Sample records for conventional laparoscopic hysterectomy

  1. Robotic-Assisted Total Laparoscopic Hysterectomy Versus Conventional Total Laparoscopic Hysterectomy

    PubMed Central

    Gill, Diana; Locher, Stephen R.

    2009-01-01

    Objectives: To compare patient characteristics, operative variables, and outcomes of 24 patients who underwent robotic-assisted total laparoscopic hysterectomy (TLH) with 44 patients who underwent conventional TLH. We retrospectively reviewed the charts of 44 patients with TLH and 24 patients with robotic TLH. Results: Robotic TLH was associated with a shorter hospital stay (1.0 vs 1.4 days, P=0.011) and a significant decrease in narcotic use (1.2 vs 5.0 units, P=0.002). EBL and drop in hemoglobin were not significantly different. The operative time was significantly longer in patients undergoing robotic TLH (142.2 vs 122.1 minutes, P=0.027). However, only need for laparoscopic morcellation, BMI, and uterine weight, not robotic use, were independently associated with increased operative times. Conclusions: Robotic hysterectomy can be performed safely with comparable operative times to those of conventional laparoscopic hysterectomy. Postoperative measures were improved over measures for conventional laparoscopy. PMID:19793478

  2. Single-port access versus conventional multi-port access total laparoscopic hysterectomy for very large uterus

    PubMed Central

    Lee, Jinhwa; Kim, Sunghoon; Nam, Eun Ji; Hwang, Sun Mi; Kim, Young Tae

    2015-01-01

    Objective The aim of this study was to compare the surgical outcomes of single-port access (SPA) and conventional multi-port access total laparoscopic hysterectomies (TLH) among patients with very large uteri (500 g or more). Methods Fifty consecutive patients who received TLH for large uterine myomas and/or adenomyoses weighing 500 g or more between February 2009 and December 2012 were retrospectively reviewed. SPA and conventional TLH were each performed in 25 patients. Surgical outcomes, including operation time, estimated blood loss, postoperative hemoglobin change, postoperative hospital stay, postoperative pain, and perioperative complications, were compared between the two groups. Results There were no significant demographic differences between the two groups. All operations were completed laparoscopically with no conversion to laparotomy. Total operation time, uterus weight, estimated blood loss, and postoperative hemoglobin change did not significantly differ between the two groups. Postoperative hospital stay was significantly shorter for the SPA-TLH group compared to that of the conventional TLH group (median [range], 3 [2.0-6.0] vs. 4 [3-7] days; P=0.004]. There were no inter-group differences in postoperative pain at 6, 24, and 72 hours after surgery. There was only one complicated case in each group. Conclusion SPA-TLH in patients with large uteri weighing 500 g or more is as feasible as conventional TLH. SPA-TLH is associated with shorter hospital stays compared to that of conventional TLH.

  3. A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates

    Microsoft Academic Search

    Robert L Summitt; Thomas G Stovall; John F Steege; Gary H Lipscomb

    1998-01-01

    Objective: To compare intraoperative and postoperative outcomes between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy among patients who are not eligible for vaginal hysterectomy.Methods: Study subjects were randomly assigned to undergo laparoscopically assisted vaginal hysterectomy or standard abdominal hysterectomy. Intraoperative and postoperative management was similar for each group. Surgical characteristics, complications, length of hospital stay, charges, and convalescence were analyzed.Results:

  4. Is laparoscopic hysterectomy a waste of time?

    Microsoft Academic Search

    R. E Richardson; N Bournas; A. L Magos

    1995-01-01

    SummaryLaparoscopic hysterectomy (LH) is a way to avoid laparotomy. However, there is evidence that most women treated by abdominal hysterectomy are suitable for vaginal surgery. To test this hypothesis, and to determine the relative merits of laparoscopic and vaginal hysterectomy (VH) and the best technique for LH, we prospectively studied 98 women who had relative contraindications for vaginal surgery by

  5. Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience.

    PubMed

    van Evert, J S; Smeenk, J M J; Dijkhuizen, F P H L J; de Kruif, J H; Kluivers, K B

    2010-02-01

    At present, there are only few data on the surgical outcomes of laparoscopic hysterectomy (LH). Up till now, it has been unclear whether there is a difference in number of complications among the subcategories of laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LSH). Therefore, we have performed a retrospective analysis to evaluate the peri- and postoperative outcomes in women undergoing LSH versus LH. This multi-centre retrospective cohort study (Canadian Task Force classification II-2) was conducted in multi-centres (two teaching hospitals and one university medical centre) in the Netherlands, all experienced in minimally invasive gynaecology. In a multi-centre retrospective cohort study we compared the long-term outcomes of laparoscopic subtotal hysterectomy and laparoscopic total hysterectomy (including laparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy and total laparoscopic hysterectomy). All laparoscopic hysterectomies from the last 10 years (January 1998 till December 2007) were included. Patient characteristics, intra- and postoperative complications, operating time and duration of hospital stay were recorded. The minimum follow-up was 6 months. A total of 390 cases of laparoscopic hysterectomies were included in the analysis: 192 laparoscopic subtotal hysterectomies and 198 laparoscopic total hysterectomies. Patient characteristics such as age and parity were equal in the groups. The overall number of short-term and long-term complications was comparable in both groups: 17% and 15%. Short-term complications (bleeding, fever) were 3% in the LSH group and 12% in the LH group. Long-term complications were (tubal prolapse and cervical stump reoperations) 15% in the LSH group and 3% in the LH group. Laparoscopic subtotal hysterectomy as compared with the different types of laparoscopic total hysterectomy is associated with more long-term postoperative complications, whereas laparoscopic total hysterectomy is associated with more short-term complications. PMID:20234836

  6. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: A prospective, randomized, multicenter study

    Microsoft Academic Search

    Riccardo Marana; Mauro Busacca; Errico Zupi; Nicola Garcea; Pierluigi Paparella; Giovan Fiore Catalano

    1999-01-01

    Objective: The objective of this study was to evaluate short-term results of laparoscopically assisted vaginal hysterectomy with those of total abdominal hysterectomy in a prospective, randomized, multicenter study. Study Design: One hundred sixteen patients referred for abdominal hysterectomy were randomized to either laparoscopically assisted vaginal hysterectomy (58 patients) or abdominal hysterectomy (58 patients). Inclusion criteria were one or more of

  7. Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept

    PubMed Central

    Mettler, Liselotte; Peters, Goentje; Noé, Günter; Holthaus, Bernd; Jonat, Walter; Schollmeyer, Thoralf

    2014-01-01

    Background and Objectives: Today, laparoscopic intrafascial hysterectomy and laparoscopic supracervical hysterectomy are well-accepted techniques. With our multimodal concept of laparoscopic hysterectomy for benign indications, preservation of the pelvic floor as well as reconstruction of pelvic floor structures and pre-existing prolapse situations can be achieved. Methods: The multimodal concept consists of 3 steps: Intrafascial hysterectomy with preservation of existing structures Technique 1: Primary uterine artery ligationTechnique 2: Classic intrafascial hysterectomyA technique for the stable fixation of the vaginal or cervical stumpA new method of pectopexy to correct a pre-existing descensus situation Results and Conclustion: This well-balanced concept can be used by advanced endoscopic gynecologic surgeons as well as by novices in our field. PMID:24680150

  8. Laparoscopic subtotal hysterectomy: evidence and techniques.

    PubMed

    Nesbitt-Hawes, Erin M; Maley, Peta E; Won, Ha Ryun; Law, Kenneth S K; Zhang, Christine S; Lyons, Stephen D; Ledger, William; Abbott, Jason A

    2013-01-01

    Laparoscopic subtotal/supracervical hysterectomy (LSH) is a surgical option when hysterectomy is indicated. Proponents of LSH suggest possible advantages including reduced recovery time, decreased risk of pelvic organ prolapse, and decreased risk of organ damage, in particular to the urinary tract. Opponents of LSH have suggested that the future risk of cervical malignancy, the possibility of ongoing cyclical bleeding, limited morbidity due to total laparoscopic hysterectomy, and similar clinical outcomes render this approach unnecessary. One study compared LSH with laparoscopically assisted vaginal hysterectomy in a randomized controlled trial that reported psychologic and sexual outcomes; however, no clinical data were published. The present review outlines techniques for subtotal hysterectomy and critically appraises the available evidence for outcomes including operative data, short- and long-term complications, and functional outcomes. PMID:23510954

  9. Laparoscopic Ureteroneocystostomy for Ureteral Injuries After Hysterectomy

    PubMed Central

    Pompeo, Alexandre; Molina, Wilson R.; Sehrt, David; Tobias-Machado, Marcos; Mariano Costa, Renato M.; Pompeo, Antonio Carlos Lima

    2013-01-01

    Objectives: To examine the feasibility of early laparoscopic ureteroneocystostomy for ureteral obstruction due to hysterectomy injury. Methods: We retrospectively reviewed a 10-y experience from 2 institutions in patients who underwent early (<30 d) or late (>30 d) laparoscopic ureteroneocystostomy for ureteral injury after hysterectomy. Evaluation of the surgery included the cause of the stricture and intraoperative and postoperative outcomes. Results: A total of 9 patients with distal ureteral injury after hysterectomy were identified. All injuries were identified and treated as early as 21 d after hysterectomy. Seven of 9 patients underwent open hysterectomy, and the remaining patients had vaginal and laparoscopic radical hysterectomy. All ureteroneocystostomy cases were managed laparoscopically without conversion to open surgery and without any intraoperative complications. The Lich-Gregoir reimplantation technique was applied in all patients, and 2 patients required a psoas hitch. The mean operative time was 206.6 min (range, 120–280 min), the mean estimated blood loss was 122.2 cc (range, 25–350 cc), and the mean admission time was 3.3 d (range, 1–7 d). Cystography showed no urine leak when the ureteral stent was removed at 4 to 6 wk after the procedure. Ureteroneocystostomy patency was followed up with cystography at 6 mo and at least 10 y after ureteroneocystostomy. Conclusion: Early laparoscopic ureteral reimplantation may offer an alternative surgical approach to open surgery for the management of distal ureteral injuries, with favorable cosmetic results and recovery time from ureteral obstruction due to hysterectomy injury. PMID:23743383

  10. Secondary Hemorrhage After Total Laparoscopic Hysterectomy

    PubMed Central

    Prathap, Talwar; Kaur, Harneet; Shabnam, Khan; Kandhari, Dimple; Chopade, Gaurav

    2014-01-01

    Background and Objectives: The purpose of this study is to estimate the cumulative incidence, patient characteristics, and potential risk factors for secondary hemorrhage after total laparoscopic hysterectomy. Methods: All women who underwent total laparoscopic hysterectomy at Paul's Hospital between January 2004 and April 2012 were included in the study. Patients who had bleeding per vaginam between 24 hours and 6 weeks after primary surgery were included in the analysis. Results: A total of 1613 patients underwent total laparoscopic hysterectomy during the study period, and 21 patients had secondary hemorrhage after hysterectomy. The overall cumulative incidence of secondary hemorrhage after total laparoscopic hysterectomy was 1.3%. The mean size of the uterus was 541.4 g in the secondary hemorrhage group and 318.9 g in patients without hemorrhage, which was statistically significant. The median time interval between hysterectomy and secondary hemorrhage was 13 days. Packing was sufficient to control the bleeding in 13 patients, and 6 patients required vault suturing. Laparoscopic coagulation of the uterine artery was performed in 1 patient. Uterine artery embolization was performed twice in 1 patient to control the bleeding. Conclusions: Our data suggest that secondary hemorrhage is rare but may occur more often after total laparoscopic hysterectomy than after other hysterectomy approaches. Whether it is related to the application of thermal energy to tissues, which causes more tissue necrosis and devascularization than sharp culdotomy in abdominal and vaginal hysterectomies, is not clear. A large uterus size, excessive use of an energy source for the uterine artery, and culdotomy may play a role. PMID:25392609

  11. [Laparoscopic hysterectomy--brief history, frequency, indications and contraindications].

    PubMed

    Tomov, S; Gorchev, G; Tzvetkov, Ch; Tanchev, L; Iliev, S

    2012-01-01

    Hysterectomy is the most common gynecological operation after Caesarean section and the laparoscopic access to uterus removal is one of the contemporary methods showing slow but steady growth in time. In reference to indications and contraindications for laparoscopic hysterectomy, the following directions emerge as controversial: malignant gynecological tumors, uterus size, and high body mass index. Laparoscopic hysterectomy can be taken into consideration at the first stage of endometrial, cervical and ovarian cancer. If there is doubt about an uterus sarcoma and a laparoscopic access is accomplished, a conversion to abdominal hysterectomy must be done. Obesity and big uteri are not a contrarindication for that minimally-invasive access. Today, laparoscopic hysterectomy is a reasonable alternative to total abdominal and vaginal hysterectomy. PMID:23234025

  12. Minimally Invasive Specialists and Rates of Laparoscopic Hysterectomy

    PubMed Central

    Morris, Stephanie N.; Isaacson, Keith B.

    2015-01-01

    Background and Objective: Despite the prevalence of hysterectomy for treatment of benign gynecologic conditions, providers nationwide have been slow to adopt minimally-invasive surgical techniques. Our objective is to investigate the impact of a department for minimally invasive gynecologic surgery (MIGS) on the rate of laparoscopic hysterectomy at an academic community hospital without robotic technology. Methods: This retrospective observational study included all patients who underwent hysterectomy for benign indications from January 1, 2004, through December 31, 2012. The primary outcome was route of hysterectomy: open, laparoscopic, or vaginal. Secondary outcomes of interest included length of stay and factors associated with an open procedure. Results: In 2004, only 24 (8%) of the 292 hysterectomies performed for benign conditions at Newton-Wellesley Hospital (NWH) were laparoscopic. The rate increased to more than 50% (189/365) by 2008, and, in 2012, 72% (316/439) of hysterectomies were performed via a traditional laparoscopic approach. By 2012, more than 93% (411/439) of all hysterectomies were performed in a minimally invasive manner (including total laparoscopic hysterectomy [TLH], laparoscopic supracervical hysterectomy [LSH], total vaginal hysterectomy [TVH], and laparoscopy-assisted vaginal hysterectomy [LAVH]). More than 85% of the hysterectomies at NWH in 2012 were outpatient procedures. By this time, the surgeon's preference or lack of expertise was rarely cited as a factor leading to open hysterectomy. Conclusions: A large diverse gynecologic surgery department transformed surgical practice from primarily open hysterectomy to a majority (>72%) performed via the traditional laparoscopic route and a large majority (>93%) performed in a minimally invasive manner in less than 8 years, without the use of robotic technology. This paradigm shift was fueled by patient demand and by MIGS department surgical mentorship for generalist obstetrician/gynecologists. PMID:25848189

  13. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy

    Microsoft Academic Search

    Ray Garry; Jayne Fountain; Su Mason; Vicky Napp; Julia Brown; Jeremy Hawe; Richard Clayton; Jason Abbott; Graham Phillips; Mark Whittaker; Richard Lilford; Stephen Bridgman

    2004-01-01

    Objective To compare the effects of laparoscopic hysterectomy and abdominal hysterectomy in the abdominal trial, and laparoscopic hysterectomy and vaginal hysterectomy in the vaginal trial. Design Two parallel, multicentre, randomised trials. Setting 28 UK centres and two South African centres. Participants 1380 women were recruited; 1346 had surgery; 937 were followed up at one year. Primary outcome Rate of major

  14. Laparoscopic hysterectomy of large uteri using three-trocar technique

    PubMed Central

    Zeng, Wenjie; Chen, Liyou; Du, Weijie; Hu, Jinghui; Fang, Xiangming; Zhao, Xiaofeng

    2015-01-01

    Aim: The uterus with its size exceeds 12 weeks of gestation have been considered a relative contraindication to laparoscopic hysterectomy. With surgical techniques progressed and laparoscopic instruments improved, laparoscopic hysterectomy for large uteri have been performed safely and effectively. The aim of this study is to assess the feasibility and safety of laparoscopic hysterectomy on uterus more than 800 g using a three-trocar technique on 18 patients. Methods: From June 2011 to June 2013 a total of 18 consecutive patients underwent laparoscopic hysterectomy for benign gynaecological conditions. All of the 18 consecutive cases were successfully completed by laparoscopy with the instruction of the procedure. Results: All of the 18 cases were completed by laparoscopy without major complication. The average time of the surgery was 107 min (65-180), the average blood lost was 225 ml (50-800 ml), the average weight of the uterus was 1105 g (820-1880 g), and the average HGB drop was 0.9 g/dl (0.2-1.9 g/dl). Conclusion: Based on appropriate techniques and careful operate, Laparoscopic hysterectomies for large uteri using three-trocar is safe and feasible to most of the patients.

  15. Laparoscopic-assisted vaginal hysterectomy vs abdominal hysterectomy for benign disease: a meta-analysis of randomized controlled trials

    Microsoft Academic Search

    Yue-xiong Yi; Wei Zhang; Qi Zhou; Wan-ru Guo; Yu Su

    The objective of this meta-analysis was to assess whether laparoscopic-assisted vaginal hysterectomy achieves better clinical results compared with abdominal hysterectomy. Medline (PubMed), EMBASE, Web of Science, ProQuest, Cochrane Library and China Biological Medicine Database were searched to identify randomized controlled trials that compared laparoscopic-assisted vaginal hysterectomy with abdominal hysterectomy. Twenty-three trials were studied and the analysis was performed using Review

  16. Comparison of minimally invasive surgical approaches for hysterectomy at a community hospital: robotic-assisted laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy and laparoscopic supracervical hysterectomy.

    PubMed

    Giep, Bang N; Giep, Hoang N; Hubert, Helen B

    2010-09-01

    The study reported here compares outcomes of three approaches to minimally invasive hysterectomy for benign indications, namely, robotic-assisted laparoscopic (RALH), laparoscopic-assisted vaginal (LAVH) and laparoscopic supracervical (LSH) hysterectomy. The total patient cohort comprised the first 237 patients undergoing robotic surgeries at our hospital between August 2007 and June 2009; the last 100 patients undergoing LAVH by the same surgeons between July 2006 and February 2008 and 165 patients undergoing LAVHs performed by nine surgeons between January 2008 and June 2009; 87 patients undergoing LSH by the same nine surgeons between January 2008 and June 2009. Among the RALH patients were cases of greater complexity: (1) higher prevalence of prior abdominopelvic surgery than that found among LAVH patients; (2) an increased number of procedures for endometriosis and pelvic reconstruction. Uterine weights also were greater in RALH patients [207.4 vs. 149.6 (LAVH; P < 0.001) and 141.1 g (LSH; P = 0.005)]. Despite case complexity, operative time was significantly lower in RALH than in LAVH (89.9 vs. 124.8 min, P < 0.001) and similar to that in LSH (89.6 min). Estimated blood loss was greater in LAVH (167.9 ml) than in RALH (59.0 ml, P < 0.001) or LSH (65.7 ml, P < 0.001). Length of hospital stay was shorter for RALH than for LAVH or LSH. Conversion and complication rates were low and similar across procedures. Multivariable regression indicated that LAVH, obesity, uterine weight ?250 g and older age predicted significantly longer operative time. The learning curve for RALH demonstrated improved operative time over the case series. Our findings show the benefits of RALH over LAVH. Outcomes in RALH can be as good as or better than those in LSH, suggesting the latter should be the choice primarily for women desiring cervix-sparing surgery. PMID:20835393

  17. Clinical observation of laparoscopic radical hysterectomy for cervical cancer

    PubMed Central

    Yin, Xiang-Hua; Wang, Zhong-Qin; Yang, Shi-Zhang; Jia, Hong-Yan; Shi, Min

    2014-01-01

    To evaluate safety, feasibility and the improvement of surgical method of laparoscopic extensive hysterectomy and pelvic lymph node dissection in patients with early-stage cervical cancer. Clinical data were prospectively collected from patients with IA2-IIA cervical cancer who underwent laparoscopic extensive hysterectomy (n1=22) and laparotomy (n2=23) in Department of Obstetrics and Gynecology in the Subei People’s Hospital from June 2010 to August 2013. The successful rates in two groups of operation were 100%. Blood loss, postoperative hospital stay, complication rate, postoperative recovery of gastrointestinal tract and bladder function of the laparoscopy group of the laparoscopic group were all better than those of the laparotomy group, and there were significant differences (all P < 0.05). But in the laparoscopy group, the operative time was longer than the laparotomy group with statistical significance (P < 0.05). There was no statistically significant difference in the number of excised lymph nodes and the duration time of postoperative urinary catheterization between the two groups (P > 0.05). Laparoscopic extensive hysterectomy and pelvic lymph node dissection can fully meet the requirement of laparotomy. It has the properties of minor trauma and rapid recovery. The clinical efficacy is superior to laparotomy surgery. The results indicated laparoscopic is an ideal method for the treatment of early cervical cancer. PMID:24995098

  18. The value of intra-operative cystoscopy at the time of laparoscopic hysterectomy

    Microsoft Academic Search

    Sergio Ribeiro; Harry Reich; Jay Rosenberg; Enrica Guglielminetti; Andrea Vidali

    The aim of this study was to determine the usefulness of routine intra-operative cystoscopy in documenting ureteral injury during total laparoscopic hysterectomy with vault suspension and to document the incidence of this compli- cation in a large series. The charts of 118 patients who underwent laparoscopic hysterectomy with vault suspen- sion from January 1992 to January 1998 were retrospec- tively

  19. The Learning Curve of Total Laparoscopic Hysterectomy: Comparative Analysis of 1647 Cases

    Microsoft Academic Search

    A. Wattiez; D. Soriano; S. B. Cohen; P. Nervo; M. Canis; R. Botchorishvili; G. Mage; J. L. Poul; P. Mille; M. A. Bruhat

    2002-01-01

    Study ObjectiveTo compare the frequency of complications of total laparoscopic hysterectomy performed in the first and more recent years of our experience, and based on that, offer ways to prevent them.

  20. Laparoscopic-Assisted Vaginal Hysterectomy for Endometrial Cancer: Clinical Outcomes and Hospital Charges

    Microsoft Academic Search

    M. L. Gemignani; J. P. Curtin; J. Zelmanovich; D. A. Patel; E. Venkatraman; R. R. Barakat

    1999-01-01

    Objective.Our objective was to compare the clinical outcomes and associated hospital charges between two methods of hysterectomy for patients with early-stage endometrial cancer.Methods.Retrospective chart review of 320 patients with early-stage endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH) was performed for the period of July 1, 1991, to September 30, 1996, at Memorial Sloan-Kettering Cancer

  1. Single-port laparoscopic pelvic lymph node dissection with modified radical vaginal hysterectomy in cervical cancer.

    PubMed

    Hahn, Ho-Suap; Kim, Yong-Wook

    2010-11-01

    There is no doubt that laparoscopic surgeries have replaced open surgeries in many gynecologic operations and have led to the development of novel techniques such as single-port laparoscopic surgery. Single-port surgery has been performed mainly for hysterectomy or adnexectomy recently, and it has also been carefully considered for other possible single-port surgeries such as cancer operations. Although pelvic lymph node dissection is a common procedure in gynecologic cancer operations, it has been rarely performed with single-port laparoscopic access because of technical difficulties. In this report, we present a detailed description of single-port laparoscopic pelvic lymph node dissection with modified radical vaginal hysterectomy in 2 patients with cervical cancer, stage IA2. Combining either classic or modified Schauta radical vaginal hysterectomy with single-port laparoscopic technique could be a good option for the management of patients with cervical cancer. PMID:21051989

  2. The Retrograde and Retroperitoneal Totally Laparoscopic Hysterectomy for Endometrial Cancer

    PubMed Central

    Volpi, Eugenio; Bernardini, Luca; Ferrero, Anna Maria

    2012-01-01

    Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed. Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized. Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129?min and 125?mL, respectively. Most patients were dismissed on days 3–5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months. Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy. PMID:22844589

  3. Hysterectomy - vaginal - discharge

    MedlinePLUS

    Vaginal hysterectomy - discharge; Laparoscopically assisted vaginal hysterectomy - discharge; LAVH - discharge ... you were in the hospital, you had a vaginal hysterectomy. Your surgeon made a cut in your ...

  4. Laparoscopic splenectomy using conventional instruments

    PubMed Central

    Dalvi, A. N.; Thapar, P. M.; Deshpande, A. A.; Rege, S. A.; Prabhu, R. Y.; Supe, A. N.; Kamble, R. S.

    2005-01-01

    Introduction: Laparoscopic splenectomy (LS) is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4), 197–200 (2004)], trauma [Ren et al., Surg Endosc 15(3), 324 (2001); Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4), 283–286 (2002)], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45), 847–852 (2002)]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported. Materials and Methods: Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision. Results: A total of 26 patients underwent LS. Twenty-two (85%) of patients had spleen size more than 500 g (average weight being 942.55 g). Mean operative time was 214 min (45–390 min). The conversion rate was 11.5% (n = 3). Average duration of stay was 5.65 days (3–30 days). Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease. Conclusion: Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS. PMID:21206648

  5. Feasibility and Safety of Outpatient Total Laparoscopic Hysterectomy

    PubMed Central

    Lemyre, Madeleine; Couture, Vanessa; Bernier, Gabrielle; Laberge, Philippe Y.

    2015-01-01

    Background and Objective: Ambulatory total laparoscopic hysterectomy (TLH) could lead to significant cost savings, but some fear the effects of what could be premature postsurgical discharge. We sought to estimate the feasibility and safety of TLH as an outpatient procedure for benign gynecologic conditions. Methods: We report a prospective, consecutive case series of 128 outpatient TLHs performed for benign gynecologic conditions in a tertiary care center. Results: Of the 295 women scheduled for a TLH, 151 (51%) were attempted as an outpatient procedure. A total of 128 women (85%) were actually discharged home the day of their surgery. The most common reasons for admission the same day were urinary retention (19%) and nausea (15%). Indications for hysterectomy were mainly leiomyomas (62%), menorrhagia (24%), and pelvic pain (9%). Endometriosis and adhesions were found in 23% and 25% of the cases, respectively. Mean estimated blood loss was 56 mL and mean uterus weight was 215 g, with the heaviest uterus weighing 841 g. Unplanned consultation and readmission were infrequent, occurring in 3.1% and 0.8% of cases, respectively, in the first 72 hours. At 3 months, unplanned consultation, complication, and readmission had occurred in a similar proportion of inpatient and outpatient TLHs (17.2%, 12.5%, and 4.7% versus 18.1%, 12.7%, and 5.4%, respectively). In a logistic regression model, uterus weight, presence of adhesions or endometriosis, and duration of the operation were not associated with adverse outcomes. Conclusion: Same-day discharge is a feasible and safe option for carefully selected patients who undergo an uncomplicated TLH, even in the presence of leiomyomas, severe adhesions, or endometriosis. PMID:25788825

  6. [Laparoscopic Galvin-TeLinde hysterectomy for treatment of a microinvasive cervical carcinoma].

    PubMed

    Skret, A; Obrzut, B; Chru?ciel, A

    1999-01-01

    The original technique of laparoscopical Galvin-TeLinde-hysterectomy in patients with FIGO IA1 cervical cancer is presented. Differences between this technique and classical abdominal procedure are discussed. Based on the presented case the authors discuss the significance of laparoscopy in cervical cancer treatment. PMID:10408079

  7. Leiomyoma mimicking an incarcerated inguinal hernia: A rare complication of laparoscopic hysterectomy

    PubMed Central

    Apestegui, Carlos; Tamer, Saadallah; Ciccarelli, Olga; Bonaccorsi-Riani, Eliano; Marbaix, Etienne; Lerut, Jan

    2011-01-01

    A 52-year-old, obese, female patient was referred for a right inguinal mass, which appeared seven months after a laparoscopic hysterectomy, which was performed because of myomatosis. Despite several examinations, including ultrasound, computed tomography (CT)-Scan, positron emission tomography (PET)-CT, and ultrasound-guided biopsy, the diagnosis remained unclear until surgical exploration, which disclosed a well-encapsulated solid tumour corresponding to a fibrotic leiomyoma. Spilling of leiomyoma cells is a rare and unusual complication of laparoscopic surgery. Tumour development in the inguinal canal after laparoscopic gynaecological surgery should be kept in mind in the differential diagnosis of inguinal hernia and other uncommon pathologies. PMID:21523240

  8. The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

    PubMed Central

    Graves, Nicholas; Janda, Monika; Merollini, Katharina; Gebski, Val; Obermair, Andreas

    2013-01-01

    Objective To summarise how costs and health benefits will change with the adoption of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer. Design Cost-effectiveness modelling using the information from a randomised controlled trial. Participants Two hypothetical modelled cohorts of 1000 individuals undergoing total laparoscopic hysterectomy and total abdominal hysterectomy. Outcome measures Surgery costs; hospital bed days used; total healthcare costs; quality-adjusted life years; and net monetary benefits. Results For 1000 individuals receiving total laparoscopic hysterectomy surgery, the costs were $509?575 higher, 3548 hospital fewer bed days were used and total health services costs were reduced by $3?746?221. There were 39.13 more quality-adjusted life years for a 5?year period following surgery. Conclusions The adoption of total laparoscopic hysterectomy is almost certainly a good decision for health services policy makers. There is 100% probability that it will be cost saving to health services, a 86.8% probability that it will increase health benefits and a 99.5% chance that it returns net monetary benefits greater than zero. PMID:23604345

  9. Tubal ectopic pregnancy two years after laparoscopic supracervical hysterectomy

    PubMed Central

    2014-01-01

    Background Ectopic pregnancy after hysterectomy is a very rare condition, but it must be kept in mind in women with history of hysterectomy who present with abdominal pain and ecographic adnexal heterogeneous images. Since first described by Wendeler in 1895, at least 67 ectopic pregnancies (tubal, ovarian and abdominal) have been described in patients subjected to prior hysterectomy. Case presentation We describe the case of a 41-year-old white caucasian woman admitted to the emergency room due to abdominal pain for two days. The ultrasounds scan and the quantification of beta-HCG led to the diagnosis of tubal ectopic pregnancy, although she had been hysterectomized two years before. An emergency laparoscopy was performed for salpingectomy. The pathology report indicated trophoblastic tubal implantation and hematosalpinx. Conclusions Ectopic pregnancy is one of the conditions to be considered in the differential diagnosis of abdominal pain in women of child bearing potential, and the absence of the uterus does not rule out its diagnosis. PMID:24886255

  10. A Comparative Study Between Laparoscopically Assisted Vaginal Hysterectomy and Vaginal Hysterectomy: Experience in a Tertiary Diabetes Care Hospital in Bangladesh

    PubMed Central

    Jahan, Samsad; Das, Tripti; Mahmud, Nusrat; Khan, Masuda Islam; Akter, Latifa; Mondol, Samiron Kumar; Yasmin, Sharmin; Nahar, Nurun; Habib, Samira Humaira; Saha, Soma; Paul, Debashish; Joarder, Mahjabin

    2011-01-01

    Objective: The study was undertaken to compare the efficiency and outcome of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Vaginal Hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complication rates and patients recovery. Materials and Methods: A total of 500 diabetic patients were prospectively collected in the study period from January 2005 through January 2009. The performance of LAVH was compared with that of VH, in a tertiary care hospital. The procedures were performed by the same surgeon. Results: There was no significant difference in terms of age, parity, body weight or uterine weight. The mean estimated blood loss in LAVH was significantly lower when compared with the VH group (126.5±39.8 ml and 100±32.8 ml), respectively. As to postoperative pain, less diclofenac was required in the LAVH group compared to the VH group (70.38±13.45 mg and 75.18±16.45 mg), respectively. Conclusions: LAVH, is clinically and economically comparable to VH, with patient benefits of less estimated blood loss, lower quantity of analgesia use, lower rate of intra- and postoperative complications, less postoperative pain, rapid patient recovery, and shorter hospital stay.

  11. A comparison of oxycodone and fentanyl in intravenous patient-controlled analgesia after laparoscopic hysterectomy

    PubMed Central

    Kim, Nan-Seol; Yoo, Sie Hyeon; Chung, Jin Hun; Chung, Ji-Won; Seo, Yonghan; Chung, Ho-Soon; Jeon, Hye-Rim; Gong, Hyung Youn; Lee, Hyun-Young; Mun, Seong-Taek

    2015-01-01

    Background We planned to compare the effect of intravenous oxycodone and fentanyl on post-operative pain after laparoscopic hysterectomy. Methods We examined 60 patients were randomized to postoperative pain treatment with either oxycodone (n = 30, Group O) or fentanyl (n = 30, Group F). The patients received 10 mg oxycodone/100 µg fentanyl with ketorolac 30 mg before the end of anesthesia and then continued with patient-controlled analgesia for 48 h postoperatively. Results The accumulated oxycodone consumption was less than fentanyl during 8, 24 and 48 h postoperatively. Numeric rating score of Group O showed significantly lower than that of Group F during 30 min, 2, 4, 8 and 24 h postoperatively. The incidences of adverse reactions were similar in the two groups, though the incidence of nausea was higher in the Group O during the 24 and 48 h postoperative period. Conclusions Oxycodone IV-PCA was more advantageous than fentanyl IV-PCA for laparoscopic hysterectomy in view of accumulated oxycodone consumption, pain control and cost beneficial effect. However, patient satisfaction was not good in the group O compared to group F. PMID:26045929

  12. AAGL practice report: practice guidelines for laparoscopic subtotal/supracervical hysterectomy (LSH).

    PubMed

    2014-01-01

    The first subtotal abdominal hysterectomy was described by Charles Clay in 1843, and the first laparoscopic subtotal hysterectomy (LSH) was described by Semm [1] in 1991. Whether to retain or remove the cervix remains controversial, with surgeons citing sexual satisfaction and prevention of pelvic organ prolapse as indicators for retention [2]. Because the only absolute indication for cervical removal is malignancy or its precursors, debate has continued as to the optimum surgical approach to hysterectomy for other indications. The evidence obtained from evaluating the effects of retaining the cervix, via any surgical approach, on sexual, urinary, and bowel function remains controversial [3-11]. The literature evaluating LSH is limited, and only 3 randomized controlled trials (RCTs), including 342 women, have reported psychologic outcomes, complications, and additional cervical procedures [4,12,13]. For the abdominal equivalent, there are 9 RCTs, including 1553 women, and a Cochrane review reported few important differences between the 2 approaches [8]. No such comparative data are available for LSH. This practice guideline will evaluate the evidence for LSH. This report was developed under the direction of the Practice Committee of the AAGL as a service to their members and other practicing clinicians. PMID:23954691

  13. Cervical Detachment Using Monopolar SupraLoop™ Electrode versus Monopolar Needle in Laparoscopic Supracervical Hysterectomy (LSH): An Interventional, Comparative Cohort Study.

    PubMed

    Brucker, S; Rothmund, R; Krämer, B; Neis, F; Schönfisch, B; Zubke, W; Taran, F A; Wallwiener, M

    2013-11-01

    Objective: Currently available monopolar loop electrodes are difficult to handle in laparoscopic supracervical hysterectomy (LSH) and are entirely disposable devices, generating additional operating costs. The aim of this interventional study was the comparison of the efficiency and safety of cervical detachment with a newly developed monopolar loop electrode (SupraLoop™) with a conventional method of cervical detachment in LSH. Material and Methods: Our study sample included 1598 patients; 1070 patients that underwent LSH with cervical detachment using the monopolar SupraLoop™ (study group) and 528 patients that underwent LSH with cervical detachment using the monopolar needle (control group). We also assessed cervical detachment time and total device application and cutting time in a subgroup of 49 patients (23 patients from the study group and 26 patients from the control group). Results: Total operation time for LSH was significantly shorter among SupraLoop™ patients (93?±?41 minutes) when compared to patients in whom cervical detachment was performed with the needle (105?±?44 minutes) (p?laparoscopic supracervical hysterectomy, and performed better than the needle, offering a significantly shorter operating time and less complications for the hysterectomy compared to the conventional method. PMID:24771898

  14. Costs and Effects of Abdominal versus Laparoscopic Hysterectomy: Systematic Review of Controlled Trials

    PubMed Central

    Bijen, Claudia B. M.; Vermeulen, Karin M.; Mourits, Marian J. E.; de Bock, Geertruida H.

    2009-01-01

    Objective Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH). Data sources Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. Selection of studies Twelve (randomized) controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. Methods The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. Findings Analysis was performed on 2226 patients, of which 1013 (45.5%) in the LH group and 1213 (54.5%) in the AH group. Five studies scored ?10 points (out of 19) for methodological quality. The reported total direct costs in the LH group ($63,997) were 6.1% higher than the AH group ($60,114). The reported total indirect costs of the LH group ($1,609) were half of the total indirect in the AH group ($3,139). The estimated mean major complication rate in the LH group (14.3%) was lower than in the AH group (15.9%). The estimated total costs in the LH group were $3,884 versus $3,312 in the AH group. The incremental costs for reducing one patient with major complication(s) in the LH group compared to the AH group was $35,750. Conclusions The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival. PMID:19806210

  15. [Hysterectomy for fibroids].

    PubMed

    Lete, Iñaki

    2013-07-01

    Occasionally, the indicated treatment for cases of fibroid uterus is a hysterectomy. Surgical approaches for hysterectomy include abdominal, vaginal or laparoscopic. The determinant for selecting the surgical approach is uterine weight. In this article, we conducted a review of studies that compared the various surgical techniques for hysterectomy, as well as the steps to consider when performing a laparoscopic hysterectomy in large uteri. PMID:24314562

  16. Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy

    PubMed Central

    Lim, Sang Woo; Kim, Hyeong Rok

    2014-01-01

    Purpose The aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer. Methods Forty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012. Results In the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes). Conclusion SILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time. PMID:25247166

  17. Laparoscopic-Assisted Vaginal versus Abdominal Surgery in Patients with Endometrial Cancer—A Prospective Randomized Trial

    Microsoft Academic Search

    Sabine Malur; Marc Possover; Wolfgang Michels; Achim Schneider

    2001-01-01

    Objective.We compared a laparoscopic-vaginal approach with the conventional abdominal approach for treatment of patients with endometrial cancer.Method. Between July 1995 and August 1999, 70 patients with endometrial cancer FIGO stage I–III were randomized to laparoscopic-assisted simple or radical vaginal hysterectomy or simple or radical abdominal hysterectomy with or without lymph node dissection.Results. Thirty-seven patients were treated in the laparoscopic versus

  18. Transumbilical laparoscopic-assisted appendectomy: an extracorporeal single-incision alternative to conventional laparoscopic techniques.

    PubMed

    Shekherdimian, Shant; DeUgarte, Daniel

    2011-05-01

    Recently the use of a single umbilical incision to perform an appendectomy has been described. The purpose of this study was to review our initial experience with transumbilical laparoscopic-assisted appendectomy (TULAA) in the pediatric population. A retrospective review of all pediatric patients treated for appendicitis over a 10-month period was performed. The surgical technique involved using a standard 3-mm or 5-mm trocar for visualization and insufflation. A dissecting/grasping instrument was used adjacent to the trocar through the same incision. Patient demographics, operative findings and time as well as postoperative course were reviewed. Of 21 patients undergoing laparoscopy appendectomy, 18 patients successfully underwent TULAA. Five patients had advanced appendicitis, four had a retrocecal appendix, and three had appendicoliths. The average total operative time was 51 ± 15 minutes. Overall, the average length of stay was 1.2 ± 0.8 days; however, all patients with nonperforated appendicitis were discharged the day after surgery. All patients were followed postoperatively, and none reported postoperative complications of abscess or wound infection. Cost analysis demonstrated a markedly reduced associated cost for TULAA compared with conventional laparoscopy. TULAA is a safe and effective single-incision approach for early appendicitis that incorporates both open and laparoscopic techniques to provide excellent exploration of the abdomen, a short hospital stay, minimal pain, and an excellent cosmetic result. The technique described is cost-effective, because it does not use any special laparoscopes, trocars, or staplers. When performed as described in this study, only a single trocar and a standard laparoscopic setup are required. Cases of advanced appendicitis may require additional trocars or "conversion" to conventional laparoscopic techniques. PMID:21679587

  19. Hysterectomy—Current Methods and Alternatives for Benign Indications

    PubMed Central

    Papadopoulos, Michail S.; Tolikas, Athanasios C.; Miliaras, Dimosthenis E.

    2010-01-01

    Hysterectomy is the commonest gynecologic operation performed not only for malignant disease but also for many benign conditions such as fibroids, endometrial hyperplasia, adenomyosis, uterine prolapse, dysfunctional uterine bleeding, and cervical intraepithelial neoplasia. There are many approaches to hysterectomy for benign disease: abdominal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy (LAVH) where a vaginal hysterectomy is assisted by laparoscopic procedures that do not include uterine artery ligation, total laparoscopic hysterectomy (TLH) where the laparoscopic procedures include uterine artery ligation, and subtotal laparoscopic hysterectomy (STLH) where there is no vaginal component and the uterine body is removed using a morcelator. In the last decades, many new techniques, alternative to hysterectomy with conservation of the uterus have been developed. They use modern technologies and their results are promising and in many cases comparable with hysterectomy. This paper is a review of all the existing hysterectomy techniques and the alternative methods for benign indications. PMID:20798870

  20. A randomized comparison of gasless laparoscopic appendectomy and conventional laparoscopic appendectomy

    PubMed Central

    2014-01-01

    Introduction The purpose of this study was to compare the clinical outcomes and cost effectiveness of the gasless laparoscopic appendectomy (GLA) and conventional laparoscopic appendectomy (LA). Methods From Aug 2010 to Feb 2012, 100 patients with a clinical diagnosis of acute appendicitis in Shanghai Tongji hospital were included in the study and randomly divided into the LA and GLA groups, fifty in the GLA group and 50 in the LA group. The two groups were comparable in age, gender, body mass index, symptom duration, ASA score, and white blood cell count. Results The mean surgical duration was 70.6?±?30.8 min in the GLA group and 62.6?±?22.0 min in the LA group (P?=?0.138). The total conversion rate was 8% in the GLA group, while no conversions occurred in the LA group. Postoperative complications did not significantly differ between the two groups. Fentanyl consumption was decreased significantly in the GLA group (P?=?0.019) postoperatively. The length of the total hospital stay was 4.36?±?1.74 days in the GLA group compared with 5.68?±?4.44 days in the LA group (P?=?0.053). There was a significant decrease in the total hospital cost when the GLA group was compared with the LA group (6659?±?1782 vs. 9056?±?2680 Yuan, respectively, P?conventional LA are comparable in terms of operative duration, complications, and total hospital stay. The obvious advantage of GLA is the significantly reduced hospital cost. The demand for postoperative analgesics may also decrease following GLA. In conclusion, GLA is a safe and feasible procedure in selected patients. Trial registration Chinese Clinical Trial Register ChiCTR-TRC-10001203. PMID:24401566

  1. Innovations in minimally invasive hysterectomy.

    PubMed

    Ridgeway, Beri; Falcone, Tommaso

    2014-03-01

    Vaginal hysterectomy, when feasible, is the safest and most cost-effective route for hysterectomy, however, when this is not possible, minimally invasive hysterectomy is often the next best option. Laparoscopic hysterectomy has advanced significantly since 1988, when it was first introduced. Continued improvements in instrumentation, energy sources, hemostatic agents, and vaginal cuff closure techniques have expanded the use of minimally invasive hysterectomy. Variations of laparoscopy, specifically laparoendoscopic single-site surgery hysterectomy and robotic-assisted laparoscopic hysterectomy, have further expanded the role of minimally invasive hysterectomy with the goal of decreasing morbidity. As with any evolving technology, well-designed studies are needed to demonstrate safety, efficacy, and cost-effectiveness before wide-spread adoption. PMID:24145361

  2. Enclosure module design thesis for Endoblend : a novel surgical device for laparoscopic hysterectomy

    E-print Network

    Hernandez-Stewart, Daniel

    2007-01-01

    The Endoblend device concept was developed by a 2.75 design team,of which I was a member; the purpose of the device is to remove tissue laparoscopically. The detailed design of one of its modules, the enclosure module, is ...

  3. Morbidity of 10 110 hysterectomies by type of approach

    Microsoft Academic Search

    Juha Makinen; Jari Johansson; Candido Tomas; Eija Tomas; Pentti K. Heinonen; Timo Laatikainen; Minna Kauko; Anna-Mari Heikkinen; Jari Sjoberg

    BACKGROUND: Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the most suitable approach to hysterectomy. METHODS: To evaluate the influence of the type of approach, in causing or avoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising all hysterectomies for benign disease performed in Finland during 1996. The primary outcomes of interest

  4. Forehead Reflectance Oximetry: A Clinical Comparison with Conventional Digit Sensors during Laparotomic and Laparoscopic Abdominal Surgery

    Microsoft Academic Search

    Andrea Casati; Grazia Squicciarini; Marco Baciarello; Marta Putzu; Alessandra Salvadori; Guido Fanelli

    2007-01-01

    Objective  This study compared the performance of forehead reflectance and conventional pulse oximetry (SpO2) in mechanically ventilated, anesthetized patients undergoing major abdominal surgery with either laparoscopic or laparotomic\\u000a techniques.\\u000a \\u000a \\u000a \\u000a Methods  SpO2 was continuously measured both with a forehead reflectance and a conventional digit sensor in 20 ASA physical status I–III,\\u000a anesthetized patients undergoing either a laparotomic (group Laparotomy, n = 10) or laparoscopic (group

  5. [Thrombophlebitis profunda in patients after conventional and laparoscopic cholecystectomy].

    PubMed

    Krasinski, Z; Gabriel, M; Oszkinis, G; Dzieciuchowicz, L; Begier-Krasinska, B

    1998-01-01

    The purpose of this study was to compare the incidence of deep venous thrombosis (DVT) in patients undergoing uncomplicated laparoscopic cholecystectomy and in whom conversion to laparotomy was required. Using the Duplex Doppler examination, we found higher incidence of DVT in patients who required conversion than in those who did not (47 vs 58%). Prolonged prophylaxis with low-molecular weight heparin should be considered in these patients. PMID:9931805

  6. Single-incision laparoscopic appendectomy is comparable to conventional laparoscopic and laparotomic appendectomy: our single center single surgeon experience

    PubMed Central

    CECI, F.; ORSINI, S.; TUDISCO, A.; AVALLONE, M.; AIUTI, F.; DI GIROLAMO, V.; STEFANELLI, F.; DE ANGELIS, F.; MARTELLUCCI, A.; COSTANTINO, A.; DI GRAZIA, C.; NICODEMI, S.; CIPRIANI, B.; NAPOLEONI, A.; MOSILLO, R.; CORELLI, S.; CASCIARO, G.; SPAZIANI, E.; STAGNITTI, F.

    2013-01-01

    Summary Several studies have demonstrated the clinical and technical benefits of the laparoscopic surgery for complicated and uncomplicated appendicitis. Our retrospective study included 12 patient who underwent SILS appendectomy (SILS-A), 14 who received conventional laparoscopic surgery (VL-A), and 12 who received laparotomic appendectomy (O-A); performed in all cases by the same surgeon (C.F.). The aim of this study was the comparison between this three different surgical techniques on same features: post operative leukocytosis, post operative pain, need abdominal drainage, esthetic viewpoint, incidence of complication, hospital stay. The results showed no significant differences between SILS-A and VLS-A, while an evident improvement shows versus O-A, even though not statistically significative. SILS was more effective in decreasing the risk of postoperative wound infection. PMID:24091177

  7. The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital

    Microsoft Academic Search

    D. Alan Johns; Benito Carrera; Janet Jones; Frank DeLeon; Rafael Vincent; Charles Safely

    1995-01-01

    Objective: Our purpose was to evaluate the medical and economic impact of operative laparoscopy on the surgical approach to hysterectomy for benign disease in a large, metropolitan, not-for-profit hospital.Study design: Retrospective analyses were performed on 2563 hysterectomies (without vaginal or bladder repair) for benign disease, performed and stapling devices were not used at any time during the study period. Electrosurgery

  8. Changing the Route of Hysterectomy into a Minimal Invasive Approach

    PubMed Central

    Hoyer-Sorensen, Christian; Hortemo, Sigurd; Lieng, Marit

    2013-01-01

    Objective. To describe the route of hysterectomy in a county hospital and evaluate the shift towards a minimal invasive approach. Design. Retrospective cohort study. Setting. A county hospital in Norway. Population. All women were scheduled for hysterectomy. Methods. Audit the route of hysterectomy in the period 2004–2012. Analyze the outcome of total laparoscopic hysterectomies. Main Outcome Measures. Complications after total laparoscopic hysterectomy. Results. A shift towards a minimal invasive approach has been achieved during the study period. In 2012 only 17.4% of the hysterectomies were performed abdominally, compared to yearly percentages of above 50% in the period 2004–2009. Laparoscopic supracervical hysterectomy was introduced in 2003, but the percentage of abdominal hysterectomy remained above 50% until total laparoscopic hysterectomy was introduced in 2010. Since the introduction of total laparoscopic hysterectomy in April 2010, 58 procedures have been performed. There have been no major complications. Two vaginal vault hematomas and one case of urinary tract infection were reported. Conclusions. It is possible for a county hospital to alter their praxis and perform mini-invasive hysterectomies, but it requires dedicated gynecologists. This change to an advanced procedure like total laparoscopic hysterectomy could be achieved without patients suffering from major complications. PMID:23762574

  9. A Comparison of Laparoscopic and Abdominal Radical Parametrectomy for Cervical or Vaginal Apex Carcinoma and Stage II Endometrial Cancer After Hysterectomy

    PubMed Central

    Jiang, Hongyuan; Qu, Lianxi; Hua, Keqin; Xu, Huan; Guo, Sun-Wei

    2013-01-01

    Background and Objective: Radical parametrectomy (RP), performed either abdominally (ARP) or laparoscopically (LRP), is a viable alternative to radiotherapy in treating invasive cervical cancer, vaginal apex cancer, and endometrial cancer that is more advanced than initially suspected after hysterectomy. We carried out a comparative study on intra- and postoperative parameters between the two performed by similarly experienced surgeons. Methods: Forty consecutive patients indicative for RP were reviewed: 22 and 18 underwent ARP and LRP, respectively. Information was collected on demographics, indications for initial and this surgery, tumor characteristics, intra- and postoperative parameters, and complications. The lengths of resected parametrial and vaginal tissues were measured. Results: Compared with ARP, LRP resulted in shorter operative time (200 vs 239 min), less blood loss (627.8 vs 929.5 mL), shorter hospital stay (16.8 vs 19.9 days), and removal of more pelvic lymph nodes (27.4 ± 5.9 vs 23.1 ± 7.1). Although it was not attempted in ARP to remove lymph nodes in the deep obturator space, it was attempted in LRP and one positive node was found. In the ARP cohort there was one case of injury to the small intestine during surgery, whereas in LRP there was one instance of lower urologic fistula after surgery. Conclusion: LRP is superior to ARP in terms of shorter operative time, less blood loss, and shorter hospital stay while still maintaining the completeness of the procedure. It can be safely performed in the hands of experienced surgeons for cervical or vaginal apex carcinoma and stage II endometrial cancer after hysterectomy. PMID:23925019

  10. [Comparison of thrombosis rate after laparoscopic and conventional interventions with the I(125) fibrinogen test].

    PubMed

    Kopánski, Z; Ciencia?a, A; Ulatowski, Z; Micherdzi?ski, J

    1996-01-01

    The purpose of the present work was to compare the frequency of thrombosis in patients after laparoscopic and conventional operations. The diagnosis of thrombotic complications of the veins of the legs was determined by means of the I125 fibrinogen test. This isotopic test was chosen because it enables the early diagnosis of a thrombosis of the venous sinus of the calf at a stage at which no clinical symptoms have yet appeared. It was shown that in the group of patients submitted to laparoscopic intervention only 19 (18.8%) developed thrombotic complications out of the 101 patients, whereas in the group of conventionally operated patients 42 cases (45.7%) occurred in the 92 patients. Moreover, there was a statistically significant difference in the incidence of thrombotic complications in patients after laparoscopic cholecystectomy in comparison with the traditional operative method, with 14 cases (23.3%) out of 60 patients versus 35 (62.5%) out of 56 patients, respectively. PMID:8867483

  11. Matched-Case Comparisons in a Single Institution to Determine Critical Points for Inexperienced Surgeons’ Successful Performances of Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Stage IA2-IIA Cervical Cancer

    PubMed Central

    Suh, Dong Hoon; Cho, Hye-Yon; Kim, Kidong; No, Jae Hong; Kim, Yong-Beom

    2015-01-01

    This is a retrospective study which aims to identify major determinants of successful laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) performed by inexperienced surgeons for stage IA2-IIA cervical cancer. A total of 161 consecutive patients with stage IA2–IIA cervical cancer who underwent RH were grouped into 2 groups according to the surgeons’ experience with LRH: experienced surgeon versus inexperienced surgeon. After matching for age and risk factors, surgical and survival outcomes were compared. Experienced surgeon selected patients with earlier-stage and fewer risk factors for LRH than ARH, but inexperience surgeons did not. After matching, the vaginal tumor-free margin of LRH was shorter than that of ARH in experienced surgeon group (1.3 versus 1.7 cm, p=0.007); however, the vaginal tumor-free margin was longer than that of ARH in the inexperienced surgeon group (1.8 versus 1.3 cm, p=0.035). The postoperative hospital stay of LRH was shorter than that of ARH in experienced surgeon group (5.5 versus 7.7 days, p<0.001), but not different from that of ARH in the inexperienced surgeon group. Vaginal tumor-free margin >1.8 cm (OR 7.33, 95% CI 1.22–40.42), stage >IB1 (OR 8.83, 95% CI 1.51–51.73), and estimated blood loss >575 mL (OR 33.95, 95% CI 4.87–236.79) were independent risk factors for longer postoperative hospital stay in the inexperienced surgeon group. There was no difference of 5-year-profression-free survival of LRH patients between experienced surgeon and inexperienced surgeon groups after matching (55.1 versus 33.3%, p=0.391). Selection of earlier-stage disease and moderate vaginal tumor-free margin might be important for an inexperienced surgeon to successfully perform LRH with minimal complications in stage IA2–IIA cervical cancer. PMID:26110866

  12. Changes in bowel function after hysterectomy

    Microsoft Academic Search

    J. H. van Dam; M. J. Gosselink; A. C. Drogendijk; W. C. J. Hop; W. R. Schouten

    1997-01-01

    PURPOSE: It has been suggested that hysterectomy has a disturbing influence on bowel function. To assess the incidence and nature of these changes, we performed a retrospective study. METHODS: A retrospective study was performed in all 593 women who had undergone hysterectomy between 1989 and 1993. A control group consisted of 100 women who had undergone laparoscopic cholecystectomy. RESULTS: The

  13. Two cases of post-coital vaginal cuff dehiscence with small bowel evisceration after robotic-assisted laparoscopic hysterectomy

    PubMed Central

    Nguyen, My-Linh T.; Kapoor, Monica; Pradhan, Tana S.; Pua, Tarah L.; Tedjarati, Sean S.

