in patients above the age of 15 during 1998-2014, meeting our inclusion criteria. For each group, the annual number of procedures and proportion of laparoscopic surgery were studied, as well as applicable subgroups. Differences in age, gender, as well as geographical differences were evaluated in the most recent 3-year period (2012-2014). In total, 537,817 procedures were studied, 43% by laparoscopic approach. In 2012-2014, the proportion of laparoscopic surgery ranged from high rates in the four common procedures (cholecystectomy 81%, appendectomy 47%, reflux surgery 72%, and bariatric surgery 97%) to rather low numbers in resectional surgery (4%-10%), however, increasing in the last years. In appendectomy and cholecystectomy, men were less likely to have laparoscopic surgery (42% versus 51% and 74% versus 85%, respectively, p laparoscopy were also noted, for example, the proportion of laparoscopic appendectomy varied from 11% to 76% among the 21 different Swedish counties. The proportion of laparoscopy was high in the four common procedures and low, but rising, in major resectional surgery. A large variation in the proportion of laparoscopic surgery by age, gender, and place of residence was noted.
Pose, J.; Hermida, M.; Berhouet, H.; Delgado, F.
Laparoscopic approach is currently the elective approach in the treatment of non complicated biliary lithiasis.There was a time when an umbilical herniation presented a series of problems at the time of deciding on the approach to be taken.The paper refers to 2 cases of laparoscopic approach in the treatment of symptomatised biliary lithiasis, with an open laparoscopy technique through umbilical hernia ton ring.The repair of herniation was performed in the same operative act with good immediate results
Warren, Oliver; Kinross, James; Paraskeva, Paraskevas; Darzi, Ara
Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.
Full Text Available Jian-kang Huang,1 Ling Ma,2 Wen-hua Song,1 Bang-yu Lu,3 Yu-bin Huang,3 Hui-ming Dong1 1Department of Surgical Oncology, 2Department of Gynecologic Tumor, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 3Department of Minimally Invasive Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: Endoscopic thyroidectomy for minimally invasive thyroid surgery has been widely applied in the past decade. The present study aimed to evaluate the effects of single-port access transaxillary totally endoscopic thyroidectomy on the postoperative outcomes and functional parameters, including quality of life and cosmetic result in patients with papillary thyroid carcinoma (PTC.Patients and methods: Seventy-five patients with PTC who underwent endoscopic thyroidectomy via a single-port access transaxillary approach were included (experimental group. A total of 123 patients with PTC who were subjected to conventional open total thyroidectomy served as the control group. The health-related quality of life and cosmetic and satisfaction outcomes were assessed postoperatively.Results: The mean operation time was significantly increased in the experimental group. The physiological functions and social functions in the two groups were remarkably augmented after 6 months of surgery. However, there was no significant difference in the scores of speech and taste between the two groups at the indicated time of 1 month and 6 months. In addition, the scores for appearance, satisfaction with appearance, role-physical, bodily pain, and general health in the experimental group were better than those in the control group at 1 month and 6 months after surgery.Conclusion: The single-port access transaxillary totally endoscopic thyroidectomy is safe and feasible for the treatment of patients with PTC. The subjects who underwent this technique have a good perception of their general
Treviño Alanís, R; Martínez Ramírez, A; Garza Treviño, F G; Calanda, A
This article shows the experience in 61 patients with adnexal tumors studied from June 1988 to June 1994; the origin of the patients in private and semiprivate, to whom we practiced a diagnostic and operative laparoscopy (56/61) at the same time. The inclusion and exclusion criteria were determined by clinical history (past history, age, symptoms, size, etc.), vaginal ultrasonography scan (ascites, papillas, cyst's content, etc.), laboratory tests (Ca 125 in postmenopausal patients), the macroscopic assessment during the diagnostic laparoscopy, transoperative biopsy (19/61) was made in order to confirm the benign findings seen before laparoscopy; and the results were accordingly on the 61 cases. The cause of consult was infertility in 24/61; 18/61 were primary infertility; 6/61 were secondary infertility. We did 22 cystectomies and 2 oophorectomies; 10 of them became pregnant. 37 from 61 had pain, nine of this group we did an oophorectomy (2 by torsion, 3 had hemorrhagic cysts that were ruptured and 4 were residual ovary), the rest 28 we performed cystectomy with frank improvement of their symptoms. The postoperative diagnosis of the tumors were: luteomas 13/61; functional cysts 17/61, Hemorrhagic cysts 8/61; endometriomas 9/61; serous cystoadenoma 3/61; mucinous cystoadenoma 1/61; ovaric fibroma 1/61; mature cystic teratoma 2/61; residual ovaries 4/61; paraovaric cysts 2/61 and Morgagni's hydatide 1/61. It is concluded that if one follows all the correct parameters for the evaluation of adnexal tumors, the endoscopic procedure could be safe with the benefits of the laparoscopic procedure.
Full Text Available Abstract Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.
Tubal block was one of the major causes of primary infertility. The diagnostic laparoscopy with hysterosalpingography (HSG) can be helpful to diagnose the tubal pathology. Keywords: Primary infertility, Diagnostic laparoscopy, hysterosalpingography, Tubal block. Internet Journal of Medical Update Vol. 1 (2) 2006: pp. 6-8.
Ankum, W. M.; van der Veen, F.; Hamerlynck, J. V.; Lammes, F. B.
Laparoscopy is regarded as the final decisive diagnostic test in suspected ectopic pregnancy. The new non-invasive diagnostic methods of transvaginal sonography and serum human chorionic gonadotrophin (HCG) monitoring now challenge this pivotal role of laparoscopy. In this prospective study the
Strandbygaard, Jeanett; Bjerrum, Flemming; Maagaard, Mathilde
The objective of this study was to develop a 4-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component.......The objective of this study was to develop a 4-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component....
Popiela, A.; Kasiak, J.; Heimrath, T.; Cislo, M. [Akademia Medyczna, Wroclaw (Poland)
The authors discuss 47 cases in which the hysterosalpingography (HSG) examination showed secondary tubar unpatency, then verified by laparoscopy. In the opinion of the authors supported by the results the HSG examination may be considered only as a preliminary element of tubar patency examination. In case of planned microsurgery the only qualifying or disqualifying examination is the laparoscopy with introduction of color contrast. (author)
Ku, Lowell; Wong, Herb; Liu, C. Y.; Phelps, John Y.
Background and Objectives: The aim of this study is to evaluate the prevalence of intraabdominal adhesions to the umbilicus following gynecologic laparoscopy through an umbilical incision. Methods: A retrospective review was performed of all gynecologic laparoscopic procedures in a private practice setting to identify patients with a repeat laparoscopy who had a history of a previous laparoscopy through an umbilical incision. Patients with a history of other surgeries were excluded. All repeat laparoscopies used a left upper quadrant entry technique where the abdominal cavity was surveyed for adhesions. We also reviewed adverse events attributable to the left upper quadrant entry approach. Results: We identified 151 patients who underwent a second laparoscopy and had a previous umbilical scar. Thirty-two of the 151 (21.2%) patients with a history of a laparoscopy had evidence of adhesions to the umbilical undersurface. No adverse events or injuries were attributed to the left upper quadrant entry technique. Conclusions: Adhesions to the umbilical undersurface occur in 21.2% of patients who have undergone a prior laparoscopy through an umbilical incision. For this reason, we recommend an alternate location for entry in patients with an umbilical scar from a previous laparoscopy. PMID:17651555
Gyedu, Adam; Fugar, Setri; Price, Raymond; Bingener, Juliane
Laparoscopy has become the gold standard for many surgical cases in the developed world. It however, remains a rarity in developing countries for several reasons, a major one being cost. This study aimed to determine the knowledge and attitude of patients attending Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana toward laparoscopic surgery and their willingness to pay for it. A cross-sectional survey was conducted among patients attending specialist clinics at KATH. 1070 patients participated. Mean age was 40±15 years. 54% were city-dwellers. 14% had salary-paying jobs. None had undergone prior laparoscopic surgery. 3% had knowledge of laparoscopy. 95% preferred laparoscopy to open surgery mainly because of faster recovery and less post-op pain. Age >45 years (AOR = 0.53, p = 0.03) and higher education (AOR = 2.00, p = 0.04) were significant predictors of patient choice. Among those preferring laparoscopy, 78% were willing to pay more than the baseline cost of open surgery for laparoscopy. A history of previous abdominal surgery (AOR = 0.67, p = 0.02), having a salaried job compared with being unemployed (AOR = 2.36, p laparoscopy. Knowledge about laparoscopy and its benefits are severely lacking among patients at KATH. Once educated about its benefits, most people prefer laparoscopy even if they needed to pay more for it even in resource-limited countries like Ghana.
van den Broek, W. T.; Bijnen, A. B.; van Eerten, P. V.; de Ruiter, P.; Gouma, D. J.
BACKGROUND: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy and to analyze the efficacy of
Soliman, Ahmed M; Du, Ella Xiaoyan; Yang, Hongbo; Wu, Eric Q; Haley, Jane C
Hysterectomy and laparoscopy are the two most common surgical options used to treat women with endometriosis, yet the disease may still recur. This study aimed to determine the long-term retreatment rates among endometriosis patients in the United States who received either hysterectomy or laparoscopy. Patients aged 18-49 years with endometriosis who underwent hysterectomy or laparoscopy were identified in the Truven Health MarketScan claims database (2004-2013). The retreatment rate up to 8 years after the initial surgery was estimated using Kaplan-Meier survival analysis. The relative risk of retreatment among patients with hysterectomy versus laparoscopy was assessed using a Cox proportional hazard model. A total of 24,915 patients with endometriosis who underwent hysterectomy and 37,308 patients with endometriosis who underwent laparoscopy were identified. The estimated retreatment rates were 3.3%, 4.7%, and 5.4% in the 2nd, 5th, and 8th year following hysterectomy, respectively, while the rates following laparoscopy were 15.8%, 27.5%, and 35.2%, respectively. The hazard ratio of retreatment was 0.157 (95% confidence interval [CI]: 0.146-0.169) comparing hysterectomy to laparoscopy. In the sensitivity analysis, which expanded the definition of retreatment by including medical treatments, the retreatment rate increased by a factor of 11-14 for the hysterectomy cohort and by a factor of 2-4 for the laparoscopy cohort, and the hazard ratio of retreatment rate for hysterectomy versus laparoscopy was 0.490 (95% CI: 0.477-0.502). Our study results indicated that the disease retreatment rate after laparoscopy is high among patients with endometriosis; even hysterectomy does not guarantee freedom from retreatment.
Tharakan, Sasha J; Kim, Aimee G; Collins, Joy L; Nance, Michael L; Blinman, Thane A
Introduction Abdominal injuries are common, costly, deadly, and a source of considerable uncertainty in pediatric trauma. In some circumstances, laparoscopy offers a diagnostic and therapeutic alternative with less morbidity than standard exploration, and more certainty than most imaging. In this study, we review our experience with laparoscopic exploration for trauma. We hypothesized that laparoscopy could be employed effectively in stable blunt or penetrating trauma patients in whom diagnostic uncertainty was unresolved by imaging. Patients and Methods A retrospective review of the trauma database identified all children admitted to our Level I pediatric trauma center between January 1, 2000, and December 31, 2012, requiring surgical abdominal exploration. The utilization of laparoscopy and laparotomy was charted over the 13-year period. Negative laparoscopies and laparotomies and nontherapeutic laparoscopies and laparotomies were examined to investigate clinical scenarios in which laparotomy might have been avoided. Statistical analyses were performed using descriptive statistics, simple linear regression analysis, and Mann-Whitney U test ( p laparoscopy. In 13 patients (34.2%), laparoscopic exploration ruled out injuries. In nine patients (23.7%), laparoscopy identified an injury for which no surgical intervention was necessary. In nine patients (23.7%), an injury was repaired laparoscopically. In seven cases (18.4%), the identified injury required conversion to laparotomy. There were no missed injuries. In the laparotomy group, a less invasive approach could have yielded the same information in 8.7% of patients. Laparoscopy was more likely to be used after a qualitative change in institutional minimally invasive surgical capability. Conclusion Laparoscopy reliably resolves diagnostic uncertainty in selected cases of pediatric abdominal blunt and penetrating trauma. In a hemodynamically stable patient with a concerning exam and inconclusive imaging
De Rosa, Antonella; Cameron, Iain C.; Gomez, Dhanwant
Background To identify indications for staging laparoscopy (SL) in patients with resectable pancreatic cancer, and suggest a pre-operative algorithm for staging these patients. Methods Relevant articles were reviewed from the published literature using the Medline database. The search was performed using the keywords ‘pancreatic cancer’, ‘resectability’, ‘staging’, ‘laparoscopy’, and ‘Whipple's procedure’. Results Twenty four studies were identified which fulfilled the inclusion criteria. Of the published data, the most reliable surrogate markers for selecting patients for SL to predict unresectability in patients with CT defined resectable pancreatic cancer were CA 19.9 and tumour size. Although there are studies suggesting a role for tumour location, CEA levels, and clinical findings such as weight loss and jaundice, there is currently not enough evidence for these variables to predict resectability. Based on the current data, patients with a CT suggestive of resectable disease and (1) CA 19.9 ≥150 U/mL; or (2) tumour size >3 cm should be considered for SL. Conclusion The role of laparoscopy in the staging of pancreatic cancer patients remains controversial. Potential predictors of unresectability to select patients for SL include CA 19.9 levels and tumour size. PMID:26776846
Fergo, Charlotte; Burcharth, Jakob; Pommergaard, Hans-Christian; Kildebro, Niels; Rosenberg, Jacob
This systematic review investigates newer generation 3-dimensional (3D) laparoscopy vs 2-dimensional (2D) laparoscopy in terms of error rating, performance time, and subjective assessment as early comparisons have shown contradictory results due to technological shortcomings. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) comparing newer generation 3D-laparoscopy with 2D-laparoscopy were included through searches in Pubmed, EMBASE, and Cochrane Central Register of Controlled Trials database. Of 643 articles, 13 RCTs were included, of which 2 were clinical trials. Nine of 13 trials (69%) and 10 of 13 trials (77%) found a significant reduction in performance time and error, respectively, with the use of 3D-laparoscopy. Overall, 3D-laparoscopy was found to be superior or equal to 2D-laparoscopy. All trials featuring subjective evaluation found a superiority of 3D-laparoscopy. More clinical RCTs are still awaited for the convincing results to be reproduced. Copyright © 2016 Elsevier Inc. All rights reserved.
Woods, Demetrius L; McAndrew, Thomas; Nevadunsky, Nicole; Hou, June Y; Goldberg, Gary; Yi-Shin Kuo, Dennis; Isani, Sara
To date there have been no comprehensive, comparative assessments of the environmental impact of surgical modalities. Our study seeks to quantify and compare the total greenhouse gas emissions, or 'carbon footprint', attributable to three surgical modalities. A review of 150 staging procedures, employing laparotomy (LAP), conventional laparoscopy (LSC) or robotically-assisted laparoscopy (RA-LSC), was performed. The solid waste generated (kg) and energy consumed (kWh) during each case were quantified and converted into their equivalent mass of carbon dioxide (kg CO(2) e) release into the environment. The carbon footprint is the sum of the waste production and energy consumption during each surgery (kg CO(2) e). The total carbon footprint of a RA-LSC procedure is 40.3 kg CO(2) e/patient (p environmental impact of their decisions to facilitate adoption of sustainable practices. Copyright © 2015 John Wiley & Sons, Ltd.
le Carpentier, M; Merlot, B; Bot Robin, V; Rubod, C; Collinet, P
To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. A retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level. We included 15 patients in the RL group and 22 in the CL group. The median age was 29 years±7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P=0.04. The median size of the bladder lesion was 30±8mm in the RL group vs 23±7mm in the CL group, P=0.03. The median operative time was 210 vs 225min, P=0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P>0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P=0.6 and the pregnancy rate was 93 vs 86%, P=0.6. Robot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Mandrioli, Matteo; Inaba, Kenji; Piccinini, Alice; Biscardi, Andrea; Sartelli, Massimo; Agresta, Ferdinando; Catena, Fausto; Cirocchi, Roberto; Jovine, Elio; Tugnoli, Gregorio; Di Saverio, Salomone
The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a
Lara-Domínguez, Maria D; López-Jiménez, Araceli; Grabowski, Jacek P; Arjona-Berral, Jose E; Zapardiel, Ignacio
To compare perioperative details among patients who underwent gynecologic surgery between traditional laparoscopy and three-dimensional laparoscopy. The present prospective non-randomized study enrolled all consecutive patients diagnosed with gynecologic pathology who underwent laparoscopic surgery at Reina Sofia Hospital, Cordoba, Spain between January 1 and April 30, 2014. Perioperative data, adverse events, and patient satisfaction were compared between patients who underwent treatment with two-dimensional and three-dimensional laparoscopic surgery techniques. The study enrolled 60 consecutive patients; 31 (52%) patients who underwent three-dimensional surgery and 29 (48%) who underwent traditional two-dimensional surgery. No significant differences were observed in the adverse-event rate, operating time, or perioperative parameters. A higher use of sealing devices was recorded among patients who underwent three-dimensional laparoscopy (P=0.021). No difference was recorded in patient satisfaction between the two patient groups. Although there was no impact on surgical outcomes, three-dimensional surgery could give a more accurate view of the surgical field. Performing three-dimensional surgery could be beneficial for more complex procedures although further comparative studies are required to investigate this hypothesis. © 2016 International Federation of Gynecology and Obstetrics.
Cho, Akihiro; Yamamoto, Hiroshi; Kainuma, Osamu; Muto, Yorihiko; Yanagibashi, Hiroo; Tonooka, Toru; Masuda, Takahito
The use of minimally invasive surgery has become widely accepted in many gastrointestinal fields, even in patients with malignancy. However, performing laparoscopic resection for the treatment of hilar cholangiocarcinoma is still not universally accepted as an alternative approach to open surgery, and only a limited number of such procedures have been reported due to the difficulty of performing oncologic resection and the lack of consensus regarding the adequacy of this approach. Laparoscopy was initially limited to staging, biopsy and palliation. Recent technological developments and improvements in endoscopic procedures have greatly expanded the applications of laparoscopic liver resection and lymphadenectomy, and some reports have described the use of laparoscopic or robot-assisted laparoscopic resection for hilar cholangiocarcinoma as being feasible and safe in highly selected cases, with the ability to obtain an adequate surgical margin. However, the benefits of major laparoscopic surgery have yet to be conclusively proven, and carefully selecting patients is essential for successfully performing this procedure. PMID:25386064
Burcharth, Jakob; Burgdorf, Stefan; Lolle, Ida
Venous air embolism (VAE) is a rare life-threatening complication that can occur during laparoscopy. A 50-year-old previously healthy woman underwent laparoscopic cholecystectomy and liver cyst fenestration. Immediately after the surgeon had left the operating room, the patient became hypotensive...... to another hospital, where she received hyperbaric oxygen treatment. The patient was discharged 14 days after surgery without any sequelae. It is important that the general surgeon suspects VAE during laparoscopy whenever the patient develops sudden and unexplained severe hypotension or cardiac arrest during...... or immediately after laparoscopy....
Chang, Yin; Tseng, Chi-Yang
Pneumoperitoneum is the beginning procedure of laparoscopy to enlarge the abdominal cavity in order to allow the surgical instruments to insert for surgical purpose. However, the insertion of Veress needle is a blind fashion that could cause blood vessels or visceral injury without attention and results in undetectable internal bleeding. Seriously it may cause a life-threatened complication. We have developed a method that can monitor the tissue reflective spectrum, which can be used for tissue discrimination, in real time during the puncture of the Veress needle. The system includes a modified Veress needle which containes an optical bundle, a light spectrum analyzing and control unit. Therefore, the tissue reflective spectrum can be vivid observed and analyzed through the fiber optical technology during the procedure of the Veress needle insertion. In this study, we have measured the reflective spectra of various porcine abdominal tissues. The features of their spectra were analyzed and characterized to build up the data base and create an algorithm for tissue discrimination in laparoscopy. The results showed that the correlation coefficient (r) of the reflective spectrum can be 0.79-0.95 for the wavelength range of 350-1000 nm and 0.85-0.98 for the wavelength range of 350-650 nm in the same tissue of various samples which were obtained from different days. An alternative way for tissue discrimination is achieved through a decision making tree according to the characteristics of tissue spectrum. For single blind test the success rate is nearly 100%. It seems that both the algorithms mentioned above for tissue discrimination are all very promising. Therefore, these algorithms will be applied to in vivo study in animal in the near future.
Gudex, Claire; Sørensen, Jan; Clausen, Ingo
This randomized controlled trial compared the clinical outcome from inpatient and ambulatory laparoscopy for benign gynaecological conditions. While 658 consecutive patients were considered for inclusion into the study, data from 26 inpatients and 40 ambulatory cases were analysed. Inpatient surg...
Mol, B. W.; Collins, J. A.; Burrows, E. A.; van der Veen, F.; Bossuyt, P. M.
In this study, we compare the prognostic significance of hysterosalpingography (HSG) and laparoscopy for fertility outcome. In a prospective cohort study in 11 clinics participating in the Canadian Infertility Treatment Evaluation Study (CITES), consecutive couples who registered between 1 April
Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M
Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.
Cortes, Dina; Thorup, J M; Lenz, K
To investigate the value of laparoscopy in boys with impalpable testes, to carry out a histological examination of testicular biopsies or orchidectomy specimens, and to present a clinical description of boys with impalpable testes.......To investigate the value of laparoscopy in boys with impalpable testes, to carry out a histological examination of testicular biopsies or orchidectomy specimens, and to present a clinical description of boys with impalpable testes....
Maurette, R; Garcia Ejarque, M; Silberman, E; Bregante, M; Bogetti, D; Pirchi, D
There are few reports about laparoscopic approach after liver transplantation (LT). The aim of this paper is to analyze in terms of feasibility and therapeutic effectiveness an initial experience with laparoscopy in patients who have had a liver transplantation. Laparoscopic procedures were divided into "early" and "late" laparoscopy. A total of 10 laparoscopic procedures after LT were performed in 9 patients: 3 early and 7 late. The early laparoscopic procedures were performed in 3 patients who had a torpid evolution in their liver transplant: 2 were diagnostic only and 1 was also therapeutic. There were no intraoperative events or conversions. We recorded 2 complications. In 7 patients a late laparoscopy was performed: 4 in the upper abdomen and 3 in the lower abdomen. Of the 4 in the upper abdomen, 3 were liver procedures and 1 was in the transverse colon, on the other side; in addition, 2 laparoscopic inguinal hernia repairs and 1 laparoscopic appendectomy also were performed. None of these 7 cases was converted, and there were no intraoperative events. The early postoperative period, in critically ill patients diagnostic and eventually therapeutic laparoscopy was feasible and effective in our cases. Late laparoscopy in the upper abdomen is difficult due to adhesions and adds to the risk of poor graft function, but was feasible for both diagnostic and therapeutic purposes. Late laparoscopy in the lower abdomen with good graft function has the same safety and efficacy as those performed on nontransplanted patients. Copyright © 2015 Elsevier Inc. All rights reserved.
Burgmeier, Christine; Schier, Felix
IntroductionThe surgical treatment of the acute neonatal abdomen still poses a challenge in pediatric surgery. Various underlying etiologies require different surgical procedures. Until today the role of laparoscopy in the surgical treatment of the acute neonatal abdomen is controversial. The aim of this study was to analyze our experiences with laparoscopy and to perform a review of the literature. Methods Retrospective, single-institution study including all term and preterm neonates initially undergoing laparoscopy due to an acute abdomen. Results Altogether, 17 neonates presenting with an acute neonatal abdomen initially underwent laparoscopy. Unnecessary laparotomy could be avoided in 9 of 17 (53%) neonates. After diagnostic laparoscopy, 2 patients did not require any further surgical intervention. Eight neonates presented midgut atresia intraoperatively, 5 of them underwent laparoscopic-assisted correction. Successful laparoscopic derotation of an acute volvulus (n = 1) and laparoscopic appendectomy (n = 1) could be performed. Conversion to open surgery was necessary in 8 neonates (47%) due to creation of a stoma (n = 5), multiple intestinal bands causing poor visualization (n = 2), and bowel necrosis (n = 1). Conclusions Laparoscopy is a useful diagnostic tool to evaluate the need for further surgical intervention in the acute neonatal abdomen and enables immediate surgical treatment of acute volvulus, appendicitis, or intestinal atresia. In case of conversion to laparotomy, precise localization of the incision is guaranteed. Minimization of the surgical trauma and avoidance of unnecessary laparotomy are the most important benefits of the minimal-invasive approach for the critically ill neonate. © The Author(s) 2016.
Ji, Chunyu; Xiang, Yangwei; Pagliarulo, Vincenzo; Lee, Jangming; Sihoe, Alan D L; Kim, HyunKoo; Zhang, Xuefei; Wang, Zhexin; Zhao, Weigang; Feng, Jian; Fang, Wentao
To assess the feasibility and perioperative outcomes of single-port (SP) and multi-port (MP) approaches for video-assisted thoracoscopic surgery (VATS) lobectomy and anatomical segmentectomy. Retrospective data from 458 patients who received VATS lobectomy or anatomical segmentectomy at Shanghai Chest Hospital, Korea University Guro Hospital, Affiliated Hospital of National Taiwan University, University of Hong Kong Queen Mary Hospital and Shenzhen Hospital were collected. Patients were divided into SP group and MP group according to the surgical approach. Perioperative factors such as operation time, blood loss during surgery, conversion rate, the number and stations of lymph nodes harvested, postoperative chest tube drainage time, postoperative hospitalization time, perioperative morbidity and mortality, and pain scores during the first 3 days after surgery were compared between the two groups. There were no differences in the number (P=0.278) and stations (P=0.564) of lymph nodes harvested, postoperative morbidity (P=0.414) or mortality(P=0.246), and pain score on the third day (P=0.630) after surgery between the two groups. The SP group had a longer operation time (P=0.042) and greater intraoperative blood loss (P<0.001), but the conversion rate was even higher in the MP group (P=0.018). Patients in the SP group had shorter chest tube removal time (P=0.012) and postoperative hospitalization time (P=0.005). Pain scores were lower on the first (P=0.014) and second (P=0.006) day after surgery in the SP group. SP VATS lobectomy and anatomical segmentectomy is technologically more demanding than MP VATS. It can be safe and feasible in the hands of experienced surgeons, with comparable preoperative outcomes to MP VATS, but less pain in the early postoperative period.
Weber, Sharon M.; DeMatteo, Ronald P.; Fong, Yuman; Blumgart, Leslie H.; Jarnagin, William R.
Objective To evaluate the benefit of staging laparoscopy in patients with gallbladder cancer and hilar cholangiocarcinoma. Summary Background Data In patients with extrahepatic biliary carcinoma, unresectable disease is often found at the time of exploration despite extensive preoperative evaluation, thus resulting in unnecessary laparotomy. Methods From October 1997 to May 2001, 100 patients with potentially resectable gallbladder cancer (n = 44) and hilar cholangiocarcinoma (n = 56) were prospectively evaluated. All patients underwent staging laparoscopy followed by laparotomy if the tumor appeared resectable. Surgical findings, resectability rate, length of stay, and operative time were analyzed. Results Patients underwent multiple preoperative imaging tests, including computed tomography scan, ultrasound, magnetic resonance cholangiopancreatography, and direct cholangiography. Laparoscopy identified unresectable disease in 35 of 100 patients. In the 65 patients undergoing open exploration, 34 were found to have unresectable disease. Therefore, the overall accuracy for detecting unresectable disease was 51%. There was no difference in the accuracy of laparoscopy between patients with gallbladder cancer and hilar cholangiocarcinoma. Laparoscopy detected the majority of patients with peritoneal or liver metastases but failed to detect all locally advanced tumors. In patients undergoing biopsy only, laparoscopic identification of unresectable disease significantly reduced operative time and length of stay compared with patients undergoing laparotomy. The yield of laparoscopy was 48% in patients with gallbladder cancer (56% in those who did not undergo previous cholecystectomy), but only 25% in patients with hilar cholangiocarcinoma. However, in patients with locally advanced but potentially resectable hilar cholangiocarcinoma, the yield of laparoscopy was greater, 36% (12/33, T2/T3 tumors) versus 9% (2/23, T1 tumors). Conclusions Laparoscopy identifies the majority
Shigeta, Masanobu; Kadonishi, Yuichi; Yasumoto, Hiroaki; Mita, Koji; Usui, Tsuguru; Marukawa, Kazushi
Retroperitoneoscopic nephrectomy is less invasive than open nephrectomy, and is an alternative surgical procedure for renal tumors and upper urothelial tumors. We evaluated the efficacy of virtual computerized tomography laparoscopy (VCTL) as a navigator for retroperitoneoscopic nephrectomy to ascertain the correct anatomy of the renal hilum pre-operatively under the retroperitoneoscopic view. Seventy-three kidneys with localized renal tumors (n=44), upper urothelial tumors (n=23), or benign renal disease (n=6) underwent multidetector-row CT. VCTL was carried out by the volume-rendered technique. The findings were compared with those of real retroperitoneoscopy. After the operation, each operator scored 1 to 5 in evaluating the usefulness of virtual retroperitoneoscopy (score 5 indicated very useful). The percentages of renal arteries depicted by VCTL compared with those noted during real surgery were 93% for kidneys with renal tumors, 100% for upper urothelial tumors and 83% for benign renal disease. Two renal arteries of 2 kidneys were not detected by virtual imaging. These were about 1 mm in diameter and directly branched from the aorta, however retroperitoneoscopic nephrectomy was performed uneventfully. VCTL depicted all the renal veins. The anatomy of the renal hilum seen on VCTL and real retroperitoneoscopy was identical, without the minor angle deviation caused by drawing the kidney during the operation. The average score for the usefulness of VCTL was 4.1, ranging from 3 to 5. The accurate surgical anatomy of the renal hilum could be predicted in almost all patients pre-operatively. VCTL is an excellent navigator for retroperitoneoscopic nephrectomy. (author)
Benson, Aaron D; Juliano, Trisha M; Viprakasit, Davis P; Herrell, S Duke
Laparoscopic pyeloplasty has emerged as the gold standard for repair of ureteropelvic junction obstruction. Microlaparoscopic (MLP, MLP, using a 5-mm camera in a hidden umbilical incision, and 1.9 or 3 mm working instruments and compared with patients undergoing conventional laparoscopic pyeloplasty (CLP). The data for MLP and CLP were compared using the Student t test, Pearson chi-square test, and Fisher exact test, where appropriate. Between January 2009 and May 2013, there were 19 MLP and 27 CLP procedures performed. The MLP group mean age was younger than the CLP group (34 vs 50 years; P=0.0003). Body mass index, previous treatment rates, operative time, length of stay, ureteral stent duration, and complication rates were not statistically different between the MLP and CLP groups. Strict success rates (indicated by follow-up renal scan T½MLP and CLP groups (89.5% vs 88.9%; P=0.95). No MLP procedures were converted to CLP or open approaches. From technical, perioperative, and outcome perspectives, transperitoneal pyeloplasty with microlaparoscopy is both safe and feasible in our hands compared with conventional laparoscopy, and results in subjectively superior cosmesis. This is the largest MLP series to date and contains, to our knowledge, the only cases described using prototype 1.9 mm instruments.
Altgassen, Christopher; Hertel, Hermann
By now laparoscopy has become an established access route in gynaecological surgery. It took many years to get to this stage for various obstacles had to be overcome. In the end, it was the low intra- and postoperative complication rates together with the rapid reconvalescence of the patients and their wish to be quickly discharged from hospital which led to an unstoppable diffusion of the method. With the increased use of the procedure and the expertise of the surgeons, it entered the field of gynaecological oncology and met similar reservations. Once again the same convincing advantages helped overcome the resistance. Thus, laparoscopic surgical procedures have secured a place in the treatment of corpus and cervical carcinomas, as their surgical safety has been proved. The aim of future examinations should be the proof of non-inferiority compared to the open techniques because the advantages of the laparoscopic procedure have been sufficiently proved. Regardless of the required proof, the method is rapidly expanding with robot-assisted procedures, while surgeons develop exenterative techniques.
Taye, Milan Kumar; Fazal, Syed Abul; Pegu, David; Saikia, Dayanada
Safe placement of the Verres needle or the primary trocar for establishment of pneumoperitoneum is the most critical step in laparoscopic procedure as it is associated with bowel, bladder and life threatening vascular injuries and embolism. In the last few decades many techniques and guidelines have been introduced to eliminate complications in creation of pneumoperitoneum. Classical closed technique (Verres needle) and the open classic technique (Hasson) are the most commonly used techniques for creation of pneumoperitoneum. To compare the rate of occurrence and nature of complications in open and closed laparoscopy during establishment of pneumoperitoneum in different surgical and gynaecological procedures. This was a comparative study conducted at three hospitals in Dibrugarh district, Assam, India from January 2012 to December 2014. Total 3000 cases were included in the study with 1500 cases of open laparoscopy and 1500 cases of closed laparoscopy. Complications occurring in both the groups were compared by using Fisher's-exact test. In closed laparoscopy group minor complications occurred in 80 (5.33%) and major complications in 20 (1.33%) cases. In open laparoscopy group minor complications were observed in 60 (4%) and major complications in 2 (0.13%). The p-value of the difference between the two groups for minor complications was 0.0834 and for major complications was 0.0001(significant). Open laparoscopy was seen to be better than closed laparoscopy in terms of not only the rate of occurrence of complications but also the nature and severity of the complications. This study is clinically relevant as there is no consensus for a particular method of safe entry in to the peritoneal cavity warranting the need for more research. Open technique can be performed in all cases irrespective of previous operative scar, suspected intra peritoneal adhesions or obesity. Favourable outcome may be achieved in closed technique in cases of normal BMI, absence of
Full Text Available Background: More than 3 decades after the introduction of in vitro fertilization (IVF and despite the improved success rates of assisted reproductive technologies, the argument for performing laparoscopy as a part of the infertility workup still stands. Objective: To evaluate the role of laparoscopy±hysteroscopy in diagnosis and management of infertility in our setting in view of modern fertility practice. Materials and Methods: This case control study was carried out on 600 infertile women subjected to laparoscopy or combined laparoscopy and hysteroscopy at endoscopy unit in Minia University Hospital, Egypt during the period from January 2012 to December 2014. Results: The causes of infertility as identified by laparoscopy±hysteroscopy were polycystic ovary syndrome (25.1%, tubal factor (30%, uterine cause (4%, and endometriosis (2.7%. No cause was identified in 38.2% of cases. Based on operative findings, women were treated with different options. Expectant management was used in 92 cases (15.3%. Ovulation induction with anti-estrogens or gonadotropins was used in 372 cases (62%. Sixty cases (10% had intrauterine insemination and sixty four cases (10.7% underwent in vitro fertilization (IVF / intracytoplasmic sperm injection (ICSI treatment. Within 1 yr after laparoscopy, 180 cases achieved pregnancy (30%. The most favorable outcome was recorded in women with unexplained infertility (36.7% of cases got pregnant followed by women with polycystic ovary syndrome (27.8%. Participants with uterine and tubal infertility factor achieved pregnancy in 25% and 22.8% of cases, respectively. The worst outcome was recorded in women with endometriosis. Conclusion: Laparoscopy still has an important role in the diagnosis and treatment of infertility.
Cao, Hop S. Tran; Kaushal, Sharmeela; Menen, Rhiana S.; Metildi, Cristina A.; Lee, Claudia; Snyder, Cynthia S.; Talamini, Mark A.; Hoffman, Robert M.
Abstract Background Staging laparoscopy can visualize peritoneal and liver metastases in pancreatic cancer otherwise undetectable by preoperative imaging. However, false-negative rates may be as high as 18%–26%. The aim of the present study was to improve detection of metastatic pancreatic cancer with the use of fluorescence laparoscopy (FL) in a nude-mouse model with the tumors expressing green fluorescent protein (GFP). Methods The carcinomatosis mouse model of human pancreatic cancer was established by intraperitoneal injections of green fluorescent protein-expressing MiaPaca-2 human pancreatic cancer cells into 6-week-old female athymic mice. Two weeks later, mice underwent diagnostic laparoscopy. Laparoscopy was performed first under standard brightfield lighting, followed by fluorescent lighting. The number of metastatic foci identified within the four quadrants of the peritoneal cavity was recorded. After laparoscopy, the animals were sacrificed, opened, and imaged with the OV-100 Small Animal Imaging system as a positive control to identify metastasis. Tumors were collected and processed for histologic review. Results FL enabled visualization of pancreatic cancer metastatic foci not visualized with standard brightfield laparoscopy (BL). Under FL, in 1 representative mouse, 26 separate micrometastatic lesions were identified. In contrast, only very large tumors were seen using BL. Use of the OV-100 images, as positive controls, confirmed the presence of tumor foci. FL thus allowed identification and exact localization of submillimeter tumor foci. Such small-sized tumor foci were not distinguished from surrounding tissue under BL. All malignant lesions were histologically confirmed. Conclusions The use of FL enables the identification of tumor foci that cannot be seen with standard laparoscopy. The technology described in this report has important potential for the clinical development of FL. PMID:21699431
Mutrynowski, Andrzej; Zabielska, Renata
A polycystic ovaries disease occurs in the case of women with anovulatory cycles as the result of neurohormonal disorders. Patients with this disease suffer from infertility and many symptoms, such as: irregular menstrual bleeding, hirsutism, obesity. The paper presents a method of the carbon dioxide laser laparoscopy in the polycystic ovary disease treatment. The study included 96 women operated on (carbon dioxide laser laparoscopy) in the II Clinic Of Obstetric and Gynecology in Warsaw. Each woman measured her body temperature in order to evaluate her menstrual cycle and had vaginal USG examination or a cytohormonal one before laparoscopy and within 6 months after the surgery. Performing the laparoscopy the operator punctured each ovary in at least 15 points using the carbon dioxide laser. The patients were followed-up for 6 months. The Chi test was used to make the statistic analysis. Comparing the percent of ovulatory cycles and regular ones before and after surgery we noticed that the differences were statistically relevant. Eighty-five patients (88%) had regular cycles and in 88 cases (92%) there was a diphasic curve of the body temperature after the laparoscopy. Fourteen percent of infertile women with polycystic ovary disease conceived.
Prosst, Ruediger L.; Pietschmann, Mathias; Rheinwald, Markus; Haase, Thomas; Herfarth, Christian; Gahlen, Johannes
Accurate staging can be a major problem in therapeutic planning of advanced abdominal malignancies. We experimentally combined conventional staging laparoscopy with aminolevulinic acid (ALA) induced fluorescence diagnosis (FD) to improve the detection of disseminated peritoneal tumors. Using different photosensitization times and ALA concentrations we evaluated the optimal fluorescence parameters for laparoscopic fluorescence diagnosis of intra abdominal tumor spread. In a rat tumor model we performed conventional and fluorescence laparoscopy to determine the increase of sensitivity gained by FD in terms of additionally detected lesions. After laparoscopic examination, the fluorescence emission from the tumors was spectrometically analyzed. Serum levels of ALA and PpIX were measured by HPLC to determine their systemic metabolism. Fluorescence staging laparoscopy was able to visualize even macroscopically occult neoplasms. Using 1.5 percent ALA solution and a photosensitization time of 4 hours as favorable parameters the diagnostic value of conventional staging laparoscopy was significantly improved: 35 percent of all malignant lesions were detected only by FD. Therefore, fluorescence laparoscopy suggest to be a highly promising preoperative staging tool requiring minimal technical and clinical expenditure. It provides the laparoscopist with a rapid and accurate technique to assess more thoroughly the full extent of malignant tumor growth in the abdominal cavity.
Wu, Ching Feng; Fernandez, Ricardo; Mercedes, de la Torre; Delgado, Maria; Fieira, Eva; Wu, Ching Yang; Hsieh, Ming Ju; Paradela, Marina; Liu, Yun-Hen; Gonzalez-Rivas, Diego
Single-port video-assisted thoracoscopic surgery (SPVATS) anatomical resection has been shown to be a feasible technique for lung cancer patients. Whether SPVATS has equivalent or better oncological outcomes for lung cancer patients remains controversial. The purpose of this study was to evaluate the perioperative and mid-term survival outcomes of SPVATS in 2 different medical centres. We retrospectively reviewed patients who underwent SPVATS anatomical resections between January 2014 and February 2017 in Coruña University Hospital's Minimally Invasive Thoracic Surgery Unit (Spain) and Chang Gung Memorial Hospital (Taiwan). Survival outcomes were assessed by pathological stage according to the American Joint Committee on Cancer (AJCC) 7th and 8th classifications. In total, 307 patients were enrolled in this study. Mean drainage days and postoperative hospital stay were 3.90 ± 2.98 and 5.03 ± 3.34 days. The overall 30-day mortality, 90-day morbidity and mortality rate were 0.7%, 20.1% and 0.7%, respectively. The 2-year disease-free survival and 2-year overall survival of the cohort were 80.6% and 93.4% for 1A, 68.8% and 84.6% for 1B, 51.0% and 66.7% for 2A, 21.6% and 61.1% for 2B, 47.6% and 58.5% for 3A, respectively, following the AJCC 7th classification. By the AJCC 8th classification, these were 92.3% and 100% for 1A1, 73.7% and 91.4% for 1A2, 75.2% and 93.4% for 1A3, 62.1% and 85.9% for 1B, 55.6% and 72.7% for 2A, 47.1% and 64.2% for 2B and 42.1% and 60.3% for 3A. Our preliminary results revealed that SPVATS anatomical resection achieves acceptable 2-year survival outcomes for early-stage lung cancer and is consistent with AJCC 8th staging system 2-year survival data. For advanced stage non-small-cell lung cancer patients, further evaluation is warranted.
Micinski, P.; Poreba, R.; Smoczynska, W. [Slaska Akademia Medyczna, Tychy (Poland)
A diagnostic laparoscopy was performed in 57 unexplained infertility patients with apparently normal hysterosalpingography pictures. Despite it, laparoscopy revealed 51% pathologic changes of reproductive organs in pelvis minor. (author) 13 refs, 3 tabs
Full Text Available Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.
Full Text Available Introduction: Chronic pelvic pain (CPP is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%, followed by congestive dysmenorrhoea (26.7%. 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%, followed by pelvic congestion (18.6%. Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%. Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001. Adhesiolysis helps only small proportion of women in achieving pain control.