    2013-01-01

    INTRODUCTION Vaginal cuff dehiscence following robotic surgery is uncommon. Published reports of vaginal cuff dehiscence following robotic surgery are increasing, but the true incidence is unknown. PRESENTATION OF CASE Case 1. A 45 year old female had sexual intercourse and presented with a vaginal cuff dehiscence complicated by small bowel evisceration 4 months after RA-TLH. Case 2. A 44 year old female had sexual intercourse and presented with a vaginal cuff dehiscence with small bowel evisceration 6 weeks after RA-TLH. DISCUSSION We discuss the rate of vaginal cuff dehiscence by mode of hysterectomy, surgical and non-surgical risk factors that may contribute to vaginal cuff dehiscence, and proposed preventative methods at the time of RA-TLH to reduce this complication. CONCLUSION Vaginal cuff dehiscence with associated evisceration of intraabdominal contents is a potentially severe complication of hysterectomy. We recommend counseling patients who undergo RA-TLH to abstain from vaginal intercourse for a minimum of 8–12 weeks. PMID:23708306

  14. A comparison of transumbilical single-port laparoscopic appendectomy and conventional three-port laparoscopic appendectomy: from the diagnosis to the hospital cost

    PubMed Central

    Baik, Seung Min; Hong, Kyung Sook

    2013-01-01

    Purpose Recently many cases of appendectomy have been conducted by single-incision laparoscopic technique. The aim of this study is to figure out the benefits of transumbilical single-port laparoscopic appendectomy (TULA) compared with conventional three-port laparoscopic appendectomy (CTLA). Methods From 2010 to 2012, 89 patients who were diagnosed as acute appendicitis and then underwent laparoscopic appendectomy a single surgeon were enrolled in this study and with their medical records were reviewed retrospectively. Cases of complicated appendicitis confirmed on imaging tools and patients over 3 points on the American Society of Anesthesia score were excluded. Results Among the total of 89 patients, there were 51 patients in the TULA group and 38 patients in the CTLA group. The visual analogue scale (VAS) of postoperative day (POD) #1 was higher in the TULA group than in the CTLA group (P = 0.048). The operative time and other variables had no statistical significances (P > 0.05). Conclusion Despite the insufficiency of instruments and the difficulty of handling, TULA was not worse in operative time, VAS after POD #2, and the total operative cost than CTLA. And, if there are no disadvantages of TULA, TULA may be suitable in substituting three-port laparoscopic surgery and could be considered as one field of natural orifice transluminal endoscopic surgery with the improvement and development of the instruments and revised studies. PMID:23908963

  15. Pelviscopic Compared to Laparotomic and Vaginal Intrafascial Hysterectomy

    PubMed Central

    Lutzewitsch, N.

    1997-01-01

    Between 1993 and 1994, 368 women underwent hysterectomies for benign disorders at the University of Kiel. Of these, 58.7% were performed either by pelviscopic or by laparotomy Classic Intrafascial Supracervical Hysterectomy (CISH). Of the remaining, 14.8% were performed by abdominal hysterectomy, 13.6% by Intrafascial Vaginal Hysterectomy (IVH), 12.2% by Vaginal Hysterectomy (VH), and only 0.05% by Laparoscopic Assisted Vaginal Hysterectomy (LAVH). Comparative data of these six surgical techniques concerning patients characteristics, indications for operation, histological features, blood loss, operating time, hospital stay, uterine weights and postoperatively used analgesics are described. PMID:18493441

  16. Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: Laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy

    PubMed Central

    Inoue, Shogo; Ikeda, Kenichiro; Kobayashi, Kanao; Kajiwara, Mitsuru; Teishima, Jun; Matsubara, Akio

    2014-01-01

    Introduction: We evaluate patient-reported satisfaction and cosmesis of laparoendoscopic single-site adrenalectomy (LESS-A) in comparison with that of conventional laparoscopic adrenalectomy (CLA). Methods: A total of 19 and 104 patients who respectively underwent LESS-A and CLA between May 1996 and June 2011 were included in the study. Questionnaires inquiring about scar pain (0: not painful, 10: very painful), satisfaction (0: not satisfied, 10: very satisfied) and cosmesis (0: very unsightly, 10: very beautiful) on the basis of a visual analogue scale were sent to patients postoperatively. Results: The respondents consisted of 11 and 54 patients who underwent LESS-A and CLA, respectively. There was no significant inter-group difference in age, sex, affected side or body mass index. No significant differences were observed in operative time or estimated blood loss. There were also no significant differences in pain (0.67 vs. 0.57, p = 0.393), satisfaction (8.92 vs. 8.46, p = 0.453), or cosmesis score (8.58 vs. 8.00, p = 0.487) between the LESS-A and CLA groups overall. In female patients, the satisfaction score was significantly higher in the LESS-A group than in the CLA group (10.0 vs. 8.72, p = 0.049). In young patients (<50 years old), the satisfaction score was also significantly higher in the LESS-A group than in the CLA group (9.17 vs. 6.38, p = 0.036). Conclusions: Young patients and female patients who had received LESS-A adrenal surgery were more satisfied with the scar outcomes than were the young patients and female patients who had received CLA. We suggest that this patient subset most values the cosmetic benefits of LESS-A. PMID:24454596

  17. No more abdominal hysterectomy for myomata using a new minimally-invasive technique

    Microsoft Academic Search

    G. Tchartchian; J. Dietzel; B. Bojahr; A. Hackethal; R. L. De Wilde

    2010-01-01

    To perform hysterectomy in uterus myomatosus, there are several surgical techniques. For a uterine weight of >1000g, after a caesarean section and in nullipara per vaginam, the most common surgical technique for hysterectomy in patients is hysterectomy per laparotomiam. A new endoscopical technique developed to treat such patients and to avoid laparotomy is described in this case report: the laparoscopic

  18. Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: A meta-analysis

    PubMed Central

    Xu, Bin; Xu, Bo; Zheng, Wen-Yan; Ge, Hai-Yan; Wang, Li-Wei; Song, Zhen-Sun; He, Bin

    2015-01-01

    AIM: To compare the results of transvaginal cholecystectomy (TVC) and conventional laparoscopic cholecystectomy (CLC) for gallbladder disease. METHODS: We performed a literature search of PubMed, EMBASE, Ovid, Web of Science, Cochrane Library, Google Scholar, MetaRegister of Controlled Trials, Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC. Data were extracted by two authors. Mean difference (MD), standardized mean difference (SMD), odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models. Statistical heterogeneity was evaluated with the ?2 test. The fixed-effects model was used in the absence of statistically significant heterogeneity. The random-effects model was chosen when heterogeneity was found. RESULTS: There were 730 patients in nine controlled clinical trials. No significant difference was found regarding demographic characteristics (P > 0.5), including anesthetic risk score, age, body mass index, and abdominal surgical history between the TVC and CLC groups. Both groups had similar mortality, morbidity, and return to work after surgery. Patients in the TVC group had a lower pain score on postoperative day 1 (SMD: -0.957, 95%CI: -1.488 to -0.426, P < 0.001), needed less postoperative analgesic medication (SMD: -0.574, 95%CI: -0.807 to -0.341, P < 0.001) and stayed for a shorter time in hospital (MD: -1.004 d, 95%CI: -1.779 to 0.228, P = 0.011), but had longer operative time (MD: 17.307 min, 95%CI: 6.789 to 27.826, P = 0.001). TVC had no significant influence on postoperative sexual function and quality of life. Better cosmetic results and satisfaction were achieved in the TVC group. CONCLUSION: TVC is safe and effective for gallbladder disease. However, vaginal injury might occur, and further trials are needed to compare TVC with CLC. PMID:25954114

  19. Hysterectomy as treatment for dysfunctional uterine bleeding

    Microsoft Academic Search

    Harry Reich; Sergio Conti Ribeiro; Andrea Vidali

    1999-01-01

    The surgical treatment of patients with dysfunctional uterine bleeding (DUB) is discussed in this chapter, including indications, techniques and complications. Hysterectomy is the definitive treatment for DUB; in most studies it has a higher rate of patient satisfaction than does hysteroscopic endometrial ablation. The vaginal or laparoscopic approach should be selected in this group of patients with small uteri, while

  20. A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions.

    PubMed

    Tapper, Anna-Maija; Hannola, Mikko; Zeitlin, Rainer; Isojärvi, Jaana; Sintonen, Harri; Ikonen, Tuija S

    2014-06-01

    In order to assess the effectiveness and costs of robot-assisted hysterectomy compared with conventional techniques we reviewed the literature separately for benign and malignant conditions, and conducted a cost analysis for different techniques of hysterectomy from a hospital economic database. Unlimited systematic literature search of Medline, Cochrane and CRD databases produced only two randomized trials, both for benign conditions. For the outcome assessment, data from two HTA reports, one systematic review, and 16 original articles were extracted and analyzed. Furthermore, one cost modelling and 13 original cost studies were analyzed. In malignant conditions, less blood loss, fewer complications and a shorter hospital stay were considered as the main advantages of robot-assisted surgery, like any mini-invasive technique when compared to open surgery. There were no significant differences between the techniques regarding oncological outcomes. When compared to laparoscopic hysterectomy, the main benefit of robot-assistance was a shorter learning curve associated with fewer conversions but the length of robotic operation was often longer. In benign conditions, no clinically significant differences were reported and vaginal hysterectomy was considered the optimal choice when feasible. According to Finnish data, the costs of robot-assisted hysterectomies were 1.5-3 times higher than the costs of conventional techniques. In benign conditions the difference in cost was highest. Because of expensive disposable supplies, unit costs were high regardless of the annual number of robotic operations. Hence, in the current distribution of cost pattern, economical effectiveness cannot be markedly improved by increasing the volume of robotic surgery. PMID:24703710

  1. Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for rectal cancer: Interim results from a single center

    PubMed Central

    TAJIMA, TAKAYUKI; MUKAI, MASAYA; NOGUCHI, WATARU; HIGAMI, SHIGEO; UDA, SHUUJI; YAMAMOTO, SOUICHIROU; HASEGAWA, SAYURI; NOMURA, EIJI; SADAHIRO, SOTARO; YASUDA, SEIEI; MAKUUCHI, HIROYASU

    2015-01-01

    Minimally invasive laparoscopic surgery has become widespread and the indications for such surgery have recently been extended to various conditions, including rectal cancer. The objective of this study was to compare the clinical outcome of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) in patients with rectal cancer. Patients who underwent radical resection of stage I–III primary rectal cancer (n=111) were classified into those receiving HALS (n=57) and those receiving CL (n=54); the two groups were matched for stage and postoperative treatment. The 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS) were calculated and compared between the two groups. Intraoperative blood loss, operating time, postoperative hospital stay and complications were also compared between the two groups. There were no significant differenceS in 3Y-RFS or 3Y-OS between the HALS and CL groups for patients with all-stage (I, II and III) rectal cancer. The mean (median) intraoperative blood loss was 344.0 (247.0) ML in the HALS group vs. 807.5 (555.5) ML in the CL group (P<0.001). The mean (median) postoperative hospital stay was 19.8 (17) and 25.5 (18.3) days, respectively (P=0.039). There were no significant differences in the operating time or the incidence of complications between the two groups. Based on these results, HALS was found to be comparable to CL regarding survival, while achieving less blood loss and a superior cosmetic outcome. However, longer follow-up is required to confirm these findings.

  2. Laparoscopic assisted adenomyomectomy using double flap method

    PubMed Central

    Kim, Jang-Kew; Shin, Chang-Soo; Ko, Young-Bok; Nam, Sang-Yun; Yim, Hyun-Sun

    2014-01-01

    Objective The purpose of this study was to evaluate postoperative prognosis and progression in patients who received laparoscopic-assisted adenomyomectomy using the double flap method. Methods The pelvic cavity was explored by the conventional laparoscopic method, and drainage was achieved through a 5-mm trocar. After a small incision in the abdomen, the uterus was incised from the fundus to the upper cervical margin until exposing the endometrial cavity. Adenomyotic tissue was removed using a scalpel, scissors, or monopolar electrical bovie. The endometrial cavity was repaired with interrupted sutures using 2-0 vicryl. One side of the serosal flap was used to cover the endometrial side of the uterus. The second serosal flap covered the first flap after removal of the serosal surface of the first flap. Results From January 2008 to March 2012, there were 11 cases of laparoscopic-assisted adenomyomectomy at Chungnam National University Hospital. Nine cases were analyzed, excluding two cases with less than one year of follow-up. The average patient age was 37.0 years and average follow-up duration was 32.8 months. All patients showed improvement in dysmenorrhea (P < 0.001) and hypermenorrhea (P = 0.001) after surgery and were evaluated by visual analogue scale score. However, symptoms of adenomyosis were aggravated in three patients. Adenomyosis was progressed in the side opposite the site of operation. One patient required a total laparoscopic hysterectomy 27 months after surgery. Conclusion Laparoscopic-assisted adenomyomectomy using the double flap method is effective for uterine reduction and relief of dysmenorrhea and hypermenorrhea. Conservative management and careful follow-up are needed because adenomyosis can recur or progress in some patients. PMID:24678486

  3. Vaginal Cuff Dehiscence in Robotic-Assisted Total Hysterectomy

    PubMed Central

    Kashani, Shabnam; Gallo, Taryn; Sargent, Anita; ElSahwi, Karim; Silasi, Dan-Arin

    2012-01-01

    Study Objective: The aim of this study was to estimate the cumulative incidence of vaginal cuff dehiscence in robotic-assisted total hysterectomies in our patients and to provide recommendations to decrease the incidence of vaginal cuff dehiscence. Methods: This was an observational case series, Canadian Task Force Classification II-3 conducted at an academic and community teaching hospital. A total of 654 patients underwent robotic-assisted total laparoscopic hysterectomy for both malignant and benign reasons from September 1, 2006 to March 1, 2011 performed by a single surgeon. The da Vinci Surgical System was used for robotic-assisted total laparoscopic hysterectomy. Results: There were 3 cases of vaginal cuff dehiscence among 654 robotic-assisted total laparoscopic hysterectomies, making our cumulative incidence of vaginal cuff dehiscence 0.4%. The mean time between the procedures and vaginal cuff dehiscence was 44.3 d (6.3 wk). All patients were followed up twice after surgery, at 3 to 4 wk and 12 to 16 wk. Conclusion: In our study, the incidence of vaginal cuff dehiscence after robotic-assisted total laparoscopic hysterectomy compares favorably to that of total abdominal and vaginal hysterectomy. Our study suggests that the incidence of vaginal cuff dehiscence is more likely related to the technique of colpotomy and vaginal cuff suturing than to robotic-assisted total hysterectomy per se. With proper technique and patient education, our vaginal dehiscence rate has been 0.4%, which is 2.5 to 10 times less than the previously reported vaginal cuff dehiscence rate in the literature. PMID:23484559

  4. Intensity-modulated radiation therapy after hysterectomy: Comparison with conventional treatment and sensitivity of the normal-tissue-sparing effect to margin size

    SciTech Connect

    Ahamad, Anesa [Department of Radiation Oncology, Unversity of Texas M.D. Anderson Cancer Center, Houston, TX (United States); D'Souza, Warren [Department of Radiation Physics, Unversity of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Salehpour, Mohammad [Department of Radiation Physics, Unversity of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Iyer, Revathy [Department of Diagnostic Radiology, Unversity of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Tucker, Susan L. [Department of Biostatistics and Applied Mathematics, Unversity of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Jhingran, Anuja [Department of Radiation Oncology, Unversity of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Eifel, Patricia J. [Department of Radiation Oncology, Unversity of Texas M.D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: peifel@mdanderson.org

    2005-07-15

    Purpose: To determine the influence of target-volume expansion on the reduction in small-bowel dose achieved with use of intensity-modulated radiation therapy (IMRT) vs. standard conformal treatment of the pelvis after hysterectomy, and to investigate the influence of patient body habitus on the normal-tissue sparing achieved with use of IMRT. Methods and Materials: A clinical target volume (CTV) was contoured on each of 10 planning computed tomography scans of patients who had been treated for cervical or endometrial cancer after a hysterectomy. Treatment planning was based on vaginal CTVs and regional nodal CTVs. To account for internal motion, margins were added to form an initial planning target volume (PTVA) as follows: 0.0 mm were added to the regional nodal CTV; 10 mm were added anteriorly to the vaginal CTV; and 5 mm were added to the vaginal CTV in all other directions. Two further PTVs (PTVB and PTVC) were produced by a 5-mm expansion of PTVA to give PTVB and a further 5-mm expansion to give PTVC. Treatment plans for all 3 PTVs were produced by use of 2 conformal fields (2FC), 4 conformal fields (4FC), or IMRT to deliver 45 Gy to more than 97% of the PTV. The primary goal of IMRT was to spare small bowel. The change in sparing that accompanied the increase in margin size was assessed by comparison of dose-volume histograms that resulted from PTVA, PTVB, and PTVC. Measured patient dimensions were correlated with bowel sparing. Results: Significantly less small bowel was irradiated by IMRT than by 2FC (p < 0.0001) or 4FC (p < 0.0001) for doses greater than 25 Gy. Significantly less rectum was irradiated by IMRT than by 2FC (p < 0.0001) or 4FC (p < 0.0001). Significantly less bladder was irradiated by IMRT than by 2FC (p < 0.0001). However, the magnitude of the sparing achieved by use of IMRT decreased as margins increased. In particular, the volume of small bowel spared by IMRT vs. 2FC or 4FC decreased as margin size increased (p = 0.0002 and p = 0.008 for 2FC and 4FC, respectively). The amount of normal-tissue sparing achieved by use of IMRT vs. 4FC was inversely correlated with patient body mass index. Conclusion: Because the small-bowel sparing achieved with use of IMRT is markedly reduced by relatively small expansions of the target volume, accurate target delineation, highly reproducible patient immobilization, and a clear understanding of internal-organ motion are needed to achieve optimal advantage in the use of IMRT over conventional methods of posthysterectomy pelvic radiation therapy.

  5. Evaluation of risk factors of vaginal cuff dehiscence after hysterectomy

    PubMed Central

    Kim, Myung Ji; Kim, Seongmin; Bae, Hyo Sook; Lee, Jae Kwan; Lee, Nak Woo

    2014-01-01

    Objective The purpose of this study was to evaluate risk factors of vaginal cuff dehiscence or evisceration according to the type of operation. Methods Medical records of 604 women who underwent hysterectomies at Korea University Anam Hospital between June 2007 and June 2011 were reviewed. They were allocated to six groups. The six types of hysterectomies included robotic hysterectomy (n = 7), robotic radical hysterectomy and node dissection (RRHND, n = 9), total laparoscopic hysterectomy (TLH, n = 274), laparoscopy assisted vaginal hysterectomy (LAVH, n = 238), laparoscopic radical hysterectomy and node dissection (n = 11), and abdominal radical hysterectomy (ARH, n = 63). The characteristics and outcomes of each groups were compared. Results There was no difference in the characteristics of patients between 6 groups. In total of 604 hysterectomies, 3 evisceration (0.49%) and 21 dehiscences (3.47%) occurred. Evisceration were found in RRHND (1/9, 11.1%), TLH (1/276, 0.36%), and ARH (1/63, 1.56%). Dehiscences occurred in TLH (15/274, 5.42%), LAVH (4/238, 1.68%), and ARH (2/63, 3.17%). In 169 cases of TLH with intra-corporeal continuous suture, 1 evisceration and 4 dehiscences occurred, whereas 11 dehiscences occurred in 105 TLH cases with vaginal continuous locking suture (2.96% vs. 10.47%, P = 0.02). Conclusion The incidence of vaginal cuff dehiscenceand eviscerationwas significantly higher in TLH than LAVH. The intra-corporeal cuff suture was superior to the vaginal suture to prevent the vaginal cuff complications in TLH. PMID:24678487

  6. Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair: A systematic review

    Microsoft Academic Search

    Falk Müller-Riemenschneider; Stephanie Roll; Meik Friedrich; Juergen Zieren; Thomas Reinhold; J.-Matthias Graf von der Schulenburg; Wolfgang Greiner; Stefan N. Willich

    2007-01-01

    Background  Incisional hernias are a common complication following abdominal surgery and represent about 80% of all ventral hernia. In\\u000a uncomplicated postoperative follow-up they develop in about 11% of cases and in up to 23% of cases with wound infections or\\u000a other forms of wound complications. While conventional mesh repair has been the standard of care in the past, the use of

  7. Implementation of a Robotic Surgical Program in Gynaecological Oncology and Comparison with Prior Laparoscopic Series

    PubMed Central

    Povolotskaya, Natalia; Woolas, Robert; Brinkmann, Dirk

    2015-01-01

    Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2?min compared to 126.3?min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3?min in robotic group and 176.5?min in laparoscopic group. RH + BPLND surgical time was similar, 263.6?min (robotic arm) and 264.0?min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention (Clavien-Dindo classification grade 2/3) was higher in the robotic arm (22.7%) compared to the laparoscopic approach (4.5%). The readmission rate was higher in the robotic group (18.2%) compared to the laparoscopic group (4.5%). The return to theatre in the robotic group was 18.2% and 4.5% in laparoscopic group. Uncomplicated robotic surgery hospital stay appeared to be shorter, 1.3 days compared to the uncomplicated laparoscopic group, 2.5 days. There was no conversion to the open procedure in either arm. Estimated blood loss in all cases was less than 100?mL in both groups. Conclusion. Robotic surgery is comparable to laparoscopic surgery in blood loss; however, the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm. Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection. The robotic surgery team learning curve may be associated with higher rate of morbidity. Further research on the benefits to the surgeon is needed to clarify the whole picture of this versatile novel surgical approach. PMID:25785195

  8. Peripartum hysterectomy – the edinburgh experience

    Microsoft Academic Search

    K Edgar; H W Unger; S N Yao; C D B Love

    2011-01-01

    Peripartum hysterectomy can be required to control persistent postpartum haemorrhage. This audit aimed to review the incidence, management and outcomes of women undergoing peripartum hysterectomy.This was a retrospective audit of women undergoing peripartum hysterectomy at the Simpson Centre of Reproductive Health, Edinburgh, over an 8-year period from 2002 to 2010.Peripartum hysterectomy was defined as hysterectomy performed following delivery of a

  9. Perioperative Complications of Robot-Assisted Laparoscopic Surgery Using Three Robotic Arms at a Single Institution

    PubMed Central

    Yim, Ga Won; Kim, Sang Wun; Nam, Eun Ji; Kim, Sunghoon

    2015-01-01

    Purpose The aim of this study was to evaluate perioperative complications of robot-assisted laparoscopic surgery in gynecology. Materials and Methods Patients who underwent elective robot-assisted laparoscopic surgery between February 2006 and December 2013 were identified. Robotic procedures were performed using the da Vinci robotic system. Patient demographic data and operative outcomes were prospectively collected in a computerized database and extracted for this study. Results Two hundred and ninety eight patients were identified during the study period. One case was converted to conventional laparoscopy due to mechanical failure of the robot system before the procedure and excluded from review. The median age and body mass index of patients were 48 years and 23.0 kg/m2, respectively. The majority (n=130, 43.6%) of operative procedures was radical hysterectomy, followed by endometrial cancer staging (n=112, 37.6%), total hysterectomy (n=39, 13.1%), and myomectomy (n=17, 5.7%). The median operative time, estimated blood loss, and postoperative hospital stay were 208.5 min, 184.8 mL, and 8.9 days, respectively. The overall complication rate was 18.8% and that for only oncologic cases was 16.1%. Intraoperative complications (n=5, 1.7%) consisted of three vessel injuries, one bowel content leakage during an appendectomy during endometrial cancer staging and one case of bladder injury during radical hysterectomy. Early and late postoperative complications were 14.4% and 2.7%, respectively. Five patients (1.7%) experienced grade 3 complications according to Clavien-Dindo classification and therefore needed further intervention. Conclusion Robot-assisted laparoscopic surgery is a feasible approach in gynecology with acceptable complications. PMID:25683998

  10. Niti CAR 27 Versus a Conventional End-to-End Anastomosis Stapler in a Laparoscopic Anterior Resection for Sigmoid Colon Cancer

    PubMed Central

    Kwag, Seung-Jin; Kim, Jun-Gi; Kang, Won-Kyung; Lee, Jin-Kwon

    2014-01-01

    Purpose The Niti CAR 27 (ColonRing) uses compression to create an anastomosis. This study aimed to investigate the safety and the effectiveness of the anastomosis created with the Niti CAR 27 in a laparoscopic anterior resection for sigmoid colon cancer. Methods In a single-center study, 157 consecutive patients who received an operation between March 2010 and December 2011 were retrospectively assessed. The Niti CAR 27 (CAR group, 63 patients) colorectal anastomoses were compared with the conventional double-stapled (CDS group, 94 patients) colorectal anastomoses. Intraoperative, immediate postoperative and 6-month follow-up data were recorded. Results There were no statistically significant differences between the two groups in terms of age, gender, tumor location and other clinical characteristics. One patient (1.6%) in the CAR group and 2 patients (2.1%) in the CDS group experienced complications of anastomotic leakage (P = 0.647). These three patients underwent a diverting loop ileostomy. There were 2 cases (2.1%) of bleeding at the anastomosis site in the CDS group. All patients underwent a follow-up colonoscopy (median, 6 months). One patient in the CAR group experienced anastomotic stricture (1.6% vs. 0%; P = 0.401). This complication was solved by using balloon dilatation. Conclusion Anastomosis using the Niti CAR 27 device in a laparoscopic anterior resection for sigmoid colon cancer is safe and feasible. Its use is equivalent to that of the conventional double-stapler. PMID:24851217

  11. Dilation of the vaginal cuff using the Bakri Postpartum Balloon to extract the large uterus at the time of robotic hysterectomy for endometrial carcinoma

    Microsoft Academic Search

    Michael L. Stitely; Younes N. Bakri

    Removal of large uterine specimens during robotic or total laparoscopic hysterectomy poses surgical challenges, particularly\\u000a in cases performed for gynecologic malignancy. A 23-year-old patient with endometrioid adenocarcinoma of the endometrium underwent\\u000a robotic total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. The large uterine specimen was removed by dilating\\u000a the colpotomy incision using the Bakri Postpartum Balloon™. Dilation of the colpotomy incision with

  12. [Sacrocolpopexy - pro laparoscopic].

    PubMed

    Hatzinger, M; Sohn, M

    2012-05-01

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

  13. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials

    Microsoft Academic Search

    Neil Johnson; David Barlow; Anne Lethaby; Emma Tavender; Liz Curr; Ray Garry

    2005-01-01

    Objective To evaluate the most appropriate surgical method of hysterectomy (abdominal, vaginal, or laparoscopic) for women with benign disease. Design Systematic review and meta-analysis. Data sources Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, and Biological Abstracts. Selection of studies Only randomised controlled trials were selected; participants had to have benign gynaecological

  14. Laparoscopic rectocele repair using polyglactin mesh.

    PubMed

    Lyons, T L; Winer, W K

    1997-05-01

    We assessed the efficacy of laparoscopic treatment of rectocele defect using a polyglactin mesh graft. From May 1, 1995, through September 30, 1995, we prospectively evaluated 20 women (age 38-74 yrs) undergoing pelvic floor reconstruction for symptomatic pelvic floor prolapse, with or without hysterectomy. Morbidity of the procedure was extremely low compared with standard transvaginal and transrectal approaches. Patients were followed at 3-month intervals for 1 year. Sixteen had resolution of symptoms. Laparoscopic application of polyglactin mesh for the repair of the rectocele defect is a viable option, although long-term follow-up is necessary. PMID:9154790

  15. Conventionalism

    E-print Network

    Einheuser, Iris, 1969-

    2003-01-01

    Certain fundamental philosophical disputes, in contrast to disputes in the empirical sciences, are characterized by the persistence of disagreement. This has led some to endorse conventionalism, the view that the 'facts ...

  16. Robotic-assisted laparoscopic cholecystectomy.

    PubMed

    Goh, P M Y; Lomanto, D; So, J B Y

    2002-01-01

    We report a case of laparoscopic cholecystectomy that was performed using a robotic surgical system. A 70-year-old woman underwent laparoscopic robotic cholecystectomy ZEUS, the robotic system used in our study, has three interactive robotic arms fixed to the side of the operating table. The arms are controlled by the surgeon, who sits at a remote computer console. The surgeon's movements can be scaled down, and tremor is filtered out. The robotic-assisted laparoscopic cholecystectomy was completed in 42 min. The time to set up the robot was 22 mins. All of the surgically reproducible robotic maneuvers were performed without any particular difficulty. The robotic movements were stable, accurate, and reliable, as well as easy to control with precision. Our preliminary experience indicates that robotic laparoscopic cholecystectomy is safe and can be as fast as conventional laparoscopic cholecystectomy. However, further clinical applications of robotic surgery are needed to confirm this observation. PMID:11961647

  17. Hysterectomy - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... Arabic) ??????? ????? - ??????? Bilingual PDF Health Information Translations Chinese - Simplified (????) Hysterectomy ????? - ???? (Chinese - Simplified) Bilingual PDF Health Information Translations Chinese - Traditional (????) Hysterectomy ????? - ???? (Chinese - Traditional) ...

  18. Laparoscopic adrenalectomy

    Microsoft Academic Search

    M. Gagner; A. Lacroix; E. Bolte; A. Pomp

    1994-01-01

    Adrenalectomy is usually performed via transabdominal or posterior approaches. Unfortunately, both approaches are associated with painful postoperative syndromes. Recently, laparoscopic surgery was applied to organ removal.

  19. Correcting reflux laparoscopically.

    PubMed

    Poulin, E C; Schlachta, C M; Mamazza, J

    1998-01-01

    Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication (Nissen) because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery. PMID:9773211

  20. COMPARATIVE OUTCOMES OF OPEN VERSUS LAPAROSCOPIC SACROCOLPOPEXY AMONG MEDICARE BENEFICIARIES

    PubMed Central

    Khan, Aqsa; Alperin, Marianna; Wu, Ning; Clemens, J. Quentin; Dubina, Emily; Pashos, Chris L.; Anger, Jennifer T.

    2014-01-01

    Introduction Since the first reported laparoscopic sacrocolpopexy in 1991, a limited number of single-center studies have attempted to assess the procedure’s effectiveness and safety. Therefore, we analyzed a national Medicare database to compare real-world short-term outcomes of open and laparoscopic-assisted (including robotic) sacrocolpopexy on a United States sample of patients. Methods Public Use File data for a 5% random national sample of all Medicare beneficiaries age 65 and older were obtained from the Centers for Medicare and Medicaid Services for years 2004–2008. Women with pelvic organ prolapse were identified using ICD-9 diagnosis codes. CPT-4 procedure codes were used to identify women who underwent open (code 57280) or laparoscopic (code 57425) sacrocolpopexy. Individual subjects were followed for one year post-operatively. Outcomes measured, using ICD-9 and CPT-4 codes, included medical and surgical complications and re-treatment rates. Results 794 women underwent open and 176 underwent laparoscopic sacrocolpopexy. Laparoscopic sacrocolpopexy was associated with a significantly increased rate of re-operation for anterior vaginal wall prolapse (3.4% vs. 1.0%, p = 0.018). However, more medical (primarily cardiopulmonary) complications occurred post-operatively in the open group (31.5% vs. 22.7%, p = 0.023). When sacrocolpopexy was performed with concomitant hysterectomy, mesh-related complications were significantly higher in the laparoscopic group (5.4% vs. 0%, p = 0.026). Conclusion Laparoscopic sacrocolpopexy resulted in increased rate of reoperation for prolapse in anterior compartment. When hysterectomy was performed at the time of sacrocolpopexy, the laparoscopic approach was associated with an increased risk of mesh-related complications. PMID:23652338

  1. Laparoscopic herniorrhaphy in girls

    Microsoft Academic Search

    F Schier

    1998-01-01

    Background\\/Purpose: Laparoscopy has been used to evaluate the contralateral side in inguinal hernias. Once a hernia was identified in such procedures, laparoscopy was terminated and a conventional groin exploration was undertaken. This study presents a purely laparoscopic approach using miniature instruments without the use of a groin incision.Methods: The technique was applied in 14 girls (median age, 6.5 years). The

  2. Laparoscopic Management of Congenital Cervico-Vaginal Agenesis

    PubMed Central

    Jain, Nutan; Sircar, Reema

    2011-01-01

    We report a case of cervical agenesis or lack of uterine cervix. It is a rare mullerian anomaly and occurs in 1 in 80,000-100,000 births. The patient presented to us with primary amenorrhea and cyclical left lower abdominal pain. She was diagnosed to have cervical agenesis associated with vaginal agenesis and left endometriotic cyst. Neovagina was created laparoscopically. Utero-vaginal anastomosis was tried but it was not technically feasible. Subsequently, laparoscopic hysterectomy was done due to recurrent endometriotic cyst formation.

  3. Husbands' experiences before wives' hysterectomy.

    PubMed

    Chou, Cheng-Chen; Lee, Tsorng-Yeh; Sun, Chi-Chen; Lin, Shu-Shan; Chen, Li-Fang

    2006-06-01

    After Caesarean section, hysterectomy ranks as the surgical procedure most frequently performed on women. To most women, the partner's support is vital. Currently, there is a lack of research on the experiences of husbands facing their wife's hysterectomy. The aim of this study was to understand husbands' experiences when their wives were to undergo a hysterectomy. The study used a phenomenological approach and purposive sampling; data were collected at three teaching hospitals in northern Taiwan. Twenty participants were interviewed and data were analyzed by Colaizzi's method. The findings demonstrated that, when their wives were to undergo a hysterectomy, six major themes emerged among the husbands, as follows: (1) limited knowledge about the surgical process; (2) considerations about and adjustments to changes in one's sex life; (3) support in making necessary decisions; (4) difficulty in acquiring information on uterine disorders; (5) ensuring the wife's safety during the operation; and (6) expecting full communication with medical personnel. The findings from this study should contribute significantly to advances in practice, education and research concerning Taiwanese males' experiences as they face their wife's hysterectomy. These findings highlight the significance of the husband's involvement in meeting his wife's needs as regards providing information and communicating. Implications for nursing practice and further research are discussed. PMID:16741861

  4. Laparoscopic management of colorectal endometriosis

    Microsoft Academic Search

    B. L. Jerby; H. Kessler; T. Falcone; J. W. Milsom

    1999-01-01

    Background: In the past, intestinal endometriosis diagnosed at laparoscopy has generally required conversion to conventional surgery.\\u000a The purpose of this study was to describe the laparoscopic management of colorectal endometriosis at a tertiary referral center.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: From November 1994 to March 1998, 509 consecutive patients with endometriosis requiring laparoscopic intervention were prospectively\\u000a evaluated. Those with colorectal involvement were analyzed for

  5. Peritonitis: laparoscopic approach

    PubMed Central

    Agresta, Ferdinando; Ciardo, Luigi Francesco; Mazzarolo, Giorgio; Michelet, Ivan; Orsi, Guido; Trentin, Giuseppe; Bedin, Natalino

    2006-01-01

    Background Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment – exploration to identify the causative pathology and performance of an appropriate operation – can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution. Methods From January 1992 and January 2002 a total of 935 patients (mean age 42.3 ± 17.2 years) underwent emergent and/or urgent surgery. Among them, 602 (64.3%) were operated on laparoscopically (of whom 112 -18.7% – with peritonitis), according to the presence of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than two previous major abdominal surgeries or massive bowel distension were not treated Laparoscopically. Peritonitis was not considered contraindication to Laparoscopy. Results The conversion rate was 23.2% in patients with peritonitis and was mainly due to the presence of dense intra-abdominal adhesions. Major complications ranged as high as 5.3% with a postoperative mortality of 1.7%. A definitive diagnosis was accomplished in 85.7% (96 pat.) of cases, and 90.6% (87) of these patients were treated successfully by Laparoscopy. Conclusion Even if limited by its retrospective feature, the present experience let us to consider the Laparoscopic approach to abdominal peritonitis emergencies a safe and effective as conventional surgery, with a higher diagnostic yield and allows for lesser trauma and a more rapid postoperative recovery. Such features make Laparoscopy a challenging alternative to open surgery in the management algorithm for abdominal peritonitis emergencies. PMID:16759400

  6. Laparoscopic live-donor nephrectomy.

    PubMed

    Gill, I S; Carbone, J M; Clayman, R V; Fadden, P A; Stone, M A; Lucas, B A; McRoberts, J W

    1994-04-01

    Laparoscopic nephrectomy with ablative intent has been performed clinically. The current study aimed to determine whether a physiologically and anatomically intact kidney suitable for transplantation could be harvested laparoscopically. Three weeks after an ablative laparoscopic right nephrectomy, 15 pigs were divided into two groups: the study group (n = 10) underwent a laparoscopic live-donor left nephrectomy of the solitary kidney and conventional autotransplantation; the control group (n = 5) underwent an open live-donor left nephrectomy of the solitary kidney and conventional autotransplantation. All study kidneys underwent laparoscopic in situ hypothermic perfusion. The mean length of the left renal artery and vein were similar in the study and control groups: 3.1 cm and 3.4 cm, respectively, in the study group compared with 2.5 cm and 3.8 cm, respectively, in the control group (P = 0.5). No intraoperative renal vascular injuries or postoperative ureteral complications were noted in either group. Renal histopathologic examination immediately after live-donor nephrectomy and at 1 month post-transplant showed similar findings in the two groups. The mean serum creatinine at 7 and 30 days postoperatively was not significantly different: 2.1 mg/dL and 1.6 mg/dL, respectively, in the study group and 1.7 mg/dL, and 1.4 mg/dL, respectively, in the control group (P = 0.4). We conclude that laparoscopic live-donor nephrectomy can be performed safely and reproducibly in the porcine model. PMID:8061673

  7. Total Microlaparoscopic Radical Hysterectomy in Early Cervical Cancer

    PubMed Central

    Gallotta, Valerio; Fagotti, Anna; Rossitto, Cristiano; Piovano, Elisa; Scambia, Giovanni

    2013-01-01

    Background and Objective: In less than 2 decades, laparoscopy has contributed to modification in the management of early cervical cancer patients, and all comparisons between open and laparoscopic-based radical operations showed an identical oncological outcome. The aim of this study is to describe surgical instrumentations and technique to perform total microlaparoscopy radical hysterectomy in early cervical cancer patients and report our preliminary results in terms of operative time and perioperative outcomes. Methods: Between January 1, 2012, and March 25, 2012, 4 consecutive early cervical cancer patients were enrolled in this study. Results: We performed 3 type B2 and 1 type C1-B2 total microlaparoscopy radical hysterectomy, and in all cases concomitant bilateral salpingo-oophorectomy and pelvic lymphadenectomy were carried out. Median operative time was 165 minutes (range: 155 to 215) (mean: 186), and median estimated blood loss was 30 mL (range: 20 to 50). Median number of pelvic lymph nodes removed was 12 (range: 11 to 15). All procedures were completed without 5-mm port insertion and without conversion. No intraoperative or early postoperative complications were reported. Conclusions: This report suggests a role of microlaparoscopy in the surgical management of early cervical cancer with adequate oncological results, superimposable operative time, and perioperative outcomes with respect to standard laparoscopy. PMID:23743381

  8. Laparoscopic Radical Prostatectomy

    Microsoft Academic Search

    Ingolf Türk; Serdar Deger; Björn Winkelmann; Bernd Schönberger; Stefan A. Loening

    2001-01-01

    Purpose: The laparoscopic access for radical prostatectomy offeres an alternative to the open surgical procedure with less morbidity. We report on our experience with 125 laparoscopic prostatectomies, especially with respect to making the laparoscopic approach a routine procedure and with a view to the oncological and functional results.Material and Methods: From June 1999 to September 2000, we performed 125 laparoscopic

  9. Synchronous autotransfusion during cesarean hysterectomy.

    PubMed

    Hatfield, Tamera; Kraus, Heidi; McConnell, Douglas; Nageotte, Michael

    2010-01-01

    Placenta accreta is associated with major morbidities including massive hemorrhage. We report a cesarean hysterectomy for placenta accreta with synchronous autotransfusion using a standard cardiopulmonary bypass machine. This technique requires complete intraoperative heparinization yet has the advantage of autotransfusion of autologous clotting factors and platelets in addition to red blood cells. PMID:19889388

  10. Operative results and outcome of twenty-four totally laparoscopic vascular procedures for aortoiliac occlusive disease

    Microsoft Academic Search

    Letterio Barbera; Achim Mumme; Senkal Metin; Volker Zumtobel; Matthias Kemen

    1998-01-01

    Purpose: The study objective was to apply laparoscopic techniques to conventional bypass procedures for aortoiliac occlusive disease. Methods: From October 1995 to August 1997, we performed seven iliofemoral (IFB), five unilateral aortofemoral (UAFB), and 11 aortobifemoral (AFB) bypass procedures and one aortic endarterectomy (TEA) totally laparoscopic. A transabdominal approach with pneumoperitoneum was preferred, and only laparoscopic vascular instruments were used.

  11. Umbilical Incision Laparoscopic Surgery with One Assist Port for Anterior Resection

    Microsoft Academic Search

    Hidejiro Kawahara; Kazuhiro Watanabe; Takuro Ushigome; Rohta Noaki; Susumu Kobayashi; Katsuhiko Yanaga

    2010-01-01

    Background: A high surgical technique is required for laparoscopic anterior resection using single-incision laparoscopic surgery such as multiport surgery. We report a novel surgical technique of umbilical incision laparoscopic surgery with one assist port which could be performed like conventional multiport surgery. Methods: With the patient in the lithotomy position, a 3-cm longitudinal skin incision is made at the umbilicus

  12. Comparison of a new reusable gynecologic laparoscopic electric morcellator with a disposable morcellator: a preliminary trial.

    PubMed

    Martínez-Zamora, M Angeles; Castelo-Branco, Camil; Balasch, Juan; Carmona, Francisco

    2009-01-01

    We compared the efficiency and safety of a newly developed reusable morcellator (Olympus VarioCarve) with that of a disposable morcellator (GyneCare Morcellex) for gynecologic laparoscopic surgery. In group 1 (n=15 patients; 11 myomectomies and 4 supracervical hysterectomies), the laparoscopic disposable morcellator was used, and in group 2 (n=14; 11 myomectomies and 3 supracervical hysterectomies), the reusable morcellator was used. There were no statistical differences in total tissue weight. Morcellating time was significantly shorter in group 2, and the rate of morcellation was significantly greater in group 2. Significantly fewer and longer pieces of tissue were removed with the reusable morcellator. No iatrogenic organ damage was observed. PMID:19596217

  13. Morphological changes in hysterectomies after endometrial ablation

    Microsoft Academic Search

    Francisco Tresserra; Pablo Grases; Alicia Ubeda; Maria Angela Pascual; Pedro J. Grases; Ramon Labastida

    1999-01-01

    Electrosurgical ablation of the endometrium is a thera- peutic choice for those patients having abnormal uterine bleeding. When ablation is followed by a hysterectomy, tissue damage due to thermal effect can be seen. From a total of 350 women with endometrial ablation, 12 required subsequent hysterectomy. The histological features found in these specimens are described and related to the elapsed

  14. Evaluation of Fundus-First Laparoscopic Cholecystectomy

    PubMed Central

    Agarwal, Prem Narayan; Kant, Ravi; Malik, Vinod

    2004-01-01

    Objectives: Laparoscopic cholecystectomy is the gold standard for gallbladder surgery. Cholecystectomy from the fundus to the cystic duct may be advantageous when cystic duct exposure becomes difficult due to adhesions on Calot's triangle. The aim of this study was to compare conventional laparoscopic cholecystectomy with the fundus-first procedure and to evaluate whether the fundus-first technique can prevent conversion in difficult cases. Methods: The study included 145 patients treated over 18 months. The inclusion criterion was the presence of ultrasound proven gallstones. Patients were excluded from the study if there was evidence of common bile duct stones, a bilioenteric fistula, or carcinoma of the gallbladder. Results: The fundus-first approach was started in 45 patients; all procedures were completed laparoscopically. Conventional laparoscopic cholecystectomy was begun in 100 patients. Twenty-seven of the 100 patients were converted to fundus dissection (adhesions within Calot's triangle). Four of the 27 were further converted to open surgery. One patient had a drop in blood pressure on creation of pneumoperitoneum. Time taken for severely inflammatory and noninflammatory cases was significantly greater (P<0.05) in the fundus-first group. The average hospital stay was 48 hours in both groups. No major complications were observed. Conclusion: The rate of conversion in the conventional laparoscopic cholecystectomy group decreased from 18.75% (27/144) to 2.08% (3/144). The fundus-first technique has the potential to decrease conversion in difficult cases. PMID:15347114

  15. Laparoscopic restorative proctocolectomy

    Microsoft Academic Search

    Peter W. Marcello; Jeffrey W. Milsom; S. K. Wong; Katherine A. Hammerhofer; Marlene Goormastic; James M. Church; Victor W. Fazio

    2000-01-01

    PURPOSE: A laparoscopic approach to restorative proctocolectomy is new and has not been compared recently with the traditional open procedure. By using prospectively gathered data, laparoscopic and open restorative proctocolectomy procedures in mucosal ulcerative colitis and familial adenomatous polyposis patients were compared by using a case-matched design. METHODS: Forty patients, composing 20 consecutive laparoscopic cases (13 mucosal ulcerative colitis, 7

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

    PubMed

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

    2007-05-01

    Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clinico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair. PMID:17626540

  17. Laparoscopic repair of recurrent lateral enterocele and rectocele.

    PubMed

    Solomon, Ellen R; Muffly, Tyler M; Hull, Tracy; Paraiso, Marie Fidela R

    2015-01-01

    It is difficult to determine what types of procedures should be attempted in patients who have recurrent prolapse. We present a case of recurrent lateral enterocele and rectocele after the patient had undergone multiple surgeries for pelvic organ prolapse (POP), including a vaginal hysterectomy, bladder-neck suspension, anterior colporrhaphy, site-specific rectocele repair, apical mesh implant, iliococcygeus vault suspension, and transobturator suburethral sling procedure. With recurrence, the patient underwent robot-assisted laparoscopic sacral colpopexy, tension-free vaginal tape transobturator sling insertion, rectocele repair, and perineorrhaphy with cystoscopy. She then presented with defecatory outlet obstruction and constipation and subsequently was treated with a stapled transanal rectal resection. The patient returned with continued defecatory dysfunction and a recurrent lateral enterocele and rectocele. The recurrence was treated laparoscopically using a lightweight polypropylene mesh. The postoperative period was uneventful. Two years later, the patient reported decreased defecatory symptoms and no further symptomatic prolapse. PMID:25224146

  18. The Decreasing Length of Hospital Stay following Vaginal Hysterectomy: 2011–2012 vs. 1996–1997 vs. 1995–1996

    PubMed Central

    Reif, P.; Drobnitsch, T.; Aigmüller, T.; Laky, R.; Ulrich, D.; Haas, J.; Bader, A.; Tamussino, K.

    2014-01-01

    Background/Definition of the Problem: In recent years, postoperative management has changed towards rapid mobilisation, early oral feeding and rapid rehabilitation (known as Fast-Track or Enhanced Recovery Concepts). This study analysed the postoperative length of stay after vaginal hysterectomy in 3 different periods of time. Material and Methods: In the period October 2011 – September 2012, 75 patients underwent vaginal hysterectomies (±?adnexectomy); another 114 vaginal or laparoscopic hysterectomies with additional operations (e.g. prolapse surgery and incontinence surgery) and malignancies were not included. The time periods August 1995 – July 1996 (n?=?50) and October 1996 – September 1997 (n?=?96) served as a comparison. Reducing the length of stay was not an explicit goal. Results: The median postoperative stay was shortened from 7 (5–9) to 5 (3–15) or 3 (0–5) days (p?hysterectomy has more than halved since 1995/1996 and continues to decline. This development occurred without a shortened stay being an explicit goal of the clinic. The shortened length of stay does not appear to have a negative impact on postoperative complications and recovery rate. PMID:25089057

  19. Ultracision in gynaecological laparoscopic surgery.

    PubMed

    Kunde, D; Welch, C

    2003-07-01

    The Ultracision harmonic scalpel and laparosonic coagulating shears use high-frequency ultrasound energy and can be used as a substitute for electrosurgery, lasers and steel scalpels in both laparoscopic and conventional gynaecological surgery. Its unique mechanism of action allows cutting and coagulation without causing a significant rise in temperature at the tissue level. Its safety has been tested extensively in animal experiments and there is now ample evidence to suggest that it produces less thermal damage in vitro compared to electrosurgery and lasers. Although these results have been extrapolated to human beings, there are no in vivo studies in humans to corroborate the above observations. This review highlights the mechanism of action, tissue effects, safety aspects, applications, versatility and limitations of this novel technique. The many advantages demonstrated by this instrument over other energy sources used in laparoscopic surgery should make it more popular in forthcoming years. PMID:12881068

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

    PubMed Central

    Angioni, Stefano; Pontis, Alessandro; Sedda, Federica; Zampetoglou, Theodoros; Cela, Vito; Mereu, Liliana; Litta, Pietro

    2015-01-01

    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. PMID:26170692

  1. Lateral transperitoneal laparoscopic adrenalectomy

    Microsoft Academic Search

    Steven J. Shichman; C. D. Anthony Herndon; R. Ernest Sosa; Giles F. Whalen; Dougald C. MacGillivray; Carl D. Malchoff; E. Darracott Vaughan

    1999-01-01

    Several laparoscopic approaches to the adrenal gland have been described. The lateral transperitoneal approach has several\\u000a distinct advantages when contrasted with other techniques for laparoscopic adrenalectomy (LA). We present our technique and\\u000a results obtained in 50 consecutive transperitoneal LAs. We review 50 consecutive laparoscopic adrenalectomies (28 female,\\u000a 19 male) performed from 1993 to 1998. S.J. Shichman or R.E. Sosa was

  2. Laparoscopic herniorrhaphy in children

    Microsoft Academic Search

    C. M. Gorsler; F. Schier

    2003-01-01

      Background: We report our clinical experience with 403 inguinal hernias in 279 children. They were treated via a purely laparoscopic\\u000a approach using 2-mm instruments, obviating the need for a groin incision. Methods: Laparoscopic herniorrhaphy was performed\\u000a in children ages 4 days to 15 years. A 5-mm laparoscope was inserted through the umbilicus, and two 2-mm needle holders were\\u000a inserted through

  3. Laparoscopic reconstructive urology

    PubMed Central

    Murphy, Declan; Challacombe, Ben; Rane, Abhay

    2005-01-01

    Objective: Laparoscopic reconstructive urology is undergoing rapid change. We review the current status of laparoscopic reconstructive urology, with particular respect to pyeloplasty and reconstructive ureteric surgery. Methods: An extensive Medline search of reconstructive laparoscopic procedures was undertaken. The initial reports and large series reports of a range of procedures was examined and summarised. The most commonly practised procedure within this remit is laparoscopic pyeloplasty. Several series of over 100 patients have been published. Success rates average over 90% for laparoscopic pyeloplasty with a low complication rate. Much less common laparoscopic reconstructive urological procedures include ureteric re-implantation, Boari flap, urinary diversion and transuretero-ureterostomy. The results of these are encouraging. Conclusions: Laparoscopic pyeloplasty may be safely performed by either the transperitoneal or retroperitoneal routes with excellent results. It should be considered the “gold standard” for the management of UPJ obstruction, especially in those patients with significant hydronephrosis, renal impairment or a crossing vessel. Laparoscopic ureteric reimplantation, Boari flap, urinary diversion and transuretero-ureterostomy have been performed by experienced laparoscopic urologists with encouraging results. PMID:21206661

  4. [Robotics-assisted laparoscopic colorectal resection].

    PubMed

    Mann, B; Virakas, G; Blase, M; Soenmez, M

    2013-08-01

    The value of laparoscopic surgery for rectal cancer is still controversially discussed. Robotics offers the opportunity to leave the limitations of conventional laparoscopy behind us. The three-dimensional visualization and the superior dexterity by wristed instruments should be particularly helpful in complex laparoscopic procedures in confined spaces such as the small pelvis. Colorectal resections using the Da Vinci® system are well established and becoming increasingly more standard procedures. Nerve-sparing total mesorectal excision in patients with rectal cancer, total mesocolic excision in patients with right-sided colon cancer and rectopexy in patients with pelvic floor insufficiency are the most promising indications. The prospective randomized ROLARR study has been evaluating the application of the Da Vinci® system in laparoscopic rectal cancer surgery since 2011. Besides the currently available clinical data the perioperative and intraoperative logistics and strategy will be presented in detail. PMID:23942962

  5. Hysterectomy

    MedlinePLUS

    ... in place. Uterine prolapse happens when the uterus drops or “falls out” because it loses support after childbirth or pelvic ... in place. Uterine prolapse happens when the uterus drops or “falls out” because it loses support after childbirth or pelvic ...

  6. Competence Acquisition for Single-Incision Laparoscopic Cholecystectomy

    PubMed Central

    Deutsch, Gary B.; Sathyanarayana, Sandeep Anantha; Giangola, Matthew; Akerman, Meredith; DeNoto, George; Klein, Jonathan D. S.; Zemon, Harry

    2015-01-01

    Background and Objectives: Within the past few years, there has been a push for an even more minimally invasive approach to biliary disease with the adoption of single-incision laparoscopic cholecystectomy. We sought to compare 4 individual surgeon experiences to define whether there exists a learning curve for performing single-incision laparoscopic cholecystectomy. Methods: We performed a retrospective review 290 single-incision laparoscopic cholecystectomies performed by a group of general surgeons, with varying levels of experience and training, at 3 institutions between May 2008 and September 2010. The procedure times were recorded for each single-incision laparoscopic cholecystectomy, ordered chronologically for each surgeon, and subsequently plotted on a graph. The patients were also combined into cohorts of 5 and 10 cases to further evaluate for signs of improvement in operative efficiency. Results: Of the 4 surgeons involved in the study, only 1 (surgeon 4, laparoscopic fellowship trained with <5 years' experience) confirmed the presence of a learning curve, reaching proficiency within the first 15 cases performed. The other surgeons had more variable procedure times, which did not show a distinct trend. When we evaluated the cases by cohorts of 5 cases, surgeon 4 had a significant difference between the first and last cohort. Increased body mass index resulted in a slightly longer operative time (P < .0063). The conversion rate to multiport laparoscopic surgery was 3.1%. Conclusions: Our results indicate that among experienced general surgeons, there does not seem to be a significant learning curve when transitioning from conventional laparoscopic cholecystectomy to single-incision laparoscopic cholecystectomy. The least experienced surgeon in the group, surgeon 4, appeared to reach proficiency after 15 cases. Greater than 5 years of experience in laparoscopic surgery appears to provide surgeons with a sufficient skill set to obviate the need for a single-incision laparoscopic cholecystectomy learning curve. PMID:25848190

  7. Laparoscopic inguinal herniorrhaphy in children: A three-center experience with 933 repairs

    Microsoft Academic Search

    Felix Schier; Philippe Montupet; Ciro Esposito

    2002-01-01

    Background\\/Purpose: Laparoscopic inguinal herniorrhaphy has been introduced recently as an alternative to conventional open repair in children. This study was undertaken to evaluate the safety, efficacy, and reproducibility of this minimally invasive approach. Methods: A total of 933 laparoscopic inguinal herniorrhaphies were performed on 666 children (597 boys and 69 girls), ranging in age from 3 weeks to 14 years

  8. Laparoscopic partial adrenalectomy

    Microsoft Academic Search

    T. Imai; Y. Tanaka; T. Kikumori; M. Ohiwa; N. Matsuura; T. Mase; H. Funahashi

    1999-01-01

    Background: Most laparoscopic adrenalectomies involve total removal of the whole adrenal gland, and reports of laparoscopic partial adrenalectomies\\u000a have been very few. The criteria for performing a laparoscopic partial adrenalectomy have not been described.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: (a) Patients with functioning adrenal tumors smaller than 3 cm in diameter were selected. (b) The solitary adrenal tumors\\u000a were evaluated by preoperative thin-slice computed

  9. Endoscopic removal of intravesical polypropylene suture with plasmakinetic resection after abdominal hysterectomy

    PubMed Central

    Küçükdurmaz, Faruk; Can, Selman; Barut, Osman

    2014-01-01

    INTRODUCTION Intravesical foreign substances such as mesh or suture are among the rare reasons of recurrent urinary tract infections. Anti-incontinence and prolapsus procedures are associated with mesh/suture extrusion into the bladder, however, this complication is uncommon with abdominal hysterectomy. PRESENTATION OF CASE A 61-year-old female, obese patient admitted to our clinic with recurrent urinary tract infections and voiding symptoms which were worsened after abdominal hysterectomy. Radiological evaluation revealed an intravesical foreign material within the bladder. The cytoscopy was performed and a polypropylene suture which was inserted from dome, passed through the base and exited from the dome of bladder during abdominal hysterectomy. Transurethral plasmakinetic resection of superficial layer of urothelium between suture entrance and exit sites was performed and suture was removed from the bladder. DISCUSSION Urogynecological procedures are associated with the increased risk of urethral or ureteral injury, intravesical mesh or suture erosion and fistulae formation. Many different techniques including open, laparoscopic and transvaginal approaches were described for the removal of intravesical mesh/suture extrusion in the literature. Transurethral approach with its minimally invasive and safe nature was used to remove suture in this patient. This technique with the use of plasmakinetic energy has the advantage of decreased risk of bleeding and urothelial injury when compared to monopolar cautery. It also avoids the need for open or extensive surgery which may have a high rate of complications. CONCLUSION Transurethral resection is the treatment of choice for the removal of intravesical foreign substances. Use of plasmakinetic energy will decrease the risk of complications and avoid the need for open interventions. PMID:25437667

  10. The role of tactile feedback in laparoscopic surgery.

    PubMed

    Ottermo, Maria V; Ovstedal, Marit; Langø, Thomas; Stavdahl, Oyvind; Yavuz, Yunus; Johansen, Tor A; Mårvik, Ronald

    2006-12-01

    Two experiments aiming at comparing palpation with gloved fingers, conventional laparoscopic instruments, and a laparoscopic instrument with a sensor array attached to its end effector are described. The sensor array provides the surgeon with visually presented tactile information. Fifteen subjects were asked to discriminate hardness and size of objects (rubber balls hidden in pig's intestine) with the 3 palpation methods. The experiments showed that the gloved fingers are better at differentiating hardness and size compared with conventional laparoscopic instruments and the instrument with sensor. There was no significant difference between conventional instruments and the instrument with sensor, although the results showed a higher average score with the instrument with sensor. This indicates that visual presentation may not be an ideal way of presenting tactile information. It also indicates that the presence of the array does not make the task more difficult. PMID:17277655

  11. Laparoscopic transabdominal lateral adrenalectomy.

    PubMed

    Bickenbach, Kai A; Strong, Vivian E

    2012-10-01

    Laparoscopic adrenalectomy is a mainstay of operative options for adrenal tumors and allows surgeons to perform adrenalectomies with less morbidity, less post-operative pain, and shorter hospital stays. The literature has demonstrated its efficacy to be equal to open adrenalectomy in most cases. With regard to malignant primary and metastatic lesions, controversy still remains, however, consideration of a laparoscopic approach for smaller, well circumscribed and non-invasive lesions is reasonable. During any laparoscopic resection, when there is doubt about the ability to safely remove the lesion with an intact capsule, conversion to an open approach should be considered. The primary goal of a safe and complete oncologic resection cannot be compromised. For most benign lesions, laparoscopic approaches are safe and feasible and conversion to an open approach is necessary only for lesions where size limits the ability of a minimally invasive resection. PMID:22933307

  12. Laparoscopic Partial Nephrectomy

    Microsoft Academic Search

    \\u000a Laparoscopic partial nephrectomy is an excellent management option for small, superficial renal masses. With experience, larger\\u000a and deeper tumors can be addressed as well. Intermediate-term follow-up (3- and 5-year) suggests cancer control similar to\\u000a that of open surgery. The benefit of laparoscopy over open surgery is a briefer and less intense convalescence. The disadvantage\\u000a of laparoscopic partial nephrectomy, at least

  13. Early Feeding After a Total Abdominal Hysterectomy

    Microsoft Academic Search

    Mary Flesher; Brenda Wagner; Lyn Jones

    Background: Oral fluids and food are traditionally introduced slowly after total abdominal hysterectomy (TAH). This descriptive study examined the effect and tolerance of early oral intake following this surgery. Methods: A retrospective chart review was conducted on 164 patients who had been on a clinical pathway following TAH. Comparisons in initiation of fluids and foods, and gastrointestinal effects were made

  14. The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study

    PubMed Central

    Barbaros, Umut; Kapakli, Mahmut Sertan; Manukyan, Manuk Norayk; ?im?ek, Selçuk; Kebudi, Abut; Mercan, Selçuk

    2013-01-01

    Purpose Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively. Methods In this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded. Results Forty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05). Conclusion SILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.) PMID:24368985

  15. Vesicosacrofistulization after robotically assisted laparoscopic sacrocolpopexy.

    PubMed

    Anand, Mallika; Tanouye, Staci L; Gebhart, John B

    2014-01-01

    Diskitis after sacrocolpopexy for pelvic organ prolapse has been increasingly reported in the literature. We present a case of vesicosacrofistulization resulting in diskitis and osteomyelitis after robotically assisted laparoscopic sacrocolpopexy performed at an outside institution. A 70-year-old woman with uterovaginal prolapse and stress urinary incontinence underwent robotic supracervical hysterectomy with sacrocolpopexy and transobturator sling placement at an outside hospital. Postoperatively, she had recurrent urinary tract infections; by 3 months postoperatively, fevers and leg and back pain had developed. She was given a diagnosis of L5-S1 spondylodiskitis. After 3.5 weeks of intravenous antibiotic therapy failed, further evaluation revealed a fistulous tract to the sacrum. She was transferred to our institution and underwent sacrocolpopexy mesh removal, L5-S1 debridement, antibiotic treatment, and physical therapy. One year after this repair surgery, she has returned to her usual activities with no current symptoms of infection, prolapse, urinary incontinence, or back pain. Vesicosacrofistulization is a serious complication of sacrocolpopexy that can result in diskitis and osteomyelitis. Prevention involves avoiding placing mesh on the bladder and at the L5-S1 disk space during open or minimally invasive sacrocolpopexy. A high index of suspicion for diskitis, even several months after surgery, should be maintained to expedite evaluation. If fistulization of pelvic structures to the sacrum is suspected, a multidisciplinary evaluation and treatment approach should be considered to optimize patient care. PMID:24763162

  16. Subtotal hysterectomy in modern gynecology: A decision analysis

    Microsoft Academic Search

    James R. Scott; Howard T. Sharp; Mark K. Dodson; Peggy A. Norton; Homer R. Warner

    1997-01-01

    OBJECTIVE: Our purpose was to compare the risks and benefits of subtotal (supracervical) hysterectomy with those of total hysterectomy in women at low risk for cervical cancer.STUDY DESIGN: A decision analysis was performed. Baseline probabilities for operative and postoperative morbidity, mortality, and long-term quality of life were established for subtotal and total hysterectomy.RESULTS: Operative complication rates and ranges for total

  17. The impact of hysterectomy on lower urinary tract symptoms

    Microsoft Academic Search

    Daniel Altman; Annika López; Christian Falconer; Jan Zetterström

    2003-01-01

    The aim of this study was to prospectively evaluate the effect of vaginal and abdominal hysterectomy on lower urinary tract symptoms. We interviewed 120 patients undergoing hysterectomy for benign conditions preoperatively using a standardized questionnaire. At 6.6 and 12.7 months, 119\\/120 and 115\\/120 patients completed the follow-up questionnaire. Forty-four patients underwent vaginal and 76 abdominal hysterectomy. At 6 months follow-up

  18. Complete laparoscopic resection of the rectum using natural orifice specimen extraction

    PubMed Central

    Hisada, Masayuki; Katsumata, Kenji; Ishizaki, Tetsuo; Enomoto, Masanobu; Matsudo, Takaaki; Kasuya, Kazuhiko; Tsuchida, Akihiko

    2014-01-01

    AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery. METHODS: Twenty patients who underwent complete laparoscopic anterior resection with NOSE and 50 patients who underwent laparoscopic assisted anterior resection by the conventional method between 2011 and 2012 were studied. Selection for complete laparoscopic anterior resection with NOSE was decided on the basis of tumor size, localization of the tumor, and body mass index. Outcomes related to surgery, including operation time, postoperative wound pain, hospital stay after surgery, the number of totally dissected lymph nodes, postoperative complications (suture failure and wound infection), and anal function, were reviewed retrospectively. Anal function was assessed at 3 and 6 mo after surgery using the Wexner fecal incontinence scoring system. RESULTS: Complete laparoscopic resection with NOSE was performed to completion in all 20 patients. There was no patient emergency that required conversion to conventional laparoscopic surgery or open surgery. The comparison between complete laparoscopic resection with NOSE and conventional laparoscopic surgery showed no significant differences in the maximal diameter of the tumor, number of totally dissected lymph nodes, bleeding volume, mean operation time, time to start of oral ingestion, postoperative hospital stay, and postoperative complications. On the other hand, with regard to pain after epidural anesthesia, the total usage of analgesia in this novel surgical technique was 1.85 ± 1.8 times, whereas it was 5.89 ± 2.86 in conventional laparoscopic surgery (P < 0.001). The postoperative pain period was 1.9 ± 1.9 d in this novel surgical technique, whereas it was 3.43 ± 1.41 d in conventional laparoscopic surgery (P < 0.004). In complete laparoscopic surgery with NOSE, the mean postoperative follow-up period was 20 mo (range: 12-30 mo). Neither local recurrence nor remote metastasis was observed during the follow-up period. CONCLUSION: Complete laparoscopic anterior resection using NOSE does not require any incision and has excellent cosmetic properties, with mitigated postoperative pain. PMID:25469041

  19. Laparoscopic treatment of intussusception

    PubMed Central

    Vilallonga, Ramon; Himpens, Jacques; Vandercruysse, Femke

    2014-01-01

    Introduction The success of laparoscopic approach in children has encouraged the application of this technique in young (<2 years) children with non-complicated intussusception. Material and method A retrospective analysis of our database provided a total of 4 patients who underwent laparoscopic reduction of intestinal intussusception between 8/2008 and 4/2013. A comprehensive review of each case was done including the video description of the laparoscopic technique of one of them. Results Four patients (2 boys) were treated by laparoscopy for intestinal intussusception. Mean age was 9 months (5–20 months). Delay time between initial symptoms and diagnosis and between diagnosis and surgery were 3.5 days and 6 h respectively. Mean operative time was 35 min. There were no conversions. There were no complications. Patients were discharged after 2.5 days (2–4 days). We herein report (video) the laparoscopic approach in a 5 month male child who suffered from a ileocecal intussusception. A 10 mm trocar was placed in the left lower quadrant and two 5 mm trocars were placed in the upper left quadrant and suprapubic just to the right midline. The cause of the intussusception was identified and the bowel was reduced. A concomitant appendectomy was performed. Conclusion Laparoscopic reduction of intussusception appears to be a safe procedure, in young children with uncomplicated intussusception. PMID:25574769

  20. Laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma.

    PubMed

    Kuroki, Tamotsu; Eguchi, Susumu

    2014-08-26

    Laparoscopic distal pancreatectomy (LDP) including laparoscopic distal pancreatosplenectomy has rapidly developed as a minimally invasive surgery. LDP is mainly indicated for benign disease and low-grade malignancy during the initial period. In recent years, an increasing number of LDPs for pancreatic ductal adenocarcinoma (PDAC) have been reported. However, the benefits of LPD for PDAC, especially in view of the oncological benefits, are unclear and remain controversial. In this review of the literature, we note that LDP has been found to be a technically feasible and safe surgical procedure in selected patients and that LDP has the advantages expected of a minimally invasive surgery. In addition, LDP has oncological feasibility for PDAC in light of its favorable rate of R0 resection and lymph node harvest compared to conventional laparotomy. Large randomized and controlled prospective studies are needed to determine the clinical advantages of LDP for left-sided PDAC. PMID:25156008

  1. Complications in laparoscopic surgery.

    PubMed

    Niebuhr, H; Nahrstedt, U; Hollmann, S; Rückert, K

    1995-01-01

    Over the last few years, laparoscopic surgery has gained widespread acceptance in surgical practice. The indications range has expanded extraordinarily in that time. Some of the practiced procedures are already considered the gold standard, while others are still on the way there. The fascinating technique and results notwithstanding, a number of risks, mistakes, and complications are possible in both the initial and the advanced states. We present our experience from 2118 laparoscopic operations performed between February 1991 to March 1995, focusing on the intraoperative complications (Tables 1, 2). PMID:21400429

  2. Elective abdominal hysterectomy in Nigerian Jehovah's Witnesses.

    PubMed

    Oladapo, O T

    2004-09-01

    In a retrospective study at a university hospital, the perioperative morbidity associated with elective total abdominal hysterectomy in 23 Jehovah's Witnesses was compared with that of 46 non-Witness controls. The mean operative blood loss was significantly less, the procedure was lengthier and the average postoperative hospital stay was longer in the study than in the control group. Febrile morbidity was insignificantly more frequent among the study group (OR: 2.05, CI: 0.61-6.88) and there was no significant difference between the overall morbidity experienced by patients in both groups (study: 43.5% versus control: 39.1%; P = 0.73). The perioperative morbidity associated with elective abdominal hysterectomy in patients unwilling to accept blood transfusion does not justify the denial of this important gynaecological surgery when indicated. Gynaecologists in poor resource settings should consciously aim at providing 'bloodless' care for all their patients undergoing abdominal hysterectomy as this may translate to reduced blood loss and decreased need for blood transfusion. PMID:16147614

  3. Laparoscopic Adjustable Gastric Banding in the Treatment of Morbid Obesity

    Microsoft Academic Search

    Paul E. O'Brien; John B. Dixon

    2003-01-01

    he epidemic of obesity requires an intervention that is both effective and broadly accept- able. Conventional medical programs have been ineffective. Traditional surgical ap- proaches, such as gastric bypass and biliopancreatic diversion, are accepted by less than 1% of the severely obese each year. Laparoscopic adjustable gastric banding (LAGB) has been in clinical use for 8 years and it is

  4. Cost Assessment of Instruments for Single-Incision Laparoscopic Cholecystectomy

    PubMed Central

    Al-Tayar, Haytham; Rosenberg, Jacob; Jorgensen, Lars Nannestad

    2012-01-01

    Background and Objectives: Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed as conventional laparoscopic 4-port cholecystectomy or as single-incision laparoscopic cholecystectomy. Methods: Two consecutive series of patients undergoing single-incision laparoscopic cholecystectomy were assessed: (1) single-incision cholecystectomy using a commercially available multichannel port (n=80) and (2) a modified single-incision cholecystectomy using 2 regular trocars inserted through the umbilicus (n=20) with transabdominal sutures for gallbladder mobilization (puppeteering technique). Patients who underwent conventional 4-port cholecystectomy during the same time period (n=100) were selected as controls. Results: The instrumental cost of the single-incision cholecystectomy using a commercial port was significantly higher (median, $1123) than the cost for conventional 4-port (median $441, P < .0005) and modified single-incision cholecystectomy (median $342, P < .0005). The cost of the modified single-incision procedure was significantly lower than that for the 4-port cholecystectomy (P < .0005). Conclusion: The modified single-incision procedure using 2 regular ports inserted through the umbilicus can be performed at lower cost than conventional 4-port cholecystectomy. PMID:23318059

  5. Considerations to improve the evidence-based use of vaginal hysterectomy in benign gynecology.

    PubMed

    Moen, Michael; Walter, Andrew; Harmanli, Oz; Cornella, Jeffrey; Nihira, Mikio; Gala, Rajiv; Zimmerman, Carl; Richter, Holly E

    2014-09-01

    Vaginal hysterectomy fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Despite proven safety and effectiveness, the vaginal approach for hysterectomy has been and remains underused in surgical practice. Factors associated with underuse of vaginal hysterectomy include challenges during residency training, decreasing case numbers among practicing gynecologists, and lack of awareness of evidence supporting vaginal hysterectomy. Strategies to improve resident training and promote collaboration and referral among practicing physicians and increasing awareness of evidence supporting vaginal hysterectomy can improve the primary use of this hysterectomy approach. PMID:25162260

  6. Laparoscopic anatomy of caprine abdomen and laparoscopic liver biopsy.

    PubMed

    Kassem, M M; el-Gendy, S A A; Abdel-Wahed, R E; el-Kammar, M

    2011-02-01

    This study was carried out on apparently healthy adult non pregnant female Baladi goats to provide normal laparoscopic anatomy of the abdomen and to assess feasibility of laparoscopy for liver biopsy. Following preparation of animals, equipment and instruments, the primary port and laparoscope was placed on the umbilicus and 360° scan was performed for orientation and exploration of the abdominal cavity. Secondary ports were placed under direct laparoscopic observation to allow insertion of accessory instruments for tissue grasping, coagulation and severing. The obtained results cleared that ventral laparoscopic approach and tilting and rotating the animal during laparoscopic procedures provided better exposure of internal abdomen. Laparoscopy provided a comprehensive description of cranial and caudal abdominal regions. Laparoscopic liver biopsy required two secondary ports; one assisting port inserted in right subcostal area and one operating port inserted subxiphoid. The procedure was safe, practical and easily performed. PMID:20553700

  7. Laparoscopic Reconstructive Urology

    Microsoft Academic Search

    JIHAD H. KAOUK; INDERBIR S. GILL

    2003-01-01

    PurposeAlthough laparoscopy has emerged as a feasible and effective alternative for a majority of open ablative abdominopelvic urological procedures, minimally invasive reconstruction has come to the forefront only recently. We present the current state of the art of laparoscopic reconstructive urology.

  8. Laparoscopic Paraesophageal Hernia Repair

    PubMed Central

    Medina, Laura; Peetz, Michael; Ratzer, Erick

    1998-01-01

    Background and Objective: Paraesophageal hernias are uncommon yet potentially lethal conditions. Their repair has now been facilitated by laparoscopic technology. We present a series of 20 patients with paraesophageal hernias repaired laparoscopically. Methods: Twenty patients with paraesophageal hernias had laparoscopic repairs. Eighteen patients had primary repair of their hiatal defect. Two required mesh reinforcement. Fifteen patients had a fundoplication procedure performed concomitantly. Results: Long-term follow-up is available on 17 patients. There was no in-hospital morbidity or mortality. Average length of stay was 2.3 days. One patient recurred in the immediate postoperative period. There were no other recurrences. The only death in the series occurred in the oldest patient 18 days postoperatively. He had been discharged from the hospital and died of cardiac failure. No patients have had complications from a paraesophageal hernia postoperatively. Conclusion: Laparoscopic repair of paraesophageal hernias is possible. Preoperative work-up should include motility evaluation to assess esophageal peristalsis as the majority of these will need a concomitant anti-reflux procedure. This data helps the surgeon to determine whether or not a complete or partial wrap should be done. Repair of the diaphragmatic defect can be accomplished in the majority of patients without the use of prosthetic material with excellent results. PMID:9876752

  9. Pediatric Laparoscopic Dismembered Pyeloplasty

    Microsoft Academic Search

    Craig A. Peters; Richard N. Schlussel; Alan B. Retik

    1995-01-01

    We performed laparoscopic dismembered pyeloplasty in a boy with right ureteropelvic junction obstruction using 4 cannula sites, and a dismembering and reanastomosis technique identical to that used in open pyeloplasty. Interrupted sutures were placed and tied intracorporeally. A nephrostomy tube was placed under direct vision for drainage but no ureteral stent was used. Total operating time was 5 hours. The

  10. Variations in hysterectomy rates in Ontario: does the indication matter?

    PubMed Central

    Hall, R E; Cohen, M M

    1994-01-01

    OBJECTIVES: To examine variations in rates of hysterectomy for the five main indications for the procedure in regions of Ontario. DESIGN: Cross-sectional population-based analysis of hospital discharge abstracts. SETTING: All acute care facilities in Ontario. PARTICIPANTS: All 65,599 women whose hospital record contained a procedure code indicating that a hysterectomy was performed between Apr. 1, 1988, and Mar. 31, 1991. Duplicate cases, records of cancelled procedures and nonresidents were excluded. MAIN OUTCOME MEASURES: Crude and age-adjusted rates of hysterectomy, by indication, for each region of Ontario. RESULTS: Five indications accounted for more than 80% of hysterectomies performed. The median age-adjusted rate of hysterectomy for Ontario regions during the study period was 6.25 per 1000 women, with a 2.7-fold variation among regions. The regions with rates of hysterectomy in the highest quartile tended to be rural, and those with rates in the lowest quartile tended to be urban areas with teaching hospitals. When rates of hysterectomy for specific indications were examined, they showed substantial variations among regions in the rate of the procedure for menstrual hemorrhage (18-fold variation), uterine prolapse (9.3-fold) and endometriosis (6.3-fold). A smaller but still significant variation was shown in the rate of hysterectomy for leiomyoma (2.3-fold). Regional variation in the rate of hysterectomy for cancer (2.5-fold) was not statistically significant. CONCLUSIONS: There are large interregional variations in rates of hysterectomy, especially for indications that are more discretionary than others (i.e., menstrual hemorrhage, uterine prolapse and endometriosis) and less variation in rates when treatment options and diagnosis are clear-cut. This result suggests the need for more definitive practice guidelines on treatment of the indications for which the rate is more variable. PMID:7994690

  11. Laparoscopic Kasai portoenterostomy for biliary atresia.

    PubMed

    Esteves, Edward; Clemente Neto, Eriberto; Ottaiano Neto, Miguel; Devanir, José; Esteves Pereira, Ruy

    2002-12-01

    Conventional surgery for extrahepatic bile-duct atresia (EHBDA) usually requires a large, painful, muscle-cutting laparotomy, dislodgment of the liver, and wide manipulations, followed by adhesions and possible complications that may disturb the postoperative course and hamper liver transplantation (LT). The main role of laparoscopy in EHBDA has been for diagnostic purposes. Besides all the advantages of minimally-invasive access, it allows excellent visibility and dissection of tiny hilar structures. The authors present the first two cases of successful Roux-en-Y laparoscopic portoenterostomy (LARP) for EHBDA, showing the importance of advanced technical skills and a new approach for extracorporeal enteroanastomosis. Laparoscopic hilar dissection and portoenterostomy was accomplished using four trocars. The umbilical site was used for extracorporeal Roux-en-Y enteroenterostomy, in the first case using a laparoscopic stapler and in the second a hand-sewn suture. Mean operative time was 190 min, and no operative complications were observed. Both girls became anicteric. The first is doing well 15 months after the operation with good hepatic function. The other was anicteric for 6 months, had one episode of cholangitis, developed an umbilical hernia, has shown slow and progressive hepatic failure, and is now being evaluated for possible LT. It is concluded that LARP for EHBDA can be done safely in infants using an extracorporeal transumbilical enteric anastomosis, with several advantages compared with open surgery. The role of LARP in facilitating LT is yet to be defined. PMID:12598978

  12. Laparoscopic Management of Large Myomas

    PubMed Central

    Sinha, Rakesh; Sundaram, Meenakshi

    2009-01-01

    The objective of this article is to review the different techniques that have been adopted for removal of large myomas laparoscopically. We have also quoted literature about the impact of myomas on Pregnancy and obstetrical outcome and the effect of laparoscopic myomectomy on the same. Technical modifications to remove large myomas have been described along with methods to reduce intraoperative bleeding. This comprehensive review describes all possibilities of laparoscopic myomectomy irrespective of size, site and number. PMID:22442517

  13. The Investigation of Laparoscopic Instrument Movement Control and Learning Effect

    PubMed Central

    Lin, Chiuhsiang Joe

    2013-01-01

    Laparoscopic surgery avoids large incisions for intra-abdominal operations as required in conventional open surgery. Whereas the patient benefits from laparoscopic techniques, the surgeon encounters new difficulties that were not present during open surgery procedures. However, limited literature has been published in the essential movement characteristics such as magnification, amplitude, and angle. For this reason, the present study aims to investigate the essential movement characteristics of instrument manipulation via Fitts' task and to develop an instrument movement time predicting model. Ten right-handed subjects made discrete Fitts' pointing tasks using a laparoscopic trainer. The experimental results showed that there were significant differences between the three factors in movement time and in throughput. However, no significant differences were observed in the improvement rate for movement time and throughput between these three factors. As expected, the movement time was rather variable and affected markedly by direction to target. The conventional Fitts' law model was extended by incorporating a directional parameter into the model. The extended model was shown to better fit the data than the conventional model. These findings pointed to a design direction for the laparoscopic surgery training program, and the predictive model can be used to establish standards in the training procedure. PMID:23984348

  14. Laparoscopic en bloc kidney transplantation

    PubMed Central

    Modi, Pranjal; Thyagaraj, Krishnaprasad; Rizvi, Syed Jamal; Vyas, Jigish; Padhi, Sukant; Shah, Kamlesh; Patel, Ram

    2012-01-01

    Laparoscopic donor nephrectomy is well establish procedure and having advantages over open donor nephrectomy in terms of having less pain, early ambulation and rapid post operative recovery. To extend the advantages of laparoscopic surgery to the recipient, recently we have performed laparoscopic kidney transplantations when kidney was procured from deceased donors. As a further extension of the procedure, here we present a case of laparoscopic en bloc kidney transplantation in obese diabetic recipient who received kidneys from 70 year old non-heart beating donor. PMID:23204675

  15. Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease.

    PubMed

    Morise, Zenichi; Kawabe, Norihiko; Kawase, Jin; Tomishige, Hirokazu; Nagata, Hidetoshi; Ohshima, Hisanori; Arakawa, Satoshi; Yoshida, Rie; Isetani, Masashi

    2013-09-27

    Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma (HCC) patients with chronic liver diseases, are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field. Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures. These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs. PMID:24073300

  16. [Laparoscopic adrenalectomy in the treatment of malignant adrenal lesions].

    PubMed

    Lombardi, C P; Raffaelli, M; Boscherini, M; De Crea, C; Alesina, P F; Traini, E; Princi, P; Bellantone, R

    2003-01-01

    The role of laparoscopic approach for the treatment of malignant adrenal diseases is still controversial. The aim of this study was to verify the results of laparoscopic adrenalectomy in the management of adrenal malignancies. The medical records of all the patients who underwent laparoscopic procedures for adrenal diseases and in whom malignancy was demonstrated at final histology were reviewed. Nine patients were included (3 malignant pheochromocytomas, 4 adrenocortical carcinomas and 2 adrenal metastases). At a mean follow-up of 17.0 +/- 12.8 months (range, 2-36), all but two patients were alive and disease free. One patient died for unrelated causes. No patient developed local or port site recurrence. The results of this study demonstrate that laparoscopic adrenalectomy can be safe and effective also in case of adrenal malignancies. Conversion to open surgery in mandatory in case of local invasion and when the dissection cannot be as accurate as in conventional operations. A preliminary laparoscopic exploration can be planned in case of suspected malignant lesions to confirm the diagnosis and to evaluate their operability. PMID:12903611

  17. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding

    Microsoft Academic Search

    Laurent Biertho; Rudolf Steffen; Thomas Ricklin; Fritz F Horber; Alfons Pomp; William B Inabnet; Daniel Herron; Michel Gagner

    2003-01-01

    BackgroundIndications for and results of laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric bypass (LGB) are still controversial, especially between Europe and the United States. The recent availability of gastric bandings in the United States made it necessary to compare the two techniques.

  18. History of laparoscopic surgery.

    PubMed

    Nagy, A G; Poulin, E C; Girotti, M J; Litwin, D E; Mamazza, J

    1992-06-01

    Since the beginning of the 20th century physicians have promoted laparoscopy as a valuable adjunct to the diagnosis of diseases of the abdominal cavity. Laparoscopy, however, failed to become popular among abdominal surgeons until the advent of laparoscopic cholecystectomy. This single new operative approach to the treatment of gallbladder stones gave rise to such enthusiasm among general surgeons that other innovative laparoscopic procedures are now being promoted in ever-increasing numbers. The general surgeon has again become the leader in the introduction of a new surgical approach. This new technique must be developed with great care, and there must be rigorous criteria for its use, critical analysis of the technique and honest reporting of results. PMID:1535544

  19. Non-closure of visceral peritoneum at abdominal hysterectomy.

    PubMed

    Kucuk, M; Okman, T K

    2001-12-01

    Our purpose was to determine whether non-closure of the visceral peritoneum alters post-operative outcome at abdominal hysterectomy. A prospective, randomized trial was performed. Of the 100 evaluable subjects, 50 had the visceral peritoneum left open whereas 50 were closed. Patients were observed for evidence of morbidity after the operation. Analysis of data was performed with use of the unpaired t-test for continuous variables. The visceral peritonization process at abdominal hysterectomy does not provide immediate post-operative benefits while unnecessarily lengthening surgical time and anesthesia exposure. We suggest that visceral peritonization process can be abolished at abdominal hysterectomy. PMID:11728498

  20. Total Laparoscopic Pancreaticoduodenectomy

    PubMed Central

    Kamyab, Armin

    2013-01-01

    Introduction: Total laparoscopic pancreaticoduodenectomy (TLPD) remains one of the most advanced laparoscopic procedures. Owing to the evolution in laparoscopic technology and instrumentation within the past decade, laparoscopic pancreaticoduodenectomy is beginning to gain wider acceptance. Methods: Data were collected for all patients who underwent a TLPD at our institution. Preoperative evaluation consisted of computed tomography scan with pancreatic protocol and selective use of magnetic resonance imaging and/or endoscopic ultrasonography. The TLPD was done with 6 ports on 3 patients and 5 ports in 2 patients and included a celiac, periportal, peripancreatic, and periduodenal lymphadenectomy. Pancreatic stents were used in all 5 cases, and intestinal continuity was re-established by intracorporeal anastomoses. Results: Five patients underwent a TLPD for suspicion of a periampullary tumor. There were 3 women and 2 men with a mean age of 60 years and a mean body mass index of 32.8. Intraoperatively, the mean operative time was 9 hours 48 minutes, with a mean blood loss of 136 mL. Postoperatively, there were no complications and a mean length of stay of 6.6 days. There was no lymph node involvement in 4 out of 5 specimens. The pathological results included intraductal papillary mucinous neoplasm in 2 patients, pancreatic adenocarcinoma in 1 patient (R0 resection), benign 4-cm periampullary adenoma in 1 patient, and a somatostatin neuroendocrine carcinoma in 1 patient (R0, N1). Conclusion: TLPD is a viable alternative to the standard Whipple procedure. Our early experience suggests decreased length of stay, quicker recovery, and improved quality of life. Complication rates appear to be improved or equivalent. PMID:23925010

  1. Laparoscopic renal surgery.

    PubMed

    Sountoulides, P G; Kaufmann, O G; Kaplan, A G; Louie, M K; McDougall, E M; Clayman, R V

    2009-08-01

    Renal surgery, radical nephrectomy in particular, was historically the first application of laparoscopic techniques in urology. Since then, laparoscopy has been constantly evolving to claim its position in the surgical armamentarium of the urologist for the treatment of both malignant and benign diseases of the kidney and upper urinary tract. Over the years of increasing surgical experience and exposure, along with the evolution in the techniques and instruments used, laparoscopy has emerged as an equally effective and even more attractive alternative to open surgery for certain indications. The currently available load of literature is able to prove beyond any doubt the oncologic efficacy and minimal morbidity of laparoscopy for the treatment of renal masses in the form of radical or partial laparoscopic nephrectomy and nephroureterectomy. On the other hand, one can claim that laparoscopy is not far from replacing open surgery for the management of benign conditions such as ureteropelvic junction obstruction and donor nephrectomy. This review on laparoscopic renal surgery will discuss the major applications, indications, techniques and outcomes of laparoscopy in the contemporary management of benign and malignant renal diseases while focusing on its benefits and drawbacks compared to open surgery. PMID:19648858

  2. NERVE INJURY AFTER LAPAROSCOPIC VARICOCELECTOMY

    Microsoft Academic Search

    KRISTIN CHROUSER; DAVID VANDERSTEEN; JULIE CROCKER; YURI REINBERG

    2004-01-01

    Purpose:Laparoscopic varicocelectomy is a minimally invasive option for varicoceles in children. Occasional reports of nerve injury after inguinal laparoscopic procedures have been published. There is anatomical variation in the sensory innervation of the anterior thigh and variable branching patterns of the nerves involved. We report a retrospective analysis of our patients, focusing on the incidence of sensory changes on the

  3. Laparoscopic Treatment of Splenic Cysts

    PubMed Central

    2001-01-01

    Presented here is a case report of laparoscopic fenestration of a symptomatic, nonparasitic splenic cyst. Technical aspects of the procedure are discussed along with a review of the literature. The laparoscopic approach to splenic cysts offers many advantages over traditional open procedures and may be the treatment of choice for this rare clinical problem. PMID:11719977

  4. Laparoscopic radical prostatectomy: preliminary results

    Microsoft Academic Search

    C. C Abbou; L Salomon; A Hoznek; P Antiphon; A Cicco; F Saint; W Alame; J Bellot; D. K Chopin

    2000-01-01

    Objectives. To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures.Methods. Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first

  5. Open versus Laparoscopic Appendectomy in Children: A Comparison of Complications

    PubMed Central

    Fakhari, Mitra; Rauhofer, Ursula; Felberbauer, Franz Xaver; Rebhandl, Winfried; Horcher, Ernst

    2000-01-01

    Although between 4% and 20% of all appendectomies in adults are performed laparoscopically, this procedure is rarely done in the pediatric age group because of the substantially more difficult technique, the expected risks and suspected higher rate of complications. In a prospective study of 500 consecutive appendectomies, we tried to assess the actual rate of complications of each operative approach. We included 362 conventional and 138 laparoscopic appendectomies, the median age of the patients was 10.8 years. The mortality was 0 in both groups. We observed 89 minor and 11 major complications. All major complications (wound infections needing re-operation under general anesthesia, intra-abdominal abscesses, ileus due to adhesions and a case of renal insufficiency because of glomerulonephritis) occurred in the conventional group (n=11, ie, 3% of 362 open appendectomies). Seventy-two minor complications were seen in the same group (20%). In the laparoscopic group, there were 17 (13%) minor complications and no severe complications. This difference was statistically significant. We conclude that in children laparoscopic appendectomy does not carry a greater risk of intra- or postoperative complications and can therefore safely be established as a standard procedure. PMID:10917118

  6. A prospective comparison of abdominal hysterectomy using absorbable staples.

    PubMed

    Beresford, J M; Moher, D

    1993-06-01

    Forty-eight abdominal hysterectomies performed using Polysorb (United States Surgical Corporation) [corrected] absorbable staples were compared prospectively with 46 hysterectomies performed using a regular suture technique. The two groups were demographically similar and it was found that the time of operation (p = 0.001) and the amount of blood loss at operation was significantly reduced (p = 0.03). The incidence of granulations at the vaginal vault at six weeks was significantly reduced (p = 0.001) and return to activity (p = 0.02) and work (p = 0.01) were also significantly reduced for the patients who had a hysterectomy performed using Polysorb staples. There was no statistical difference in morbidity, complications, use of analgesics and period of hospitalization. The continued use of absorbable staples in abdominal hysterectomy is supported, related to the advantages that were statistically significant. PMID:8322128

  7. Adjuvant hysterectomy in low-risk gestational trophoblastic disease

    Microsoft Academic Search

    Kiyomi Suzuka; Hideo Matsui; Yoshinori Iitsuka; Koji Yamazawa; Katsuyoshi Seki; Souei Sekiya

    2001-01-01

    Objective: To evaluate the efficacy of adjuvant hysterectomy with chemotherapy for women with low-risk gestational trophoblastic disease.Methods: One hundred fifteen consecutive Japanese women (16–52 years old) with low-risk gestational trophoblastic disease (46 with metastatic disease and 69 without) were treated initially with single-agent chemotherapy (etoposide in 85, methotrexate in 27, and actinomycin D in three) with or without adjuvant hysterectomy,

  8. Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study

    PubMed Central

    Palanivelu, Chinnusamy; Rangarajan, Muthukumaran; Jategaonkar, Priyadarshan Anand; Madankumar, Madhupalayam Velusamy; Anand, Natesan Vijay

    2009-01-01

    INTRODUCTION Even though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from ‘postcholecystectomy syndrome’. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi. PATIENTS AND METHODS We managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant. RESULTS The mean duration between first and second surgery was 8.35 months (range, 6–10.7 months). The mean operating time was 103.5 min (range, 75–132 min). Duration of hospital stay was 4–12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy 13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality. CONCLUSIONS Leaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. ‘T’-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory. PMID:18990269

  9. Laparoscopic Sacropexy: A Retrospective Analysis of Perioperative Complications and Anatomical Outcomes

    PubMed Central

    Tchartchian, Garri; Waldschmidt, Matthias; Schollmeyer, Thoralf; De Wilde, Rudy L.

    2012-01-01

    Background and Objective: The aim of this study was to evaluate the surgical outcomes and complications of laparoscopic sacropexy with regard to 3 varying mesh attachment points: the vaginal stump, the cervical stump, and the posterior side of the cervix in the case of uterus preservation. Method: A retrospective study was conducted among 310 women treated for descensus with laparoscopic sacropexy between January 2000 and December 2007. Information was obtained from medical files and follow-up examinations. Results: Sacropexies with mesh attachment to the cervical stump, to the vaginal stump, and with uterus preservation were performed in 213, 67, and 30 cases, respectively. In 40 cases, no concomitant interventions were necessary. One perioperative conversion and 2 terminations occurred. Short-term complications included fever in 15 cases and urinary incontinence in 7 cases. Average follow-up was 7.9 mo with 211 patients completing follow-up. Prolapse recurrence rate was 10.4%; the reoperation rate was 4%. No significant differences between groups were detected for cystocele recurrence. Rectocele recurrence was significantly higher (P < .05) for sacropexy with vaginal mesh attachment. A reduction of incontinence was observed, which was significant (P < .05) for those patients treated with simultaneous or previous hysterectomy. Conclusion: Laparoscopic sacropexy shows good short-term results with low reprolapse and complication rates. PMID:23318069

  10. Laparoscopic splenectomy for ITP

    Microsoft Academic Search

    R. L. Friedman; M. J. Fallas; B. J. Carroll; J. R. Hiatt; E. H. Phillips

    1996-01-01

    Background: A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic\\u000a purpura (ITP) was performed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching\\u000a hospital between 3\\/91 and 8\\/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss,

  11. Stereoscopic visualization of laparoscope image using depth information from 3D model.

    PubMed

    Kumar, Atul; Wang, Yen-Yu; Wu, Ching-Jen; Liu, Kai-Che; Wu, Hurng-Sheng

    2014-03-01

    Laparoscopic surgery is indispensable from the current surgical procedures. It uses an endoscope system of camera and light source, and surgical instruments which pass through the small incisions on the abdomen of the patients undergoing laparoscopic surgery. Conventional laparoscope (endoscope) systems produce 2D colored video images which do not provide surgeons an actual depth perception of the scene. In this work, the problem was formulated as synthesizing a stereo image of the monocular (conventional) laparoscope image by incorporating into them the depth information from a 3D CT model. Various algorithms of the computer vision including the algorithms for the feature detection, matching and tracking in the video frames, and for the reconstruction of 3D shape from shading in the 2D laparoscope image were combined for making the system. The current method was applied to the laparoscope video at the rate of up to 5 frames per second to visualize its stereo video. A correlation was investigated between the depth maps calculated with our method with those from the shape from shading algorithm. The correlation coefficients between the depth maps were within the range of 0.70-0.95 (P<0.05). A t-test was used for the statistical analysis. PMID:24444752

  12. Laparoscopic excision of Meckel's diverticulum in children: What is the current evidence?

    PubMed Central

    Chan, Kin Wai Edwin; Lee, Kim Hung; Wong, Hei Yi Vicky; Tsui, Siu Yan Bess; Wong, Yuen Shan; Pang, Kit Yi Kristine; Mou, Jennifer Wai Cheung; Tam, Yuk Him

    2014-01-01

    Complications aroused from Meckel’s diverticulum tend to developed in children. Children presented with abdominal pain, intestinal obstruction, intussusception or gastrointestinal bleeding may actually suffered from complicated Meckel’s diverticulum. With the advancement of minimally invasive surgery (MIS) in children, the use of laparoscopy in the diagnosis and subsequent laparoscopic excision of Meckel’s diverticulum has gained popularity. Recently, single incision laparoscopic surgery (SILS) has emerged as a new technique in minimally invasive surgery. This review offers the overview in the development of MIS in the management of children suffered from Meckel’s diverticulum. The current evidence in different laparoscopic techniques, including conventional laparoscopy, SILS, the use of special laparoscopic instruments, intracorporeal diverticulectomy and extracorporeal diverticulectomy in the management of Meckel’s diverticulum in children were revealed. PMID:25386065

  13. Laparoscopic myomectomy using endoscopic loops under progressive tension

    Microsoft Academic Search

    Pietro Gambadauro; Vincenzo Campo; Sebastiano Campo

    2010-01-01

    The Authors describe a novel technique for laparoscopic myomectomy of fibroids with a subserosal component which involves\\u000a the use of endoscopic loops under progressive tension to avoid bleeding, facilitate enucleation and possibly reduce the need\\u000a of conventional sutures. Data analysis from a series of 34 consecutive operations shows that the use of endoloops helps achieving\\u000a a good haemostasis, and no

  14. LAPAROSCOPIC HEMINEPHROURETERECTOMY IN PEDIATRIC PATIENTS

    Microsoft Academic Search

    Gunter Janetschek; Jorg Seibold; Christian Radmayr; Georg Bartsch

    1997-01-01

    PurposeAn increasing number of operative procedures in pediatric urology can be performed by laparoscopy. We report our experience with laparoscopic heminephroureterectomy, which is a typical operation in pediatric patients.

  15. Laparoscopic treatment of perforated appendicitis

    PubMed Central

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

    2014-01-01

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

  16. Laparoscopic management of complicated foreign body ingestion: a case series.

    PubMed

    Chia, Daryl K A; Wijaya, Ramesh; Wong, Andrew; Tan, Su-Ming

    2015-05-01

    This study aims to demonstrate the safety and feasibility of laparoscopic management of complicated foreign body (FB) ingestion in a series of 5 patients. We present the merits of a minimally-invasive approach in this clinical setting from our series as well as published case reports. FB ingestion is occasionally complicated by abscess formation or perforation, requiring surgical intervention. Anecdotal reports of such cases managed by laparoscopic surgery have alluded to its merits over the conventional approach of open surgery. Over an 18-month period, 5 of 256 patients with FB ingestion at our unit were managed by laparoscopic surgery. Clinical and operative data were collected for this study. In all 5 cases, patients could not recall their FB ingestion and had normal plain radiographs. The diagnosis was made on a computed tomography (CT) scan. Laparoscopy was successfully employed to retrieve all FBs (fish bones), deroof abscesses, and primarily repair gastrointestinal perforations. The mean operative time was 69 minutes (55-85), utilizing 2 to 4 noncamera ports. There was no operative mortality and patients were discharged on average postoperative day (POD) 5 (2-8). Laparoscopic surgery is safe and feasible in small-diameter, complicated FB ingestion requiring surgical intervention and should be considered in similar patients. PMID:26011205

  17. Laparoscopic Gastric Banding: preliminary series

    Microsoft Academic Search

    Antonio Catona; Marcus Gossenberg; Antonella La Manna; Giovanni Mussini

    1993-01-01

    Gastric banding as a laparoscopic procedure was performed on 40 morbidly obese patients. This operation matches the advantages\\u000a of the gastric banding (efficacy, reversibility and low invasivity) with the advantages of the laparoscopic procedure (low\\u000a surgical risk, short hospital stay and less complications in the short and long term). The maximum follow-up is 6 months and\\u000a so far the weight

  18. Laparoscopic Surgery for Ulcerative Colitis

    PubMed Central

    Stocchi, Luca

    2010-01-01

    Laparoscopic techniques have become increasingly used in the treatment of ulcerative colitis: in experienced hands, they are safe and feasible. Recovery advantages have not been consistently demonstrated and functional results have been comparable to open surgery. Other possible benefits and costs issues have also been inconsistent. Further investigation on the role of laparoscopic surgery for ulcerative colitis with larger populations and longer follow-up with a focus on recovery parameters, quality of life, and costs are needed. PMID:22131895

  19. Rhabdomyolysis after Laparoscopic Bariatric Surgery

    Microsoft Academic Search

    Philippe Mognol; Stéphane Vignes; Denis Chosidow; Jean-Pierre Marmuse

    2004-01-01

    Background: Postoperative rhabdomyolysis is an uncommon event. The aim of this study was to determine the incidence of rhabdomyolysis\\u000a following laparoscopic obesity surgery. Methods: Rhabdomyolysis was studied prospectively. Over a 6-month period, 66 consecutive\\u000a patients underwent bariatric surgery (gastric banding (n=50) and gastric bypass (n=16)). All patients underwent laparoscopic\\u000a procedures. A range of blood tests, including serum creatine phosphokinase (CPK)

  20. Laparoscopic repair of Morgagni hernia

    Microsoft Academic Search

    E. Durak; S. Gur; A. Cokmez; K. Atahan; E. Zahtz; E. Tarcan

    2007-01-01

    Background  Foramen of Morgagni hernias are rare diaphragmatic hernias. They account for 3–5% of all diaphragmatic hernias and the majority\\u000a of the cases are asymptomatic. They are caused by trauma, obesity or pregnancy. With the advancements of laparoscopic surgery,\\u000a laparoscopic repair has become an excellent alternative to open repair for Morgagni hernias. We report five cases of Morgagni\\u000a hernia repaired with

  1. Laparoscopic Placement of Cervical Cerclage

    PubMed Central

    Tusheva, Olga A; Cohen, Sarah L; McElrath, Thomas F; Einarsson, Jon I

    2012-01-01

    Cervical shortening is believed to be a marker for generalized intrauterine inflammation and has a strong association with spontaneous preterm birth. A variety of therapies, including vaginal and intramuscular progesterone, pessary, and cerclage, have been demonstrated to be effective in specific clinical circumstances. Cervical cerclage can be placed via transvaginal, open transabdominal, or laparoscopic transabdominal approach, preferably before pregnancy. A laparoscopic approach may be superior to the transabdominal approach in terms of surgical outcomes, cost, and postoperative morbidity. PMID:23483629

  2. [Complications of laparoscopic cholecystectomy. Free intraperitoneal calculi].

    PubMed

    Schroeyers, P; Mansvelt, B; Bertrand, C; de Neve de Roden, A

    1994-01-01

    With the use of laparoscopic cholecystectomy, increasing numbers of gallstones are being left in the peritoneal cavity. To our knowledge, the rarely cause complications. We present two cases with stone spillage after laparoscopic cholecystectomy, with a different outcome. PMID:7864541

  3. Laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis

    Microsoft Academic Search

    H. L. Tan; A. Najmaldin

    1993-01-01

    Although great advances in laparoscopic techniques have been made in the field of adult surgery, its application in infants and young children has been limited. We present a technique of laparoscopic pyloromyotomy that has been successfully used in two babies, employing specially made instruments. Laparoscopic surgery deserves further consideration in this age group.

  4. Application of Augmented Reality to Laparoscopic Surgery

    E-print Network

    Whitton, Mary C.

    Application of Augmented Reality to Laparoscopic Surgery by Jeremy D. Ackerman A Dissertation to Laparoscopic Surgery. (Under the direction of Henry Fuchs, Ph. D..) ABSTRACT The usefulness and feasibility of an augmented reality visualization system for laparoscopic surgery is examined. This technology could enable

  5. Laparoscopic adrenalectomy—indications and technique

    Microsoft Academic Search

    Geeta Lal; Quan-Yang Duh

    2003-01-01

    Laparoscopic adrenalectomy has become the procedure of choice for the surgical management of most adrenal tumors, including functional and non-functional lesions. The role of laparoscopic adrenalectomy in the management of malignant adrenal tumors is controversial and most adrenocortical cancers are generally treated by open adrenalectomy. Laparoscopic adrenalectomy can be performed by both the anterior or lateral trans-abdominal approach and by

  6. [Comparative results of open robot-assisted and laparoscopic distal pancreatic resection].