Reich, Heidi; Ramzy, Danny; Czer, Lawrence; Esmailian, Fardad; Moriguchi, Jaime; Ihnken, Kai; Yusufali, Taizoon; D'Attellis, Nicola; Arabia, Francisco; Annamalai, Alagappan
Technologic advances and superior survival with mechanical circulatory support (MCS) have led to an expanding population that develops intraabdominal conditions requiring intervention. Whether laparoscopy can be performed without detrimental effects on hemodynamics and device function is not well described. Effects of laparoscopy performed on MCS were retrospectively assessed. Intraoperative hemodynamics and device function were compared with the same time interval 24 hours prior to surgery using intrapatient paired t tests. Outcomes included survival, transfusion, thromboembolic events, and infection. Twelve patients with ventricular assist devices or total artificial hearts underwent laparoscopy from 2012 to 2014. Median follow-up was 116 days. Operations included cholecystectomy, diagnostic laparoscopy, gastrojejunostomy, and gastrostomy. There were no differences between preoperative and intraoperative mean arterial pressure, heart rate, and inotrope or vasopressor requirements (P > .05). Device fill volume, flow, rate, and power were unchanged (P > .05), whereas pulsatility index decreased by 0.2 (95% confidence interval, 0.03, 0.36) with laparoscopy (P = .03). All intraoperative fluctuations in hemodynamics and device function improved with reduction of pneumoperitoneum, adjusting device speed, or pharmacologic support. There were no operative mortalities. Thirty-day survival and survival to discharge were 75% and 50%, respectively. Despite antiplatelet therapy and preoperative international normalization ratio of 2.2 ± 0.9, there were no re-operations for bleeding, and 50% did not require transfusion. Two patients with recent cardiac surgery had thromboembolic events: one stroke and one device thrombus. None had postoperative bacteremia or driveline infection. Laparoscopy can be performed on MCS with low morbidity and mortality and minimal perturbations in hemodynamics and device function.
... Adolescent Brain Comorbidity College-Age & Young Adults Criminal Justice Drugged Driving Drug Testing Drugs and the Brain ... Notes Subscribe to NIDA Notes Subscribe by Topic View by interest area Treatment Basic Science Public Health ...
Ferløv Schwensen, Jakob; Bulut, Mustafa; Nordholm-Carstensen, Andreas
A 17-year-old man with weight loss, abdominal pain and fever for three months was admitted to the Digestive Disease Centre. Laboratory tests revealed leucocytosis and a low haemoglobin level, and a CT-scan of the abdomen indicated non-specific abscess cavities. Diagnostic laparoscopy was conducted...... and widespread pale nodules were found throughout the peritoneum. Consequently, the patient was diagnosed with peritoneal tuberculosis. This case demonstrates that atypical manifestations of tuberculosis exist in Denmark and that laparoscopy with biopsy can be performed to obtain the diagnosis when suspecting...
or hysteroscopy in AKTH within the study period were retrieved from the operation record book; their case files were retrieved, studied and recorded in a ... Key words: Anaesthesia; hysteroscopy; laparoscopy. Introduction. Laparoscopy and ... local anaesthesia with sedation may also be used for office laparoscopy..
O'Donnell, I; Farmer, R; Catalan, J
Detailed case reports of incidents of suicide and attempted suicide on the London Underground railway system between 1985 and 1989 were examined for the presence of suicide notes. The incidence of note-leaving was 15%. Notes provided little insight into the causes of suicide as subjectively perceived, or strategies for suicide prevention.
A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy. ... South African Medical Journal ... Ruptured ectopic pregnancy (REP) is a common gynaecological emergency in resource-poor settings, where laparotomy is the standard treatment despite ...
Background: Laparoscopic surgery is important for gynaecological practice and became the method of choice for many gynaecological procedures having advantages over open surgery. Objective: To report our modified teaching methods, and evaluation of the gynaecological laparoscopy courses in United Arab Emirates.
Ferløv Schwensen, Jakob; Bulut, Mustafa; Nordholm-Carstensen, Andreas
and widespread pale nodules were found throughout the peritoneum. Consequently, the patient was diagnosed with peritoneal tuberculosis. This case demonstrates that atypical manifestations of tuberculosis exist in Denmark and that laparoscopy with biopsy can be performed to obtain the diagnosis when suspecting...... peritoneal tuberculosis....
Sørensen, Stine Maya Dreier; Mahmood, Oria; Konge, Lars
BACKGROUND: During laparoscopy, the surgeon's loss of depth perception and spatial orientation is problematic. Laser visual guidance (LVG) is an innovative technology that improves depth perception to enhance the visual field. In this trial, we examined the effect of LVG on surgical novices' motor...
Abdullah, M.T.; Waqar, S.H.; Zahid, M.A.
Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. Methods: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Results: Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Conclusion: Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients. (author)
While 4 patients had laparoscopic tubal sterilization with Filshie clip, 1 patient each had laparoscopic ovarian cyst drainage and IUCD retrieval. The overall complication rate was 2.34%. Conclusion: Laparoscopy is a useful tool in trained hands as important diagnostic and surgical procedures can be carried out, obviating ...
Introduction: Laparoscopy has proved to be an important tool in the minimally invasive exploration of selected patients with chronic abdominal disorders, whose diagnosis remains uncertain, despite exploring the requisite laboratory and imaging investigations like ultrasonography, computed tomography (CT) scan, and the ...
Jayakumaran, Jayapriya; Patel, Sejal D; Gangrade, Bhushan K; Narasimhulu, Deepa Maheswari; Pandian, Soundarya Ramanatha; Silva, Celso
Robotic surgery is a conceptual fusion of the conventional open surgery and the minimally invasive laparoscopic surgery. We reviewed the current role of robotic-assisted laparoscopy in the field of reproductive surgery by a literature search in PubMed database. We analyzed the reported advantages and limitations of the use of robotics in reproductive surgeries like myomectomy, tubal reanastomosis, endometriosis, ovarian tissue cryopreservation, and ovarian transposition. Overall, robotic assistance in reproductive surgery resulted in decreased blood loss, less post-operative pain, shorter hospital stay, and faster convalescence, whereas reproductive outcomes were similar to open/laparoscopic approaches. The main drawbacks of robotic surgery were higher cost and longer operating times. It is as safe and effective as the conventional laparoscopy and represents a reasonable alternate to abdominal approach. Procedures that are technically challenging with the conventional laparoscopy can be performed with robotic assistance. It has advantages of improved visualization and Endowrist™ movements allowing precise suturing. This helps to overcome the limitations of laparoscopy, especially in complicated procedures, and may shorten the steep learning curve in minimal invasive surgery. Randomized controlled trials looking at both short- and long-term outcomes are warranted to strengthen the role of robotic surgery in the field of reproductive surgery.
Rajaram, Shalini; Gupta, Priyanka; Gupta, Bindiya; Kaur, Iqbal R; Goel, Neerja
To estimate the prevalence of genital tuberculosis in women with idiopathic chronic pelvic pain on laparoscopy, correlate laparoscopic findings with microbiological and histological diagnosis of tuberculosis and assess the response to anti tubercular treatment (ATT) in these cases. In a prospective cohort study, fifty women with idiopathic chronic pelvic pain were enrolled. Diagnostic laparoscopy was done in all women and fluid from pouch of Douglas and/or saline washings were sent for acid fast bacilli (AFB) smear, conventional and rapid culture and DNA polymerase chain reaction (PCR) analysis for diagnosis of genital TB. The results of these tests were analyzed and agreement with laparoscopy was assessed using Kappa statistics. Pain scores using visual analogue scale were compared before and after treatment. Pelvic pathology was present in 44 (88%) women of idiopathic chronic pelvic pain, with a 34% prevalence rate of genital tuberculosis. Pelvic inflammation was associated with positive peritoneal fluid PCR (n=4) and AFB culture (n=3). Acid fast bacilli PCR had substantial agreement (kappa statistics=0.716) with visual findings at laparoscopy. There was a significant reduction in pain scores after treatment. Genital tuberculosis contributes to one-third cases of chronic pelvic pain. Pelvic inflammation is an early feature of genital TB and peritoneal fluid PCR has the best co-relation with laparoscopic findings of genital tuberculosis. Copyright © 2016 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.
Summary: Diagnostic Laparoscopy is an established investigative procedure. Its advantage in establishing accurate diagnosis has been proven over time. The duration is short, it provides direct visualization of the lesion and it avoids exposure to irradiation. It is also far cheaper to set up compared to CT scan and MRI.
Since the days of Hippocrates, medical science is constantly thriving to peep into dark places of the body and to achieve such techniques that would bring perfection to diagnosis. Laparoscopy, one such achievement developed in the twentieth century, offers a simple, rapid, and safe method to evaluate and diagnose ...
Wentink, M; Stassen, L P S; Alwayn, I; Hosman, R J A W; Stassen, H G
Compared to aviation, where virtual reality (VR) training has been standardized and simulators have proven their benefits, the objectives, needs, and means of VR training in minimally invasive surgery (MIS) still have to be established. The aim of the study presented is to introduce Rasmussen's model of human behavior as a practical framework for the definition of the training objectives, needs, and means in MIS. Rasmussen distinguishes three levels of human behavior: skill-, rule-, and knowledge-based behaviour. The training needs of a laparoscopic novice can be determined by identifying the specific skill-, rule-, and knowledge-based behavior that is required for performing safe laparoscopy. Future objectives of VR laparoscopy trainers should address all three levels of behavior. Although most commercially available simulators for laparoscopy aim at training skill-based behavior, especially the training of knowledge-based behavior during complications in surgery will improve safety levels. However, the cost and complexity of a training means increases when the training objectives proceed from the training of skill-based behavior to the training of complex knowledge-based behavior. In aviation, human behavior models have been used successfully to integrate the training of skill-, rule-, and knowledge-based behavior in a full flight simulator. Understanding surgeon behavior is one of the first steps towards a future full-scale laparoscopy simulator.
Keller, Deborah S; Parikh, Niraj; Senagore, Anthony J
Despite proven safety and efficacy, rates of minimally invasive approaches for colon cancer remain low in the USA. Given the known benefits, investigating the root causes of underutilization and methods to increase laparoscopy is warranted. Our goal was to develop a predictive model of factors impacting use of laparoscopic surgery for colon cancer. The Premier Hospital Database was reviewed for elective colorectal resections for colon cancer (2009-2014). Patients were identified by ICD-9-CM diagnosis code and then stratified into open or laparoscopic approaches by ICD-9-CM procedure codes. An adjusted multivariate logistic regression model identified variables predictive of use of laparoscopy for colon cancer. A total of 24,245 patients were included-12,523 (52 %) laparoscopic and 11,722 (48 %) open. General surgeons performed the majority of all procedures (77.99 % open, 71.60 % laparoscopic). Overall use of laparoscopy increased from 48.94 to 52.03 % over the study period (p colon cancer laparoscopically. Colorectal surgeons were 32 % more likely to approach a case laparoscopically than general surgeons (OR 1.315, 95 % CI [1.222, 1.415], p characteristics that can be identified preoperatively to predict who will undergo surgery for colon cancer using laparoscopy. However, additional patients may be eligible for laparoscopy based on patient-level characteristics. These results have implications for regionalization and increasing teaching of MIS. Recognizing and addressing these variables with training and recruiting could increase use of minimally invasive approaches, with the associated clinical and financial benefits.
Chiu, Chieh Jack; Lobo Prabhu, Kristel; Tan-Tam, Clara Chia-Hua; Panton, Ormond Neely M; Meneghetti, Adam
Laparoscopic skills training is an essential component of general surgery training. This study proposes the use of three-dimensional (3D) laparoscopy as the initial training tool for beginners to shorten the learning curve. This study evaluates the surgical performance and subjective experience of junior and senior trainees with 3D versus two-dimensional laparoscopy. Peg transfer task was used as the objective time measurement. A subjective evaluation of the 2 systems using a questionnaire was also used. The mean difference in the juniors was 16.33 seconds, while in the seniors it was only 3.46 seconds (P = .036). The time difference between groups was much smaller in the 3D than the two-dimensional (P = .14 vs .02) laparoscopy. In the subjective evaluation, the novice group also scored significantly higher for the 3D system in the bimanual dexterity category (P = .004, .007). Our study demonstrates the feasibility of using 3D laparoscopy for laparoscopic skills training in novices. Copyright © 2015 Elsevier Inc. All rights reserved.
In music, the term note has two primary meanings: A sign used in musical notation to represent the relative duration and pitch of a sound (♪, ♫); A pitched sound itself. Notes are the "atoms" of much written music: discretizations of musical phenomena that facilitate performance, comprehension, and analysis. http://musicnotes.pp.ua/
Sørensen, Stine D; Savran, Mona Meral; Konge, Lars
were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction. RESULTS: Three hundred and forty articles were screened for eligibility, and 31 RCTs were included...... through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. METHODS: A systematic search of the literature...... in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71 %) showed a reduction in performance time, and 12 out of 19...
Sadot, Eran; Telem, Dana A; Arora, Manjit; Butala, Parag; Nguyen, Scott Q; Divino, Celia M
The aim of this study was to evaluate laparoscopic versus open surgery for suspected appendicitis during pregnancy. A hospital-based retrospective review of 65 consecutive pregnant patients who underwent surgery for suspected appendicitis from 1999 to 2008 was performed. Significance was determined by Pearson's chi(2) test, Fisher's exact test, Mann-Whitney test, and Kruskal-Wallis test. Of the 65 patients, 48 cases were laparoscopic and 17 open. Use of the laparoscopic versus open approach was significantly increased in the first (100% vs. 0%, p appendicitis. While methodological limitations preclude a definitive recommendation, laparoscopy appears to be a safe, feasible, and efficacious approach for pregnant patients with presumed acute appendicitis. We conclude that it is likely not the surgical approach but the underlying diagnosis combined with maternal factors that determine the risk for pregnancy complications. A benefit of laparoscopy is the diagnostic ability to identify other intra-abdominal pathology which may mimic appendicitis and harbor pregnancy risks.
Hoffmann, Elise; Bennich, Gitte; Larsen, Christian Rifbjerg
of the study is to determine if 3D laparoscopy gives better quality of life, less postoperative pain, less per- and postoperative complications, shorter operative time, or a shorter stay in hospital and a faster return to work or normal life, compared to conventional laparoscopy for benign hysterectomy...... of 12 points on SF 36 questionnaire, a risk of type I error of 3.3% and a risk of type II error of 10% a sample size of 190 patients in each arm of the trial is needed. Secondarily, we will investigate operative time, time to return to work, length of hospital stay, and - and postoperative complications...... for benign hysterectomy. TRIAL REGISTRATION: This study is registered at ClinicalTrial.gov: NCT02610985 November 16th 2015. November 2015. The regional Ethical committee approved it on the 12. November 2015, approval number: SJ-498. Data handling was approved by the Danish Data Protection Agency: REG-109...
Kamine, Tovy Haber; Papavassiliou, Efstathios; Schneider, Benjamin E
Increased abdominal pressure may have a negative effect on intracranial pressure (ICP). Human data on the effects of laparoscopy on ICP are lacking. We retrospectively reviewed laparoscopic operations for ventriculoperitoneal shunt placement to determine the effect of insufflation on ICP. Nine patients underwent insufflation with carbon dioxide (CO(2)) at pressures ranging from 8 to 15 mm Hg and ICP measured through a ventricular catheter. We used a paired t test to compare ICP with insufflation and desufflation. Linear regression correlated insufflation pressure with ICP. The mean ICP increase with 15-mm Hg insufflation is 7.2 (95% CI, 5.4-9.1 [P pressure (P = .04). Maximum ICP recorded was 25 cm H(2)O. Intracranial pressure significantly increases with abdominal insufflation and correlates with laparoscopic insufflation pressure. The maximum ICP measured was a potentially dangerous 25 cm H(2)O. Laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.
Please note that the Safety Note no 29 (NS 29) entitled 'Fire Prevention for Insulating Core (Sandwich) Panel Structures for Inside Use Guidelines for Selection, Installation and Use' is available on the web at the following url: https://edms.cern.ch/document/475438/LAST_RELEASED Paper copies can also be obtained from the SC Unit secretariat, e-mail : firstname.lastname@example.org SC Secretariat
Kyle, Esther B; Maheux-Lacroix, Sarah; Boutin, Amélie; Laberge, Philippe Y; Lemyre, Madeleine
The optimal intraperitoneal pressure during laparoscopy is not known. Recent literature found benefits of using lower pressures, but the safety of doing abdominal surgery with low peritoneal pressures needs to be assessed. This systematic review compares low with standard pneumoperitoneum during gynecologic laparoscopy. We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing intraperitoneal pressures during gynecologic laparoscopy. Two authors reviewed references and extracted data from included trials. Risk ratios, mean differences, and standard mean differences were calculated and pooled using RevMan5. Of 2251 studies identified, three were included in the systematic review, for a total of 238 patients. We found a statistically significant but modest diminution in postoperative pain of 0.38 standardized unit based on an original 10-point scale (95% confidence interval [CI], -0.67 to -0.08) during the immediate postoperative period when using low intraperitoneal pressure of 8 mm Hg compared with ≥ 12 mm Hg and of 0.50 (95% CI, -0.80 to -0.21) 24 hours after the surgery. Lower pressures were associated with worse visualization of the surgical field (risk ratio, 10.31; 95% CI, 1.29-82.38). We found no difference between groups over blood loss, duration of surgery, hospital length of stay, or the need for increased pressure. Low intraperitoneal pressures during gynecologic laparoscopy cannot be recommended on the behalf of this review because improvement in pain scores is minimal and visualization of the surgical field is affected. The safety of this intervention as well as cost-effectiveness considerations need to be further studied.
Marcinczak, Jan Marek; von Öhsen, Udo; Grigat, Rolf-Rainer
Laparoscopy is a reliable imaging method to examine the liver. However, due to the limited field of view, a lot of experience is required from the surgeon to interpret the observed anatomy. Reconstruction of organ surfaces provide valuable additional information to the surgeon for a reliable diagnosis. Without an additional external tracking system the structure can be recovered from feature correspondences between different frames. In laparoscopic images blurred frames, specular reflections and inhomogeneous illumination make feature tracking a challenging task. We propose an ego-motion estimation system for minimal invasive laparoscopy that can cope with specular reflection, inhomogeneous illumination and blurred frames. To obtain robust feature correspondence, the approach combines SIFT and specular reflection segmentation with a multi-frame tracking scheme. The calibrated five-point algorithm is used with the MSAC robust estimator to compute the motion of the endoscope from multi-frame correspondence. The algorithm is evaluated using endoscopic videos of a phantom. The small incisions and the rigid endoscope limit the motion in minimal invasive laparoscopy. These limitations are considered in our evaluation and are used to analyze the accuracy of pose estimation that can be achieved by our approach. The endoscope is moved by a robotic system and the ground truth motion is recorded. The evaluation on typical endoscopic motion gives precise results and demonstrates the practicability of the proposed pose estimation system.
Ahmed, Irfan; Asgeirsson, Kristjan S; Beckingham, Ian J; Lobo, Dileep N
The vermiform appendix has no constant position and the data on the variations in its position are limited. The aim of this study was to determine the frequency of the various positions of the appendix at laparoscopy. Patients undergoing emergency or elective laparoscopy at a university teaching hospital between April and September 2004 were studied prospectively. The positions of the appendix and the caecum were determined after insertion of the laparoscope, prior to any other procedure and the relative frequencies calculated. A total of 303 (102 males and 201 females) patients with a median age of 52 years (range 18-93 years) were studied. An emergency appendicectomy was performed in 67 patients, 49 had a diagnostic laparoscopy, 179 underwent a laparoscopic cholecystectomy and eight had other procedures. The caecum was at McBurney's point in 245 (80.9%) patients, pelvic in 45 (14.9%) and high lying in 13 (4.3%). The appendix was pelvic in 155 (51.2%) patients, pre-ileal in 9 (3.0%), para-caecal in 11 (3.6%), post-ileal in 67 (22.1%) and retrocaecal in 61 (20.1%) patients. Contrary to the common belief the appendix is more often found in the pelvic rather than the retrocaecal position. There is also considerable variation in the position of the caecum.
Kim, Hyun-wook; Oh, Ye-in; Choi, Ji-hye; Kim, Dae-yong; Youn, Hwa-young
Diagnosis of acute pancreatitis in dogs remains a significant challenge despite the development of advanced diagnostic methodologies. Visual inspection and pancreas biopsy using laparoscopy are generally considered to be procedures free of complications when conducted on healthy animals. However, the usefulness of laparoscopy for diagnosing acute pancreatitis has not been assessed. In the present study, the efficacy of laparoscopy for diagnosing acute pancreatitis in dogs was evaluated in animals with experimentally induced acute pancreatitis. Gross appearance of the pancreatic area was examined by laparoscopy to survey for the presence of edema, adhesions, effusion, pseudocysts, hemorrhage, and fat necrosis. Laparoscopic biopsy was performed and the histopathologic results were compared to those of pancreatic samples obtained during necropsy. The correlation between laparoscopy and histopathologic findings of the pancreas was evaluated. The presence of adhesions, effusion, and hemorrhage in the pancreatic area observed by laparoscopy significantly correlated with the histopathologic results (p pancreatitis in dogs.
On-demand endoscopic CO2 insufflation with feedback pressure regulation during natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy induces minimal hemodynamic and respiratory changes.
Navarro-Ripoll, Ricard; Martínez-Pallí, Graciela; Guarner-Argente, Carlos; Córdova, Henry; Martínez-Zamora, Maria Angels; Comas, Jaume; Rodríguez de Miguel, Cristina; Beltrán, Mireia; Rodríguez-D'Jesús, Antonio; Hernández-Cera, Clara; Llach, Josep; Balust, Jaume; Fernández-Esparrach, Glòria
Endoscopic insufflation has been associated with marked increase in intra-abdominal pressure (IAP) and hemodynamic and respiratory changes during transgastric surgery. To investigate the hemodynamic and respiratory effects during intraperitoneal cavity exploration through 3 different natural orifice transluminal endoscopic surgery (NOTES) access locations compared with laparoscopy. Survival experiments using 40 female pigs randomized to transgastric, transcolonic, transvaginal, and laparoscopic peritoneoscopy. On-demand endoscopic insufflation of CO(2) with feedback pressure regulation was used in NOTES with a maximum pressure of 14 mm Hg. In the laparoscopy group, the IAP was maintained at 14 mm Hg. NOTES procedures were performed by an endoscopist (with the assistance of a gynecologist in the transvaginal group and a second endoscopist in the transgastric and transrectal groups) and laparoscopy by 2 surgeons. Invasive hemodynamic and respiratory data. Blood samples were drawn for gas analyses. All experiments except one in the transrectal group were completed. The IAP was significantly lower in all NOTES groups compared with the laparoscopy group. A significant increase in mean systemic arterial blood pressure was observed in the laparoscopy group at 15 and 30 minutes of intraperitoneal cavity exploration, but it remained unchanged during all NOTES procedures. An increase in airway pressures was observed at 15 and 30 minutes of peritoneoscopy in the animals undergoing laparoscopy, whereas those parameters remained unchanged in the NOTES groups. The laparoscopy group showed a significant impairment in pulmonary gas exchange (decrease in Pao(2), increase in Paco(2), and decrease in arterial pH) after 30 minutes of peritoneoscopy, whereas only a slight increase in Paco(2) was observed in the transrectal and transvaginal groups. Healthy animal model. On-demand endoscopic insufflation of CO(2) with feedback pressure regulation can minimize the risk of hemodynamic and
Morris, Stephen; Gurusamy, Kurinchi S; Sheringham, Jessica; Davidson, Brian R
Surgical resection is the only curative treatment for pancreatic and periampullary cancer, but many patients undergo unnecessary laparotomy because tumours can be understaged by computerised tomography (CT). A recent Cochrane review found diagnostic laparoscopy can decrease unnecessary laparotomy. We compared the cost-effectiveness of diagnostic laparoscopy prior to laparotomy versus direct laparotomy in patients with pancreatic and periampullary cancer with resectable disease based on CT scanning. Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. One-way and probabilistic sensitivity analyses were undertaken. When laparotomy following diagnostic laparoscopy occurred in a subsequent admission, diagnostic laparoscopy incurred similar mean costs per patient to direct laparotomy (£7470 versus £7480); diagnostic laparoscopy costs (£995) were offset by avoiding unnecessary laparotomy costs. Diagnostic laparoscopy produced significantly more mean QALYs per patient than direct laparotomy (0.346 versus 0.337). Results were sensitive to the accuracy of diagnostic laparoscopy and the probability that disease was unresectable. Diagnostic laparoscopy had 63 to 66% probability of being cost-effective at a maximum willingness to pay for a QALY of £20 000 to £30 000. When laparotomy was undertaken in the same admission as diagnostic laparoscopy the mean cost per patient of diagnostic laparoscopy increased to £8224. Diagnostic laparoscopy prior to laparotomy in patients with CT-resectable cancer appears to be cost-effective in pancreatic cancer (but not in periampullary cancer), when laparotomy following diagnostic laparoscopy occurs in a subsequent admission.
Behuria, Pritish; Buur, Lars; Gray, Hazel
employed in varied ways in the political settlements literature, which in turn has led to various methodologies to study power. The note discusses a number of these methodologies, including studying political ruptures as a window into analyzing the distribution of power in African countries, and emphasizes......The political settlements approach emerged out of a critique of new institutional economics developed by Mushtaq Khan in the 1990s. Since then, the political settlements approach has proliferated in donor programmingand academic scholarship on African countries. This has led to some confusion about...... its core conceptual and methodological features. This Research Note starts by setting out our understanding of political settlements and provides an overview of existing political settlements literature on African countries. The note then explores how the key concept of ‘holding power’ has been...
Elbiss, Hassan M; Raheel, Hina; George, Sami; Abu-Zidan, Fikri M
To evaluate the impact of gynecologic laparoscopy courses on the participants' laparoscopy practice. We conducted 5 repeated laparoscopy courses between 2008 and 2012 at the United Arab Emirates University in Al Ain, United Arab Emirates, so as to enhance performance in the operating room. An electronic questionnaire was sent to all participants from each of the courses to evaluate the impact of course attendance on clinical practice. Of 70 participants who were approached to complete the online questionnaire, 38 (54.3%) responded. The majority were female (94.7%) and specialists (65.8%). Half the participants (50.0%) thought they would probably not have started performing laparoscopy without having attended the course. Of the participants, 18.4% thought that their operating skills had greatly improved, 63.2% felt that their operating skills had improved moderately to a lot, and 6/12 participants who had not been performing laparoscopy before attendance of the course began doing so. Overall, the course had no significant impact on the participants' performance of laparoscopy (P=0.51, McNemar test), but the proportion of participants who performed level II laparoscopy was significantly increased after course attendance (10.5% versus 47.4%; P=0.001, McNemar test). Gynecologic laparoscopy courses encourage gynecologists to use laparoscopy in clinical practice. © 2013.
Please note that the revisions of safety notes no 3 (NS 3 Rev. 2) and no 24 (NS 24 REV.) entitled respectively 'FIRE PREVENTION FOR ENCLOSED SPACES IN LARGE HALLS' and 'REMOVING UNBURIED ELV AND LVA ELECTRIC CONDUITS' are available on the web at the following urls: http://edmsoraweb.cern.ch:8001/cedar/doc.download?document_id=322811&version=1&filename=version_francaise.pdf http://edmsoraweb.cern.ch:8001/cedar/doc.download?document_id=322861&version=2&filename=version_francaise.pdf Paper copies can also be obtained from the TIS Divisional Secretariat, email email@example.com
Members of the personnel are invited to take note that only parcels corresponding to official orders or contracts will be handled at CERN. Individuals are not authorised to have private merchandise delivered to them at CERN and private deliveries will not be accepted by the Goods Reception services. Thank you for your understanding. (Version française la semaine prochaine.)
Editor's note. It gives me immense pleasure to present this first issue of the Journal for the year 2004. You may notice several changes. The most important one is the change in the name; the Journal is renamed as Journal of Chemical. Sciences. We have also introduced the publication of. Perspective articles highlighting ...
On another note: the editor and the editorial team acknowledge the financial support of the Carnegie Corporation of New York through the University of Ghana Building A New Generation of Academics in Africa (BANGA-Africa) Project. We also use this platform to express our gratitude for the support of various stakeholders, ...
Masud, M.; Adil, M.; Gondal, Z.I.; Aquil, A.
Objective: To evaluate the diagnostic efficacy of laparoscopy in ill-defined recurrent chronic abdominal pain. Study Design: Prospective study. Place and Duration of Study: Surgical department, Military Hospital Rawalpindi, from Jul 2011 to Dec 2013. Material and Methods: A total of 102 patients who presented to surgical department with chronic recurrent abdominal pain of unknown etiology and underwent diagnostic laparoscopy were included in our study. Patients with acute onset of abdominal pain, hemodynamically unstable, pregnant or those in which diagnosis can be made by radiological techniques were excluded from our study. Patient's demographic data, clinical findings and laparoscopic findings were recorded. Finally data was analyzed by using SPSS version 21. Results: Out of 110 patients 96 were female while remaining 14 were male. The age range of the patients was 20- 70 years with mean age of 50 +- 10 years. The most common site of pain was lower abdomen while mean duration of abdominal pain was 34 weeks. Laparoscopic findings include acute recurrent appendicitis in 32 (29.09%) patients, cholecystitis with biliary sludge in 14 (12.72%), pelvic inflammatory disease in 12 (10.90%), ovarian cyst in 11(10%), adhesions in 10(9.09%), intestinal tuberculosis in 8 (7.27%), mesenteric lymphadenitis in 7 (6.36%), lymphoma in 4 (3.63%), ectopic pregnancy in 3 (2.7%), CA gallbladder in 2 (1.81%), meckels diverticulum in 2 (1.81%), endometriosis in 2 (1.81%) and crohns disease in 1 (0.9%) patients. Mean operative time was 48 min while average hospital stay was 2-3 days. No major complications were noticed. Conclusion: Laparoscopy in our clinical setup has significant role in diagnosing cases of vague abdominal pain which cannot be diagnosed by routine investigations. (author)
Cesario, E; Crochet, P; Boyer de Latour, F-X; Eglin, G; De Rochambeau, B; Agostini, A
Port insertion is a high-risk period during laparoscopy. The French Gynecologist and Obstetricians College (CNGOF) published recommendations in 2010 to minimize those risks. The aim of our analysis was to establish the accidents' circumstances and consequences and to determine if those incidents could have been depending on whether recommendations had been respected or not. Gynerisq is an approved organism by the Haute Autorité de santé (HAS). Its mission is to evaluate and improve practices by a risk management centered approach. We analysed incidents reported by Gynerisq's adherents in an experience report database. Above 114 incidents analysed in the Gynerisq's database, we reported 31 bowel injuries. Those injuries occurred for 77.4% (24/31) during planned interventions. For 32.3% of the cases (10/31), interventions were judged complex by the surgeons. A total of 54.8% (17/31) of the patients had a history of laparotomy. Above 27 injuries occurred during Veress needle or open laparoscopy, 17 could have been avoided regarding to the surgeon. The causes reported were in 10 cases that the recommendations had not been respected, in 2 cases another cause and in 5 cases no causes were given to explain the incident. Our analysis shows that bowel injuries after port insertion, in open laparoscopy or Veress needle use, do not seem to occur only in an emergency context or during complicated interventions. However, most of the incidents occurred for patients with risk factors. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Russo, Thomas V.
The development of the XyceTM Parallel Electronic Simulator has focused entirely on the creation of a fast, scalable simulation tool, and has not included any schematic capture or data visualization tools. This application note will describe how to use the open source schematic capture tool gschem and its associated netlist creation tool gnetlist to create basic circuit designs for Xyce, and how to access advanced features of Xyce that are not directly supported by either gschem or gnetlist.
Correction note for Sanders, M., Calam, R., Durand, M., Liversidge, T. and Carmont, S. A. (2008), Does self-directed and web-based support for parents enhance the effects of viewing a reality television series based on the Triple P - Positive Parenting Programme?. Journal of Child Psychology and Psychiatry, 49: 924-932. doi: 10.1111/j.1469-7610.2008.01901.x. © 2014 Association for Child and Adolescent Mental Health.
Humphreys, Mitchell R
The surgical management of urolithiasis has undergone a remarkable clinical evolution over the past three decades. The once common practice of open stone surgery has nearly been relegated to historical interest by modern technology. The introduction of minimally invasive techniques, laparoscopy and robot-assisted surgery, have emerged to complete the urologist's armamentarium. The benefits to patients when other endourologic procedures have failed include less pain, shorter hospitalization and convalescence, and improved cosmesis. This chapter explores the historical shift from open to minimally invasive management for stone disease and the unique risks and outcomes associated with these procedures in modern urology. Copyright © 2013 Elsevier Inc. All rights reserved.
Larsen, Christian Rifbjerg; Oestergaard, Jeanett; Ottesen, Bent S
medical subject headings (MeSh) terms: Laparoscopy/standards, Computing methodologies, Programmed instruction, Surgical procedures, Operative, and the following free text terms: Virtual real* OR simulat* AND Laparoscop* OR train* Limits: Controlled trials. Study eligibility criteria. All randomized...... regarding VR training efficacy compared with traditional or no training, with outcome measured as surgical performance in humans or animals. Data sources. In June 2011 Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar were searched using the following...
Objective: To determine various indications for laparoscopy and hysteroscopy in Aminu Kano Teaching, hospital (AKTH), Kano. Materials and Methods: This is a descriptive study conducted at the (AKTH, which involved all the patients who had laparoscopy and or hysteroscopy from January 2011 to December 2014 (4 year) ...
Full Text Available Ectopic pregnancy means implantation of fertilized ovum outside the endometrial lining of the uterus. It remains the leading cause of early pregnancy-related death. Delay in diagnosis and treatment puts the life of women at risk. Laparoscopic surgery is increasingly becoming the preferred approach for ectopic pregnancy management. Laparoscopic treatment in ectopic pregnancy raises question of safety and feasibility when compared to laparotomy. In this review article our objective is to summarize the role of laparoscopy in management of ectopic pregnancy in comparison to laparotomy. For this, a literature search was done by using Google and PubMed. The selected articles were analyzed on laparoscopic treatment outcomes such as surgery success rate, operating time, intraoperative and postoperative complications, hospital stay, future fertility, postoperative recurrent ectopic pregnancy, cost-effectiveness in comparison to laparotomy. After analyzing all selected articles, it can be concluded that the laparoscopic management of ectopic pregnancy is safe, effective, and economical in comparision to laparotomy. So, for the patients’ benefit, laparoscopy should be considered as the gold standard method in management of ectopic pregnancy and is worthy to be popularized in clinical practice.
Quddus, M. B.; Mahmud, S. M.
Objective: To describe the results of laparoscopic procedures at a Urology - Nephrology tertiary care centre. Study Design: Case series / observational study. Place and Duration of Study: The Kidney Centre Postgraduate Training Institute, Karachi, from August 2007 to March 2012. Methodology: Medical records of all planned laparoscopic surgery conducted during the study period were reviewed. Those cases which to open surgery were excluded. All were performed by a single surgeon, initially as supervised and later independently. Data was maintained for demographic data, procedure details, length of hospital stay, and complications including conversion to open surgeries. Data was analyzed through SPSS 17.0. Results: There were 36 planned laparoscopic surgeries in the specified period. Out of 36 cases, 8 were converted to open surgery. Those who underwent laparoscopic surgery include two diagnostic procedures and renal cyst deroofing each, four ureterolithotomy, nineteen simple nephrectomy and one radical nephrectomy. So in total 28 cases were performed on 15 females and 13 males with mean age of 33.01 A +- 10.9 years. The mean operative time was 216 A +- 100 minutes and mean length of hospital stay was as 2.7 A +- 1.04 days. There were 10 complications in 28 cases, majority being Clavien Grade II including 7% (2/28) blood transfusion. Conclusion: There are technical challenges in learning laparoscopy for practicing urologists. Following some learning model in a systematic manner will help surmounting the technical challenges in learning laparoscopy. (author)
Huber, Tobias; Wunderling, Tom; Paschold, Markus; Lang, Hauke; Kneist, Werner; Hansen, Christian
Virtual reality (VR) applications with head-mounted displays (HMDs) have had an impact on information and multimedia technologies. The current work aimed to describe the process of developing a highly immersive VR simulation for laparoscopic surgery. We combined a VR laparoscopy simulator (LapSim) and a VR-HMD to create a user-friendly VR simulation scenario. Continuous clinical feedback was an essential aspect of the development process. We created an artificial VR (AVR) scenario by integrating the simulator video output with VR game components of figures and equipment in an operating room. We also created a highly immersive VR surrounding (IVR) by integrating the simulator video output with a [Formula: see text] video of a standard laparoscopy scenario in the department's operating room. Clinical feedback led to optimization of the visualization, synchronization, and resolution of the virtual operating rooms (in both the IVR and the AVR). Preliminary testing results revealed that individuals experienced a high degree of exhilaration and presence, with rare events of motion sickness. The technical performance showed no significant difference compared to that achieved with the standard LapSim. Our results provided a proof of concept for the technical feasibility of an custom highly immersive VR-HMD setup. Future technical research is needed to improve the visualization, immersion, and capability of interacting within the virtual scenario.
Marcello Barbosa Barros
Full Text Available CONTEXT: Iatrogenic vascular problems due to laparoscopy are a well recognized problem and lead to significant repercussions. In this context, a ten-year review of cases topic is presented, based on experience gained while heading two important vascular surgery services. CASES: Five patients with vascular injuries during elective laparoscopy are described. These patients presented with seven lesions of iliac vessels. All cases were evaluated immediately and required laparotomy, provisional hemostasis and urgent attendance by a vascular surgeon. Direct suturing was performed in three cases. One aortoiliac bypass and one ilioiliac reversed venous graft were made. Venous lesions were sutured. One case of a point-like perforation of the small bowel was found. There were no deaths and no complications during the postoperative period. DISCUSSION: Important points on this subject are made, and advice is given. There needs to be immediate recognition of the vascular injury, and expert repair by a vascular surgeon is recommended, in order to significantly reduce the degree of complications.
The Research Article "A bacterium that can grow by using arsenic instead of phosphorus" by F. Wolfe-Simon et al., published online 2 December 2010, was the subject of extensive discussion and criticism following its online publication. Science received a wide range of correspondence that raised specific concerns about the Research Article's methods and interpretations. Eight Technical Comments that represent the main concerns, as well as a Technical Response by Wolfe-Simon et al., are published online in Science Express at the addresses listed in this note. They have been peer-reviewed and revised according to Science's standard procedure.
Miyahara, Yoshiya; Yoshida, Shigeki; Shirakawa, Tokuro; Makihara, Natsuko; Niiya, Kiyoshi; Ebina, Yasuhiko; Yamada, Hideto
The purpose of this study was to validate the therapeutic efficacy of the innovative surgical approach using laparoscopy, atelocollagen sponge, and hand-made mould on the achievement of a satisfactory neovagina in patients with vaginal agenesis. The current study involved four patients diagnosed as having Mayer-Rokitansky-Küster-Hauser syndrome. After creating a vaginal tunnel, the mould wrapped with atelocollagen sponge was placed within the neovagina. The hand-made mould made of expanded polystyrene was started to insert into the neovagina at 7 days after operation. Since this mould is lighter and easier to adjust compared with the previous commercialized ones, it was less stressful for the patients to master the procedure than previous methods. Average operation time was 124 minutes with average blood loss being 45 ml. Average hospital stay was 23 days. The mean length of the neovagina one week postoperation was 8 cm with two fingers in width in all patients. No remarkable postoperative complications were noted. At two months after surgery, the neovagina was confirmed to be completely epithelialized in all patients, assessed by Schiller's test. This innovative surgical procedure using a mould wrapped with atelocollagen sponge may be a more useful approach for the treatment of vaginal agenesis.
Full Text Available Tumor size smaller than 4 cm as an indication for surgical treatment of incidentaloma is still a subject of discussion. Our aim was the estimation of the incidence of malignancy and analysis of treatment outcomes in patients with incidentaloma smaller than 4 cm in comparison to bigger lesions. 132 patients who underwent laparoscopic adrenalectomy for nonsecreting tumors were divided into two groups: group 1 (55 pts., size 40 mm. Operation parameters and histopathological results were analyzed. No differences in group characteristics, mean operation time, and estimated blood loss were noted. Complications in groups 1 and 2 occurred in 3.6% and 5.2% of patients, respectively (P=0.67. Malignancy in groups 1 and 2 was present in 1 and 6 patients, respectively (P=0.13. Potentially malignant lesions were identified in 4 patients in group 1 and 4 patients in group 2 (P=0.39. The results do not allow for straightforward recommendations for surgical treatment of smaller adrenal tumors. The safety of laparoscopy and minimal, but impossible to omit, risk of malignancy support decisions for surgery. On the other hand, the risk of malignancy in smaller adrenal tumors is lower than surgical complications, which provides an important argument against surgery.
VolumiVito Campanelli, Web Aesthetics. How Digital Media Affect Culture and Society; Id., Remix It Yourself. Analisi socio-estetica delle forme comunicative del Web [Emanuele Crescimanno] • Jean-François Bordron, Image et vérité. Essais sur les dimensions iconiques de la connaissance [Veronica Estay Stange] • Stéphane Dumas, Les peaux créatrices – Esthétique de la sécrétion [Marc-Vincent Howlett]NoteQuidam veritatis effectus. A proposito di A Plea for Balance in Philosophy. Essays in honour o...
This note discusses multi-sensor fusion. Through sensor fusion we may combine readings from different sensors, remove inconsistencies and combine the information into one coherent structure. This kind of processing is a fundamental feature of all animal and human navigation, where multiple...... information sources such as vision, hearing and balance are combined to determine position and plan a path to a goal. While the concept of data fusion is not new, the emergence of new sensors, advanced processing techniques, and improved processing hardware make real-time fusion of data increasingly possible...... interface. Sensor fusion seeks to overcome the drawbacks of current sensor technology by combining information from many independent sources of limited accuracy and reliability to give information of better accuracy and reliability. This makes the system less vulnerable to failures of a single component...
Gani, Rafiqul; Hrymak, A.; Lee, J.
The “aims and scope” of the Computers & Chemical Engineering has been revised (see the inside cover page for the new version). We would like to make this journal the indisputable journal for the Process Systems Engineering (PSE) area as well as define the PSE agenda for the future. The principal...... components of PSE—modeling, numerical analysis, optimization, systems and control theory, computer science, and, management science will be highlighted through the published articles (full-length papers, perspective papers, review papers, short notes and letters to the editor). They will cover...... need your support and cooperation as potential reviewers. We would very much appreciate if reviewers, who accept our invitation to review, send their comments to us within the agreed deadline. We will strive to maintain and strengthen the scientific quality of Computers & Chemical Engineering and make...
Barzana, Daniel C; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W
Enthusiasm for the use of laparoscopy in trauma has not rivaled that for general surgery. The purpose of this study was to evaluate our experience with laparoscopy at a level II trauma center. A retrospective review of all trauma patients undergoing diagnostic or therapeutic laparoscopy was performed from January 2004 to July 2010. Laparoscopy was performed in 16 patients during the study period. The average age was 35 years. Injuries included left diaphragm in 4 patients, mesenteric injury in 2, and vaginal laceration, liver laceration, small bowel injury, renal laceration, urethral/pelvic, and colon injury in 1 patient each. Diagnostic laparoscopy was performed in 11 patients (69%) with 3 patients requiring conversion to an open procedure. Successful therapeutic laparoscopy was performed in 5 patients for repair of isolated diaphragm injuries (2), a small bowel injury, a colon injury, and placement of a suprapubic bladder catheter. Average length of stay was 5.6 days (range, 0 to 23), and 75% of patients were discharged home. Morbidity rate was 13% with no mortalities or missed injuries. Laparoscopy is a seldom-used modality at our trauma center; however, it may play a role in a select subset of patients.