    PubMed

    Kriger, A G; Berelavichus, S V; Smirnov, A V; Gorin, D S; Akhtanin, E A

    2015-01-01

    It was performed a retrospective analysis of the results of distal pancreatic resections (DPR) in 89 patients with different tumors. Conventional open operations were performed in 60 patients, robot-assisted - in 19 patients, laparoscopic - in 10 cases. Absolute indication for open surgery was pancreatic cancer T3-4 stages. Mini-invasive distal resections (robot-assisted and laparoscopic) were performed in cases of pancreatic cancer T1-2 stages, benign tumors and tumors with low potential of malignancy and diameter up to 4-5 cm. Results of robot-assisted and laparoscopic interventions are similar but robot-assisted technique provides more precise surgery. It improves quality of lymphadenectomy, decreases probability of intraoperative bleeding. Duration of robot-assisted and open operation did not differ significantly. Blood loss was significantly lower in group of robot-assisted method (mean 470 ml) while in cases of open and laparoscopic techniques this parameter was 1013.8 and 833.3 ml respectively. Postoperative complications in open, laparoscopic and robot-assisted groups developed in 45.1, 52.6 and 50% of observations respectively. Pancreatic fistulas were revealed in 58.8, 80 and 58.3% of cases respectively. There were not deaths after laparoscopic and robot-assisted pancreatic resections. 2 patients died after open surgery. PMID:25909547

  7. Error analysis in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

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

    1998-06-01

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

  8. Laparoscopic cryptorchidectomy in standing bulls.

    PubMed

    Kaneko, Yasuyuki; Torisu, Shidow; Kitahara, Go; Hidaka, Yuichi; Satoh, Hiroyuki; Asanuma, Taketoshi; Mizutani, Shinya; Osawa, Takeshi; Naganobu, Kiyokazu

    2015-06-01

    Laparoscopic cryptorchidectomy without insufflation was applied in 10 standing bulls aged 3 to 15 months. Nine bulls were preoperatively pointed out intra-abdominal testes by computed tomography. Preoperative fasting for a minimum of 24 hr provided laparoscopic visualization of intra-abdominal area from the kidney to the inguinal region. Surgical procedure was interrupted by intra-abdominal fat and testis size. It took 0.6 to 1.5 hr in 4 animals weighing 98 to 139 kg, 0.8 to 2.8 hr in 4 animals weighing 170 to 187 kg, and 3 and 4 hr in 2 animals weighing 244 and 300 kg to complete the cryptorchidectomy. In conclusion, standing gasless laparoscopic cryptorchidectomy seems to be most suitable for bulls weighing from 100 to 180 kg. PMID:25715955

  9. Laparoscopic cryptorchidectomy in standing bulls

    PubMed Central

    KANEKO, Yasuyuki; TORISU, Shidow; KITAHARA, Go; HIDAKA, Yuichi; SATOH, Hiroyuki; ASANUMA, Taketoshi; MIZUTANI, Shinya; OSAWA, Takeshi; NAGANOBU, Kiyokazu

    2015-01-01

    Laparoscopic cryptorchidectomy without insufflation was applied in 10 standing bulls aged 3 to 15 months. Nine bulls were preoperatively pointed out intra-abdominal testes by computed tomography. Preoperative fasting for a minimum of 24 hr provided laparoscopic visualization of intra-abdominal area from the kidney to the inguinal region. Surgical procedure was interrupted by intra-abdominal fat and testis size. It took 0.6 to 1.5 hr in 4 animals weighing 98 to 139 kg, 0.8 to 2.8 hr in 4 animals weighing 170 to 187 kg, and 3 and 4 hr in 2 animals weighing 244 and 300 kg to complete the cryptorchidectomy. In conclusion, standing gasless laparoscopic cryptorchidectomy seems to be most suitable for bulls weighing from 100 to 180 kg. PMID:25715955

  10. Adjuvant chemotherapy for endometrial cancer after hysterectomy

    PubMed Central

    Johnson, Nick; Bryant, Andrew; Miles, Tracie; Hogberg, Thomas; Cornes, Paul

    2014-01-01

    Background Endometrial adenocarcinoma (womb cancer) is a malignant growth of the lining (endometrium) of the womb (uterus). It is distinct from sarcomas (tumours of the uterine muscle). Survival depends the risk of microscopic metastases after surgery. Adjuvant (postoperative) chemotherapy improves survival from some other adenocarcinomas, and there is evidence that endometrial cancer is sensitive to cytotoxic therapy. This systematic review examines the effect of chemotherapy on survival after hysterectomy for endometrial cancer. Objectives To assess efficacy of adjuvant (postoperative) chemotherapy for endometrial cancer. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 3), MEDLINE and EMBASE up to August 2010, registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) comparing adjuvant chemotherapy with any other adjuvant treatment or no other treatment. Data collection and analysis We used a random-effects meta-analysis to assess hazard ratios (HR) for overall and progression-free survival and risk ratios (RR) to compare death rates and site of initial relapse. Main results Five RCTs compared no additional treatment with additional chemotherapy after hysterectomy and radiotherapy. Four trials compared platinum based combination chemotherapy directly with radiotherapy. Indiscriminate pooling of survival data from 2197 women shows a significant overall survival advantage from adjuvant chemotherapy (RR (95% CI) = 0.88 (0.79 to 0.99)). Sensitivity analysis focused on trials of modern platinum based chemotherapy regimens and found the relative risk of death to be 0.85 ((0.76 to 0.96); number needed to treat for an additional beneficial outcome (NNT) = 25; absolute risk reduction = 4% (1% to 8%)). The HR for overall survival is 0.74 (0.64 to 0.89), significantly favouring the addition of postoperative platinum based chemotherapy. The HR for progression-free survival is 0.75 (0.64 to 0.89). This means that chemotherapy reduces the risk of being dead at any censorship by a quarter. Chemotherapy reduces the risk of developing the first recurrence outside the pelvis (RR = 0.79 (0.68 to 0.92), 5% absolute risk reduction; NNT = 20). The analysis of pelvic recurrence rates is underpowered but the trend suggests that chemotherapy may be less effective than radiotherapy in a direct comparison (RR = 1.28 (0.97 to 1.68)) but it may have added value when used with radiotherapy (RR = 0.48 (0.20 to 1.18)). Authors’ conclusions Postoperative platinum based chemotherapy is associated with a small benefit in progression-free survival and overall survival irrespective of radiotherapy treatment. It reduces the risk of developing a metastasis, could be an alternative to radiotherapy and has added value when used with radiotherapy. PMID:21975736

  11. Laparoscopic colposuspension using mesh reinforcement

    Microsoft Academic Search

    R. A. Birken; P. L. Leggett

    1997-01-01

    Background: For patients with stress urinary incontinence, surgical reestablishment of the bladder neck has proved amenable to a laparoscopic\\u000a approach, which shortens hospitalization and reduces tissue trauma. The use of mesh reinforcement to improve the durability\\u000a of colposuspension can refine this proven procedure even further.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: We performed laparoscopic Burch colposuspension on 54 patients with stress urinary incontinence and compared

  12. Laparoscopic Splenectomy in Blunt Trauma

    PubMed Central

    Dissanaike, Sharmila

    2006-01-01

    We describe the first reported use of laparoscopic splenectomy as initial treatment in high-grade blunt splenic trauma. A 21-year-old man sustained a blow to the left flank from a large construction pipe and was transferred to our hospital with a grade V splenic laceration and a grade II left peri-renal hematoma with hematuria. He was hemodynamically stable. He underwent a laparoscopic splenectomy shortly after arrival. The patient's renal injury was managed nonoperatively, and he was discharged home with no complications and has remained well. PMID:17575766

  13. [Peritoneum and laparoscopic environment].

    PubMed

    Canis, Michel; Matsuzaki, Sachiko; Bourdel, Nicolas; Jardon, Kris; Cotte, Benjamin; Botchorishvili, Revaz; Rabischong, Benoit; Mage, Gérard

    2007-12-01

    Laparoscopic surgery takes place in a closed environment, the peritoneal cavity distended by the pneumoperitoneum whose parameters, such as pressure, composition, humidity and temperature of the gas, may be changed and adapted to influence the intra and postoperative surgical processes. Such changes were impossible in the "open" environment. This review includes recent data on peritoneal physiology, which are relevant for surgeons, and on the effects of the pneumoperitoneum on the peritoneal membrane. The ability to work in a new surgical environment, which may be adapted to each situation, opens a new era in endoscopic surgery. Using nebulizers, the pneumoperitoneum may become a new way to administer intraoperative treatments. Most of the current data on the consequences of the pneumoperitoneum were obtained using poor animal models so that it remains difficult to estimate the progresses, which will be brought to the operative theater by this new concept. However this revolution will likely be used by thoracic or cardiac surgeon who are also working in a serosa. This approach may even appear essential to all the surgeons who are using endoscopy in a retroperitoneal space such as urologists or endocrine surgeons. PMID:18156111

  14. Laparoscopic telesurgical workstation

    NASA Astrophysics Data System (ADS)

    Cavusoglu, Murat C.; Cohn, Michael B.; Tendick, Frank; Sastry, S. Shankar

    1998-06-01

    Robotic telesurgery is a promising application of robotics to medicine, aiming to enhance the dexterity and sensation of minimally invasive surgery through millimeter-scale manipulators under control of the surgeon. With appropriate communication links, it would also be possible to perform remote surgery for care in rural areas where specialty care is unavailable, or to provide emergency care en route to a hospital. The UC Berkeley/Endorobotics/UCSF Telesurgical Workstation is a master-slave telerobotic system, with two 6 degree of freedom (DOF) robotic manipulators, designed for laparoscopic surgery. The slave robotic has a 2 DOF wrist inside the body to allow high dexterity manipulation in addition to the 4 DOF of motion possible through the entry port, which are actuated by an external gross motion platform. The kinematics and the controller of the system are designed to accommodate the force and movement requirements of complex tasks, including suturing and knot tying. The system has force feedback in 4 axes to improve the sensation of telesurgery. In this paper, the telesurgical system will be introduced with discussion of kinematic and control issues and presentation of in vitro test results.

  15. Premenopausal hysterectomy is associated with increased brain ferritin iron

    Microsoft Academic Search

    Todd A. Tishler; Erika P. Raven; Po H. Lu; Lori L. Altshuler; George Bartzokis

    Iron is essential for triggering oligodendrocytes to myelinate, however, in gray matter (GM) iron increases with age and is associated with age-related degenerative brain diseases. Women have lower iron levels than men, both in the periphery and in the brain, particularly in white matter (WM), possibly due to iron loss through menstruation. We tested the hypothesis that hysterectomy could increase

  16. Retroperitoneal uterine leiomyoma occurring 5 years after hysterectomy for fibroids.

    PubMed

    Fukamachi, Nobuyuki; Togami, Shinichi; Iwamoto, Ichiro; Tsuji, Takahiro; Nomoto, Mitsuharu; Goto, Masamichi; Kamiyama, Takuro; Fukukura, Yoshihiko; Douchi, Tsutomu

    2007-12-01

    We encountered a 49-year-old, multiparous female with a very rare isolated retroperitoneal uterine leiomyoma measuring 72 x 43 mm in diameter occurring 5 years after hysterectomy for fibroids. The case was preliminarily diagnosed as right ovarian cancer or fibroma. An edematous, isolated solid tumor in the right retroperitoneal cavity was surgically resected. Pathological findings demonstrated uterine leiomyoma. PMID:18001458

  17. The Role of Robotic Surgery for Rectal Cancer: Overcoming Technical Challenges in Laparoscopic Surgery by Advanced Techniques.

    PubMed

    Park, Seungwan; Kim, Nam Kyu

    2015-07-01

    The conventional laparoscopic approach to rectal surgery has several limitations, and therefore many colorectal surgeons have great expectations for the robotic surgical system as an alternative modality in overcoming challenges of laparoscopic surgery and thus enhancing oncologic and functional outcomes. This review explores the possibility of robotic surgery as an alternative approach in laparoscopic surgery for rectal cancer. The da Vinci® Surgical System was developed specifically to compensate for the technical limitations of laparoscopic instruments in rectal surgery. The robotic rectal surgery is associated with comparable or better oncologic and pathologic outcomes, as well as low morbidity and mortality. The robotic surgery is generally easier to learn than laparoscopic surgery, improving the probability of autonomic nerve preservation and genitourinary function recovery. Furthermore, in very complex procedures such as intersphincteric dissections and transabdominal transections of the levator muscle, the robotic approach is associated with increased performance and safety compared to laparoscopic surgery. The robotic surgery for rectal cancer is an advanced technique that may resolve the issues associated with laparoscopic surgery. However, high cost of robotic surgery must be addressed before it can become the new standard treatment. PMID:26130943

  18. Laparoscopic Roux-En-Y Gastric Bypass in Morbidly Obese Adolescents

    Microsoft Academic Search

    Ala Stanford; John Matthew Glascock; George M. Eid; Timothy Kane; Henri R. Ford; Sayeed Ikramuddin; Philip Schauer

    2003-01-01

    Background\\/Purpose: Obesity has contributed significantly to morbidity and premature deaths in the adolescent popu- lation. Because many patients do not respond to dietary modification, exercise regimens, or pharmacologic treat- ment, weight reduction surgery has become a viable alter- native, although the morbidity of conventional gastric by- pass has tempered enthusiasm for this approach. Experience with the laparoscopic approach has not

  19. Entrapment neuropathy in laparoscopic herniorrhaphy

    Microsoft Academic Search

    A. S. Seid; E. Amos

    1994-01-01

    In laparoscopic hernia repairs, the staples used to affix prosthetic mesh have resulted in entrapment neuropathies. This paper describes the diagnosis and treatment of nine cases of entrapment neuropathy. Injuries to all the branches of the lumbar plexus, with the exception of the obdurator nerve, have been treated. Generally, the entrapments are self-limiting, but chronic disability requiring surgical intervention can

  20. Robotic-assisted laparoscopic adrenalectomy.

    PubMed

    Wu, Jungle C H; Wu, Hurng-Sheng; Lin, Mao-Sheng; Huang, Min-Ho

    2005-10-01

    Robotic surgical systems have recently been used to perform laparoscopic procedures in several diseases. We report the initial 2 cases of robotic-assisted laparoscopic adrenalectomy from Taiwan. Both cases were performed transperitoneally using the ZEUS surgical system (Intuitive Surgical Inc., Mountain View, CA, USA). This system consists of 3 interactive robotic arms and a remote control unit, allowing the surgeon to control the 2 instrument arms and 1 camera arm via a surgical console. The key component of the ZEUS surgical system is the MicroWrist (Computer Motion Inc., CA, USA) technology, which allows the surgeon to roll, pitch and grip laparoscopic tools freely and provides the surgeon with a 3-dimensional view of the operative field. Postoperative courses were uneventful and the patients were discharged on the third and fourth postoperative days, respectively. No intraoperative or postoperative complications were encountered. These cases suggest that robotic-assisted laparoscopic adrenalectomy is technically feasible, and that the role of robotic surgery in urologic laparoscopy is likely to expand in Taiwan. PMID:16385378

  1. [Technical principles of laparoscopic cholecystectomy].

    PubMed

    Kurdo, S A; Ga?dukov, V N

    1995-01-01

    The technical principles of laparoscopic cholecystectomy are described from experience in 87 operations in acute and chronic appendicitis. The authors discuss the stages of the operation and the peculiarities of the technical procedures at each stage, and give recommendations on the use of the instruments and indications for abdominal drainage. PMID:7474695

  2. Spleen removal - laparoscopic - adults - discharge

    MedlinePLUS

    Your spleen was removed after you were given general anesthesia (asleep and pain-free). The surgeon made 3 to ... Recovering from laparoscopic spleen removal usually takes about 1 to 3 weeks. You may have some of these symptoms as you recover: Pain ...

  3. Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy

    Microsoft Academic Search

    A.-Hon Kwon; Hiroyuki Inui; Yasuo Kamiyama

    2001-01-01

    Accidentai injuries to the bile duct and bowel are significant risks of laparoscopic surgery and sometimes require conversion\\u000a to open surgery. Although some of the injuries related to laparoscopic cholecystectomy can be managed by endoscopic techniques,\\u000a laparoscopic surgery is not yet sufficiently perfected. We investigated the efficacy of laparoscopic management combined with\\u000a endoscopic tube or stent insertion in cases of

  4. Laparoscopic resection of giant liver hemangioma using laparoscopic Habib probe for parenchymal transection

    PubMed Central

    Gadiyaram, Srikanth; Shetty, Neel

    2012-01-01

    Experience with laparoscopic liver resections is limited. Laparoscopic resection of a variety of liver lesions has been reported and is considered appropriate for lesions in the left lateral segment and inferior segments of the right lobe. Herein, we report a 52-year-old male patient who underwent a laparoscopic resection of giant liver hemangioma with the use of a laparoscopic 4× Habib probe. PMID:22623829

  5. Laparoscopic Salpingo-oophorectomy in Conscious Sedation

    PubMed Central

    Bramante, Silvia; Conti, Fiorella; Rizzi, Maria; Frattari, Antonella; Spina, Tullio

    2015-01-01

    Introduction: Conscious sedation has traditionally been used for laparoscopic tubal ligation. General anesthesia with endotracheal intubation may be associated with side effects, such as nausea, vomiting, cough, and dizziness, whereas sedation offers the advantage of having the patient awake and breathing spontaneously. Until now, only diagnostic laparoscopy and minor surgical procedures have been performed in patients under conscious sedation. Case Description: Our report describes 5 cases of laparoscopic salpingo-oophorectomy successfully performed with the aid of conventional-diameter multifunctional instruments in patients under local anesthesia. Totally intravenous sedation was provided by the continuous infusion of propofol and remifentanil, administered through a workstation that uses pharmacokinetic–pharmacodynamic models to titrate each drug, as well as monitoring tools for levels of conscious sedation and local anesthesia. We have labelled our current procedure with the acronym OLICS (Operative Laparoscopy in Conscious Sedation). Four of the patients had mono- or bilateral ovarian cysts and 1 patient, with the BRCA1 gene mutation and a family history of ovarian cancer, had normal ovaries. Insufflation time ranged from 19 to 25 minutes. All patients maintained spontaneous breathing throughout the surgical procedure, and no episodes of hypotension or bradycardia occurred. Optimal pain control was obtained in all cases. During the hospital stay, the patients did not need further analgesic drugs. All the women reported high or very high satisfaction and were discharged within 18 hours of the procedure. Discussion and Conclusion: Salpingo-oophorectomy in conscious sedation is safe and feasible and avoids the complications of general anesthesia. It can be offered to well-motivated patients without a history of pelvic surgery and low to normal body mass index. PMID:26175550

  6. Anesthetic implications of laparoscopic surgery.

    PubMed Central

    Cunningham, A. J.

    1998-01-01

    Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease. PMID:10604786

  7. Obstetric hysterectomy: changing trends over 20 years in a multiethnic high risk population

    Microsoft Academic Search

    Wai Yoong; Nadine Massiah; Ade Oluwu

    2006-01-01

    The aim of this study was to determine the demographics, indication and complications of emergency postpartum hysterectomy\\u000a in a multiethnic high-risk obstetric population and to assess if there is a change in trend between 1983 and 2003. Eighteen\\u000a women underwent postpartum hysterectomies in the 20 year period (prevalence 0.028%) and there were two maternal deaths. Overall,\\u000a 77% of the postpartum hysterectomies

  8. The introduction of laparoscopic sacral colpopexy to a fellowship training program

    PubMed Central

    Kantartzis, Kelly; Sutkin, Gary; Winger, Dan; Wang, Li; Shepherd, Jonathan

    2014-01-01

    Introduction and Hypothesis Minimally invasive sacral colpopexy has increased over the past decade with many senior physicians adopting this new skillset. However, skill acquisition at an academic institution in the presence of post-graduate learners is not well described. This manuscript outlines the introduction of laparoscopic sacral colpopexy to an academic urogynecology service that was not performing minimally invasive sacral colpopexies while also defining a surgical learning curve. Methods The first 180 laparoscopic sacral colpopexies done by 4 attending urogynecologists from January 2009 to December 2011 were retrospectively analyzed. The primary outcome was operative time. Secondary outcomes included conversion to laparotomy, estimated blood loss, and intra- and postoperative complications. Linear regression was used to analyze trends in operative times. Fisher’s exact test compared surgical complications and counts of categorical variables. Results Mean total operative time was 250 ± 52 minutes (range 146–452) with hysterectomy and 222 ± 45 (range 146–353) for sacral colpopexy alone. When compared to the first 10 cases performed by each surgeon, operative times in subsequent groups decreased significantly with a 6 to 16.3% reduction in overall times. There was no significant difference in the rate of overall complications regardless of the number of prior procedures performed (p=0.262). Conclusions The introduction of laparoscopic sacral colpopexy in a training program is safe and efficient. The reduction in operative time is similar to published learning curves in teaching and non-teaching settings. Introducing this technique does not add additional surgical risk as these skills are acquired. PMID:23549650

  9. Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery

    Microsoft Academic Search

    Catharina Forsgren; Cecilia Lundholm; Anna L. V. Johansson; Sven Cnattingius; Jan Zetterström; Daniel Altman

    Introduction and hypothesis  This study aims to determine the risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery related\\u000a to mode of hysterectomy focusing on vaginal hysterectomy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We performed a nationwide cohort study. Women exposed to hysterectomy on benign indications (n?=?118,601) were compared to women unexposed to hysterectomy (n?=?579,200). The outcome was defined as first occurrence of POP

  10. Laparoscopic Adjustable Esophagogastric Banding: a Preliminary Experience

    Microsoft Academic Search

    Erik Niville; Joost Vankeirsbilck; Anné Dams; Thierry Anne

    1998-01-01

    Background: Laparoscopic adjustable gastric banding is an efficient surgical method in the treatment of morbid obesity. In\\u000a order to reduce the number of complications, we have modified the technique to what we term ‘laparoscopic adjustable esophagogastric\\u000a banding’. Methods: Between December 1994 and July 1997, 126 laparoscopic adjustable banding procedures were carried out. Of\\u000a these, 40 underwent a gastric banding operation

  11. Hand-assisted laparoscopic low anterior resection

    Microsoft Academic Search

    A. Pietrabissa; C. Moretto; A. Carobbi; U. Boggi; M. Ghilli; F. Mosca

    2002-01-01

      Background: Laparoscopic low anterior resection for rectal cancer has never gained wide acceptance among general surgeons,\\u000a mainly due to the technical difficulties encountered during pelvic dissection. It has therefore been stated that these patients\\u000a should undergo open rather than laparoscopic surgery. Hand-assisted laparoscopic surgery (HALS) is a new technique that has\\u000a the potential to overcome many of the existing limitations

  12. Augmented Reality Visualization for Laparoscopic Surgery

    Microsoft Academic Search

    Henry Fuchs; Mark A. Livingston; Ramesh Raskar; D’nardo Colucci; Kurtis Keller; Andrei State; Jessica R. Crawford; Paul Rademacher; Samuel H. Drake; Anthony A. Meyer

    1998-01-01

    We present the design and a prototype implementation of a three-dimensional visualization system to assist with laparoscopic surgi- cal procedures. The system uses 3D visualization, depth extraction from laparoscopic images, and six degree-of-freedom head and laparoscope tracking to display a merged real and synthetic image in the surgeon's video-see-through head-mounted display. We also introduce a custom design for this display.

  13. Transumbilical Single-Incision Laparoscopic Resection of Focal Hepatic Lesions

    PubMed Central

    Yu, Xiao-Peng; Tian, Yu; Siwo, Ernest Amos; Li, Yongnan; Yu, Hong; Yao, Dianbo; Lv, Chao

    2014-01-01

    Background and Objectives: Transumbilical single-incision laparoscopic surgery (SILS) is gaining in popularity as a minimally invasive technique. The reduced pain and superior cosmetic appearance it affords make it attractive to many patients. For this study, we focused on SILS, analyzing the outcomes of transumbilical single-incision laparoscopic liver resection (SILLR) achieved at our institution between January 2010 and February 2013. Patients and Methods: Pre- and postoperative data from 17 patients subjected to transumbilical SILLR for various hepatic lesions (8 hemangiomas, 2 hepatocellular carcinomas, 2 metastases, 2 calculi of left intrahepatic duct, and 3 adenomas) were assessed. Altogether, eight wedge resections, seven left lateral lobectomies, a combination wedge resection/left lateral lobectomy, and a proximal left hemihepatectomy segmentectomy were performed, as well as four simultaneous laparoscopic cholecystectomies. In each instance, three ports were installed through an umbilical incision. Once vessels and bleeding were controlled, the lesion(s) were resected with 5-mm margins of normal liver. Resected tissues were then bagged and withdrawn through the umbilical incision. The follow-up period lasted for a minimum of 6 months. Results: All 17 patients were successfully treated through a single umbilical incision. The procedures required 55 to 185 minutes to complete, with blood loss of 30 to 830 mL. Subjects regained bowel activity 0.8 to 2.3 days postoperatively and were discharged after 3 to 10 days. There were few complications (23.5%), limited to pleural effusion, wound infection, and incisional hernia. Conclusions: Transumbilical SILLR is challenging to perform through conventional laparoscopic instrumentation. The risk of bleeding and technical difficulties is high for lesions of the posterosuperior hepatic segment. Surgical candidates should be carefully selected to optimize the benefits of this technique. PMID:25392646

  14. Laparoscopic pouch surgery in ulcerative colitis

    PubMed Central

    Hemandas, Anil K.; Jenkins, John T.

    2012-01-01

    Laparoscopic restorative proctocolectomy is a complex procedure with a steep learning curve. It has been proven to be safe and feasible with outcomes comparable to those of open surgery if performed in experienced centers. Published evidence in favor of laparoscopic approach is mainly from small case series and data from randomized controlled trials are currently awaited. This article reviews and analyzes the existing literature on laparoscopic ileoanal pouch surgery in light of the available evidence, demonstrating safety and efficacy of the laparoscopic approach and potential short-term benefits. Technical aspects and future directions in the minimally invasive approach to restorative proctocolectomy are also discussed. PMID:24714253

  15. Establishment of a laparoscopic cholecystectomy training program.

    PubMed

    Bailey, R W; Imbembo, A L; Zucker, K A

    1991-04-01

    A recently developed alternative to traditional laparotomy and cholecystectomy is laparoscopic-guided cholecystectomy. This procedure has the advantages of reduced hospital stay, early return to work, diminished abdominal wall scarring, and less patient discomfort. The complex nature of this procedure and the current lack of extensive clinical experience preclude the traditional "hands-on" training normally practiced in surgical residency programs. At the University of Maryland, we have developed a program to instruct both surgeons and surgical residents in the techniques of laparoscopic surgery. Technical competence is achieved under the close supervision and guidance of an experienced laparoscopic surgeon. Training of residents in this procedure, therefore, is not very different than that for other general surgical procedures. Surgeons already in clinical practice, however, gain experience under somewhat different circumstances. Initial training involves didactic instruction through laparoscopic surgical atlases and educational videotapes. Further training uses a simulation device which enables the trainee to practice techniques of laparoscopic suturing, knot-tying, and clip application. Actual operative experience is acquired primarily in experimental animal preparations. Laparoscopic-guided removal of the gallbladder is performed in young swine (20-25 kg) under conditions that mimic those in the operating room. Further clinical experience can be acquired by assisting on several laparoscopic operations, usually involving diagnostic or pelvic procedures. Actual operative experience with laparoscopic cholecystectomy, of course, comprises the final phase of the educational program. The introduction of clinical laparoscopic training into general surgery residency programs should influence the widespread adoption of this new procedure. PMID:1828943

  16. Laparoscopic repair of post-abdominoperineal resection hernia: biological mesh and augmentation technique.

    PubMed

    Chelala, E; Declercq, S

    2013-11-16

    Perineal hernias are infrequent complications following abdominoperineal surgeries. These hernias require surgical repair when they become symptomatic by several conventional or reconstructive techniques. The benefits of a full laparoscopic approach and/or the combined approach of a perineal repair of the pelvic floor associated to the laparoscopic placement of a traditional synthetic mesh have been previously demonstrated. In this article, we present the case of a perineal incisional hernia, post-abdominoperineal resection of the rectum after radio chemotherapy, in the neoadjuvant treatment of a rectal adenocarcinoma tumor. An alternative approach, not previously described for the surgical repair of this type of hernia, is presented to assess the feasibility of the suturing repair, and efficacy of a biological acellular porcine collagen implant Permacol(®). A full laparoscopic suturing for the closure of the perineal defect associated to biological mesh reinforcement was successfully undertaken, with good short-term outcomes. PMID:24241325

  17. Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique.

    PubMed

    Yussra, Y; Sutton, P A; Kosai, N R; Razman, J; Mishra, R K; Harunarashid, H; Das, S

    2013-01-01

    Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome. PMID:24217830

  18. Laparoscopic splenectomy. Technique and results in a series of 27 cases.

    PubMed

    Emmermann, A; Zornig, C; Peiper, M; Weh, H J; Broelsch, C E

    1995-08-01

    Between early 1992 and December 1994, laparoscopic splenectomy was performed in 27 patients with idiopathic thrombocytopenia (ITP), hairy-cell leucemia, HIV, or Hodgkin's disease. In all cases medical treatment, especially cortisone therapy, failed. In Hodgkin's disease the splenectomy was combined with liver biopsies and dissection of parailiacal, paraaortic, and mesenteric lymph nodes for abdominal staging. The operation was performed using four trocars; the splenic vessels were divided by a linear stapler. In general the spleen was removed in a bag through a slightly enlarged trocar incision or after morcellation. Three patients needed a small laparotomy for the removal (laparoscopic assisted). In a recent case of Hodgkin's disease the intact spleen was removed via posterior colpotomy. In 22 of 27 cases (81%) the operation was finished laparoscopically. Five times a conversion to conventional laparotomy was necessary because of bleeding of enlarged lymph nodes at the hilum. Wound infections occurred in two cases. In one patient with ITP the platelet count did not improve and continuous blood loss led to relaparotomy at the 1st postoperative day. No surgical bleeding was found. All patients tolerated a fluid diet at the 1st postoperative day and hospitalization time was 4.4 days (range 3-14). Regarding the low complication rate and the advantages of a smaller abdominal trauma in the postoperative period, the laparoscopic approach for elective splenectomy and laparoscopic abdominal staging has a substantial benefit for the patients. PMID:8525451

  19. Ureteral Obstruction Swine Model through Laparoscopy and Single Port for Training on Laparoscopic Pyeloplasty

    PubMed Central

    Díaz-Güemes Martín-Portugués, Idoia; Hernández-Hurtado, Laura; Usón-Casaús, Jesús; Sánchez-Hurtado, Miguel Angel; Sánchez-Margallo, Francisco Miguel

    2013-01-01

    This study aims firstly to assess the most adequate surgical approach for the creation of an ureteropelvic juntion obstruction (UPJO) animal model, and secondly to validate this model for laparoscopic pyeloplasty training among urologists. Thirty six Large White pigs (28.29±5.48 Kg) were used. The left ureteropelvic junction was occluded by means of an endoclip. According to the surgical approach for model creation, pigs were randomized into: laparoscopic conventional surgery (LAP) or single port surgery (LSP). Each group was further divided into transperitoneal (+T) or retroperitoneal (+R) approach. Time needed for access, surgical field preparation, wound closure, and total surgical times were registered. Social behavior, tenderness to the touch and wound inflammation were evaluated in the early postoperative period. After ten days, all animals underwent an Anderson-Hynes pyeloplasty carried out by 9 urologists, who subsequently assessed the model by means of a subjective validation questionnaire. Total operative time was significantly greater in LSP+R (p=0.001). Tenderness to the touch was significantly increased in both retroperitoneal approaches, (p=0.0001). Surgeons rated the UPJO porcine model for training on laparoscopic pyeloplasty with high or very high scores, all above 4 on a 1-5 point Likert scale. Our UPJO animal model is useful for laparoscopic pyeloplasty training. The model created by retroperitoneal single port approach presented the best score in the subjective evaluation, whereas, as a whole, transabdominal laparoscopic approach was preferred. PMID:23801892

  20. Towards an understanding of conventional surgical haptics for use in MIS.

    PubMed

    Zelek, John S; Xin, Hao

    2007-01-01

    In order to define what haptics to provide to surgeons during MIS (minimally invasive surgery), it is important to determine what a surgeon experiences via the tactile modality during conventional and laparoscopic surgery. We performed a set of experiments towards this goal using a laparoscopic tool during a push and gasp task, using an Omni haptic device to simulate the elastic properties of biological tissue. We found attenuation during both tasks, more so for passive (pushing) than active (gasping) activities. PMID:17377341

  1. Laparoscopic artificial insemination in sheep.

    PubMed

    Gourley, D D; Riese, R L

    1990-11-01

    The goal of any AI program is to create improved offspring, and the achievement of this objective will depend on the breeding value of the ram and ewe selected. Laparoscopic AI is being utilized in the sheep industry to extend the use of superior rams, and it offers the producer the opportunity to maximize the reproductive potential of superior sheep. Rapid genetic trait infusion of known superior stud rams into the flock is the primary economic benefit of laparoscopic AI. The success of laparoscopic AI depends on events and factors that interrelate in a complex way. Once the selection and preparation of the ewe have been accomplished, one of the more important steps in the program is the successful synchronization of the ewe to deliver the necessary ova to the site of fertilization at a specific time. One of the best methods of synchronization for laparoscopic AI is the use of a progesterone product for a controlled time period and the administration of PMSG upon its removal. Detecting the onset of estrus is critical, and the addition of sterile (e.g., vasectomized) males is helpful, even essential, to accurately determine when each ewe begins her estrus. The ram effect has been shown to stimulate ovulation and estrus. Ewes must be inseminated within a narrow window of time after the synchronization product is removed. Ewes should be inseminated in the order in which they begin to exhibit signs of behavioral estrus, but age, stage of lactation, duration of behavioral estrus, and breed must be taken into account when this order is established. Fresh-extended semen works well throughout this preferred time frame established for laparoscopic AI, but frozen semen gives best results when used near the end. Advancement in manufacturing technology today removes equipment as a variable factor. It is important, therefore, that the inseminator develop a level of expertise in laparoscopy to ensure maximum fertilization rates. If available, fresh-extended semen is preferred over frozen semen, using at least the minimal number of spermatozoa necessary for fertilization. Evaluation of the post-thaw frozen or fresh semen is necessary to determine motility, morphology, and concentration, all of which help determine the volume of the insemination dose. The minimum necessary for laparoscopic AI in fine-wooled breeds is 20 X 10(6) normal motile spermatozoa; however, the more seasonal and less fertile American sheep need approximately 40 to 50 X 10(6) normal motile sperm to achieve acceptable fertility rates.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2147121

  2. Development and evaluation of a master-slave robot system for single-incision laparoscopic surgery.

    PubMed

    Horise, Yuki; Nishikawa, Atsushi; Sekimoto, Mitsugu; Kitanaka, Yu; Miyoshi, Norikatsu; Takiguchi, Shuji; Doki, Yuichiro; Mori, Masaki; Miyazaki, Fumio

    2012-03-01

    PURPOSE : Single-incision laparoscopic surgery (SILS) brings cosmetic benefits for patients, but this procedure is more difficult than laparoscopic surgery. In order to reduce surgeons' burden, we have developed a master-slave robot system which can provide robot-assisted SILS as if it were performing conventional laparoscopic surgery and confirmed the feasibility of our proposed system. METHODS : The proposed system is composed of an input device (master side), a surgical robot system (slave side), and a control PC. To perform SILS in the same style as regular laparoscopic surgery, input instruments are inserted into multiple incisions, and the tip position and pose of the left-sided (right-sided) robotic instrument on the slave side follow those of the right-sided (left-sided) input instruments on the master side by means of a control command from the PC. To validate the proposed system, we defined four operating conditions and conducted simulation experiments and physical experiments with surgeons under these conditions, then compared the results. RESULTS : In the simulation experiments, we found learning effects between trials (P = 0.00013 < 0.05). Our proposed system had no significant difference from a condition simulating classical laparoscopic surgery (P = 0.23 > 0.1), and the task time of our system was significantly shorter than the simulated SILS (P = 0.011 < 0.05). In the physical experiments, our system performed SILS more easily, efficiently, and intuitively than the other operating conditions. CONCLUSION : Our proposed system enabled the surgeons to perform SILS as if they were operating conventionally with laparoscopic techniques. PMID:21927865

  3. Pure laparoscopic hepatectomy combined with a pure laparoscopic pringle maneuver in patients with severe cirrhosis.

    PubMed

    Miyagi, Shigehito; Nakanishi, Chikashi; Kawagishi, Naoki; Kamei, Takashi; Satomi, Susumu; Ohuchi, Noriaki

    2015-01-01

    Laparoscopic hepatectomy is a standard surgical procedure. However, it is difficult to perform in patients with severe cirrhosis because of fibrosis and a high risk of hemorrhage. We report our recent experience in five cases of pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver in patients with severe cirrhosis. From 2012 to 2014, we performed pure laparoscopic partial hepatectomy in five patients with severe liver cirrhosis (indocyanine green retention rate at 15 min [ICG R15] >30% and fibrosis stage f4). A pure laparoscopic Pringle maneuver was employed in all patients. We investigated operative time, blood loss, duration of hospitalization and the days when discharge was possible, and compared these findings with those of patients with a normal liver (ICG R15 <10%, f0) who underwent pure laparoscopic partial hepatectomy during the same period (n = 7). As a result, operative time, blood loss, duration of hospitalization and the days when discharge was possible were similar in patients with cirrhosis undergoing pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver to those in patients with a normal liver undergoing pure laparoscopic partial hepatectomy. In conclusion, pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver appears to be safe in patients with severe cirrhosis. PMID:26034471

  4. Pure Laparoscopic Hepatectomy Combined with a Pure Laparoscopic Pringle Maneuver in Patients with Severe Cirrhosis

    PubMed Central

    Miyagi, Shigehito; Nakanishi, Chikashi; Kawagishi, Naoki; Kamei, Takashi; Satomi, Susumu; Ohuchi, Noriaki

    2015-01-01

    Laparoscopic hepatectomy is a standard surgical procedure. However, it is difficult to perform in patients with severe cirrhosis because of fibrosis and a high risk of hemorrhage. We report our recent experience in five cases of pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver in patients with severe cirrhosis. From 2012 to 2014, we performed pure laparoscopic partial hepatectomy in five patients with severe liver cirrhosis (indocyanine green retention rate at 15 min [ICG R15] >30% and fibrosis stage f4). A pure laparoscopic Pringle maneuver was employed in all patients. We investigated operative time, blood loss, duration of hospitalization and the days when discharge was possible, and compared these findings with those of patients with a normal liver (ICG R15 <10%, f0) who underwent pure laparoscopic partial hepatectomy during the same period (n = 7). As a result, operative time, blood loss, duration of hospitalization and the days when discharge was possible were similar in patients with cirrhosis undergoing pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver to those in patients with a normal liver undergoing pure laparoscopic partial hepatectomy. In conclusion, pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver appears to be safe in patients with severe cirrhosis.

  5. Simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery – new experience with port placement

    PubMed Central

    Panek, Wojciech; Lewandowski, Jaroslaw; Tuchendler, Tomasz; Urba?czyk, Grzegorz; Litarski, Adam; Apozna?ski, Wojciech

    2013-01-01

    The aim of the study was to describe simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery, to discuss the details of a convenient laparoscopic approach and the way of port placement, as well as to present a review of the literature concerning combined laparoscopic procedures. A 72-year-old woman was admitted to our department because of a tumor of the right adrenal gland and a small tumor of the right kidney. The patient underwent simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery. The postoperative period was uncomplicated. The patient was discharged from the hospital on the 4th postoperative day. We believe that the proposed way of trocar placement would help to avoid a ‘rollover’ problem between the laparoscope and a Satinsky clamp or a ‘crossing swords’ problem between a Satinsky clamp and manipulators. PMID:24501608

  6. Non-closure of visceral peritoneum at abdominal hysterectomy

    Microsoft Academic Search

    M Kucuk; T. K Okman

    2001-01-01

    Our purpose was to determine whether non-closure of the visceral peritoneum alters post-operative outcome at abdominal hysterectomy. A prospective, randomized trial was performed. Of the 100 evaluable subjects, 50 had the visceral peritoneum left open whereas 50 were closed. Patients were observed for evidence of morbidity after the operation. Analysis of data was performed with use of the unpaired t-test

  7. [The laparoscopic treatment of varicocele].

    PubMed

    Stepanov, V N; Mumladze, R B; Kadyrov, Z A; Perel'man, V M; Rozikov, Iu Sh; Tomkevich, B A; Puzhik, A M; Kosachenko, V M

    1997-01-01

    Laparoscopic treatment of varicocele is described for 37 patients. The operation was performed under endotracheal, epidural and intravenous anesthesia with ligation of the testicular vein in 18 patients. Ligation with the dissection was conducted in 19 patients. On the first postoperative day 2 patients were given promedol (2%, 1.0 ml), the rest were injected baralgin (2-3 injections). The patients were discharged after 1-2 days of hospital stay and resumed their usual way of life 2-7 days after the discharge. One month later varicocele disappeared in 29 patients, diminished in size in 7 patients, pain relief occurred in 15 patients. Due to its advantages (simple performance, good visualization of the testicular vein, minimal use of narcotic drugs, short hospital stay, absence of serious complications) laparoscopic treatment may be considered as a method of choice. PMID:9123663

  8. Laparoscopic appendectomy for perforated appendicitis

    Microsoft Academic Search

    Jimmy B. Y. So; Ee-Cherk Chiong; Edmond Chiong; Wei-Keat Cheah; David Lomanto; Peter Goh; Cheng-Kiong Kum

    2002-01-01

    Although laparoscopic appendectomy for uncomplicated appendicitis is feasible and safe, its application to perforated appendicitis\\u000a is uncertain. A retrospective study of all patients with perforated appendicitis from 1992 to 1999 in a university hospital\\u000a was performed. A series of 231 patients were diagnosed as having perforated appendicitis. Of these patients, 85 underwent\\u000a laparoscopy (LA), among whom 40 (47%) required conversion

  9. Complications of Laparoscopic Donor Nephrectomy

    Microsoft Academic Search

    Alexei Wedmid; Michael A. Palese

    \\u000a “Laparoscopic donor nephrectomy is a unique surgical procedure due to the fact that the surgeon is operating on a healthy\\u000a individual in order to benefit another patient he or she is unlikely managing, with a potential for complications ensuing\\u000a in both the donor and the recipient patients. Overall surgical technique, anatomic considerations, and perioperative management\\u000a remain important for minimizing the

  10. Severe endometriosis: laparoscopic rectum resection

    Microsoft Academic Search

    Ingolf Juhasz-Böss; Claus Lattrich; Alois Fürst; Eduard Malik; Olaf Ortmann

    2010-01-01

    Aim  Endometriosis is a frequent benign disease of women in reproductive age. An infiltration of the spatium rectovaginal is rare,\\u000a but if it occurs, in up to 73% the rectum is involved. If there is the indication for surgery, a partial resection of the\\u000a rectum might be necessary. This can be performed by a laparoscopic approach. It is the aim of

  11. Review. Laparoscopic appendicectomy: current status.

    PubMed Central

    Memon, M. A.

    1997-01-01

    Laparoscopic appendicectomy (LA), has failed to gain unequivocal acceptance by the general surgical community as an alternative to open appendicectomy (OA). This is because the early postoperative recovery leading to quicker hospital discharge, which led to the worldwide acceptance of laparoscopic cholecystectomy, has not been universally seen with LA. Moreover, in the majority of the published series of LAs, there seems to be a trend towards an increased incidence of intra-abdominal abscesses. However, laparoscopy is superior to the 'watch and wait' policy where the diagnosis of appendicitis is questionable. Furthermore, since a large incision can be avoided by using the LA technique in obese patients, the incidence of postoperative morbidity can be reduced considerably. Nevertheless, before endorsing routine and widespread use of LA, it is essential that this technique is critically evaluated in well-designed, controlled, randomised trials, showing clearly the major benefits to the patient in terms of quicker hospital discharge, reduced postoperative pain, decreased wound infection and early return to full activities. Laparoscopic appendicectomy will never replace all open appendicectomies, but should become an alternative in certain groups of patients. PMID:9422862

  12. Laparoscopic pancreatectomy: Indications and outcomes

    PubMed Central

    Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

    2014-01-01

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

  13. Symptomatic internal hernias after laparoscopic bariatric surgery

    Microsoft Academic Search

    E. Comeau; M. Gagner; W. B. Inabnet; D. M. Herron; T. M. Quinn; A. Pomp

    2005-01-01

    Background: The aim of this study was to describe the occurrence and clinical characteristics of symptomatic internal hernias (IH) after laparoscopic bariatric procedures. Methods: We conducted a retrospective review of cases of IH after 1,064 laparoscopic gastric bypasses (LGB) and biliopancreatic diversions with duodenal switch (LBPD-DS) performed from September 1998 to August 2002. Results: We documented 35 cases of IH

  14. Laparoscopic Era of Operations for Morbid Obesity

    Microsoft Academic Search

    Daniel R. Cottam; Samer G. Mattar; Philip R. Schauer

    2003-01-01

    he goal of this article is to review the status of the emerging field of laparoscopic bariat- ric surgery, to discuss developmental issues regarding technique and training, and fi- nally, to summarize the present and future roles of laparoscopic bariatric surgery. We reviewed all published literature from 1992 to the present on MEDLINE. Articles were excludedforanalysesthatwerecasereportsorarticlesontechnicalaspectsofgivenprocedures.Lap- aroscopic vertical banded gastroplasty

  15. Laparoscopically assisted vaginal resection of rectovaginal endometriosis

    Microsoft Academic Search

    Marc Possover; Herbert Diebolder; Karin Plaul; Achim Schneider

    2000-01-01

    Background: We wanted to establish a technique of laparoscopically assisted radical vaginal surgery for deep endometriosis of the rectovaginal septum with extensive rectal involvement.Technique: The procedure is started by vaginally excising the involved area which is left on the rectum, followed by bilateral dissection of the pararectal and retrorectal spaces. Para- and retrosigmoido-rectal spaces are developed laparoscopically along the coccygeosacral

  16. [Laparoscopic partial nephrectomy: technique and outcomes].

    PubMed

    Colombo, J R; Gill, I S

    2006-05-01

    The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN. PMID:16884101

  17. Laparoscopic treatment of cornual heterotopic pregnancy.

    PubMed

    Pasic, Resad P; Hammons, Grant; Gardner, Julie S; Hainer, Meg

    2002-08-01

    A woman with spontaneous heterotopic pregnancy at approximately 7 weeks' gestation, diagnosed by ultrasound, was treated by laparoscopic cornuostomy. Intrauterine pregnancy continued to develop uneventfully. Two days after laparoscopic surgery, the patient decided to terminate the intrauterine pregnancy. Pathology report confirmed cornual pregnancy, and showed a partial molar gestation of the terminated pregnancy. PMID:12101338

  18. In vivo kinematic measurement during laparoscopic cholecystectomy

    Microsoft Academic Search

    M. Rasmus; R. Riener; S. Reiter; A. Schneider; H. Feussner

    2004-01-01

    Background: Despite the rapid development of computer-assisted surgery, studies on kinematic measurement for surgical innovation are rare. This study describes a system for kinematic measurement in real operating theater environments. Six laparoscopic cholecystectomies were recorded and analyzed. In addition to a demonstration of the feasibility of the method, basis data for the development of an actuated laparoscopic camera holder are

  19. Laparoscopic excision of splenic hydatid cyst

    PubMed Central

    Gharaibeh, K

    2001-01-01

    Hydatid disease of the spleen is a rare condition. The standard treatment is open total or partial splenectomy. Recently hand assisted laparoscopic total splenectomy for splenic hydatid cyst has been reported. A case is described of splenic hydatid cyst in a 45 year old man that was excised laparoscopically; the related literature is reviewed.???Keywords: hydatid disease; spleen; laparoscopy; Jordan PMID:11222831

  20. Successful Transfer of Open Surgical Skills to a Laparoscopic Environment Using a Robotic Interface: Initial Experience With Laparoscopic Radical Prostatectomy

    Microsoft Academic Search

    THOMAS E. AHLERING; DOUGLAS SKARECKY; DAVID LEE; RALPH V. CLAYMAN

    2003-01-01

    PurposeFor a skilled laparoscopic surgeon the learning curve for achieving proficiency with laparoscopic radical prostatectomy (LRP) is estimated at 40 to 60 cases. For the laparoscopically naïve surgeon the curve is estimated at 80 to 100 cases. The development of a robotic interface might significantly shorten the LRP learning curve for an experienced open yet naïve laparoscopic surgeon. To our

  1. Laparoscopic Diagnosis and Treatment in Gynecologic Emergencies

    PubMed Central

    Cantele, Héctor; Leyba, José Luis; Navarrete, Manuel; Llopla, Salvador Navarrete

    2003-01-01

    Objective: To present an analysis of our experience with 22 consecutive cases of acute abdominal gynecologic emergencies managed with a laparoscopic approach. Methods: From March 1997 to October 1998, 22 patients with a diagnosis of acute abdominal gynecologic emergencies underwent laparoscopic intervention. A transvaginal ultrasound was performed on all patients preoperatively to supplement the diagnostic workup. Surgical time, complications, and length of hospital stay were evaluated, and the laparoscopic diagnosis was compared with the preoperative diagnosis. Results: The laparoscopic diagnosis was different from the preoperative diagnosis in 31.8% of patients. Of the 22 patients, laparoscopic therapeutic procedures were performed in 18 (81.8%), all satisfactorily, and with no need for conversion to open surgery. No morbidity or mortality occurred. Conclusion: Laparoscopy is a safe and effective method for diagnosing and treating gynecologic emergencies. PMID:14558712

  2. [Indications of laparoscopic surgery for gastric cancer].

    PubMed

    Li, Ziyu

    2014-08-01

    Consensus has been reached on the advantage and validity of laparoscopic surgery, but how to extend the usage of laparoscopic surgery in gastric cancer properly in China remains a problem as advanced gastric cancer occupies the majority of patients here. In the treatment of early gastric cancer, laparoscopic surgery nowadays is one of the standard treatments but surgeons still need to follow the indication of surgery strictly to avoid the excessive treatment in patients who are indicated for endoscopic therapy. There is still lack of evidence on the application of laparoscopic surgery in the treatment of advanced gastric cancer, therefore these procedures should be performed in the context of clinical trials. With the development of laparoscopic surgery in the treatment of advanced gastric cancer, training, certification and supervision systems are still not established. More attention should be paid to the choice of patients during the early period of learning curves and the indication of advanced stage. PMID:25164886

  3. Laparoscopic vs. laparoscopically assisted management of Meckel’s diverticulum in children

    PubMed Central

    Duan, Xufei; Ye, Guogang; Bian, Hongqiang; Yang, Jun; Zheng, Kai; Liang, Chong; Sun, Xuan; Yan, Xueqiang; Yang, Hu; Wang, Xin; Ma, Jingwei

    2015-01-01

    To investigate the management of Meckel’s diverticulum in children and the feasibility of using laparoscopic and laparoscopically assisted Meckel’s diverticulum resection and intestinal anastomosis according to the different subtypes classified laparoscopically. 55 symptomatic Meckel’s diverticulum cases were classified into two categories, the simple and the complex types depending on Meckel’s diverticulum appearance upon laparoscopic exploration. Forty-one cases of simple Meckel’s diverticulum were treated with simple diverticulectomy during laparoscopy, and 14 cases of complicated Meckel’s diverticulum were treated with laparoscopically assisted Meckel’s diverticulum resection and intestinal anastomosis. The operation time for the laparoscopically assisted was significant longer than laparoscopic-only surgeries [45~123 min (54.57 ± 20.17min) vs 29~78min (38.85 ± 9.75 min)], P = 0.013. Among the 55 cases, Just one child with simple type MD during laparoscopic exploration, and presented a diverticulum with a base that was considered to be in the mesangial margin. The remaining 54 patients were cured, and follow-up for 4~36 months revealed that they did not present abdominal pain, and no hematochezia occurred as a complication. Surgery selection either laparoscopy only or transumbilical laparoscopically assisted intestinal resection and intestinal anastomosis by laparoscopic exploration for Meckel’s diverticulum treatment, based on the type of Meckel’s diverticulum in children, is safe, feasible, and effective. PMID:25784978

  4. Single-Port Onlay Mesh Repair of Recurrent Inguinal Hernias after Failed Anterior and Laparoscopic Repairs

    PubMed Central

    Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

    2015-01-01

    Background and Objectives: Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias. Methods: Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months. Conclusion: Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM. PMID:25848186

  5. Hemodynamic effects of the laparoscopic pneumoperitoneum during sepsis in a porcine endotoxic shock model.

    PubMed Central

    Greif, W M; Forse, R A

    1998-01-01

    OBJECTIVE: The authors compared the hemodynamic effects of laparoscopic intervention with conventional laparotomy in an endotoxic shock model in the pig. SUMMARY BACKGROUND DATA: Laparoscopic techniques are being applied more frequently to severely ill patients to evaluate potential abdominal sources of sepsis. Although hemodynamic effects of laparoscopy are minimal in healthy patients, recent studies have shown more significant changes in patients with chronic cardiopulmonary disease. It is unclear whether these effects are applicable to acutely septic patients. METHODS: Twelve domestic pigs received intravenous lipopolysaccharide (LPS) injection and underwent surgical abdominal exploration using either laparoscopy or conventional laparotomy. For baseline comparison, four pigs underwent exploratory laparoscopy without intravenous LPS injection. Hemodynamic measurements and blood gas analyses were obtained using Swan-Ganz and arterial catheters. RESULTS: After LPS exposure, animals undergoing laparoscopic evaluation were significantly more hypercarbic (p < 0.01) and acidotic (p < 0.01) than those undergoing conventional laparotomy. Their mean pulmonary arterial pressure and pulmonary vascular resistance were greater as well (not significant). The cardiac index (p < 0.05) and stroke volume (p < 0.05) were decreased in the laparoscopic group. Their oxygen delivery was decreased and oxygen consumption increased, although these were not significantly different from those of the laparotomy group. The degree of acidosis was highly correlated with the cardiac index (correlation coefficient, r = 0.82). CONCLUSIONS: Animals exposed to LPS tolerate laparoscopy but with significant hemodynamic compromise. Much of this effect seems to be mediated by a cardiodepressive effect of acidosis. This study suggests that laparoscopic intervention, when used in septic patients, should be used with caution. PMID:9563532

  6. Hysterectomy improves sexual response? Addressing a crucial omission in the literature

    PubMed Central

    Komisaruk, Barry R.; Frangos, Eleni; Whipple, Beverly

    2011-01-01

    The prevailing view in the literature is that hysterectomy improves the quality of life. This is based on claims that hysterectomy alleviates pain (dyspareunia and abnormal bleeding), and improves sexual response. Since hysterectomy requires cutting the sensory nerves that supply the cervix and/or uterus, it is surprising that the reports of deleterious effects on sexual response are so limited. However, we note that almost all the papers we found reported that some of the women in their studies claim that hysterectomy is detrimental to their sexual response. It is likely that the degree to which a woman’s sexual response and pleasure are affected by hysterectomy would depend not only upon which nerves were severed by the surgery, but also the genital regions whose stimulation the woman enjoys for eliciting sexual response. Since clitoral sensation (via pudendal and genitofemoral nerves) should not be affected by hysterectomy, this surgery would not diminish sexual response in women who prefer clitoral stimulation. However, women whose preferred source of stimulation is vaginal or cervical would be more likely to experience a decrement in sensation and consequently sexual response after hysterectomy, because the nerves innervating those organs -- pelvic, hypogastric and vagus -- are more likely to be damaged or severed in the course of hysterectomy. However, all the published reports of the effects of hysterectomy on sexual response fail to specify the women’s preferred sources of genital stimulation. As discussed in the present review, we believe that the critical lack of information as to the women’s preferred sources of genital stimulation is key to accounting for the discrepancies in the literature as to whether hysterectomy improves or attenuates sexual pleasure. PMID:21545957

  7. Laparoscopic cholecystectomy: technique, safety, and results

    NASA Astrophysics Data System (ADS)

    Simutis, Gintaras; Bubnys, A.; Vaitkuviene, Aurelija

    1994-12-01

    Laparoscopic cholecystectomy (LC) is a minimally invasive method of removing the diseased gallbladder. It was introduced into Lithuania in December 1992 and has gained wide acceptance. While LC offers many advantages over the conventional laparotomy procedure one of its drawbacks is delayed biliary complications. Those complications may be avoided with appropriate precautions. The aim of this research is to maximize the safety of LC. The potential way to solve this problem is to minimize the possible heat damage and electrical injury remote from the site of surgery during dissection of the cystic duct, cystic artery, and the gallbladder. Neodymium:YAG laser applications with endoscopic fiber have been investigated. The possibilities to use it as a scalpel and as coagulator to release the gallbladder from all its peritoneal attachments during LC have been investigated. The controversy over optimal sources for thermal dissection of the gallbladder has been performed. The potential benefits of Nd:YAG laser in surgery -- precise cutting, limited collateral tissue damage, and improved capillary and arteriole hemostasis -- have been found.

  8. Laparoscopic repair and groin hernia surgery.

    PubMed

    Crawford, D L; Phillips, E H

    1998-12-01

    Over the past 15 years, laparoscopic herniorrhaphy has made the transition from an experimental to a proven procedure. With increasing laparoscopic skills in the surgical community, many surgeons are now faced with the question of when to recommend laparoscopic herniorrhaphy to their patients. A surgeon's best hernia repair is the one with which they have had the greatest experience. This results in the lowest recurrence and complication rate in his or her hands. Certainly, simple, unilateral hernias and bilateral hernias can be repaired with either anterior or laparoscopic techniques. Many times, laparoscopic herniorrhaphy is too much surgery for a young patient with a unilateral hernia. In such a case, repair is best performed with the patient under local anesthesia. Also, young patients in whom it is advantageous to avoid mesh should not undergo laparoscopic herniorrhaphy. The authors prefer laparoscopic TEP herniorrhaphy in patients with recurrent hernias, bilateral hernias, and unilateral hernias with a suspected contralateral hernia. There is also a consensus that patients with multiple recurrent hernias in whom a preperitoneal repair is appropriate are best served with a laparoscopic repair. Surgeons without advanced laparoscopic skills or without the time to develop the skills necessary to perform laparoscopic herniorrhaphy should consider referring patients with recurrent hernias to surgeons with experience in TEP. TEP is preferable to TAPP because of its lower complication and recurrence rates and in the authors' hands is the "best repair." TAPP should be reserved for patients with prior lower abdominal wall incisions that make the dissection of the peritoneum from the underside of the incision impossible. Patients who cannot tolerate general anesthesia or who have had extensive lower abdominal surgery should not undergo laparoscopic herniorrhaphy. Complication and recurrence rates, although initially higher than traditional repairs, have now fallen to equal or lower levels at centers experienced in laparoscopic techniques. Prospective randomized trials prove that when patients are selected properly and surgeons are adequately trained and proctored, laparoscopic herniorrhaphy can be performed with acceptably low incidences of recurrence and complications. PMID:9927983

  9. Single-Port Laparoscopic Parastomal Hernia Repair with Modified Sugarbaker Technique

    PubMed Central

    Turingan, Isidro; Zajkowska, Marta; Tran, Kim

    2014-01-01

    Introduction: Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. Materials and Methods: All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, “inline” and “chopsticks” to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Results: Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m2 did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm2 with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Conclusion: Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care. PMID:24680140

  10. Laparoscopic cholecystectomy does not prevent the postoperative protein catabolic response in muscle.

    PubMed Central

    Essén, P; Thorell, A; McNurlan, M A; Anderson, S; Ljungqvist, O; Wernerman, J; Garlick, P J

    1995-01-01

    OBJECTIVE: The authors determined the effect of laparoscopic cholecystectomy on protein synthesis in skeletal muscle. In addition to a decrease in muscle protein synthesis, after open cholecystectomy, the authors previously demonstrated a decrease in insulin sensitivity. This study on patients undergoing laparoscopic and open surgery, therefore, included simultaneous measurements of protein synthesis and insulin sensitivity. SUMMARY BACKGROUND DATA: Laparoscopy has become a routine technique for several operations because of postoperative benefits that allow rapid recovery. However, its effect on postoperative protein catabolism has not been characterized. Conventional laparotomy induces a drop in muscle protein synthesis, whereas degradation is unaffected. METHODS: Patients were randomized to laparoscopic or open cholecystectomy, and the rate of protein synthesis in skeletal muscle was determined 24 hours postoperatively by the flooding technique using L-(2H5)phenylalanine, during a hyperinsulinemic normoglycemic clamp to assess insulin sensitivity. RESULTS: The protein synthesis rate decreased by 28% (1.77 +/- 0.11%/day vs. 1.26 +/- 0.08%/day, p < 0.01) in the laparoscopic group and by 20% (1.97 +/- 0.15%/day vs. 1.57 +/- 0.15%/day, p < 0.01) in the open cholecystectomy group. In contrast, the fall in insulin sensitivity after surgery was lower with laparoscopic (22 +/- 2%) compared with open surgery (49 +/- 5%). CONCLUSIONS: Laparoscopic cholecystectomy did not avoid a substantial decline in muscle protein synthesis, despite improved insulin sensitivity. The change in the two parameters occurred independently, indicating different mechanisms controlling insulin sensitivity and muscle protein synthesis. PMID:7618966

  11. Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus

    PubMed Central

    Rivier, Pablo; Furneaux, Rob; Viguier, Eric

    2011-01-01

    This prospective study describes a simple method of combining laparoscopic ovariectomy and laparoscopic-assisted prophylactic gastropexy and determines the duration of surgery, complications, and long-term outcome including prevention of gastric dilatation-volvulus (GDV). Laparoscopic ovariectomy and laparoscopic-assisted gastropexy were performed on 26 sexually intact female dogs susceptible to GDV. The mean surgery time was 60.8 ± 12.4 min. No GDV episode was seen during the study period (mean follow-up: 5.2 ± 1.4 y). All dogs had an intact gastropexy attachment assessed by ultrasonography at 1 y. Post-operative complications were minor and owners were satisfied with the procedure. Combined laparoscopic ovariectomy and laparoscopic- assisted gastropexy appears to be a successful and low morbidity alternative procedure to both ovariectomy/ovariohysterectomy and gastropexy via open ventral-midline laparotomy. PMID:21461209

  12. Is cirrhosis a contraindication to laparoscopic cholecystectomy?

    PubMed

    McGillicuddy, John W; Villar, Juan José E; Rohan, Vinayak S; Bazaz, Sapna; Taber, David J; Pilch, Nicole A; Baliga, Prabhakar K; Chavin, Kenneth D

    2015-01-01

    Laparoscopic cholecystectomy is the gold standard treatment for the vast majority of patients with symptomatic cholelithiasis. Although cirrhotic patients are twice as likely to develop gallstones as compared with noncirrhotic patients, cirrhosis has historically been considered a relative, if not absolute, contraindication to laparoscopic cholecystectomy. More recently a number of authors have reported on the safety of laparoscopic cholecystectomy in cirrhotic patients. We reviewed our patients retrospectively and assessed the safety of laparoscopic cholecystectomy in cirrhotic patients as compared with noncirrhotics at a large liver transplant center. A retrospective longitudinal cohort study was conducted of all laparoscopic cholecystectomies performed by our surgical group between August 2002 and April 2011. Of 63 patients undergoing laparoscopic cholecystectomy, 32 (51%) were cirrhotic. Of the 30 for whom a Child score could be calculated, 11 (34%) were Child A, 14 (44%) were Child B, and five (16%) were Child C. The morbidity rate was 33 per cent and mortality rate was 2 per cent. Length of stay, conversion rates, 30-day readmission rates, and morbidity and mortality rates were not significantly different between the cirrhotic and noncirrhotic groups. There was a trend toward higher complication rates in Child C cirrhotics. Our results indicate that laparoscopic cholecystectomy can be performed with acceptable morbidity and mortality in carefully selected cirrhotic patients. PMID:25569066

  13. Laparoscopic splenectomy: lessons from the learning curve

    PubMed Central

    Poulin, Eric C.; Mamazza, Joseph

    1998-01-01

    Objective Initial reports suggest that laparoscopic splenectomy is a difficult procedure with a steep learning curve and limited scope. The objective of this study was to review various approaches to simplify the operation. Design A descriptive study of a prospective database. Setting A tertiary care teaching hospital. Patients Fifty-one consecutive patients, seen over a 4-year period, who underwent laparoscopic splenectomy (partial laparoscopic splenectomy in 1 patient) for a wide variety of disorders. Interventions Anterior and lateral surgical approaches to laparoscopic splenectomy and the selective use of preoperative splenic artery embolization. Main outcome measures Blood loss, morbidity, mortality and rate of conversion to open splenectomy, operating time and postoperative hospital stay. Results The morbidity (11%), death rate (2%), and rate of conversion were low. The recovery rate of accessory spleens was high (24%). Average operating time (3 hours), postoperative stay (3 days) and volume of blood loss improved with time. Conclusions Laparoscopic splenectomy is a reliable procedure for patients with spleens less than 20 cm long. For spleens 20 to 30 cm long, preoperative embolization is advisable, and the surgeon should be experienced. Laparoscopic splenectomy should not be performed for spleens more than 30 cm long. The lateral approach has eliminated most of the difficulty with this procedure for spleens less than 20 cm long (no embolization). The anterior approach is reserved for large spleens and partial laparoscopic splenectomy (with embolization). PMID:9492745

  14. Laparoscopic cholecystectomy in the pregnant patient.

    PubMed

    Comitalo, J B; Lynch, D

    1994-08-01

    Laparoscopic cholecystectomy has rapidly replaced open cholecystectomy as the preferred surgical treatment of symptomatic cholelithiasis. Although the indications are similar for both procedures, some surgeons believe that pregnancy is a contraindication for the laparoscopic approach. Several recent reports in the literature have shown that laparoscopic cholecystectomy can be performed safely in the pregnant patient. A review of all patients who underwent laparoscopic cholecystectomy from January 1991 to January 1993 at Scott Air Force Base (AFB) and Edwards AFB was performed. Of 248 patients reviewed, four procedures were performed in the gravid patient. All patients were operated on during the second trimester of pregnancy. Laparoscopic cholecystectomy was successful in all four. Cholangiogram was performed in two patients. No postoperative morbidity was encountered (maternal or fetal). Twenty-one cases of laparoscopic cholecystectomy in the pregnant patient, with no fetal or maternal morbidity or mortality, have been reported in the literature to date. We conclude that in selected cases, laparoscopic cholecystectomy can be performed safely during pregnancy. PMID:7952436

  15. Single incision laparoscopic TAPP with standard laparoscopic instruments and suturing of flaps: A continuing study

    PubMed Central

    Sinha, Rajeev; Malhotra, Vivek; Sikarwar, Prashant

    2015-01-01

    BACKGROUND: Single incision laparoscopic surgery, especially transumbilical, should be the closest to replicate the minimal access results achieved by natural orifice endoscopic surgery (NOTES). This study of single incision transabdominal preperitoneal (SITAPP) inguinal hernia repair is a continuing study exploring the peroperative variables and short and long term complications of this procedure. PATIENTS AND METHODS: All the 183 patients were operated by the same surgeon through a horizontal transumbilical incision positioned across the lower third of the umbilicus. Port access was through three separate transfacial punctures. Routine rigid instruments were used and the peritoneal flaps were either tacked or sutured into place. Patients with irreducible hernia and obstructed hernia were included, while those with strangulated hernia were excluded. RESULTS: All the patients were male with an average age of 41.4 years. Twenty four patients had bilateral hernia, 15 patients had irreducible and 6 patients had obstructed hernia. The mean operating time was 38.3 mins for unilateral hernias completed with tackers and 42.8 mins in those with intracorporeal suturing. The corresponding operating time for bilateral hernias was 53.2 and 62.7 minutes. There was minimal serous discharge from the umbilicus in 8 patients, port site infection in 1 patient and recurrence in 2 patients over a 36 months period. CONCLUSIONS: SITAPP for groin hernias, performed with conventional instruments is feasible, easy to learn, has a very high patient acceptance and is cosmetically superior to conventional TAPP. The use of tackers reduces the operating time significantly. PMID:25883454

  16. The laparoscopic evaluation of ascites.

    PubMed

    Inadomi, J M; Kapur, S; Kinkhabwala, M; Cello, J P

    2001-01-01

    Laparoscopy is an invaluable technique for the evaluation of ascites in subgroups of patients with ascites. Indications for laparoscopic examination include determination of the causes of ascites when routine tests fail to disclose the source, evaluation for the presence of multiple causes of ascites formation, or histopathologic verification of malignancy within the peritoneal cavity. Several reported series have illustrated the efficacy of laparoscopy for the diagnosis of peritoneal carcinomatosis, tuberculous peritonitis, or unsuspected cirrhosis, securing its role in the management of selected patients with ascites. PMID:11175976

  17. Laparoscopic repair of complicated umbilical hernia with Strattice Laparoscopic™ reconstructive tissue matrix

    PubMed Central

    Tsuda, Shawn

    2014-01-01

    INTRODUCTION Complex hernias continue to present a challenge. Surgical techniques for repair are carefully considered to reduce risk for complications. Laparoscopic repairs improve postoperative infection rates, and placement of biologic mesh decreases mesh infection rates. However, laparoscopic repairs using biologic mesh is generally challenging due to difficulty with maneuverability. PRESENTATION OF CASE We present a case of a complex ventral hernia that was laparoscopically repaired using a new FDA cleared laparoscopic biologic graft. The patient had multiple comorbidities, including obesity, hepatitis C, endocarditis secondary to IV drug use, tobacco smoking, bilateral inguinal hernia, and recurrent umbilical hernia. The recurrent hernia was larger, irreducible, and discolored compared to original defect. The patient underwent laparoscopic repair with primary closure and reinforcement with Strattice™ Tissue Matrix Laparoscopic (LifeCell Corporation, Branchburg, NJ). At nine months postoperative, the patient had no evidence of recurrence, infection, or chronic pain, demonstrating early success from the surgical management. DISCUSSION Presence of multiple comorbidities and incarcerated recurrent hernia increase risk for complications during and/or after hernia repair. Considering these factors, laparoscopic repair with Strattice Laparoscopic and defect closure was a reasonable technique for repair. CONCLUSION Laparoscopic suture repair reinforced with biologic dermal tissue matrix was successfully performed during a complex hernia repair. PMID:25437666

  18. Laparoscopic gastric resection for gastrointestinal stromal tumors

    Microsoft Academic Search

    Jennifer A. Sexton; Richard A. Pierce; Valerie J. Halpin; J. Christopher Eagon; William G. Hawkins; David C. Linehan; L. Michael Brunt; Margaret M. Frisella; Brent D. Matthews

    2008-01-01

    Background  This study aimed to review clinical outcomes for patients selected to undergo laparoscopic resection for gastrointestinal\\u000a stromal tumor (GIST) of the stomach.\\u000a \\u000a \\u000a \\u000a Methods  All 112 laparoscopic gastric resections performed from February 1995 to March 2007 were reviewed. Pre- and postoperative variables\\u000a were analyzed, and data are given as mean ± standard deviation.\\u000a \\u000a \\u000a \\u000a Results  Laparoscopic gastric resection was attempted for 63 GIST in 61 patients

  19. Single-incision laparoscopic colectomy without using special articulating instruments: an initial experience

    PubMed Central

    2011-01-01

    Background Single-incision laparoscopic colectomy (SILC) was introduced as a novel minimally invasive technique. The benefits of this technique include reducing number of the incision and cosmetic improvement. Unlike the conventional laparoscopic colectomy, majority of previously reported SILC need to be performed using special curved or articulated instruments. The purpose of this study is to demonstrate our initial experience of SILC, which could be performed using the standard laparoscopic instruments. Material and methods Retrospective review of 14 patients who underwent SILC at Siriraj Hospital from May to December 2010, patient's demographic data, perioperative outcomes, early postoperative complications and pathological data were collected and analyzed. Results The mean age of all patients was 60 years. The most common operation with SILC was sigmoidectomy (n = 9), followed by right hemicolectomy (n = 2), left hemicolectomy (n = 1), anterior resection (n = 1), and total colectomy (n = 1). The trocar insertion techniques were multi-fascial incision using regular port (n = 11) and GelPOINT® (n = 3). The mean operative time was 155 minutes (range 90-280) and the mean estimate blood loss was 32.1 mL (range 10-100). All patients were successfully operated without conversion. The mean length of hospital stay was 9 days (range 5-20). There was no mortality. The pathological results revealed colorectal cancer (n = 12), neoplastic polyp (n = 1) and Familial adenomatous polyposis (FAP) (n = 1). The mean number of lymph nodes retrieval was 16.6 (range 3-34). Conclusion SILC can successfully and safely be performed with standard laparoscopic instruments. This technique might be an alternative procedure to conventional laparoscopic colectomy with better cosmetic result. PMID:22151649

  20. Laparoscopic liver mobilization: tricks of the trade to avoid complications.

    PubMed

    Ikoma, Naruhiko; Itano, Osamu; Oshima, Go; Kitagawa, Yuko

    2015-02-01

    Laparoscopic liver resection is gaining popularity because of the availability of new laparoscopic instruments and advanced techniques. Laparoscopic liver mobilization is not only necessary for pure laparoscopic liver resection but also for laparoscopy-assisted hepatectomy. Laparoscopy-assisted hepatectomy significantly reduces the length of the laparotomy incision, and it is a good educational transition to the more advanced laparoscopic liver resection. Laparoscopic liver mobilization is a simple and easy procedure if surgeons know what challenges to expect. Here, the technique of liver mobilization is summarized, along with those challenges. PMID:25370795

  1. Laparoscopic Liver Mobilization: Tricks of the Trade to Avoid Complications

    PubMed Central

    Ikoma, Naruhiko; Oshima, Go; Kitagawa, Yuko

    2015-01-01

    Laparoscopic liver resection is gaining popularity because of the availability of new laparoscopic instruments and advanced techniques. Laparoscopic liver mobilization is not only necessary for pure laparoscopic liver resection but also for laparoscopy-assisted hepatectomy. Laparoscopy-assisted hepatectomy significantly reduces the length of the laparotomy incision, and it is a good educational transition to the more advanced laparoscopic liver resection. Laparoscopic liver mobilization is a simple and easy procedure if surgeons know what challenges to expect. Here, the technique of liver mobilization is summarized, along with those challenges. PMID:25370795

  2. Single-Incision Laparoscopic Repair of Spigelian Hernia

    PubMed Central

    Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

    2015-01-01

    Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair. Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh. Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m2. An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months). Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy. PMID:25722629

  3. Fast-track laparoscopic bariatric surgery: a systematic review.

    PubMed

    Elliott, Jessie A; Patel, Vanash M; Kirresh, Ali; Ashrafian, Hutan; Le Roux, Carel W; Olbers, Torsten; Athanasiou, Thanos; Zacharakis, Emmanouil

    2013-06-01

    This study aimed to systematically evaluate the evidence-based literature on fast-track laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) to determine the feasibility and safety of fast-track laparoscopic bariatric surgery. A literature search of PubMed, EMBASE and Cochrane Library using the MeSH terms "bariatric surgery", "ambulatory surgical procedures" and related terms as keywords was performed. The study included articles that reported on intended next-day discharge for LRYGB and same-day discharge for LAGB. Data were extracted on study design and size, patient demographics, patient-selection criteria, patient preparation, perioperative management, operative details, clinical outcomes, and follow-up. The review included 13 studies classified as level 3b or 4 evidence. There were seven studies that investigated LAGB, five studies investigated LRYGB and one study detailed outcomes from both LRYGB and LAGB. Next-day discharge rate ranged from 81 to 100 % for LRYGB. Same-day discharge rate ranged from 76 to 98 % for LAGB. In LRYGB and LAGB complication, re-admission and mortality rates (?10.5, ?7.5, ?0.1 %, respectively) were comparable with the conventional perioperative care. From our results, the fast-track management of patients undergoing LRYGB and LAGB is feasible. With careful patient selection and preparation within high-volume centres, and application of care pathways including close outpatient follow-up, outcomes for fast-track bariatric procedures can compare favourably with those reported in the literature for standard management, but with decreased cost. However, further studies from independent researchers are required to determine the safety of a generalised adoption of this approach outside of dedicated bariatric units, and to formally demonstrate the cost-benefit of fast-track bariatric surgery. PMID:23371325

  4. Laparoscopic Cholecystectomy During Pregnancy: Three Case Reports

    PubMed Central

    Menzo, Emanuele Lo; Smink, Robert D.; Feuerstein, Brandt; Fantazzio, Michelle; Kaufman, Jarrod; Brennan, Edward J.; Russell, Randal

    1999-01-01

    Objective: The purpose of this presentation is to investi-gate the effects and feasibility of laparoscopic cholecystectomy during pregnancy. Methods and Procedures: We present three pregnant patients who underwent a laparoscopic cholecystectomy for biliary colic during the early second and early third trimester of pregnancy. We also reviewed the literature regarding this topic. Results: All three pregnant patients had uneventful hospital courses after their procedures and delivered full-term babies without complications. Laparoscopic cholecystectomy during the first trimester of pregnancy is contraindicated due to the ongoing fetal organogenesis and during the third trimester is not technically feasible due to the large uterine size. Conclusions: We conclude that laparoscopic cholecystectomy during the second and very early third trimester of pregnancy is safe and feasible. PMID:10323173

  5. LAPAROSCOPIC BOWEL INJURY: INCIDENCE AND CLINICAL PRESENTATION

    Microsoft Academic Search

    JAY T. BISHOFF; MOHAMAD E. ALLAF; WIM KIRKELS; ROBERT G. MOORE; LOUIS R. KAVOUSSI; FRITZ SCHRODER

    1999-01-01

    PurposeBowel injury is a potential complication of any abdominal or retroperitoneal surgical procedure. We determine the incidence and assess the sequelae of laparoscopic bowel injury, and identify signs and symptoms of an unrecognized injury.

  6. Minimizing knot tying during reconstructive laparoscopic urology

    Microsoft Academic Search

    Arieh L. Shalhav; Marcelo A. Orvieto; Gary W. Chien; Albert A. Mikhail; Gregory P. Zagaja; Kevin C. Zorn

    2006-01-01

    ObjectivesIntracorporeal knot tying during urologic reconstructive surgery is one of the most technically challenging skills of laparoscopic surgery. We describe our experience using the Lapra-Ty clip to substitute for knot tying.

  7. LYMPHATIC SPARING LAPAROSCOPIC VARICOCELECTOMY: A MICROSURGICAL REPAIR

    Microsoft Academic Search

    RADIM KO?VARA; JAN DVO?Á?EK; JOSEF SEDLÁ?EK

    2005-01-01

    Purpose:The division of lymphatic vessels during pediatric varicocelectomy is complicated by hydrocele formation, testicular hypertrophy due to intratesticular edema and decline in testicular function. To prevent these complications, we introduced a microsurgical lymphatic sparing dissection into laparoscopic varicocelectomy.

  8. Technical approaches to single port/incision laparoscopic appendicectomy: a literature review

    PubMed Central

    Rehman, H; Ahmed, I

    2011-01-01

    INTRODUCTION Single port/incision laparoscopic surgery (SPILS) is a modern advancement toward stealth surgery. Despite the paucity of high-quality scientific studies assessing its effectiveness, this procedure is being used increasingly. This review aims to describe commonly used techniques for SPILS appendicectomies (SPILA), to summarise complication rates in the literature and to provide discussion on indications and implementation. METHODS All available databases including the Cochrane Central Register of Controlled Trials, MEDLINE® and Embase™ were searched in February 2011 and cross-referenced for available English literature describing SPILA in patients of any age. RESULTS Three broad technical approaches are described: procedures using laparoscopic instruments through a single skin incision in the abdominal wall, regardless of the number of fascial incisions, with or without the additional use of percutaneous sutures or wires to ‘assist’ the operation, and hybrid procedures, in which the appendix is exteriorised using a single incision laparoscopically assisted operation but subsequently divided using a conventional ‘open’ appendicectomy technique. Complication rates seem to be highest in SPILA procedures unassisted by sutures or wires. CONCLUSIONS Future research assessing the efficacy of single incision laparoscopic procedures should consider variation in technique as a possible factor affecting outcome. PMID:22004632

  9. The effect of total hysterectomy on sexual function and depression

    PubMed Central

    Goktas, Sonay Baltaci; Gun, Ismet; Yildiz, Tulin; Sakar, Mehmet Nafi; Caglayan, Sabiha

    2015-01-01

    Background & Objectives: To investigate whether the operations of Type 1 hysterectomy and bilateral salpingo-oophorectomy performed for benign reasons have any effect on sexual life and levels of depression. Method: This is a multi-center, comparative, prospective study. Healthy, sexual active patients aged between 40 and 60 were included into the study. Data was collected with the technique of face-to-face meeting held three months before and after the operation by using the demographic data form developed by the researchers i.e. the Female Sexual Function Index (FSFI) and the Beck Depression Scale (BDS). Results: In the post-operative third month, there was an improvement in dysuria in terms of symptomatology (34% and 17%, P<0.001), while in FSFI (41.47±25.46 to 34.20±26.67, P<0.001) and BDS (12.87±11.19 to 14.27±10.95, P=0.015) there was a deterioration. For FSFI, 50-60 age range, extended family structure; and for BDS, educational status, not working and extended family structure were statistically important confounding factors for increased risk in the post-operative period. Conclusion: While hysterectomy and bilateral salpingo-oophorectomy performed for benign reasons brought about short-term improvement in urinary problems after the operation for sexually active and healthy women, they resulted in sexual dysfunction and increase in depression. The age, educational status, working condition and family structure is also important.

  10. Incidence of complications following laparoscopic hernioplasty

    Microsoft Academic Search

    E. H. Phillips; M. Arregui; B. J. Carroll; J. Corbitt; W. B. Crafton; M. J. Fallas; C. Filipi; R. J. Fitzgibbons; M. J. Franklin; B. McKernan; D. Olsen; A. Ortega; J. H. Payne; J. Peters; R. Rodriguez; P. Rosette; L. Schultz; A. Seid; R. Sewell; R. Smoot; F. Toy; R. Waddell; S. Watson

    1995-01-01

    Smaller individual series on the outcome of laparoscopic hernioplasty techniques have been reported. This study reports on the complications of 3,229 laparoscopic hernia repairs performed by the authors in 2,559 patients. The TAPP (transabdominal preperitoneal) technique was the most frequently performed: 1,944 (60%). The totally preperitoneal technique was performed 578 (18%) times. The IPOM (intraperitoneal onlay mesh) repair was performed

  11. Laparoscopic cardiomyotomy and anterior partial fundoplication forachalasia

    Microsoft Academic Search

    R. Ackroyd; D. I. Watson; P. G. Devitt; G. G. Jamieson

    2001-01-01

      Background: Although surgical myotomy is considered the gold standard, many different treatments have been advocated for achalasia.\\u000a There are now a number of reports of cardiomyotomy being performed laparoscopically. Methods: This is a prospective study\\u000a of 82 patients (47 male and 35 female; median age, 47 years) who underwent laparoscopic cardiomyotomy and anterior partial\\u000a fundoplication for achalasia. Results: Four of

  12. In vivo kinematic measurement during laparoscopic cholecystectomy

    Microsoft Academic Search

    M. Rasmus; R. Riener; S. Reiter; A. Schneider; H. Feussner I

    2004-01-01

    Background  Despite the rapid development of computer-assisted surgery, studies on kinematic measurement for surgical innovation are rare.\\u000a This study describes a system for kinematic measurement in real operating theater environments. Six laparoscopic cholecystectomies\\u000a were recorded and analyzed. In addition to, a demonstration of the feasibility of the method, basis data for the development\\u000a of an actuated laparoscopic camera holder are evaluated.

  13. Laparoscopic Approaches to Pancreatic Endocrine Tumors

    Microsoft Academic Search

    John B. Martinie; Stephen M. Smeaton

    \\u000a Pancreatic endocrine tumors (PETs) are rare. Resection is the only curative treatment [1, 2]. A brief overview of the pathophysiology\\u000a and classification of PETs along with epidemiology and survival data is presented. The role of various diagnostic imaging\\u000a modalities is discussed and appropriate patient selection is presented as a guide. Laparoscopic and hand-assisted laparoscopic\\u000a (HALS) approaches to distal pancreatectomy, with

  14. Laparoscopic nephrectomy for renal cell carcinoma

    Microsoft Academic Search

    Isaac Yi Kim; Peter G. Schulam

    2001-01-01

    Since the first reported case of laparoscopic nephrectomy by Clayman et al. [1] in 1991, laparoscopy is gaining acceptance as a viable alternative to open surgery for renal cell carcinoma. The benefits\\u000a of laparoscopy include improved quality of life and lower incidence of perioperative morbidity. The perceived risks of laparoscopic\\u000a nephrectomy for renal cell carcinoma include port-site metastasis, increased operative

  15. Laparoscopic TME associated with neoadjuvant chemoradiation towards aggressive colorectal cancer

    PubMed Central

    Yin, Tao; Cui, Dian-Sheng; Xiong, Zhi-Guo; Wei, Shao-Zhong

    2015-01-01

    Objective: This study aims to investigate the clinical synchronization of the neoadjuvant chemoradiation (NC) and the laparoscopic total mesorectal excision (TME) in the treatment of locally aggressive colorectal cancer (LACC). Methods: 92 LACC patients were selected for the research, among who 46 cases, who were performed the synchronized NC, were divided into the treatment group, after having rest for 4-6 weeks after the treatment, the 40 patients of the treatment group, who were performed the laparoscopic surgery, formed the laparoscopy group. The rest 46 patients were divided into the control group, who were performed the conventional treatment. The intraoperative conditions, postoperative recoveries, postoperative complications and recurrence rates of the two groups were compared. Results: The stage-declining rate of the treatment group was 67.3%, and the surgical resection rate, anal preservation rate and postoperative complications were 86.9%, 69.6% and 26%, respectively, which were significantly higher than the control group; while the long-term recurrence rate significantly decreased to 21.7%, and the difference was statistically significant (P<0.05). Conclusion: The NC could effectively achieve the stage-declining purpose against the LACC, improve the resection rate and reduce the postoperative recurrence rate.

  16. Automated Instrument Tracking in Robotically-Assisted Laparoscopic Surgery

    E-print Network

    Wang, Yuan-Fang

    Automated Instrument Tracking in Robotically-Assisted Laparoscopic Surgery Darrin R. Uecker automated instrument localization and scope maneuvering in robotically-assisted laparoscopic surgery efficient in performing surgery without requiring additional use of the hands. Key Words: Laparoscopy

  17. Single-Incision Laparoscopic Surgery for Undiagnosed Small Bowel Obstruction in a Patient without a History of Abdominal Surgery

    PubMed Central

    Koizumi, Noriaki; Kobayashi, Hiroki; Takagi, Tsuyoshi; Fukumoto, Kanehisa

    2015-01-01

    We herein report a 66-year-old female patient who developed an undiagnosed small bowel obstruction without a history of prior abdominal surgery and was successfully treated by single-incision laparoscopic surgery. A small bowel obstruction with unknown cause typically requires some sort of surgical treatment in parallel with a definitive diagnosis. Although open abdominal surgery has been generally performed for the treatment of small bowel obstructions, laparoscopic surgery for small bowel obstructions has been increasing in popularity due to its less invasiveness, including fewer postoperative complications and a shorter hospital stay. As a much less invasive therapeutic strategy, we have performed single-incision laparoscopic surgery for the treatment of an undiagnosed small bowel obstruction. We were able to make a definitive diagnosis after sufficient intra-abdominal inspection and to perform enterotomy through a small umbilical incision. Single-incision laparoscopic surgery appears to be comparable to conventional laparoscopic surgery and provides improved cosmesis, although it is an optional strategy only applicable to selected patients. PMID:25861511

  18. Postural mechatronic assistant for laparoscopic solo surgery (PMASS)

    Microsoft Academic Search

    Arturo Minor Martinez; Jesús Villalobos Gomez; Ricardo Ordorica Flores; Daniel Lorias Espinoza

    2009-01-01

    Background and purpose  Laparoscopes used in laparoscopic surgery are manipulated by human means, passive systems or robotic systems. All three methods\\u000a accumulate downtime when the laparoscope is cleaned and the optical perspective is adjusted. This work proposes a new navigation\\u000a system that autonomously handles the laparoscope, with a view to reducing latency, and that allows real-time adjustment of\\u000a the visual perspective.

  19. Soy product intake and premenopausal hysterectomy in a follow-up study of Japanese women

    Microsoft Academic Search

    C Nagata; N Takatsuka; N Kawakami; H Shimizu

    2001-01-01

    Objective: The estrogenicity of dietary soy may increase the risk of diseases, such as uterine leiomyoma and endometriosis, which originate from uterine tissue and are predominant indications for hysterectomy. We sought to determine whether soy product intake is associated with an increased risk of premenopausal hysterectomy.Design: Prospective cohort study.Setting: Takayama City, Gifu, Japan.Subjects: A cohort of 1172 female residents randomly

  20. Laparoscopic duodenoduodenostomy for duodenal atresia.

    PubMed

    Bax, N M; Ure, B M; van der Zee, D C; van Tuijl, I

    2001-02-01

    A 3,220-g newborn baby with trisomy 21 presented with duodenal atresia. No other congenital malformations were diagnosed. Informed consent for a laparoscopic approach was obtained. The child was placed in a supine, head-up position slightly rotated to the left at the end of a shortened operating table. The surgeon stood at the bottom end with the cameraperson to his left and the scrub nurse to his right. The screen was at the right upper end. Open insertion of a cannula for a 5-mm 30 degrees telescope through the inferior umbilical fold was performed. A carbon dioxide (CO2) pneumoperitoneum with a pressure of 8 mmHg and a flow of 2l/min was established. Two 3.3-mm working cannulas were inserted; one in the left hypogastrium and one pararectally on the right at the umbilical level. Two more such cannulas were inserted; one under the xyphoid for a liver elevator and one in the right hypogastrium for a sucker. Mobilization of the dilated upper and collapsed lower duodenum was easy. After transverse enterotomy of the upper duodenum and longitudinal enterotomy of the distal duodenum, a diamond-shaped anastomosis with interrupted 5 zero Vicryl sutures were performed. The absence of air in the bowel beyond the atresia increased the working space and greatly facilitated the procedure. The technique proved to be easy, and the child did very well. Laparoscopic bowel anastomosis in newborn babies had not been described previously. Recently, a diamond-shaped duodenoduodenostomy for duodenal atresia was performed. The technique proved to be simple and is described in detail. The child did very well. PMID:12200660

  1. Morgagni hernia: Repair with a mesh using laparoscopic surgery

    Microsoft Academic Search

    A. Albarracín Marín-Blazquez; M. F. Candel; P. A. Parra; M. Méndez; J. Ródenas; M. J. Rojas; F. Carrión; M. Madrigal

    2004-01-01

    The aim of this study is to present two patients diagnosed with diaphragmatic Morgagni hernia and treated by repairing the hernia defect with a mesh by laparoscopic surgery. We describe the placement of a double-layer mesh anchored with helicoidal staples to repair the hernia defect using laparoscopic surgery. Laparoscopic surgery allows repair of these defects whilst avoiding the disadvantages of

  2. Cutaneous Metastasis Following Laparoscopic Pelvic Lymphadenectomy for Prostatic Carcinoma

    Microsoft Academic Search

    Chr H. Bangma; W. J. Kirkels; S. Chadha; F. H. Schroder

    1995-01-01

    A case of implantation metastasis in the abdominal wall following transabdominal laparoscopic pelvic lymphadenectomy is reported. A cutaneous nodule was palpated at 1 of the laparoscopic ports 6 months after laparoscopic lymphadenectomy in a 66-year-old patient with stage T3pN1M0, grade 2 adenocarcinoma of the prostate. Aspiration cytology confirmed metastatic adenocarcinoma.

  3. Role and Limitations of Laparoscopic Liver Resection of Colorectal Metastases

    Microsoft Academic Search

    Tom Mala; Bjørn Edwin

    2005-01-01

    Background: The current experience of laparoscopic liver resection is reviewed focusing on the role and limitations of resection of colorectal metastases. Surgical technique, outcome, and the main controversies regarding the procedures are described. Methods: Current literature on laparoscopic liver resection is reviewed based on reports identified following a specified PubMed search. Results: Available evidence indicates that laparoscopic liver resection can

  4. Laparoscopic hemicolectomy in a patient with situs inversus totalis

    Microsoft Academic Search

    Yushi Fujiwara; Yosuke Fukunaga; Masayuki Higashino; Shinya Tanimura; Masashi Takemura; Yoshinori Tanaka; Harushi Osugi

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

  5. A study of 362 consecutive laparoscopic Nissen fundoplications

    Microsoft Academic Search

    Constantine T Frantzides; Christina Richards

    1998-01-01

    Background: Open Nissen fundoplication has been shown to be a very effective operation in the treatment of intractable gastroesophageal reflux. Because of its technical rather than amputative nature, this procedure offers itself to a completely laparoscopic approach. Several studies have shown the feasibility; however, very few have dealt with the effectiveness of the laparoscopic approach. Methods: Results of laparoscopic Nissen

  6. Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses' Health Study

    Microsoft Academic Search

    William H. Parker; Michael S. Broder; Eunice Chang; Diane Feskanich; Cindy Farquhar; Zhimae Liu; Donna Shoupe; Jonathan S. Berek; Susan Hankinson; JoAnn E. Manson

    OBJECTIVE: To report long-term health outcomes and mortality after oophorectomy or ovarian conservation. METHODS: We conducted a prospective, observational study of 29,380 women participants of the Nurses' Health Study who had a hysterectomy for benign disease; 16,345 (55.6%) had hysterectomy with bilateral oophorectomy, and 13,035 (44.4%) had hysterectomy with ovarian con- servation. We evaluated incident events or death due to

  7. Turkish hysterectomy and mastectomy patients - depression, body image, sexual problems and spouse relationships.

    PubMed

    Keskin, Gulseren; Gumus, Aysun Babacan

    2011-01-01

    The aim of this study was to compare hysterectomy and mastectomy patients in terms of depression, body image, sexual problems and spouse relations. The study group comprised 94 patients being treated in Ege University Radiation Oncology Clinic, Tulay Aktas Oncology Hospital, Izmir Aegean Obstetrics and Gynecology Training and Research Hospital for breast and gynecological cancer (42 patients underwent mastectomy, 52 patient underwent hysterectomy). Five scales were used in the study: Sociodemographic Data Form, Beck Depression Scale, Body Image Scale, Dyadic Adjustment Scale, Golombok Rust Sexual Functions Scale. Mastectomy patients were more depressive than hysterectomy patients (t = 2.78, p < 0.01). Body image levels of the patients were bad but there was no significant difference between the two patient groups (p > 0.05). Hysterectomy patients had more problems in terms of vaginismus (t = 2.32, p < 0.05), avoidance of sexual intercourse (t = 2.31, p < 0.05), communication (t = 2.06, p < 0.05), and frequency of sexual intercourse than mastectomy patients (t = 2.10, p < 0.05). As compared with compliance levels between patients and spouses; hysterectomy patients had more problems related to expression of emotions than mastectomy patients (t = 2.12, p < 0.05). In conclusion, body image was negative, mastectomy was associated with more depression and hysterectomy with greater sexual problems and difficulties with spouse relationships. PMID:21545207

  8. Cost and Reimbursement for Three Fibroid Treatments: Abdominal Hysterectomy, Abdominal Myomectomy, and Uterine Fibroid Embolization

    SciTech Connect

    Goldberg, Jay, E-mail: jaygoldbergmd@yahoo.com; Bussard, Anne [Jefferson Medical College, Department of Obstetrics and Gynecology (United States); McNeil, Jean [Jefferson Medical College, Department of Finance (United States); Diamond, James [Jefferson Medical College, Department of Family Medicine (United States)

    2007-02-15

    Purpose. To compare costs and reimbursements for three different treatments for uterine fibroids. Methods. Costs and reimbursements were collected and analyzed from the Thomas Jefferson University Hospital decision support database from 540 women who underwent abdominal hysterectomy (n 299), abdominal myomectomy (n = 105), or uterine fibroid embolization (UFE) (n = 136) for uterine fibroids during 2000-2002. We used the chi-square test and ANOVA, followed by Fisher's Least Significant Difference test, for statistical analysis. Results. The mean total hospital cost (US$) for UFE was $2,707, which was significantly less than for hysterectomy ($5,707) or myomectomy ($5,676) (p < 0.05). The mean hospital net income (hospital net reimbursement minus total hospital cost) for UFE was $57, which was significantly greater than for hysterectomy (-$572) or myomectomy (-$715) (p < 0.05). The mean professional (physician) reimbursements for UFE, hysterectomy, and myomectomy were $1,306, $979, and $1,078, respectively. Conclusion. UFE has lower hospital costs and greater hospital net income than abdominal hysterectomy or abdominal myomectomy for treating uterine fibroids. UFE may be more financially advantageous than hysterectomy or myomectomy for the insurer, hospital, and health care system. Costs and reimbursements may vary amongst different hospitals and regions.

  9. Laparoscopic cholecystectomy: experience of a single surgeon.

    PubMed

    Soper, N J; Dunnegan, D L

    1993-01-01

    Gallbladder removal using laparoscopic techniques has rapidly been adopted by surgeons around the world. Questions have been raised concerning laparoscopic cholecystectomy, including the safety of the operation, its implications for management of common bile duct stones, and the means by which surgeons should be trained. In the present series, 424 patients were referred to a single surgeon for cholecystectomy during a 22-month period. A traditional open cholecystectomy was performed in 9 patients (2.1%) because of presumed contraindications to laparoscopic cholecystectomy. Laparoscopic cholecystectomy was attempted in the remaining 415 patients (97.9%). On the basis of preoperative investigations, 19 patients (4.6%) underwent endoscopic retrograde cholangiopancreatography. Endoscopic sphincterotomy and stone extraction were performed in the 13 patients (3.1%) demonstrating choledocholithiasis. Laparoscopic cholecystectomy was converted to an open operation in 8 patients (1.9%) owing to dense adhesions, obscure anatomy, or cholangiographic abnormalities. Laparoscopic cholecystectomy was successfully performed in 407 patients (96%) in 95 +/- 2 minutes (mean +/- SEM). Surgical trainees were involved in all operations and performed 68% of the procedures under supervision. Cystic duct cholangiograms were obtained selectively in 129 patients (30.4%). Intraoperative complications occurred in 3 patients, including 1 patient with a minor injury to the common bile duct (0.2%). There was no perioperative mortality, and major complications occurred in 6 patients (1.4%). Minor complications were seen in 12 others (2.8%), and one patient required reoperation for a trocar injury to the jejunum. Prolonged follow-up has revealed one case of asymptomatic retained common bile duct stones (0.2%). Laparoscopic cholecystectomy can therefore be performed in more than 95% of patients with no mortality and minimal morbidity.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8447133

  10. Triple, double- and single-incision laparoscopic cholecystectomy: a prospective study

    PubMed Central

    Sabuncuoglu, Mehmet Zafer; Benzin, Mehmet Fatih; Cakir, Tugrul; Sozen, Isa; Sabuncuoglu, Aylin

    2014-01-01

    Purpose: Advances in laparoscopic techniques have enabled complicated intra-abdominal surgical procedures to be made with less trauma and a better cosmetic appearance. The techniques have been developed by decreasing the number of incisions in conventional laparoscopic procedures in order to increase patient satisfaction. The aim of this study was to compare the results of cholecystectomies made with 3, 2 or a single incision. Method: A total of 95 cholecystectomy patients from Elbistan State Hospital and Suleyman Demirel University Hospital between 2011 and 2013 were prospectively evaluated. The patients were separated into 3 groups as triple incision laparoscopic cholecystectomy (TILC), double incision laparoscopic cholecystectomy (DILC) and single incision laparoscopic cholecystectomy (SILC). Patients were evaluated in respect of demographic characteristics, operation time, success rate, analgesia requirement, length of hospital stay and patient satisfaction. Results: Successful procedures were completed in 40 TILC, 40 DILC and 15 SILC cases. Transfer to open cholecystectomy was not required in any case. The mean duration of operation was 71 mins (range, 55-120 mins) for SILC cases, 45 mins (range, 32-125 mins) for DILC cases and 42 mins (range, 29-96 mins) for TILC cases. The mean time for the SILC cases was statistically significantly longer than the other two groups (p < 0.000). Conclusions: At a comparable level with DILC and TILC, single incision laparosccopic cholecystectomy is a method which can be used without incurring any extra costs or requiring additional instrumentation or training and which has good cosmetic results and a low requirement for analgesia. PMID:25419372

  11. Study on Multi-DOF Ultrasonic Actuator for Laparoscopic Instrument

    NASA Astrophysics Data System (ADS)

    Park, Shinsuk; Takemura, Kenjiro; Maeno, Takashi

    In surgical robots, compact manipulators with multi-degree-of-freedom (DOF) are essential owing to a small work volume in the patient body. Conventional single-DOF actuators such as electromagnetic motors require a multiple number of actuators to generate multi-DOF motion, which in turn results in bulky mechanism combined with transmission device. Our previous work has developed a compact ultrasonic motor capable of generating a multi-DOF rotation of a spherical rotor utilizing three natural vibration modes of a bar-shaped stator. The present study designs and builds a novel multi-DOF master-slave system for laparoscopic surgical procedures, using a single ultrasonic actuator. The system consists of surgical forceps on multi-DOF wrist with joystick controller. Experimental results have confirmed high responsiveness and precise position control of the master-slave system.

  12. [Regular menstrual bleeding in a woman after hysterectomy].

    PubMed

    Grys, E; Pawlaczyk, M

    2001-06-01

    The authors present a rare case of 39 years old woman, who had regular monthly bleedings mimicking menstruation during the two years after abdominal hysterectomy (without the adnexa). The woman was operated on in 1997 because of large uterine myoma and presented no other pathology in the abdominal cavity. She also suffered from autoimmunological anemia and chorea, which decreased her life activity and resulted in lack of gynecological care after the operation. The patient misunderstood the effect of surgery and mistook bleedings for signs of normal hormonal function. Deep external endometriosis of vaginal cuff and surrounding tissues was the cause of 'menstruation'. All this tissues were surgically removed. An immunological mechanism which plays role in endometriosis, chorea and anemia, was discussed. PMID:11526749

  13. Image acquisition in laparoscopic and endoscopic surgery

    NASA Astrophysics Data System (ADS)

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

    1995-04-01

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

  14. Laparoscopic Resection of Retroperitoneal Neural Tumors

    PubMed Central

    Nozaki, Tetsuo; Kato, Tomonori; Morii, Akihiro; Fuse, Hideki

    2013-01-01

    Purpose Retroperitoneal neural tumor (RNT) is rarely excised laparoscopically, and the laparoscopic management of RNT remains controversial. We herein report 4 cases of laparoscopic excision of RNT that resulted in diverse clinical outcomes. Patients and Methods Between August 2005 and January 2011, we performed laparoscopic excision of RNT in 4 patients. The mean tumor size was 4.5 cm. The mean operative time was 297 minutes and the mean amount of blood loss was 55 ml. The surgeries were uneventful, with no operative complications or evidence of intra-abdominal bleeding. However, 2 patients required reoperation for delayed hemorrhage and urinoma formation, respectively. Results The postoperative pathological diagnoses were schwannoma in 3 patients and ganglioneuroblastoma in 1 patient. All patients were well with no signs of peripheral neuropathy or radiculopathy, and CT and/or 18F-FDG PET/CT performed during follow-up indicated no evidence of disease. Conclusions Obtaining extensive preoperative knowledge of the source neural and vascular anatomy of the tumor is important for the surgical planning of laparoscopic resection of RNT. When a great deal of care is taken to divide the tumor and the source nerves and vital vessels, safe execution of RNT can be achieved for minimal postoperative mortality and morbidity. PMID:24917756

  15. [Laparoscopic cholecystectomy: experience of VGH-Kaohsiung].

    PubMed

    Liu, S I; Mok, K T; Chiang, F; Chang, H T; Chen, C H

    1992-12-01

    One hundred consecutive patients underwent laparoscopic cholecystectomy from May 1991 to February 1992 at Veterans General Hospital--Kaohsiung. Ninety-seven of them presented on an elective basis, including eight patients undergoing endoscopic sphincterotomy with extraction of common bile duct stone before laparoscopic cholecystectomy. The remaining 3 patients were operated during acute cholecystitis episode. Two patients with biliary injuries during laparoscopic cholecystectomy were converted to laparotomy, with a conversion rate of 2%. Intraoperative cystic cholangiogram was done selectively in 7 patients. Major complications occurred in 3 patients, including two biliary injuries and one residual CBD stone. Minor complications of wound infection were found in 7 patients. The overall morbidity rate was 10%. No operative mortality was found. Mean operation time was 112 minutes and mean blood loss was 90 ml. The mean hospital stay (3.1 days) and the mean time of returning to normal activity (14.7 days) were longer than those of Western series, but were shorter than those of open cholecystectomy. Laparoscopic cholecystectomy is a safe and effective procedure that can be performed with minimal risk. However, the importance of accurate preoperative screening and surgical experience should be emphasized for this new procedure. In patients with gall stone plus CBD stone, combined endoscopic sphincterotomy with extraction of CBD stone and laparoscopic cholecystectomy may offer a new therapeutic approach but the long term effect of endoscopic sphincterotomy needs further evaluation. PMID:1338024

  16. Current status of laparoscopic distal pancreatectomy.

    PubMed

    Rosales-Velderrain, A; Stauffer, J A; Bowers, S P; Asbun, H J

    2012-09-01

    Distal pancreatectomy is the therapeutic option of choice for patients with a benign or malignant lesion located in the body and/or tail of the pancreas when surgical intervention is indicated. With recent advances in and wide spread use of imaging studies, lesions of the pancreas are being diagnosed more commonly and it is likely that this will translate into an increased number of patients undergoing surgical resection. The laparoscopic approach to pancreatic resections has not been adopted as rapidly as it has for most other general surgical procedures. This is despite the fact that the current literature appears to validate laparoscopy as an acceptable and safe approach for distal pancreatectomy in patients with benign lesions, and has demonstrated the known benefits inherent to the laparoscopic technique. These benefits include lower intraoperative blood loss, less pain and analgesic requirements, earlier return of bowel function, and shorter recovery and hospital stay. Yet controversy still exists for the role of laparoscopy in the resection of malignant lesions. Recent reports however, have shown that laparoscopic distal pancreatectomy can safely be performed in known malignancies and, most importantly, after a laparoscopic oncological resection, the oncological benchmarks that have been related to survival, (such as negative surgical margins and number of peripancreatic lymph nodes resected), can also be accomplished. We sought to review the current literature on distal pancreatectomy, specifically the indications, laparoscopic approaches, splenectomy and spleen-preserving techniques, intraoperative and short-term outcomes, morbidity, mortality and oncological outcomes. PMID:22971634

  17. Minimally invasive management of huge ovarian cysts by laparoscopic extracorporeal approach.

    PubMed

    Yi, Sang Wook

    2012-11-01

    Laparoscopy has been widely performed in adnexal surgery for benign masses. For large adnexal masses, laparoscopy has not been commonly used and laparotomy remains the gold standard due to several technical difficulties in the former, including a limited surgical field, risk of unintended cyst rupture during the insertion of the Veress needle or trocar, and the possibility of malignancy. Recent advances in laparoscopic techniques have offered acceptable options for performing laparoscopy in patients with very large adnexal cysts. We performed ovarian cystectomy of huge ovarian cysts via a laparoscopic extracorporeal approach through an umbilical single-site incision, successfully minimizing the possibility of cyst contents leaking into the peritoneal cavity. Use of a single-site incision at the umbilicus for huge adnexal cystic masses appears safe and spares the additional costs of using conventional surgical instruments. It is also cosmetically effective and highly appreciated by patients because it results in minimal abdominal scarring. PMID:22211916

  18. Elective laparoscopic surgery for sigmoid colon carcinoma incarcerated within an inguinal hernia: report of a case.

    PubMed

    Kanemura, Takashi; Takeno, Atsushi; Tamura, Shigeyuki; Okishiro, Masatsugu; Nakahira, Shin; Suzuki, Rei; Nakata, Ken; Egawa, Chiyomi; Miki, Hirohumi; Takeda, Yutaka; Kato, Takeshi

    2014-07-01

    Primary colon carcinoma within an inguinal hernia sac is very rare and most reported cases were found at emergency open surgery for an incarcerated hernia. We report a case of incarcerated sigmoid colon carcinoma diagnosed preoperatively and treated with elective laparoscopic surgery. A 67-year-old man with a 2-year history of swelling of the scrotum and a breast lump was referred to us for surgical treatment of an irreducible left inguinal hernia and a right breast tumor. Blood examination results showed severe anemia. Computed tomography scan and endoscopic biopsy confirmed sigmoid colon carcinoma incarcerated in the left inguinal hernia. Thus, we performed definitive laparoscopic sigmoidectomy and conventional hernia repair for preoperatively diagnosed sigmoid colon carcinoma within an inguinal hernia. PMID:23846798

  19. [Laparoscopic cystoprostatectomy, initial experience: 13 patients].

    PubMed

    Vaessen, Christophe; Mouzin, Marc; Malavaud, Bernard; Gamé, Xavier; Berrogain, Nathalie; Rischmann, Pascal

    2004-09-01

    From July 2003 to February 2004, 13 laparoscopic radical cysto-prostatectomies have been achieved in our department. The technique is describe, the ablation of the bladder and prostate is done through a pure laparoscopic approach when the reconstruction is done trough a small incision under the umbilicus. The uretro-neobladder anastomoses are performed under laparoscopy after re-integration of the bladder. All procedures have been successfully achieved; the mean operative time is 400 minutes, 320 for the cutaneous diversions and 450 for the Camey 2 procedures. Blood loss were 390 ml, blood transfusion was d for only one patient. No major complication was observed, the mean hospital stay was 14.2 days (+3.5). In our experience laparoscopic radical cystectomy is a safe option, associated with shorter hospital stays and gentler postoperative recovery. PMID:15776921

  20. Diagnostic laparoscopic biopsy for intraabdominal tumors.

    PubMed

    Sakamoto, Yasuo; Karashima, Ryuichi; Ida, Satoshi; Imamura, Yu; Iwagami, Shiro; Baba, Yoshifumi; Miyamoto, Yuji; Yoshida, Naoya; Baba, Hideo

    2015-03-01

    Improvements in imaging technology have resulted in an increase in the incidental detection of intraabdominal tumors. Diagnostic computed tomography (CT)- and ultrasound (US)-guided biopsy, while minimally invasive, often provides specimens that are insufficient for histological evaluation. Moreover, it can be difficult to perform because the location and size of the tumor. In such cases, laparoscopic biopsy is useful because it is less invasive than laparotomy, but more reliable than imaging-guided biopsy, to obtain a sufficient specimen, regardless of the location and size of the tumor. We report a series of seven patients who underwent laparoscopic biopsy of intraabdominal tumors of unknown origin. There were no cases of conversion to laparotomy and all patients were able to resume oral intake on postoperative day 1. There were no intraoperative or postoperative complications. Thus, laparoscopic biopsy for a tumor of unknown origin is useful and minimally invasive. PMID:25212568

  1. Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis.