Strandbygaard, Jeanett; Maagaard, Mathilde; Larsen, Christian Rifbjerg
conversational interviews with experts in laparoscopy. The subsequent relevance of the test questions was evaluated using the Delphi method involving regional chief physicians. Construct validity was tested by comparing test results from three groups with expected different clinical competence and knowledge...... levels: senior medical students, first-year residents, and chief physicians. RESULTS: The four conversational interviews resulted in the development of 47 test questions, which were narrowed down to 37 test questions after two Delphi rounds involving 12 chief physicians. Significant differences were...... found between the test scores from the senior medical students (n = 14) and the first-year residents (n = 52) (median test scores, 18 vs. 24, respectively; p = 0.001), and between the first-year residents and the chief physicians (n = 12) (median test scores, 24 vs. 33, respectively; p = 0...
Carbonnel, Marie; Goetgheluck, Julie; Frati, Albane; Even, Marc; Ayoubi, Jean Marc
To determine the interest of using robotic laparoscopic surgery in the management of female infertility, we reviewed our own activity and searched the Medline database for publications on robotic technology in infertility surgery, with the use of the following search words: robotic laparoscopy, tubal anastomosis, myomectomy, deep infiltrating endometriosis, and adnexal surgery. Robot-assisted laparoscopic surgery has seen rapid progression over the past few years. It has been mostly used for myomectomy, proximal tubal reanastomosis, and deep endometriosis surgery. Despite its increased range of indications, no randomized control studies are available. The place of robotic surgery in the management of infertility remains undetermined. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Rovetta, Alberto; Sala, Remo; Cosmi, Francesca; Wen, Xia; Sabbadini, Dario; Milanesi, Santo; Togno, Arianna; Angelini, Licinio; Bejczy, Antal K.
This paper describes the significance in human, scientific, and technical terms of the first experiment of robotic telesurgery effected between the Telerobotics Laboratory of the Politecnico di Milano and the Jet Propulsion Laboratory, NASA, in Pasadena California, on 7 July 1993. An Italian surgeon controlled from the U.S. A. an Italian robot in the Telerobotics Laboratory in such a way that the robot performed a biopsy, on a model containing the organs of a pig, carrying out an aspiration of organic material and two incisions for the commencement of the surgical operation of laparoscopy. Transmission was effected by means of a double satellite link with three stations -- one in Italy, one in New York and one in Pasadena -- and two geostationary satellites, the first over the Atlantic and the second over the United States.
Mikkelsen, A L; Felding, C
The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women...... had ultrasound examination performed. This investigation showed to be helpful especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did...... not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic...
Atul A. Thakre
Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as 0.4 to 1.8% among the pediatric population. In children with urinary tract infection, the prevalence is typically from 30–50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of presenting our surgical technique: laparoscopic intravesical ureteric reimplantation is to highlight the use of laparoscopy to perform ureteric reimplantation for the management of pediatric VUR.
Ramesh, Jayapal; Christein, John; Varadarajulu, Shyam
While laparoscopy-assisted endoscopic retrograde cholangiopancreatography can be performed for the diagnosis and management of pancreaticobiliary diseases in patients with Roux-en-Y (RY) anatomy; the technical feasibility of performing laparoscopy-assisted endoscopic ultrasound (EUS) is unknown. In this report, we describe the technique for performing laparoscopy-assisted EUS in two patients with RY gastric bypass anatomy who presented with obstructive jaundice, abnormal liver function tests, and dilated biliary tree. While the examination was normal in one patient, EUS-guided fine needle aspiration of pancreatic head mass revealed adenocarcinoma in the other. Laparoscopic assisted EUS examination including FNA is feasible in Roux-en-Y surgical anatomy.
Shan, Cheng-Xiang; Ni, Chong; Qiu, Ming; Jiang, Dao-Zhen
AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model. METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to evaluate the abdominal injuries, particularly the types, sites, and numbers of SBIs. Traditional open surgery or therapeutic laparoscopy was then performed. All pigs were kept alive within the observational period (postoperative 72 h). The postoperative recovery of each pig was carefully observed. RESULTS: The vital signs of all pigs were stable within 1-2 h after shooting and none of the pigs died from gunshot wounds or SBIs immediately. The SBI model was successfully established in all pigs and definitively diagnosed with single or multiple SBIs either by exploratory laparotomy or laparoscopy. Compared with exploratory laparotomy, laparoscopy took a significantly longer time for diagnosis (41.27 ± 12.04 min vs 27.64 ± 13.32 min, P = 0.02), but the time for therapeutic laparoscopy was similar to that of open surgery. The length of incision was significantly reduced in the laparoscopy group compared with the laparotomy group (5.27 ± 1.86 cm vs 15.73 ± 1.06 cm, P surgery, both laparotomy and laparoscopy offered a definitive diagnosis with no missed injuries. Postoperative complications occurred in four cases (three following laparotomy and one following laparoscopy, P = 0.326). The average recovery period for bowel function, vital appearance, and food re-intake after laparoscopy was 10.36 ± 4.72 h, 14.91 ± 3.14 h, and 15.00 ± 7.11 h, respectively. All of these were significantly shorter than after laparotomy (21.27 ± 10.17 h, P = 0.004; 27.82 ± 9.61 h, P laparotomy
Full Text Available VolumiVito Campanelli, Web Aesthetics. How Digital Media Affect Culture and Society; Id., Remix It Yourself. Analisi socio-estetica delle forme comunicative del Web [Emanuele Crescimanno] • Jean-François Bordron, Image et vérité. Essais sur les dimensions iconiques de la connaissance [Veronica Estay Stange] • Stéphane Dumas, Les peaux créatrices – Esthétique de la sécrétion [Marc-Vincent Howlett]NoteQuidam veritatis effectus. A proposito di A Plea for Balance in Philosophy. Essays in honour of Paolo Parrini [Fabrizio Desideri] • A Single Face to Capture the Whole World: Literary Shapes and Shadows. An Interview With Tolm Coibin [Fabrizia Abbate] •Convegno Le sensible a l’oeuvre: savoirs du corps entre esthetique et neurosciences, Parigi, 15 Maggio 2014 [Jessica Murano]
van der Meer, F.; Ommen Kloeke, E.
With this editorial note we would like to update you on the performance of the International Journal of Applied Earth Observation and Geoinformation (JAG) and inform you about changes that have been made to the composition of the editorial team. Our Journal publishes original papers that apply earth observation data for the management of natural resources and the environment. Environmental issues include biodiversity, land degradation, industrial pollution and natural hazards such as earthquakes, floods and landslides. As such the scope is broad and ranges from conceptual and more fundamental work on earth observation and geospatial sciences to the more problem-solving type of work. When I took over the role of Editor-in-Chief in 2012, I together with the Publisher set myself the mission to position JAG in the top-3 of the remote sensing and GIS journals. To do so we strived at attracting high quality and high impact papers to the journal and to reduce the review turnover time to make JAG a more attractive medium for publications. What has been achieved? Have we reached our ambitions? We can say that: The submissions have increased over the years with over 23% for the last 12 months. Naturally not all may lead to more papers, but at least a portion of the additional submissions should lead to a growth in journal content and quality.
O'Riordan, J M
Laparoscopic colorectal surgery has increasingly become the standard of care in the management of both benign and malignant colorectal disease. We herein describe our experience with laparoscopy in the management of complications following laparoscopic colorectal surgery.
N.D. Kannekens-Bouvy (Nicole); R.L. Marquet (Richard); H.J. Bonjer (Jaap); J. Jeekel (Hans)
textabstractOBJECTIVE: A tumor model in the rat was used to study peritoneal tumor growth and abdominal wall metastases after carbon dioxide (CO2) pneumoperitoneum, gasless laparoscopy, and laparotomy. SUMMARY BACKGROUND DATA: The role of laparoscopic resection of
Hulscher, J. B.; Nieveen van Dijkum, E. J.; de Wit, L. T.; van Delden, O. M.; van Lanschot, J. J.; Obertop, H.; Gouma, D. J.
OBJECTIVE: To investigate the role of diagnostic laparoscopy and laparoscopic ultrasonography in the staging of carcinoma of the gastric cardia that is involving the distal oesophagus. DESIGN: Retrospective consecutive case series. SETTING: Tertiary care centre, The Netherlands. SUBJECTS: 48
Lin, Heng-Fu; Chen, Ying-Da; Lin, Keng-Li; Wu, Meng Che; Wu, Cheng Yi; Chen, Shyr-Chyr
The aim of this study was to evaluate the effect of laparoscopy on patients with blunt hollow viscus and mesenteric injuries (BHVMIs). Hemodynamically stable patients with BHVMIs were diagnosed using computed tomography and serial examinations. Patients admitted from July 1, 1999 to June 30, 2006 underwent exploratory laparotomy (group A), and those admitted from January 1, 2007 to December 31, 2013 received laparoscopy (group B). There were 62 patients in group A, and 59 patients in group B. There were no significant differences in demographic characteristics, injury severity score, and injuries requiring surgical intervention between the groups (all, P > .05). Patients in group B had a shorter hospital stay (mean 11.0 vs 17.6 days, P laparoscopy to laparotomy in group B was 8.5%, compared with a 100% laparotomy rate in group A (P Laparoscopy is feasible and safe for hemodynamically stable patients with BHVMIs. Copyright © 2015 Elsevier Inc. All rights reserved.
Furriel, Frederico T. G.; Laguna, Maria P.; Figueiredo, Arnaldo J. C.; Nunes, Pedro T. C.; Rassweiler, Jens J.
To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments. A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during
Mudayana, Ahmad Ahid
Background : Complexity of hospital marketing strategy that have social function needed research to analyses marketing strategy have been applied by PKU Muhammadiyah Yogyakarta hospital, especially to promote Laparoscopy Product. Marketing strategy of the segmentation, targeting and positioning. The aim of the research to analyses marketing strategy of PKU Muhammadiyah Yogyakarta to promote Laparoscopy product.Method : This was descriptive research using qualitative method. The subject was di...
Rappe, B J; Zandberg, A R; De Vries, J D; Froeling, F M; Debruyne, F M
From January 1981 till October 1991, 47 diagnostic laparoscopies were performed in 50 impalpable testicles. In total, 28 intra-abdominal testes were found. In 14 cases no testes were found, but a deferential duct and vessels were seen. In 7 cases the diagnosis of testicular agenesia was made. One laparoscopy was a technical failure. We bring our results of this safe and reliable procedure, and discuss our management. A review of treatment options for intra-abdominal testes is given.
Ikoma, Naruhiko; Blum, Mariela; Chiang, Yi-Ju; Estrella, Jeannelyn S; Roy-Chowdhuri, Sinchita; Fournier, Keith; Mansfield, Paul; Ajani, Jaffer A; Badgwell, Brian D
This study aimed to identify the yield of staging laparoscopy with peritoneal lavage cytology for gastric cancer patients and to track it over time. The medical records of patients with gastric or gastroesophageal adenocarcinoma who underwent pretreatment staging laparoscopy at the authors' institution from 1995 to 2012 were reviewed. The yield of laparoscopy was defined as the proportion of patients who had positive findings on laparoscopy, including those with macroscopic carcinomatosis, positive cytology, or other clinically important findings. To compare the yield of laparoscopy over time, the patients were divided into three 6-year ranges based on the date of diagnosis. Associations between clinicopathologic factors and peritoneal disease were examined using uni- and multivariate analyses. The study included 711 patients. Among these patients, 43.5 % had gastroesophageal junction tumors, 72.9 % had poorly differentiated adenocarcinoma, and 53 % had signet ring cell morphology. Endoscopic ultrasound had most commonly identified T3 (83.9 %) and N-positive (66.4 %) tumors. At laparoscopy, 148 (20.8 %) patients had been found to have macroscopic peritoneal carcinomatosis. Among 514 macroscopically negative patients who underwent peritoneal lavage cytologic analysis, 68 (13.2 %) had positive cytology results for malignancy. The total laparoscopy yield was 36 %, which did not change over time (p = 0.58). Multivariate analysis demonstrated that positive cytology or carcinomatosis was associated with poorly differentiated histology, linitis plastica, and equivocal computed tomography findings. Laparoscopy remains a useful staging procedure to evaluate for peritoneal spread when treatment or surgery is considered, even with the current availability of high-quality imaging.
Moriya, K; Morita, K; Mitsui, T; Kitta, T; Nakamura, M; Kon, M; Nonomura, K
To review laparoscopy in patients with disorders of sex development (DSD) in order to clarify its usefulness in diagnosis, devising subsequent therapeutic strategies and managing patients with various conditions. Between April 1992 and December 2012, 29 laparoscopic surgeries were performed in 25 DSD patients. Among them, ten were diagnostic laparoscopy including gonadal biopsy, and 19 were therapeutic laparoscopy. Surgical procedures and complications were evaluated. For diagnostic laparoscopy, laparoscopic gonadal biopsy was performed in three patients. Inspection, with or without open gonadal biopsy, was performed on four out of seven patients with 46XY DSD or mixed gonadal dysgenesis (MGD). Additional surgery was planned and performed based on diagnostic laparoscopic findings in six out of seven patients. In the three patients with ovotesticular DSD, the gonadal pathology was diagnosed as: testis/ovary in one, testis/ovotestis in one and ovary/ovotestis in one--this was from the laparoscopic inspection and/or gonadal biopsy. However, the final diagnoses were bilateral ovotestis in two patients and ovary/ovotestis in one patient. For therapeutic laparoscopy, surgical procedures were: gonadectomy in 17 patients (bilateral in 13, unilateral in three, partial in two); hysterectomy in two patients; orchiopexy in one; and sigmoid vaginoplasty in one patient (included multiple procedures). There were no severe perioperative complications. In the four patients with a history of diagnostic laparoscopy, no severe intra-abdominal adhesions that would disturb therapeutic laparoscopic surgery were observed. While diagnostic laparoscopy was helpful in devising a therapeutic surgical strategy in most of the patients with DSD who were suspected as having complex gonadal status or Müllerian duct derivatives, attention must be paid to precisely diagnosing the gonadal status in ovotesticular DSD. On the other hand, therapeutic laparoscopic surgeries were valuable procedures in
Sakar, Mehmet N.; Atay, Ahmet E.; Gul, T.; Celik, Y.
Objective was to compare tuboperitoneal factors of infertile women hysterosalpingography (HSG) and laparoscopy. In this cohort study, 82 infertile cases were evaluated retrospectively by laparoscopy, 3 months subsequent to HSG in the Department of Gynecology and Obstetrics, Medical School of Dicle University, Diyarbakir, Turkey between March 2004 and April 2006. The findings of HSG and laparoscopy were compared. Out of 82 infertile women, pathological findings were observed in 45.1% by HSG and 54.9% had no pathological findings. On laparoscopic evaluation, however, pathological findings were observed in 65.85% and 34.15% had no pathological findings. The pathological findings were detected by laparoscopy in 20 of the 45(44.4%) patients who had had no pathological findings by HSG and no pathological findings were detected by laparoscopy in 3 of the 37 (8.1%) patients who had pathological findings by HSG. Laparoscopy revealed no pathological findings in 6 of 35 patients who had tubal pathology by HSG. The sensitivity of HSG was 63%, specificity was 89.3% and positive predictive value was 92% with a 55% predictive value and the accuracy ratio was 72%. Laparoscopy is a superior method for the result of tubal and pelvic pathologies in the evaluation of infertility. However, HSG is a more economical and elementary method suitable for evaluation of endometrial and tubal pathologies and laparoscopy is an appropriate method for examining the external part of tubae, fimbriae, the relation of tuba and ovary, endometriosis, adhesions, tuberculosis and other pathologies. Therefore, these 2 methods are not alternative but complementary. (author)
Full Text Available Background. Ruptured ectopic pregnancy (REP is a common gynaecological emergency in resource-poor settings, where laparotomy is the standard treatment despite laparoscopic surgery being regarded as the optimal treatment. There is a lack of prospective randomised data comparing laparoscopic surgery with laparotomy in the surgical management of women with REP. Objective. To compare operative laparoscopy with laparotomy in women with REP. Methods. This was a randomised parallel study. One hundred and forty women with suspected REP were randomised to undergo operative laparoscopy or laparotomy. The outcome measures were operating time, hospital stay, pain scores and analgesic requirements, blood transfusion, time to return to work, and time to full recovery. Results. Operating time was significantly longer in the laparoscopy group (67.3 v. 30.5 minutes, p<0.001. Duration of hospital stay, pain scores and need for analgesia were significantly less in the laparoscopy group. Women in this group returned to work 8 days earlier and their time to full recovery was significantly shorter compared with those in the laparotomy group. Significantly more women undergoing laparotomy required blood transfusion than women in the laparoscopy group. In the latter group, 14.5% of women required blood transfusion compared with 26.5% in the laparotomy group (p=0.01. Conclusion. Operative laparoscopy in women treated for REP is feasible in a resource-poor setting and is associated with significantly less morbidity and a quicker return to economic activity.
Jadranka Domazet Fink
Full Text Available Background. The aim of this study was to assess the share of organic changes in patients with chronic pelvic pain (CPP as well as evaluate the need for invasive CPP diagnostics – laparoscopy.Methods. The data for the analysis were gathered retrospectively from the descriptions of 287 CPP patients who were treated at the Clinic of Gynaecology in Ljubljana from 1993 to 1999. In this analysis the share of laparoscopically established organic causes of CPP was assessed and the findings of invasive (laparoscopy and non-invasive diagnostics (clinical status and ultrasound were compared.Results. Out of 287 patients, 272 underwent laparoscopy, 7 underwent laparotomy while 8 were only observed. As regards organic CPP causes, an organic cause was established in 70.7% patients through laparoscopy. The most frequently observed phenomena were adhesions, namely in 97 (35.7% patients, endometriosis in 68 (25.0% and pelvic varices in 29 (10% patients.By comparing the results of invasive and non-invasive diagnostics it was established that up to three times more organic changes – a possible cause of CPP – can be discovered through laparoscopy than through the use of non-invasive diagnostics methods.Conclusions. Laparoscopy is considered to be the most reliable method of diagnostics and detection of organic causes of CPP. An adequate psychological treatment within a multidisciplinary approach is necessary in patients in whom an organic cause of CPP can not be discovered in their genital tract.
Koca, Dilek; Yıldız, Sedat; Soyupek, Feray; Günyeli, İlker; Erdemoglu, Ebru; Soyupek, Sedat; Erdemoglu, Evrim
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.
Ren, Jianan; Liu, Song; Wang, Gefei; Gu, Guosheng; Ren, Huajian; Hong, Zhiwu; Li, Jieshou
Benefits of laparoscopic surgery in the management of gastrointestinal fistula caused by Crohn disease need to be fully elucidated. We conducted this retrospective study to investigate the safety and feasibility and emphasize the advantages of laparoscopy compared with that of laparotomy for patients with gastrointestinal fistula caused by Crohn disease. A total of 1213 patients with gastrointestinal fistula in our center were screened, and 318 qualified patients were enrolled and divided into laparoscopy (n = 122) and laparotomy (n = 196) groups. Postoperative complications, length of hospital stay, systemic stress responses to surgery, postoperative mortality, and economic burden were collected and compared. A total of 125 laparoscopic interventions were performed with a conversion rate of 20.0%. Fifteen versus 84 postoperative complications were obtained in laparoscopy and laparotomy groups, respectively (P = 0.0033). Total hospitalization was 22.7 d and 38.0 d in laparoscopy and laparotomy groups, respectively (P laparoscopy was significantly lower than that to laparotomy. Reduced postoperative mortality (P = 0.0292) and postoperative cost (P = 0.0292) were observed in laparoscopy instead of laparotomy group. Laparoscopic approach is safe and feasible and could improve clinical outcome in gastrointestinal fistula patients with Crohn disease. Copyright © 2016 Elsevier Inc. All rights reserved.
Gao, Huiqiao; Zhang, Zhenyu
Abstract The aim of this study was to compare the long-term safety and efficacy of laparoscopic surgery and laparotomy for high-risk endometrial cancer (EC). A retrospective analysis based on our decade of clinical data of patients with high-risk EC who were comprehensively surgically staged by laparotomy or laparoscopy was performed. The surgical outcomes were compared between different approaches using propensity score matching (PSM). Eighty-one pairs of patients from the initial 220 enrolled ones were matched by PSM. The mean operative time is similar between laparotomy and laparoscopy groups (258 minutes vs. 253 minutes). The laparoscopy cohort has less blood loss (107 mL vs.414 mL, P laparoscopy (16.4) were significant less than that dissected by laparotomy (21.9). The 5- and 10-year survival rate for laparotomy were 89.2% and 75.8% compared with 85.3% and 85.3% for the laparoscopy. There was no significant difference in overall survival (P = 0.97). Laparoscopy is as effective as laparotomy in the long term and can be safely carried out in patients with high-risk EC for surgery treatment. PMID:26222865
Khan, Khaleque Newaz; Fujishita, Akira; Kitajima, Michio; Hiraki, Koichi; Nakashima, Masahiro; Masuzaki, Hideaki
Is there any occurrence of hidden (occult) endometriotic lesions in normal peritoneum of women with and without visible endometriosis? We detected a slightly higher occurrence of occult microscopic endometriosis (OME) in normal peritoneum of women with visible endometriosis than in control women. Based on a small number of cases, the concept of invisible microscopic endometriosis in visually normal peritoneum has been reported for more than a decade but there is controversy regarding their tissue activity and clinical significance. This case-controlled research study was conducted with prospectively collected normal peritoneal samples from 151 women with and 62 women without visible endometriosis. Normal peritoneal biopsy specimens from different pelvic sites of were collected during laparoscopy. A histological search of all peritoneal biopsy specimens for the detection of invisible endometriosis was done by immunoreaction to Ber-EP4 (epithelial cell marker), CD10 (stromal cell marker) and Calretinin (mesothelial cell marker). Tissue expression of estrogen/progesterone receptors (ER/PR) and cell proliferation marker, Ki-67, was performed by immunohistochemistry to identify tissue activity. Three different patterns of OME were detected based on (I) the presence of typical gland/stroma, (II) reactive hyperplastic change of endometrioid epithelial cells with surrounding stroma and (III) single-layered epithelium-lined cystic lesions with surrounding stroma. A higher tendency toward the occurrence of OME was found in women with visible endometriosis (15.2%, 23/151) compared with control women (6.4%, 4/62) (P = 0.06, χ(2) test). The epithelial cells and/or stromal cells of OME lesions were immunoreactive to Ber-EP4 and CD10 but not reactive to Calretinin. ER and PR expression was observed in all patterns of OME lesions. Ki-67 index was significantly higher in pattern I/II OME lesions than in pattern III OME lesions (Pendometriosis due to the presence of adhesions in
Li, Haojie; Zhang, Qi; Chen, Ling; Min, Lingqiang; Wang, Xuefei; Liu, Fenglin; Sun, Yihong
To assess the clinical value of the diagnostic laparoscopy in choosing treatment strategies for patients with gastric cancer. Retrospective analysis was performed on clinical and pathological data collected from 2 023 patients undergoing gastric cancer surgery in the Zhongshan Hospital of Fudan University from 2009 to 2014. All the patients were diagnosed as gastric cancer by endoscopic biopsy and staged by imaging examination before surgery. During the diagnostic laparoscopy procedure, a small periumbilical incision was made and a pneumoperitoneum with CO 2 under 10-15 mmHg was established through a port. A 10 mm trocar was put in, and the camera was inserted. Two 5 mm trocars were put in two ports which located in midclavicular line two fingers under the left and right costal margin and then the instruments were inserted. A thorough inspection included ascites, the abdominal cavity, liver, diaphragm, spleen, greater omentum, colon, small intestine, mesentery, adnexa (female) and pelvic floor. If the tumor located at the posterior part of the stomach, the gastrocolic ligament was opened in order to look for carcinomatosis in the omental bursa. The accuracy rate of diagnostic laparoscopy in diagnosing adjacent organ invasion and intra-abdominal metastasis was calculated, and the rate of adjusting treatment plans after diagnostic laparoscopy was also calculated. There were 52.7%(1 067/2 023) of patients underwent diagnostic laparoscopy. The accuracy rate of diagnostic laparoscopy in evaluating adjacent organ invasion and intra-abdominal metastasis were 98.3%(1 049/1 067) and 98.1%(1 047/1 067) respectively. Besides, 14 patients with stage T4b and 32 with intra-abdominal metastasis, which were missed by imaging examination, were diagnosed by diagnostic laparoscopy. The treatment plans of 9.3% (99/1 067) of patients were changed after diagnostic laparoscopy, and 65 (6.1%) cases of non-therapeutic laparotomy were avoided. However, 18 cases of adjacent organ invasion
Dubuisson, J B; Lecuru, F; Foulot, H; Mandelbrot, L; Aubriot, F X; Mouly, M
To evaluate the technique and short-term results of intraperitoneal (IP) myomectomies. From January 1, 1990, to March 1, 1991, IP myomectomies were performed in all cases in which it appeared feasible. This study was conducted in a tertiary care center, the Port-Royal University Hospital. Among 49 consecutive patients with interstitial or subserous myomas, 6 patients with voluminous, multiple myomas had laparotomies. Intraperitoneal myomectomy was performed in 43 patients. The indication for laparoscopy was a pelvic mass in 29 cases, infertility in 13, and severe endometriosis in 1 case. Thermocoagulation or monopolar coagulation was used for the uterine incision. Myometrium and serosa were sutured in 23 of 43 patients. Myomas were removed through the suprapubic puncture site after fragmentation of large myomas. We evaluated the length of the procedures, blood loss, and postoperative course. Ninety-two myomas were removed laparoscopically. No complication was observed. In selected cases, IP myomectomy appears to be a safe technique with the advantages of laparoscopic surgery.
Ponsky, Todd A; Nam, Arthur; Orkin, Bruce A; Lin, Paul P
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.
Ganpule, Arvind; Chhabra, Jaspreet Singh; Desai, Mahesh
To review the most recent literature and contemporary role of the use of porcine and chicken models in laparoscopic and robotic simulation exercises, for training and skill assessment. There are multiple types of the simulators which include mechanical, virtual reality, hybrid simulators and animal models. The recent literature has seen insurgence of several of such simulators, specifically the animate ones comprising porcine and chicken models. The different training models reported have evolved from generalized and simpler, to a more task dedicated and complex versions. Unlike in the past, the recent publications include analysis of these models incorporating different measures of validity assessment. On account of the natural tissue properties inherent to these porcine and chicken models, they are proving to be instrumental in acquisition of higher surgical skills such as dissection, suturing and use of energy sources, all of which are required in real-time clinical scenarios be it laparoscopy or robotic-assisted procedures. In-vivo training in the animal model continues to be, perhaps, the most sophisticated training method before resorting to real-time surgery.
Tan, Zhen; Li, Ang; Chen, Long; Xu, XiaoWen; Fu, ChuanGang
We report a case of port-site metastasis after laparoscopic surgery for early stage uterine carcinosarcoma (UCS) and review the related literature. A 53-year-old woman with suspected uterine malignance underwent a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, infra-colic omentectomy, and pelvic lymphadenectomy resulting pathologically in a stage IA UCS. Twelve months later she developed a palpable abdominal-wall mass at the trocar site without other synchronous metastases. A mass resection was performed and it was pathologically diagnosed with port-site metastasis of UCS. When performing surgery for UCS, specimens should be carefully removed in case small pieces of the occult disseminated metastatic tissues are trapped between the outer surface of the trocar sleeve and the abdominal wall incisional canal. Despite the low incidence, a laparotomy might be considered rather than laparoscopy to prevent port-site metastasis and more gynecological oncology clinical practices might be relevant to the management of port-site metastasis. © 2017 The Korean Academy of Medical Sciences.
Full Text Available Aims: The laparoscopic "Spaghetti Maneuver" consists in holding an organ by its extremity with a grasper and rolling it up around the tool to keep the organ stable and facilitate its traction within a small space. We describe our experience with the "Spaghetti Maneuver" in some minimally invasive procedures. Materials and Methods: We successfully adopted this technique in 13 patients (5F : 8M aged between 6 and 14 years (average age, 10 on whom we performed 7 appendectomies, 2 ureteral reimplantation and 4 cholecystectomies. In all cases, after the first steps, the appendix, the gallbladder and the ureter were rolled around the grasper and easily isolated; hemostasis was thus induced and the organ was mobilized until removal during cholecystectomy and appendectomy, and before the reimplantation in case of ureteral reimplantation. Results: We found that this technique facilitated significantly the acts of holding, isolating and removing, when necessary, the structures involved, which remained constantly within the visual field of the operator. This allowed a very ergonomic work setting, overcoming the problem of the "blind" zone, which represents a dangerous and invisible area out of the operator′s control during laparoscopy. Moreover the isolation maneuvers resulted easier and reduced operating time. Conclusion: We think that this technique is easy to perform and very useful, because it facilitates the dissection of these organs, by harmonizing and stabilizing the force of traction exercised.
Atul A Thakre
Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.
Full Text Available Thirty patients with ovarian dermoid cysts removed by laparoscopic surgery were compared with 42 patients with ovarian dermoid cysts removed by laparotomy, with respect to the selection criteria, surgical procedures, operating time, intraoperative and postoperative complications, blood loss, and hospital stay. Although the operating time for unilateral cystectomy, unilateral salpingo-oophorectomy, and bilateral cystectomy performed by laparoscopic surgery was longer (120.3 ± 43.7 min, mean ± SD than those for the same procedures performed by laparotomy (73.9 ± 21.6 min, p < 0.01, we observed a learning curve with a remarkable declining tendency (linear regression model, p < 0.01. At the end of this study, the times taken for laparoscopic procedures were almost the same as those for laparotomy. Less blood loss (18.2 ± 1.7 ml versus 105.9 ± 84.3 ml, p < 0.01 and shorter hospital stay (5.9 ± 1.9 days versus 12.0 ± 2.9 days, p < 0.01 were also found to be advantages of laparoscopic surgery. This article discusses the technical procedures of laparoscopic surgery. The efficiency and safety of operative laparoscopy as an alternative access route for the management of ovarian dermoid cysts were recognized. We stress that strict criteria for selection of patients should always be followed and the necessity of retraining schedules for gynecologists and nursing staff in the speciality of laparoscopic surgery.
Tourani, Saam S; Cabalag, Carlos; Link, Emma; Chan, Steven T F; Duong, Cuong P
Previous studies have suggested that patients with occult peritoneal metastases not seen on preoperative imaging have poor prognosis. In this study, we aim to evaluate the utility and impact of staging laparoscopy and peritoneal cytology in patients with gastric adenocarcinoma. A retrospective analysis of patients with gastric adenocarcinoma managed at two major metropolitan hospitals in Melbourne, Australia, between January 1999 and July 2010 was undertaken. The main outcome measures were the number of patients in whom laparoscopy and/or peritoneal cytology changed treatment intent, and the overall survival of patients with occult metastases detected by laparoscopy/cytology. Staging laparoscopy as an independent procedure was performed in 74.3% (148/199) of patients who had neither unequivocal metastases (M1) on preoperative imaging nor early T1 disease on endoscopic ultrasound. Laparoscopy/cytology detected occult metastases in 38 (25.6%) patients (27 macroscopic M1 and 11 microscopic M1 with positive peritoneal cytology only), leading to change in the treatment intent in 37 cases. The median overall survivals of patients with metastatic disease detected at staging laparoscopy (8.3 months, 95% confidence interval (CI) 5.4-16.5) or on peritoneal cytology (4.9 months, 95% CI 4.2-48) were as poor as those with M1 disease seen on preoperative imaging (6.7 months, 95% CI 4.2-8.9), P = 0.97. Laparoscopy and peritoneal cytology add incremental value to modern imaging in the staging of gastric adenocarcinomas by detecting occult metastatic disease. Their utility needs to be optimized to allow better treatment selection for gastric cancer patients. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.
Findlay, J M; Bradley, K M; Maile, E J; Braden, B; Maw, J; Phillips-Hughes, J; Gillies, R S; Maynard, N D; Middleton, M R
Following CT, guidelines for staging oesophageal and gastro-oesophageal junction (GOJ) cancer recommend endoscopic ultrasonography (EUS), PET-CT and laparoscopy for T3-T4 GOJ tumours. These recommendations are based on generic utilities, but it is unclear whether the test risk outweighs the potential benefit for some patients. This study sought to quantify investigation risks, benefits and utilities, in order to develop pragmatic, personalized staging recommendations. All patients with a histological diagnosis of oesophageal or GOJ cancer staged between May 2006 and July 2013 comprised a development set; those staged from July 2013 to July 2014 formed the prospective validation set. Probability thresholds of altering management were calculated and predictive factors identified. Algorithms and models (decision tree analysis, logistic regression, artificial neural networks) were validated internally and independently. Some 953 patients were staged following CT, by [(18) F]fluorodeoxyglucose PET-CT (918), EUS (798) and laparoscopy (458). Of these patients, 829 comprised the development set (800 PET-CT, 698 EUS, 397 laparoscopy) and 124 the validation set (118 PET-CT, 100 EUS, 61 laparoscopy). EUS utility in the 71.8 per cent of patients with T2-T4a disease on CT was minimal (0.4 per cent), its risk exceeding benefit. EUS was moderately accurate for pT1 N0 disease. A number of factors predicted metastases on PET-CT and laparoscopy, although none could inform an algorithm. PET-CT altered management in 23.0 per cent, and laparoscopy in 7.1 per cent, including those with T2 and distal oesophageal tumours. Although EUS provided additional information on T and N category, its risk outweighed potential benefit in patients with T2-T4a disease on CT. Laparoscopy seemed justified for distal oesophageal tumours of T2 or greater. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.
Fang, Jia-feng; Zheng, Zong-heng; Huang, Yong; Wei, Bo; Huang, Jiang-long; Lei, Pu-run; Wei, Hong-bo
Synchronous gastrointestinal multiple primary cancers (SGMPC) is infrequent. This study aimed to investigate the feasibility and outcomes of laparoscopy-assisted combined resection for SGMPC. We retrospectively reviewed 16 cases of SGMPC underwent either open or laparoscopy-assisted combined resection in the Third Affiliated Hospital of Sun Yat-sen University from Jan. 2005 to Jan. 2014. Sixteen cases contained synchronous colon cancers (n = 10), gastric and rectal cancer (n = 5), gastric and duodenal cancer (n = 1). Either laparoscopy-assisted or open procedure was performed. Compared with the open group, the laparoscopy group presented less blood loss (77.1 ± 46.3 ml vs. 145.0 ± 75.9 ml, P = 0.047) and shorter incision length (5.2 ± 0.7 cm vs. 16.4 ± 1.9 cm, P = 0.000), while no differences in operative time (228.3 ± 38.8 min vs. 188.8 ± 47.7 min, P > 0.05) and postoperative hospital stay (10.0 ± 3.4 days vs. 12.0 ± 4.8 days, P > 0.05). Two cases of postoperative complications occurred in the open group and one case of incision infection occurred in the laparoscopy one. Upon follow-up, 2 cases of open group (50.0%) and 8 cases of laparoscopy group (66.7%) were under status of disease free survival. Laparoscopy-assisted combined resection for SGMPC is feasible, safe and effective. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Doumouras, Aristithes G; Saleh, Fady; Eskicioglu, Cagla; Amin, Nalin; Cadeddu, Margherita; Hong, Dennis
The rates of laparoscopic colectomy for colon cancer have steadily increased since its inception. Laparoscopic colectomy currently accounts for a third of colectomy procedures in the United States, but little is known regarding the spatial pattern of the utilization of laparoscopy for colon cancer. This study evaluated the utilization of laparoscopy for colon cancer at the neighborhood level in Ontario. Retrospective analysis of prospectively collected data was performed. This study was conducted at all hospitals in the province of Ontario. This population-based study included all patients aged ≥18 who received an elective colectomy for colon cancer from April 2008 until March 2012 in the province of Ontario. The primary outcome measure was the neighborhood rates of laparoscopy. Overall, 9,969 patients underwent surgery, and the cluster analysis identified 74 cold-spot neighborhoods, representing 1.8 million people, or 14% of the population. In the multivariate analysis, patients from rural neighborhoods were less than half as likely to receive laparoscopy, OR 0.44 (95% CI, 0.24-0.84; p = 0.012). Additionally, having a minimally invasive surgery fellowship training facility within the same administrative health region as the neighborhood made it more than 23 times as likely to be a hot spot, OR 25.88 (95% CI, 12.15-55.11; p laparoscopy. Patient case mix could affect laparoscopy use. This study identified an unequal utilization of laparoscopy for colon cancer within Ontario with rural neighborhoods experiencing low rates of laparoscopic colectomy, whereas neighborhoods in the same administrative region as minimally invasive surgery training centers experienced increased utilization. Further study into the causes of this variation in resource allocation is needed to identify ways to improve more efficient spread of knowledge and technical skills advancement.
Tran Cao, Hop S.; Kaushal, Sharmeela; Lee, Claudia; Snyder, Cynthia S.; Thompson, Kari J.; Horgan, Santiago; Talamini, Mark A.; Hoffman, Robert M.
Background The use of fluorescent proteins to label tumors is revolutionizing cancer research, enabling imaging of both primary and metastatic lesions, which is important for diagnosis, staging, and therapy. This report describes the use of fluorescence laparoscopy to image green fluorescent protein (GFP)-expressing tumors in an orthotopic mouse model of human pancreatic cancer. Methods The orthotopic mouse model of human pancreatic cancer was established by injecting GFP-expressing MiaPaCa-2 human pancreatic cancer cells into the pancreas of 6-week-old female athymic mice. On postoperative day 14, diagnostic laparoscopy using both white and fluorescent light was performed. A standard laparoscopic system was modified by placing a 480-nm short-pass excitation filter between the light cable and the laparoscope in addition to using a 2-mm-thick emission filter. A camera was used that allowed variable exposure time and gain setting. For mouse laparoscopy, a 3-mm 0° laparoscope was used. The mouse’s abdomen was gently insufflated to 2 mm Hg via a 22-gauge angiocatheter. After laparoscopy, the animals were sacrificed, and the tumors were collected and processed for histologic review. The experiments were performed in triplicate. Results Fluorescence laparoscopy enabled rapid imaging of the brightly fluorescent tumor in the pancreatic body. Use of the proper filters enabled simultaneous visualization of the tumor and the surrounding structures with minimal autofluorescence. Fluorescence laparoscopy thus allowed exact localization of the tumor, eliminating the need to switch back and forth between white and fluorescence lighting, under which the background usually is so darkened that it is difficult to maintain spatial orientation. Conclusion The use of fluorescence laparoscopy permits the facile, real-time imaging and localization of tumors labeled with fluorescent proteins. The results described in this report should have important clinical potential. PMID:20533064
Sørensen, Stine Maya Dreier; Savran, Mona Meral; Konge, Lars; Bjerrum, Flemming
Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. The search was accomplished in accordance with the PRISMA guidelines using the PubMed, EMBASE, and The Cochrane Library electronic databases. No language or year of publication restrictions was applied. Data extracted were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction. Three hundred and forty articles were screened for eligibility, and 31 RCTs were included in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71%) showed a reduction in performance time, and 12 out of 19 (63%) showed a significant reduction in error when using 3D compared to 2D. Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.
Hu, Yan-Feng; Deng, Zhen-Wei; Liu, Hao; Mou, Ting-Yu; Chen, Tao; Lu, Xin; Wang, Da; Yu, Jiang; Li, Guo-Xin
To evaluate the clinical value of staging laparoscopy in treatment decision-making for advanced gastric cancer (GC). Clinical data of 582 patients with advanced GC were retrospectively analyzed. All patients underwent staging laparoscopy. The strength of agreement between computed tomography (CT) stage, endoscopic ultrasound (EUS) stage, laparoscopic stage, and final stage were determined by weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. A χ(2) test was used to analyze the correlation between peritoneal metastasis or positive cytology and clinical characteristics. Among the 582 patients, the distributions of pathological T classifications were T2/3 (153, 26.3%), T4a (262, 45.0%), and T4b (167, 28.7%). Treatment plans for 211 (36.3%) patients were changed after staging laparoscopy was performed. Two (10.5%) of 19 patients in M1 regained the opportunity for potential radical resection by staging laparoscopy. Unnecessary laparotomy was avoided in 71 (12.2%) patients. The strength of agreement between preoperative T stage and final T stage was in almost perfect agreement (Kw = 0.838; 95% confidence interval (CI): 0.803-0.872; P laparoscopy; compared with CT and EUS, which was in fair agreement. The strength of agreement between preoperative M stage and final M stage was in almost perfect agreement (Kw = 0.990; 95% CI: 0.977-1.000; P laparoscopy; compared with CT, which was in slight agreement. Multivariate analysis revealed that tumor size (≥ 40 mm), depth of tumor invasion (T4b), and Borrmann type (III or IV) were significantly correlated with either peritoneal metastasis or positive cytology. The best performance in diagnosing P-positive was obtained when two or three risk factors existed. Staging laparoscopy can improve treatment decision-making for advanced GC and decrease unnecessary exploratory laparotomy.
Sallum, Luis Felipe; Sarian, Luis Otávio; Bastos, Joana Fróes Bragança; Derchain, Sophie
Objectives: We compared the indication of laparoscopy for treatment of adnexal masses based on the risk scores and tumor diameters with the indication based on gynecology-oncologists' experience. Methods: This was a prospective study of 174 women who underwent surgery for adnexal tumors (116 laparotomies, 58 laparoscopies). The surgeries begun and completed by laparoscopy, with benign pathologic diagnosis, were considered successful. Laparoscopic surgeries that required conversion to laparotomy, led to a malignant diagnosis, or facilitated cyst rupture were considered failures. Two groups were defined for laparoscopy indication: (1) absence of American College of Obstetrics and Gynecology (ACOG) guideline for referral of high-risk adnexal masses criteria (ACOG negative) associated with 3 different tumor sizes (10, 12, and 14 cm); and (2) Index of Risk of Malignancy (IRM) with cutoffs at 100, 200, and 300, associated with the same 3 tumor sizes. Both groups were compared with the indication based on the surgeon's experience to verify whether the selection based on strict rules would improve the rate of successful laparoscopy. Results: ACOG-negative and tumors ≤10 cm and IRM with a cutoff at 300 points and tumors ≤10cm resulted in the same best performance (78% success = 38/49 laparoscopies). However, compared with the results of the gynecology-oncologists' experience, those were not statistically significant. Discussion: The selection of patients with adnexal mass to laparoscopy by the use of the ACOG guideline or IRM associated with tumor diameter had similar performance as the experience of gynecology-oncologists. Both methods are reproducible and easy to apply to all women with adnexal masses and could be used by general gynecologists to select women for laparoscopic surgery; however, referral to a gynecology-oncologist is advisable when there is any doubt. PMID:25392617
Full Text Available BACKGROUND Laparoscopy has been a new entry in the field of surgery with an active history of around just two decades. Today, it is in a position to challenge the conventional surgery which is in use since ages. It is making rapid inroads into various disciplines of surgery. Rapid improvements in optics, along with improvements in energy devices and mechanical stapling devices gave a fillip to acceptance of laparoscopy by the majority of surgeons. Also accumulating data and evidence has started influencing the sceptical, mobilising them to jump into the bandwagon. Barriers to adoption of new techniques, resistance to learning are common to human nature and it is necessary to have a systematic overview of the issues that might crop, so as to be prepared to overcome the problems of accepting laparoscopy into established centres of surgery. AIMS This publication is a reflection of our experience, our trials and tribulations in taking forward the laparoscopy program at our institution. This publication will give an overview of the steps involved in initiation of laparoscopy and aspires to be a source of answers, for day-to-day issues that crop during the process of learning laparoscopy. METHODS AND MATERIALS Just the way, executing laparoscopic surgery is a team effort, incorporating laparoscopy program in an institution is also a team effort where the members of team extend beyond the operating room. Involvement and co-operation of individuals across departments is a must along with benevolent seniors and a proactive administration. So we collated data by interviewing all the stakeholders of laparoscopy program, analysed observations of the faculty from the operating room and reviewed literature on the world wide web. Opinions of the administrators about their perceptions and the issues faced by the junior staff of the department were taken into consideration. Patients were interviewed before and after laparoscopic surgery. CONCLUSIONS Success at
Vuorinen, Riikka-Liisa K; Mäenpää, Minna M; Nieminen, Kari; Tomás, Eija I; Luukkaala, Tiina H; Auvinen, Anssi; Mäenpää, Johanna U
The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.