    PubMed

    Darwish, Maram; Atlantis, Evan; Mohamed-Taysir, Tamara

    2014-03-01

    Hysterectomy is one of the commonest operative procedures in the developed world, mostly occurring among premenopausal women, with contradictory results regarding post-operative psychological wellbeing. This review aims to inform practice by examining whether hysterectomy predicts depression or anxiety outcomes. We searched PubMed, EMBASE, and PsycINFO electronic databases for articles published before November 2012. Reference lists of relevant articles were hand searched, and expert opinions were sought. Refereed studies investigating an association between hysterectomy for benign (non-cancerous) conditions and post-operative symptoms of depression or anxiety were chosen for this review. Two authors independently abstracted data from original articles. Authors of relevant studies were contacted for data that could not be extracted from the published articles. Review Manager 5.1 was used throughout the meta-analysis to calculate the summary relative risks (RRs), and the weighted standardized mean difference (WstdMD), and their corresponding 95% confidence intervals (CI). A random effects model was used in data analysis and verified using a fixed effect model. Overall, hysterectomy was associated with a decreased risk of clinically relevant depression (RR=1.69, 95% CI 1.19-2.38). Additionally, hysterectomy was associated with a decrease in standardized depression outcomes (standardized mean difference (SMD) 0.38 (95% CI 0.27-0.49)). Conversely, there was no significant association between hysterectomy and risk of clinically relevant anxiety (RR=1.41, 95% CI 0.72-2.75). In conclusion, data from before and after studies suggest that hysterectomy for benign gynecological conditions is not adversely associated with anxiety and may be positively rather than adversely associated with depression. PMID:24398028

  2. Development of a collapsible guard component for a novel surgical instrument

    E-print Network

    Buckley, Darragh

    2007-01-01

    The Endoblend is a novel surgical device for use in laparoscopic hysterectomy surgery. Laparoscopic hysterectomy surgery requires that the uterus be removed through a laparoscopic port. To achieve this, the Endoblend ...

  3. Ureteral Injury After Laparoscopic Versus Open Colectomy

    PubMed Central

    Ahaghotu, Chiledum A.; Libuit, Laura; Ortega, Gezzer; Coleman, Pamela W.; Cornwell, Edward E.; Tran, Daniel D.; Fullum, Terrence M.

    2014-01-01

    Background and Objectives: Ureteral injury is an infrequent but potentially lethal complication of colectomy. We aimed to determine the incidence of intraoperative ureteral injury after laparoscopic and open colectomy and to determine the independent morbidity and mortality rates associated with ureteral injury. Methods: We analyzed data from the National Surgical Quality Improvement Program for the years 2005–2010. All patients undergoing colectomy for benign, neoplastic, or inflammatory conditions were selected. Patients undergoing laparoscopic colectomy versus open colectomy were matched on disease severity and clinical and demographic characteristics. Multivariate logistic regression analyses and coarsened exact matching were used to determine the independent difference in the incidence of ureteral injury between the 2 groups. Multivariate models were also used to determine the independent association between postoperative complications associated with ureteral injury. Results: Of a total of 94 526 colectomies, 33 092 (35%) were completed laparoscopically. Ureteral injury occurred in a total of 585 patients (0.6%). The crude incidence in the open group was higher than that in the laparoscopic group (0.66% versus 0.53%, P = .016). CEM produced 14 630 matching pairs. Matched analysis showed the likelihood of ureteral injury after laparoscopic colectomy to be 30% less than after open colectomy (odds ratio, 0.70; 95% confidence interval, 0.51–0.96). Patients with ureteral injury were independently more likely to have septic complications and have longer lengths of hospital stay than those without ureteral injury. Conclusion: Laparoscopic colectomy is associated with a lower incidence of intraoperative ureteral injury when compared with open procedures. Ureteral injury leads to significant postoperative morbidity even if identified and repaired during the colectomy. PMID:25392666

  4. Single-incision laparoscopic liver resection

    Microsoft Academic Search

    Sébastien Gaujoux; T. Peter Kingham; William R. Jarnagin; Michael I. D’Angelica; Peter J. Allen; Yuman Fong

    2011-01-01

    Background  Laparoscopic liver surgery has become a safe and effective approach to the surgical management of liver disease. Recently\\u000a developed, single-port-access surgery is of growing interest in an attempt to minimize abdominal wall trauma. Various abdominal\\u000a procedures have already been performed via single-port access, but to date, single-port-access surgery has never been reported\\u000a for liver resection.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  One patient underwent laparoscopic fenestration

  5. Ergonomic problems associated with laparoscopic surgery

    Microsoft Academic Search

    R. Berguer; D. L. Forkey; W. D. Smith

    1999-01-01

    Background: The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Task Force on Ergonomics conducted a subjective and\\u000a objective assessment of ergonomic problems associated with laparoscopic instrument use. The goal was to assess the prevalence,\\u000a causes, and consequences of operational difficulties associated with the use of laparoscopic instruments.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: A questionnaire was distributed asking respondents to rate the frequency with which

  6. Laparoscopic ventral hernia repair: a systematic review

    Microsoft Academic Search

    Clarabelle T. Pham; Caryn L. Perera; D. Scott Watkin; Guy J. Maddern

    2009-01-01

    Background  Laparoscopic ventral hernia repair may be an alternative to open mesh repair as it avoids a large abdominal incision, and\\u000a thus potentially reduces pain and hospital stay. This review aimed to assess the safety and efficacy of laparoscopic ventral\\u000a hernia repair in comparison with open ventral hernia repair.\\u000a \\u000a \\u000a \\u000a Method  A systematic review was conducted, with comprehensive searches identifying six randomised controlled

  7. Opioid Requirements after Laparoscopic Bariatric Surgery

    Microsoft Academic Search

    Toby N. Weingarten; Juraj Sprung; Antolin Flores; Ana M. Oviedo Baena; Darrell R. Schroeder; David O. Warner

    Background  Postoperative analgesia following bariatric surgery is complicated by the high prevalence of obstructive sleep apnea which\\u000a is worsened by systemic opioids. The primary aim of this study is to identify patient factors associated with greater postoperative\\u000a opioid use in patients undergoing laparoscopic bariatric surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective chart review of 384 consecutive patients who underwent laparoscopic bariatric surgery from January 2000

  8. Laparoscopic resection of pancreatic neuroendocrine tumors

    PubMed Central

    Al-Kurd, Abbas; Chapchay, Katya; Grozinsky-Glasberg, Simona; Mazeh, Haggi

    2014-01-01

    Pancreatic neuroendocrine tumors (PNETs) are a rare heterogeneous group of endocrine neoplasms. Surgery remains the best curative option for this type of tumor. Over the past two decades, with the development of laparoscopic pancreatic surgery, an increasingly larger number of PNET resections are being performed by these minimally-invasive techniques. In this review article, the various laparoscopic surgical options for the excision of PNETs are discussed. In addition, a summary of the literature describing the outcome of these treatment modalities is presented. PMID:24803802

  9. Laparoscopic Resection of Unruptured Rudimentary Horn Pregnancy

    PubMed Central

    Sharma, Deepti; Usha, MG; Gaikwad, Ramesh; Sudha, S

    2011-01-01

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

  10. Laparoscopic Radiofrequency Ablation of Neuroendocrine Liver Metastases

    Microsoft Academic Search

    Eren Berber; Nora Flesher; Allan E. Siperstein

    2002-01-01

      \\u000a We previously reported on the safety and\\u000a efficacy of laparoscopic radiofrequency thermal ablation (RFA) for\\u000a treating hepatic neuroendocrine metastases. The aim of\\u000a this study is to report our 5-year RFA experience in the treatment of\\u000a these challenging group of patients. Of the 222 patients with 803 liver\\u000a primary and secondary tumors undergoing laparoscopic RFA between\\u000a January 1996 and August

  11. Retroperitoneal laparoscopic bilateral lumbar sympathectomy.

    PubMed

    Segers, B; Himpens, J; Barroy, J P

    2007-06-01

    The first retroperitoneal lumbar sympathectomy was performed in 1924 by Julio Diez. The classic procedure for sympathectomy is open surgery. We report a unilateral laparoscopic retroperitoneal approach to perform bilateral lumbar sympathectomy. This approach was performed for a 43-year-old man with distal arterial occlusive disease and no indication for direct revascularization. His predominant symptoms were intermittent claudication at 100 metres and cold legs. The patient was placed in a left lateral decubitus position. The optical system was placed first in an intra-abdominal position to check that the trocars were well positioned in the retroperitoneal space. The dissection of retroperitoneum was performed by CO2 insufflation. The inferior vena cava was reclined and the right sympathetic chain was individualized. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. The aorta was isolated on a vessel loop and careful anterior traction allowed a retro-aortic pre-vertebral approach between the lumbar vessels. The left sympathetic chain was dissected. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. PMID:17685269

  12. Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

    PubMed Central

    Madan, Atul K.; Carlson, Mark A.; Zeni, Tallal M.; Zografakis, John G.; Moore, Ronald M.; Meiselman, Mick; Luu, Minh; Ayiomamitis, Georgios D.

    2009-01-01

    Abstract Objective The aim of this study was to evaluate the mechanisms of failure after laparoscopic fundoplication and the results of revision laparoscopic fundoplication. Background Laparoscopic Nissen fundoplication has become the most commonly performed antireflux procedure for the treatment of gastroesophageal reflux disease, with success rates from 90 to 95%. Persistent or new symptoms often warrant endoscopic and radiographic studies to find the cause of surgical failure. In experienced hands, reoperative antireflux surgery can be done laparoscopically. We performed a retrospective analysis of all laparoscopic revision of failed fundoplications done by the principle author and the respective fellow within the laparoscopic fellowship from 1992 to 2006. Methods A review was performed on patients who underwent laparoscopic revision of a failed primary laparoscopic fundoplication. Results Laparoscopic revision of failed fundoplication was performed on 68 patients between 1992 and 2006. The success rate of the laparoscopic redo Nissen fundoplication was 86%. Symptoms prior to the revision procedure included heartburn (69%), dysphagia (8.8%), or both (11.7%). Preoperative evaluation revealed esophagitis in 41%, hiatal hernia with esophagitis in 36%, hiatal hernia without esophagitis in 7.3%, stenosis in 11.74%, and dysmotility in 2.4%. The main laparoscopic revisions included fundoplication alone (41%) or fundoplication with hiatal hernia repair (50%). Four gastric perforations occurred; these were repaired primarily without further incident. An open conversion was performed in 1 patient. Length of stay was 2.5?±?1.0 days. Mean follow-up was 22 months (range, 6–42), during which failure of the redo procedure was noted in 9 patients (13.23%). Conclusion Laparoscopic redo antireflux surgery, performed in a laparoscopic fellowship program, produces excellent results that approach the success rates of primary operations. PMID:19216692

  13. Transmesocolic Approach for Left Side Laparoscopic Pyeloplasty: Comparison with Laterocolic Approach in the Initial Learning Period

    PubMed Central

    Han, Hyun Ho; Ham, Won Sik; Kim, Jang Hwan; Choi, Young Deuk; Han, Sang Won; Chung, Byung Ha

    2013-01-01

    Purpose To evaluate the outcome of transmesocolic (TMC) laparoscopic pyeloplasty compared with conventional laterocolic procedure for surgeons with limited experience. Materials and Methods We started laparoscopic pyeloplasty for ureteropelvic junction obstruction in 2009. Since then, 21 patients of left side disease have undergone this surgery in our institution. To access the left ureteropelvic junction, we used the conventional laterocolic approach in 9 patients, while the transmesocolic approach was used in the remaining 12 patients, and perioperative results and follow-up data were then compared. Results The mean operative time using the transmesocolic approach was significantly shorter than the conventional laterocolic approach (242 vs. 308 min, p=0.022). Furthermore, there was no complication or open conversion. Postoperative pain was significantly decreased in the TMC group (2.8 vs. 4.0 points, measured using the visual analogue scale on the first postoperative day, p=0.009). Postoperative complications were encountered in two patients. All patients were symptom-free after 1 year of follow-up, and radiologic success rates for each group were 92 and 89%, respectively. Conclusion Direct exposure of the ureteropelvic junction via the mesocolon saves time during the colon mobilization procedure. The approach is safe and feasible even for surgeons with limited experience, and has success rates similar to those of the conventional laterocolic approach. PMID:23225819

  14. Management of mechanical ventilation during laparoscopic surgery.

    PubMed

    Valenza, Franco; Chevallard, Giorgio; Fossali, Tommaso; Salice, Valentina; Pizzocri, Marta; Gattinoni, Luciano

    2010-06-01

    Laparoscopy is widely used in the surgical treatment of a number of diseases. Its advantages are generally believed to lie on its minimal invasiveness, better cosmetic outcome and shorter length of hospital stay based on surgical expertise and state-of-the-art equipment. Thousands of laparoscopic surgical procedures performed safely prove that mechanical ventilation during anaesthesia for laparoscopy is well tolerated by a vast majority of patients. However, the effects of pneumoperitoneum are particularly relevant to patients with underlying lung disease as well as to the increasing number of patients with higher-than-normal body mass index. Moreover, many surgical procedures are significantly longer in duration when performed with laparoscopic techniques. Taken together, these factors impose special care for the management of mechanical ventilation during laparoscopic surgery. The purpose of the review is to summarise the consequences of pneumoperitoneum on the standard monitoring of mechanical ventilation during anaesthesia and to discuss the rationale of using a protective ventilation strategy during laparoscopic surgery. The consequences of chest wall derangement occurring during pneumoperitoneum on airway pressure and central venous pressure, together with the role of end-tidal-CO2 monitoring are emphasised. Ventilatory and non-ventilatory strategies to protect the lung are discussed. PMID:20608559

  15. Laparoscopic repair of adult Bochdalek's hernia

    PubMed Central

    Husain, Musharraf; Hajini, Firdoos Farooq; Ganguly, Pavitra; Bukhari, Syed

    2013-01-01

    Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring in approximately 1 in 2200–12?500 live births. It is considered to be extremely rare in adults and poses a diagnostic challenge. We present a case of a young man who was diagnosed as a case of congenital Bochdalek's hernia and underwent laparoscopic mesh repair. PMID:23761496

  16. Reasons for early recurrence following laparoscopic hernioplasty

    Microsoft Academic Search

    E. H. Phillips; R. Rosenthal; M. Fallas; B. Carroll; M. Arregui; J. Corbitt; R. Fitzgibbons; A. Seid; L. Schultz; F. Toy; R. Wadell; B. McKernan

    1995-01-01

    The incidence and reasons for early recurrences following laparoscopic hernioplasty have not been studied. Because the incidence is small and the follow up is short, a multi-institutional study was performed among the pioneers in the field. The incidence figures were obtained by survey of surgeons who had significant experience (over 100 cases) and kept concurrent records.

  17. Laparoscopic surgery and the systemic immune response.

    PubMed Central

    Vittimberga, F J; Foley, D P; Meyers, W C; Callery, M P

    1998-01-01

    OBJECTIVE: The authors review studies relating to the immune responses evoked by laparoscopic surgery. SUMMARY BACKGROUND DATA: Laparoscopic surgery has gained rapid acceptance based on clinical grounds. Patients benefit from faster recovery, decreased pain, and quicker return to normal activities. Only more recently have attempts been made to identify the metabolic and immune responses that may underlie this clinical success. The immune responses to laparoscopy are now being evaluated in relation to the present knowledge of immune responses to traditional laparotomy and surgery in general. METHODS: A review of the published literature of the immune and metabolic responses to laparoscopy was performed. Laparoscopic surgery is compared with the traditional laparotomy on the basis of local and systemic immune responses and patterns of tumor growth. The impact of pneumoperitoneum and insufflation gases on the immune response is also reviewed. CONCLUSIONS: The systemic immune responses for surgery in general may not apply to laparoscopic surgery. The body's response to laparoscopy is one of lesser immune activation as opposed to immunosuppression. PMID:9527054

  18. Preoperative Surgical Planning Using Virtual Laparoscopic Camera

    E-print Network

    Zhukov, Leonid

    Preoperative Surgical Planning Using Virtual Laparoscopic Camera Dmitry Oleynikov, M.D Leonid. La- paroscopic virtual reality simulators have not been designed to represent individual patient in anatomy and body habi- tus of individuals. Preoperative CT imaging allows the surgeon to identify

  19. Laparoscopic urology: Past, present, and future

    Microsoft Academic Search

    Ralph V. Clayman; Louis R. Kavoussi

    1993-01-01

    Laparoscopy has begun to have a significant impact on the management of urologic problems. Although initially limited to diagnostic pediatric problems, it has more recently been used to resolve myriad adult urologic conditions. Indeed, during the past year laparoscopic urology has moved well beyond the diagnosis of the undescended testicle and has been successfully used for pelvic lymphadenectomy, varicocelectomy, ureterolysis,

  20. Laparoscopic splenectomy for atraumatic splenic rupture.

    PubMed

    Grossi, Ugo; Crucitti, Antonio; D'Amato, Gerardo; Mazzari, Andrea; Tomaiuolo, Pasquina M C; Cavicchioni, Camillo; Bellantone, Rocco

    2011-01-01

    A traumatic splenic rupture (ASR) is a rare clinical entity. Several underlying benign and malignant conditions have been described as a leading cause. We report on a case of ASR in a 41-year-old man treated with laparoscopic splenectomy. Considering ASR as a life-threatening condition, a prompt diagnosis can be life saving. PMID:21675627

  1. Laparoscopic versus open splenectomy in children

    Microsoft Academic Search

    Robert K Minkes; Mara Lagzdins; Jacob C Langer

    2000-01-01

    Background: The authors have reviewed their initial experience with laparoscopic splenectomy (LS) to identify the indications, success rate, and complications associated with this procedure compared with a series of children undergoing open splenectomy (OS) during the same time period. Methods: The records of 51 children who underwent splenectomy from 1993 through 1998 were reviewed retrospectively. Results: Thirty-five patients aged 1

  2. PARAMIS parallel robot for laparoscopic surgery.

    PubMed

    Pisla, D; Plitea, N; Vaida, C; Hesselbach, J; Raatz, A; Vlad, L; Graur, F; Gyurka, B; Gherman, B; Suciu, M

    2010-01-01

    The paper presents the parallel robot, which has been developed in Romania and it is used for laparoscope camera positioning. Based on its mathematical modeling, the first low-cost experimental model of the PARAMIS surgical robot has been built. The system has been built in such a way that it has the possibility to transform it in a multiarm robot controlled from the console. The control input allows the user to give commands in a large area for the positioning of the laparoscope using different interfaces: joystick, microphone, keyboard & mouse and haptic device. The first results have been obtained through the performing of an experimental laparoscopic cholecystectomy using PARAMIS surgical robot. The model which was used was a porcine liver, removed with the gall-bladder and the bile ducts. Due to its very easy use control system, surgeons have adapted rapidly to the use of PARAMIS in surgical procedures. Some of its advantages could be emphasized: precision of the movements; absence of the laparoscope operator's natural tremor, direct control over a smooth, precise, stable view of the internal surgical field for the surgeon; no fatigue; allows the use of both hands for the actual procedure; reduces eye fatigue; eliminates the need for a second surgeon to be present for the entire procedure. PMID:21141094

  3. Hysterectomy and Bilateral Salpingoovariectomy in a Transsexual Subject without Visible Scaring.

    PubMed

    Perrone, Anna Myriam; Scifo, Maria Cristina; Martelli, Valentina; Casadio, Paolo; Morselli, Paolo Giovanni; Pelusi, Giuseppe; Meriggiola, Maria Cristina

    2010-01-01

    Objective. To report on the use of laparoendoscopic single-site surgery (LESS) for the management of total hysterectomy (TH) with bilateral salpingoovariectomy (BSO) in a subject affected by gender identity disorder. Design. Case report. Setting. University Hospital. Patient(s). A 27-year-old affected by Gender Identity Disorder underwent a hysterectomy and BSO as part of surgical sex reassignment. Intervention(s). Laparoendoscopic single-site surgery access for TH and BSO. Main Outcome Measure(s). The procedure was performed without incident. The trocar placement was easy and safe, without inadvertent port removal. No vascular or visceral injuries, loss of pneumoperitoneum, or intraoperative port site bleeding occurred. Result(s). A detailed description of the technique of a single-site surgery for management of hysterectomy and BSO. Conclusion. Our case presents the first report of single-site surgery for surgical treatment of subjects affected by GID. PMID:20811647

  4. Major Vascular Injury in Laparoscopic Urology

    PubMed Central

    Basiri, Abbas; Ziaee, Seyed-Amir-Mohsen; Tabibi, Ali; Nouralizadeh, Akbar; Radfar, Mohammad Hadi; Sarhangnejad, Reza; Mirsadeghi, Amin

    2014-01-01

    Background and Objectives: Major vascular injury is the most devastating complication of laparoscopy, occurring most commonly during the laparoscopic entry phase. Our goal is to report our experience with major vascular injury during laparoscopic entry with closed- and open-access techniques in urologic procedures. Methods: All 5347 patients who underwent laparoscopic urologic procedures from 1996 to 2011 at our hospital were included in the study. Laparoscopic entry was carried out by either the closed Veress needle technique or the modified open Hasson technique. Patients' charts were reviewed retrospectively to investigate for access-related major vascular injuries. Results: The closed technique was used in the first 474 operations and the open technique in the remaining 4873 cases. Three cases of major vascular injury were identified among our patients. They were 3 men scheduled for nephrectomy without any history of surgery. All injuries occurred in the closed-access group during the setup phase with insertion of the first trocar. The injury location was the abdominal aorta in 2 patients and the external iliac vein in 1 patient. Management was performed after conversion to open surgery, control of bleeding, and repair of the injured vessel. Conclusions: Given the high morbidity and mortality rates associated with major vascular injury, its clinically higher incidence in laparoscopic urologic procedures with the closed-access technique leads us to suggest using the open technique for the entry phase of laparoscopy. Using the open-access technique may decrease laparophobia and encourage a higher number of urologists to enter the laparoscopy field. PMID:25392667

  5. Emergency laparoscopic-assisted gastrotomy for the treatment of an iron bezoar.

    PubMed

    Haider, Fayza; De Carli, Claudio; Dhanani, Sonny; Sweeney, Brian

    2009-04-01

    Iron ingestion accounts for approximately 3% of calls to poison control centers. The profound local and systemic effects of an iron overdose have an associated mortality rate of 5%. Laparotomy and gastrotomy has been reported as a life-saving maneuver to extract the retained iron aggregates that are notoriously resistant to, removal by conventional emesis or lavage techniques. In this paper, we describe, for the first time, the use of laparoscopic-assisted gastrotomy in the treatment of an iron overdose. A 14-year-old girl attempted suicide by means of a polydrug drug overdose, which included ferrous fumarate, at a calculated potentially lethal dose of 70 mg/kg. A gastric iron bezoar was seen on plain radiograph. The regional poison control center recommended surgical removal of the retained iron tablets. Upper endoscopy confirmed the retention of iron and showed its dense adherence to the gastric mucosa. A 5-mm laparoscope was introduced at the umbilicus, and the stomach was grasped by an instrument introduced through a left-upper quadrant incision. The incision was then enlarged to allow the formation of a gastrotomy. The iron bezoar was removed with the aid of digital disimpaction and copious saline irrigation. The patient made a rapid postoperative recovery prior to undergoing psychiatric treatment. We conclude that laparoscopic-assisted gastrotomy is a simple and safe option in the acute management of a retained iron bezoar. PMID:18976122

  6. Gasless laparoscopic surgery during pregnancy: evaluation of its role and usefulness.

    PubMed

    Sesti, Francesco; Pietropolli, Adalgisa; Sesti, Franz Federico; Piccione, Emilio

    2013-09-01

    The minimally invasive laparoscopic approach in the surgical treatment of diseases during pregnancy has become progressively more accepted and applied. In an attempt to overcome the potential adverse effects of pneumoperitoneum on the fetus, gasless laparoscopic surgery (GLS) has been developed. This article reviews the evidence available for the role and effectiveness of GLS in pregnancy. A computerized literature search was conducted on Medline, Science Citation Index, Current Contents, Embase, and PubMed databases for English language publications from the first report of GLS in pregnancy in 1995 to June 2012. Eleven case reports or retrospective series were identified. A total of 44 pregnant women underwent GLS for various surgical indications. In all cases, the procedures were carried out without complication, and the women were discharged from hospital with a continuing pregnancy. GLS in pregnancy has comparable outcomes to conventional CO2 laparoscopy, but it is associated with some advantages. Hypercarbia and increased intraperitoneal pressure due to CO2 insufflation are avoided. The use of high-pressure continuous suction may prevent the problems that are potentially associated with intra-abdominal smoke generated by electrosurgery, which can increase the risk of fetal exposure to elevated levels of toxic gases. Because this procedure may be performed under regional anesthesia, avoiding general anesthesia, there is a minimal transplacental passage of anesthetic drugs to the fetus. The surgeon must be expert in advanced laparoscopic procedures. PMID:23746633

  7. [Oncologic and functional outcomes after robot-assisted laparoscopic radical prostatectomy].

    PubMed

    Drouin, S-J; Vaessen, C; Misraï, V; Ferhi, K; Bitker, M-O; Chartier-Kastler, E; Haertig, A; Richard, F; Rouprêt, M

    2009-03-01

    The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. From 1992, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface, are some reasons that explain the worldwide widespread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared to other approaches. Intermediate oncological and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP do not allow to draw any definitive statement in comparison with conventional techniques. PMID:19268252

  8. Robot-assisted extraperitoneal laparoscopic radical prostatectomy: a review of the current literature.

    PubMed

    Xylinas, Evanguelos; Ploussard, Guillaume; Durand, Xavier; de la Taille, Alexandre

    2013-04-01

    Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men will benefit from radical treatment, considerable efforts are being made to reduce treatment related side-effects and in optimizing outcomes. The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. Since the early 1990s, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface are some of the reasons that explain the worldwide wide spread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared with other approaches. Intermediate oncologic and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP does not allow drawing any definitive statement in comparison with conventional techniques. The aim of our study was to underline the perioperative, oncologic, and functional outcomes of all extraperitoneal RALP series published. PMID:20864364

  9. Laparoscopic gastrectomy for gastric cancer in China: an overview.

    PubMed

    Lan, Huanrong; Zhu, Naibiao; Lan, Yuefu; Jin, Ketao; Teng, Lisong

    2015-01-01

    Since its introduction in China in 2000, laparoscopic gastrectomy has shown classical advantages of minimally invasive surgery over open counterpart. Like all the pioneers of the technique, Chinese gastrointestinal surgeons claim that laparoscopic gastrectomy led to faster recovery, shorter hospital stay and more rapid return to daily activities respect to open gastrectomy while offering the same functional and oncological results. There has been booming interest in laparoscopic gastrectomy since 2006 in China. The last decade has witnessed national growth in the application of laparoscopic gastrectomy and yielded a significant amount of scientific data to support its clinical merits and advantages. However, few prospective randomized controlled trials have investigated the benefits of laparoscopic gastrectomy in China. In this article, we make an overview of the current data and state of the art of laparoscopic gastrectomy for gastric cancer in China. PMID:25911902

  10. Laparoscopic surgery for colorectal cancer in China: an overview

    PubMed Central

    Jin, Ketao; Wang, Jun; Lan, Huanrong; Zhang, Ruili

    2014-01-01

    Since its introduction into China in 2001, laparoscopic techniques have been extensively used for the surgical management of colorectal cancer during the last two decades in China. Like all the pioneers of the technique, Chinese gastrointestinal surgeons claim that laparoscopic surgery for colorectal cancer led to faster recovery, shorter hospital stay and more rapid return to daily activities respect to open surgery while offering the same functional and oncological results. There has been booming interest in laparoscopic surgery for colorectal cancer since 2006 in China. The last decade has witnessed national growth in the application of laparoscopic surgery for colorectal cancer and yielded a significant amount of scientific data to support its clinical merits and advantages. However, few prospective randomized controlled trials have investigated the benefits of laparoscopic surgery for colorectal cancer in China. In this article, we make an overview of the current data and state of the art of laparoscopic surgery for colorectal cancer in China. PMID:25663960

  11. Hand-assisted laparoscopic splenectomy for ruptured spleen.

    PubMed

    Ren, C J; Salky, B; Reiner, M

    2001-03-01

    Although the laparoscopic technique is an accepted method for elective splenectomy, it is controversial in the setting of trauma. A few reports have described laparoscopic splenorrhaphy for trauma, but none have performed laparoscopic splenectomy for splenic rupture. When the spleen is injured, vascular control and poor visibility due to bleeding present obstacles to laparoscopy. The development of the hand-assist device has helped surgeons make the transition from laparotomy to laparoscopy because of the advantages it provides, such as tactile sensation and immediate vascular control. We utilized these benefits of the hand-assist device to convert a laparoscopic operation to a hand-assisted laparoscopic operation and were thus able to avoid a laparotomy. We report a case in which the hand-assist device was used as an alternative to conversion during a laparoscopic splenectomy for ruptured spleen. PMID:11344442

  12. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication

    Microsoft Academic Search

    Guilherme M. R. Campos; Jeffrey H. Peters; Tom R. DeMeester; Stefan Öberg; Peter F. Crookes; Silvia Tan; Steven R. DeMeester; Jeffrey A. Hagen; Cedric G. Bremner

    1999-01-01

    Laparoscopic Nissen fundoplication has been applied with increasing frequency in the treatment of gastroesophageal reflux\\u000a disease. The aim of this study was to determine the variahles that predict outcome of laparoscopic Nissen fundoplication.\\u000a A multivariate analysis was performed on data from 199 consecutive patients undergoing laparoscopic Nissen fundoplication.\\u000a Variables included age, sex, body mass index, primary symptoms, clinical response to

  13. The laparoscopic management of appendicitis and cholelithiasis during pregnancy

    Microsoft Academic Search

    David G Affleck; Diana L Handrahan; Marlene J Egger; Raymond R Price

    1999-01-01

    Background: Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy remains controversial. We report the single largest series of laparoscopic cholecystectomies and appendectomies during pregnancy.Methods: Medical records of all pregnant patients who underwent open or laparoscopic management of appendicitis\\/cholelithiasis at LDS Hospital from 1990 to 1998 were reviewed.Results: Eighteen open appendectomies (OA) and 13 open cholecystectomies (OC) were performed. Forty-five

  14. Laparoscopic repair of Morgagni-Larrey hernia in a child

    Microsoft Academic Search

    Mario Lima; Marcello Dòmini; Michele Libri; Antonino Morabito; Giovanni Tani; Remigio Dòmini

    2000-01-01

    Primary laparoscopic repair of Morgagni-Larrey hernia has been described in adult patients but not in children. This is the first report of primary laparoscopic correction in the pediatric age group without using a prosthesis. A Morgagni-Larrey hernia was found incidentally in a 3-year-old-girl. Laparoscopic correction of the defect was performed. After 6 months the patient is doing well. The chest

  15. Laparoscopic classification and treatment of the impalpable testis

    Microsoft Academic Search

    Sameh A. Hay; Hesham A. Soliman; Ahmed H. Abdel Rahman; Ibrahim E. Bassiouny

    1999-01-01

    Laparoscopic orchiopexy has gained popularity in recent years. However, the decision when to perform one-stage laparoscopic\\u000a orchiopexy without division of the spermatic vessels versus initial ligation of the spermatic vessels followed later by orchiopexy\\u000a is not clear. A new laparoscopic classification to facilitate decision-making during laparoscopy, according to the position\\u000a of the impalpable testis and the relation of the spermatic

  16. Laparoscopic ovarian transposition for pelvic malignancies: indications and functional outcomes

    Microsoft Academic Search

    Philippe Morice; Damienne Castaigne; Christine Haie-Meder; Patricia Pautier; Janah El Hassan; Pierre Duvillard; Alain Gerbaulet; Guy Michel

    1998-01-01

    Objective: To assess the indications and effectiveness of laparoscopic ovarian transposition before pelvic irradiation for a gynecologic cancer.Design: Prospective study.Setting: A gynecologic oncology department in a French anti-cancer center.Patient(s): Twenty-four patients treated for pelvic cancer.Intervention(s): Laparoscopic ovarian transposition to paracolic gutters. Uterine conservation in 18 patients.Main Outcome Measure(s): Clinical and laboratory follow-up tests of ovarian function.Result(s): Bilateral laparoscopic ovarian transposition

  17. Laparoscopic Italian Experience with the Lap-Band ®

    Microsoft Academic Search

    L. Angrisani; M. Alkilani; N. Basso; N. Belvederesi; F. Campanile; F. D. Capizzi; C. D'Atri; L. Di Cosmo; S. B. Doldi; F. Favretti; P. Forestieri; F. Furbetta; F. Giacomelli; C. Giardiello; A. Iuppa; G. Lesti; M. Lucchese; F. Puglisi; L. Scipioni; M. Toppino; G. U. Turicchia; A. Veneziani; C Docimo; V. Borrelli; M. Lorenzo

    2001-01-01

    Background: An increasing number of surgeons with different levels of experience with laparoscopic surgery and open obesity\\u000a surgery have started to perform laparoscopic implantation of the Lap-Band?. Methods: An electronic patient data sheet was created and was mailed and e-mailed to all surgeons performing laparoscopic\\u000a adjustable silicone gastric banding (LASGB) in Italy. Patients were recruited since January 1996. Data on

  18. Subhepatic Sterile Abscess 10 Years After Laparoscopic Cholecystectomy

    PubMed Central

    Bartels, Anne K.; Zamora, Jose Gonzales

    2015-01-01

    We present a case of a large, sterile, subhepatic abdominal wall abscess secondary to foreign body reaction to dropped gallstones during laparoscopic cholecystectomy performed 10 years ago. Dropped gallstones are common complications of laparoscopic cholecystectomy, but they rarely result in abscess formation. When abscesses do occur, they may present a few months to a few years after surgery. It is important to recognize dropped gallstones as an etiology for subhepatic abscess in patients with history of laparoscopic cholecystectomy. PMID:26157931

  19. Hand-assisted laparoscopic splenectomy for ruptured spleen

    Microsoft Academic Search

    C. J. Ren; B. Salky; M. Reiner

    2001-01-01

    Although the laparoscopic technique is an accepted method for elective splenectomy, it is controversial in the setting of\\u000a trauma. A few reports have described laparoscopic splenorrhaphy for trauma, but none have performed laparoscopic splenectomy\\u000a for splenic rupture. When the spleen is injured, vascular control and poor visibility due to bleeding present obstacles to\\u000a laparoscopy. The development of the hand-assist device

  20. Psychosexual perspectives of the husbands of women treated with an elective hysterectomy.

    PubMed

    Hoga, Luiza Akiko Komura; Higashi, Aline Baraldi; Sato, Priscila Mayumi; Bozzini, Nilo; Baracat, Edmund Chada; Manganiello, Adriana

    2012-01-01

    The purpose of this study was to explore the psychosexual perspectives of a group of Brazilian men whose wives underwent an elective hysterectomy. A qualitative design based on the narrative analysis method was used to interview 22 husbands. Results showed similarities and differences among husbands regarding the support provided to their wives, the notion of sexual absence in the postsurgical period, the notion of sexual pleasure after the hysterectomy, and feelings regarding the impossibility of having children. The authors conclude that personal care requirements should be identified and satisfied to provide comprehensive and meaningful care. PMID:22891740

  1. Application of single-image camera calibration for ultrasound augmented laparoscopic visualization

    NASA Astrophysics Data System (ADS)

    Liu, Xinyang; Su, He; Kang, Sukryool; Kane, Timothy D.; Shekhar, Raj

    2015-03-01

    Accurate calibration of laparoscopic cameras is essential for enabling many surgical visualization and navigation technologies such as the ultrasound-augmented visualization system that we have developed for laparoscopic surgery. In addition to accuracy and robustness, there is a practical need for a fast and easy camera calibration method that can be performed on demand in the operating room (OR). Conventional camera calibration methods are not suitable for the OR use because they are lengthy and tedious. They require acquisition of multiple images of a target pattern in its entirety to produce satisfactory result. In this work, we evaluated the performance of a single-image camera calibration tool (rdCalib; Percieve3D, Coimbra, Portugal) featuring automatic detection of corner points in the image, whether partial or complete, of a custom target pattern. Intrinsic camera parameters of a 5-mm and a 10-mm standard Stryker® laparoscopes obtained using rdCalib and the well-accepted OpenCV camera calibration method were compared. Target registration error (TRE) as a measure of camera calibration accuracy for our optical tracking-based AR system was also compared between the two calibration methods. Based on our experiments, the single-image camera calibration yields consistent and accurate results (mean TRE = 1.18 ± 0.35 mm for the 5-mm scope and mean TRE = 1.13 ± 0.32 mm for the 10-mm scope), which are comparable to the results obtained using the OpenCV method with 30 images. The new single-image camera calibration method is promising to be applied to our augmented reality visualization system for laparoscopic surgery.

  2. Outcomes analysis of laparoscopic resection of pancreatic neoplasms

    Microsoft Academic Search

    R. A. Pierce; J. A. Spitler; W. G. Hawkins; S. M. Strasberg; D. C. Linehan; V. J. Halpin; J. C. Eagon; L. M. Brunt; M. M. Frisella; B. D. Matthews

    2007-01-01

    Background  Experience with laparoscopic resection of pancreatic neoplasms remains limited. The purpose of this study is to critically\\u000a analyze the indications for and outcomes after laparoscopic resection of pancreatic neoplasms.\\u000a \\u000a \\u000a \\u000a Methods  The medical records of all patients undergoing laparoscopic resection of pancreatic neoplasms from July 2000 to February 2006\\u000a were reviewed. Data are expressed as mean ± standard deviation.\\u000a \\u000a \\u000a \\u000a Results  Laparoscopic pancreatic resection

  3. Robotic-Assisted Laparoscopic Donor Nephrectomy: Decreasing Length of Stay

    PubMed Central

    Cohen, Ari J.; Williams, Darin S.; Bohorquez, Humberto; Bruce, David S.; Carmody, Ian C.; Reichman, Trevor; Loss, George E.

    2015-01-01

    Background The number of robotic operations performed with the da Vinci Surgical System has increased during the past decade. This system allows for greater maneuverability and control than hand-assisted laparoscopic procedures, resulting in less tissue manipulation and irritation. Methods We retrospectively analyzed the results of 100 consecutive robotic-assisted laparoscopic donor nephrectomies and compared them to our most recent 20 hand-assisted laparoscopic donor nephrectomies. Results Between May 2008 and June 2012, 120 laparoscopic donor nephrectomies were performed at Ochsner Clinic Foundation. Of those, 100 live kidney donors underwent robotic-assisted laparoscopic donor nephrectomies. Surgical time and hospital length of stay improved after the first 20 patients receiving robotic-assisted laparoscopic nephrectomies, which was considered the learning curve. Sixty percent of patients who underwent robotic-assisted laparoscopic donor nephrectomies were released on postoperative day 1 compared to 45% of patients who underwent hand-assisted laparoscopic techniques. Conclusion In our experience, robotic-assisted laparoscopic donor nephrectomy resulted in decreased postoperative length of stay that decreased the global cost of the procedure and allowed our institution to admit more patients. PMID:25829876

  4. [Laparoscopic surgery for colorectal cancer with liver metastasis].

    PubMed

    Zheng, Minhua; Ma, Junjun

    2015-06-25

    For the patients who have colorectal cancer with liver metastasis, synchronous resection or staged surgery for primary colorectal tumor and liver metastasis is usually needed which is associated with significant trauma. The role of laparoscopic colorectal surgery has been established and its application in colorectal cancer with liver metastasis increases gradually. Laparoscopic surgery for colorectal liver metastasis as a minimally invasive approach should also follow the oncological principles of colorectal liver metastasis, and the appropriate timing for laparoscopic surgery should be individualized. With the development of the laparoscopic surgery, more patients will benefit from minimally invasive surgery for colorectal liver metastasis. PMID:26108758

  5. Superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy.

    PubMed

    Pineda, Lucas; Sarhan, Mohammad; Ahmed, Leaque

    2013-08-01

    Laparoscopic procedures for morbid obesity are becoming standard of care which, in experienced hands, has a very low mortality and morbidity. Superior mesenteric vein thrombosis has been reported in the literature after different bariatric and nonbariatric laparoscopic procedures. Laparoscopic sleeve gastrectomy is a relatively new procedure in the treatment of morbid obesity; its complications being well-known including staple line leak, bleeding, and stricture among others. We present a case of superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy successfully managed conservatively with therapeutic anticoagulation, and propose a different hypothesis for the development of such a complication. PMID:23917607

  6. Laparoscopic Conversion of Laparoscopic Gastric Banding to Roux-en-Y Gastric Bypass: a Review of 70 Patients

    Microsoft Academic Search

    Philippe Mognol; Denis Chosidow; Jean-Pierre Marmuse

    2004-01-01

    Background: The feasibility and outcomes of conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y\\u000a gastric bypass (LRYGBP) was evaluated. Methods: From November 2000 to March 2004, all patients who underwent laparoscopic\\u000a conversion of LAGB to LRYGBP were retrospectively analyzed. The procedure included adhesiolysis, resection of the previous\\u000a band, creation of an isolated gastric pouch, 100-cm Roux-limb, side-to-side jejuno-jejunostomy,

  7. Laparoscopic Gastric ReBanding versus Laparoscopic Gastric Bypass as a Rescue Operation for Patients with Pouch dilatation

    Microsoft Academic Search

    M. Lanthaler; R. Mittermair; B. Erne; H. Weiss; F. Aigner; H. Nehoda

    2006-01-01

    Background:The authors assessed whether laparoscopic rebanding or laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the best\\u000a approach for failed gastric banding after pouch dilatation. Methods: Between January 2000 and June 2005, 489 patients underwent\\u000a laparoscopic gastric banding, and of these, 33 (6.7%) required rescue procedures for pouch dilatation. Each reoperated patient\\u000a was contacted to obtain information about their postoperative course. Additionally,

  8. A comparison between randomly alternating imaging, normal laparoscopic imaging, and virtual reality training in laparoscopic psychomotor skill acquisition

    Microsoft Academic Search

    Julie-Anne Jordan; Anthony G Gallagher; Jim McGuigan; Kieran McGlade; Neil McClure

    2000-01-01

    Objectives: To evaluate virtual reality as a laparoscopic training device in helping surgeons to automate to the “fulcrum effect” by comparing it to time-matched training programs using randomly alternating images (ie, y-axis inverted and normal laparoscopic) and normal laparoscopic viewing conditions.Methods: Twenty-four participants (16 females and 8 males), were randomly assigned to minimally invasive surgery virtual reality (MIST VR), randomly

  9. Comparison of open and laparoscopic live donor nephrectomy.

    PubMed Central

    Flowers, J L; Jacobs, S; Cho, E; Morton, A; Rosenberger, W F; Evans, D; Imbembo, A L; Bartlett, S T

    1997-01-01

    OBJECTIVE: This study compares an initial group of patients undergoing laparoscopic live donor nephrectomy to a group of patients undergoing open donor nephrectomy to assess the efficacy, morbidity, and patient recovery after the laparoscopic technique. SUMMARY BACKGROUND DATA: Recent data have shown the technical feasibility of harvesting live renal allografts using a laparoscopic approach. However, comparison of donor recovery, morbidity, and short-term graft function to open donor nephrectomy has not been performed previously. METHODS: An initial series of patients undergoing laparoscopic live donor nephrectomy were compared to historic control subjects undergoing open donor nephrectomy. The groups were matched for age, gender, race, and comorbidity. Graft function, intraoperative variables, and clinical outcome of the two groups were compared. RESULTS: Laparoscopic donor nephrectomy was attempted in 70 patients and completed successfully in 94% of cases. Graft survival was 97% versus 98% (p = 0.6191), and immediate graft function occurred in 97% versus 100% in the laparoscopic and open groups, respectively (p = 0.4961). Blood loss, length of stay, parenteral narcotic requirements, resumption of diet, and return to normal activity were significantly less in the laparoscopic group. Mean warm ischemia time was 3 minutes after laparoscopic harvest. Morbidity was 14% in the laparoscopic group and 35% in the open group. There was no mortality in either group. CONCLUSIONS: Laparoscopic live donor nephrectomy can be performed with morbidity and mortality comparable to open donor nephrectomy, with substantial improvements in patient recovery after the laparoscopic approach. Initial graft survival and function rates are equal to those of open donor nephrectomy, but longer follow-up is necessary to confirm these observations. PMID:9351716

  10. A Laparoscopic Knot-Tying Device for Minimally Invasive Cardiac Surgery

    PubMed Central

    Jernigan, Shaphan; Chanoit, Guillaume; Veeramani, Arun; Owen, S. Brian; Hilliard, Matthew; Cormier, Denis; Laffitte, Bryan; Buckner, Gregory

    2009-01-01

    Objectives Intracorporeal suturing and knot tying can complicate, prolong or preclude minimally invasive surgical procedures, reducing their advantages over conventional approaches. An automated knot-tying device has been developed to speed suture fixation during minimally invasive cardiac surgery while retaining the desirable characteristics of conventional hand-tied surgeon's knots: holding strength and visual and haptic feedback. A rotating slotted disk (at the instrument's distal end) automates overhand throws, thereby eliminating the need to manually pass one suture end through a loop in the opposing end. Electronic actuation of this disk produces left or right overhand knots as desired by the operator. Methods To evaluate the effectiveness of this technology, 7 surgeons with varying laparoscopic experience tied knots within a simulated minimally invasive setting, using both the automated knot-tying tool and conventional laparoscopic tools. Suture types were 2-0 braided and 4-0 monofilament. Results Mean knot-tying times were 246 ±116 seconds and 102 ±46 seconds for conventional and automated methods, respectively, showing an average 56% reduction in time per surgeon (p=0.003, paired t-test). The peak holding strength of each knot (the force required to break the suture or loosen the knot) was measured using tensile testing equipment. These peak holding strengths were normalized by the ultimate tensile strength of each suture type (57.5 N and 22.1 N for 2-0 braided and 4-0 monofilament, respectively). Mean normalized holding strengths for all knots were 68.2% and 71.8% of ultimate tensile strength for conventional and automated methods, respectively (p= 0.914, paired t-test). Conclusions Experimental data reveal that the automated suturing device has great potential for advancing minimally invasive surgery: it significantly reduced knot-tying times while providing equivalent or greater holding strength than conventionally tied knots. PMID:19854658

  11. Haptic rendering for VR laparoscopic surgery simulation.

    PubMed

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

    2006-03-01

    This project concerns the application of haptic feedback to a VR laparoscopic surgery simulator. Haptic attributes such as mass, friction, elasticity, roughness and viscosity are individually modeled, validated and applied to the existing visual simulation created by researchers at Monash University. Haptic feedback is an essential element in an immersive and realistic virtual reality laparoscopic training simulator. The haptic system must display stable, continuous and realistic multi-dimensional force feedback, and its inclusion should enhance the simulators training capability. Stability is a recurring concern throughout haptic history, and will be tackled with the implementation of a stable control algorithm and a passive environment model. Haptic force feedback modeling, systems implementation and validation studies form the principal areas of new work associated with this project. PMID:16623225

  12. Laparoscopic fascial suture repair of parastomal hernia

    PubMed Central

    Zia, Khawaja; McGowan, David Ross; Moore, Etienne

    2013-01-01

    Parastomal hernia is a recognised complication following stoma formation, representing a challenging problem to surgeons. At least three approaches for parastomal hernia repair have been described: fascial suture repair, relocation of stoma and local repair with use of mesh. In simple fascial suture repair only open techniques have been described. Relocation of stoma can be complicated with another parastomal hernia at the new site and risk of incisional hernia at the site of previous stoma. Mesh repair can be either open or laparoscopic. The recurrence rate and complications of parastomal hernia repair remain very high. We have invented a simple fascial suture laparoscopic repair of parastomal hernia with the use of the Crochet hook needle (EndoClose). This new technique may result in reduced pain, earlier discharge from hospital and reduced risk of infection as there is no mesh used as well as reduced risk of seroma formation. PMID:23780775

  13. Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy.

    PubMed

    Eljaja, Salameh; Hadi, Sabah; El-Hussuna, Alaa

    2015-01-01

    We present a case of 47-year-old healthy man who underwent an uneventful elective laparoscopic cholecystectomy. Despite the postoperative analgesia with non-steroidal anti-inflammatory drugs (NSAIDs), the patient developed diffuse abdominal pain culminating on the second postoperative day when the patient also had rebound tenderness. A diagnostic laparoscopy showed diverticular perforation, which was treated with laparoscopic lavage and drain. The patient's condition continued to deteriorate and the drain output resembled faecal material necessitating an emergency sigmoidium resection. The histopathological examination confirmed inflammation and perforation in the diverticulosis-bearing segment. The use of NSAID can be a reason for perforation, and may be for diverticulitis. NSAID should be used with caution in patients with a previous history or endoscopic-verified diverticulosis. PMID:25770142

  14. Laparoscopic cholecystectomy for traumatic gallbladder perforation

    PubMed Central

    Hamilton, C; Carmichael, SP; Bernard, AC

    2012-01-01

    In trauma, laparoscopic surgery is commonly utilized as a diagnostic rather than therapeutic measure (1). Its use is often negated because of exigency or limitations in visibility due to haemorrhage. In the present case, a 35-year-old male was involved in a motor vehicle collision and arrived haemodynamically stable with abdominal pain. Abdominal CT revealed liver laceration and active contrast extravasation near the gallbladder fossa. Although angiography with embolization would normally be used, exploratory laparoscopy was performed because of concern for gallbladder injury. The gallbladder was found to be perforated and nearly completely avulsed from the fossa. Laparoscopic cholecystectomy was performed and the patient recovered uneventfully. Gallbladder perforation after trauma is typically an incidental finding during operation for haemorrhagic shock or other indication. Early diagnosis and swift surgical intervention are required, usually via laparotomy. However, when diagnosed preoperatively in the stable trauma victim, gallbladder perforation can be treated successfully with laparoscopy. PMID:24960682

  15. Hysterectomy, Oophorectomy and Risk of Dementia: A Nationwide Historical Cohort Study

    Microsoft Academic Search

    Thien Kieu Thi Phung; Berit Lindum Waltoft; Thomas Munk Laursen; Annette Settnes; Lars Vedel Kessing; Preben Bo Mortensen; Gunhild Waldemar

    2010-01-01

    Background: This study aimed to determine whether there is an association between hysterectomy and dementia. Methods: All female Danish residents born before 1966, alive on their 40th birthday and without a dementia diagnosis prior to 1977 (n = 2,313,388) were followed from January 1, 1977, or the age of 40, whichever came later, until dementia diagnosis, death, emigration or December

  16. Placenta percreta managed by transverse uterine fundal incision with retrograde cesarean hysterectomy: a novel surgical approach

    PubMed Central

    Matsuzaki, Shinya; Yoshino, Kiyoshi; Kumasawa, Keiichi; Satou, Noriko; Mimura, Kazuya; Kanagawa, Takeshi; Ueda, Yutaka; Kimura, Tadashi

    2014-01-01

    Key Clinical Message Placenta percreta (with bladder invasion) is a rare obstetric condition with the risk of massive intraoperative hemorrhage. In these cases, the combination of a transverse uterine fundal incision and retrograde cesarean hysterectomy could be useful to minimize maternal hemorrhage and avoid severe bladder injury. PMID:25548627

  17. Factors Related to Hysterectomy in Women with Physical and Mobility Disabilities

    ERIC Educational Resources Information Center

    Lin, Lan-Ping; Hsieh, Molly; Chen, Si-Fan; Wu, Chia-Ling; Hsu, Shang-Wei; Lin, Jin-Ding

    2012-01-01

    This paper aims to identify self-report data for hysterectomy prevalence and to explore its correlated factors among women with physical and mobility disabilities in Taiwan. This paper was part of a larger study, "Survey on Preventive Health Utilizations of People with Physical and Mobility Disability in Taiwan," which is a cross-sectional survey…

  18. Unexpected pathology during laparoscopic bariatric surgery

    Microsoft Academic Search

    C. W. Finnell; A. K. Madan; C. A. Ternovits; S. J. Menachery; D. S. Tichansky

    2007-01-01

    Background  The popularity of bariatric surgery has increased in recent years with the escalating incidence of morbid obesity in our society.\\u000a The improvement in minimally invasive technology and the increased number of laparoscopic bariatric procedures being performed\\u000a have resulted in the discovery of unexpected pathology not suspected preoperatively. The authors hypothesized that the occurrence\\u000a of unexpected pathology is not associated with

  19. Laparoscopic repair of a Morgagni hernia

    Microsoft Academic Search

    H. G. Rau; H. M. Schardey; V. Lange

    1994-01-01

    Laparoscopic repair of a diaphragmatic hernia through the right sternocostal foramen of Morgagni in an obese 42-year-old man is described. The indications for surgery were symptoms of strain-induced dyspnea and tightness in the chest. The technique was carried out by incorporating a marlex mesh into the defect and fixing it in place with hernia staples. The patient had an immediate

  20. Laparoscopic Radical Trachelectomy: Technique, Feasibility, and Outcomes

    PubMed Central

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

    2015-01-01

    Background and Objectives: Our objectives are to describe our surgical technique for laparoscopic radical trachelectomy, to evaluate its feasibility, and to present the perioperative results at Hospital Italiano de Buenos Aires, Argentina. Methods: We analyzed 4 patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer between December 2011 and May 2013. Results: Four patients were included in this study. Total laparoscopic radical trachelectomy was performed in all cases. The mean age was 26 years (range, 19–32 years), the mean body mass index was 21 (range, 18–23), and the mean length of hospital stay was 33 hours (range, 24–36 hours). The mean operative time was 225 minutes (range, 210–240 minutes), and no complications were reported. During the postoperative period, only 1 patient presented with left vulvar edema, which resolved spontaneously. The pelvic and parametrial lymph nodes, as well as the vaginal cuff and cervical resection margins, were negative for malignancy in all cases. On average, 18 pelvic lymph nodes (range, 15–20) were removed. The tumor stage was IB in all 4 patients, and the mean tumor size was 17 mm (range, 12–31 mm). No patient required conversion to laparotomy. Conclusion: We consider laparoscopic radical trachelectomy, performed by trained surgeons, a feasible and safe therapeutic option as a fertility-sparing surgical technique, with good perioperative outcomes for women with early-stage cervical cancer with a desire to preserve their fertility. Minimally invasive surgery provides the widely known benefits of this type of approach. PMID:25848183

  1. The Development of Laparoscopic Surgery in Spain

    Microsoft Academic Search

    Xavier Feliu; Eduardo María Targarona; Ana García-Agustí; Albert Pey; Angel Carrillo; Antonio María Lacy; Salvador Morales; José Luis Salvador; Antonio Torres; Enrique Veloso

    2004-01-01

    Aim: To assess degree of development and level of acceptance of laparoscopic surgery in Spain. Method: A questionnaire was sent to all members of the Spanish Association of Surgeons in April 2003. It included 32 questions, 9 of which were general, and 23 referred to specific clinical situations, techniques, and standard practice. Results: Eight hundred and fifty-eight (33.1%) surgeons replied.