Qiu, W; Sun, X-D; Wang, G-Y; Zhang, P; Du, X-H; Lv, G-Y
To compare and analyze the clinical efficacy of laparoscopy combined with choledochoscopy, and laparoscopy combined with duodenoscopy, for cholelithiasis and choledocholithiasis. A total of 105 patients with cholelithiasis and choledocholithiasis from our hospital, from January 2014 to January 2015, were enrolled in this study. All patients weren given primary treatment. After obtaining consent from our hospital Ethics Committee and the patients, all 10529 cases were divided into two groups according to their time of admission. The observation group consisted of 59 cases and the control group consisted of 46 cases. The control group were treated by laparoscopy combined with duodenoscopy (cholecystectomy +ERCP+calculi extraction with an endoscope) and the observation group were treated by laparoscopy combined with choledochoscopy. We then compared the clinical efficacy between the two groups of patients. The success rate of the first surgery in the observation group, was higher than that in the control group. The time of surgery and intra-operative blood loss of the observation group were less than the control group. The differences had statistical significance p choledocholithiasis. Its treatment outcomes might be superior to laparoscopy combined with duodenoscopy.
Hashimoto, Daisuke; Chikamoto, Akira; Sakata, Kazuya; Nakagawa, Shigeki; Hayashi, Hiromitsu; Ohmuraya, Masaki; Hirota, Masahiko; Yoshida, Naoya; Beppu, Toru; Baba, Hideo
Preoperatively evaluating the resectability of pancreatobiliary cancers is difficult. The aim of this study was to investigate the benefit of staging laparoscopy in unresectable pancreatobiliary cancers. Between 2010 and 2013, 25 patients with pancreatobiliary cancers underwent staging laparoscopy after conventional tumor staging; they were compared with 10 patients who had unresectable or metastatic tumors that were found during laparotomy. Staging laparoscopy did not show unresectable factors in 11 patients, and resections were performed in these patients. Unresectable factors were found in other 14 patients who underwent staging laparoscopy. In these patients, chemotherapy was started after median postoperative day 3 (range, 2-10 days). This period was significantly longer in patients who received unnecessary laparotomy; chemotherapy was started after median postoperative day 11 (range, 6-15 days). These results suggest that staging laparoscopy, while avoiding laparotomy with unsuccessful resection, can lead to rapid induction of chemotherapy for unresectable pancreatobiliary cancers. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
van de Vrie, Roelien; van Meurs, Hannah S; Rutten, Marianne J; Naaktgeboren, Christiana A; Opmeer, Brent C; Gaarenstroom, Katja N; van Gorp, Toon; Ter Brugge, Henk G; Hofhuis, Ward; Schreuder, Henk W R; Arts, Henriette J G; Zusterzeel, Petra L M; Pijnenborg, Johanna M A; van Haaften, Maarten; Engelen, Mirjam J A; Boss, Erik A; Vos, M Caroline; Gerestein, Kees G; Schutter, Eltjo M J; Kenter, Gemma G; Bossuyt, Patrick M M; Mol, Ben Willem; Buist, Marrije R
To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility=0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € -80 per patient (95% CI -470 to 300)). Findings were consistent across various sensitivity analyses. In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.
Background Surgical intervention-related trauma contributes largely to the development of postoperative immunosuppression, with reduced resistance to secondary bacterial infection. This study compared the impact of laparotomy versus laparoscopy on macrophage-associated bactericidal ability and examined whether laparotomy renders the host more susceptible to microbial infection. Results BALB/c mice were randomized into control, laparotomy, and laparoscopy groups. Laparotomy, but not laparoscopy, significantly downregulated CR3 expression on macrophages, diminished macrophage-induced uptake and phagocytosis of E. coli and S. aureus, and impaired macrophage-mediated intracellular bacterial killing. Consistent with this, mice that underwent laparotomy displayed substantially higher bacterial counts in the blood and visceral organs as well as a significantly enhanced mortality rate following bacterial infection, whereas mice subjected to laparoscopy did not show any defects in their bacterial clearance. Conclusion Laparotomy has an adverse effect on host innate immunity against microbial infection by impairing macrophage-mediated phagocytosis and killing of the invaded bacteria. By contrast, laparoscopy appears to preserve macrophage-associated bactericidal ability, thus alleviating the development of postoperative immunosuppression. PMID:23786397
Berretta, Roberto; Gizzo, Salvatore; Noventa, Marco; Marrazzo, Vivienne; Franchi, Laura; Migliavacca, Costanza; Michela, Monica; Merisio, Carla; Modena, Alberto Bacchi; Patrelli, Tito Silvio
The aim of this study is to verify if the surgical approach (laparoscopy/laparotomy/vaginal) in stage-I endometrial cancer treatment, may have effects on intra- and post-operative outcomes and on the patient's quality of life. The study group consisted of patients with histological diagnosis of type-I endometrial adenocarcinoma, stage-I. They were divided into three groups according to surgical approach chosen (laparotomic/laparoscopic/vaginal). Every patient answered a telephone health survey (SF-36) at 30 and 180 days post-surgery. Surgical-operating times, hospitalization length and short/long-term complications after surgery were also compared. The SF-36 survey revealed a better performance status in patients who underwent laparoscopy as compared to those who received laparotomy or vaginal surgery. We found significantly better results considering General Health, Physical Functioning, Role-Physical and Bodily Pain in the laparoscopy group after 30 and 180 days. Patients who underwent laparoscopy had significantly shorter hospitalization and less post-operative complications even if laparoscopy required significantly longer surgical-operating times compared to vaginal surgery. Our data confirm the superiority of the laparoscopic approach respect to the laparotomic and vaginal ones both in term of hospitalization length and post-operative complications.
Stabile Ianora, A.A.; Moschetta, M.; Lorusso, F.; Lattarulo, S.; Telegrafo, M.; Rella, L.; Scardapane, A.
Aim: To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard. Materials and methods: Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement. Results: In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84). Conclusion: Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated
Schoenthaler, Martin; Schnell, Daniel; Wilhelm, Konrad; Schlager, Daniel; Adams, Fabian; Hein, Simon; Wetterauer, Ulrich; Miernik, Arkadiusz
To compare task performances of novices and experts using advanced high-definition 3D versus 2D optical systems in a surgical simulator model. Fifty medical students (novices in laparoscopy) were randomly assigned to perform five standardized tasks adopted from the Fundamentals of Laparoscopic Surgery (FLS) curriculum in either a 2D or 3D laparoscopy simulator system. In addition, eight experts performed the same tasks. Task performances were evaluated using a validated scoring system of the SAGES/FLS program. Participants were asked to rate 16 items in a questionnaire. Overall task performance of novices was significantly better using stereoscopic visualization. Superiority of performances in 3D reached a level of significance for tasks peg transfer and precision cutting. No significant differences were noted in performances of experts when using either 2D or 3D. Overall performances of experts compared to novices were better in both 2D and 3D. Scorings in the questionnaires showed a tendency toward lower scores in the group of novices using 3D. Stereoscopic imaging significantly improves performance of laparoscopic phantom tasks of novices. The current study confirms earlier data based on a large number of participants and a standardized task and scoring system. Participants felt more confident and comfortable when using a 3D laparoscopic system. However, the question remains open whether these findings translate into faster and safer operations in a clinical setting.
Uchida, Masafumi; Ishibashi, Masatoshi; Nishimura, Hiroshi; Hayabuchi, Naofumi [Kurume Univ., Fukuoka (Japan). School of Medicine
The purpose of this study was to determine the feasibility of virtual endoscopy, named as ''virtual CT laparoscopy'', in the hepatobiliary system prior to laparoscopic cholecystectomy. We applied this technique to 28 patients suspected of having biliary disease. These images were compared and analyzed qualitatively based on visualization of the structures critical to operative cholangiography and surgical findings. Twenty-four patients, who underwent laparoscopic cholecystectomy, were evaluated as follows: the common bile duct and the hepatic duct were adequately visualized in 23 (96%) of the 24 patients, the cystic duct in 21 (88%), the gallbladder opacification in 20 (83%), the liver inferior surface in 20 (83%). Four patients had anatomic variations detected virtual CT laparoscopy and were proven by operative cholangiography and surgical findings. We emphasize that our new technique may contribute to the laparoscopy during surgery as the aid of understanding of anatomical structures in these organs. (author)
Full Text Available Shan-rong Shu, Xin Luo, Zhi-xin Wang, Yu-hong Yao Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, HuangPu Road West, Guangzhou, People’s Republic of China Abstract: Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient. Keywords: cesarean scar pregnancy, laparoscopy, curettage and aspiration
De Win, Gunter; Van Bruwaene, Siska; Aggarwal, Rajesh; Crea, Nicola; Zhang, Zhewen; De Ridder, Dirk; Miserez, Marc
To investigate whether preclinical laparoscopy training offers a benefit over standard apprenticeship training and apprenticeship training in combination with simulation training. This randomized controlled trial consisted of 3 groups of first-year surgical registrars receiving a different teaching method in laparoscopic surgery. The KU LEUVEN Faculty of Medicine is the largest medical faculty in Belgium. Thirty final-year medical students starting a general surgical career in the next academic year. Thirty final-year medical students were randomized into 3 groups, which differed in the way they were exposed to laparoscopic simulation training but were comparable in regard to ambidexterity, sex, age, and laparoscopic psychomotoric skills. The control group received only clinical training during surgical residentship, whereas the interval group received clinical training in combination with simulation training. The registrars were allowed to do deliberate practice. The Centre for Surgical Technologies Preclinical Training Programme (CST PTP) group received a preclinical simulation course during the final year as medical students, but was not exposed to any extra simulation training during surgical residentship. At the beginning of surgical residentship and 6 months later, all subjects performed a standardized suturing task and a laparoscopic cholecystectomy in a POP Trainer. All procedures were recorded together with time and motion tracking parameters. All videos were scored by a blinded observer using global rating scales. At baseline the 3 groups were comparable. At 6 months, for suturing, the CST PTP group was better than both the other groups with respect to time, checklist, and amount of movements. The interval group was better than the control group on only the time and checklist score. For the cholecystectomy evaluation, there was a statistical difference between the CST PTP study group and both other groups on all evaluation scales in favor of the CST PTP
Cheng, Ji; Gao, Jinbo; Shuai, Xiaoming; Wang, Guobin; Tao, Kaixiong
Laparoscopy is a revolutionary technique in modern surgery. However, the comparative efficacy between two-dimensional laparoscopy and three-dimensional laparoscopy remains in uncertainty. Therefore we performed this systematic review and meta-analysis in order to seek for answers. Databases of PubMed, Web of Science, EMBASE and Cochrane Library were carefully screened. Clinical trials comparing two-dimensional versus three-dimensional laparoscopy were included for pooled analysis. Observational and randomized trials were methodologically appraised by Newcastle-Ottawa Scale and Revised Jadad's Scale respectively. Subgroup analyses were additionally conducted to clarify the potential confounding elements. Outcome stability was examined by sensitivity analysis, and publication bias was analyzed by Begg's test and Egger's test. 21 trials were screened out from the preliminary 3126 records. All included studies were high-quality in methodology, except for Bilgen 2013 and Ruan 2015. Three-dimensional laparoscopy was superior to two-dimensional laparoscopy in terms of surgical time (P analysis. Although Begg's test (P = 0.215) and Egger's test (P = 0.003) revealed that there was publication bias across included studies, Trim-and-Fill method confirmed that the results remained stable. Three-dimensional laparoscopy is a preferably surgical option against two-dimensional laparoscopy due to its better surgical efficacy.
Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N
Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P general surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in
Talat, Nabila; Afzal, Muhammad; Ahmad, Sarfraz; Rasool, Naima; Wasti, Arsalan Raza; Saleem, Muhammad
Chronic abdominal Pain in children is a very common cause of hospital admission. Many of them are discharged without a diagnosis even after battery of investigations. Laparoscopy plays a significant role in diagnosis and management of many causes of acute and chronic abdominal pain. The purpose of this study was to determine the efficacy of laparoscopy as an efficient diagnostic and management tool in children with chronic abdominal pain. A descriptive, prospective case series was collected in the department of Paediatric surgery Mayo's Hospital Lahore, over the period of 5 years between Jan 2007-Dec 2013. The data of consecutive 50 patients, who were admitted in the department with the diagnosis of chronic abdominal pain, was recorded. All patients who had 2-3 admissions in hospital for last 2 months and failed to establish a definitive diagnosis after clinical examination and base line investigations underwent laparoscopy. The details of associated symptoms, finding of laparoscopy, laparoscopic procedures done, definitive diagnosis, histopathology, complications and relief of symptoms were collected and analysed and results were evaluated using SPSS-17. Out of 50 patients studies, 27/50 (54%) were male, 23/50 (46%) were female. Age ranged from 2-12 years, with the mean age of 7.24 year. Tuberculosis abdomen, adhesions, mesenteric lymphadenitis, appendicitis and cholecystitis were the final diagnosis. Five abdomens were found normal on laparoscopy. Complete pain relief was achieved in 30/50 (60%), reduced intensity of pain was gained in 12/50 (24%) cases while 16% (8/50) still complained of pain. Laparoscopy is an efficient diagnostic and treatment tool in children with chronic unexplained abdominal pain. It avoids serial examinations; prolong admission, battery of investigations and unnecessary surgeries.
Barry, Katie S; Case, J Brad; Winter, Matthew D; Garcia-Pereira, Fernando L; Buckley, Gareth; Johnson, Matthew D
OBJECTIVE To evaluate the feasibility of laparoscopy versus exploratory laparotomy for the diagnosis of specific lesions in dogs with suspected gastrointestinal obstruction. DESIGN Controlled trial. ANIMALS 16 client-owned dogs with physical and radiographic findings consistent with gastrointestinal obstruction. PROCEDURES Single-incision laparoscopy with intracorporeal and extracorporeal examination of the gastrointestinal tract was performed by 1 surgeon. Immediately afterward, exploratory laparotomy was performed by a second surgeon. Accessibility and gross appearance of organs, surgical diagnoses, incision lengths, procedure duration, and complications were compared between diagnostic techniques. RESULTS Mean (95% confidence interval) incision length was 4.9 cm (3.9 to 5.9 cm) for laparoscopy and 16.4 cm (14.0 to 18.7 cm) for exploratory laparotomy. Mean (95% confidence interval) procedure duration was 36.8 minutes (31.6 to 41.2 minutes) and 12.8 minutes (11.4 to 14.3 minutes), respectively. Diagnoses of the cause of obstruction were the same with both methods. In 13 dogs, the laparoscopic examination was successfully completed, and in the other 3, it was incomplete. In 4 dogs in which laparoscopy was successful, conversion to exploratory laparotomy or considerable extension of the laparoscopic incision would have been required to allow subsequent surgical treatment of identified lesions. No dogs developed major complications, and minor complication rates were similar between procedures. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopy was feasible and clinically applicable in dogs with suspected gastrointestinal obstruction. Careful patient selection and liberal criteria for conversion to an open surgical approach are recommended when laparoscopy is considered for the diagnosis of gastrointestinal lesions in dogs.
Godinjak, Zulfo; Idrizbegović, Edin
The aim of this study was to clarify the role of simultaneous combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility. In a retrospective study, 360 infertile women underwent complete fertility evaluation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of the routine infertility evaluation. Laparoscopy and hysteroscopy were successful in 360 patients. Bilateral tubes were blocked in 18 (5%) and unilateral tubal occlusion were in 30 (8,33%) of patients. Pelvic adhesions were revealed in 40 (11,11%), and myomas in 42 (11,65%) out of that 31 (8,6%) were revealed by laparoscopy and 11 (3,05%) by hysteroscopy. Endometrial polyps were revealed in 26 (7,22%) and Syndrome Asherman in 3(0,83%) of patients. Uterine anomaly was found in 19 (5,27%) of cases and out of that septate uterus in 7 (37,15%), bicornuate uterus in 5 (26,31%), arcuate uterus in 4 (21,26%) and uterus unicornu cum cornu rudimentario in 3 (15,27%) of uterine anomalies. Endometriosis was found in 51 (14,16%), dermoid cysts in 8 (2,22%) and in 16 (4,44%) functional cysts of patients. Also, Fitz-Hugh- Curtis syndrome was revealed in 23 (6,11%) of our patients. Laparoscopy and hysteroscopy play very important role as diagnostic tools in the infertility women. Combined diagnostic simultaneous laparoscopy and hysteroscopy should be performed in all infertile patients before the treatment. PMID:18318671
El Khouly, N I; Barr, R L; Kim, B B; Jeng, C J; Nagarsheth, N P; Fishman, D A; Nezhat, F R; Gretz, H F; Chuang, L T
To compare the outcome of robotic-assisted laparoscopy vs conventional laparoscopy in the management of ovarian masses. Retrospective cohort (Canadian Task Force classification II-3). Academic medical centre in the northeast United States. Retrospective medical record review of 71 consecutive patients with presumed benign ovarian masses. Robotic-assisted laparoscopy in 30 patients with presumed benign ovarian masses was compared with conventional laparoscopy in 41 patients. Operative outcomes including operative time, estimated blood loss, length of hospital stay, and complications were recorded. Standard statistical analysis was used to compare the outcomes in the 2 groups. Mean (SD) operative time in the robotic group was 1.95 (0.63) hours, which was significantly longer than in the conventional laparoscopic group, 1.28 (0.83) hours (p = .04). Estimated blood loss in the robotic group was 74.52 (56.23) mL, which was not significantly different from that in the conventional laparoscopic group, 55.97 (49.18) mL. There were no significant differences in length of hospital stay between the robotic and conventional laparoscopic groups: 1.20 (0.78) days and 1.48 (0.63). Conversion to laparotomy was not necessary in either group of patients. Intraoperative and postoperative complications were similar between the 2 groups. Robotic-assisted laparoscopy is a safe and efficient technique for management of various types of ovarian masses. However, conventional laparoscopy is preferred for management of ovarian masses because of shorter operative time. Prospective studies are needed to evaluate the outcomes of robotic-assisted laparoscopic management of benign and malignant ovarian neoplasms. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.
Ataseven, Beyhan; Grimm, Christoph; Harter, Philipp; Heikaus, Sebastian; Heitz, Florian; Traut, Alexander; Prader, Sonia; Kahl, Annett; Schneider, Stefanie; Kurzeder, Christian; du Bois, Andreas
This study was designed to evaluate the prevalence, morbidity, and prognostic impact of port-site metastasis (PSM) in patients with epithelial ovarian cancer (EOC) undergoing laparoscopy before subsequent primary debulking surgery (PDS). All consecutive patients treated between 2000 and 2014, who had a laparoscopy followed by PDS, were extracted from our prospectively maintained database. All patients with histological examination of port-sites were included in this unicentric exploratory analysis. A total of 250 (25.5 %) of 982 patients with EOC underwent laparoscopy before PDS. Port-site resection was performed in those 214 (85.6 %) patients in whom a complete or almost complete resection with residuals ≤1 cm was achieved. Median interval between laparoscopy and PDS was 25 days. PSM was detected in 100 of 214 patients (46.7 %). Risk factors for PSM were higher tumor stage (odds ratio [OR] 13.5, 95 % confidence interval [CI] 2.9-62.0, p = 0.04), positive lymph node status (OR 3.0, 95 % CI 1.3-6.7, p = 0.009), and ascites >500 mL (OR 3.9, 95 % CI 1.5-10.0, p = 0.005). Wound healing disorders and postoperative morbidity were significantly higher in patients with PSM (Clavien-Dindo Classification grade 3-5: 41.0 vs. 14.9 %, p laparoscopy in EOC patients is considerably high. PSM had no impact on survival; however, PSM were associated with more postoperative complications and a higher surgical treatment burden. This should be balanced with the expected benefit when laparoscopy is considered for the management of EOC.
Tanprasertkul, Chamnan; Patumanond, Jayanton; Manusook, Sakol; Suwannarurk, Komsun; Somprasit, Charintip; Sreshthaputra, Opas; Vutyavanich, Teeraporn
To investigate the recurrence rate and disease-free interval between laparoscopy versus laparotomy for the conservative surgery of endometrioma. A retrospective cohort study was conducted. The medical records of reproductive women who underwent conservative ovarian cystectomy surgery (laparoscopy or laparotomy) for endometrioma at Thammasat University Hospital were retrieved. The patients were followed through 24 months to evaluate the recurrence of endometrioma. Propensity scoring was used to adjust for confounding by indication and confounding by contraindication. Model for competing time to event was used in analysis. One hundred and twenty-eight and 114 patients were enrolled in laparoscopy and laparotomy groups, respectively. Mean age and body weight in laparotomy group were statistically higher than those in the other group were. Mean height and body mass index were, however not statistically different in either groups. In addition, the stage of disease and bilaterality in both groups were comparable. Diameter ofendometrioma in laparotomy group was significantly larger than that in laparoscopy group (7.0 ± 2.5 vs. 6.2 ± 1.8 cm, respectively; p = 0.004). After adjusting for propensity scoring, the endometrioma recurrence rate was significantly higher in laparoscopy group as compared to laparotomy group (27.3% vs. 14.9%, respectively; p = 0.02). However, the cumulative rate of pregnancy after surgery was not statistically different (4.7% vs. 4.4%, respectively; p = 1.0). The present study has demonstrated that the surgical technique has a strong impact on the recurrence or disease-free interval. Laparoscopy might not eradicate the disease pathology as effectively as open laparotomy in some situations, such as in cases with complexity of disease.
Bird, N; Elmasry, M; Jones, R; Elniel, M; Kelly, M; Palmer, D; Fenwick, S; Poston, G; Malik, H
Cholangiocarcinoma is a rare cancer with a poor prognosis. Radical surgical resection is the only option for curative treatment. Optimal determination of resectability is required so that patients can be stratified into operative or chemotherapeutic treatment cohorts in an accurate and time-efficient manner. Staging laparoscopy is utilized to determine the presence of radiologically occult disease that would preclude further surgical treatment. The aim of this study was to analyse the utility of staging laparoscopy in a contemporary cohort of patients with perihilar cholangiocarcinoma. Patients diagnosed with potentially resectable perihilar cholangiocarcinoma between January 2010 and April 2015 were analysed retrospectively from a prospective database linked to UK Hospital Episode Statistics data. Patients with distal cholangiocarcinoma and gallbladder cancer were excluded from analysis. A total of 431 patients with perihilar cholangiocarcinoma were referred for assessment of potential resection at a supraregional referral centre. Some 116 patients with potentially resectable disease subsequently underwent surgical assessment. The cohort demonstrated an all-cause yield of staging laparoscopy for unresectable disease of 27·2 per cent (31 of 114). The sensitivity for detection of peritoneal disease was 71 per cent (15 of 21; P laparoscopy was 66 per cent (31 of 47) with a positive predictive value of progress to resection of 81 per cent (69 of 85). Neither the Bismuth-Corlette nor the Memorial Sloan Kettering Cancer Center preoperative scoring system was contingent with cause of unresectability at staging laparoscopy (P = 0·462 and P = 0·280 respectively). In the present cohort, staging laparoscopy proved useful in determining the presence of radiologically occult metastatic disease in perihilar cholangiocarcinoma. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.
Leitao, Mario M; Bartashnik, Aleksandra; Wagner, Isaac; Lee, Stephen J; Caroline, Ari; Hoskins, William J; Thaler, Howard T; Abu-Rustum, Nadeem R; Sonoda, Yukio; Brown, Carol L; Jewell, Elizabeth L; Barakat, Richard R; Gardner, Ginger J
Objective We assessed the direct costs of 3 surgical approaches in uterine cancer and the cost impact of incorporating robot-assisted surgery. Methods A cost system that allocates the actual cost of resources used to treat each patient, as opposed to borrowing cost data from a billing system, was used to determine direct costs for patients who underwent surgery for uterine cancer from 2009–2010. These costs included all aspects of surgical care up to 6 months after discharge. Total amortized direct costs (AC) included the capital cost of 3 dual console DaVinci Si platforms with 5 years of service contracts. Non-amortized costs (NAC) were also calculated (excluded capital costs). Modeling was performed to estimate the mean cost of surgical care for patients presenting with endometrial cancer from 2007–2010 Results Of 436 cases (132 laparoscopic, 262 robotic, 42 laparotomy), total mean AC/case was $20,489 (laparoscopy), $23,646 (robot), and $24,642 (laparotomy) (P<0.05 [robot vs laparoscopy]; P=0.6 [robot vs laparotomy]). Total NAC/case was $20,289, $20,467, and $24,433, respectively (P=0.9 [robot vs laparoscopy]; P=0.03 [robot vs laparotomy]). The planned surgical approach in 2007 was laparoscopy-68%, robot-8%, and laparotomy-24% compared to 26%, 64%, and 9%, respectively, in 2010 (P<0.001). The modeled mean AC/case was $21,738 in 2007 and $22,678 in 2010 (+$940). NAC was $21,298 in 2007 and $20,573 in 2010 (−$725). Conclusion Laparoscopy is least expensive when including capital acquisition costs. Laparoscopy and robotic surgery are comparable if upfront costs are excluded. There is cost neutralization with the robot when it helps decrease laparotomy rates. PMID:24785856
Pérez Martínez, Caridad de Jesús; Universidad de Ciencias Médicas de La Habana
Minimal access surgery has been a true revolution in the field of surgery, especially in general surgery, with the apparition of laparoscopy surgery. In this article has been made a bibliographic research with one main purpose: To describe the antecedents, origins, and development of the minimal access surgery and laparoscopy surgery in Cuba and around the world. Recent publications have been consulted, and, finally, we counting with thirty bibliographic references. A relevant conclusion has ...
Zhou, Jia-Min; Yao, Li-Qing; Xu, Jian-Min; Xu, Mei-Dong; Zhou, Ping-Hong; Chen, Wei-Feng; Shi, Qiang; Ren, Zhong; Chen, Tao; Zhong, Yun-Shi
AIM: To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer (CRC) patients with acute colorectal obstruction (ACO). METHODS: From April 2008 to April 2012, surgery-related parameters, complications, overall survival (OS), and disease-free survival (DFS) of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent (SEMS) placement followed by one-stage open (n = 58) or laparoscopic resection (n = 16) were evaluated retrospectively. The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics. RESULTS: The characteristics of patients among these groups were comparable. The rate of conversion to open surgery was 12.5% in the stent-laparoscopy group. Bowel function recovery and postoperative hospital stay were significantly shorter (3.3 ± 0.9 d vs 4.2 ± 1.5 d and 6.7 ± 1.1 d vs 9.5 ± 6.7 d, P = 0.016 and P = 0.005), and surgical time was significantly longer (152.1 ± 44.4 min vs 127.4 ± 38.4 min, P = 0.045) in the stent-laparoscopy group than in the stent-open group. Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group. There were no significant differences in the interval between stenting and surgery, intraoperative blood loss, OS, and DFS between the two stent groups. Compared with those in the stent-laparoscopy group, all surgery-related parameters, complications, OS, and DFS in the control group were comparable. CONCLUSION: The stent-laparoscopy approach is a feasible, rapid, and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis. PMID:24023495
Trotman, Gylynthia; Foley, Christine; Taylor, Janelle; DeSale, Sameer; Gomez-Lobo, Veronica
To compare institutional experience in postoperative recovery in children and adolescents who undergo laparoscopy vs minilaparotomy in the management of benign adnexal cystic lesions. Retrospective cohort study. Tertiary care children's hospital. Patients ages 6-21 years who underwent surgical management for benign adnexal lesions. Comparison of surgery times, size of lesions, pain scores, and patient length of stay after minilaparotomy vs laparoscopy. Forty-four patients were identified. Of those, 59% (n = 26) had a laparoscopic procedure and 41% (n = 18) underwent minilaparotomy. Patients who underwent minilaparotomy were more likely to have a larger adnexal mass than those in the laparoscopy group with a median size of 15.5 cm vs 6.0 cm, respectively (P laparoscopy. The minilaparotomy approach should be considered when laparoscopy is limited. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Abstract: The aim of this note is to analyse Gadda's Giornale di campagna, first part of the Giornale di guerra e prigionia (War and imprisonment journal) looking for the founding elements of Gadda's political thought. The note investigates the. Giornale in order to explain Gadda's political opinions also in the framework of.
Married women constituted the majority of our sample with a relative majority of 64.98% compared to those unmarried. We noted that 72.94% of our patients presented with secondary infertility. Endometriosis was found in 13.53% of patients operated upon. The most frequent site of endometriotic implantation was ovarian in ...
Wright, Andrew S; Khandelwal, Saurabh
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.
Prasanta K Nayak
Full Text Available Objective: To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres. Materials and Methods: This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included. Results: Out of 300 cases, 206 (69% patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14% and adnexal adhesion (12% in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups. Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.
Hamminga, Jenneke T. H.; Hofker, H. Sijbrand; Broens, Paul M. A.; Kluin, Philip M.; Heineman, Erik; Haveman, Jan Willem
Diagnostic laparoscopy is the ultimate diagnostic tool to evaluate the appendix. Still, according to the literature, this strategy results in a negative appendectomy rate of approximately 12-18 % and associated morbidity. Laparoscopic criteria for determining appendicitis are lacking. The goal of
Stefansson, T. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery]|[Univ. Hospital, Uppsala (Sweden). Dept. of Epidemiology; Nyman, R. [Univ. Hospital, Uppsala (Sweden). Dept. of Diagnostic Radiology; Nilsson, S. [Univ. Hospital, Uppsala (Sweden). Dept. of Diagnostic Radiology; Ekbom, A. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery]|[Univ. Hospital, Uppsala (Sweden). Dept. of Epidemiology; Paahlman, L. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery
Purpose: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP)) in diagnosing diverticulitis of the sigmoid colon. Material and Methods: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. Results: Fity-two patients were found to have sigmoid diverticulitis: 20 patients by lanparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. Conclusion: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be rule out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis. (orig.).
Acholonu, Uchenna C; Chang-Jackson, Shao-Chun R; Radjabi, A Reza; Nezhat, Farr R
We performed a search of PUBMED and MEDLINE for articles concerning surgical management of early stage endometrial cancer from 1950 to 2011. From the articles collected we extracted data such as estimated blood loss, operating room time, complications, conversion to laparotomy, and length of hospital stay. Forty-seven relevant sources were analyzed. The patients in the laparoscopy group had less blood loss, fewer complications, longer operating room times, and a shorter length of stay. Lymph node count was similar in both groups. Although obesity is not a contraindication to laparoscopy, it does lead to a higher conversion rate. Route of surgical treatment had no impact on recurrence or survival. Robotic surgery has significant advantages over laparotomy, but advantages over laparoscopy are not as distinct. Laparoscopic hysterectomy offers several advantages over laparotomy. These advantages relate to improvements in patient care with comparable clinical outcome. After careful analysis we believe laparoscopy should be the standard of care for surgical management of early stage endometrial cancer. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.
SUSSENBACH, Samanta; SILVA, Everton N; PUFAL, Milene Amarante; ROSSONI, Carina; CASAGRANDE, Daniela Schaan; PADOIN, Alexandre Vontobel; MOTTIN, Cláudio Corá
Background Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. Aim 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. Methods A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. Results From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. Conclusion 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy. PMID:25409964
image‑guided percutaneous aspiration or drainage in addition to systemic antimicrobial agents became the standard of ... Indications for surgical drainage have now been limited to cases of failure of percutaneous .... Figure 1: Drainage catheter (chest tube) passed percutaneously into the abscess cavity during laparoscopy ...
Mais, Valerio; Peiretti, Michele; Gargiulo, Tigellio; Parodo, Giuseppina; Cirronis, Maria Giuseppina; Melis, Gian Benedetto
Recent studies reported the feasibility of intraoperative lymphatic mapping in women with endometrial cancer but none of these studies compared the sentinel lymph nodes (SLNs) detection rates obtainable through laparoscopy or laparotomy. The purpose of this study was to address this issue. Thirty-four patients with clinical stage I-II endometrial cancer were enrolled in this prospective comparative trial. Four milliliters of Patent Blue Violet were injected into the cervix after the induction of general anesthesia. The assessment of SLNs was done in 17 patients through laparoscopy and in 17 patients through laparotomy as first step of systematic pelvic lymphadenectomy. Both SLNs and non-SLNs were evaluated for micrometastases. The SLNs detection rate was significantly higher (82%) for laparoscopy than for laparotomy (41%; P = 0.008). Pelvic lymph node metastases were present in 6 out of 34 patients (18%) but only 3 (50%) of these patients were correctly identified. SLNs detection rate is significantly higher through laparoscopy than through laparotomy after vital dye pericervical injection but intraoperative vital dye pericervical injection is not reliable as part of standard care for predicting lymphatic spread in women with early stage endometrial cancer. (c) 2010 Wiley-Liss, Inc.
Full Text Available Assisted reproductive technologies are used to accelerate genetic gain and improve reproductive performances in farm animals, including small ruminants. This technologies include estrous synchronization, artifi cial insemination (AI using fresh, frozen or sexed semen, embryo transfer (ET using in vivo or in vitro produced embryos, and more advanced - cloning and production of transgenic animals. Diagnostic procedures, such as ultrasonography and laparoscopy, have been used as additional tools for monitoring the ovarian response to superovulatory treatment in donor animals as well as for AI and collection and transfer of embryos. The use of laparoscopy for assisted reproduction techniques in Macedonia commenced in the early 90’s, with the acquisition of a set of ,,Karl Storz” equipment. After the adoption of the required routine, our group has completed several scientifi c projects where laparoscopy was used for intrauterine inseminations as well as for recovery and transfer of embryos in both sheep andgoats. In the following period our group endeavored into introduction of laparoscopic insemination in the routine farm practice. Ovine intrauterine/intracornual insemination by frozen-thawed semen resulted with pregnancy rates of 45% and 60%, when AI was performed out of season and during the breeding season, respectively. In goats, this percentage occasionally peaked at 85%. The aim of this article is to review the status of implementation of laparoscopy in Assisted Reproduction Technologies (ART of small ruminants and to present our experience in this field.
Stefansson, T.; Univ. Hospital, Uppsala; Nyman, R.; Nilsson, S.; Ekbom, A.; Univ. Hospital, Uppsala; Paahlman, L.
Purpose: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP)) in diagnosing diverticulitis of the sigmoid colon. Material and Methods: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. Results: Fity-two patients were found to have sigmoid diverticulitis: 20 patients by lanparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. Conclusion: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be rule out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis. (orig.)
Iunusov, M Iu; Ugarov, B A; Ten, S L
Diagnostic laparoscopy was performed in 28 patients at the age of from 5 to 32 years. The endoscopic semiotics of the inguinal and intraabdominal retention, testicular agenesia were studied. Laparoscopic and intraoperative diagnoses coincided in all the cases. No complications were observed.
Ho, Be; Lewis, Aaron; Paz, I Benjamin
The present study aims to evaluate the role of laparoscopy in frail patients undergoing colorectal surgery for colorectal cancer. A review of the 2011 to 2014 American College of Surgeons National Surgical Quality Improvement Program database was performed to identify frail patients (using a frailty index), who underwent resection for colorectal cancer. Univariable and multivariable analyses were performed to evaluate 30-day mortality and Clavien-Dindo grade IV (CD-IV) complications. A total of 52,087 patients with colorectal cancer were identified, of which frailty accounted for 2.63 per cent (index score ≥5). Patients above the age 85 were considered frail 6.8 per cent of the time and accounted for 24.5 per cent of patients with frailty. Laparoscopic surgery was performed in 32.9 and 53.1 per cent of patients with and without frailty (P < 0.001). Patients with frailty were less likely to die within 30 days of surgery if younger (P = 0.004), performed electively (P < 0.001), or laparoscopically (P < 0.001). On multivariate analysis, laparoscopy and elective surgery were associated with better perioperative survival; whereas, older age, male sex, and tobacco use were associated with 30-day mortality. Laparoscopy and lower body mass index were associated with fewer Clavien-Dindo grade IV complications. Although laparoscopy is performed less commonly in the frail, this study indicated better perioperative outcomes for patients undergoing elective surgery who were <85 years old.
Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Majda, Kaja; Gutowski, Piotr
Celiac trunk (CT) compression syndrome caused by the median arcuate ligament (MAL) is a rarely diagnosed disease because of its nonspecific symptoms, which cause a delay in the correct diagnosis. Intestinal ischemia occurs, which causes symptoms of abdominal angina. One method of treatment for this disease is surgical release of the CT - the intersection of the MAL. Laparoscopy is the first step of the hybrid technique combined with percutaneous angioplasty and stenting of the CT. To demonstrate the usefulness and advantages of the laparoscopic approach in the treatment of Dunbar syndrome. Between 2013 and 2016 in the General and Minimally Invasive Surgery Department of the Medical Sciences Faculty of the University of Warmia and Mazury in Olsztyn, 6 laparoscopic procedures were performed because of median arcuate ligament syndrome. During the laparoscopy the MAL was cut with a harmonic scalpel. One month after laparoscopy 5 patients had Doppler percutaneous angioplasty of the CT with stent implantation in the Vascular Surgery Department in Pomeranian Medical University in Szczecin. In one case, there was a conversion of laparoscopic surgery to open due to unmanageable intraoperative bleeding. In one case, postoperative ultrasound examination of the abdominal cavity demonstrated the presence of a large hematoma in the retroperitoneal space. All patients reported relief of symptoms in the first days after the operation. The hybrid method, combining laparoscopy and angioplasty, seems to be a long-term solution, which increases the comfort of the patient, brings the opportunity for normal functioning and minimizes the risk of restenosis.
Laparoscopy May Have a Role in the Drainage of. Liver Abscess: Early Experience at Owerri, Nigeria. Christopher N Ekwunife, Ogechukwu Okorie1, Ogechukwu Nwobe. Departments of Surgery and 1Anaesthesia, Federal Medical Centre, Owerri, Nigeria. ABSTRACT. Background: Image‑guided percutaneous drainage ...
Lu, Qi; Qu, Hong; Liu, Chongdong; Wang, Shuzhen; Zhang, Zhiqiang; Zhang, Zhenyu
Abstract The aim of this study was to compare the safety and morbidity of laparoscopic versus laparotomic comprehensive staging of apparent early stage ovarian cancer. In this retrospective study, the outcomes of patients with apparent stage I ovarian cancer who underwent laparoscopic or laparotomic comprehensive surgical staging from January 2002 to January 2014 were evaluated. The long-term survival of patients with early ovarian cancer was compared. Forty-two patients were treated by laparoscopy, and 50 were treated by laparotomy. The median operative time was 200 minutes in the laparoscopy group and 240 minutes in the laparotomy group (P >0.05). The median length of hospital stay was 3 days in the laparoscopy group and 7 days in the laparotomy group (P laparoscopy and laparotomy groups. Laparoscopic and laparotomic comprehensive staging of early ovarian cancer were similar in terms of staging adequacy, accuracy and survival rate. Laparoscopic staging was associated with a significantly reduced hospital stay. Prospective randomized trials are required to evaluate the overall oncologic outcomes. PMID:27196468
Iskandar Rahardjo Budianto
Conclusions: Laparoscopy is superior to ultrasound in the management of impalpable testes when high-resolution ultrasound is not available during the diagnostic process, with respect to both the sensitivity of localizing the testis and being more time and cost effective.
Objectives Management for urachal anomalies (UAs) is controversial. Although traditional treatment of UAs has been surgical excision, recent literature report also a conservative approach. We reviewed our experience to define the role of laparoscopy in the management of UAs in children. Patients and methods From July ...
Ran, Longke; Jin, Jing; Xu, Yan; Bu, Youquan; Song, Fangzhou
Purpose To compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis. Methods The MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT), number of complications, length of hospital stay (LOHS), estimated blood loss (EBL), number of transfusions, total lymph nodes harvested (TLNH), and number of conversions. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated using either a fixed-effects or random-effects model. Results Twenty-two studies were included in the meta-analysis. These studies involved a total of 4420 patients, 3403 of whom underwent both robotic surgery and laparoscopy and 1017 of whom underwent both robotic surgery and laparotomy. The EBL (p = 0.01) and number of conversions (p = 0.0008) were significantly lower and the number of complications (plaparoscopy. The OT, LOHS, number of transfusions, and TLNH showed no significant differences between robotic surgery and laparoscopy. The number of complications (plaparoscopy and laparotomy for patients with endometrial cancer. Robotic surgery is associated with significantly lower EBL than both laparoscopy and laparotomy; fewer conversions but more complications than laparoscopy; and shorter LOHS, fewer complications, and fewer transfusions but a longer OT than laparoscopy. Further studies are required. PMID:25259856
Asgari, Zahra; Hafizi, Leili; Hosseini, Rayhaneh; Javaheri, Atiyeh; Rastad, Hathis
Background: Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion (synechiae). Objective: To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy. Materials and Methods: In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran’s Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups. Results: Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma’s size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02). Conclusion: With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae. PMID:26000007
Chakravartty, Saurav; Sarma, Diwakar R; Noor, Muhammad; Panagiotopoulos, Spyros; Patel, Ameet G
Laparoscopy is increasingly utilised as a diagnostic tool in management of abdominal trauma; however its role in therapeutic intervention remains unexplored. The aim of this study is to compare laparoscopy with laparotomy in the treatment of abdominal trauma in haemodynamically stable patients. A review of patients undergoing surgery for abdominal trauma between January 2004-2014 identified 25 patients who underwent laparoscopy for therapeutic intervention (TL). This group was matched with 25 similar patients undergoing laparotomy (LT). Matching of the two cohorts was based on patient characteristics, severity of injuries, haemodynamic compromise and radiological findings. Peri-operative outcomes were compared. Patient characteristics were similar in TL and LT patients for age (median 33 vs. 26 years), gender distribution and clinical presentation. Injury severity score was also similar with a median of 16 in both groups (major trauma = ISS>15, normal range 0-75). Types of injuries included; hollow viscus [bowel repair = 10 (TL) vs. 16 (LT)] and solid organs [5(TL) vs. 2 (LT)]. Median operating time was similar in both groups; 105(TL) compared to 98 (LT) minutes. Post-operative complications (1 vs. 10, p = 0.02), analgesia requirements, specifically opiate use (34 vs. 136 morphine equivalents, p = 0.002) and hospital stay (4 vs. 9 days, p = 0.03) were significantly lower in the laparoscopy group. Abdominal trauma in haemodynamically stable patients can be managed effectively and safely with laparoscopy by experienced surgeons. Major benefits may include lower morbidity, reduced pain, and shorter length of hospital stay. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Ran, Longke; Jin, Jing; Xu, Yan; Bu, Youquan; Song, Fangzhou
To compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis. The MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT), number of complications, length of hospital stay (LOHS), estimated blood loss (EBL), number of transfusions, total lymph nodes harvested (TLNH), and number of conversions. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated using either a fixed-effects or random-effects model. Twenty-two studies were included in the meta-analysis. These studies involved a total of 4420 patients, 3403 of whom underwent both robotic surgery and laparoscopy and 1017 of whom underwent both robotic surgery and laparotomy. The EBL (p = 0.01) and number of conversions (p = 0.0008) were significantly lower and the number of complications (psurgery than in laparoscopy. The OT, LOHS, number of transfusions, and TLNH showed no significant differences between robotic surgery and laparoscopy. The number of complications (psurgery than in laparotomy. The TLNH showed no significant difference between robotic surgery and laparotomy. Robotic surgery is generally safer and more reliable than laparoscopy and laparotomy for patients with endometrial cancer. Robotic surgery is associated with significantly lower EBL than both laparoscopy and laparotomy; fewer conversions but more complications than laparoscopy; and shorter LOHS, fewer complications, and fewer transfusions but a longer OT than laparoscopy. Further studies are required.