  2. Laparoscopic versus Open Appendectomy: Time to Decide

    Microsoft Academic Search

    Abe Fingerhut; Bertrand Millat; Fredéric Borrie

    1999-01-01

    .   Although widely practiced, laparoscopic appendectomy (LA) has not met with universal approval. Several controlled trials\\u000a have been conducted, some in favor, others not. The goal of this review was to ascertain (1) if laparoscopy was capable of\\u000a improving the diagnostic and therapeutic difficulties encountered during open appendectomy (OA) and (2) if the introduction\\u000a of laparoscopy in the overall management

  3. Revisional surgery after laparoscopic sleeve gastrectomy.

    PubMed

    Ferrer-Márquez, Manuel; Belda-Lozano, Ricardo; Solvas-Salmerón, Ma José; Ferrer-Ayza, Manuel

    2015-02-01

    The recent increase in the frequency of bariatric surgery, especially laparoscopic sleeve gastrectomy, is associated with an increase in the frequency of revisional bariatric surgery. The causes of this are numerous but can be summarized as: (1) late fistulae (2) stenosis; (3) gastroesophageal reflux; and (4) weight regain (by increasing or not increasing the gastric volume). We present below a review of the clinical features, diagnosis, and treatment of them. PMID:25318535

  4. Laparoscopic Treatment of Pancreatic Pseudocysts in Children

    PubMed Central

    Rothenberg, Steven; Tsao, Kuojen; Wulkan, Mark L.; Ponsky, Todd A.; St. Peter, Shawn D.; Ostlie, Daniel J.; Kane, Timothy D.

    2009-01-01

    Abstract Background Pancreatic pseudocysts are problematic sequelae of pancreatitis or pancreatic trauma causing persistent abdominal pain, nausea, and gastric outlet obstruction. Due to the low volume of disease in children, there is scant information in the literature on the operative management of pseudocysts with minimally invasive techniques. We conducted a multi-institutional review to illustrate several technical variations utilized in achieving laparoscopic cystgastrostomy in the pediatric population. Methods A retrospective review was conducted of all patients who underwent laparoscopic cystgastrostomy in five institutions. Patient data, operative techniques, and postoperative course were analyzed. Results There were 13 patients with a mean age of 10.4 years and mean weight of 52.1 kg. The etiologies of pancreatitis included: trauma (4), gallstones (3), chemotherapy (2), hereditary (1), and idiopathic (3). Preoperative radiographic measurements of the maximal cyst diameter averaged 11.7 cm. Cystgastrostomy was approached by using transgastric exposure in 5 cases and intragastric ports in 8 cases. An average of four ports were used to complete these operations. Mean operative time was 113 minutes. There were no conversions in this series. Cystgastrostomy was performed by using an endoscopic stapler (average 3.8 loads) in 6 cases, sutures in 6 cases, and 1 was formed solely with the Harmonic Scalpel (Johnson and Johnson). Gastrotomy sites were closed by using a stapler in 4 cases and suture techniques in 9. Mean time to initial and goal feeds was 3 and 4 days, respectively. Postoperative imaging revealed persistent pseudocyst in 1 patient, who was treated with a distal pancreatectomy. Therefore, 92% required no further operative intervention and remained asymptomatic upon recovery from their pancreatitis. Conclusion A laparoscopic approach to pancreatic cystgastrostomy for chronic pseudocyst proved to be safe and effective in this five-institution survey. Techniques varied, but 92% had complete resolution with minimal morbidity and rapid recovery. Laparoscopic cystgastrostomy should be considered as an appropriate first-line treatment for chronic pseudocysts in children. PMID:19281422

  5. Learning kinematic mappings in laparoscopic surgery

    Microsoft Academic Search

    Felix C. Huang; Carla M. Pugh; James L. Patton; Ferdinando A. Mussa-Ivaldi

    2010-01-01

    We devised an interactive environment in which subjects could perform simulated laparoscopic maneuvers, using either unconstrained movements or standard mechanical contact typical of a box-trainer. During training the virtual tool responded to the absolute position in space (Position-Based) or the orientation (Orientation-Based) of a hand-held sensor. Volunteers were further assigned to different sequences of target distances (Near-Far-Near or Far-Near-Far). Orientation-Based

  6. Outcomes of Laparoscopic Cholecystectomy in Octogenarians

    PubMed Central

    Marcari, Rafael S.; Roberto Nadal, Luis; Rego, Ronaldo E.; Coelho, Andrea M.; de Matos Farah, José Francisco

    2012-01-01

    Background and Objectives: Extremely elderly patients usually present with complicated gallstone disease and are less likely to undergo definitive treatment. The purpose of this study was to evaluate the results of laparoscopic cholecystectomy in octogenarians, with an interest in patients presenting initially with complicated gallstone disease and pancreatitis who underwent laparoscopic cholecystectomy during the same hospitalization. Methods: Data for 42 patients ?80 years who underwent an elective laparoscopic cholecystectomy between January 2007 and August 2011 were retrospectively reviewed. Indications for the procedure were stratified into 2 groups: Outpatients, who were admitted electively to undergo cholecystectomy, and Inpatients, who came to our Emergency Room due to complicated biliary diseases. Data analysis included age, sex, ASA score, conversion to open surgery, time spent under general anesthesia, and length of hospital stay. Results: Mean age was 83.9 years; 19 (45.2%) were men. Thirteen patients (30.9%) were in the outpatient group, and 13 (30.9%) had a preoperative ASA of 3. Fourteen patients (33.3%) needed ICU. Two patients (4.8%) had their surgery converted. There were 7 (16.7%) postoperative complications, all of them classified as Dindo-Clavien I or II. No differences were noted between groups regarding conversion rates or complications. We had no mortalities in this series. There was no difference in hospital length of stay between the groups. Conclusion: Laparoscopic cholecystectomy in the extremely elderly is safe, with acceptable morbidity. Patients with complicated gallstone disease seem not to have worse postoperative outcomes once the initial diagnosis is properly treated and would benefit from definitive therapy during the same hospitalization. PMID:23477177

  7. Laparoscopic Anderson-Hynes pyeloplasty in children

    Microsoft Academic Search

    F. Schier

    1998-01-01

    In two children (ages 14 and 7 years) a laparoscopic Anderson-Hynes pyeloplasty was performed. In the 14-year-old boy a para-anastomotic\\u000a drain was placed; a urinoma developed postoperatively, which was treated by a pyelostoma placed transcutaneously. In the 7-year-old\\u000a boy a transanastomotic pyelostoma splint was placed intraoperatively. The splint was removed 10?days later; the postoperative\\u000a course was uneventful. Operative time was

  8. Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial - the MIRO trial

    PubMed Central

    2011-01-01

    Background Open transthoracic oesophagectomy is the standard treatment for infracarinal resectable oesophageal carcinomas, although it is associated with high mortality and morbidity rates of 2 to 10% and 30 to 50%, respectively, for both the abdominal and thoracic approaches. The worldwide popularity of laparoscopic techniques is based on promising results, including lower postoperative morbidity rates, which are related to the reduced postoperative trauma. We hypothesise that the laparoscopic abdominal approach (laparoscopic gastric mobilisation) in oesophageal cancer surgery will decrease the major postoperative complication rate due to the reduced surgical trauma. Methods/Design The MIRO trial is an open, controlled, prospective, randomised multicentre phase III trial. Patients in study arm A will receive laparoscopic-assisted oesophagectomy, i.e., a transthoracic oesophagectomy with two-field lymphadenectomy and laparoscopic gastric mobilisation. Patients in study arm B will receive the same procedure, but with the conventional open abdominal approach. The primary objective of the study is to evaluate the major postoperative 30-day morbidity. Secondary objectives are to assess the overall 30-day morbidity, 30-day mortality, 30-day pulmonary morbidity, disease-free survival, overall survival as well as quality of life and to perform medico-economic analysis. A total of 200 patients will be enrolled, and two safety analyses will be performed using 25 and 50 patients included in arm A. Discussion Postoperative morbidity remains high after oesophageal cancer surgery, especially due to major pulmonary complications, which are responsible for 50% of the postoperative deaths. This study represents the first randomised controlled phase III trial to evaluate the benefits of the minimally invasive approach with respect to the postoperative course and oncological outcomes in oesophageal cancer surgery. Trial Registration NCT00937456 (ClinicalTrials.gov) PMID:21781337

  9. Cost-Effective Restrictive Bariatric Surgery: Laparoscopic Vertical Banded Gastroplasty Versus Laparoscopic Adjustable Gastric Band

    Microsoft Academic Search

    Peter Ojo; Elmer Valin

    2009-01-01

    Background  Among bariatric restrictive operations, the procedure of choice is still controversial. The aim of this study is to compare\\u000a the cost of two gastric restrictive procedures: laparoscopic vertical banded gastroplasty (LVBG) and laparoscopic adjustable\\u000a gastric banding (LAGB).\\u000a \\u000a \\u000a \\u000a Methods  This is a prospective nonrandomized study comparing the cost effectiveness of LVBG and LAGB. Fifty-nine LVBG are compared\\u000a to 83 LAGB performed during

  10. Laparoscopic fundoplication for gastroesophageal reflux disease

    PubMed Central

    Frazzoni, Marzio; Piccoli, Micaela; Conigliaro, Rita; Frazzoni, Leonardo; Melotti, Gianluigi

    2014-01-01

    Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor (PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total (360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior (Toupet) fundoplication, and the anterior (Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard. PMID:25339814

  11. [A novel technique of laparoscopic hepatectomy].

    PubMed

    Ishizaki, Morihiko; Kaibori, Masaki; Matsui, Kosuke; Iida, Hiroya; Nakatake, Richi; Matsushima, Hideyuki; Sakaguchi, Tatsuma; Kwon, A-Hon

    2014-11-01

    We report a novel technique of laparoscopic hepatectomy (lap-HT) performed at our hospital and the outcomes.Lap -HT was performed in 90 cases at our hospital, including 38 cases of anatomical resection of the liver.After mobilization of the right lobe with the patient in the half-lateral position, we resected the liver tissue using cavitron ultrasonic surgical aspirator (CUSA) and AquamantysTM Bipolar®.This surgical instrument is useful for laparoscopic anatomical resection of the liver because it is based on vessel sealing technology.In the 90 cases in which lap-HT was performed, the mean duration of surgery and mean blood loss were 332.9 minutes and 381 mL, respectively. The mean duration of hospitalization after surgery was 12.1 days, and postoperative complications were noted in 5 cases(5.6%). Comparison of the clinical factors and short-term performance of the surgery between liver cirrhosis patients who underwent open hepatectomy and lap-HT revealed that blood loss was significantly lower and the hospital stay duration was significantly shorter in patients who underwent lap-HT. Our findings suggest that laparoscopic anatomical resection of the liver can be safely performed using this novel technique and surgical instrument. PMID:25731230

  12. Prospective comparison of open vs . laparoscopic colon surgery for carcinoma

    Microsoft Academic Search

    Morris E. Franklin; Daniel Rosenthal; Daniel Abrego-Medina; James P. Dorman; Jeffrey L. Glass; Richard Norem; Antonio Diaz

    1996-01-01

    Laparoscopy for colonic diseases began in 1990 and has established a role in benign disease. Early observations and experiences demonstrated feasibility of laparoscopic surgery for a variety of colonic disease processes, but the applicability to colonic carcinoma was unclear. METHODS: In 1990, we began a comparative study of open (OCR)vs.laparoscopic (LCR) approach to colon cancer. The study progressed 65 months,

  13. Laparoscopic preservation of ovarian function: An underused procedure

    Microsoft Academic Search

    Mazen Bisharah; Togas Tulandi

    2003-01-01

    Objective: There are many young women undergoing irradiation or chemotherapy without having the option of preserving their ovarian function. Our purpose was to review the literature on laparoscopic ovarian transposition, to evaluate its efficacy, and to provide clinical opinion on the subject. Study design: We evaluated the English articles on laparoscopic ovarian transposition identified through a MEDLINE search. We also

  14. Pilot Study on Laparoscopic Surgery in Port-Harcourt, Nigeria

    PubMed Central

    Ray-Offor, E; Okoro, PE; Gbobo, I; Allison, AB

    2014-01-01

    Background: Video-laparoscopic surgery has long been practiced in western countries; however documented practice of this minimal access surgical technique are recently emanating from Nigeria. To the best of our knowledge, this is the first documented study on laparoscopic surgery from the Niger Delta region. Aim: To evaluate the feasibility of laparoscopy as a useful tool for management of common surgical abdominal conditions in our environment. Patients and Methods: This was a prospective outcome study of all consecutive surgical patients who had laparoscopic procedures in general and pediatric surgery units of our institution from August 2011 to December 2012. Data on patient's age, gender, indication for surgery, duration of hospital stay and outcome of surgery were collected and analyzed. Results: A total of 15 laparoscopic procedures were performed during this study period with age range of 2-65 years; mean: 32.27 ± 17.86 years. There were 11 males and four females. Six laparoscopic appendicectomies, one laparoscopy-assisted orchidopexy, five diagnostic laparoscopy ± biopsy, one laparoscopic trans-abdominal pre-peritoneal herniorrhaphy for bilateral indirect inguinal hernia and two laparoscopic adhesiolysis for small bowel obstruction were performed. All were successfully completed except one conversion (6.7%) for uncontrollable bleeding in an intra-abdominal tumor. Conclusion: The practice of laparoscopic surgery in our environment is feasible and safe despite the numerous, but surmountable challenges. There is the need for adequate training of the support staff and a dedicated theatre suite. PMID:24665198

  15. Comparison of laparoscopic versus open repair of paraesophageal hernia

    Microsoft Academic Search

    Philip R Schauer; Sayeed Ikramuddin; Robert H McLaughlin; Toby O Graham; Adam Slivka; K. K. W Lee; W. H Schraut; J. D Luketich

    1998-01-01

    Background: Recent reports suggest that laparoscopic paraesophageal hernia repair (LPHR) is feasible, but no direct comparisons with the standard open paraesophageal hernia repair (OPHR) have been reported. The purpose of this study was to compare the short-term outcome of LPHR versus OPHR at a single institution.Methods: The operative and postoperative courses of 95 consecutive patients undergoing open or laparoscopic repair

  16. Laparoscopic Total Mesorectal Excision—The Turin Experience

    Microsoft Academic Search

    M. Morino; G. Giraudo

    Improved local control and survival rates in the treatment of rectal cancer have been reported after total mesorectal excision (TME). We performed an analysis of TME for rectal cancer by laparoscopic approach during a prospective nonrandomized trial. A prospective consecutive series of 98 laparoscopic total mesorectal excision (LTME) procedures for low and mid-rectal tumors. All patients had a sphincter-saving procedure.

  17. Smaller Ports Result in Shorter Convalescence After Laparoscopic Varicocelectomy

    Microsoft Academic Search

    Tadashi Matsuda; Keiji Ogura; Junji Uchida; Ichiro Fujita; Toshiro Terachi; Osamu Yoshida

    1995-01-01

    Minimal postoperative pain and a shorter convalescence after laparoscopic surgery are attributable to the small puncture wounds produced to accommodate trocars. We investigated the effects of trocar size on convalescence after 37 laparoscopic varicocelectomies. The initial 21 patients underwent the procedure with 2, 10 mm. ports and 1, 5 mm. port, while the last 16 underwent surgery with 3, 5

  18. Learning laparoscopic surgery by imitation using robot trainer

    Microsoft Academic Search

    Chee-Kong Chui; Chin-Boon Chng; Tao Yang; Rong Wen; Weimin Huang; Jimmy Liu; Yi Su; Stephen Chang

    2011-01-01

    Laparoscopic surgery requires rigorous training in order to overcome physical, spatial and visual constraints. We are developing a laparoscopic robot trainer. The robot trainer can learn the motion of the master surgeon when he is performing a virtual surgery, and drive the surgical tool by mimicking the learnt trajectory during training. This paper reports our investigation on robot learning using

  19. Laparoscopic cholecystectomy in-patient with situs inversus.

    PubMed

    Shah, A Y; Patel, B C; Panchal, B A

    2006-03-01

    In modern era, laparoscopic surgery is gold standard for gall bladder calculi. Situs inversus is a rare condition. To diagnose as well as operate any pathology in such patients is difficult. Laparoscopic cholecystectomy in such patient is a challenge but not contraindication. PMID:21170224

  20. A 3 TROCAR TECHNIQUE FOR TRANSPERITONEAL LAPAROSCOPIC NEPHRECTOMY

    Microsoft Academic Search

    FRANCOIS DESGRANDCHAMPS; DOMINIQUE GOSSOT; MICHEL E. JABBOUR; PAUL MERIA; PIERRE TEILLAC; ALAIN LE DUC

    1999-01-01

    PurposeAdditional trocars and retractor instruments may enhance the risk of iatrogenic injuries during laparoscopic nephrectomy. We describe a modified technique of laparoscopic nephrectomy requiring only 3 ports of entry and no extra instruments instead of the 5 ports, 2 of which are used for retractors, usually required.

  1. Band slippage after laparoscopic adjustable gastric banding: etiology and treatment

    Microsoft Academic Search

    A. Keidar; A. Szold; E. Carmon; A. Blanc; S. Abu-Abeid

    2005-01-01

    Background: Laparoscopic adjustable gastric banding is a safe and effective procedure for the management of morbid obesity. However, band slippage is a common complication with variable presentation that can be rectified by a second laparoscopic procedure. Methods: We studied case series of 125 consecutive patients who suffered from band slippage between November 1996 and May 2001 from a group of

  2. Open and Laparoscopic Treatment of Nonparasitic Splenic Cysts

    Microsoft Academic Search

    Duri Gianom; Alessandro Wildisen; Thomas Hotz; Federico Goti; Marco Decurtins

    2003-01-01

    Background: Nonparasitic splenic cysts are rare. Therefore, there is no ‘evidence-based’ information regarding their optimal surgical management. In the last years the laparoscopic approach has gained increasing acceptance in splenic surgery. The aim of this study is to present our experience with the laparoscopic management of splenic cysts. Methods:The medical records of 7 patients with splenic cysts were reviewed retrospectively.

  3. Force Propagation Models in Laparoscopic Tools and Shahram Payandeh

    E-print Network

    are beingfocused on developing a virtual laparoscopic trainers where the sense of touch in manipulating the virtual of instruments and system designs 1 2 3 . One of these limitations is the lack of haptic sensa- tion the surgeons to interact with graphical simulation of virtual laparoscopic environ- ment through a computer

  4. Laparoscopic Liver Resection for Malignant Liver Tumors

    PubMed Central

    Gigot, Jean-François; Glineur, David; Santiago Azagra, Juan; Goergen, Martine; Ceuterick, Marc; Morino, Mario; Etienne, José; Marescaux, Jacques; Mutter, Didier; van Krunckelsven, Ludo; Descottes, Bernard; Valleix, Dominique; Lachachi, François; Bertrand, Claude; Mansvelt, Baudouin; Hubens, Guy; Saey, Jean-Pierre; Schockmel, Romain

    2002-01-01

    Objective To assess the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors. Summary Background Data The precise role of laparoscopy in resection of liver malignancies (hepatocellular carcinoma [HCC] and liver metastases) remains controversial despite an increasing number of publications reporting laparoscopic resection of benign liver tumors. Methods A retrospective study was performed in 11 surgical centers in Europe regarding their experience with laparoscopic resection of liver malignancies. Detailed questionnaires were sent to each surgeon focusing on patient characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. All patients had radiologic investigations at follow-up to exclude disease recurrence. Results From February 1994 to December 2000, 37 patients with malignant liver tumors were included in this study. Ten patients had HCC, including 9 with cirrhotic liver, and 27 patients had liver metastases. The mean tumor size was 3.3 cm, and 89% of the tumors were located in the left lobe or in the anterior segments of the right liver. Liver procedures included 12 wedge resections, 9 segmentectomies, 14 bisegmentectomies (including 13 left lateral segmentectomies), and 2 major hepatectomies. The transfusion rate, the use of pedicular clamping, the conversion rate (13.5% in the whole series), and the complication rate were significantly greater in patients with HCC. There were no deaths. Postoperative complications occurred in eight patients (22%). The surgical margin was less than 1 cm in 30% of the patients. During a mean follow-up of 14 months, the 2-year disease-free survival was 44% for patients with HCC and 53% for patients having hepatic metastases from colorectal cancer. No port-site metastases were observed during follow-up. Conclusions In patients with small malignant tumors, located in the left lateral segments or in the anterior segments of the right liver, laparoscopic resection is feasible and safe. The complication rate is low, except in patients with HCC on cirrhotic liver. By using laparoscopic ultrasound, a 1-cm free surgical margin should be routinely obtained. The late outcome needs to be evaluated in expert centers. PMID:12131090

  5. Robotic laparoscopic surgery: cost and training.

    PubMed

    Amodeo, A; Linares Quevedo, A; Joseph, J V; Belgrano, E; Patel, H R H

    2009-06-01

    The advantages of minimally invasive surgery are well accepted. Shorter hospital stays, decreased postoperative pain, rapid return to preoperative activity, decreased postoperative ileus, and preserved immune function are among the benefits of the laparoscopic approach. However, the instruments of laparoscopy afford surgeons limited precision and poor ergonomics, and their use is associated with a significant learning curve and the amount of time and energy necessary to develop and maintain such advanced laparoscopic skills is not insignificant. The robotic surgery allows all laparoscopists to perform advanced laparoscopic procedures with greater ease. The potential advantages of surgical robotic systems include making advanced laparoscopic surgical procedures accessible to surgeons who do not have advanced video endoscopic training and broadening the scope of surgical procedures that can be performed using the laparoscopic method. The wristed instruments, x10 magnifications, tremor filtering, scaling of movements and three-dimensional view allow the urologist to perform the intricate dissection and anastomosis with high precision. The robot is not, however, without significant disadvantages as compared with traditional laparoscopy. These include greater expense and consumption of operating room resources such as space and the availability of skilled technical staff, complete elimination of tactile feedback, and more limited options for trocar placement. The current cost of the da Vinci system is $ 1.2 million and annual maintenance is $ 138000. Many studies suggest that depreciation and maintenance costs can be minimised if the number of robotic cases is increased. The high cost of purchasing and maintaining the instruments of the robotic system is one of its many disadvantages. The availability of the robotic systems to only a limited number of centres reduces surgical training opportunities. Hospital administrators and surgeons must define the reasons for developing a robotic surgical program: it is very important to show that robotics will add a dimension that will benefit the hospital, the patient care and institutional recognition. Another essential task to overcome is the important education of the operating room nursing staff, a significant difference between this modality and traditional surgery. Without operating room environment support, most surgeons will revert to traditional methods even after a few successful robotics cases. As the field of robotic surgery continues to grow, graduate medical education and continuing medical education programs that address the surgical robotic learning needs of residents and practicing surgeons need to be developed. PMID:19451894

  6. Minimally invasive surgical management of ureteropelvic junction obstruction: laparoscopic and robot-assisted laparoscopic pyeloplasty.

    PubMed

    Munver, Ravi; Del Pizzo, Joseph J; Sosa, R Ernest; Poppas, Dix P

    2003-01-01

    Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by an intrinsic or extrinsic obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital in origin; however, acquired conditions at the level of the ureteropelvic junction may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options, with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy and robot-assisted applications has allowed for minimally invasive reconstructive surgery that mirrors open surgical techniques. These techniques offer substantial benefits to patients by reducing morbidity, hastening postoperative recovery, and improving cosmetic outcome. During the last decade, laparoscopic pyeloplasty has garnered much interest. However, because of the technically challenging nature of this procedure, it is performed only at select medical centers by surgeons with advanced laparoscopic training. The recent introduction of robotics to the field of minimally invasive surgery may facilitate this procedure and allow for more widespread implementation by surgeons of varying skill levels. This review is limited primarily to the treatment of congenital or acquired UPJ obstruction via laparoscopic and robot-assisted laparoscopic pyeloplasty. Herein, we report the early results, ongoing evolution, and potential future role for these novel surgical procedures. PMID:14649575

  7. Sexuality and Body Image After Uterine Artery Embolization and Hysterectomy in the Treatment of Uterine Fibroids: A Randomized Comparison

    PubMed Central

    Volkers, Nicole A.; Bartholomeus, Wouter; de Blok, Sjoerd; Birnie, Erwin; Reekers, Jim A.; Ankum, Willem M.

    2007-01-01

    In this paper the effect of uterine artery embolization (UAE) on sexual functioning and body image is investigated in a randomized comparison to hysterectomy for symptomatic uterine fibroids. The EMbolization versus hysterectoMY (EMMY) trial is a randomized controlled study, conducted at 28 Dutch hospitals. Patients were allocated hysterectomy (n = 89) or UAE (n = 88). Two validated questionnaires (the Sexual Activity Questionnaire [SAQ] and the Body Image Scale [BIS]) were completed by all patients at baseline, 6 weeks, and 6, 12, 18, and 24 months after treatment. Repeated measurements on SAQ scores revealed no differences between the groups. There was a trend toward improved sexual function in both groups at 2 years, although this failed to reach statistical significance except for the dimensions discomfort and habit in the UAE arm. Overall quality of sexual life deteriorated in a minority of cases at all time points, with no significant differences between the groups (at 24 months: UAE, 29.3%, versus hysterectomy, 23.5%; p = 0.32). At 24 months the BIS score had improved in both groups compared to baseline, but the change was only significant in the UAE group (p = 0.009). In conclusion, at 24 months no differences in sexuality and body image were observed between the UAE and the hysterectomy group. On average, both after UAE and hysterectomy sexual functioning and body image scores improved, but significantly so only after UAE. PMID:17671809

  8. Sexuality and Body Image After Uterine Artery Embolization and Hysterectomy in the Treatment of Uterine Fibroids: A Randomized Comparison

    SciTech Connect

    Hehenkamp, Wouter J. K. [Academic Medical Centre Amsterdam, Department of Gynaecology (Netherlands)], E-mail: w.j.k.hehenkamp@amc.uva.nl; Volkers, Nicole A. [Academic Medical Centre Amsterdam, Department of Radiology (Netherlands); Bartholomeus, Wouter [Academic Medical Centre Amsterdam, Faculty of Medicine (Netherlands); Blok, Sjoerd de [Onze Lieve Vrouwe Gasthuis, Amsterdam, Department of Gynaecology (Netherlands); Birnie, Erwin [Academic Medical Centre Amsterdam, Public Health Epidemiology (Netherlands); Reekers, Jim A. [Academic Medical Centre Amsterdam, Department of Radiology (Netherlands); Ankum, Willem M. [Academic Medical Centre Amsterdam, Department of Gynaecology (Netherlands)

    2007-09-15

    In this paper the effect of uterine artery embolization (UAE) on sexual functioning and body image is investigated in a randomized comparison to hysterectomy for symptomatic uterine fibroids. The EMbolization versus hysterectoMY (EMMY) trial is a randomized controlled study, conducted at 28 Dutch hospitals. Patients were allocated hysterectomy (n = 89) or UAE (n 88). Two validated questionnaires (the Sexual Activity Questionnaire [SAQ] and the Body Image Scale [BIS]) were completed by all patients at baseline, 6 weeks, and 6, 12, 18, and 24 months after treatment. Repeated measurements on SAQ scores revealed no differences between the groups. There was a trend toward improved sexual function in both groups at 2 years, although this failed to reach statistical significance except for the dimensions discomfort and habit in the UAE arm. Overall quality of sexual life deteriorated in a minority of cases at all time points, with no significant differences between the groups (at 24 months: UAE, 29.3%, versus hysterectomy, 23.5%; p = 0.32). At 24 months the BIS score had improved in both groups compared to baseline, but the change was only significant in the UAE group (p = 0.009). In conclusion, at 24 months no differences in sexuality and body image were observed between the UAE and the hysterectomy group. On average, both after UAE and hysterectomy sexual functioning and body image scores improved, but significantly so only after UAE.

  9. Single incision laparoscopic cholecystectomy: A review on the complications

    PubMed Central

    Fransen, Sofie; Stassen, L.; Bouvy, N.

    2012-01-01

    BACKGROUND: The aim of this study was to establish the incidence of postoperative complications after single incision laparoscopic cholecystectomy. MATERIALS AND METHODS: A literature search was performed using the PubMed database. Search terms included single incision laparoscopic cholecystectomy, single port cholecystectomy, minimal invasive laparoscopic cholecystectomy, nearly scarless cholecystectomy and complications. RESULTS: A total of 38 articles meeting the selection criteria were reviewed. A total of 1180 patients were selected to undergo single incision laparoscopic cholecystectomy. Introduction of extra ports was necessary in 4% of the patients. Conversion to open cholecystectomy was required in 0.4% of the patients. Laparoscopic cholangiography was attempted in 4% of the patients. The incidence of major complications requiring surgical intervention or ERCP with stenting was 1.7%. The mortality rate was zero. CONCLUSION: Although the number of complications after single incision laparoscopic cholecystectomy seems favourable, it is too early to conclude that single incision laparoscopic cholecystectomy is a safe procedure. Large randomised controlled trials will be necessary to further establish its safety. PMID:22303080

  10. Management of giant hepatic cysts in the laparoscopic era

    PubMed Central

    Choi, Chan Joong; Roh, Young Hoon; Jung, Ghap Joong; Seo, Jeong Wook; Baek, Yang Hyun; Lee, Sung Wook; Roh, Myung Hwan; Han, San Young; Jeong, Jin Sook

    2013-01-01

    Purpose We sought to evaluate the feasibility and outcomes of laparoscopic resection of giant hepatic cysts and surgical success, focusing on cyst recurrence. Methods From February 2004 to August 2011, 37 consecutive patients with symptomatic hepatic cysts were evaluated and treated at Dong-A University Hospital. Indications were simple cysts (n = 20), multiple cysts (n = 6), polycystic disease (n = 2), and cystadenoma (n = 9). Results The median patient age was 64 years, with a mean lesion diameter of 11.4 cm. The coincidence between preoperative imaging and final pathologic diagnosis was 54% and half (n = 19) of the cysts were located in segments VII and VIII. Twenty-two patients had American Society of Anesthesiologists (ASA) classification I and II, and nine had ASA classification III. Surgical treatment of hepatic cysts were open liver resection (n = 3), laparoscopic deroofing (n = 24), laparoscopic cyst excision (n = 4), laparoscopic left lateral sectionectomy (n = 2), hand assisted laparoscopic procedure (n = 2), and single port laparoscopic deroofing (n = 2). The mean fellow-up was 21 months, and six patients (16%) experienced radiographic-apparent recurrence. Reoperation due to recurrence was performed in two patients. Among the factors predicting recurrence, multivariate analysis revealed that interventional radiological procedures and pathologic diagnosis were statistically significant. Conclusion Laparoscopic resection of giant hepatic cysts is a simple and effective method to relieve symptoms with minimal surgical trauma. Moreover, the recurrence is dependent on the type of pathology involved, and the sclerotherapy undertaken. PMID:24020020

  11. [Laparoscopic surgery for colonic cancer: present status and evaluation].

    PubMed

    Okajima, Masazumi; Ikeda, Satoshi; Egi, Hiroyuki; Yoshimitsu, Masanori; Asahara, Toshimasa

    2006-03-01

    It has been 15 years since laparoscopic surgery was first performed in colonic cancer. An inquiry-based analysis by the Japan Society of Endoscopic Surgery (JSES) in 2003 showed a steady increase in the number of laparoscopic colonic resections for cancer. This report also indicates that advanced cancer candidates exceeded early-stage patients in 2003. From the technical point of view, pure laparoscopic access and a medial dissection approach rather than hand-assisted laparoscopic surgery (HALS) and a lateral dissection approach is more likely to be selected as a standard procedure. In 2004, the Endoscopic Surgical Skill Qualification System was proposed by the JSES to promote safer laparoscopic surgery in Japan. For colonic qualification, a thorough videotape of colonic cancer resection is to be evaluated so that not only laparoscopic surgical skill but also oncologic handling is taken into account. In clinical research, based on the results of a multicenter, randomized, controlled study of open vs. laparoscopic-assisted colectomy in the USA and Europe, a Japanese trial has also now started to determine the optimum quality control of surgical skill. The results of this study arre expected to lead to less deviation in the level of surgical skill. PMID:16613209

  12. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    PubMed Central

    Singh, Harsimran; Kundra, Sandeep; Singh, Rupinder M; Grewal, Anju; Kaul, Tej K; Sood, Dinesh

    2013-01-01

    Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy. PMID:24249984

  13. Stentless laparoscopic pyeloplasty: A single center experience

    PubMed Central

    Khawaja, Abdul Rouf; Dar, Tanveer Iqbal; Bashir, Farzana; Sharma, Ajay; Tyagi, Vipin; Bazaz, Mohammad Sajid

    2014-01-01

    Aim: To assess the effectiveness of laparoscopic stentless pyeloplasty for congenital ureteropelvic junction obstruction. Materials and Methods: This was a prospective comparative study conducted over a period of 5 years. The study included 35 cases of primary ureteropelvic junction obstruction (UPJO) with mean age of 29.5 years, divided in two groups- Group A (stent-less, 18 patients) and Group B (stented, 17 patients). Follow up ranged from one to 4years (mean 2 years). Transperitoneal laparoscopic Anderson- Hyene's pyeloplasty was standard for both the groups. Perioperative and postoperative complications were prospectively collected and analyzed by Statistical Package for Social Sciences (SPSS) 17 version using Pearson chi square test. Results: Both the groups were comparable with respect to preoperative differential renal function (DRF) and time required for maximum activity in minutes (tmax.min). Average post operative DRF was significantly higher than preoperative DRF in both the groups. Average tmax was significantly lower after pyeloplasty than pre operative tmax. Mean operative time, mean duration of urethral catheter, and mean duration of drain removal were comparable in both the groups. However bothersome irritative lower urinary tract symptoms (LUTS) and hematuria were significantly more in group B patients (P < 0.0001 and <0.013 respectively). Conclusion: In experienced hands, laparoscopic stentless pyeloplasty is as effective method for treating UPJO as its stented counterpart. It is cost effective, avoids stent-related morbidity, and could be performed without compromising the success rate. However, more randomized studies are needed to evaluate the safety of stentless pyeloplasty. PMID:25125891

  14. Development and clinical application of surgical navigation system for laparoscopic hepatectomy

    NASA Astrophysics Data System (ADS)

    Hayashi, Yuichiro; Igami, Tsuyoshi; Hirose, Tomoaki; Nagino, Masato; Mori, Kensaku

    2015-03-01

    This paper describes a surgical navigation system for laparoscopic surgery and its application to laparoscopic hepatectomy. The proposed surgical navigation system presents virtual laparoscopic views using a 3D positional tracker and preoperative CT images. We use an electromagnetic tracker for obtaining positional information of a laparoscope and a forceps. The point-pair matching registration method is performed for aligning coordinate systems between the 3D positional tracker and the CT images. Virtual laparoscopic views corresponding to the laparoscope position are generated from the obtained positional information, the registration results, and the CT images using a volume rendering method. We performed surgical navigation using the proposed system during laparoscopic hepatectomy for fourteen cases. The proposed system could generate virtual laparoscopic views in synchronization with the laparoscope position during surgery.

  15. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound.

    PubMed Central

    John, T G; Greig, J D; Crosbie, J L; Miles, W F; Garden, O J

    1994-01-01

    OBJECTIVE. The authors describe the technique of staging laparoscopy with laparoscopic contact ultrasonography in the preoperative assessment of patients with liver tumors, and assess its impact on the selection of patients for hepatic resection with curative intent. SUMMARY BACKGROUND DATA. Laparoscopy may be useful in the selection of patients with a variety of intra-abdominal malignancies for operative intervention. Laparoscopic ultrasonography is a new technique that combines the principles of high resolution intraoperative contact ultrasound with those of the laparoscopic examination, and thus, allows the laparoscopist to perform detailed assessment of the liver. METHODS. This study analyzes a cohort of 50 consecutive patients who were diagnosed as having potentially resectable liver tumors, and in whom staging laparoscopy was successfully undertaken. Laparoscopic ultrasonography was performed in 43 patients, and the impact of the ensuing findings on the decision to proceed to operative assessment of resectability is examined. The resectability rate in those patients assessed laparoscopically and subsequently submitted to laparotomy is compared with a preceding group of patients in whom no laparoscopic assessment was performed. RESULTS. Laparoscopy demonstrated factors precluding curative resection in 23 patients (46%). Laparoscopic ultrasonography identified liver tumors not visible during laparoscopy in 14 patients (33%), and provided staging information in addition to that derived from laparoscopy alone in 18/43 patients (42%). The resectability rate was significantly higher among those patients undergoing laparoscopic staging (93%) compared with those in whom operative assessment was undertaken without laparoscopy (58%). CONCLUSIONS. Staging laparoscopy with laparoscopic ultrasonography optimizes patient selection for liver resection with curative intent. Images Figure 1. Figure 2. PMID:7986136

  16. Laparoscopic management of benign liver diseases: where are we?

    PubMed Central

    Hubert, Catherine; Banice, Radu; Kendrick, Michael L

    2004-01-01

    Background The role of laparoscopic surgery in the management of benign cystic and solid liver tumours appears to differ according to each tumour type. As regards congenital liver cysts, laparoscopic treatment is now the gold standard for treating selected, huge, accessible, highly symptomatic or complicated cysts. In contrast, the laparoscopic approach is not useful for patients suffering from adult polycystic liver disease (PLD), except for type I PLD with large multiple hepatic cysts. For benign hepatocellular tumours, the surgical management has recently benefited from a better knowledge of the natural history of each type of tumour and from the improvement of imaging techniques in assuring a precise diagnosis of tumour nature. Thus the general tendency has led to a progressive restriction and tailoring of indications for resection in benign liver tumours, selecting only patients with huge, specifically symptomatic or compressive benign tumours or patients suffering from liver cell adenoma. Despite the enthusiastic use of the laparoscopic approach, selective indications for resection of benign liver tumours should indeed remain unchanged. For all types of benign liver tumours, the best indication remains small, superficial lesions, located in the anterior or the lateral segments of the liver. Deep, centrally located lesions or tumours in contact with major vascular or biliary trunks are not ideal candidates for laparoscopic liver resections. When performed by expert liver and laparoscopic surgeons using an adequate surgical technique, the laparoscopic approach is safe for performing minor liver resections and is accompanied by the usual postoperative benefits of laparoscopic surgery. When applied in selected patients and tumours, laparoscopic management of benign liver diseases appears to be a promising technique for hepatobiliary surgeons. PMID:18333077

  17. Bladder perforation during laparoscopic donor nephrectomy.

    PubMed

    Metcalfe, P D; Hickey, L; Lawen, J G

    2004-12-01

    We present two cases of bladder perforation during laparoscopic donor nephrectomy at our institution. Neither of the surgeries was otherwise complicated, and the diagnoses were made post-operatively. The kidneys were extracted through a Pfannenstiel incision and used blunt dissection to penetrate the peritoneum. Both patients had previous tubal ligations, adhesions from which may have increased the chance of injury. We believe that this is a previously unreported complication that merits attention. Care should be taken with the peritoneal incision and dissection as the bladder may be susceptible to injury. PMID:15636672

  18. Laparoscopic resection for gastric carcinoma: Western experience.

    PubMed

    Strong, Vivian E

    2012-01-01

    There has been much speculation regarding differences in outcome for patients who have gastric cancer in the Eastern versus Western world. Among other factors, these differences have contributed to a unique cohort of patients and experience in the Western staging/evaluation of gastric cancer and in the application of minimally invasive approaches for treatment. This review summarizes the current state of laparoscopic approaches for the staging and treatment of gastric adenocarcinoma for patients presenting in Western countries, with their associated unique presentation, comorbidities, and outcomes. PMID:22098837

  19. Laparoscopic diagnosis of ascites in Lesotho.

    PubMed Central

    Menzies, R I; Fitzgerald, J M; Mulpeter, K

    1985-01-01

    In a prospective study of 98 consecutive patients with undiagnosed ascites examined by laparoscopy a correct immediate diagnosis was made in 76 (78%) and a final diagnosis in 92 (94%) of those who underwent laparoscopy. Visual diagnosis was highly accurate in patients with tuberculous peritonitis but only moderately accurate in those with carcinomatosis and liver disease. When the laparoscopic findings were compared with histological and microbiological results visual diagnosis was found to be the most accurate diagnostic method. Laparoscopy may readily be used in rural hospitals for diagnosing ascites. PMID:3160432

  20. Perforated marginal ulcers after laparoscopic gastric bypass

    Microsoft Academic Search

    Edward L. Felix; John Kettelle; Elijah Mobley; Daniel Swartz

    2008-01-01

    Background  Perforated marginal ulcer (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a serious complication, but its incidence\\u000a and etiology have rarely been investigated. Therefore, a retrospective review of all patients undergoing LRYGB at the authors’\\u000a center was conducted to determine the incidence of PMU and whether any causative factors were present.\\u000a \\u000a \\u000a \\u000a Methods  A prospectively kept database of all patients at the

  1. Completely Intracorporeal Robotic-Assisted Laparoscopic Ileovesicostomy

    PubMed Central

    Dolat, MaryEllen T.; Wade, Greg; Grob, B. Mayer; Hampton, Lance J.; Klausner, Adam P.

    2014-01-01

    We present a report of a completely intracorporeal robotic-assisted laparoscopic ileovesicostomy with long term follow-up. The patient was a 55-year-old man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction. The procedure was performed using a da Vinci Surgical system (Intuitive Surgical, Sunnyvale, CA) and took 330 minutes with an estimated blood loss of 100?mL. The patient recovered without perioperative complications. He continues to have low pressure drainage without urethral incontinence over two years postoperatively. PMID:24600527

  2. Robotic-assisted laparoscopic mesh sacrocolpopexy

    PubMed Central

    Gilleran, Jason P.; Johnson, Matthew; Hundley, Andrew

    2010-01-01

    The current ‘gold standard’ surgical repair for apical prolapse is the abdominal mesh sacrocolpopexy. Use of a robotic-assisted laparoscopic surgical approach has been demonstrated to be feasible as a minimally invasive approach and is gaining popularity amongst pelvic floor reconstructive surgeons. Although outcome data for robotic-assisted sacrocolpopexy (RASC) is only just emerging, several small series have demonstrated anatomic and functional outcomes, as well as complication rates, comparable to those reported for open surgery. The primary advantages thus far for RASC over open surgery include decreased blood loss and shorter hospital stay. PMID:21789075

  3. Laparoscopic myomectomy and pregnancy outcome in infertile patients

    Microsoft Academic Search

    Sergio Conti Ribeiro; Harry Reich; Jay Rosenberg; Enrica Guglielminetti; Andrea Vidali

    1999-01-01

    Objective: To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients.Design: Retrospective analysis.Setting: Tertiary care advanced laparoscopic center.Patient(s): Twenty-eight infertile patients with at least one uterine leiomyoma of >5 cm in diameter.Intervention(s): Laparoscopic myomectomy.Main Outcome Measure(s): Occurrence of pregnancy, delivery rate, and pregnancy-related complications.Result(s): The average size of the myomas removed was 6 cm (range, 4–13.3 cm). None

  4. Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications

    Microsoft Academic Search

    Rajesh Varma; Janesh K. Gupta

    2008-01-01

    Background  This study aimed to establish criteria for safe laparoscopic entry through a systematic literature search and evidence-based\\u000a medicine appraisal, to determine surgeon preferences for laparoscopic entry in the United Kingdom, and to appraise the medicolegal\\u000a ramifications of complications arising from laparoscopic entry.\\u000a \\u000a \\u000a \\u000a Methods  A systematic literature search of MEDLINE and EMBASE (1996–2007) was performed as well as a national surgeon survey

  5. Higher incidence of hysterectomy and oophorectomy in women suffering from clinical depression: retrospective chart review.

    PubMed

    Mantani, Akio; Yamashita, Hidehisa; Fujikawa, Tokumi; Yamawaki, Shigeto

    2010-02-01

    The aim of the present study was to retrospectively evaluate women who were admitted to Hiroshima University Hospital, Department of Psychiatry and Neurosciences, from 1979 to 2008. The women were classified as 'depressed women' (n = 159; mean age, 52.3 +/- 5.7 years) or 'non-depressed women' (n = 182; mean age, 51.5 +/- 4.5 years). A total of 14.5% of the depressed women and 3.3% of the non-depressed women had a hysterectomy and/or oophorectomy; this difference was statistically significant (P = 0.0003). This is consistent with previous reported information as well as clinical experience that depressed women had a higher incidence of hysterectomy and/or oophorectomy. PMID:20416028

  6. Hysterectomy and psychiatric disorder: II. Demographic psychiatric and physical factors in relation to psychiatric outcome.

    PubMed

    Gath, D; Cooper, P; Bond, A; Edmonds, G

    1982-04-01

    One hundred and fifty-six patients with menorrhagia of benign origin were interviewed before hysterectomy, and again six months (n = 147) and 18 months (n = 148) after the operation. Psychiatric outcome, measured in terms of PSE cases detected at 18 months, was strongly associated with pre-operative mental state, neuroticism, previous psychiatric history, and family psychiatric history. No association was found with organic pathology in the uterus, bilateral oophorectomy or demographic variables. PMID:7201337

  7. Remains of the day: Biliary complications related to single-port laparoscopic cholecystectomy

    PubMed Central

    Allemann, Pierre; Demartines, Nicolas; Schäfer, Markus

    2014-01-01

    AIM: To assesse the rate of bile duct injuries (BDI) and overall biliary complications during single-port laparoscopic cholecystectomy (SPLC) compared to conventional laparoscopic cholecystectomy (CLC). METHODS: SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery. So far, its safety with respect to bile duct injuries has not been specifically evaluated. A systematic review of the literature published between January 1990 and November 2012 was performed. Randomized controlled trials (RCT) comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included. The quality of RCT was assessed using the Jadad score. Analysis was made by performing a meta-analysis, using Review Manager 5.2. This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A retrospective study including all retrospective reports on SPLC was also performed alongside. RESULTS: From 496 publications, 11 RCT including 898 patients were selected for meta-analysis. No studies were rated as high quality (Jadad score ? 4). Operative indications included benign gallbladder disease operated in an elective setting in all studies, excluding all emergency cases and acute cholecystitis. The median follow-up was 1 mo (range 0.03-18 mo). The incidence of BDI was 0.4% for SPLC and 0% for CLC; the difference was not statistically different (P = 0.36). The incidence of overall biliary complication was 1.6% for SPLC and 0.5% for CLC, the difference did not reached statistically significance (P = 0.21, 95%CI: 0.66-15). Sixty non-randomized trials including 3599 patients were also analysed. The incidence of BDI reported then was 0.7%. CONCLUSION: The safety of SPLC cannot be assumed, based on the current evidence. Hence, this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy. PMID:24574757

  8. Laparoscopic Gastric Bypass versus Laparoscopic Adjustable Gastric Banding in the Super-obese: A Comparative Study of 290 Patients

    Microsoft Academic Search

    Philippe Mognol; Denis Chosidow; Jean-Pierre Marmuse

    2005-01-01

    Background: Controversy exists regarding the best surgical treatment for super-obesity (BMI >50 kg\\/m 2 ). The two most common\\u000a bariatric procedures performed worldwide are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric\\u000a bypass (LRYGBP). We undertook a retrospective single-center study to compare the safety and efficacy of these two operations\\u000a in super-obese patients. Methods: 290 super-obese patients underwent laparoscopic

  9. Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer

    PubMed Central

    Ahn, Sang-Hoon; Son, Sang-Yong; Jung, Do Hyun; Park, Young Suk; Shin, Dong Joon; Park, Do Joong

    2015-01-01

    Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer. PMID:26161287

  10. Laparoscopic Splenectomy for Isolated Splenic Sarcoidosis

    PubMed Central

    Tempes, Bruna Cogo; Lambert, Bruna Franco; Trindade, Eduardo Neubarth; Trindade, Manoel Roberto Maciel

    2014-01-01

    Introduction: Sarcoidosis is an inflammatory disease with an unknown etiology. The pulmonary interstitium is mainly involved, with noncaseating granulomas and lymphadenopathy. It is a multisystemic disease, and the differential diagnosis should include infectious, neoplastic, and autoimmune diseases to prevent inappropriate treatment and unnecessary surgery. Abdominal disease without evidence of pulmonary abnormalities on chest radiography in sarcoidosis can be found in approximately 25% to 38% of cases. The approach to isolated splenic nodules in a patient with nonspecific abdominal symptoms should be focused on exclusion of malignancies and infections, and may require computed tomography, magnetic resonance imaging, and positron emission tomography–computed tomography imaging; scintigraphy; bone marrow biopsy; breast and genital examinations; and endoscopies. This report documents a rare case of isolated granulomatous disease of the spleen that was diagnosed and treated laparoscopically. Case: A 29-year-old woman presented with nonspecific complaints such as nausea, vomiting, and epigastric discomfort. Further laboratory test results were normal. Abdominal ultrasonography, computed tomography, and magnetic resonance imaging revealed multiple splenic lesions. Additional examination findings were negative for occult neoplasia or infectious disease. Laparoscopic splenectomy was performed as a diagnostic procedure, without complications, and the final diagnosis was sarcoidosis. Conclusion: Isolated splenic sarcoidosis is a rare manifestation of extrapulmonary disease. The final diagnosis may be achieved only by histology, requiring biopsy or splenectomy. Minimally invasive surgery is a safe and efficient method for diseases of the spleen and should be the first option when feasible. The patient did well; however, further monitoring is required to diagnose recurrence. PMID:24680162

  11. Teaching instrument: a laparoscopic training model.

    PubMed

    Tintara, H; Choobun, T

    2001-11-01

    A laparoscopic training model with female surface anatomy has been developed. This training model is made of a plastic boutique-showing model that is equivalent to normal-size female anatomy from the neck to the upper thigh. Four holes were made on the model's abdominal wall as puncture-sites to enter the cavity, the first is 80-mm diameter at the umbilical area, and the other three 38-mm diameter holes are located on both sides of the lower abdomen and suprapubic area. The umbilical hole can be covered with a simulated abdominal wall made from 6.5-mm insulation sheet, fixed to the model using a rubber band. The other three puncture-sites were plugged with a flexible rubber diaphragm as working ports. When used as video-laparoscopy, the auto-focus camcorder is used as a telescope and is connected to a regular television set as a monitor. This model can be used for training of abdominal entry by Veress needle or trocar, laparoscopic tubal ligation (LTL), and video-eye-hand co-ordination. This model has been a training medium in our Department for 1 year and was included in the OSCE for the Board Examination of the Royal Thai College of Obstetricians and Gynecologists in the year 2000 to assess the process of Veress needle insertion. PMID:11853305

  12. Single incision laparoscopic cholecystectomy: for what benefit?

    PubMed Central

    Tranchart, Hadrien; Ketoff, Serge; Lainas, Panagiotis; Pourcher, Guillaume; Di Giuro, Giuseppe; Tzanis, Dimitrios; Ferretti, Stefano; Dautruche, Antoine; Devaquet, Niaz; Dagher, Ibrahim

    2013-01-01

    Background A single-incision laparoscopic cholecystectomy (SILC) was developed to improve outcomes as compared with the four-port classic laparoscopic cholecystectomy (CLC). Any potential benefits associated with a SILC have been suggested by previous studies reporting few patients with different surgical techniques. The aim of this study was to describe the experience with a standardized SILC as compared with CLC. Methods From June 2010 to January 2012, 40 patients underwent a SILC [median age: 47.5?years (25–92)] and operative and peri-operative data were prospectively collected. Over the same period, 37 patients underwent a CLC. A 10-point visual analogue scale (VAS) was used for qualitative data. The costs of SILC and CLC were also compared. Results For those patients undergoing a SILC the median operating time was 70?min (24–110). There were no conversions. An additional trocar was necessary in 16 patients. Four patients developed post-operative complications. The median immediate post-operative pain score was 5 (0–10). The median quality of life and cosmetic satisfaction at the initial post-operative visit were 10 (6–10) and 10 (5–10), respectively (VAS). Although the surgical results of both groups were similar, post-operative complications were exclusively reported in the SILC group (two incisional hernias). Conclusion Standardization of SILC is possible but associated with an important rate of additional trocar placement and a disturbing rate of incisional hernias. PMID:23659566

  13. Laparoscopic (endoscopic) radical prostatectomy: techniques and results

    NASA Astrophysics Data System (ADS)

    Nelius, Thomas; de Riese, Werner T. W.; Reiher, Frank; Lindenmeir, Tobias; Filleur, Stephanie; Allhoff, Ernst P.