Alsulaimy, Mohammad; Punchai, Suriya; Ali, Fouzeyah A; Kroh, Matthew; Schauer, Philip R; Brethauer, Stacy A; Aminian, Ali
Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies. A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative preoperative CT scan and upper endoscopy were included. Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n = 12), chronic cholecystitis (n = 4), mesenteric defect (n = 2), internal hernia (n = 1), and necrotic omentum (n = 1). Two patients developed post-operative complications including a pelvic abscess and an abdominal wall abscess. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients required long-term medical treatment for management of chronic abdominal pain. Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 40% of patients who undergo diagnostic laparoscopy and 70% of patients with positive findings on laparoscopy experience significant symptom improvement. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases.
Rutten, Marianne J; van Meurs, Hannah S; van de Vrie, Roelien; Gaarenstroom, Katja N; Naaktgeboren, Christiana A; van Gorp, Toon; Ter Brugge, Henk G; Hofhuis, Ward; Schreuder, Henk W R; Arts, Henriette J G; Zusterzeel, Petra L M; Pijnenborg, Johanna M A; van Haaften, Maarten; Fons, Guus; Engelen, Mirjam J A; Boss, Erik A; Vos, M Caroline; Gerestein, Kees G; Schutter, Eltjo M J; Opmeer, Brent C; Spijkerboer, Anje M; Bossuyt, Patrick M M; Mol, Ben Willem; Kenter, Gemma G; Buist, Marrije R
Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom > 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer centers in the Netherlands. Patients with suspected advanced-stage ovarian cancer who qualified for PCS were eligible. Participating patients were randomly assigned to either laparoscopy or PCS. Laparoscopy was used to guide selection of primary treatment: either primary surgery or neoadjuvant chemotherapy followed by interval surgery. The primary outcome was futile laparotomy, defined as a PCS with residual disease of > 1 cm. Primary analyses were performed according to the intention-to-treat principle. Results Between May 2011 and February 2015, 201 participants were included, of whom 102 were assigned to diagnostic laparoscopy and 99 to primary surgery. In the laparoscopy group, 63 (62%) of 102 patients underwent PCS versus 93 (94%) of 99 patients in the primary surgery group. Futile laparotomy occurred in 10 (10%) of 102 patients in the laparoscopy group versus 39 (39%) of 99 patients in the primary surgery group (relative risk, 0.25; 95% CI, 0.13 to 0.47; P laparoscopy group, three (3%) of 102 patients underwent both primary and interval surgery compared with 28 (28%) of 99 patients in the primary surgery group ( P laparoscopy reduced the number of futile laparotomies in patients with suspected advanced-stage ovarian cancer. In women with a plan for PCS, these data suggest that performance of diagnostic laparoscopy first is reasonable and that if cytoreduction to < 1 cm of residual disease seems feasible, to proceed with PCS.
Dove, Graham; Abildgaard, Sille Julie; Biskjær, Michael Mose
The Post-ItTM note is a frequently used, and yet seldom studied, design material. We investigate the functions Post-ItTM notes serve when providing cognitive support for creative design team practice. Our investigation considers the ways in which Post-ItTM notes function as design externalisation...
Meining, A; Spaun, G; Fernández-Esparrach, G
transluminal endoscopic surgery (NOTES) in Europe. In accordance with previous meetings, five working groups were formed. In 2012, emphasis was put on specific indications for NOTES and interventional endoscopy. Each group was assigned an important indication related to ongoing research in NOTES...
De Iaco, Pierandrea [Department of Gynaecology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Musto, Alessandra [Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Orazi, Luca [Department of Gynaecology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Zamagni, Claudio; Rosati, Marta [Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Allegri, Vincenzo [Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Cacciari, Nicoletta [Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Al-Nahhas, Adil [Department of Nuclear Medicine, Hammersmith Hospital, London (United Kingdom); Rubello, Domenico, E-mail: firstname.lastname@example.org [Department of Nuclear Medicine, PET/CT Centre, Radiology, Medical Physics, ' Santa Maria della Misericordia' Hospital, Viale Tre Martiri 140, 45100 Rovigo (Italy); Venturoli, Stefano [Department of Gynaecology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Fanti, Stefano [Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy)
abdominal quadrants (epigastrium and diaphragmatic areas). Final analysis showed a sensitivity and specificity for PET/TC of 78.9 and 68.4% respectively with a positive predictive value of 95.3%. A significant difference was noted between mean SUVmax associated with lesions smaller or larger than 0.5 cm (p = 0.006). Conclusion: Our results suggest that PET/CT may prove a useful tool for pre-surgical staging of ovarian cancer with a sensitivity and specificity of 78 and 68%, respectively. However, it may be used in combination with laparoscopy for better results. PET/CT showed an adequate correlation between SUVmax values and laparoscopy findings of lesions >5 mm, but a high rate of false negative results in lesions <5 mm such as in carcinomatosis. PET/CT should be used carefully in early stage disease, with low risk of peritoneal infiltration, because of high rate of false positive results, to avoid unnecessary therapy procedures.
Gaitán, Hernando G; Reveiz, Ludovic; Farquhar, Cindy; Elias, Vanessa M
This is an updated version of the original review, published in Issue 1, 2011, of The Cochrane Library. Acute lower abdominal pain is common, and making a diagnosis is particularly challenging in premenopausal women, as ovulation and menstruation symptoms overlap with symptoms of appendicitis, early pregnancy complications and pelvic infection. A management strategy involving early laparoscopy could potentially provide a more accurate diagnosis, earlier treatment and reduced risk of complications. To evaluate the effectiveness and harms of laparoscopy for the management of acute lower abdominal pain in women of childbearing age. The Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, LILACS and CINAHL were searched (October 2013). The International Clinical Trials Registry Platform (ICTRP) was also searched. No new studies were included in this updated version. Randomised controlled trials (RCTs) that included women of childbearing age who presented with acute lower abdominal pain, non-specific lower abdominal pain or suspected appendicitis were included. Trials were included if they evaluated laparoscopy with open appendicectomy, or laparoscopy with a wait and see strategy. Study selection was carried out by two review authors independently. Data from studies that met the inclusion criteria were independently extracted by two review authors and the risk of bias assessed. We used standard methodological procedures as expected by The Cochrane Collaboration. A summary of findings table was prepared using GRADE criteria. A total of 12 studies including 1020 participants were incorporated into the review. These studies had low to moderate risk of bias, mainly because allocation concealment or methods of sequence generation were not adequately reported. In addition, it was not clear whether follow-up was similar for the treatment groups
Chestovich, Paul J; Browder, Timothy D; Morrissey, Shawna L; Fraser, Douglas R; Ingalls, Nichole K; Fildes, John J
Laparoscopic techniques have evolved, allowing increased capabilities within most subspecialties of general surgery, but have failed to gain traction managing injured patients. We hypothesized that laparoscopy is effective in the diagnosis and treatment of penetrating abdominal injuries. We retrospectively reviewed patients undergoing abdominal exploration following penetrating trauma at our Level 1 trauma center during a 6-year period from January 1, 2008, to December 31, 2013. Demographic and resuscitation data were obtained from our trauma registry. Charts were reviewed for operative details, hospital course, and complications. Hospital length of stay (LOS) and complications were primary end points. Patients were classified as having nontherapeutic diagnostic laparoscopy (DL), nontherapeutic diagnostic celiotomy (DC), therapeutic laparoscopy (TL), or therapeutic celiotomy (TC). TL patients were case-matched 2:1 with TC patients having similar intra-abdominal injuries. A total of 518 patients, including 281 patients (55%) with stab wounds and 237 patients (45%) with gunshot wounds, were identified. Celiotomy was performed in 380 patients (73%), laparoscopy in 138 (27%), with 44 (32%) converted to celiotomy. Nontherapeutic explorations were compared including 70 DLs and 46 DCs with similar injury severity. LOS was shorter in DLs compared with DCs (1 day vs. 4 days, p < 0.001). There were no missed injuries. Therapeutic explorations were compared by matching all TL patients 2:1 to TC patients with similar type and severity of injuries. Twenty-four patients underwent TL compared with 48 TC patients in the case matched group. LOS was shorter in the TL group than in the TC group (4 days vs. 2 days, p < 0.001). Wound infections were more common with open exploration (10.4% vs. 0%, p = 0.002), and more patients developed ileus or small bowel obstruction after open exploration (9.4% vs. 1.1%, p = 0.018). Laparoscopy is safe and accurate in penetrating abdominal injuries
Favero, Giovanni; Anton, Cristina; Le, Xin; Silva E Silva, Alexandre; Dogan, Nasuh Utku; Pfiffer, Tatiana; Köhler, Christhardt; Baracat, Edmund Chada; Carvalho, Jesus Paula
Laparoscopy is considered the method of choice in the operative treatment of type I endometrial carcinoma (EC). However, there is a paucity of data regarding the safety of endoscopy for type II EC because these malignancies have several biological similarities with ovarian cancer. This study aimed to evaluate the feasibility, operative outcomes, and oncologic safety of laparoscopic surgery in patients with type II EC. A retrospective study with histologically confirmed serous or clear-cell EC without peritoneal carcinomatosis treated by laparoscopy (G1) or laparotomy (G2) was conducted. Procedures included hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymphadenectomy. From 2009 to 2015, 89 patients were included; 53 women underwent laparoscopy and 36 underwent laparotomy. No relevant epidemiological or oncologic difference between groups was observed. The mean number of removed pelvic nodes was 16 [±10] and 12 [±13] in group 1 (G1) and group 2 (G2), respectively (P = 0.127). The mean number of dissected para-aortic nodes was significantly greater in the laparoscopic group (11 [±9] vs 6 [±9], P = 0.006). Para-aortic metastasis was significantly more often observed in the endoscopy group (26% vs 13%, P = 0.04). Adjuvant therapies were given to 86% of the patients in the study and 75% in the control group (P = 0.157). No excessive blood loss, casualty related to surgery, intraoperative complication, or conversion to laparotomy occurred in G1. Ten (18%) women from G1 and 36% (13/36) in G2 developed relevant postoperative complications (P = 0.03). The median duration of follow-up was 38 months for the laparoscopy and 47 months for the open surgery (P = 0.12). The 5-year overall and disease-free survival were similar, 86% versus 78% and 58% versus 51% for G1 and G2, respectively (P = 0.312). Laparoscopy is oncologically at least not inferior to laparotomy for the surgical treatment of type II EC. Endoscopic techniques are
Chen, Ying-Da; Chen, Shyr-Chyr
Laparoscopy has been used for the diagnosis and treatment for hemodynamically stable patients with penetrating abdominal trauma. This study evaluated whether diagnostic and therapeutic laparoscopy can be used as effectively in select patients with blunt abdominal trauma. All hemodynamically stable patients undergoing operations for blunt abdominal trauma over a 10-year period (2006–2015) at a tertiary medical center were included. Patients undergoing laparotomy were categorized as group A. Patients who underwent laparoscopy were categorized as group B. The clinical outcomes of the 2 groups were compared. There were 139 patients in group A and 126 patients in group B. Group A patients were more severely injured (mean injury severity score of 23.3 vs. 18.9, P .05). Laparoscopy is a feasible and safe tool for the diagnosis and treatment of hemodynamically stable patients with blunt abdominal trauma who require surgery. PMID:29470527
Wacker, F; Cholewa, D; Waldschmidt, J; Wolf, K J
The use of mini-laparoscopy scissors to remove a central venous catheter inadvertently fixed to the wall of the brachiocephalic vein is described. During a rethoracotomy in a 15-year-old female patient, a central venous catheter preoperatively introduced in the left subclavian vein was inadvertently trapped by a suture and fixed to the wall of the left brachiocephalic vein. The foreign body was removed by use of a transjugularly introduced venous sheath, a catheter wire snare, and mini-laparoscopy scissors. The fixed catheter was freed from the wall of the vein under fluoroscopic control with the help of a mini-laparoscopy scissors. Since the intravasal end of the catheter had already been grasped during mobilization with the wire snare it could be completely removed subsequently without any problem. The percutaneous, intravascular use of mini-laparoscopy instruments may be considered for foreign body removal in special cases.
Full Text Available Ik Yong Kim,1,* Bo Ra Kim,2,* Hyun Soo Kim,2 Young Wan Kim1 1Department of Surgery, Division of Colorectal Surgery, 2Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea *These authors contributed equally to this work Purpose: To identify differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. We also evaluated short-term and oncologic outcomes after laparoscopy and open surgery.Methods: A total of 100 consecutive stage IV patients undergoing open (n=61 or laparoscopic (n=39 major resection were analyzed. There were four cases (10% of conversion to laparotomy in the laparoscopy group.Results: Pathological T4 tumors (56% vs 26%, primary colon cancers (74% vs 51%, and larger tumor diameter (6 vs 5 cm were more commonly managed with open surgery. Right colectomy was more common in the open surgery group (39% and low anterior resection was more common in the laparoscopy group (39%, P=0.002. Hepatic metastases in segments II, III, IVb, V, and VI were more frequently resected with laparoscopy (100% than with open surgery (56%, although the difference was not statistically significant. In colon and rectal cancers, mean operative time and 30-day complication rates of laparoscopy and open surgery did not differ. In both cancers, mean time to soft diet and length of hospital stay were shorter in the laparoscopy group. Mean time from surgery to chemotherapy commencement was significantly shorter with laparoscopy than with open surgery. In colon and rectal cancers, 2-year cancer-specific and progression-free survival rates were similar between the laparoscopy and open surgery groups.Conclusion: Based on our findings, laparoscopy can be selected as an initial approach in patients with a primary tumor without adjacent organ invasion and patients without primary tumor-related symptoms. In selected stage
Ran, Longke; Jin, Jing; Xu, Yan; Bu, Youquan; Song, Fangzhou
Purpose To compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis. Methods The MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT), number of complications, len...
Plaut, Alfred B J
In this paper the author explores the theoretical and technical issues relating to taking notes of analytic sessions, using an introspective approach. The paper discusses the lack of a consistent approach to note taking amongst analysts and sets out to demonstrate that systematic note taking can be helpful to the analyst. The author describes his discovery that an initial phase where as much data was recorded as possible did not prove to be reliably helpful in clinical work and initially actively interfered with recall in subsequent sessions. The impact of the nature of the analytic session itself and the focus of the analyst's interest on recall is discussed. The author then describes how he modified his note taking technique to classify information from sessions into four categories which enabled the analyst to select which information to record in notes. The characteristics of memory and its constructive nature are discussed in relation to the problems that arise in making accurate notes of analytic sessions.
To describe the clinical workup and laparoscopic treatment of ovarian remnant syndrome in dogs and cats. After confirming the diagnosis with some or all of the following tests - vaginoscopy with cytology, hormonal tests, and ultrasound - laparoscopic removal of the ovarian remnants was performed. A three-portal technique was used in the four dogs and a two-portal technique in the two cats. All patients recovered well and were discharged the same day. No post-operative complications occurred in any patient. Overall, in the hands of an experienced laparoscopic surgeon, laparoscopic removal of ovarian remnants appears to be a safe procedure in dogs and cats. In addition, laparoscopy offers the advantages of excellent visualization and a reduced morbidity for the patient. Careful case selection and complete pre-operative workup to rule out co-morbidities or underlying neoplasia are important. As with any laparoscopy the surgeon should always be prepared to convert to an open laparotomy if necessary.
Yasuda, Hiroshi; Okumura, Satoshi; Toyoda, Shou; Yamamoto, Kansuke; Mizumura, Naoto; Itou, Aya; Ogawa, Masao; Kawasaki, Masayasu; Kameyama, Masao
A 69-year-old man with right upper quadrant abdominal pain and fever was referred to our hospital. He had a history of asbestosis exposure. Computed tomography(CT)revealed a mass at the right subhepatic space, and an antibiotic was administered after a diagnosis of an abdominal abscess. However, the patient did not respond to the treatment, and finally, exploratory laparoscopy was performed. A sheet of combined white nodules surrounding the right lobe of the liver was found, and the mass was continuous with the covering particles. Biopsy of the mass and immunohistochemical examination was performed. The resulting diagnosis was diffuse epithelial malignant peritoneal mesothelioma(MPM). Postoperative systematic chemotherapy of pemetrexed and cisplatin was administered. Laparoscopy was useful to evaluate the distribution of the MPM, which led to adequate therapeutic determination.
Bjerrum, Flemming; Sorensen, Jette Led; Thinggaard, Jette; Strandbygaard, Jeanett; Konge, Lars
Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the implementation of a regional cross-specialty training program for basic laparoscopy, to increase the flexibility of educational courses, and to provide a more efficient use of simulation equipment. Using a regional training program in basic laparoscopy for gynecology as a model, we developed a cross-specialty training program for residents in surgery, gynecology, urology, and thoracic surgery. We reviewed data on training for the first year of the program and evaluated the program by using a scoring system for quality criteria for laparoscopic curricula and skills. We held 6 full-day theoretical courses involving 67 residents between September 1, 2013, and August 31, 2014. In the weeks following each course, residents practiced in a self-directed, distributed, and proficiency-based manner at a simulation center and in local hospital departments. A total of 57 residents completed the self-practice and a subsequent practical animal laboratory-based course. The structure of the training program was evaluated according to identified quality criteria for a skills laboratory, and the program scored 38 of a maximum 62 points. Implementation of a regional cross-specialty training program in basic laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up.
Padin, Esther Mariño; Santos, Raquel Sánchez; Fernández, Sonia González; Jimenez, Antonia Brox; Fernández, Sergio Estevez; Dacosta, Ester Carrera; Duran, Agata Rial; Artime Rial, Maria; Dominguez Sanchez, Ivan
3D laparoscopy allows the surgeon to regain the sense of depth and improve accuracy. The aim of the study was to assess the impact of 3D in bariatric surgery. A retrospective cohort study was conducted. All our patients who underwent bariatric surgery (sleeve gastrectomy (SG) or gastric bypass (GB)) between 2013 and 2016 were included. We compared 3D laparoscopy cohort and 2D laparoscopy cohort. Variables are as follows: age, sex, DM, hypertension, surgeon experience, and type of intervention. Comparisons of operative time, hospital stay, conversion, complications, reoperation, and exitus are completed. Three hundred twelve consecutive patients were included. 56.9% of patients underwent GB and 43.1% SG. Global complications were 3.2% (fistula 2.5%, hemoperitoneum 0.3%, others 0.4%). One hundred four procedures were performed in the 3D cohort and 208 in the 2D cohort. The 2D cohort and 3D cohort were similar regarding the following: percentage of GB vs SG, age, gender, learning curve, diabetes mellitus 2, hypertension, and sleep apnea. The operating time and hospital stay were significantly reduced in the 3D cohort (144.07 ± 58.07 vs 172.11 ± 76.11 min and 5.12 ± 9.6 vs 7.7 ± 13.2 days. It was the same when we stratified the sample by type of surgery or experience of the surgeon. Complications were reduced in the 3D cohort in the surgeries performed by novice surgeons (10.2 vs 1.8%, p = 0.034). The use of 3D laparoscopy in bariatric surgery in our center has helped reducing the operating time and hospital stay, and improving the safety of the surgery, either in GB or SG, being equally favorable in novice or more experienced surgeons.
Schipper, Erica; Nezhat, Camran
Erica Schipper,1 Camran Nezhat21Center for Minimally Invasive and Robotic Surgery, Palo Alto, CA; 2Obstetrics/Gynecology and Surgery, Stanford University Medical Center, Palo Alto, CA, USAAbstract: Endometriosis is a highly enigmatic disease with multiple presentations ranging from infertility to severe pain, often causing significant morbidity. Video-assisted laparoscopy (VALS) has now replaced laparotomy as the gold standard for the diagnosis and management of endometriosis. While imaging h...
Xu, Weifeng; Li, Hanzhong; Ji, Zhigang; Yan, Weigang; Zhang, Yushi; Zhang, Xuebin; Li, Qian
To compare transumbilical laparoendoscopic single-site surgery with conventional laparoscopy for the resection of retroperitoneal paragangliomas. In the present case-control study, we compared 11 transumbilical laparoendoscopic single-site surgery procedures with 22 conventional laparoscopy procedures carried out to treat retroperitoneal paragangliomas between June 2004 and October 2013 at Peking Union Medical Hospital, Beijing, China. Operative time, estimated intraoperative blood loss, blood transfusions, intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, postoperative fatigue time, postoperative systematic inflammation reaction syndrome, 24-h postoperative visual analog scale scores, postoperative hospital stay duration, and postoperative complications were recorded and analyzed. There were no significant differences in patient characteristics. All surgical procedures were successfully completed in both groups. Minor complications occurred in one case in the laparoendoscopic single-site surgery group and in two cases in the conventional laparoscopy group. In the laparoendoscopic single-site surgery group, the operative time was longer than that in the conventional laparoscopy group (P = 0.001). There were no significant differences in terms of intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, estimated blood loss, postoperative fatigue time, postoperative hospital stay or systematic inflammation reaction syndrome between the two groups. The 24-h postoperative visual analog scale score was lower in the laparoendoscopic single-site surgery group (P = 0.002). No recurrence or metastases were observed over the duration of the postoperative follow up. In properly selected patients, transumbilical laparoendoscopic single-site surgery is a feasible, safe and effective
Zimmermann, M; Hoffmann, M; Laubert, T; Bruch, H P; Keck, T; Benecke, C; Schlöricke, E
The purpose of the present study was to investigate on the acceptance and frequency of laparoscopic surgery for the management of acute and chronic bowel obstruction in a general patient population in German hospitals. To receive an authoritative opinion on laparoscopic treatment of bowel obstruction in Germany, a cross-sectional online study was conducted. We designed an online-based survey, supported by the German College of Surgeons (Berufsverband der Deutschen Chirurgen, BDC) to get multi-institutional-based data from various level providers of patient care. Between January and February 2014, we received completed questionnaires from 235 individuals (16.7 %). The participating surgeons were a representative sample of German hospitals with regard to hospital size, level of center size, and localization. A total of 74.9 % (n = 176) of all responders stated to use laparoscopy as the initial step of exploration in expected bowel obstruction. This procedure was highly statistically associated with the frequency of overall laparoscopic interventions and laparoscopic experience. The overall conversion rate was reported to be 29.4 %. This survey, investigating on the use of laparoscopic exploration or interventions in bowel obstruction, was able to show that by now, a majority of the responding surgeons accept laparoscopy as an initial step for exploration of the abdomen in the case of bowel obstruction. Laparoscopy was considered to be at least comparable to open surgery in an emergency setting. Furthermore, data analysis demonstrated generally accepted advantages and disadvantages of the laparoscopic approach. Indications for or against laparoscopy are made after careful consideration in each individual case.
Full Text Available Introduction : Celiac trunk (CT compression syndrome caused by the median arcuate ligament (MAL is a rarely diagnosed disease because of its nonspecific symptoms, which cause a delay in the correct diagnosis. Intestinal ischemia occurs, which causes symptoms of abdominal angina. One method of treatment for this disease is surgical release of the CT – the intersection of the MAL. Laparoscopy is the first step of the hybrid technique combined with percutaneous angioplasty and stenting of the CT. Aim: To demonstrate the usefulness and advantages of the laparoscopic approach in the treatment of Dunbar syndrome. Material and methods : Between 2013 and 2016 in the General and Minimally Invasive Surgery Department of the Medical Sciences Faculty of the University of Warmia and Mazury in Olsztyn, 6 laparoscopic procedures were performed because of median arcuate ligament syndrome. During the laparoscopy the MAL was cut with a harmonic scalpel. One month after laparoscopy 5 patients had Doppler percutaneous angioplasty of the CT with stent implantation in the Vascular Surgery Department in Pomeranian Medical University in Szczecin. Results : In one case, there was a conversion of laparoscopic surgery to open due to unmanageable intraoperative bleeding. In one case, postoperative ultrasound examination of the abdominal cavity demonstrated the presence of a large hematoma in the retroperitoneal space. All patients reported relief of symptoms in the first days after the operation. Conclusions : The hybrid method, combining laparoscopy and angioplasty, seems to be a long-term solution, which increases the comfort of the patient, brings the opportunity for normal functioning and minimizes the risk of restenosis.
Levine, Howard B
In extreme situations of massive projective identification, both the analyst and the patient may come to share a fantasy or belief that his or her own psychic reality will be annihilated if the psychic reality of the other is accepted or adopted (Britton 1998). In the example of' Dr. M and his patient, the paradoxical dilemma around note taking had highly specific transference meanings; it was not simply an instance of the generalized human response of distracted attention that Freud (1912) had spoken of, nor was it the destabilization of analytic functioning that I tried to describe in my work with Mr. L. Whether such meanings will always exist in these situations remains a matter to be determined by further clinical experience. In reopening a dialogue about note taking during sessions, I have attempted to move the discussion away from categorical injunctions about what analysis should or should not do, and instead to foster a more nuanced, dynamic, and pair-specific consideration of the analyst's functioning in the immediate context of the analytic relationship. There is, of course, a wide variety of listening styles among analysts, and each analyst's mental functioning may be affected differently by each patient whom the analyst sees. I have raised many questions in the hopes of stimulating an expanded discussion that will allow us to share our experiences and perhaps reach additional conclusions. Further consideration may lead us to decide whether note taking may have very different meanings for other analysts and analyst-patient pairs, and whether it may serve useful functions in addition to the one that I have described.
Hosoda, Kei; Yamashita, Keishi; Sakuramoto, Shinichi; Katada, Natsuya; Moriya, Hiromitsu; Mieno, Hiroaki; Watanabe, Masahiko
Little is known about postgastrectomy syndrome and quality of life (QOL after laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG). The aim of this study was to assess postgastrectomy syndrome and QOL after LAPPG as compared with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGBI). Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaires were sent by mail to 167 patients. To balance the characteristics of the groups, propensity score matching was performed. Of the 167 patients sent questionnaires, 112 (67%) responded, including 47 who underwent LAPPG and 65 who underwent LADGBI. After propensity score matching, the LAPPG group scored significantly better on the diarrhea and dumping subscales. Multiple regression analysis showed that female sex and LADGBI were independent factors predicting dumping. Evaluation of outcome measures for singular symptom showed that the LAPPG group scored significantly worse on the acid regurgitation subscale, but significantly better on the lower abdominal pain and early dumping abdominal subscales. LAPPG is superior to LADGBI for ameliorating postgastrectomy syndrome and maintaining QOL. LAPPG is recommended for patients with cT1N0 middle third gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.
Afshari, Elnaz; Najarian, Siamak; Simforoosh, Nasser
Artificial tactile sensing is a novel method for obtaining different characteristics of a hard object embedded in a soft tissue. In this regard, artificial palpation is one of the most valuable achievements of artificial tactile sensing that can be used in various fields of medicine and more specifically in surgery. In this study, considering the present problems and limitations in kidney-stone-removal laparoscopy, a new application will be presented for artificial tactile sensing approach. Having imitated surgeon's palpation during open surgery and modeled it conceptually, indications of stone existence that appear on the surface of kidney (due to exerting mechanical load) were determined. A number of different cases were created and solved by the software. Using stress distribution contours and stress graphs, it is illustrated that the created stress patterns on the surface of kidney not only show the existence of stone inside, but also its exact location. In fact, the reliability and accuracy of artificial tactile sensing method in detection of kidney stone during laparoscopy is demonstrated by means of finite element analysis. Also, in this paper, the functional principles of tactile system capable of determining the exact location of stone during laparoscopy will be presented.
Kong, Tae-Wook; Park, Hyogyeong; Cheong, Ji-Yoon; Min, Sang-Ki; Ryu, Hee-Sug
To assess the efficacy of analgesia provided by continuous ropivacaine wound infiltration after gynecologic laparoscopy. Sixty patients who underwent gynecologic laparoscopy at Ajou University School of Medicine, Suwon, Republic of Korea, between March and May 2012 were randomized to receive either intravenous fentanyl and ketorolac infusion on demand by patient-controlled analgesia (IV PCA group, n=31) or continuous wound infiltration of local ropivacaine (CWI group, n=29). Postoperative pain and postoperative nausea and vomiting (PONV) were assessed via a visual analog scale. The number of patients who requested rescue analgesia was recorded. There was no significant difference in postoperative pain between the 2 groups, but more patients requested rescue analgesia in the CWI group than in the IV PCA group in 24 hours (18 versus 9 patients, respectively; P=0.010). The PONV scores at 12 and 24 hours were, respectively, 0.28 and 0.27 in the CWI group, and 0.71 and 0.73 in the IV PCA group (P=0.004). Nine patients requested cessation of IV PCA because of severe nausea or vomiting. Continuous ropivacaine wound infiltration was found to be as effective as patient-controlled analgesia for postoperative pain relief after gynecologic laparoscopy. This technique provides good analgesia with less opioid analgesic requirement and few adverse effects. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Borkar, Jyoti; Dave, Nandini
To compare the analgesic efficacy of caudal block with diclofenac suppository and local anesthetic infiltration in children undergoing laparoscopy. We studied 50 children undergoing laparoscopy for diagnostic and therapeutic purposes. Their ages ranged from 3 to 13 years, and all belonged to American Society of Anesthesiologists (ASA) class I or II. Anesthesia was carried out using the standard procedure. Patients were randomly assigned to one of two groups. Group 1 received caudal block with bupivacaine 1 mL/kg after anesthetic induction. Group 2 received diclofenac suppository 3 mg/kg postinduction and local anesthetic infiltration at the port sites at the end of the procedure. Pain was assessed using the Hannallah objective pain scale at 15, 30, 60, 120, and 360 minutes postextubation. The pain scores were comparable in both groups at all times. Twelve percent of caudal block patients and 20% of diclofenac patients needed rescue analgesic, a statistically insignificant difference. In 2 patients, caudal block was technically difficult and they were excluded from the study. The incidence of side effects was low in our study. We find the analgesic efficacy of diclofenac suppository combined with local anesthetic infiltration at port sites comparable to caudal block. Given the necessarily invasive nature of caudal block, we suggest the combined use of diclofenac suppository with local anesthetic infiltration at port sites as a useful and more economical alternative for analgesia following pediatric laparoscopy.
Achurra, Pablo; Lagos, Antonia; Avila, Ruben; Tejos, Rodrigo; Buckel, Erwin; Alvarado, Juan; Boza, Camilo; Jarufe, Nicolas; Varas, Julian
Simulated laparoscopy training is limited by its low-quality image. A high-definition (HD) laparoscopic training box was developed under the present necessity of simulating advanced surgery. To describe and test a new HD laparoscopic training box for advanced simulation training. We describe the features and image quality of the new training box. The simulator was tested and then evaluated by a group of 76 expert surgeons using a 4-item questionnaire. To assess the effectiveness of training using this simulation box, 15 general surgery residents were trained to perform a laparoscopic jejuno-jejunostomy in a validated simulation program. They were assessed with objective rating scales before and after the training program, and their results were compared with that of experts. The training box was assembled using high-density fiberglass shaped as an insufflated abdomen. It has an adapted full-HD camera with a LED-based illumination system. A manually self-regulated monopod attached to the camera enables training without assistance. Of the expert surgeons who answered the questionnaire, 91% said that the simulation box had a high-quality image and that it was very similar to real laparoscopy. All residents trained improved their rating scores significantly when comparing their initial versus final assessment ( P .2). This novel laparoscopic training box presents a high-resolution image and allows training different types of advanced laparoscopic procedures. The simulator box was positively assessed by experts and demonstrated to be effective for laparoscopy training in resident surgeons.
Tirlapur, Seema A; Daniels, Jane P; Khan, Khalid S
Chronic pelvic pain (CPP) has an annual prevalence of 38/1000 in the UK, with coexisting pathologies often present. Diagnostic laparoscopy has long been the gold standard diagnostic test, but with up to 40% showing no abnormality, we explore the value of noninvasive imaging, such as pelvic ultrasound and MRI. A literature review from inception until January 2015 of the following databases: PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, and System for Information on Grey Literature in Europe were performed to identify published studies assessing the usefulness of ultrasound, MRI, and laparoscopy in the diagnosis of CPP. Three studies (194 women) addressed their comparative performance in patients with endometriosis, showing the sensitivity of ultrasound ranged between 58 and 88.5%; MRI was 56-91.5% and in the one study using histology as its reference standard, the sensitivity of laparoscopy was 85.7%. Noninvasive imaging has the additional benefit of being well tolerated, safer, and cheaper than surgery. CPP, by nature of its multifactorial causation, can be difficult to manage and often requires a multidisciplinary team. Ultrasound and MRI may provide information about the presence or lack of abnormality, which would allow general practitioners or office gynaecologists to initiate treatment and think about surgery as a second-line investigative tool.
Liu, Lu-Lu; Bao, Ning; Lu, Huang-Wei
To evaluate the effects of CO2 pneumoperitoneum during gynecologic laparoscopy on patients' postoperative cognitive function. This prospective clinical study included 225 adult female patients with American Society of Anesthesiologists physical status I or II. Patients underwent conventional open surgery (group I, n = 115) or gynecologic laparoscopy using abdominal insufflation with CO2 to an intra-abdominal pressure of 15 mm Hg (group II, n = 110). Serum S100β and neuron-specific enolase (NSE) concentrations were measured, both immediately before surgery and before the patient awoke after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery as well as 1, 6, 12, 24 and 72 h after surgery and before discharge. MMSE scores were significantly lower relative to baseline at 1, 6 and 12 h post surgery, but returned to baseline by 48 h (group I) or 72 h (group II) post surgery. One hour after surgery, S100β serum levels were higher in group II than in group I (p gynecologic laparoscopy. © 2015 S. Karger AG, Basel.
Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.
Liatsikos, Evangelos; Kyriazis, Iason; Kallidonis, Panagiotis; Do, Minh; Anja, Anja; Rigopoulos, Christos; Al-Aown, Abdulrahman; Stolzenburg, Jens-Uwe
Laparoscopy has gained a place in everyday surgical routine as an alternative surgical approach that decreases morbidity and postoperative hospitalization. Single port laparoscopic surgery has been introduced as a further development of laparoscopy. The feasibility and safety of single port laparoscopy is under extensive evaluation in specialized laparoscopic centers. Nevertheless, wide acceptance of the technique requires adequate documentation of the advantages of the approach over conventional laparoscopy and further refinement of surgical instrumentation to overcome intraoperative ergonomic problems.
Introduces notetaking tools used successfully with English-as-a-second-language students and low-achieving high school freshmen. Provides an overview of each tool and explains how students use them to take notes when reading textbooks and articles. Notes these tools and academic habits have helped students succeed in their mainstream academic…
Lagos Notes and Records is an annual, interdisciplinary journal of the humanities. It is devoted to the publication of well-researched articles in all the subjects in the Arts, Social Sciences, and Law. In addition to original articles, the journal publishes review articles, brief accounts of work in progress, notes and comments on ...
Galili, Offer; Shaoul, Ron; Mogilner, Jorge
Functional chronic recurrent abdominal pain (FCRAP) is long lasting, intermittent, or constant pain affecting 15-30% of children ages 4-18 and presents a diagnostic and treatment challenge to the physician. The predictive value of diagnostic tests is questionable, and studies of the treatment of chronic abdominal pain show inconclusive evidence regarding diet regimens as well as medical and surgical treatments. However, there is evidence that cognitive-behavioral therapy may be useful in improving pain and disability outcome. Increasing the understanding of the neural-pain pathways and research in cognitive modulation of pain led to the application of behavioral strategies in children with FCRAP with variable success. However, the use of hypnotherapy in children with recurrent abdominal pain is not common. During the last 3 years, we have implemented hypnosis as the preferred treatment for patients with FCRAP. In the current study, we aimed to summarize our experience with hypnosis for the treatment of FCRAP in children. Twenty patients who met the criteria for FCRAP were candidates for hypnosis. Hypnosis or imagery was offered to the families, of whom 3 refused. Seventeen patients underwent just one single session of hypnosis. A possible nonorganic etiology for the abdominal pain was revealed in all cases. In 14 adolescents, all clinical symptoms resolved. Hypnosis was not effective in 3 cases, in whom secondary gain was probably responsible for their symptoms. No side effects have been noted during and after the study. Follow-up was available for a period of 4-24 months. Although effective in the management of acute pain and distress in pediatric cancer patients, the use of hypnotherapy in children with FCRAP is not a common practice. The current study highly supports the use of hypnosis as a part of the biobehavioral approach for this dilemma.
Full Text Available Purpose: To report a case of combined laparoscopic and carbon dioxide partial cystectomy and foreign body removal and to review the existing literature on the topic. Materials and Methods: A 43-year-old Asian woman was found to have an intrauterine device embedded in the bladder wall during evaluation for chronic pelvic pain and urinary tract infection. She underwent cystoscopic-laparoscopic partial cystectomy, with an uncomplicated postoperative course. She had normal renal function during the follow-up period. This case demonstrates the possibility and safety of performing cystoscopic-laparoscopic partial cystectomy for the removal of a partially implanted intravesical foreign body. Results: The patient recovered without incident and was discharged 7 days after surgery. No abnormalities were noted in the urine output or renal function in the postoperative follow-up period. No complications due to retrograde flow of carbon dioxide up the ureters or air embolism were noted during the procedure or postoperatively. Conclusions: The combination of laparoscopy and air cystoscopy has been shown to be an optimal method for retracting foreign bodies embedded in the bladder wall. Also, air cystoscopy can be used to give doctors a better view in cases in which vision is compromised under water-contrast cystoscopy.
Jin, Chengyue; Fan, Yu; Zhang, Qian; Wang, Yu; Wu, Shiliang; Jin, Jie
To report a case of combined laparoscopic and carbon dioxide partial cystectomy and foreign body removal and to review the existing literature on the topic. A 43-year-old Asian woman was found to have an intrauterine device embedded in the bladder wall during evaluation for chronic pelvic pain and urinary tract infection. She underwent cystoscopic-laparoscopic partial cystectomy, with an uncomplicated postoperative course. She had normal renal function during the follow-up period. This case demonstrates the possibility and safety of performing cystoscopic-laparoscopic partial cystectomy for the removal of a partially implanted intravesical foreign body. The patient recovered without incident and was discharged 7 days after surgery. No abnormalities were noted in the urine output or renal function in the postoperative follow-up period. No complications due to retrograde flow of carbon dioxide up the ureters or air embolism were noted during the procedure or postoperatively. The combination of laparoscopy and air cystoscopy has been shown to be an optimal method for retracting foreign bodies embedded in the bladder wall. Also, air cystoscopy can be used to give doctors a better view in cases in which vision is compromised under water-contrast cystoscopy.
Issa, N; Fenig, Y; Yasin, M; Schmilovitz-Weiss, H; Khoury, W; Powsner, E
Peritoneal entry (PE) during transanal endoscopic microsurgery (TEM) for tumors of the upper rectum is not an uncommon complication. The suture line of the rectal defect performed for PE is not devoid of leaks. Diagnostic laparoscopy after PE enables visualization and testing of the suture line. Here, we report the outcome of patients undergoing laparoscopy for PE following TEM. Data pertaining to patients undergoing laparoscopy for PE following TEM between 2004 and 2013 were retrospectively collected. One hundred and forty-one TEM procedures were performed, and 19 (13 %) with PE were included. The mean age was 68.1 ± 10.6 years, mean distance from the anal verge 12.5 ± 2 cm, and mean tumor size 2 cm. Lesions were located in the lateral wall (n = 14), anteriorly (n = 4), and posteriorly (n = 1). Indications for TEM were: adenoma (n = 13), indeterminate margins after polypectomy (n = 4, a submucosal lesion (n = 1), and a T1N0 adenocarcinoma (n = 1). In all patients, the rectal wall defect was closed primarily. Twelve patients underwent additional laparoscopy and suture line leak testing. In one patient, a small leak was detected which was repaired laparoscopically. In another, a hematoma of the suture line was observed and a drain was left in place. The mean operative time was 109 min (range 80-135 min) for TEM and 33 min (range 22-45 min) for laparoscopy. A diverting ileostomy was fashioned in one patient on postoperative day 3 after TEM without laparoscopy. No other major complications were observed. Laparoscopy after PE during TEM permits visualization and testing of the suture line. It is not associated with increased morbidity, and it may increase the safety of TEM.
Jokela, Tero; Lucero, Andrés
Affinity Diagramming is a technique to organize and make sense of qualitative data. It is commonly used in Contextual Design and HCI research. However, preparing notes for and building an Affinity Diagram remains a laborious process, with a wide variety of different approaches and practices....... In this paper, we present MixedNotes, a novel technique to prepare physical paper notes for Affinity Diagramming, and a software tool to support this technique. The technique has been tested with large real-life Affinity Diagrams with overall positive results....
Dove, Graham; Abildgaard, Sille Julie Jøhnk; Biskjær, Michael Mose
The Post-ItTM note is a frequently used, and yet seldom studied, design material. We investigate the functions Post-ItTM notes serve when providing cognitive support for creative design team practice. Our investigation considers the ways in which Post-ItTM notes function as design externalisations......, both individually and when grouped, and their role in categorisation in semantic long-term memory. To do this, we adopt a multimodal analytical approach focusing on interaction between humans, and between humans and artefacts, alongside language. We discuss in detail examples of four different...
Bolcar, Matthew R.; Shaklan, Stuart; Roberge, Aki; Rioux, Norman; Feinberg, Lee; Werner, Michael; Rauscher, Bernard; Mandell, Avi; France, Kevin; Schiminovich, David
We present nine "tech notes" prepared by the Large UV/Optical/Infrared (LUVOIR) Science and Technology Definition Team (STDT), Study Office, and Technology Working Group. These tech notes are intended to highlight technical challenges that represent boundaries in the trade space for developing the LUVOIR architecture that may impact the science objectives being developed by the STDT. These tech notes are intended to be high-level discussions of the technical challenges and will serve as starting points for more in-depth analysis as the LUVOIR study progresses.
Bansler, Jørgen; Havn, Erling C.; Mønsted, Troels
This paper examines physicians’ progress notes, an artifact that, in spite of its obvious importance in the coordination of cooperative work in clinical settings, has not been subjected to systematic study under CSCW auspices. While several studies have addressed the role of the medical record...... in patient care, they have not dealt specifically with the role, structure, and content of the progress notes. As a consequence, CSCW research has not yet taken fully into account the fact that progress notes are coordinative artifacts of a rather special kind, an open-ended chain of prose texts, written...... sequentially by cooperating physicians for their own use as well as for that of their colleagues. We argue that progress notes are the core of the medical record, in that they marshal and summarize the overwhelming amount of data that is available in the modern hospital environment, and that their narrative...
NOTES ON CONTRIBUTORS. Samuel AMOAKO, Associate Researcher, South African Research Unit in Social Change. Contact Details: C/o Lucinda Bercony, Humanities Research Village (House No. 3). University of Johannesburg, P. O. Box 524. Bunting Road Campus, Auckland Park, 2006.
Robertson, Scott P.; Vatrapu, Ravi; Abraham, George
Participants were observed while searching and browsing the internet for campaign information in a mock-voting situation in three online note-taking conditions: No Notes, Private Notes, and Shared Notes. Note taking significantly influenced the manner in which participants browsed for information...... about candidates. Note taking competed for time and cognitive resources and resulted in less thorough browsing. Effects were strongest when participants thought that their notes would be seen by others. Think-aloud comments indicated that participants were more evaluative when taking notes, especially...... shared notes. Our results suggest that there could be design trade-offs between eDemocracy and e-Participation technologies....
Lindenbaum, Samuel D
This book comprises a set of lecture notes on rational mechanics, for part of the graduate physics curriculum, delivered by the late Prof. Shirley L. Quimby during his tenure at Columbia University, New York. The notes contain proofs of basic theorems, derivations of formulae and amplification of observations, as well as the presentation and solution of illustrative problems. Collateral readings from more than 50 source references are indicated at appropriate places in the text.
Luiz Roberto Lopes
Full Text Available INTRODUCTION: Dysphagia is the important symptom in achalasia, and surgery is the most common treatment. The Heller-Pinotti technique is the method preferred by Brazilian surgeons. For many years, this technique was performed by laparotomy, and now the laparoscopic method has been introduced. The objective was to evaluate the immediate and long-term results of patients submitted to surgery by either laparotomy or laparoscopy. MATERIALS AND METHODS: A total of 67 patients submitted to surgery between 1994 and 2001 with at least 5 years of follow-up were evaluated retrospectively and divided into two groups: laparotomy (41 patients and laparoscopy (26 patients. Chagas was the etiology in 76.12% of cases. Dysphagia was evaluated according to the classification defined by Saeed et al. RESULTS: There were no cases of conversion to open surgery. The mean duration of hospitalization was 3.32 days for laparotomy and 2.54 days for laparoscopy (p<0.05. An improvement in dysphagia occurred with both groups reporting good or excellent results (laparotomy: 73.17% and laparoscopy: 73.08%. Mean duration of follow-up was 8 years. CONCLUSIONS: There was no difference between the two groups with respect to relief from dysphagia, thereby confirming the safety and effectiveness of the Heller-Pinotti technique, which can be performed by laparotomy or laparoscopy, depending on the surgeon's experience.
Ogiso, Satoshi; Nomi, Takeo; Araki, Kenichiro; Conrad, Claudius; Hatano, Etsuro; Uemoto, Shinji; Fuks, David; Gayet, Brice
Despite diffusion of laparoscopic hepatectomy, the acquisition of necessary skills is not easy for open liver surgeons. Concepts and techniques have totally changed in laparoscopic hepatectomy compared with open hepatectomy, which is an underlying cause of a technical hurdle in laparoscopic hepatectomy. This study aimed to illustrate laparoscopy-specific concepts and techniques for hepatectomy. Video footages of laparoscopic and open hepatectomies stored in the Institut Mutualiste Montsouris and Kyoto University were reviewed to define the differences in surgical view, surgical concept, and technical details, using left lateral sectionectomy (LLS) and right hepatectomy (RH) as representative examples. By comparison with open LLS and RH, laparoscopy-specific procedures were identified with regard to surgical view, parenchymal transection, available landmarks, and vascular dissection. By laparoscopy, the surgical field was constantly viewed and accessed from the caudal side to the cranial side. Similarly, the parenchyma was divided, and intrahepatic vessels were dissected in the same direction. Laparoscopy-specific landmarks were identified for both LLS and RH, behind the liver. The concepts and techniques in laparoscopic hepatectomy are totally different from those of open hepatectomy because of the different surgical views. Understanding the laparoscopy-specific concepts and techniques would facilitate safe and efficient execution of laparoscopic hepatectomy.
Cao, Hop S Tran; Kaushal, Sharmeela; Metildi, Cristina A; Menen, Rhiana S; Lee, Claudia; Snyder, Cynthia S; Messer, Karen; Pu, Minya; Luiken, George A; Talamini, Mark A; Hoffman, Robert M; Bouvet, Michael
Background/Aims Laparoscopy is important in staging pancreatic cancer, but false negatives remain problematic. Making tumors fluorescent has the potential to improve the accuracy of staging laparoscopy. Methodology Orthotopic and carcinomatosis models of pancreatic cancer were established with BxPC-3 human pancreatic cancer cells in nude mice. Alexa488-anti-CEA conjugates were injected via tail vein 24 hours prior to laparoscopy. Mice were examined under bright field laparoscopic (BL) and fluorescence laparoscopic (FL) modes. Outcomes measured included time to identification of primary tumor for the orthotopic model and number of metastases identified within 2 minutes for the carcinomatosis model. Results FL enabled more rapid and accurate identification and localization of primary tumors and metastases than BL. Using BL took statistically significantly longer time than FL. More metastatic lesions were detected and localized under FL compared to BL and with greater accuracy, with sensitivities of 96% vs. 40%, respectively, when compared to control. FL was sensitive enough to detect metastatic lesions laparoscopy with tumors labeled with fluorophore-conjugated anti-CEA antibody permits rapid detection and accurate localization of primary and metastatic pancreatic cancer in an orthotopic model. The results of the present report demonstrate the future clinical potential of fluorescence laparoscopy. PMID:22369743
Yücel, Metin; Özpek, Adnan; Tolan, Hüseyin Kerem; Başak, Fatih; Baş, Gürhan; Ünal, Ethem; Alimoğlu, Orhan
Stab wounds in the left thoracoabdominal region may cause diaphragmatic injury. The aim of the present study was to determine incidence of diaphragmatic injury and role of diagnostic laparoscopy in detection of injury in patients with left thoracoabdominal stab wound. Total of 81 patients (75 male, 6 female; mean age 27.5±9.8 years; range 14 to 60 years) who presented with left thoracoabdominal stab wound between April 2009 and September 2014 were evaluated. Laparotomy was performed on patients who had hemodynamic instability, signs of peritonitis, or organ evisceration. Remaining patients were followed conservatively. After 48 hours, diagnostic laparoscopy was performed on patients without laparotomy indication to examine the left diaphragm for injury. Follow-up and treatment findings were prospectively evaluated. Thirteen patients underwent laparotomy while diagnostic laparoscopy was performed on remaining 68 patients. Left diaphragmatic injury was observed in 19 patients (23.5%) in the study group. Four injuries were diagnosed by laparotomy and 15 were diagnosed by laparoscopy. Presence of hemopneumothorax did not yield difference in incidence of diaphragmatic injury (p=0.131). No significant difference was detected in terms of diaphragmatic injury with respect to entry site of stab wound in the thoracoabdominal region (p=0.929). It is important to evaluate the diaphragm in left thoracoabdominal stab injuries, and diagnostic laparoscopy is still the safest and most feasible method.
Tandon, A; Rajendran, I; Aziz, M; Kolamunnage-Dona, R; Nunes, Q M; Shrotri, M
BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.
Redondo, C; Esquinas, C; Meilán, E; García-Tello, A; Arance, I; Angulo, J C
To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. Hybrid LESS technique with auxiliary 3.5mm trocar (n=20) was compared with conventional multiport laparoscopy (n=26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. Follow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P=0.09) and benign histology (P=0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P=0.006) and hospital stay (P=0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
Marano, Alessandra; Giuffrida, Maria Carmela; Giraudo, Giorgio; Pellegrino, Luca; Borghi, Felice
Although laparoscopy is becoming the standard of care for the treatment of colorectal disease, its application in case of postoperative peritonitis is still not widespread. The objective of this article is to evaluate the role of laparoscopy in the management of postoperative peritonitis after elective minimally invasive colorectal resection for malignant and benign diseases. Between April 2010 and May 2016, 536 patients received primary minimally invasive colorectal surgery at our Department. Among this series, we carried out a retrospective study of those patients who, having developed signs of peritonitis, were treated with a laparoscopic reintervention. Patient demographics, type of complication and of the main relaparoscopic treatment, and main outcomes of reoperation were recorded. A total of 20 patients (3.7%) underwent relaparoscopy for the management of postoperative peritonitis, of which exact causes were detected by laparoscopy in 75% as follows: anastomotic leakage (n = 8, 40%), colonic ischemia (n = 2, 10%), iatrogenic bowel tear (n = 4, 20%), and other (n = 1, 5%). The median time between operations was 3.5 days (range, 2-8). The laparoscopic reintervention was tailored case by case and ranged from lavage and drainage to redo anastomosis with ostomy fashioning. Conversion rate was 10% and overall morbidity was 50%. No cases required additional surgery and 30-day mortality was nil. Three patients (15%) were admitted to intensive care unit for 24-hour surveillance. Our experience suggests that in experienced hands and in hemodynamically stable patients, a prompt laparoscopic reoperation appears as an accurate diagnostic tool and an effective and safe option for the treatment of postoperative peritonitis after primary colorectal minimally invasive surgery.
O'Riordain, M G
Over the last number of years, the emphasis in abdominal surgery has been to reduce invasiveness and to minimise trauma to the patient. This has led to the rapid development of laparoscopic techniques initially for the surgical management of benign disease and later for the successful management of malignant disease. Laparoscopy has now been shown to provide significant benefits to the cancer patient, in particular the reduction of wound infection, herniation and pain. More recently, benefits have been demonstrated in earlier discharge from hospital and return to normal activity. Laparoscopy has therefore been accepted as at least a valid alternative to open surgery for most types of abdominal cancer. With the objective of reducing invasiveness even more, the last few years has seen a rapid expansion in the development of Natural Orifice Translumenal Endoscopic Surgery (NOTES). Currently, NOTES is still in the early stages of evolution but its potential uses in the field of cancer surgery are already being proposed. To develop NOTES to the stage that it will be safe, effective and widely available for the management of cancer patients represents a huge challenge ranging from the development of equipment and techniques to the demonstration of safety and efficacy in clinical trials as well as training and competence issues. It is still not clear whether these challenges will be surmounted so that NOTES becomes mainstream therapy. A period of \\'watchful waiting\\' seems appropriate therefore for the uncommitted general surgeon in order that NOTES may be given time to prove compelling and convincing before its general uptake into routine practice.
Dai, L N; Chen, C D; Lin, X K; Wang, Y B; Xia, L G; Liu, P; Chen, X M; Li, Z R
Hydronephrosis is a common disease in children and may be caused by ureteral fibroepithelial polyps (UFP). Ureteral fibroepithelial polyps are rare in children and are difficult to precisely diagnose before surgery. Surgical treatment for symptomatic UFP is recommended. At the present institution, retroperitoneal laparoscopy has been used to treat five boys with UFP since 2006. To highlight the significance of UFP as an etiological factor of hydronephrosis in children and evaluate the applicative value of retroperitoneal laparoscopy in the treatment of children with UFP. Between 2006 and 2013 five boys underwent retroperitoneal laparoscopy at the present institution. They were identified with UFP by review of the clinical database. Detailed data were collected, including: radiographic studies, gross anatomical pathology, and pathology and radiology reports. All boys had been followed up at least every 6 months. All of the boys were aged between 7 and 16 years (mean 9.8 years). The main symptoms were flank pain (all five) and hematuria (three). Radiographic examination showed that all of the boys presented with incomplete ureteral obstruction and hydronephrosis. The ureteral fibroepithelial polyps were located near the left UPJ or the left proximal ureter. All of the boys had the UFP removed: three underwent retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty and polypectomy, and two had retroperitoneal laparoscopic ureteral anastomosis. These polyps were all on the left side and between 15 and 35 mm in length (mean 22 mm) (Figure). All of the boys recovered well and were discharged from hospital. The postoperative histological report confirmed that the specimens were UFP. Hydronephrosis was periodically assessed by ultrasonography (using the same method as pre-surgical ultrasonography) after surgery. Mean follow-up was 33 months (range 6-58 months) and no complications were found afterwards. Ureteral fibroepithelial polyps are rare but rather
Abou-Haidar, Hiba; Al-Qaoud, Talal; Jednak, Roman; Brzezinski, Alex; El-Sherbiny, Mohamed; Capolicchio, John-Paul
Laparoscopic reconstructive surgery is associated with a steep learning curve related to the use of two-dimensional (2D) vision and rigid instruments. With the advent of robotic surgery, three-dimensional (3D) vision, and articulated instruments, this learning curve has been facilitated. We present a hybrid alternative to robotic surgery, using laparoscopy with 3D vision and articulated shears. To compare outcomes of children undergoing pyeloplasty using 3D laparoscopy with articulated instruments with those undergoing the same surgery using standard laparoscopy with 2D vision and rigid instruments. Medical charts of 33 consecutive patients with ureteropelvic junction obstruction who underwent laparoscopic pyeloplasty by a single surgeon from 2006 to 2013 were reviewed in a retrospective manner. The current 3D cohort was compared with the previous 2D cohort. Data on age, weight, gender, side, operative time, dimension (2D = 19 patients, 3D = 8 patients), presence of a crossing vessel, length of hospital stay, and complication rate were compared between the two groups. Articulating shears were used for pelvotomy and spatulation of the ureter in the 3D group. Statistical tests included linear regression models and chi square tests for trends using STATA software. Operative time per case was decreased by an average of 48 min in the group undergoing 3D laparoscopic pyeloplasty compared with the group undergoing 2D laparoscopic pyeloplasty (p = 0.02) (Figure). Complication rate and length of hospital stay were not significantly affected by the use of 3D laparoscopy. These favorable results are in accordance with previous literature emphasizing the importance of 3D vision in faster and more precise execution of complex surgical maneuvers. The use of flexible instruments has also helped overcome the well-described delicate step of a dismembered pyeloplasty, namely the pelvotomy and ureteral spatulation. Limitations of this study are those inherent to the
Houston, James; Jalil, Rozh; Isla, Alberto
Diaphragmatic rupture is a serious but frequently missed condition that is potentially curable. While surgical management has classically been performed through open thoracotomy, a laparoscopic approach has been suggested as a preferable alternative. A man in his mid-50s presented with non-specific abdominal symptoms, 8 months after falling down some stairs. Diaphragmatic rupture was suspected after old rib fractures were noticed on an admitting chest radiograph. Further signs and symptoms presented following deterioration due to the unstable pathology. Prompt surgical treatment using laparoscopy was attempted with success and resulted in rapid and lasting improvement in symptoms.
Full Text Available Hufei Zhang,1,* Xinhe Liu,2,* Hongye Jiang,3 Zimeng Liu,4 Xu-Yu Zhang,1 Hong-Zhe Xie,3 1Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 2Department of Anesthesiology, Shenzhen Hospital, University of Hong Kong, Shenzhen, 3Department of Obstetrics and Gynecology, 4Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China *These authors contributed equally to this work Objectives: Postlaparoscopic shoulder pain (PLSP remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT.Materials and methods: The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus and forearm (flexor carpi ulnaris. Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. Results: Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01. Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07–0.382; P<0
Mirza, A; Galloway, S
The staging laparoscopy has been used in the management of gastrointestinal cancers. The aim of this study was to evaluate the role of staging laparoscopy, in comparison with computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in staging patients with gastro-oesophageal junction (GOJ) and gastric cancers. The data were collected for patients between 1996 and 2013 undergoing investigation and treatment for GOJ and gastric cancers at a single institute. The pre-operative data (staging data), intraoperative details, post-operative course and follow-up were analysed for individual cases. Staging laparoscopy altered management plan in 64 (17 %) of 387 patients with negative staging CT and FDG-PET scan. Twenty-seven (7 %) patients with GOJ cancer (types I, II and III) were identified with pathological intraperitoneal nodes, 15 (4 %) gastric cancer with metastatic intraperitoneal deposits and liver metastases and 3 % gastric cancers with positive ascitic fluid for cancer cells. Ten (3 %) of patients were downstaged and were offered curative resection. Patients with metastatic disease were referred for palliative chemotherapy. The overall sensitivity of staging laparoscopy in diagnosing intraabdominal pathology was 86 % in comparison with CT (81 %) and FDG-PET (78 %). The diagnostic laparoscopy is useful for detecting and confirming nodal involvement and distant metastatic disease not evident on the staging CT scan and FDG-PET. This could potentially alter treatment and prognosis in patients with upper gastrointestinal cancer. The diagnostic laparoscopy should be performed as part of investigation and treatment planning for patients suffering from GOJ and gastric cancers. This can help to avoid surgery in patients with advanced disease.
Akhtar, Kash; Sugand, Kapil; Wijendra, Asanka; Sarvesvaran, Muthuswamy; Sperrin, Matthew; Standfield, Nigel; Cobb, Justin; Gupte, Chinmay
The primary objective was observing transferability of minimally invasive surgical skills between virtual reality simulators for laparoscopy and arthroscopy. Secondary objectives were to assess face validity and acceptability. Prospective single-blinded crossover randomized controlled trial. MSk Laboratory, Imperial College London. Student doctors naïve to simulation and minimally invasive techniques. A total of 72 medical students were randomized into 4 groups (2 control groups and 2 training groups), and tested on haptic virtual reality simulators. Group 1 (control; n = 16) performed a partial laparoscopic cholecystectomy and Group 2 (control; n = 16) performed a diagnostic knee arthroscopy. Both groups then repeated the same task a week later. Group 3 (training; n = 20) completed a partial laparoscopic cholecystectomy, followed by an arthroscopic training program, and repeated the laparoscopic cholecystectomy a week later. Group 4 (training; n = 20) performed a diagnostic knee arthroscopy, followed by a laparoscopic training program, and then repeated the initial arthroscopic test a week later. The time taken, instrument path length, and speed were recorded for each participant and analyzed. Time taken for task: All 4 cohorts were significantly quicker on their second attempt but the 2 training groups outperformed the 2 control groups, with the laparoscopy-trained group improving the most (p laparoscopy-trained group improving the most (p laparoscopy-trained group improving the most (p laparoscopy simulator are transferable to arthroscopy and vice versa, with greater effect after training on the laparoscopy simulator. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Redondo, Antonio [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)
These notes provide a pedagogical discussion of the physics of piezoelectricity. The exposition starts with a brief analysis of the classical (continuum) theory of piezoelectric phenomena in solids. The main subject of the notes is, however, a quantum mechanical analysis. We first derive the Frohlich Hamiltonian as part of the description of the electron-phonon interaction. The results of this analysis are then employed to derive the equations of piezoelectricity. A couple of examples with the zinc blende and and wurtzite structures are presented at the end
List, Markus; Franz, Michael; Tan, Qihua
be advantageous if an ELN was Integrated with a laboratory information management system to allow for a comprehensive documentation of experimental work including the location of samples that were used in a particular experiment. Here, we present OpenLabNotes, which adds state-of-the-art ELN capabilities to Open......LabFramework, a powerful and flexible laboratory information management system. In contrast to comparable solutions, it allows to protect the intellectual property of its users by offering data protection with digital signatures. OpenLabNotes effectively Closes the gap between research documentation and sample management...
Spruit, Edward N; Kleijweg, Luca; Band, Guido P H; Hamming, Jaap F
Determining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. Twenty-four trainees (control group) without prior experience received a 3 weeks laparoscopic skills training utilizing four basic and one advanced training task. Twenty-eight trainees (experimental group) received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a 2 months retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity, and trainee characteristics are discussed.
Gala, Rajiv B; Margulies, Rebecca; Steinberg, Adam; Murphy, Miles; Lukban, James; Jeppson, Peter; Aschkenazi, Sarit; Olivera, Cedric; South, Mary; Lowenstein, Lior; Schaffer, Joseph; Balk, Ethan M; Sung, Vivian
The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.
Hao, Zhang; Zhenya, Shen; Lei, Wang
To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Experimental study. Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed.
Hao, Z.; Lei, W.; Zhenya, S.
Objective: To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Study Design: Experimental study. Place and Duration of Study: Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Methodology: Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. Results: The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. Conclusion: The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed. (author)
Fu, Kuang I; Hamahata, Yukihiro; Tsujinaka, Yasunobu
We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum. Endoscopic mucosal resection (EMR) was carried out successfully and completely with the assistance of laparoscopy. A 71-year-old man was admitted to our hospital because of melena and anemia. Emergent colonoscopy showed diverticulosis in the right-sided colon. However, endoscopy could not exactly detect the bleeding site. A flat elevated polyp was found within a single diverticulum located in the descending colon and diagnosed as an intramucosal carcinoma, as magnifying chromoendoscopy revealed a type IV pit pattern. As his diverticular bleeding repeated, a right-sided hemicolectomy was decided for treatment, the polyp within the diverticulum was also completely removed by EMR with the assistance of laparoscopy. Although a colonic perforation was detected immediately after EMR, the perforation was closed with endoclips intraluminally and also repaired laparoscopically from the serosal side. Histologically, the resected lesion was an intramucosal well-differentiated adenocarcinoma and the surgical margin was free of tumor. PMID:20333800
Ghesquière, L; Garabedian, C; Boukerrou, M; Dennis, T; Garbin, O; Hery, R; Rubod, C; Cosson, M
The objective of this study was to evaluate laparoscopy training using pelvitrainers for gynaecological surgeons in a low-income country. The study was carried out in Madagascar from April 2016 to January 2017. The participants were gynaecological surgeons who had not previously performed laparoscopy. Each surgeon was timed to evaluate the execution times of four proposed exercises, based on the fundamentals of laparoscopic surgery (FLS) programme's skills manual, as follows: exercise 1, involving a simple object transfer; exercises 2 and 3, comprising complex object transfers; and exercise 4, a precision cutting exercise. The 8-month training and evaluation programme was divided into different stages, and the four following evaluations were compared: a pretest (T0), assessment at the end of the first training (T1) and auto-evaluation at 2 months (T2) and 8 months (T3). Eight participants were included. The median time was significantly reduced (Pincome countries before providing the necessary equipment. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
Guterman, S; Mandelbrot, L; Keita, H; Bretagnol, F; Calabrese, D; Msika, S
To assess complications and outcomes of pregnancies following laparoscopic abdominal surgery during the second and third trimesters of pregnancy. Retrospective single-center study of 23 cases of laparoscopic surgery in the second or third trimesters of pregnancy between January 2005 and May 2016. The laparoscopies were performed between 15 and 33 weeks of gestation, a mean of 23 weeks+2 days, with 6 cases in the 3rd trimester. The operations were: 11 cholecystectomies, 6 appendectomies, 1 intestinal occlusion (volvulus on a gastric band), 3 adnexal torsions, 1 ovarian cyst and 1 paratubal cyst with torsion. No secondary laparotomy was required. The postoperative courses were favorable in most cases. However, 3 appendectomies were complicated, one by chorioamnionitis and miscarriage at 20½ weeks of gestation and 2 by right iliac fossa abscesses requiring percutaneous radiological drainage, one of these women delivered a healthy term baby and the other had chorioamnionitis and preterm delivery at 34 weeks, followed by neonatal death. Laparoscopy can be safely performed for surgical indications in the second and third trimesters of pregnancy. In case of abdominal symptoms, a timely diagnosis is required to decide whether or not to operate and imaging should not be withheld particularly in case of suspected appendicitis which has a high risk of complications. Copyright © 2017. Published by Elsevier Masson SAS.
Berto, Patrizia; Lopatriello, Stefania; Aiello, Andrea; Corcione, Francesco; Spinoglio, Giuseppe; Trapani, Vincenzo; Melotti, Gianluigi
The comparative costs of laparoscopy and laparotomy in surgical resection of colorectal cancer, especially of the hospital provider, have not yet been assessed in the perspective of the Italian National Healthcare System. This paper aims to fill this gap by providing economic information on this research topic of growing relevance at a time of reduced healthcare budgets. Three Italian reference centres retrospectively provided from their databases data on 90 cases of laparotomy (OP) or laparoscopy (LAP) interventions for right colon (RCol), left colon/sigma (LCol) and rectum (Rec). Costs were retrieved according to phases of the in-hospital procedure: pre-operative, operative and post-operative phase, including diagnostic work-up, hospital length of stay, duration of intervention, theatre occupation time, type of anaesthesia, medical devices and drugs used and staff time throughout the management process from hospital admission to discharge. The cost estimation was carried out using a microcosting, bottom-up technique, and statistical analysis was carried out using appropriate techniques. The average cost of colorectal surgery was euro 10,539/patient (median euro 10,396) with rectum procedures being statistically more costly than colon procedures (mean Rec euro 12,562/patient versus LCol euro 9,054 and RCol euro 10,002; median euro 11,704 versus euro 8,941 and euro 9,513, respectively; p surgery is a costly procedure, and in-patient DRG tariffs are currently insufficient to cover the cost of its management for Italian hospital providers.
Full Text Available Erica Schipper,1 Camran Nezhat21Center for Minimally Invasive and Robotic Surgery, Palo Alto, CA; 2Obstetrics/Gynecology and Surgery, Stanford University Medical Center, Palo Alto, CA, USAAbstract: Endometriosis is a highly enigmatic disease with multiple presentations ranging from infertility to severe pain, often causing significant morbidity. Video-assisted laparoscopy (VALS has now replaced laparotomy as the gold standard for the diagnosis and management of endometriosis. While imaging has a role in the evaluation of some patients, histologic examination is needed for a definitive diagnosis. Laboratory evaluation currently has a minor role in the diagnosis of endometriosis, although studies are underway investigating serum markers, genetic studies, and endometrial sampling. A high index of suspicion is essential to accurately diagnose this complex condition, and a multidisciplinary approach is often indicated. The following review discusses laparoscopic diagnosis of endometriosis from the pre-operative evaluation of patients suspected of having endometriosis to surgical technique for safe and adequate laparoscopic diagnosis of the condition and postsurgical care.Keywords: endometriosis, video-assisted, laparoscopy, diagnosis
Siraj, A.; Naseer, S.; Khan, S.
Objective: To determine the frequency of various causes of infertility through diagnostic laparoscopy. Study Design: Cross sectional comparative study. Place and Duration of Study: The study was conducted in gynaecology/obstetrics department unit I of Military Hospital Rawalpindi from May 2011 - May 2012. Patients and Methods: A total of 50 patients were recruited in the study through outpatient clinic, 32 out of 50 had primary infertility and 18 had secondary infertility. Diagnostic laparoscopy was performed under general anesthesia and findings were recorded. Result: The mean age of patients was 26.4 years. Out of 50 patients 20 (40%) had polycystic ovaries, 15 (30%) had tubal blockage, 7 (14%) had endometriosis and 2 (4%) had fibroids while 6(12%) were found to have normal pelvis and no pathology was detected. Conclusion: polycystic ovaries was found major cause of infertility in this study group, followed by tubal factor infertility either secondary to pelvic inflammatory disease or otherwise, both these causes are treatable to variable extent and fertility can be resumed if managed properly. (author)
Jayakrishnan, Thejus T; Nadeem, Hasan; Groeschl, Ryan T; George, Ben; Thomas, James P; Ritch, Paul S; Christians, Kathleen K; Tsai, Susan; Evans, Douglas B; Pappas, Sam G; Gamblin, T Clark; Turaga, Kiran K
Objectives Laparoscopy is recommended to detect radiographically occult metastases in patients with pancreatic cancer before curative resection. This study was conducted to test the hypothesis that diagnostic laparoscopy (DL) is cost-effective in patients undergoing curative resection with or without neoadjuvant therapy (NAT). Methods Decision tree modelling compared routine DL with exploratory laparotomy (ExLap) at the time of curative resection in resectable cancer treated with surgery first, (SF) and borderline resectable cancer treated with NAT. Costs (US$) from the payer's perspective, quality-adjusted life months (QALMs) and incremental cost-effectiveness ratios (ICERs) were calculated. Base case estimates and multi-way sensitivity analyses were performed. Willingness to pay (WtP) was US$4166/QALM (or US$50 000/quality-adjusted life year). Results Base case costs were US$34 921 for ExLap and US$33 442 for DL in SF patients, and US$39 633 for ExLap and US$39 713 for DL in NAT patients. Routine DL is the dominant (preferred) strategy in both treatment types: it allows for cost reductions of US$10 695/QALM in SF and US$4158/QALM in NAT patients. Conclusions The present analysis supports the cost-effectiveness of routine DL before curative resection in pancreatic cancer patients treated with either SF or NAT. PMID:25123702
Nishizawa, Shuji; Nukui, Akinori; Koshimizu, Takeshi [Jichi Medical School, Minamikawachi, Tochigi (Japan)] (and others)
Preoperative localization of nonpalpable testes will aid in planning of the surgical management. We evaluate the efficacy of magnetic resonance imaging (MRI) as the preoperative study in the management of the nonpalpable testis in the laparoscopic era. From 1997 to 2001, a total of 30 MRI evaluation was performed for 30 patients with nonpalpable testis. When the imaging study demonstrated a viable testis in the inguinal region, the patient underwent inguinal orchiopexy. Diagnostic laparoscopy was performed for the patient whose testis was intraabdominal or could not be detected by imaging. Thirty-one testes from 30 patients were evaluated. The imaging studies showed 16 testes from 15 patients in the inguinal region. Fifteen testes were found in the inguinal region and one was intraabdominal during groin exploration. Four testes were pointed out to be intraabdominal by MRI and identified by laparoscopic examination. Eleven testes could not be detected by the imaging studies and they underwent laparoscopic examination. Two abdominal testes were identified. Nine patients underwent inguinal surgical exploration and had a diagnosis of inguinal vanishing testis. No gonadal tissue was identified in those specimens. The sensitivity and the specificity of our MRI studies in predicting the presence of nonpalpable testis were 90.5% and 100%, respectively. Inguinal undescended testes could be diagnosed accurately with MRI and laparoscopy was informative regarding the testis location in all cases. When no intraabdominal testis is identified laparoscopically in the patient whose testis can not be detected in the inguinal region by MRI, the testis is likely vanished. (author)
Kwon, Steve; Billingham, Richard; Farrokhi, Ellen; Florence, Michael; Herzig, Daniel; Horvath, Karen; Rogers, Terry; Steele, Scott; Symons, Rebecca; Thirlby, Richard; Whiteford, Mark; Flum, David
Background The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. Study Design The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement (QI) benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a composite of adverse events (CAE; death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from 4th quarter of 2005 through 4th quarter of 2010. Results Of the 9,705 patients undergoing elective colorectal surgeries (mean age 60.6 ± 15.6 (SD) yrs; 55.2% women), 38.0% were performed laparoscopically (17.8% laparoscopic procedures converted to open). The use of laparoscopic procedures increased from 23.3% in 2005 quarter 4 to 41.6% in 2010 quarter 4 (trend over study period, plaparoscopy. Within those hospitals that had been in SCOAP since 2006, hospitals where laparoscopy was most commonly used also had a significant increase in the volume of all types of colon surgery (202 cases per hospital in 2010 from 112 cases per hospital in 2006, 80.4% increase), and in particular the number of resections for non-cancer diagnoses and right sided pathology. Conclusions The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery. PMID:22533998
Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Zacharz, Krzysztof
An important yet difficult problem is qualification for surgery in elderly patients. With age the risk of comorbidities increases - multi-disease syndrome. Elderly patients suffer from frailty syndrome. Many body functions become impaired. All these factors make the elderly patient a major challenge for surgical treatment. Analysis of the possibility of developing the indications and contraindications and the criteria for surgical treatment of the elderly based on our own cases. Discussion whether there is a place for laparoscopy during surgery of the elderly in emergency room (ER) mode. The analysis was performed based on seven cases involving surgical treatment of elderly patients who were admitted to the hospital in emergency room mode. The patients were hospitalized in the General and Minimally Invasive Surgery Clinic in Olsztyn in 2016. Surgical treatment of elderly patients should be planned with multidisciplinary teams. Geriatric surgery centers should be developed to minimize the risk of overzealous treatment and potential complications. Laparoscopy should always be considered in the case of ER procedures or diagnostics. Elderly patients should not be treated as typical adults, but as a separate group of patients requiring special treatment. Due to the existing additional disease in the elderly, the frailty syndrome, any surgical intervention should be minimally invasive. The discussion about therapy should be conducted by a team of specialists from a variety of medical fields.
Edward N. eSpruit
Full Text Available AbstractDetermining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. 24 trainees (control group without prior experience received a three week laparoscopic skills training utilizing four basic and one advanced training task. 28 trainees (experimental group received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a two month retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity and trainee characteristics are discussed.
Khan, Zohaib Amjad; Kamal, Nabeel; Hameed, Asad; Mahmood, Amama; Zainab, Rida; Sadia, Bushra; Mansoor, Shamyl Bin; Hasan, Osman
Virtual reality (VR) training simulators have started playing a vital role in enhancing surgical skills, such as hand-eye coordination in laparoscopy, and practicing surgical scenarios that cannot be easily created using physical models. We describe a new VR simulator for basic training in laparoscopy, i.e. SmartSIM, which has been developed using a generic open-source physics engine called the simulation open framework architecture (SOFA). This paper describes the systems perspective of SmartSIM including design details of both hardware and software components, while highlighting the critical design decisions. Some of the distinguishing features of SmartSIM include: (i) an easy-to-fabricate custom-built hardware interface; (ii) use of a generic physics engine to facilitate wider accessibility of our work and flexibility in terms of using various graphical modelling algorithms and their implementations; and (iii) an intelligent and smart evaluation mechanism that facilitates unsupervised and independent learning. Copyright © 2016 John Wiley & Sons, Ltd.
Kneale, Pauline E.
Addresses geography students' questions about why, when, and how to take notes. Outlines a step-by-step process for taking notes from written sources and from class lectures. Discusses what types of notes are appropriate for various types of sources. Suggests some ideas for making notes useful for individual learning styles. (DSK)
... a laparoscope. Most patients feel a short-lived “bee sting” that lasts a second or two. Small ... procedure was performed. You should have nothing to eat or drink for a set time period before ...
Mansard, Magnus Jayaraj; Reddy, D Nageshwar; Rao, G Venkat
A few years ago a new approach to performing abdominal surgery was presented, i.e. via the natural body orifices using endoscopes. The interest and research in this approach progressed very rapidly, in spite of the initial skepticism. It was initially demonstrated in animal models, then in human beings and has now very nearly become routine practice. This article reviews the development of natural orifice transluminal endoscopic surgery (NOTES), its benefits and the hurdles we have yet to overcome.
Full Text Available Objective To explore the feasibility, safety and efficacy of laparoscopy assisted ultrasound guided radiofrequency ablation (RFA in the treatment of hepatocellular carcinoma (HCC beneath the diaphragm. Methods Twenty- three consecutive patients with solitary HCC beneath the diaphragm were treated by laparoscopy assisted ultrasound guided RFA in the Chinese PLA General Hospital from January 2013 to March 2016. We observed the perioperative complications and followed- up long-term effect. Results All the 23 patients successfully underwent laparoscopy assisted ultrasound guided radiofrequency ablation. No serious complications such as massive hemorrhage, biliary fistula and severe pleural effusion, hemopneumothorax occurred in the patients during perioperative period. CT examination 2-3 days after the operation revealed that the tumor was completely covered by the ablation area. Besides, the survival condition was satisfactory during follow-up period of 9-38 months. Conclusion Laparoscopy-assisted ultrasound-guided radiofrequency ablation is effective and safe for HCC beneath the diaphragm. DOI: 10.11855/j.issn.0577-7402.2017.05.16
Makki, Kausar; Chorasiya, Vishal Kumar; Sood, Gaurav; Srivastava, Piyush Kumar; Dargan, Puneet; Vij, Vivek
The conventional incision for donor hepatectomy is a right subcostal incision with a midline extension. With increased experience in both donor hepatectomy and laparoscopy, the conventional incision can be shortened to a significant extent. Laparoscopic mobilization of the liver coupled with a hand port allows the insertion of one hand inside the abdomen for control; this makes small-incision donor hepatectomy a technically feasible alternative. We compared 26 right lobe donor hepatectomies performed with a laparoscopy-assisted technique (the laparoscopy-assisted donor hepatectomy group) to 24 donor hepatectomies performed with the conventional open technique (the conventional donor hepatectomy group). The donors in both groups and their recipients were followed for 6 months. Pain, discomfort related to the scar [including abdominal wall sensorineural deficits (numbness and differences in tactile and temperature sensations) and tightness around the scar], and donor quality of life (assessed with the International Quality of Life Assessment Short Form 8 scoring system) were compared between the 2 groups. In conclusion, laparoscopy-assisted surgery can be a technically feasible alternative in experienced hands, and as with other minimally invasive surgeries, it has advantages such as significantly less pain, reduced incision-related complications, and better donor quality of life during the early postoperative period without compromising donor safety. © 2014 American Association for the Study of Liver Diseases.
H.J.F. Brenkman (Hylke J.F.); Gertsen, E.C. (E. C.); E. Vegt (Erik); R. van Hillegersberg (Richard); M.I. van Berge Henegouwen; S.S. Gisbertz (Suzanne S.); M. Luyer (Misha); G.A.P. Nieuwenhuijzen (Gerard); J.J.B. van Lanschot (Jan); S.M. Lagarde (Sjoerd); W.O. de Steur (Wobbe O.); H.H. Hartgrink (H.); J.H.M.B. Stoot (Jan); K.W.E. Hulsewé (Karel W.E.); E.J. Spillenaar Bilgen (Ernst Jan); M.J. van Det (Marc J.); E.A. Kouwenhoven (Ewout); D.L. van der Peet (Donald); F. Daams (Freek); J.W. van Sandick (J.); N.C.T. Grieken (Nicole); J. Heisterkamp (Joos); B. van Etten (Boudewijn); J.W. Haveman; J.-P.E.N. Pierie (Jean-Pierre); Jonker, F. (F.); Thijssen, A.Y. (A. Y.); E.J.T. Belt (Eric); P. van Duijvendijk (Peter); Wassenaar, E. (E.); H.W.M. van Laarhoven (Hanneke); Wessels, F.J. (F. J.); N. Haj Mohammad; H.F. van Stel (Henk); G.W.J. Frederix (Geert); P.D. Siersema (Peter); J.P. Ruurda (Jelle)
textabstractBackground: Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3-4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but
Full Text Available Introduction. Congenital pelviureteric junction obstruction (PUJO is one of the most common causes of hydronephrosis. Historically, open dismembered pyeloplasty has been considered the gold standard intervention for correcting PUJO. The aim of this study was to compare the surgical and functional outcomes of three different approaches, namely, open, conventional laparoscopy, and robotic pyeloplasty. Material and Methods. 60 patients underwent minimally invasive pyeloplasty (30 conventional laparoscopies and 30 robotics for congenital PUJO at a tertiary health center in India. Demographic, perioperative, and postoperative data were prospectively collected and analyzed. The data of these patients were retrospectively compared with another cohort of 30 patients who had undergone open pyeloplasty. Results. There was significant difference in operative time, time to drain removal, hospital stay, pain score, and complications rate between open and minimally invasive pyeloplasty (P<0.05. SFI was considerably lesser in robotic as compared to conventional laparoscopy. The success rate in OP, CLP, and RP was 93.33, 96.67, and 96.67%. Conclusion. Robotic pyeloplasty is safe, effective, and feasible. It is associated with significantly lesser operative time, lesser blood loss, less pain, shorter hospital stay, and fewer complications. It is also associated with considerably lesser surgeon fatigue as compared to conventional laparoscopy pyeloplasty.
Li, Yueli; Xiang, Ying; Wu, Na; Wu, Long; Yu, Zubin; Zhang, Mengxuan; Wang, Minghao; Jiang, Jun; Li, Yafei
This study aimed to systematically review and compare the perioperative outcomes of laparoscopy with laparotomy for abdominal trauma patients. We conducted a systematic review and meta-analysis comparing the perioperative outcomes of laparoscopy with laparotomy for abdominal trauma patients. Clinical endpoints included length of hospital stay, operation time, amount of intraoperative blood loss, time to postoperative exhaust, time to regular diet, time to out of bed, duration of postoperative pain, postoperative complications, perioperative mortality rate, length of intensive care unit (ICU) stay, missed injuries, conversions to laparotomy, and cure rate. Sixty-four studies including 9058 patients with abdominal trauma were included. In these studies, laparoscopy was used as a screening, diagnostic, or therapeutic tool. Meta-analysis showed significant reductions in the incidence of postoperative complications (relative risk [RR] [95 % confidence interval (CI)] 0.37 [0.29-0.46]), perioperative mortality rate (RR 0.64; 95 % CI 0.52-0.80), operation time (mean difference [MD] [95 % CI] -19.93 min [-34.43 to 5.43]), length of hospital stay (MD -5.15 days; 95 % CI -6.80 to 3.50), amount of intraoperative blood loss (MD -141.33 ml; 95 % CI -260.99 to 21.67), time to postoperative exhaust (MD -5.32 h; 95 % CI -8.60 to 2.05), time to regular diet (MD -3.46 h; 95 % CI -6.31 to 0.61), time to out of bed (MD -23.51 h; 95 % CI -24.85 to 22.16), duration of postoperative pain (MD -21.34 h; 95 % CI -22.65 to 20.03), length of ICU stay (MD -1.89 days; 95 % CI -4.05 to 0.27) in patients with abdominal trauma treated with laparoscopy compared with laparotomy. The pooled incidence of postoperative complications, missed injuries, conversions, and perioperative mortality rate of laparoscopy among the case reports were 0.04 (95 % CI 0.03-0.06), 0.01 (95 % CI 0.01-0.02), 0.24 (95 % CI 0.20-0.28), 0.01(95 % CI 0.01-0.02), respectively. Cure rate of laparoscopy ranged from 46 to 95 % and
Hajibandeh, Shahin; Hajibandeh, Shahab; Gumber, Ashutosh O; Wong, Chee Siong
Controversy exists regarding the role of laparoscopy in the evaluation of patients with penetrating abdominal trauma (PAT). Our objective was to perform a comprehensive review of the literature and conduct a meta-analysis to compare outcomes of laparoscopy and laparotomy in PAT. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Missed injury, mortality, and complications were defined as the primary outcome parameters. Procedure time, length of hospital stay, sensitivity and specificity of the procedure were the secondary outcomes. Combined overall effect sizes were calculated using fixed-effect or random-effects models. We identified one randomised controlled trial (RCT) and 8 observational studies comparing outcomes of laparoscopy with laparotomy in PAT. Laparoscopy was associated with a significantly lower risk of wound infection (Odd ratio (OR): 0.55; 95% Confidence interval (CI), 0.37-0.81, P = 0.003) and pneumonia (OR: 0.22; 95% CI, 0.13-0.37, P Laparoscopy was 100% sensitive in most of the included studies and avoided non-therapeutic laparotomies in 45.6% of patients. Our analysis of best available evidence mainly from heterogeneous observational studies has demonstrated that laparoscopic evaluation of haemodynamically stable patients with PAT may be safe and can reduce post-operative complications and length of hospital stay. The most important advantage of laparoscopy is avoidance of non-therapeutic laparotomies which are
Luis Cláudio Lopes Correia da Silva
Full Text Available Este trabalho experimental objetivou a avaliação do uso da laparoscopia para biópsia hepática em eqüino e o estudo das possíveis alterações clínicas e laboratoriais decorrentes de tal procedimento. Foram utilizados 10 animais, os quais foram submetidos a procedimento cirúrgico em posição quadrupedal, por abordagem pelo flanco direito, no 17º espaço intercostal, após jejum alimentar e hídrico de 36 e 18 horas respectivamente. A avaliação pós-operatória constou de exame físico diário e colheita de amostras de sangue seriadas. O procedimento possibilitou inspeção dos órgãos e estruturas anatômicas localizados dorsalmente à direita da cavidade abdominal, favorecendo a escolha do local de biópsia hepática. Não foram observadas alterações no exame físico dos animais. Os exames hematológicos e de função hepática não apresentaram alterações significativas. Concluiu-se que o emprego da laparoscopia para realização de biópsia hepática em eqüino é simples, eficaz e seguro.The purpose of this research was to evaluate the use of laparoscopy in obtaining hepatic biopsy in horses and to determine a possible clinical and laboratorial changes related to the procedure. Ten animals were submitted to 36 hours of fastening and 18 hours of water deprivation and then operated in the standing position, through a right flank approach at the level of the 17th intercostal space. Post-operative evaluation consisted of daily physical examination and seriated blood sampling. The procedure allowed for wide visualization of the viscera and anatomical structures located on the right side of the abdominal cavity, favouring the choice of the spot for hepatic biopsy collection. No changes were noted in the physical state of the animals and alterations in hemogram and hepatic function tests were not statistically significant. It was concluded that laparoscopy is a simple, effective and safe technique for obtaining hepatic biopsy
Wong, Jacqueline M K; Bortoletto, Pietro; Tolentino, Jocelyn; Jung, Michael J; Milad, Magdy P
To perform a comprehensive literature review of the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. A systematic review of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted. Four hundred thirty-three studies were screened for inclusion with 136 full-text articles reviewed. Ninety studies published between 1975 and 2015 met inclusion criteria, representing 140,444 surgeries. Articles reporting the incidence of urinary tract injury in gynecologic laparoscopy for benign indication were included. Exclusion criteria comprised malignancy, surgery by urogynecologists, research not in English, and insufficient data. A total of 458 lower urinary tract injuries were reported with an incidence of 0.33% (95% CI 0.30-0.36). Bladder injury (0.24%, 95% CI 0.22-0.27) was overall three times more frequent than ureteral injury (0.08%, 95% CI 0.07-0.10). Laparoscopic hysterectomy not otherwise specified (1.8%, 95% CI 1.2-2.6) and laparoscopically assisted vaginal hysterectomy (1.0%, 95% CI 0.9-1.2) had the highest rates of injury. Most ureteral injuries resulted from electrosurgery (33.3%, 95% CI 24.3-45.8), whereas most bladder injuries resulted from lysis of adhesions (23.3%, 95% CI 18.7-29.0). Ureteral injuries were most often recognized postoperatively (60%, 95% CI 47-76) and were repaired by open ureteral anastomosis (47.4%, 95% CI 36.3-61.9). In contrast, bladder injuries were most often recognized intraoperatively (85%, 95% CI 75-95) and were repaired by laparoscopic suturing (34.9%, 95% CI 29.2-41.7). The incidence of lower urinary tract injury in gynecologic laparoscopy for benign indication remains low at 0.33%. Bladder injury was three times more common than ureteral injury, although ureteral injuries were more often unrecognized intraoperatively and underwent open surgical repair. These risk estimates can assist gynecologic surgeons in effectively
Chang, K H; Bourke, M G; Kavanagh, D O; Neary, P C; O'Riordan, J M
The benefits of laparoscopic versus open surgery for patients with both benign and malignant colorectal disease have been well established. Re-laparoscopy in patients who develop complications following laparoscopic colorectal surgery has recently been reported by some groups and the aim of this systematic review was to summarise this literature. A literature search of PubMed, Medline and EMBASE identified a total of 11 studies that reported laparoscopic re-intervention for complications in 187 patients following laparoscopic colorectal surgery. The majority of these patients required re-intervention in the immediate postoperative period (i.e. less than seven days). Anastomotic leakage was the commonest complication requiring re-laparoscopy reported (n = 139). Other complications included postoperative hernia (n = 12), bleeding (n = 9), adhesions (n = 7), small bowel obstruction (n = 4), colonic ischaemia (n = 4), bowel and ureteric injury (n = 3 respectively) and colocutaneous fistula (n = 1). Ninety-seven percent of patients (n = 182) who underwent re-laparoscopy had their complications successfully managed by re-laparoscopy, maintaining the benefits of the laparoscopic approach and avoiding a laparotomy. We conclude that re-laparoscopy for managing complications following laparoscopic colorectal surgery appears to be safe and effective in highly selected patients. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
Strandby, R B; Svendsen, L B; Fallentin, E; Egeland, C; Achiam, M P
The implementation of the multidisciplinary team conference has been shown to improve treatment outcome for patients with gastric- and gastroesophageal cancer. Likewise, the staging laparoscopy has increased the detection of patients with disseminated disease, that is, patients who do not benefit from a surgical resection. The aim of this study was to compare the multidisciplinary team conference's decision in respect of M-staging with the findings of the following staging laparoscopy. Patients considered operable and resectable within the multidisciplinary team conference in the period 2010-2012 were retrospectively reviewed. Patient data were retrieved by searching for specific diagnosis and operation codes in the in-house system. The inclusion criteria were as follows: biopsy-verified cancer of the esophagus, gastroesophageal junction or stomach, and no suspicion of peritoneal carcinomatosis or liver metastases on multidisciplinary team conference before staging laparoscopy. Furthermore, an evaluation with staging laparoscopy was required. In total, 222 patients met the inclusion criteria. Most cancers were located in the gastroesophageal junction, n = 171 (77.0%), and most common with adenocarcinoma histology, n = 196 (88.3%). The staging laparoscopy was M1-positive for peritoneal carcinomatosis in eight patients (16.7%) with gastric cancer versus nine patients (5.3%) with gastroesophageal junction cancer. Furthermore, liver metastases were evident in zero patients (0.0%) and four patients (2.3%) with gastric- and gastroesophageal junction cancer, respectively. The staging laparoscopy findings regarding peritoneal carcinomatosis were significantly different between gastric- and gastroesophageal junction cancers, p = 0.01. No significant differences were found regarding T-/N-stage or histological tumor characteristics between the positive- and negative-staging laparoscopy group. The M-staging of the multidisciplinary team conference without staging
Baker, Talia B; Jay, Colleen L; Ladner, Daniela P; Preczewski, Luke B; Clark, Lori; Holl, Jane; Abecassis, Michael M
Minimally invasive liver surgery is a rapidly advancing field with demonstrated applicability to living donation. In this paper, we compare the safety and efficacy of laparoscopy-assisted donor right hepatectomy (LADRH) to open donor right hepatectomy (ODRH). We performed a retrospective, comparative analysis of 33 LADRH to the most recent 33 ODRH performed at our institution, evaluating donor complications, costs, and recipient outcomes. Donor demographics including age, gender, body mass index (BMI), and vascular and biliary anomalies were comparable. Donor complication rates were equivalent for LADRH and ODRH. Donor operative times were shorter for LADRH (LADRH 265 minutes, ODRH 316; P size, recipient patient or graft survival, or recipient vascular or biliary complications. Our experience suggests that LADRH compares favorably with ODRH with equivalent safety, resource utilization, and effectiveness. We believe that LADRH provides potential physical and psychological benefits without an adverse effect on outcomes.
Nielsen, Liv Bjerre Juul; Tengberg, Line Toft; Bay-Nielsen, Morten
INTRODUCTION: Laparoscopy is well established in the majority of elective procedures in abdominal surgery. In contrast, it is primarily used in minor surgery such as appendectomy or cholecystectomy in the emergent setting. This study aimed to analyze the safety and effectiveness of a laparoscopic...... approach in a large cohort of major abdominal emergencies. METHODS: A population-based cohort from the Region of Copenhagen, Denmark, including n = 1,139 patients undergoing major abdominal emergency surgery in 2012. RESULTS: A total of 313 patients were operated with an initial laparoscopic approach; 37...... days in the laparoscopic group, 12 days in the converted group and 11 days in the group of open operations. CONCLUSIONS: In a large, unselected group of major abdominal emergencies, we report a low rate of complications for operations conducted by an initial laparoscopic approach, and a high rate...
Sheikh, Abu Baker; Akhtar, Aisha; Nasrullah, Adeel; Haq, Shujaul; Ghazanfar, Haider
A bezoar is a collection of indigestible material found in the alimentary canal, which can cause mechanical obstruction of the gastrointestinal tract. Phytobezoar is a variant composed of mostly plant material and indigestible fiber. Phytobezoar is a rare cause of small bowel obstruction (SBO) and happens more commonly in patients with risk factors predisposing to impaired gastrointestinal motility. We present a rare case of SBO secondary to phytobezoar in a 60-year-old female patient with type 2 diabetes. There was no prior history of any abdominal surgery. The abdominal computed tomography (CT) scan was inconclusive. Laparoscopy was found to be an effective diagnostic and therapeutic procedure in this patient.
Byron, J W; Markenson, G; Miyazawa, K
Two hundred and fifty-two women scheduled to undergo laparoscopy were randomly assigned to a Verres needle or direct insertion group. The groups were similar with respect to incidence of obesity, prior surgical treatment, indication for operation and level of training of the surgeon performing the procedure. There were no major complications associated with either technique. Minor complications (preperitoneal insufflation, failed entry or more than three attempts necessary to enter the peritoneal cavity with the trocar) were significantly more frequent (p Verres needle technique group. One hundred and thirteen of these patients underwent sterilization procedures. The mean times for performance of the laparoscopic procedure using the direct insertion and Verres needle techniques was 15.3 and 19.6 minutes, respectively. The time saved using the direct insertion technique is explained by a significant (p Verres needle techniques, respectively. We prefer the direct insertion technique for trocar placement because it has fewer minor complications and requires less operating time.
Hotta, Masahiro; Yamamoto, Kazuhito; Cho, Kazumitsu; Takao, Yoshimune; Fukuoka, Takeshi; Uchida, Eiji
Arteriovenous malformations of the stomach are an uncommon cause of upper GI bleeding. We report a case of stomach arteriovenous malformation in an 85-year-old Asian man who presented with massive hematemesis. Initial esophagogastroduodenoscopy did not detect this lesion, but contrast multi-detector CT confirmed GI bleeding. Multi-detector CT revealed a mass of blood vessels underlying the submucosa that arose from the right gastroepiploic artery. Repeat esophagogastroduodenoscopy showed that the lesion was a submucosal tumor with erosion and without active bleeding in the lower body of the stomach on the greater curvature. We performed partial gastrectomy via laparoscopy-assisted surgery. The histopathological diagnosis was arteriovenous malformation. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.
Setúbal, António Gutierrez; Alves, João Sequeira; Lavado, Olga; Faria, Joana
To demonstrate our technique of mini-laparoscopic adnexectomy or salpingectomy at the time of total laparoscopic hysterectomy (TLH). Step-by-step video demonstration of our technique. The advantages of laparoscopic surgery have been widely recognized, including improved visualization and exposure, reduced operative trauma owing to smaller incisions and gentler tissue handling, and faster postoperative recovery. Continuing technological developments have allowed the use of smaller-caliber instruments while maintaining a high standard of surgical performance. Mini-laparoscopy requires the use of 3-mm or smaller ports. The main advantage of mini-laparoscopy is the reduced incision size, which can translate into a lower incidence of incision-related complications such as postoperative pain, infection, and trocar site herniation, along with superior cosmetic results. Today, in younger patients, prophylactic salpingectomy can be considered instead of adnexectomy, taking into account the well-known benefits of ovarian conservation. Prophylactic salpingectomy involves Fallopian tube removal for primary prevention of epithelial carcinoma of the fallopian tubes, ovaries, and peritoneum in women undergoing pelvic surgery for another indication. Other advantages of this intervention are the avoidance of hydrosalpinx (which affects ∼30% women after hysterectomy), the 7.8% lifetime risk of revision surgery , tubal infection, and benign and malignant Fallopian tube tumors. Finally, salpingectomy has no known physiological side effects, is safe and feasible, does not worsen surgical outcomes, does not significantly increase the operative time, and is not related to increased rates of intraoperative and postoperative complications or readmission. The patient is a 44-year-old woman with a history of 2 previous cesarean sections with adenomyosis and endometriosis infiltration of the uterosacral ligaments. After discussion about the risks and benefits of ovarian conservation with
Thinggaard, Ebbe; Konge, Lars; Bjerrum, Flemming
modalities, and four practised first on box trainers then on virtual reality simulators. Twelve practised only at home, while five practised at both places and one practised solely at the simulation centre. After a delayed start, most practised for some time, then had a period without training......BACKGROUND: Simulation training can prepare trainees for clinical practice in laparoscopic surgery. Training on box trainers allows for simulation training at home, which studies have shown to be a feasible method of training. However, little research has been conducted into how to make it a more...... efficient method of training. Our aim was to investigate how box trainers are used in take-home training to help guide the design of take-home training courses. METHODS: This study was designed using a mixed methods approach. Junior doctors participating in a laparoscopy curriculum, which included...
Chene, G; Chauvy, L; Buenerd, A; Moret, S; Nadaud, B; Beaufils, E; Le Bail-Carval, K; Chabert, P; Mellier, G; Lamblin, G
To investigate the technical feasibility of optical biopsy (probe-based confocal laser endomicroscopy [pCLE]) during laparoscopy and by the vaginal route in the exploration of pelvic gynecological cancers. Prospective study including 31 patients undergoing laparoscopic hysterectomy (benign or malignant indication). Confocal microlaparoscopy (analysis of tubes, ovaries, and depending on the type de cancer, pelvic adenopathies) and optical biopsy of the endometrium were first carried out by the vaginal route under general anesthesia. The surgical procedure was then carried out. Thirty-one consecutive patients were included (16 for benign hysterectomy, 12 for endometrial cancer and 3 for ovarian carcinoma). pCLE offered dynamic pictures that were correlated with the histopathological images. pCLE provides high resolution imaging of cancerous and benign tissues in real-time similar to histopathological results. Both feasibility and safety were confirmed. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Intraoperative verification of hysterosalpingography and laparoscopy in cases of oviductal infertility; Srodoperacyjna weryfikacja badania histerosalpingograficznego i laparoskopowego w przypadkach nieplodnosci pochodzenia jajowodowego
Cislo, M.; Murawski, M.; Popiela, A. [Akademia Medyczna, Wroclaw (Poland)
There has been made an analysis of 45 cases of women`s oviductal infertility qualified to surgical treatment. In search of these reasons of infertility these patients underwent hysterosalpingographic examination and 24 of them additionally, diagnostic laparoscopy with chromoturbation. Positive intraoperative verification of HSG and laparoscopy, as a confirmation of tubal obstruction, they obtained at 40 women (88.9%) that made possible to carry out microsurgical operations in them. Such a big percentage of correct diagnoses make sure, that both HSG and laparoscopy are indispensable for proper qualification of a patient to microsurgical treatment of oviductal infertility. (author) 10 refs, 1 tab
Yanar, Hakan; Taviloglu, Korhan; Ertekin, Cemalettin; Ozcinar, Beyza; Yanar, Fatih; Guloglu, Recep; Kurtoglu, Mehmet
AIM: To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia (AMI). METHODS: Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room. RESULTS: The average time of admission to the hospital after the initiation of symptoms was 3 d (range, 5 h-9 d). In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% (n = 6). CONCLUSION: Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis. PMID:17659674
Ludwin, A; Ludwin, I; Martins, W P
Robert's uterus is a unique malformation, described as a septate uterus with a non-communicating hemicavity, consisting of a blind uterine horn usually with unilateral hematometra, a contralateral unicornuate uterine cavity and a normally shaped external uterine fundus. The main symptom in affected young women is pelvic pain that becomes intensified near menses. We describe the case of a 22-year-old woman who was referred for diagnostic assessment and treatment of a congenital uterine anomaly. We used three-dimensional sonohysterography with volume-contrast imaging, HDLive rendering mode and automatic volume calculation (SonoHysteroAVC) for the diagnosis, surgical planning and postoperative evaluation. These imaging techniques provided a complete understanding of the internal and external uterine structures, enabling us to perform a minimally invasive hysteroscopic metroplasty, guided by transrectal ultrasound, and therefore avoiding the need for laparotomy/laparoscopy. The outcome of treatment was considered satisfactory; menstruation ceased to be painful and, after two hysteroscopic procedures, the communicating 0.3-cm 3 hemicavity was visualized as a 3.6-cm 3 normalized uterine cavity using the same imaging techniques. The findings of this case report raise questions about the embryological origin of Robert's uterus, the suitability of current classification systems, and the role of more invasive approaches (laparoscopy/laparotomy) and surgical procedures (horn resection/endometrectomy) that do not aim to improve uterine cavity shape and volume in women with this condition. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
These notes are a record of a one semester course on Functional Analysis given by the author to second year Master of Statistics students at the Indian Statistical Institute, New Delhi. Students taking this course have a strong background in real analysis, linear algebra, measure theory and probability, and the course proceeds rapidly from the definition of a normed linear space to the spectral theorem for bounded selfadjoint operators in a Hilbert space. The book is organised as twenty six lectures, each corresponding to a ninety minute class session. This may be helpful to teachers planning a course on this topic. Well prepared students can read it on their own.
Since there is no complete modern edition of Shelley’s drama, I have used a variety of texts. For Prometheus Unbound, Tasso and The Cenci I have used The Poems of Shelley edited by Kelvin Everest and Geoffrey Matthews, but I have also noted the stage directions in BSMIX which comprises the intermediate fair copy of Prometheus Unbound which Shelley transcribed into three notebooks for safe-keeping. For Hellas I have used Shelley’s Poetry and Prose edited by Donald H. Reiman and Neil Fraistat (...
Zygomalas, Apollon; Kehagias, Ioannis; Giokas, Konstantinos; Koutsouris, Dimitrios
Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present. © The Author(s) 2014.
Serra-Aracil, Xavier; Mora-López, Laura; Casalots, Alex; Pericay, Carles; Guerrero, Raul; Navarro-Soto, Salvador
Laparoscopic surgery for rectal TME achieves better patient recovery, lower morbidity, and shorter hospital stay than open surgery. However, in laparoscopic rectal surgery, the overall conversion rate is nearly 20%. Transanal TME combined with laparoscopy, known as Hybrid NOTES, is a less invasive procedure that provides adequate solutions to some of the limitations of rectal laparoscopy. Transanal TME via TEO with technical variants (intracorporeal resection and anastomosis, TEO review of the anastomosis) attempts to standardize and simplify the procedure. Prospective observational study was used describe and assess the technique in terms of conversion to open surgery, overall morbidity, surgical site infection and hospital stay. The sample comprised consecutive patients diagnosed with rectal tumor less than 10 cm from the anal verge who were candidates for low anterior resection using TME (except T4). Demographic, surgical, postoperative, and pathological variables were analyzed, as well as morbidity rates. From September 2012 to August 2014, 32 patients were included. The conversion rate was 0%. Overall morbidity was 31.3%, SSI rate was 9.4%, and mean hospital stay was 8 days. Oncological radical criteria were achieved with pathological parameters of 94% of complete TME and a median circumferential margin of 13 mm. The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.
a cura di Mariagrazia Portera
Full Text Available Volumi Winfried Menninghaus, La promessa della bellezza, [Fabrizio Desideri, p. 272] • David Rothenberg, Survival of the Beautiful. Art, Science and Evolution [Danae Crocchiola, p. 274] • Lev Manovich, Software Takes Command [Angela Maiello, p. 277]. Note Method in Aesthetics: Philosophy, Evolution and the Cognitive Sciences [Aaron Meskin, Matthew Kieran, Gregory Currie, p. 280] • L’Abitare possibile. Estetica, Architettura e New Media, Ravello, Auditorium Oscar Niemeyer, 28-30 maggio 2013 [Sara Matetich, p. 282] • Copenhagen Summer School in Phenomenology and Philosophy of Mind, University of Copenhagen, 12-16 Agosto 2013 [Raoul Frauenfelder, p. 289] • Ciò che è vivo e ciò che è morto nell’estetica di Archibald Ali- son. Nota a margine del convegno: Neoestetica ed emozione. Archibald Alison e l’estetica con- temporanea, Palermo, 4-5 ottobre 2013 [Giuseppe Pucci, p. 294
Combining of ETHOS Operating Ergonomic Platform, Three-dimensional Laparoscopic Camera, and Radius Surgical System Manipulators Improves Ergonomy in Urologic Laparoscopy: Comparison with Conventional Laparoscopy and da Vinci in a Pelvi Trainer.
Tokas, Theodoros; Gözen, Ali Serdar; Avgeris, Margaritis; Tschada, Alexandra; Fiedler, Marcel; Klein, Jan; Rassweiler, Jens
Posture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. To combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. Fifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. Task completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. The use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (psystem nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. The ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. The study was conducted in a pelvi trainer and no patients were recruited. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Background Gastric cancer is a common malignancy worldwide and a common cause of death from cancer. Despite recent advances in multimodality treatment and targeted therapy, complete resection remains the only treatment that can lead to cure. This study was devised to investigate the technical feasibility, safety and oncologic efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer without serosa invasion. Methods A retrospective matched cohort study was performed in south China comparing laparoscopy-assisted gastrectomy and open gastrectomy for advanced gastric cancer without serosa invasion. Eighty-three patients with advanced gastric cancer undergoing laparoscopy-assisted gastrectomy between January 2008 and December 2010 were enrolled. These patients were compared with 83 patients with advanced gastric cancer undergoing open gastrectomy during the same period. Results There was no significant difference in clinicopathologic characteristics between the two groups. Regarding perioperative characteristics, the operation time and time to ground activities did not differ between the two groups, whereas the blood loss, transfused patient number, time to first flatus, time to resumption of diet, and postoperative hospital stay were significantly less in laparoscopy-assisted gastrectomy than in open gastrectomy (P Laparoscopy-assisted gastrectomy with D2 lymphadenectomy is a safe and feasible procedure for advanced gastric cancer without serosa invasion. To be accepted as a choice treatment for advanced gastric cancer, well-designed randomized controlled trials comparing short-term and long-term outcomes between laparoscopy-assisted gastrectomy and open gastrectomy in a larger number of patients are necessary. PMID:23311966
Kjaer, Mie Dilling; Laursen, Stig Borbjerg; Qvist, Niels
and laparoscopic IPAA; however, there was a tendency toward lower postoperative self-esteem among women compared to men (p = 0.07). We also found a tendency toward a better body image among laparoscopy-treated women compared to open-treated women (p = 0.07). CONCLUSIONS: Although there might be a tendency toward...... postoperative sexual function and body image compared to those after open surgery IPAA. METHODS: Patients treated with IPAA in the period from October 2008 to March 2012 were included. Evaluation of sexual function, body image, and quality of life was performed using the Female Sexual Function Index (FSFI......), the International Index of Erectile Function (IIEF), the Body Image Questionnaire (BIQ), and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). RESULTS: We included 72 patients (38 laparoscopy-assisted and 34 open). Response rate was 74 %. There were no differences in demographics, functional outcome...
Full Text Available Background. The aim of this retrospective study was to find the incidence and type of adnexal masses in pregnancy, reliability of preoperative ultrasound examination and the effect of the surgical approach used, duration of pregnancy at the time of surgery, and the effect of emergency or planned surgery on the outcome of pregnancy. The obtained results and the data from literature were to provide the basis of the guidelines for the management of pregnant women with adnexal masses.Methods. In the study we enrolled 42 women, who underwent a surgery in pregnancy for adnexal masses. All surgeries were performed at the Department of Obstetrics and Gynecology in the period 1 January 1993–31 August 2000. The course of pregnancy was followed by 28 February 2001. The data were obtained from the records kept at the Department and from the questionnaire sent to the women. Statistical analysis was done using Chi-square test. Statistical significance was set at P ≤ 0.05.Results. We found the incidence of adnexal masses in pregnancy, requiring surgical treatment, to be 1/1034 deliveries. There were 6 (14.3% borderline malignant and malignant ovarian tumours, the incidence being 1/7239 deliveries. Preoperative ultrasound examination was not reliable enough to differentiate neither between benign and malignant adnexal masses, nor between adnexal masses and leiomyomas. Forty-two surgeries were made, 21 by laparoscopy and 21 by laparotomy. The size of removed tumours ranged between 4 and 30 cm (mean 9.4 cm, the most frequent type was mature cystic teratoma (n = 12. There were no differences in the outcome of pregnancy between the laparoscopy and laparotomy approach, between emergency and planned surgery, and between laparotomy performed by the 23rd and after the 23rd gestational week. Hemorrhagic shock due to heterotopic pregnancy lead to 1 spontaneous abortion. There were 2 preterm deliveries in the 37th week, 2 babies had intrauterine growth retardation
Full Text Available Goats (n=12 undergoing laparoscopy assisted embryo transfer were randomly allotted to two groups (I and II and injected lignocaine hydrochloride (4mg/kg or ropivacaine hydrochloride (1mg/kg at the lumbosacral epidural space. The animals were held with raised hind quarters for first three minutes following injection. Immediately after induction of regional anaesthesia, they were restrained in dorsal recumbency in Trendelenburg position in a cradle. Laparoscopy was performed after creating pneumoperitoneum using filtered room air. The mean (± S.E induction time in animals of group I was significantly shorter (5.33 ± 0.61 min than those belonging to group II (12.66 ±1.99 min. Complete analgesia developed throughout the hind quarters and abdomen for 30 min and 60 min in group I and II animal’s respectively. Unlike animals of group I, group II goats continued to show moderate analgesia for 180 minutes. The motor activity returned after a lapse of 130.00 ± 12.64 min and 405.00 ± 46.31 min respectively. Occasional vocalization and struggling was noticed in two goats one from each group irrespective of the surgical manipulations during laparoscopy. The rectal temperature and respiration rates showed only non-significant increase, but the heart rate values were significantly higher (P < 0.5 up to 150 min in animals of both the groups when compared to their baseline values. From this study, it was concluded that both anaesthetic agents produced satisfactory regional anaesthesia in goats undergoing laparoscopy. However, considering the very long delay in regaining the hind limb motor activity, the use of ropivacaine may not be recommended for this purpose. Supplementation of sedative/tranquilizer with lumbosacral epidural anaesthesia needs evaluation.
Facy, Olivier; Paquette, Brice; Orry, David; Santucci, Nicolas; Rat, Paul; Rat, Patrick; Binquet, Christine; Ortega-Deballon, Pablo
C-reactive protein and procalcitonin are reliable early predictors of infection after colorectal surgery. However, the inflammatory response is lower after laparoscopy as compared to open surgery. This study analyzed whether a different cutoff value of inflammatory markers should be chosen according to the surgical approach. A prospective, observational study included consecutive patients undergoing elective colorectal surgery in three academic centers. All infections until postoperative day (POD) 30 were recorded. The inflammatory markers were analyzed daily until POD 4. Areas under the ROC curve and diagnostic values were calculated in order to assess their accuracy as a predictor of intra-abdominal infection. Five-hundred-one patients were included. The incidence of intra-abdominal infection was 11.8%. The median levels of C-reactive protein (CRP) and procalcitonin (PCT) were lower in the laparoscopy group at each postoperative day (p laparoscopy group (p = 0.0036) but were not different in patients presenting with intra-abdominal infections (p = 0.3243). In the laparoscopy group, CRP at POD 4 was the most accurate predictor of overall and intra-abdominal infection (AUC = 0.775). With a cutoff of 100 mg/L, it yielded 95.7% negative predictive value, 75% sensitivity, and 70.3% specificity for the detection of intra-abdominal infection. The impact of infection on inflammatory markers is more important than that of the surgical approach. Defining a specific cutoff value for early discharge according to the surgical approach is not justified. A patient with CRP values lower than 100 mg/L on POD 4 can be safely discharged.
Shakir, Fevzi; Jan, Haider; Kent, Andrew
The advent of three-dimensional passive stereoscopic imaging has led to the development of 3D laparoscopy. In simulation tasks, a reduction in error rate and performance time is seen with 3D compared to two-dimensional (2D) laparoscopy with both novice and expert surgeons. Robotics utilises 3D and instrument articulation through a console interface. Robotic trials have demonstrated that tasks performed in 3D produced fewer errors and quicker performance times compared with those in 2D. It was therefore perceived that the main advantage of robotic surgery was in fact 3D. Our aim was to compare 3D straight-stick laparoscopic task performance (3D) with robotic 3D (Robot), to determine whether robotic surgery confers additional benefit over and above 3D visualisation. We randomised 20 novice surgeons to perform four validated surgical tasks, either with straight-stick 3D laparoscopy followed by 3D robotic surgery or in the reverse order. The trial was conducted in two fully functional operating theatres. The primary outcome of the study was the error rate as defined for each task, and the secondary outcome was the time taken to complete each task. The participants were asked to perform the tasks as quickly and as accurately as possible. Data were analysed using SPSS version 21. The median error rate for completion of all four tasks with the robot was 2.75 and 5.25 for 3D with a P value performance time for completion of all four tasks with the robot was 157.1 and 342.5 s for 3D with a P value 3D robotic systems over 3D straight-stick laparoscopy, in terms of reduced error rate and quicker task performance time.
Pestian, John P; Matykiewicz, Pawel; Linn-Gust, Michelle
This paper reports on the results of an initiative to create and annotate a corpus of suicide notes that can be used for machine learning. Ultimately, the corpus included 1,278 notes that were written by someone who died by suicide. Each note was reviewed by at least three annotators who mapped words or sentences to a schema of emotions. This corpus has already been used for extensive scientific research.
Allen, Victoria B; Gurusamy, Kurinchi Selvan; Takwoingi, Yemisi; Kalia, Amun; Davidson, Brian R
Surgical resection is the only potentially curative treatment for pancreatic and periampullary cancer. A considerable proportion of patients undergo unnecessary laparotomy because of underestimation of the extent of the cancer on computed tomography (CT) scanning. Laparoscopy can detect metastases not visualised on CT scanning, enabling better assessment of the spread of cancer (staging of cancer). This is an update to a previous Cochrane Review published in 2013 evaluating the role of diagnostic laparoscopy in assessing the resectability with curative intent in people with pancreatic and periampullary cancer. To determine the diagnostic accuracy of diagnostic laparoscopy performed as an add-on test to CT scanning in the assessment of curative resectability in pancreatic and periampullary cancer. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, EMBASE via OvidSP (from inception to 15 May 2016), and Science Citation Index Expanded (from 1980 to 15 May 2016). We included diagnostic accuracy studies of diagnostic laparoscopy in people with potentially resectable pancreatic and periampullary cancer on CT scan, where confirmation of liver or peritoneal involvement was by histopathological examination of suspicious (liver or peritoneal) lesions obtained at diagnostic laparoscopy or laparotomy. We accepted any criteria of resectability used in the studies. We included studies irrespective of language, publication status, or study design (prospective or retrospective). We excluded case-control studies. Two review authors independently performed data extraction and quality assessment using the QUADAS-2 tool. The specificity of diagnostic laparoscopy in all studies was 1 because there were no false positives since laparoscopy and the reference standard are one and the same if histological examination after diagnostic laparoscopy is positive. The sensitivities were therefore meta-analysed using a univariate random-effects logistic
Costi, Renato; Gnocchi, Alessandro; Di Mario, Francesco; Sarli, Leopoldo
Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones (CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound (EUS) and magnetic resonance cholangiography (MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and cost-effectiveness of imaging techniques used to identify CBDS increase together in a parallel way, the concept of “risk of carrying CBDS” has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of “under-studying” by poor diagnostic work up or “over-studying” by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. “Low risk” patients do not require further examination before laparoscopic cholecystectomy. Two main “philosophical approaches” face each other for patients with an “intermediate to high risk” of carrying CBDS: on one hand, the “laparoscopy-first” approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the “endoscopy-first” attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent
Sussenbach, Samanta Pereira; Silva, Everton Nunes; Pufal, Milene Amarante; Casagrande, Daniela Shan; Padoin, Alexandre Vontobel; Mottin, Cláudio Corá
Background Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB). Methods A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB. Results In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost. Conclusion This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs. PMID:24945704
Ghaem, Haleh; Amiri, Zahra; Kianpour, Fatemeh; Rezaianzadeh, Abbas; Hosseini, Seyed Vahid; Khazraei, Hajar
The goal of this study was to compare the rate of recurrence and occurrence of complications in colorectal cancer patients after two kinds of laparoscopy and laparotomy. A followup study was carried out among 358 patients who suffered from colorectal cancer from 20122014. The data were gathered from colorectal research center in Shiraz, Shahid Faghihi hospital, and analyzed using the chisquare test, logistic regression, and multinomial regression. The average age of these patients was 56.3±14.6, 55.0% being men. Moreover, 57.8% of them underwent laparoscopy surgery and 42.2% of the patients underwent laparotomysurgery and the conversion rate was 58.0% which ultimately was put under the category of laparotomy surgery. After biennial median followup, differences in the occurrence of complications such as bleeding (hemorrhage), fever, intestine blockage and wound infection in these two kinds of surgery werestatistically significant (Psurgery groups. Post operation complications were laparoscopy surgery were less than those in laparotomy. However, the outcomes such as patients' ultimate status and recurrence were similar between the two groups.
Chantada, C; García-Tello, A; Esquinas, C; Moraga, A; Redondo, C; Angulo, J C
Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy. A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n=49) or multiport laparoscopy (n=53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis. There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P=.6). Intraoperative transfusion (P=.03) and blood loss (Plaparoscopy (P=.0013). Umbilical LESS surgery with reusable platform enables various surgical techniques to be performed when treating renal masses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
Fuchs, Karl-Hermann; Breithaupt, Wolfram; Kühl, Hans-Jürgen; Schulz, Thomas; Dignass, Axel
The transgastric approach to the abdominal cavity has been under experimental investigation in recent years as a method of natural orifice transluminal endoscopic surgery (NOTES). In this study our team, consisting of surgeons and gastroenterologists, focused on training techniques with currently available instruments to perform transgastric procedures. The purpose of this paper is to evaluate the learning process during the establishment of a training program for NOTES. Therefore several procedures were tested in terms of training issues such as the applicability of instruments and techniques for both gastroenterologists and surgeons. After initial testing of the basic steps, a defined training program was initialized in an animal facility of a medical company. Permission for animal training was applied for and granted by the local government. Ten training sessions were performed on a porcine model using animals with a median weight of 65 kg (40-85 kg). General anesthesia was performed in all cases. Transgastric tube resection (TTR), cholecystectomy (TCE), cardiomyotomy (TMY), and small bowel segmental resection (TSBR) were performed. The learning process was evaluated, including handling issues for flexible instruments, access, closure problems, and special technical issues. Procedure duration, as a marker of the learning curve effect, was evaluated. Intra-esophageal friction, lack of platform stability, lack of precision in tissue retraction, and lack of independence of endoscopic vision were the most difficult technical problems encountered. The operative time range was 25-85 min for TTR, 75-185 min for TCE, 95-220 min for TMY, and 100-260 min for TSBR. A learning curve was demonstrated for each investigated technique. These results are promising in terms of the ability of surgeons and gastroenterologists to develop these procedures into a clinical applicable version. Technical limitations were more important than differences in medical education, providing
Full Text Available Echinococcus multilocularis is an important pathogenic zoonotic parasite of health concern, though absent in the United Kingdom. Eurasian beavers (Castor fiber may act as a rare intermediate host, and so unscreened wild caught individuals may pose a potential risk of introducing this parasite to disease-free countries through translocation programs. There is currently no single definitive ante-mortem diagnostic test in intermediate hosts. An effective non-lethal diagnostic, feasible under field condition would be helpful to minimise parasite establishment risk, where indiscriminate culling is to be avoided. This study screened live beavers (captive, n = 18 or wild-trapped in Scotland, n = 12 and beaver cadavers (wild Scotland, n = 4 or Bavaria, n = 11, for the presence of E. multilocularis. Ultrasonography in combination with minimally invasive surgical examination of the abdomen by laparoscopy was viable under field conditions for real-time evaluation in beavers. Laparoscopy alone does not allow the operator to visualize the parenchyma of organs such as the liver, or inside the lumen of the gastrointestinal tract, hence the advantage of its combination with abdominal ultrasonography. All live beavers and Scottish cadavers were largely unremarkable in their haematology and serum biochemistry with no values suspicious for liver pathology or potentially indicative of E. multilocularis infection. This correlated well with ultrasound, laparoscopy, and immunoblotting, which were unremarkable in these individuals. Two wild Bavarian individuals were suspected E. multilocularis positive at post-mortem, through the presence of hepatic cysts. Sensitivity and specificity of a combination of laparoscopy and abdominal ultrasonography in the detection of parasitic liver cyst lesions was 100% in the subset of cadavers (95%Confidence Intervals 34.24-100%, and 86.7-100% respectively. For abdominal ultrasonography alone sensitivity was only 50% (95%CI 9
Liao, Chih-Hsien; Tan, Elise Chia-Hui; Chen, Chien-Chih; Yang, Ming-Chin
Laparoscopic colectomy is increasingly being adopted for the treatment of colon cancer; however, the long-term effectiveness of this approach in a real-world clinical setting has yet to be verified. This study aims to compare the effectiveness and costs associated with laparoscopic and open colectomy from the perspective of the National Health Insurance (NHI) system in Taiwan. A nationwide population-based colon cancer cohort was observed by linking the Taiwan Cancer Registry, claims data from NHI system, and the National Death Registry. Adult patients with Stage I to Stage III colon cancer who underwent primary cancer resection using either laparoscopy or open colectomy between 2009 and 2011 were included. A propensity score-matched cohort (1745 pairs) was applied to examine three clinical endpoints: overall survival, recurrence-free survival, and disease-free survival within 2 years after the operation. To comply with the perspective as well as the analytic horizon of the study, we limited the research to NHI claims from the study population for the corresponding time period. The health outcomes and net monetary benefits were verified by multivariate mixed-effect models. This analysis revealed that laparoscopy resulted in longer overall survival (adjusted difference 16.8 days, 95 % CI 7.3-26.2), recurrence-free survival (16.8 days, 5.0-28.6) and disease-free survival (26.4 days, 7.4-45.4), compared to open colectomy at 2 years post-op. Laparoscopy also led to a significantly shorter length of stay (3.2 days, 2.4-3.9) and lower index hospitalization costs (US$ 455, 181-729) than open colectomy; however, no differences in costs were observed over the long term. Overall, laparoscopy was more cost-effective than open colectomy under various willingness-to-pay thresholds in the setting of the Taiwan NHI. The continued adoption of laparoscopy in primary curable colon cancer resection is expected to reduce health care costs over the short term while providing
Kawashita, Yujo; Iwata, Toru; Kanetaka, Kengo; Ono, Shinichiro; Kawahara, Yasuhiro; Fujisawa, Hiroyuki; Yoshida, Toshiaki; Miyahara, Shinichi; Eto, Shozo; Kanematsu, Takashi
Laparoscopic hepatectomy provides the usual advantages of a minimally invasive surgery. This study presents a case of Fasciola hepatica infection that was successfully treated with laparoscopic hepatectomy. The patient was referred because of persistent fever and right hypochondralgia with a huge mass occupying the right lobe of the liver, which was detected by imaging analysis. Serologic tests indicated an F. hepatica infection. The patient underwent a laparoscopic resection because the anthelmintic agent, triclabendazole was not effective. During the surgical technique, 5 trocars were inserted. After liver mobilization, the Glissonian pedicles and right hepatic veins were safely taped. A Penrose drain was placed behind the liver for a liver-hanging maneuver. A liver parenchymal transection was performed through an 8 cm handport site using a dissecting sealer (TissueLink Medical) after precoagulating its superficial layer by microtaze. Glissonian pedicles and the right hepatic vein were divided using an endolinear stapler (endcutter 45, Ethicon). Finally, the resected specimen was extracted from the handport. The surgical time was 450 minutes and the surgical blood loss was 370 mL. The patient was discharged 10 days after the surgery with an uneventful postoperative course. The laparoscopy-assisted hepatectomy in this case was beneficial for the patient's quality of life as a minimally invasive operation with a high degree of safety.
Ueda, Junji; Ichimiya, Hitoshi; Okido, Masayuki; Kato, Masato
Laparoscopy-assisted distal gastrectomy (LADG) has been widely accepted for the treatment for early gastric cancer. Obesity is a rapidly growing epidemic, and the number of obese patients with gastric cancer is increasing, but the impact of visceral fat (VF) accumulation on laparoscopic gastric surgery remains unknown. The aim of the present study was to determine the impact of VF accumulation on LADG. The medical charts of 30 patients who underwent LADG for early gastric cancer in our hospital between November 2000 and November 2006 were analyzed retrospectively. The patients were divided into two groups on the basis of VF accumulation measured on cross-sectional computed tomography at the level of the umbilicus. Twelve patients had high VF accumulation (> or =100 cm2) and 18 had low VF accumulation (group had a significantly longer operation time and significantly more operative blood loss than the low-VF-accumulation group. There was no significant difference in the rate of postoperative complications or conversion to open laparotomy between the two groups. There were no operative deaths or requirements for blood transfusion in either group. VF accumulation was significantly correlated with operative difficulties during LADG. Although LADG was as safe for patients with high VF accumulation as for patients with low VF accumulation, a longer operative time and more operative blood loss were observed in patients with high VF accumulation. VF accumulation appears to be a possible risk factor in LADG and should be considered when making a decision about treating early gastric cancer with LADG.
Nervil, G G; Medici, R; Thomsen, J L D; Staehr-Rye, A K; Asadzadeh, S; Rosenberg, J; Gätke, M R; Madsen, M V
Recently, studies have focused on how to optimize laparoscopic surgical workspace by changes in intra-abdominal pressure, level of muscle relaxation or body position, typically evaluated by surgeons using subjective rating scales. We aimed to validate two rating scales by having surgeons assess surgical workspace in video sequences recorded during laparoscopic surgery. Video sequences were obtained from laparoscopic procedures. Eight experienced surgeons assessed the video sequences on a categorical 5-point scale and a numerical 10-point rating scale. Intraclass correlations coefficients (ICC) and 95% confidence intervals (CI) were calculated for intra- and inter-rater reliability. The 5-point rating scale had an intra-rater ICC of 0.76 (0.69; 0.83) and an inter-rater ICC of 0.57 (0.45; 0.68), corresponding to excellent and fair reliability, respectively. The 10-point scale had an intra-rater ICC of 0.86 (0.82; 0.89) and an inter-rater ICC of 0.54 (0.39; 0.68), corresponding to excellent and fair as well. All surgeons used the full range of the 5-point scale, but only one surgeon used the full range of the 10-point scale. In conclusion, both scales showed excellent intra-rater and fair inter-rater reliability for assessing surgical workspace in laparoscopy. The 5-point surgical rating scale had all categories employed by all surgeons. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Huber, T; Paschold, M; Hansen, C; Lang, H; Kneist, W
For virtual reality laparosopic simulation we developed a new, highly immersive simulation mode. The goal of the current pilot study was to investigate if kinetosis or other negative vegetative side effects can be caused by a total virtual training set-up (TVRL). In this study 20 participants with varying degrees of expertise in laparoscopy performed 3 tasks (i.e. ring exchange, fine dissection and cholecystectomy) in regular (VRL) and immersive mode (TVRL) with a head-mounted display (HMD) on a laparoscopic simulator. Aside from performance scores, the heart rate was recorded and the occurrence of vertigo was investigated. Surgical performance was independent of the VR mode (VRL or TVRL). Participants' heart rate was higher in TVRL without reaching statistical significance. Kinetosis occurred in two participants (10%) with a history of motion sickness. Laparoscopic training can take place in a total virtual environment with limited nagative vegetative side effects. Special attention should be paid to participants with a history of motion sickness. The development of TVRL enables new perspectives for surgical training.
Takahashi, Toshiaki; Miyano, Go; Shiyanagi, Satoko; Lane, Geoffrey J; Yamataka, Atsuyuki
We aimed at assessing the effect of using a "Funada-kit II" device during laparoscopy-assisted percutaneous endoscopic gastrostomy (Lap-PEG), by reviewing 29 cases of Lap-PEG we performed from 2001 to 2011. We started using the "Funada-kit II" (CREATE MEDIC CO., Kanagawa, Japan) device with two parallel needles to puncture the stomach and assist suturing the anterior gastric wall to the anterior abdominal wall during Lap-PEG in 2011 (F-PEG). By introducing a loop through the lumen of one needle which allows placement of a suture introduced through the lumen of the other needle. Once repeated, the stomach can be pexied at two points, approximately 2 cm apart. We compared Lap-PEG (n = 23) with F-PEG (n = 6) where the mean ages and weights at surgery and sex ratios were similar. All cases were uneventful without intraoperative complications, although one postoperative wound infection occurred in a Lap-PEG case. There were no differences in the duration of analgesia, time taken to commence tube feeding, and return to full feeding. However, mean operating time was significantly shorter in F-PEG (28.1 min) versus Lap-PEG (46.1 min) p < 0.05. As per results F-PEG would appear to be as safe as Lap-PEG, but much quicker.
Chen, Ching-Hui; Chiu, Li-Hsuan; Chang, Ching-Wen; Yen, Yuan-Kuei; Huang, Yan-Hua; Liu, Wei-Min
The aim of this study was to compare the outcomes of robotic surgery, laparoscopy, and laparotomy for the surgical treatment of stage IA to IIB cervical cancer. This retrospective study was carried out in a university-affiliated teaching hospital. A total of 100 women with an initial diagnosis of stage IA to IIB cervical cancer, without preoperative brachytherapy or chemotherapy, were included in this study. With selection of the cases, 44 patients received laparotomy surgery, 32 patients received laparoscopic surgery, and 24 patients received robotic surgery. The perioperative parameters measured included operation time, blood loss, transfusion rate, lymph node yield, adhesion score, laparotomy conversion rate, postoperative and 24-hour pain scores, time to full diet resumption, and hospital stay. The perioperative complication and disease-free survival were also evaluated. The robotic group showed a shorter operation time, less blood loss, lower transfusion rate, and lower laparotomy conversion rate than the laparoscopic or laparotomy group. As for the postoperative parameters, the robotic group showed reduced postoperative and 24-hour pain scores, shortened length of hospital stay, and decreased time to full diet resumption compared with the other 2 surgical groups. No significant differences were found between the groups in perioperative complication rate or disease-free survival. The data suggested that robotic surgery is a feasible and potentially optimal option for the treatment of stage IA to IIB cervical cancer with favorable short-term surgical outcomes.
Ye, Bin; Wang, Liqiang; Duan, Huilong
Light-emitting diodes (LEDs) bring great flexibility in color choice and high luminous efficacy design for biomedical illumination. Based on the state-of-the-art LED chips, a three-chip LED illumination system was developed specially for laparoscopy and minimal access surgery. White light is produced by mixing three specific wavelengths of amber red, true green and blue, and then coupled into a fiber-optic light guide with 2mm diameter. The whole device has a compact size of 145mm × 92mm × 84 mm which is more suitable than a conventional xenon lamp source for portable endoscopes. The illuminance and color characteristic of the three-chip model were analyzed, compared to those of traditional light source. A maximum illuminance of 1960 lux was obtained at the distance of 100 mm, with the average current of 450 mA of the LEDs. Additionally, a simulation environment had been set up to find out the performance of the endo-illuminator in the specific circumstance, which was closer distance and crawl space. Experiments showed that images taken under the three-chip LED illumination had better contrast and saturation. With the temperature of 31.5 degrees Celsius at the end of the fiber bundle, the endo-illuminator is also a cold light source.
Full Text Available Postoperative nausea and vomiting (PONV are still a significant problem in modern anesthetic practice. Discomfort caused by PONV intensifies other unpleasant elements of recovery, such as pain, frustration or fear. PONV also generates aversion to future anesthesia and have a negative impact on staff and patient's family. PONV can increase the cost of completing a surgical procedure, because it extends the time a patient spends in the postanesthesia care unit (PACU or delay discharge of ambulatory patients. It is generally accepted that the incidence of PONV after general anesthesia for various types of surgery in the last decade is still between 20-30%, and 70% in laparoscopic abdominal surgery. The incidence is three times higher in females compared to males. Many factors are involved in triggering PONV, such as patientrelated factors, the type of surgery, anesthesia management, etc. The results of this study suggest that the patient positioning (modified supine lithotomy position with ''Trendelenburg" increases the risk of PONV in gynecologic laparoscopy.
V. V. S. S. Chandrasekharam
Full Text Available Aim: To evaluate an alternative way of reducing intussusceptions under laparoscopic guidance. Materials and Methods: This is a retrospective observational study of children who underwent laparoscopy-assisted hydrostatic in situ reduction of intussusceptions (LAHIRI. Under general anesthesia with laparoscopic vision, warm saline was infused into the rectum with a 16-18 F Foley catheter and a drip set till the intussusception was reduced. Results: Eleven patients [age 7.8 (±2.8 months] were operated over a period of 1 year. Ten (90.9% patients had ileocolic intussusception, which got completely reduced, but one (9% had ileo-ileocolic intusussception, in whom manual reduction by extending the subumbilical incision was required to reduce the ileoileal part. The mean duration of surgery was 38.5 (±6.6 min. No patient had bowel ischemia and there were no intra- or postoperative complications. Conclusions: LAHIRI appears to be an effective and safe technique in children. Specific advantages are that it is performed in a controlled environment in the operating room, avoids patient apprehension and discomfort, avoids bowel handling, provides a safe opportunity to create higher intraluminal pressure, ensures visual assessment of bowel vascularity and completeness of reduction.
María Fernanda Gómez-Ramírez
Full Text Available Introduction: Due to the growing economical and ethical limitations in surgeons training for minimally invasive surgery (mis, e.g. laparoscopy, this study aims at evaluating the effect of a continuous practice of a particular videogame on the development of the fundamental and specific skills needed to perform this type of procedure successfully. Materials and methods: To evaluate the effectiveness of video game practicing, three essential and common activities were chosen (cutting, suturing, and eye-hand coordination to be performed in laparoscopic simulators. Eight different indexes or variables of performance were measured in the three activities. Fourteen voluntaries without previous experience in surgery were divided in two groups (intervention and control and their performance was evaluated before and after a one-month standardized training program with the video game Marble Mania®. Results: A general improvement of all the performance variables was observed after one month training in the intervention group. This improvement was significant with respect to the control group in three of the eight variables: suturing errors (p = 0.003, and the execution and number of errors in the eye-hand coordination (p = 0.025 and 0.001, respectively.
Technical Notes: Notes and Proposed Guidelines on Updated Seismic Codes in Ethiopia - Implication for Large-Scale Infrastructures. ... basic seismic design philosophy to focus on performance basis are provided. Key-words seismic design, building code, seismic hazard, earthquake, infrastructure, codes and standards.
Dunn Emmett Reid
Full Text Available The Lizard Genus Echinosaura (Teiidae in Colombia / Notes on the habits of the Tadpole-Carrying Frog Hyloxalus granuliventris / A New Marsupian Frog (Gastrotheca from Colombia The Lizard Genus Echinosaura (Teiidae in Colombia / Notes on the habits of the Tadpole-Carrying Frog Hyloxalus granuliventris / A New Marsupian Frog (Gastrotheca from Colombia.
Grenader, Tal; Plotkin, Yevgeni; Mohammadi, Borzoueh; Dawas, Khaled; Hashemi, Majid; Mughal, Muntzer; Bridgewater, John A
Despite advances in imaging techniques, peritoneal and/or metastatic disease have been identified by staging laparoscopy in up to 50 % of patients with a negative preoperative imaging. Neutrophil to lymphocyte ratio (NLR) has been recently shown as a prognostic factor in gastric and esophageal cancers. We retrospectively reviewed the medical records of 117 patients with early gastric and lower esophagus adenocarcinoma that were referred for staging laparoscopy in the last two years in the University College Hospital, London. Complete blood count was performed preceding staging laparoscopy. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count; a high NLR was defined ≥3.28. We evaluated the predictive power of a high NLR for a positive staging laparoscopy. The median age was 66.7 years; 87 (74.4 %) were male. Forty-four percent of the tumors were located at the gastroesophageal junction, 18 % were esophageal, and 38 % were gastric. Twenty-five (21.4 %) patients were found to have peritoneal or metastatic disease on staging laparoscopy. NLR ≥3.28 was an independent predicting factor for the discovery of peritoneal and/or metastatic disease (OR 3.9, 95 % CI: 1.54-9.86, p = 0.005). The median value of NLR was significantly higher in patients for whom the laparoscopy had discovered peritoneal or metastatic disease, than in those it had not (3.3 vs. 2.2, p = 0.011). Our findings suggest that the NLR may be reliable for predicting the presence of peritoneal or metastatic involvement on staging laparoscopy, in patients with early gastric cancer or lower esophageal cancer.
Suggests that students can learn the physics of a musical note by learning how to synthesize sounds on a computer. Discusses ADSR (attack, decay, sustain, and release of a note) and includes a program (with listing) which students can use to examine ADSR on a Commodore 64 microcomputer. (JN)
The principles of laparoscopic and robotic surgery are fascinating. These have brought unprecedented transformation in the field of surgery. It is quite interesting to note the practice of the same core principles in the pages of history and mythology.
de Jesus, Victor Hugo Fonseca; da Costa Junior, Wilson Luiz; de Miranda Marques, Tomás Mansur Duarte; Diniz, Alessandro Landskron; de Castro Ribeiro, Héber Salvador; de Godoy, André Luis; de Farias, Igor Correia; Coimbra, Felipe José Fernandez
Proper staging is critical to the management of pancreatic ductal carcinoma (PDAC). Laparoscopy has been used to stage patients without gross metastatic disease with variable success. We aimed to identify the frequency of patients diagnosed by laparoscopy with occult metastatic disease. Also, we looked for variables related to a higher chance of occult metastasis. Patients with PDAC submitted to staging laparoscopy either immediately before pancreatectomy or as a separate procedure between January 2010 and December 2016 were included. None presented gross metastatic disease at initial staging. We used logistic regression to search for variables associated with metastatic disease. The study population consisted of 63 patients. Among all patients, nine (16.7%) had occult metastases at laparoscopy. Unresectable tumor (Odds ratio = 18.0, P = 0.03), increasing tumor size (Odds ratio = 1.36, P = 0.01), and abdominal pain (Odds ratio = 5.6, P = 0.04) significantly predicted the risk of occult metastases in univariate analysis. In multivariate analysis, only tumor size predicted the risk of occult metastases. Laparoscopy remains a valuable tool in PDAC staging. Patients with either large or unresectable tumors, or presenting with abdominal pain present the highest risk for occult intra-abdominal metastases. © 2018 Wiley Periodicals, Inc.
Wells, K M; Shalabi, H; Sergelen, O; Wiessner, P; Zhang, C; deVries, C; Price, R
In 2005, the general population of Mongolia was not aware of laparoscopic surgery and was skeptical about the safety of surgical care. A 9-year initiative to expand laparoscopic surgery was initiated by Mongolian surgeons. This study examines the current barriers to and perceptions of surgical care following laparoscopic surgical expansion countrywide. In September 2013, interviews were conducted with 71 patients, and 39 physicians in Mongolia. Patients and physicians were interviewed using separate sets of interview questions. Questions were designed to gauge perceptions of surgical care in Mongolia evaluating for access, affordability, sustainability, barriers to care, quality, and knowledge of laparoscopy. Responses were fine coded for statistical analysis. 79 % of patients felt surgical care was improving in Mongolia, and 76 % would choose laparoscopy if available. Physicians (100 %) felt laparoscopic surgery had improved surgical care in Mongolia. Barriers to care for patients were time to work up and diagnosis (37 %), and funding an operation (39 %). None of the 36 % of patients who stated funding an operation would be difficult identified government sources of funding (p laparoscopy. 74 % of physicians felt that Mongolian physicians return or stay in Mongolia after training, defying the trend of migration in low-resource settings. Improved local patient and physician perception of laparoscopy is propelling the expansion of laparoscopy in Mongolia.
Coronado, Pluvio J; Fasero, María; Magrina, Javier F; Herraiz, Miguel A; Vidart, José A
To compare perioperative outcomes and cost of robotic-assisted and laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) for treatment of gynecologic malignant conditions. Prospective non-randomized study (Canadian Task Force classification II-2). Tertiary center for women's health. Sixty-two patients with gynecologic cancer operated on by the same surgical team. Thirty-two patients underwent TIPAL via robotic-assisted laparoscopy, and 30 via conventional laparoscopy. Comparison analyses of perioperative outcomes and estimated costs were performed. There were no differences between robotic-assisted and laparoscopy insofar as age, body mass index, presurgical morbidity, operating time (92.5 minutes for robotics vs 96.6 minutes for laparoscopy), number of aortic nodes (12 vs. 12), hospitalization stay (2 vs. 2 days), or rate of complications (12.5% vs. 13.3%). Blood loss tended to be lower in the robotic group (75.0 vs. 92.5 mL; p = .08). Surgical cost was higher in the robotic group ($3.42 vs. $2.55; p laparoscopy provide similar perioperative outcomes. However, the robotic-assisted approach is associated with higher surgical cost. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.
Kishi, Kentaro; Fujiwara, Yoshiyuki; Yano, Masahiko; Motoori, Masaaki; Sugimura, Keijiro; Takahashi, Hidenori; Ohue, Masayuki; Sakon, Masato
Successful cases have shown that conversion surgery after chemotherapy improves the prognosis of advanced gastric cancer. However, it is necessary to carefully select patients who have no unresectable factors prior to surgery. We recently reported that diagnostic laparoscopy with photodynamic diagnosis using oral 5-aminolevulinic acid (ALA-PDD) is a promising tool for diagnosing early peritoneal metastasis in gastric cancer. We herein evaluated the usefulness of this technique for detecting peritoneal metastases of advanced gastric cancer after chemotherapy. Diagnostic laparoscopy using sequential white light (WL) and ALA-PDD observations was performed in 38 patients with advanced gastric cancer after chemotherapy. The sensitivity of ALA-PDD for detecting peritoneal disease was compared with that of WL. The relationship between the state of peritoneal metastasis assessed by ALA-PDD and a cytological examination of the peritoneal fluid was evaluated. Twelve of the 38 patients (32 %) were diagnosed with peritoneal metastases by conventional laparoscopy. However, laparoscopy with ALA-PDD detected peritoneal metastases in 4 (11 %) of the 26 remaining patients. Three of these 4 patients had negative cytological results from the evaluation of the peritoneal fluid. Diagnostic laparoscopy using ALA-PDD is a useful technique for detecting metastases and determining treatment strategies to select patients with advanced gastric cancer who have received chemotherapy.
Feng, Fan; Li, Xiao Hua; Shi, Hai; Wu, Guo Sheng; Zhang, Hong Wei; Liu, Xiao Nan; Zhao, Qing Chuan
In this study we aimed to assess the feasibility and safety of fast-track surgery (FTS) combined with laparoscopy for treating patients with rectal cancer and compare the results with those of the conventional perioperative intervention group. A total of 120 patients with rectal cancer were prospectively randomly assigned to the FTS combined with laparoscopy group and the conventional perioperative intervention plus laparoscopy group from November 2011 to November 2012. All patients received radical anterior resection with total mesorectal excision. Their baseline characteristics and the perioperative outcomes were recorded for analyses. Compared with the conventional perioperative intervention group, the fast-track protocol combined with laparoscopy could shorten the time to the first flatus (53.44 ± 23.64 h vs 67.85 ± 20.12 h, P = 0.001) and first defecation (65.23 ± 22.24 h vs 86.98 ± 24.85 h, P = 0.000) after operation, accelerate the decrease of white blood cell count (P laparoscopy may accelerate the clinical recovery of patients with rectal cancer after surgery. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.
Miyano, Go; Ochi, Takanori; Lane, Geoffrey J; Okazaki, Tadaharu; Yamataka, Atsuyuki
We compared laparoscopy-assisted Duhamel (Lap-D) with open surgery (Duhamel or Soave = D/S) for treating total colonic aganglionosis (TCA) in children to establish what factors may affect outcome. Fourteen TCA cases treated between 1990 and 2010 were reviewed. Open D/S (O-D/S) through a vertical midline abdominal incision was routine from 1990 to 2005, whereupon Lap-D became routine. Lap-D involves laparoscopic colon resection, ileostomy take-down, and ileum pull-through through an additional Pfannenstiel incision. We compared pre-operative nutrition, operating time, intraoperative blood loss, duration until oral challenge, postoperative analgesic usage, incidence of enterocolitis, early complications that arose within 30 days of surgery, and late complications, and wound cosmesis 1 year postoperatively (Grade-1: unacceptable, Grade-2: passable, Grade-3: excellent). Six had O-D/S (2D, 4S) and eight had Lap-D. Differences in patient demographics, mean ages/weights at surgery, average length of the aganglionic segment from the terminal ileum, operating time, and time taken for oral challenge were all not significant, full feeding took longer in O-D/S (6.7 vs. 5.9 days). Preoperative central vein intravenous hyperalimentation was required for one case in O-D/S and two cases in Lap-D. These three required hospitalization for at least 30 days postoperatively and parenteral nutrition after discharge. Although there were no intraoperative complications in either group, there was one case of transient ileus in O-D/S that resolved conservatively. Cosmesis was significantly better in Lap-D (O-D/S = 1.2; Lap-D = 2.1; p < 0.05). Cosmesis was the only factor that was significantly different between Lap-D and O-D/S; all other factors were similar.
Miyano, Go; Miyahara, Katsumi; Halibieke, Abudebieke; Lane, Geoffrey J; Okazaki, Tadaharu; Yamataka, Atsuyuki
We tested our laparoscopy-assisted "open" ligation (LOL) technique on testicular vessels. We ligated the left testicular artery and vein (TAV) in 8-week-old male Wister rats using LOL (LOL group; n=10) or laparotomy (open group; n=10). In LOL, a 0-degree laparoscope was introduced through a 5-mm epigastric trocar. A 3-mm grasper was used to expose the left TAV. A lapa-her-closure (LHC) needle loaded with 3-0 SurgiPro was directly inserted into the left lower quadrant where the left TAV should be and advanced under the vessels, and the suture material was released leaving one end outside. The LHC was then withdrawn a little and advanced again over the vessels to grasp the end of the suture material just released to bring it outside. This was proximally repeated. The two ends of both sutures were conventionally tied outside, and the knot was passed through the insertion site and tightened around the vessels. In the open group, the left TAV were ligated using two 3-0 SurgiPro ties. In both groups, the right side was left intact. All rats were sacrificed 2 weeks postoperatively, and both testes were examined with hematoxylin and eosin. Treatment time was 5-7 minutes for LOL and 7-8 minutes for the open group. Postoperative recovery was uneventful. No adhesions were present between the ligated vessels and bowel in any rat. Histopathology of all left testes showed coagulative necrosis of germinal cells and seminiferous tubules; all right testes were normal. LOL appears to be as effective as open ligation and may find application for treating varicocele.
Date, S; Noguchi, H; Kaku, K; Kurihara, K; Miyasaka, Y; Okabe, Y; Nakamura, U; Ohtsuka, T; Nakamura, M
Living pancreas transplantation plays an important role in the treatment of patients with severe type 1 diabetes. However, pancreatectomy is very invasive for the donor, and less-invasive surgical procedures are needed. Although some reports have described hand-assisted laparoscopic surgery for distal pancreatectomy in living-donor operations, less-invasive laparoscopy-assisted (LA) procedures are expected to increase the donor pool. We herein report the outcomes of four cases of LA spleen-preserving distal pancreatectomy (Warshaw technique [WT]) in living pancreas donors. Four living pancreas donors underwent LA-WT at our institution from September 2010 to January 2013. All donors fulfilled the donor criteria established by the Japan Society for Pancreas and Islet Transplantation. The median donor age was 54 years. Two donors underwent left nephrectomy in addition to LA-WT for simultaneous pancreas-kidney transplantation. The median donor operation time for pancreatectomy was 340.5 minutes. The median pancreas warm ischemic time was 3 minutes. The median donor blood loss was 246 g. All recipients immediately achieved insulin independence. One donor required reoperation because of obstructive ileus resulting from a port-site hernia. Another donor developed a pancreatic fistula (International Study Group of Pancreatic Fistula grade B), which was controlled with conservative management. After a maximum follow-up of 73 months, no clinically relevant adverse events had occurred. These results were comparable with those of previous studies concerning living-donor pancreas transplantation. The LA-WT is a safe and acceptable operation for living-donor pancreas transplantation. Copyright © 2017 Elsevier Inc. All rights reserved.
Sekimoto, Tadashi, E-mail: email@example.com [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Maruyama, Hitoshi, E-mail: firstname.lastname@example.org [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Kondo, Takayuki, E-mail: email@example.com [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Shimada, Taro, E-mail: firstname.lastname@example.org [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Takahashi, Masanori, E-mail: email@example.com [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Yokosuka, Osamu, E-mail: firstname.lastname@example.org [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Otsuka, Masayuki, E-mail: email@example.com [Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Miyazaki, Masaru, E-mail: firstname.lastname@example.org [Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Mine, Yoshitaka, E-mail: email@example.com [Toshiba Medical Systems Corporation, Ultrasound Systems Division, Ultrasound Systems Development Department, Otawara, Tochigi (Japan)
Objective: To examine the potential utility of 3D-reconstructed sonograms to distinguish cirrhotic from non-cirrhotic livers by demonstrating hepatic surface characteristics. Materials and methods: A preliminary phantom study was performed to examine the potential resolution of 3D images, recognizing surface irregularities as a difference in height. In a prospective clinical study of 31 consecutive patients with ascites (21 cirrhosis, 10 non-cirrhosis), liver volume data were acquired by transabdominal mechanical scanning. The hepatic surface features of cirrhotic and non-cirrhotic patients were compared by 2 independent reviewers. Intra- and inter-operator/reviewer agreements were also examined. Results: The phantom study revealed that 0.4 mm was the minimum recognizable difference in height on the 3D sonograms. The hepatic surface image was successfully visualized in 74% patients (23/31). Success depended on the amount of ascites; visualization was 100% with ascites of 10 mm or more between the hepatic surface and abdominal wall. The images showed irregularity of the hepatic surface in all cirrhotic patients. The surface appearance was confirmed as being very similar in 3 patients who had both 3D sonogram and liver resection for transplantation. The ability to distinguish cirrhotic liver from non-cirrhotic liver improved with the use of combination of 2D- and 3D-imaging versus 2D-imaging alone (sensitivity, p = 0.02; accuracy, p = 0.02) or 3D-imaging alone (sensitivity, p = 0.03). Intra-/inter-operator and inter-reviewer agreement were excellent (κ = 1.0). Conclusion: 3D-based sonographic visualization of the hepatic surface showed high reliability and reproducibility, acting as a virtual laparoscopy method, and the technique has the potential to improve the diagnosis of cirrhosis.
Oh, J.Y., E-mail: firstname.lastname@example.org [Department of Diagnostic Radiology, Dong-A University College of Medicine, Busan (Korea, Republic of); Cho, J.H.; Kang, M.J.; Lee, J.H.; Kwon, H.J.; Nam, K.J. [Department of Diagnostic Radiology, Dong-A University College of Medicine, Busan (Korea, Republic of); Kim, M.C. [Department of Surgery, Dong-A University College of Medicine, Busan (Korea, Republic of); Choi, H. [Department of Diagnostic Imaging, University of Texas, M.D. Anderson Cancer Center, Houston, TX (United States)
Aim: To investigate the computed tomography (CT) imaging features of omental infarction in patients who underwent laparoscopy-assisted gastrectomy (LAG) for gastric cancer. Materials and methods: A retrospective study was performed on 390 patients who underwent LAG for gastric cancer. Two radiologists evaluated the CT images for the presence of omental infarction. The CT pattern was characterized at initial presentation and the evolutional changes were evaluated. The initial CT appearance of omental infarctions were categorized into the following four types: type 1 (ill-defined, heterogeneous, fat density lesion); type 2 (well-defined fat density lesion with rim enhancement); type 3 (well-defined heterogeneous lesion with fat component); and type 4 (well-defined heterogeneous lesion without a fat component). Results: Of the 390 patients involved, nine patients (2.3%; six male and three female with a mean age of 57 years) were diagnosed with omental infarction. Infarctions averaged 4.1 cm (range 2-7.3 cm) in diameter. Among nine patients with omental infarction, two patients had type 1 lesions, two had type 2, two had type 3, and three type 4. All infarctions became smaller and better defined with evolution. In two patients who presented with type 1 lesions on initial CT, each lesion was progressed to type 2 and type 3 on follow-up CT. In two patients with type 3 lesions on initial CT, the lesions changed to type 4 on follow-up CT. Conclusion: An awareness of the various CT features and evolutional changes in omental infarction after LAG for gastric cancer can help ensure the correct diagnosis and to avoid misdiagnosis for omental implants.
McCartan, D P
Aim The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis. Method Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy. Results The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048). Conclusion This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.
Sekimoto, Tadashi; Maruyama, Hitoshi; Kondo, Takayuki; Shimada, Taro; Takahashi, Masanori; Yokosuka, Osamu; Otsuka, Masayuki; Miyazaki, Masaru; Mine, Yoshitaka
Objective: To examine the potential utility of 3D-reconstructed sonograms to distinguish cirrhotic from non-cirrhotic livers by demonstrating hepatic surface characteristics. Materials and methods: A preliminary phantom study was performed to examine the potential resolution of 3D images, recognizing surface irregularities as a difference in height. In a prospective clinical study of 31 consecutive patients with ascites (21 cirrhosis, 10 non-cirrhosis), liver volume data were acquired by transabdominal mechanical scanning. The hepatic surface features of cirrhotic and non-cirrhotic patients were compared by 2 independent reviewers. Intra- and inter-operator/reviewer agreements were also examined. Results: The phantom study revealed that 0.4 mm was the minimum recognizable difference in height on the 3D sonograms. The hepatic surface image was successfully visualized in 74% patients (23/31). Success depended on the amount of ascites; visualization was 100% with ascites of 10 mm or more between the hepatic surface and abdominal wall. The images showed irregularity of the hepatic surface in all cirrhotic patients. The surface appearance was confirmed as being very similar in 3 patients who had both 3D sonogram and liver resection for transplantation. The ability to distinguish cirrhotic liver from non-cirrhotic liver improved with the use of combination of 2D- and 3D-imaging versus 2D-imaging alone (sensitivity, p = 0.02; accuracy, p = 0.02) or 3D-imaging alone (sensitivity, p = 0.03). Intra-/inter-operator and inter-reviewer agreement were excellent (κ = 1.0). Conclusion: 3D-based sonographic visualization of the hepatic surface showed high reliability and reproducibility, acting as a virtual laparoscopy method, and the technique has the potential to improve the diagnosis of cirrhosis
Bakkegaard, Riyong Kim; Bee, Skylar; Naswa, Prakriti
needs and low capability, would need means of implementation (MoI) for adaptation and to take ambitious mitigation actions. Developing countries would include MoI needs in the context of mitigation and adaptation. The note explains briefly how countries can identify their unconditional contributions.......The objective of this note is to explain the elements of the Lima Decision and its implications for developing INDCs. Further, the note explains different ways in which countries could express the mitigation and adaptation components of their INDC. Developing countries, given their development...
Bentzen, Thomas Ruby
note is divided into four main topics: First, a short review of the precipitation in Denmark as well as how historical (actual) rainfall data can be used advantageously to those simple design methods, then how pipelines and reservoirs can be dimensioned and finally how safety in the design can......This technical note will present simple but widely used methods for the design of drainage systems. The note will primarily deal with surface water (rainwater) which on a satisfactorily way should be transport into the drainage system. Traditional two types of sewer systems exist: A combined system...
Han, Ding-Pei; Lu, Ai-Guo; Feng, Hao; Wang, Pu-Xiong-Zhi; Cao, Qi-Feng; Zong, Ya-Ping; Feng, Bo; Zheng, Min-Hua
To study the feasibility, safety, and short-/long-term outcomes of laparoscopy-assisted right hemicolectomy with D3 lymphadenectomy for colon cancer. The clinical data of 177 cases that underwent laparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy for colon cancer between Jun 2003 and Sep 2010 was collected; the safety of operation, status of recovery, complication, oncological outcomes, and results of short-/long-term follow-up were analyzed. No case died in this study; five cases (2.82 %) were converted to open surgery. Four cases (2.26 %) underwent hand-assisted laparoscopic right hemicolectomy. The average operation time was 133 ± 36 min, and the blood loss was 94 ± 34 ml. The average time for passage of flatus, liquid food eating, and hospitalization were 2.1 ± 0.7, 3.2 ± 0.5, and 10.4 ± 2.7 day, respectively. The total number of lymph nodes removed was 15.2 ± 10.1. Postoperative complications were observed in 23 of 177 patients (12.99 %). The median follow-up period was 54 months; port-site recurrence was observed in one patient; local recurrence was found in five cases (2.82 %); distant metastasis was found in 21 cases (11.86 %). The cumulative overall survival of all stages at 12, 36, 60, and 72 months was 97.18 %, 83.73 %, 70.37 %, and 68.99 %, respectively. The cancer-specific survival was 98.73 % (12 months), 87.81 % (36 months), and 80.17 % (60 months). Laparoscopy-assisted right hemicolectomy with D3 lymphadenectomy can be successfully performed for right colon cancer with the advantages of minimally invasive surgery. Moreover, the results implied appropriate short- and long-term outcomes.
He, Mingliang; Ouyang, Leping; Wang, Shengwen; Zheng, Meiguang; Liu, Anmin
OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25-0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8-23), operative time was shorter (mean difference [MD], -12.84; 95% CI -20.68 to -5.00; p = 0.001), and blood loss was less (MD -9.93, 95% CI -17.56 to -2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD -1.77, 95% CI -3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.
... Issue Past Issues Special Section A Note on Complementary Medicines Past Issues / Winter 2007 Table of Contents For ... meditation, chiropractic manipulation, and acupuncture are types of complementary and alternative medicine (CAM) currently being used by millions of Americans. ...
Lectures notes (in italian) of some arguments of classical analysis, with exercises. A particular emphasis to functional analysis and elementary operator algebra theory is given, by means of exercises and examples.
Hendriks, M L; König, T; Korsen, T; Melgers, I; Dekker, J; Mijatovic, V; Schats, R; Hompes, P G A; Homburg, R; Kaaijk, E M; Twisk, J W R; Lambalk, C B
Which reproductive endocrine changes are attributed exclusively to laparoscopic ovarian drilling in polycystic ovarian syndrome (PCOS)? Laser evaporation-specific endocrine effects were the prevention of an immediate increase in inhibin B and a sustained decrease in testosterone, androstenedione and anti-Müllarian hormone (AMH). All ovarian drilling procedures result in reproductive endocrine changes. It is not known which of these changes are the result of ovarian drilling and which are related to the surgery per se. This prospective controlled study was performed at an outpatient academic fertility clinic. Between 2007 and 2010, a total of 21 oligo- or amenorrheic PCOS patients were included. Included were oligo- or amenorrheic PCOS patients with all three of the Rotterdam criteria and luteinizing hormone (LH) >6.5 U/l. All PCOS patients had an indication for diagnostic surgery due to subfertility. There were 12 PCOS patients who chose to undergo ovarian laser evaporation (CO2 laser, 25 W, 20 times/ovary) and 9 PCOS who chose a diagnostic laparoscopy only (controls). Reproductive endocrinology was measured before, and until 5 days after, surgery, and four gonadotrophin-releasing hormone (GnRH) 'double pulse' tests were included. The main outcome measures were changes in reproductive endocrinology and pituitary sensitivity/priming to GnRH after laser evaporation compared with diagnostic laparoscopy only. In the first hours after surgery, both groups showed an increase in LH, follicle stimulating hormone, estrogen and a decrease in testosterone, androstenedione, AMH and insulin growth factor-1 (P evaporation or laparoscopy only. The limitations of this study are the short follow-up period and the relatively small groups. The strength of this study is the integrally measured endocrine profiles in combination with an optimal control group of PCOS patients undergoing diagnostic laparoscopy only. Interestingly, most of the immediate endocrine changes after laser
A Ponzi scheme is an arrangement whereby a promoter offers an investment opportunity with attractive dividends, but where the only basis for the dividends is the future receipts from new investors. The first of these two notes explores some of the analytical properties of a Ponzi scheme, addressing in particular the question whether it is possible for a Ponzi scheme to exist if all the participants are rational. The second note briefly examines the collapse of the PMPA insurance company whos...
Please note that the SAFETY INSTRUCTION N0 49 (IS 49) and the SAFETY NOTE N0 28 (NS 28) entitled respectively 'AVOIDING CHEMICAL POLLUTION OF WATER' and 'CERN EXHIBITIONS - FIRE PRECAUTIONS' are available on the web at the following urls: http://edms.cern.ch/document/335814 and http://edms.cern.ch/document/335861 Paper copies can also be obtained from the TIS Divisional Secretariat, email: TIS.Secretariat@cern.ch
Strandby, Rune Broni; Svendsen, Lars Bo; Fallentin, E.
in the period 2010-2012 were retrospectively reviewed. Patient data were retrieved by searching for specific diagnosis and operation codes in the in-house system. The inclusion criteria were as follows: biopsy-verified cancer of the esophagus, gastroesophageal junction or stomach, and no suspicion of peritoneal......BACKGROUND: The implementation of the multidisciplinary team conference has been shown to improve treatment outcome for patients with gastric- and gastroesophageal cancer. Likewise, the staging laparoscopy has increased the detection of patients with disseminated disease, that is, patients who do...... carcinomatosis or liver metastases on multidisciplinary team conference before staging laparoscopy. Furthermore, an evaluation with staging laparoscopy was required. RESULTS: In total, 222 patients met the inclusion criteria. Most cancers were located in the gastroesophageal junction, n = 171 (77.0%), and most...
I. I. Kirsanov
Full Text Available BACKGROUND Misdiagnosis of acute appendicitis reaches 40%. Video laparoscopy allows the correct diagnosis to be establishedin 98.1%, and identify the other disease excluding the initial diagnosisin 1.6%, as well as to determine the optimal surgical approach and perform minimally invasive surgery, if possible.MATERIAL Clinical observation of 2 cases of perforation of the small intestine.CONCLUSION The use of laparoscopy in acute surgical disease of abdominal organs allows to establish the correct diagnosis and properly provide a therapy with a minimal surgical trauma.
... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Note account. 561.33 Section 561.33 Banks and... SAVINGS ASSOCIATIONS § 561.33 Note account. The term note account means a note, subject to the right of... States Treasury Department regulations. Note accounts are not savings accounts or savings deposits. ...
Van Sickle, K R; Gallagher, A G; Smith, C D
In the acquisition of new skills that are difficult to master, such as those required for laparoscopy, feedback is a crucial component of the learning experience. Optimally, feedback should accurately reflect the task performance to be improved and be proximal to the training experience. In surgery, however, feedback typically is in vivo. The development of virtual reality training systems currently offers new training options. This study investigated the effect of feedback type and quality on laparoscopic skills acquisition. For this study, 32 laparoscopic novices were prospectively randomized into four training conditions, with 8 in each group. Group 1 (control) had no feedback. Group 2 (buzzer) had audio feedback when the edges were touched. Group 3 (voiced error) had an examiner voicing the word "error" each time the walls were touched. Group 4 (both) received both the audio buzzer and "error" voiced by the examiner All the subjects performed a maze-tracking task with a laparoscopic stylus inserted through a 5-mm port to simulate the fulcrum effect in minimally invasive surgery (MIS). A computer connected to the stylus scored an error each time the edge of the maze was touched, and the subjects were made aware of the error in the aforementioned manner. Ten 2-min trials were performed by the subjects while viewing a monitor. At the conclusion of training, all the subjects completed a 2-min trial of a simple laparoscopic cutting task, with the number of correct and incorrect incisions recorded. Group 4 (both) made significantly more correct incisions than the other three groups (F = 12.13; df = 3, 28; p < 0.001), and also made significantly fewer errors or incorrect incisions (F = 14.4; p < 0.0001). Group 4 also made three times more correct incisions and 7.4 times fewer incorrect incisions than group 1 (control). The type and quality of feedback during psychomotor skill acquisition for MIS have a large effect on the strength of skills generalization to a simple
Aggarwal, R; Mishra, A; Crochet, P; Sirimanna, P; Darzi, A
Sleep deprivation affects surgical performance and has the potential to endanger patient safety. Pharmacological stimulants may counter this consequence of long working hours. This study aimed to investigate whether commonly available stimulants can counter the effects of fatigue on technical and neurocognitive skill. This was a single-blind crossover study of surgical novices trained to proficiency on the Minimally Invasive Surgical Trainer-Virtual Reality laparoscopic simulator. Participants were acutely sleep-deprived three times each, followed by administration of either placebo, 150 mg caffeine, or 150 mg caffeine combined with 2 g taurine before simulated laparoscopy. Outcome measures were: laparoscopic psychomotor skill, cognitive performance and the Stanford Sleepiness Scale (range 1-7). Rested baselines were gathered following completion of test sessions. Baseline performance was recorded for 18 participants in the rested state. Sleep-deprived participants receiving the placebo took longer (median 41 versus 35 s; P = 0·016), were less economical with movement (3·25 versus 2·95 m; P = 0·016) and made more errors (66 versus 59; P = 0·021) on the laparoscopic task compared with the rested state. Caffeine restored psychomotor skills to baseline for time taken (37 versus 35 s; P = 0·101), although the number of errors remained significantly greater than in the rested state (63 versus 59; P = 0·046). Sleep-deprived subjects receiving placebo had slower reaction times (377 versus 299 ms; P = 0·008) and a higher score on the Stanford Sleepiness Scale (6 versus 2 points; P = 0·001) than rested surgeons. Negative effects of sleep deprivation on reaction time were reversed when caffeine (307 ms versus 299 ms in rested state; P = 0·214) or caffeine plus taurine (326 versus 299 ms; P = 0·110) was administered. Subjective sleepiness was also improved, but not to baseline levels. Sleep deprivation affects laparoscopic psychomotor skills, reaction time and
Bourgin, C; Lambaudie, E; Houvenaeghel, G; Foucher, F; Levêque, J; Lavoué, V
This study aims to evaluate the different surgical approaches, perioperative morbidity and surgical staging according to age in patients with endometrial cancer. Multicentre retrospective study. Cancer characteristics and perioperative data were collected for patients surgically treated for endometrial cancer. The patients were divided into 2 groups according to their age: younger or older than 75 years. Surgery was performed on 270 women surgery was performed less often in the elderly compared with their younger counterparts (58.2% vs. 74.8%; p = 0.006). Independently of the surgical approach, the rate of pelvic and para-aortic lymphadenectomy was lower in women older than 75 years old than their younger counterparts (52.7% vs. 74.8%; p laparotomy, laparoscopy or robotic surgery group. We found a shorter length of hospital stay for the women who underwent laparoscopy or robotic surgery compared with laparotomy (p surgery and optimal surgical staging to the same extent as younger women. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Kullman, Mikael; Campillo, Javier; Dahlquist, Erik
Globally, more than 50% of all people are living in cities today. Enhancing sustainability and efficiency of urban energy systems is thus of high priority for global sustainable development. The European research project PLEEC (Planning for Energy Efficient Cities) focuses on technological......, innovative, behavioural and structural capacities of European medium-sized cities in their transition towards Energy Smart Cities. The variation of strengths and weaknesses of cities’ capabilities as well as practices and tools for enhancing energy efficient performance of urban energy systems were...
Physics Teacher, 1979
Some topics included are: the relative merits of a programmable calculator and a microcomputer; the advantages of acquiring a sound-level meter for the laboratory; how to locate a virtual image in a plane mirror; center of gravity of a student; and how to demonstrate interference of light using two cords.
This note was published for the public at the occasion of the admission to Euronext's Eurolist of the existing shares that make the capital of Gaz de France company, the French gas utility. The note gives some informations about Gaz de France activity, and about its strategy of development in the European gas market. Then it describes the offer relative to the opening of Gaz de France capital. Some selected financial data and some precision about the risk factors and the management of the company complete the document. (J.S.)
In  it is proved that mixtures of exponential distributions are infinitely divisible (id). In  it is proved that the same holds for the discrete analogue, i.e. for mixtures of geometric distributions. In this note we show that these results imply that a density function $f(x)$ (or distribution
The purpose of this note is to draw attention to two limitations of Churchill's war memoirs as a source of accurate information about Stalin, his views ans actions. they concern, first Stalin's alleged remarks in 1942 about collectivisation, and second Stalin's allleged response to Churchill's
Gregg, Newton D.
This set of lecture notes is used as a supplemental text for the teaching of fluid dynamics, as one component of a thermodynamics course for engineering technologists. The major text for the course covered basic fluids concepts such as pressure, mass flow, and specific weight. The objective of this document was to present additional fluids…