    2005-04-01

    Laparoscopic radical prostatectomy (LRP) is a relatively new technique for treating organ-confined prostate cancer. Recent progress of laparoscopic/endoscopic techniques allow to perform these complex oncological procedure. Since the first description of LRP in the early 1990s the technique has undergone significant technical modifications. Two operation routes were mainly used: the transperitoneal LRP and the extraperitoneal endoscopic radical prostatectomy (EERPE). Here we review the surgical techniques of both operation routes, and highlight results, outcome and complications. The transperitoneal LRP and the EERPE can be used successfully and reproducibly, giving results comparable with those from the open retropubic procedure. Despite many advantages, transperitoneal LRP is associated with potential intraperitoneal complications. The technical improvements of the EERPE completely obviates these complications. The available data are encouraging and promising, but long-term oncological results will define the definitive role of these new techniques. We truly believe that minimally invasive surgery in treating localized prostate cancer has a bright future and that these techniques will continue to be developed.

  14. Reduction of feral cat (Felis catus Linnaeus 1758) colony size following hysterectomy of adult female cats.

    PubMed

    Mendes-de-Almeida, Flavya; Remy, Gabriella L; Gershony, Liza C; Rodrigues, Daniela P; Chame, Marcia; Labarthe, Norma V

    2011-06-01

    The size of urban cat colonies is limited only by the availability of food and shelter; therefore, their population growth challenges all known population control programs. To test a new population control method, a free-roaming feral cat colony at the Zoological Park in the city of Rio de Janeiro was studied, beginning in 2001. The novel method consisted of performing a hysterectomy on all captured female cats over 6 months of age. To estimate the size of the colony and compare population from year to year, a method of capture-mark-release-recapture was used. The aim was to capture as many individuals as possible, including cats of all ages and gender to estimate numbers of cats in all population categories. Results indicated that the feral cat population remained constant from 2001 to 2004. From 2004 to 2008, the hysterectomy program and population estimates were performed every other year (2006 and 2008). The population was estimated to be 40 cats in 2004, 26 in 2006, and 17 cats in 2008. Although pathogens tend to infect more individuals as the population grows older and maintains natural behavior, these results show that free-roaming feral cat colonies could have their population controlled by a biannual program that focuses on hysterectomy of sexually active female cats. PMID:21440475

  15. Immediate versus delayed hysterectomy for endometrial carcinoma: surgical morbidity and hospital stay

    SciTech Connect

    Chambers, J.T.; Kapp, D.S.; Lawrence, R.; Kohorn, E.I.; Schwartz, P.E.

    1985-02-01

    A retrospective review presented is of the intraoperative complications, postoperative morbidity, and length of hospitalization in 138 patients with stage I endometrial carcinoma treated at Yale-New Haven Hospital from January 1, 1977 to December 31, 1981. One group (stage IA, grade 1) was treated with surgery alone; two groups were treated with preoperative intracavitary radium, followed with either an immediate or a delayed hysterectomy. The three groups were comparable in age, weight, and major preoperative medical problems. The mean estimated blood loss during surgery and transfusion requirements during hospitalization were similar for all three groups. The duration of the surgery in the immediate group was longer than the other two groups. The occurrence of febrile morbidity and major postoperative complications in the three groups was similar, except for bacteriuria, which was significantly more common in the immediate group. The length of the postoperative hospitalization was the same for each group; however, the delayed group as compared with the immediate group had a total hospitalization of two days longer. Hence, in the current study, immediate hysterectomy did not significantly increase the surgical or postoperative morbidity rate, compared with delayed hysterectomy. The single hospital stay in the former treatment group represented cost containment.

  16. Clinical Outcomes of Single Incision Laparoscopic Cholecystectomy in the Anglophone Caribbean: A Multi Centre Audit of Regional Hospitals

    PubMed Central

    Cawich, Shamir O.; Albert, Matthew; Singh, Yardesh; Dan, Dilip; Mohanty, Sanjib; Walrond, Maurice; Francis, Wesley; Simpson, Lindberg K.; Bonadie, Kimon O.; Dapri, Giovanni

    2014-01-01

    Introduction: There has been no report on Single-Incision Laparoscopic Surgery (SILS) cholecystectomy outcomes since it was first performed in the Anglophone Caribbean in 2009. Methods: A retrospective audit evaluated the clinical outcomes of SILS cholecystectomies at regional hospitals in the 17 Anglophone Caribbean countries. Any cholecystectomy using a laparoscopic approach in which all instruments were passed through one access incision was considered a SILS cholecystectomy. The following data were collected: patient demographics, indications for operation, intraoperative details, surgeon details, surgical techniques, specialized equipment, conversions, morbidity and mortality. Descriptive statistics were generated using SPSS 12.0. Results: There were 85 SILS cholecystectomies in women at a mean age of 37.4 ± 8.5 years with a mean BMI of 30.9 ± 2.8. There were 59 elective and 26 emergent cases. Specialized access platforms were used in the first 35 cases and reusable instruments were passed directly across fascia in the latter 50 cases. The mean operative time was 62.9 ± 17.9 minutes. There was no mortality, 2 conversions to multi-trocar laparoscopy and 5 minor complications. Ambulatory procedures were performed in 43/71 (60.6%) patients scheduled for elective operations. Conclusion: In the Caribbean setting, SILS cholecystectomy is a feasible and safe alternative to conventional multi-trocar laparoscopic cholecystectomy for gallbladder disease. PMID:25324700

  17. Laparoscopic spigelian hernia repair: a series of 40 patients.

    PubMed

    Kelly, Michael E; Courtney, Danielle; McDermott, Frank D; Heeney, Anna; Maguire, Donal; Geoghegan, Justin G; Winter, Des C

    2015-06-01

    Spigelian hernias are a rare abdominal wall hernia. The aim of this study was to assess the efficacy and outcomes of patients who underwent a laparoscopic spigelian hernia repair. A retrospective study was performed reviewing all patients who had a laparoscopic spigelian hernia repair. We assessed the success of the procedure including conversion rates, postoperative morbidities, and recurrence rates. Forty patents had a laparoscopic repair. Two thirds (n=25) had an intraperitoneal repair. There was no conversion to open repair. Four patients had postoperative morbidities. At 6-month follow-up all patients were pain free, with 1 recurrence. There is considerable evidence supporting the opinion that laparoscopic repair offers excellent outcomes. This report is the largest series to date, and we advocate that this approach should become the standard of care. PMID:25383942

  18. Laparoscopic transperitoneoscopic nephroureterectomy in a patient with situs inversus totalis.

    PubMed

    Gökçen, Kaan; Çelik, Hüseyin; Kobaner, Murat; Karazindiyano?lu, Sinan

    2015-04-01

    This article discusses the case of a 78-year-old female with painless gross hematuria. Chest X-rays showed dextrocardia with situs inversus, and whole-body computed tomography scanning showed a renal mass in the right renal pelvis, no evidence of metastasis, and mirror-image organs with left-to-right transposition, which resulted in a diagnosis of situs inversus totalis (SIT). A laparoscopic transperitoneoscopic right nephroureterectomy was scheduled. To our knowledge, our case is the second case of laparoscopic nephroureterectomy in renal pelvic urothelial carcinoma with SIT to be presented, but it is the first case of laparoscopic transperitoneoscopic nephroureterectomy. Laparoscopic transperitoneoscopic nephroureterectomy was successfully performed in a renal pelvic urothelial carcinoma patient with SIT with a correct description of renal vascularity and abdominal anatomy. PMID:25972677

  19. The role of laparoscopic surgery in gastric cancer

    PubMed Central

    Pavlidis, Theodoros E; Pavlidis, Efstathios T; Sakantamis, Athanasios K

    2012-01-01

    The laparoscopic surgery in gastric cancer is applied with increasing frequency nowadays; noticeable reports come mainly from Korea and Japan with satisfactory results. This review presents briefly the issue by evaluating its role. A PubMed search of relevant articles published up to 2010 was performed to identify current information. Most data come from Far East, where gastric cancer occurs more often, and the proportion of early gastric cancer is high. Laparoscopic approach includes both the diagnostic laparoscopy and laparoscopic resection. Laparoscopic gastrectomy has currently limited application for gastric cancer in the West; it is not widely accepted and raises important considerations necessitating the planning of multicentre randomised control trials based mainly on the long-term results. PMID:22623823

  20. Treatment Options by Stage (Endometrial Cancer)

    MedlinePLUS

    ... a laparoscope , the operation is called a total laparoscopic hysterectomy. Enlarge Hysterectomy. The uterus is surgically removed ... clinical trials is available from the NCI Web site . Targeted ... laboratory from a single type of immune system cell. These antibodies can ...

  1. Stages of Cervical Cancer

    MedlinePLUS

    ... checked under a microscope for signs of cancer. Laparoscopy : A surgical procedure to look at the organs ... a laparoscope , the operation is called a total laparoscopic hysterectomy. Enlarge Hysterectomy. The uterus is surgically removed ...

  2. Laparoscope Self-calibration for Robotic Assisted Minimally Invasive Surgery

    Microsoft Academic Search

    Danail Stoyanov; Ara Darzi; Guang-zhong Yang

    2005-01-01

    For robotic assisted minimal access surgery, recovering 3D soft tis- sue deformation is important for intra-operative surgical guidance, motion compensation, and prescribing active constraints. We propose in this paper a method for determining varying focal lengths of stereo laparoscope cameras during robotic surgery. Laparoscopic images typically feature dynamic scenes of soft-tissue deformation and self-calibration is difficult with existing ap- proaches

  3. The Swedish Adjustable Gastric Band: Laparoscopic Technique and Preliminary Results

    Microsoft Academic Search

    Antonio Catona; Luigi La Manna; Peter Forsell

    2000-01-01

    Background: The laparoscopic technique for the Swedish Adjustable Gastric Band (SAGB) has been developed based on the previously\\u000a established open technique. Methods: From March 1996-June 1997, laparoscopic SAGB was attempted in 85 consecutive obese patients\\u000a (77 women and 8 men). The average preoperative BMI was 44 (34-59). Results: All operations except one were completed by laparoscopy.\\u000a One patient had to

  4. [Peritoneal closure using absorbable knotless device during laparoscopic sacrocolpopexy].

    PubMed

    Deffieux, X; Pachy, F; Donnadieu, A-C; Trichot, C; Faivre, E; Fernandez, H

    2011-02-01

    Laparoscopic sacrocolpopexy is one of the gold standards of pelvic organ surgery. However, this intervention is associated with long operation duration. One of the steps of this intervention (peritoneal closure) can be shortened using several methods of suturing (e.g. staples). Recently, a self-anchoring barbed suture has been described for wound closure. The goal of this initial feasibility study was to describe the use of the barbed suture (V-Loc™) in peritoneal closure during laparoscopic sacrocolpopexy. PMID:20943328

  5. Robotic-Assisted Versus Laparoscopic Colectomy: Cost and Clinical Outcomes

    PubMed Central

    Davis, Bradley R.; Yoo, Andrew C.; Moore, Matt

    2014-01-01

    Background and Objectives: Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Methods: Patients aged ?18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Results: Of 25 758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17 445 vs $15 448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Conclusion: Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies. PMID:24960484

  6. Surgical technology and the ergonomics of laparoscopic instruments

    Microsoft Academic Search

    R. Berguer

    1998-01-01

    .   Laparoscopic surgery provides patients with less painful surgery and a more rapid recovery, while requiring that surgeons\\u000a work harder and in a more remote manner from the operating field. Cost-containment pressures on surgeons demand efficient\\u000a surgery, whereas the increased technological complexity and sometimes poorly adapted equipment have led to increased complaints\\u000a of surgeon fatigue and discomfort during laparoscopic surgery.

  7. Metrics for Laparoscopic Skills Trainers: The Weakest Link

    Microsoft Academic Search

    Stephane Cotin; Nicholas Stylopoulos; Mark P. Ottensmeyer; Paul F. Neumann; David W. Rattner; Steven Dawson

    2002-01-01

    Metrics are widely employed in virtual environments and provide a yardstick for performance measurement. The current method\\u000a of defining metrics for medical simulation remains more an art than a science. Herein, we report a practical scientific approach\\u000a to defining metrics, specifically aimed at computer-assisted laparoscopic skills training. We also propose a standardized\\u000a global scoring system usable across different laparoscopic trainers

  8. Lessons learned from laparoscopic gastric banding for morbid obesity

    Microsoft Academic Search

    Jeff W Allen; Mark G Coleman; George A Fielding

    2001-01-01

    Background: Laparoscopic gastric banding is a minimally invasive bariatric operation that is increasing in popularity at many centers worldwide. Although this procedure is not yet approved in the United States, clinical trials are ongoing.Methods: We report our results of a 3-year follow-up on 60 patients who underwent the laparoscopic gastric band procedure for the treatment of morbid obesity. The procedure

  9. Laparoscopic Exploration in the Management of Retroperitoneal Masses

    PubMed Central

    Chan, Steve W.H.; Bercowsky, Eduardo; Elbahnassy, Abdelhamid M.; McDougall, Elspeth M.; Clayman, Ralph V.

    1999-01-01

    Background and Objectives: The isolated finding of a retroperitoneal mass (RM) often represents a diagnostic challenge. Image-guided biopsy is frequently inadequate for diagnosis. With increasing experience, the use of laparoscopy for exploration of an indeterminate RM may provide a minimally invasive alternative to open exploration. Herein, we present a retrospective review of our initial four laparoscopic explorations, comparing our experience to four contemporary open explorations for an RM. Patients and Methods: From July 1995 to January 1998, four patients, aged 50 to 62 years old, with an RM of undetermined etiology underwent laparoscopic exploration. Another four patients underwent open exploration at the same hospital. The medical records of these patients were reviewed. Results: The tumors were smaller in the laparoscopic group, averaging 3.7 cm (range 2-6 cm) vs 6.5 cm (range 1-10 cm) in the open group. A definitive diagnosis was obtained for all eight patients. Postoperative complications were observed in one of the laparoscopic explorations, and in three of the open explorations; there was no operative mortality. The blood loss (90 vs 440 ml), fall in hematocrit (5.1 vs 7.8%), time to resumption of a regular diet (3 vs 5 days), amount of morphine sulfate equivalents required for analgesia (128 mg vs 161 mg), time to ambulation (2.3 vs 6 days) and hospital stay (4.8 vs 6 days) were all less among the laparoscopy patients. However, the operative time was longer for the laparoscopic procedure; this time included stent placement and patient repositioning in addition to the time for laparoscopic excision of the mass (7.8 vs 4.3 hours). Conclusion: Laparoscopic exploration appears to be a viable alternative to open exploration in patients presenting with a retroperitoneal mass. It is as effective as an open procedure and provides benefits with regard to patient morbidity and convalescence. However, operative time for this laparoscopic procedure is lengthy. PMID:10527333

  10. Laparoscopic treatment of hydatid cysts of the liver

    Microsoft Academic Search

    G. Khoury; T. Geagea; A. Hajj; S. Jabbour-Khoury; A. Baraka; G. Nabbout

    1994-01-01

    We report for the first time treatment of hydatid cyst of the liver laparoscopically. The patient is a 27-year-old man who presented to our hospital with a 6-week history of recurrent right-upper-quadrant pain with abdominal ultrasound findings compatible with hydatid cyst of the liver. The cyst was approached laparoscopically using the same hydatid asepsis as in open surgery. The cyst

  11. Case report: Three-trocar technique for bilateral laparoscopic nephropexy.

    PubMed

    Chekulaev, Dimitri; Dayma, Thierry; Abecassis, Jean-Paul; Peyromaure, Michaël

    2007-01-01

    Nephroptosis is a rare syndrome, which affects the right kidney in the majority of cases. In the current report, a case of bilateral nephroptosis with an unusual presentation is presented. We performed bilateral laparoscopic nephropexy using a three-trocar approach. The intervention was successful, with a short operative time and minimal blood loss. The clinical presentation of our patient and the surgical technique for bilateral laparoscopic nephropexy are described. PMID:17263609

  12. Structuralized box-trainer laparoscopic training significantly improves performance in complex virtual reality laparoscopic tasks

    PubMed Central

    Stefaniak, Tomasz J.; Makarewicz, Wojciech; Proczko, Monika; Gruca, Zbigniew; ?ledzi?ski, Zbigniew

    2011-01-01

    Introduction In the era of flowering minimally invasive surgical techniques there is a need for new methods of teaching surgery and supervision of progress in skills and expertise. Virtual and physical box-trainers seem especially fit for this purpose, and allow for improvement of proficiency required in laparoscopic surgery. Material and methods The study included 34 students who completed the authors‘ laparoscopic training on physical train-boxes. Progress was monitored by accomplishment of 3 exercises: moving pellets from one place to another, excising and clipping. Analysed parameters included time needed to complete the exercise and right and left hand movement tracks. Students were asked to do assigned tasks prior to, in the middle and after the training. Results The duration of the course was 28 h in total. Significant shortening of the time to perform each exercise and reduction of the left hand track were achieved. The right hand track was shortened only in exercise number 1. Conclusions Exercises in the laboratory setting should be regarded as an important element of the process of skills acquisition by a young surgeon. Virtual reality laparoscopic training seems to be a new, interesting educational tool, and at the same time allows for reliable control and assessment of progress. PMID:23255997

  13. Laparoscopic versus open surgery for rectal cancer: Results of a systematic review and meta-analysis on clinical efficacy.

    PubMed

    Zhao, Jun-Kang; Chen, Nan-Zheng; Zheng, Jian-Bao; He, Sai; Sun, Xue-Jun

    2014-11-01

    Colorectal cancer is one of the main malignant tumors threatening human health. Surgery plays a pivotal role in treating colorectal cancer. The present study aimed to compare the clinical effect in patients with rectal cancer undergoing laparoscopic versus open surgery by meta-analysis of the randomized controlled trials (RCTs) published in the past 20 years. The data showed that 14 RCTs comparing laparoscopic surgery with conventional open surgery for rectal cancer matched the selection criteria and reported on 2,114 subjects, of whom 1,111 underwent laparoscopic surgery and 1,003 underwent open surgery for rectal cancer. Blood loss (P<0.00001), days to passage of flatus (P=0.0003), first bowel movement (P=0.0006), fluids intake (P<0.00001), walking independently (P<0.00001), length of hospital duration (P=0.003) and the rate of wound infection (P=0.04) were all significantly reduced following laparoscopic surgery. The incidence of complications, such as ureteric injury (P=0.33), urinary retention (P=0.43), ileus (P=0.05), anastomotic leakage (P=0.09) and incisional hernia (P=0.88), were not significantly different between the two groups. There were no significant differences in lymph nodes harvested (P=0.88), length of specimen (P=0.60), circumferential resection margin (CRM) (P=0.86), regional recurrence ((P=0.08), port site or wound metastasis (P=0.67), distant metastasis (P=0.12), 3-year overall survival (OS) (P=0.42), 3-year disease-free survival (DFS) (P=0.44), 5-year OS (P=0.60) and 5-year DFS (P=0.70). Therefore, laparoscopy for the treatment of patients with rectal cancer has the advantage of recovery and the same complications and prognosis as laparotomy, which indicates that laparoscopy may provide a potential survival benefit for patients with rectal cancer. PMID:25279204

  14. Single incision laparoscopic surgery in general surgery: a review

    PubMed Central

    Greaves, N; Nicholson, J

    2011-01-01

    Single incision laparoscopic surgery (SILS) is a rapidly developing field that may represent the future of laparoscopic surgery. The major advantage of SILS over standard laparoscopic surgery is in cosmesis, with surgery becoming essentially scarless if the incision is hidden within the umbilicus. Only one incision is required so the risk of potential complications like port site hernias, haematomas and wound infection is reduced. The trade-off for this is a technically more challenging procedure with different underlying principles to that of traditional laparoscopic surgery. A wide variety of new equipment has been developed to support SILS and the range of procedures that are amenable to the technique is increasing. To date most of the published data relating to SILS are in the form of case series, with the first large randomised controlled trials due to be completed by the end of 2012. The existing evidence suggests that SILS is similar to standard laparoscopic surgery in terms of complication rates, completion rates and post-operative pain scores. However, the duration of SILS is longer than equivalent laparoscopic procedures. This article discusses SILS with regard to its applications in general surgery and reviews the evidence currently available. PMID:21929912

  15. Safety and effectiveness of three-port laparoscopic cholecystectomy

    PubMed Central

    Mayir, Burhan; Dogan, Ugur; Koc, Umit; Aslaner, Arif; B?lec?k, Tuna; Ensar?, Cemal Ozben; Cakir, Tugrul; Oruc, Mehmet Tahir

    2014-01-01

    Most commonly performed laparoscopic surgery is laparoscopic cholecystectomy. Although cholecystectomy through three port is not commonly preferred, researches have shown that it is a safe and feasible way of surgery. Material and Methods. We evaluate 100 patient that have undergone elective laparoscopic cholecystectomy through three port (group one). These patients were compared with 50 patients that have undergone laparoscopic cholecystectomy through four port (group two). Complications, lenght of stay in hospital, operation time, conversion to open surgery rate were compared in two group. Results: In group one, fourth port was necessary for nine (9%) patients. Duration of operation in group one was in average 31 min and in group two, 31, 3 min. Operation time, lenght of stay in hospital, complication rate, conversion to open surgery rate was similar in both groups. Conclusion: Three port laparoscopic cholecystectomy is a safer method when performed by experienced surgeons. Laparoscopic cholecyctectomy can be tried through three ports firstly and can be continued with addition of fourth port if necessary. PMID:25232432

  16. The biliopancreatic diversion. A comparison of laparoscopic and laparotomic techniques.

    PubMed

    Stefanoni, M; Casciola, L; Ceccarelli, G; Spaziani, A; Conti, D; Bartoli, A; Di Zitti, L; Bellocchi, R; Valeri, R

    2006-06-01

    AIM: Morbid obesity has increased its frequency in the last 20 years in association with the increase of a country's richness. Bariatric surgery has developed a role which is becoming more and more important. The aim of this study, after 10 years of experience with the biliopancreatic diversion, is to compare the laparoscopic versus open technique RESULTS: METHODS: From March 1993 to December 2004, 150 patients were operated by biliopancreatic diversion. We divided our experience into 2 groups: laparotomic and laparoscopic techniques. We compared the following variables in the 2 groups: total operating time, intestinal functions, postoperative pain, patient's discharge and recovery time, major postoperative complications, postoperative mortality, late complications, incisional hernia incidence and anastomotic ulceration. RESULTS: We found a significant difference in both the reduction of the postoperative pain and the recanalization time in the laparoscopic group. Equally, we found a reduction in the incidence of abdominal wall complications, especially the reduction of incisional hernia and infections. The mean operative time was longer in the laparoscopic group, in particular due to the hard learning curve. CONCLUSIONS: The laparoscopic biliopancreatic diversion is a feasible and safe operation with good results: less postoperative discomfort, shorter recanalization and ospedalization time, less incidence of abdominal wall morbidity (incisional hernia). However, the procedure may prove difficult and it needs a highly experienced surgeon in laparoscopic technique. PMID:16858302

  17. Laparoscopic liver resection: Toward a truly minimally invasive approach.

    PubMed

    Ogiso, Satoshi; Hatano, Etsuro; Nomi, Takeo; Uemoto, Shinji

    2015-03-16

    In the surgical treatment of hepatocellular carcinoma and colorectal liver metastasis, it is important to preserve sufficient liver volume after resection in order to avoid post-hepatectomy liver sufficiency and to increase the feasibility of repeated hepatectomy in case of intrahepatic recurrence. Parenchyma-sparing approach, which minimizes the extent of resection while obtaining sufficient surgical margins, has been developed in open hepatectomy. Although this approach can possibly have positive impacts on morbidity and mortality, it is not popular in laparoscopic approach because parenchyma-sparing resection is technically demanding especially by laparoscopy due to its intricate curved transection planes. "Small incision, big resection" is the words to caution laparoscopic surgeons against an easygoing trend to seek for a superficial minimal-invasiveness rather than substantial patient-benefits. Minimal parenchyma excision is often more important than minimal incision. Recently, several reports have shown that technical evolution and accumulation of experience allow surgeons to overcome the hurdle in laparoscopic parenchyma-sparing resection of difficult-to-access liver lesions in posterosuperior segments, paracaval portion, and central liver. Laparoscopic surgeons should now seek for the possibility of laparoscopic parenchyma-sparing hepatectomy as open approach can, which we believe is beneficial for patients rather than just a small incision and lead laparoscopic hepatectomy toward a truly minimally-invasive approach. PMID:25789085

  18. Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: a systematic review and meta-analysis.

    PubMed

    Moran, Patrick S; O'Neill, Michelle; Teljeur, Conor; Flattery, Martin; Murphy, Linda A; Smyth, Gordon; Ryan, Máirín

    2013-03-01

    Medline and Embase were searched for studies comparing robot-assisted radical prostatectomy with open prostatectomy and conventional laparoscopic prostatectomy. Random effects meta-analysis was used to calculate a pooled estimate of effect. The 95% prediction intervals are also reported. One randomized study and 50 observational studies were identified. The results show that compared with open surgery, robot-assisted surgery is associated with fewer positive surgical margins for pT2 tumors (relative risk 0.63, 95% confidence interval 0.49-0.81, P?conventional laparoscopic prostatectomy, robot-assisted surgery is associated with a slight increase in urinary function at 12?months (relative risk 1.09, 95% confidence interval 1.02 to 1.17, P?=?0.013). The overall methodological quality of the included studies was low, with high levels of heterogeneity. The use of prediction intervals as an aid to decision making in regard to the introduction of this technology is examined. Clinically significant improvements in positive surgical margins rates for pT2 tumors and sexual function at 12?months associated with robot-assisted surgery in comparison with open surgery should be interpreted with caution given the limitations of the evidence. Differences between robot-assisted and conventional laparoscopic surgery are minimal. PMID:23311943

  19. Intraoperative sentinel lymph node mapping guides laparoscopic-assisted distal gastrectomy for distal gastric cancer

    PubMed Central

    Liu, Naiqing; Niu, Zhengchuan; Niu, Wei; Peng, Cheng; Zou, Xueqing; Sun, Shuxiang; Shinichi, Obo; Shahbaz, Muhammad; Sun, Qinli; Jun, Niu

    2015-01-01

    Aims: The aim of this retrospective study is to explore the effects of sentinel lymph node (SLN) mapping guided laparoscopic-assisted distal gastrectomy (LADG) for distal gastric cancer. Methods: Two hundred patients were enrolled in this study. One hundred and one patients undergoing SLN guided LADG were designated as the SLN group. Ninety-nine patients having conventional LADG with D1 or D2 lymph node dissection were designated as the control group. Intraoperative and postoperative indicators such as the number of lymph nodes dissected, intraoperative and postoperative conditions, flow cytometry analysis of T lymphocyte subsets and natural killer (NK) cells, survival rates, recurrence rates and postoperative complications were investigated between these two groups. Results: The number of lymph nodes dissected in the SLN group was significantly lesser than that in the control group. Furthermore, in the SLN group, the patients achieved better immunization status, improved intraoperative and postoperative conditions and decreased postoperative complications. There were no significant differences were found in the positive lymph nodes detected, the distance between proximal and distal cutting edge, postoperative survival or recurrence rates. Conclusions: SLN guided LADG for gastric cancer is a safe and effective method and could achieve an equal clinical effect as traditional laparoscopic D1 or D2 radical operation with less operation trauma and better recovery.

  20. Strategies for High-Resolution Imaging of Epithelial Ovarian Cancer by Laparoscopic Nonlinear Microscopy1

    PubMed Central

    Williams, Rebecca M; Flesken-Nikitin, Andrea; Ellenson, Lora Hedrick; Connolly, Denise C; Hamilton, Thomas C; Nikitin, Alexander Yu; Zipfel, Warren R

    2010-01-01

    Ovarian cancer remains the most frequently lethal of the gynecologic cancers owing to the late detection of this disease. Here, by using human specimens and three mouse models of ovarian cancer, we tested the feasibility of nonlinear imaging approaches, the multiphoton microscopy (MPM) and second harmonic generation (SHG) to serve as complementary tools for ovarian cancer diagnosis. We demonstrate that MPM/SHG of intrinsic tissue emissions allows visualization of unfixed, unsectioned, and unstained tissues at a resolution comparable to that of routinely processed histologic sections. In addition to permitting discrimination between normal and neoplastic tissues according to pathological criteria, the method facilitates morphometric assessment of specimens and detection of very early cellular changes in the ovarian surface epithelium. A red shift in cellular intrinsic fluorescence and collagen structural alterations have been identified as additional cancer-associated changes that are indiscernible by conventional pathologic techniques. Importantly, the feasibility of in vivo laparoscopic MPM/SHG is demonstrated by using a “stick” objective lens. Intravital detection of neoplastic lesions has been further facilitated by low-magnification identification of an indicator for cathepsin activity followed by MPM laparoscopic imaging. Taken together, these results demonstrate that MPM may be translatable to clinical settings as an endoscopic approach suitable for high-resolution optical biopsies as well as a pathology tool for rapid initial assessment of ovarian cancer samples. PMID:20563260

  1. Single-incision laparoscopic colectomy for cancer: short-term outcomes and comparative analysis.

    PubMed

    Pedraza, Rodrigo; Aminian, Ali; Nieto, Javier; Faraj, Chadi; Pickron, T Bartley; Haas, Eric M

    2013-01-01

    Introduction. Single-incision laparoscopic colectomy (SILC) is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies (n = 33) and anterior resections (n = 12). There were no significant differences in operative time (127.9 versus 126.7?min), conversions (0 versus 1), complications (14% versus 8%), length of stay (4.5 versus 4.0 days), readmissions (2% versus 2%), and reoperations (2% versus 2%). Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques. PMID:23766897

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

    PubMed Central

    Pedraza, Rodrigo; Aminian, Ali; Faraj, Chadi; Pickron, T. Bartley; Haas, Eric M.

    2013-01-01

    Introduction. Single-incision laparoscopic colectomy (SILC) is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies (n = 33) and anterior resections (n = 12). There were no significant differences in operative time (127.9 versus 126.7?min), conversions (0 versus 1), complications (14% versus 8%), length of stay (4.5 versus 4.0 days), readmissions (2% versus 2%), and reoperations (2% versus 2%). Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques. PMID:23766897

  3. Technical considerations for laparoscopic right renal surgery in presence of Riedel's lobe of the liver.

    PubMed

    Chien, Gary W; Orvieto, Marcelo A; Galocy, R Matthew; Sokoloff, Mitchell H; Shahav, Arieh L

    2005-04-01

    Riedel's lobe of the liver is an anatomic variant, described as a caudal extension of the right lobe of the liver, that presents a challenge in laparoscopic right renal surgery. A 52-year-old woman with a Riedel's lobe of the liver and a large right renal mass underwent laparoscopic right radical nephrectomy. Transperitoneal access with the Veress needle through a right lateral port was initially unsuccessful. After a supraumbilical approach, pneumoperitoneum was eventually achieved. The right lateral liver attachments were freed, and the lobe was retracted medially to expose the right kidney and its hilum. The surgery was then performed successfully. Riedel's lobe presents two special technical concerns: intraperitoneal access and hilar exposure. For access, an initial supraumbilical approach, or possibly an open approach, decreases the risk of liver injury. For renal and hilar exposure, the right lateral liver attachments can be taken down so that the hepatic lobe can be retracted medially instead of in the conventional cephalad direction. Retroperitoneal access, if feasible, may also circumvent these problems. Surgery can then be performed safely and effectively. PMID:15865517

  4. Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy.

    PubMed

    Memon, Jan Muhammad; Memon, Muhammad Rafique; Arija, Dharmoon; Bozdar, Ali Gohar; Talpur, Mir Muhammad Ali

    2014-11-01

    This comparative prospective study was conducted at the Ghulam Muhammad Mahar Medical College Hospital and Red Crescent General Hospital, Sukkur, Pakistan, for a period of two years from July 2012 to June 2014. The study included 1800 patients who underwent laparoscopic cholecystectomy for symptomatic cholethiasis. These patients were divided in to two groups. Group I included 900 patients, who underwent conventional laparoscopic cholecystectomy with the four port technique. In these patients, the gall-bladder was retrieved through umbilical port by a sterile surgical hand glove (size 6 ½ or 7 inches) endobag. The fascial defect of 10 mm umbilical port was closed by vicryl "0" with J-shaped needle, while three 5 mm ports closed by applying steri strips. Group-II also included 900 patients. In these patients laparoscopic cholecystectomy was done by using three ports, 10 mm epigastric working port, 5 mm umbilical port for 5 mm telescope and lateral 5 mm port for assistant. The gall-bladder was retrieved through epigastric port without endobag. The results of both these techniques were collected and analyzed on SPSS version 14. The mean age of patients was 45 years. The male to female ratio was 1:3. In group-I, after laparoscopic cholecystectomy, gall-bladder was retrieved safely through 10 mm umbilical port in surgical glove endobag. In acutely inflamed cases, the gall-bladder was opened at the umbilical port site inside the endobag and decompressed before retrieval. In this group, wound infection of umbilical port occurred in 5.11% patients, port-site hernia in 3.66%, port-site bleeding in 1.33% while difficulty in retrieval of gall-bladder in acutely inflamed cases in 1.88% patients. In group-II, wound infection in epigastric port was found in 1.55% patients, port-site hernia in 0.11%, port-site bleeding in 4%, difficulty in retrieval of gall-bladder in 5.33% while leakage /perforation of gall-bladder in 4.11% patients. The serious complications like wound infection and port-site hernia are more frequently found in group-I patients as compared to group-II. PMID:26045380

  5. Laparoscopic Swedish Adjustable Gastric Banding: 6-year Follow-up and Comparison to other Laparoscopic Bariatric Procedures

    Microsoft Academic Search

    Reinhard P. Mittermair; Helmut Weiss; Hermann Nehoda; Werner Kirchmayr; Franz Aigner

    2003-01-01

    Background: The advantages of laparoscopy over open surgery are well known. The aim of this study was to compare our results\\u000a with Swedish adjustable gastric banding (SAGB) with other laparoscopically performed bariatric procedures (gastric bypass,\\u000a LapBand?, vertical banded gastroplasty). Methods: Between January 1996 and December 2001, 454 patients (381 women, 73 men) underwent\\u000a laparoscopic SAGB. All data (demographic and morphologic,

  6. Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: A single-institution comparison study of early results

    Microsoft Academic Search

    Jay C. Jan; Dennis Hong; Natasha Pereira; Emma J. Patterson

    2005-01-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are common surgical procedures\\u000a for morbid obesity, but few studies have compared LRYGB and LAGB. All patients who underwent LRYGB and LAGB by a single surgeon\\u000a at Legacy Health System were identified from a prospectively maintained database. Preoperatively, most patients were allowed\\u000a to choose between LRYGB and LAGB. Age,

  7. Laparoscopic Application Of Radio Frequency Energy Enables In Situ Renal Tumor Ablation And Partial Nephrectomy

    Microsoft Academic Search

    LUCAS JACOMIDES; KENNETH OGAN; LORI WATUMULL; JEFFREY A. CADEDDU

    2003-01-01

    PurposeTo our knowledge we present the initial series of renal mass in situ laparoscopic radio frequency ablation. We also discuss the indications for and results of subsequent laparoscopic partial nephrectomy.

  8. Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant

    Microsoft Academic Search

    Inderbir S. Gill; Anup P. Ramani; Massimiliano Spaliviero; Meng Xu; Antonio Finelli; Jihad H. Kaouk; Mihir M. Desai

    2005-01-01

    ObjectivesTo evaluate whether using a biologic hemostatic sealant facilitates hemostasis during laparoscopic partial nephrectomy. Secure and durable parenchymal hemostasis is a critical requirement during laparoscopic partial nephrectomy.

  9. Peritoneal adhesions after laparoscopic gastrointestinal surgery

    PubMed Central

    Mais, Valerio

    2014-01-01

    Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2, N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no greater than 60%. A recent small, randomized clinical trial suggested that the combination of broad peritoneal cavity protection with local application of a barrier could be almost 100% effective in preventing post-operative adhesion formation. Future studies should confirm the efficacy of this global strategy in preventing adhesion formation after laparoscopy by focusing on clinical end points, such as reduced incidences of bowel obstruction and abdominal pain and increased fertility. PMID:24803803

  10. Hystérectomie cœlioscopique : technique, indications

    Microsoft Academic Search

    V. Thoma; M. Salvatores; L. Mereu; I. Chua; A. Wattiez

    2007-01-01

    Today, hysterectomy is, after caesarean section, the most frequent surgical intervention performed in fertile women. Introduced in 1989, laparoscopic hysterectomy remains poorly diffused: today, less than 5% of all hysterectomies remain done by laparoscopy. Nevertheless after a correct learning curve, laparoscopic hysterectomy finds perfect indications in benign and even some malignant indications. In these conditions, the complication rate is similar

  11. Evolution and future of laparoscopic colorectal surgery

    PubMed Central

    Kaiser, Andreas M

    2014-01-01

    The advances of laparoscopic surgery since the early 1990s have caused one of the largest technical revolutions in medicine since the detection of antibiotics (1922, Flemming), the discovery of DNA structure (1953, Watson and Crick), and solid organ transplantation (1954, Murray). Perseverance through a rocky start and increased familiarity with the chop-stick surgery in conjunction with technical refinements has resulted in a rapid expansion of the indications for minimally invasive surgery. Procedure-related factors initially contributed to this success and included the improved postoperative recovery and cosmesis, fewer wound complications, lower risk for incisional hernias and for subsequent adhesion-related small bowel obstructions; the major breakthrough however came with favorable long-term outcomes data on oncological parameters. The future will have to determine the specific role of various technical approaches, define prognostic factors of success and true progress, and consider directing further innovation while potentially limiting approaches that do not add to patient outcomes. PMID:25386060

  12. Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

    PubMed Central

    Srirangam, Shalom J.; van Cleynenbreugel, Ben; van Poppel, Hein

    2009-01-01

    Transitional cell carcinoma affecting the upper urinary tract, though uncommon, constitutes a serious urologic disease. Radical nephroureterectomy remains the treatment of choice but has undergone numerous modifications over the years. Although the standard technique has not been defined, the laparoscopic approach has gained in popularity in the last two decades. The most appropriate oncological management of the distal ureteral and bladder cuff has been a subject of much debate. The aim of the nephroureterectomy procedure is to remove the entire ipsilateral upper tract in continuity while avoiding extravesical transfer of tumor-containing urine during bladder surgery. A myriad of technical modifications have been described. In this article, we review the literature and present an overview of the options for dealing with the lower ureter during radical nephroureterectomy. PMID:19020654

  13. Paravesical gossypiboma following inguinal herniorrhaphy: Laparoscopic retrieval.

    PubMed

    Huang, Chao-Chun; Huang, Che-Jen; Hsieh, Jan-Sing

    2015-01-01

    Retained surgical sponge (gossypiboma) following an inguinal herniorrhaphy is a rare condition and may cause medicolegal problems. Differential diagnosis for the lesion should be made meticulously. We report a case of a 45-year-old man who had a herniorrhaphy about 8 years previously. He presented one episode of painless gross hematuria. Laboratory and imaging studies excluded any significant lesion in the urological organs. Abdominal CT scan demonstrated a heterogeneous neoplasm of 4 cm in size in the left paravesical area that was retrieved laparoscopically. Abdominal CT and clinical suspicion are helpful for diagnosis. Laparoscopy may be used to confirm the diagnosis and to remove the retained surgical gauze, and considered as an alternative therapy for some selected patients. PMID:26195885

  14. Paravesical gossypiboma following inguinal herniorrhaphy: Laparoscopic retrieval

    PubMed Central

    Huang, Chao-Chun; Huang, Che-Jen; Hsieh, Jan-Sing

    2015-01-01

    Retained surgical sponge (gossypiboma) following an inguinal herniorrhaphy is a rare condition and may cause medicolegal problems. Differential diagnosis for the lesion should be made meticulously. We report a case of a 45-year-old man who had a herniorrhaphy about 8 years previously. He presented one episode of painless gross hematuria. Laboratory and imaging studies excluded any significant lesion in the urological organs. Abdominal CT scan demonstrated a heterogeneous neoplasm of 4 cm in size in the left paravesical area that was retrieved laparoscopically. Abdominal CT and clinical suspicion are helpful for diagnosis. Laparoscopy may be used to confirm the diagnosis and to remove the retained surgical gauze, and considered as an alternative therapy for some selected patients. PMID:26195885

  15. Laparoscopic repair of penetrating splenic injury.

    PubMed

    Davoodi, Puya; Budde, Cristina; Minshall, Christian Todd

    2009-12-01

    Historically, all splenic injuries were treated with splenectomy. In recent decades, however, there has been a trend toward splenic conservation methods in an attempt to preserve immunologic functions. Although cases of splenic conservation in the setting of penetrating injuries exist in the literature, this method of management is more commonly attempted in blunt traumas. When presented with penetrating splenic trauma, surgeons generally still proceed directly to exploratory laparotomy with splenectomy. Splenic injuries are rarely repaired with splenorrhaphy due to surgeon inexperience and concern for reoperation. We conclude from this case that when presented with a penetrating splenic trauma in a hemodynamically stable patient, management by laparoscopic exploration with splenorrhaphy can be safe and effective. PMID:19637964

  16. Complete laparoscopic nephroureterectomy with intravesical lockable clip

    PubMed Central

    Eret, Viktor; Ürge, Tomáš; Kle?ka, Ji?í; Trávní?ek, Ivan; Hes, Ond?ej; Petersson, Fredrik; Stránský, Petr

    2012-01-01

    Introduction We present a cohort of patients with low-stage pelviureteric neoplastic disease who underwent complete laparoscopic nephroureterectomy (CLNUE) with intravesical lockable clip (IVLC). Due to the absence of a standard technique of NUE, the study was not randomized. Materials From 1/2010 to 1/2012, 21 patients were subjected to CLNUE-IVLC. The first step was transurethral excision of the ureterovesical junction with Collin's knife deep into the paravesical adipose tissue. The ureter was grasped with biopsy forceps and the distal end of the ureter was occluded with lockable clip. The applicator was introduced through a 5 mm port inserted as an epicystostomy. The patients were rotated to flank position and CLNUE followed. The endoscopically introduced clip on the distal ureter is proof of completion of the total ureterectomy. Results The mean operation time was 161 (115-200) min. In four (19.0%), the application of the clip failed and CLNUE was completed with non-occluded ureter. In three cases, subsequent laparoscopic nephrectomy was converted to open surgery. In two cases, the distal ureterectomy was completed with pluck technique through a lower abdominal incision that was also used for extraction of the specimen. There were four complications (Clavien II 2x, IIIb, V). Follow-up was available for all – mean 10.6 (range: 0-25) months. One died of disease generalization within 11 months. Conclusion CLNUE-IVLC is fast and safe. If needed, the endoscopic phase can be switched to open NUE. Disadvantages include: the need to change the position of the patient, the risk of inability to apply the clip on the distal ureter, and the risk of an unclosed defect of the urinary bladder. PMID:24578933

  17. A simple technique of laparoscopic full-thickness anterior abdominal wall repair of retrosternal (Morgagni) hernias

    Microsoft Academic Search

    Georges Azzie; Kiki Maoate; Spencer Beasley; Wilhelm Retief; Arie Bensoussan

    2003-01-01

    Background\\/Purpose: Previous reports of laparoscopic repair of Morgagni hernias in children have involved relatively complex laparoscopic techniques. This report describes a simpler method of repair that we have applied to 4 children. Methods: Four children with retrosternal (Morgagni) hernias underwent primary laparoscopic repair by placement of interrupted synthetic nonabsorbable sutures through the full-thickness of the anterior abdominal wall, incorporating the

  18. Tactile Feedback Ottermo et al. 2006 The Role of Tactile Feedback in Laparoscopic Surgery

    E-print Network

    Johansen, Tor Arne

    Tactile Feedback Ottermo et al. 2006 The Role of Tactile Feedback in Laparoscopic Surgery MV National Center for Advanced Laparoscopic Surgery, St. Olav's Hospital, Trondheim, Norway Corresponding the National Center for Advanced Laparoscopic Surgery at St. Olav's hospital for providing the necessary

  19. An ergonomic evaluation of surgeons’ axial skeletal and upper extremity movements during laparoscopic and open surgery

    Microsoft Academic Search

    Ninh T Nguyen; Hung S Ho; Warren D Smith; Constantine Philipps; Clare Lewis; Rodel M De Vera; Ramon Berguer

    2001-01-01

    Background: Many surgeons have complained of fatigue and musculoskeletal pain after laparoscopic surgery. We evaluated differences in surgeons’ axial skeletal and upper extremity movements during laparoscopic and open operations.Methods: Five surgeons were videotaped performing 16 operations (8 laparoscopic and 8 open) to record their neck, trunk, shoulder, elbow, and wrist movements during the first hour of surgery. We also compared

  20. Virtual reality training leads to faster adaptation to the novel psychomotor restrictions encountered by laparoscopic surgeons

    Microsoft Academic Search

    J. A. Jordan; A. G. Gallagher; J. McGuigan; N. McClure

    2001-01-01

    Background: The fulcrum effect of the body wall on instrument handling poses a major obstacle to the mastery of instrument coordination for junior laparoscopic surgeons. This study evaluated three types of laparoscopic simulator training to assess their ability to promote the user's adaptation to the fulcrum effect. Methods: Thirty-two participants with no previous experience in laparoscopic surgery were randomly assigned

  1. Laparoscopic bowel injury in an animal model: monocyte migration and apoptosis

    Microsoft Academic Search

    A. El-Hakim; J. P. A. Aldana; K. Reddy; P. Singhal; B. R. Lee

    2005-01-01

    Background: Unrecognized laparoscopic bowel injury has a delayed and covert presentation. Differences in monocyte migration and apoptosis between laparoscopic and open bowel injury were determined. Methods: For this study, 24 rabbits were divided into laparoscopic (n = 9) and open surgical (n = 9) bowel injury groups and a control group (n = 6) without bowel injury. Bowel injury was

  2. Decomposing Composing Conventions.

    ERIC Educational Resources Information Center

    Beers, Terry

    Recent research has invited critiques of the authoritative descriptions of composing found in many rhetoric textbooks. The concept of "convention" may be especially useful in rethinking the teleological basis of these textbook descriptions. Conventions found in composition textbooks need to be unmasked as arbitrary concepts which serve to…

  3. Proving the Value of Simulation in Laparoscopic Surgery

    PubMed Central

    Fried, Gerald M.; Feldman, Liane S.; Vassiliou, Melina C.; Fraser, Shannon A.; Stanbridge, Donna; Ghitulescu, Gabriela; Andrew, Christopher G.

    2004-01-01

    Objective: To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) physical laparoscopic simulator for construct and predictive validity and for its educational utility. Summary Background Data: MISTELS is the physical simulator incorporated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in their Fundamentals of Laparoscopic Surgery (FLS) program. MISTELS’ metrics have been shown to have high interrater and test-retest reliability and to correlate with skill in animal surgery. Methods: Over 200 surgeons and trainees from 5 countries were assessed using MISTELS in a series of experiments to assess the validity of the system and to evaluate whether practicing MISTELS basic skills (transferring) would result in skill acquisition transferable to complex laparoscopic tasks (suturing). Results: Face validity was confirmed through questioning 44 experienced laparoscopic surgeons using global rating scales. MISTELS scores increased progressively with increasing laparoscopic experience (n = 215, P < 0.0001), and residents followed over time improved their scores (n = 24, P < 0.0001), evidence of construct validity. Results in the host institution did not differ from 5 beta sites (n = 215, external validity). MISTELS scores correlated with a highly reliable validated intraoperative rating of technical skill during laparoscopic cholecystectomy (n = 19, r = 0.81, P < 0.0004; concurrent validity). Novice laparoscopists were randomized to practice/no practice of the transfer drill for 4 weeks. Improvement in intracorporeal suturing skill was significantly related to practice but not to baseline ability, career goals, or gender (P < 0.001). Conclusion: MISTELS is a practical and inexpensive inanimate system developed to teach and measure technical skills in laparoscopy. This system is reliable, valid, and a useful educational tool. PMID:15319723

  4. Transient Occlusion of Uterine Arteries in Laparoscopic Uterine Surgery

    PubMed Central

    Kwon, Yong-Soon; Roh, Hyun Jin; Ahn, Jun Woo; Lee, Sang-Hun

    2015-01-01

    Background and Objectives: This study was conducted to determine the feasibility and effectiveness of transient occlusion of the uterine arteries (TOUA) during laparoscopic surgery for benign uterine tumors, with preservation of fertility. Methods: Patients with uterine myoma or adenomyoma underwent laparoscopic uterine surgery, with or without TOUA, performed by a single surgeon (Y.-S.K.). Surgical outcomes included operative time; occurrence of intraoperative injury of blood vessels, nerves, and pelvic organs; and intraoperative blood loss. Results: Of the 168 surgical patients included in this study, 144 were enrolled consecutively during the study period, and 24 had undergone adenomectomy before the study period. A total of 104 women (70 with myoma; 34 with adenomyoma) seeking uterine preservation underwent laparoscopic surgery with TOUA for benign uterine tumors. Sixty-four women (40 with myoma; 24 with adenomyoma) underwent surgery without TOUA. The mean total surgical time of the TOUA groups was 74.85 minutes for uterine myoma and 84.09 minutes for uterine adenomyoma. The mean estimated blood loss during laparoscopic myomectomy and adenomyomectomy was less in the TOUA groups than in the non-TOUA groups (109 vs. 203.4 mL in myomectomy, P < .05; 148.1 vs. 158.9 mL in adenomyomectomy; P < .05). Time to perform TOUA was 13.9 minutes in laparoscopic myomectomy and 7.33 minutes in laparoscopic adenomyomectomy. The hospital stay of the TOUA groups was 3.32 days for uterine myoma and 3.82 days for uterine adenomyoma. No intraoperative conversion to laparotomy was necessary, and no major complications occurred during any of the procedures. Conclusion: Laparoscopic uterine surgery with TOUA could be a safe and effective surgical method for women with symptomatic benign uterine tumors who wish to preserve fertility. PMID:25848179

  5. Relation between vaginal and endocervical pH in patients undergoing cold-knife conization and hysterectomy

    Microsoft Academic Search

    Eddie F. C. Murta; Paula B. Perfeito; Tânia M. Oliveira; Márcia A. Michelin; Paulo J. Maluf

    2008-01-01

    Objective  This study aimed to investigate the influence of endocervical pH on vaginal pH, and also the changes in these pH values following\\u000a hysterectomy and cold-knife conization. Vaginal pH is important for maintaining the equilibrium of the vaginal microflora.\\u000a \\u000a \\u000a \\u000a Patients and methods  Two groups of women were studied: the first (n = 20, median age 45, range 33–50 years-old), before and after hysterectomy (without ovariectomy)

  6. Single port/incision laparoscopic surgery compared with standard three-port laparoscopic surgery for appendicectomy - a randomised controlled trial

    PubMed Central

    2012-01-01

    Background Laparoscopic surgery has become the preferred approach for many procedures because of reduced post-operative pain, better recovery, shorter hospital stay and improved cosmesis. Single incision laparoscopic surgery is one of the many recent variants where either standard ports or a specially designed single multi-channel port is introduced through a single skin incision. While the cosmetic advantage of this is obvious, the evidence base for claims of reduced morbidity and better post-operative recovery is weak. This study aims to compare the effectiveness of single port/incision laparoscopic appendicectomy with standard three-port laparoscopic appendicectomy in adult patients at six weeks post-surgery. We also wish to assess the feasibility of a multicentre randomised controlled trial comparing single port/incision laparoscopic surgery with standard three-port laparoscopic surgery for other surgical techniques. Methods and design Patients diagnosed with suspected appendicitis and requiring surgical treatment will be randomised to receive either standard three-port or single incision laparoscopic surgery. Data will be collected from clinical notes, operation notes and patient reported questionnaires. The following outcomes will be considered: 1. Effectiveness of the surgical procedure in terms of: •patient reported outcomes •clinical outcomes •resource use 2. Feasibility of conducting a randomised controlled trial (RCT) in the emergency surgical setting by quantifying: •patient eligibility •randomisation acceptability •feasibility of blinding participants to the intervention received •completion rates of case report forms and patient reported questionnaires Trial registration ISRCTN66443895 (assigned 10 March 2011, first patient randomised 09 January 2011) PMID:23111090

  7. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices.

    PubMed

    Nickel, Felix; Brzoska, Julia A; Gondan, Matthias; Rangnick, Henriette M; Chu, Jackson; Kenngott, Hannes G; Linke, Georg R; Kadmon, Martina; Fischer, Lars; Müller-Stich, Beat P

    2015-05-01

    This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n?=?42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n?=?42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3?×?4?hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80?min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80?min than BL (45% v 21%, P?=?.02). The BL group scored higher than the VR group in the knowledge test (13.3?±?1.3 vs 11.0?±?1.7, P?laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches. PMID:25997044

  8. Recovery of Immunological Homeostasis Positively Correlates Both with Early Stages of Right-Colorectal Cancer and Laparoscopic Surgery

    PubMed Central

    Ferri, Mario; Rossi Del Monte, Simone; Salerno, Gerardo; Bocchetti, Tommaso; Angeletti, Stefano; Malisan, Florence; Cardelli, Patrizia; Ziparo, Vincenzo; Torrisi, Maria Rosaria; Visco, Vincenzo

    2013-01-01

    Differences in postoperative outcome and recovery between patients subjected to laparoscopic-assisted versus open surgery for colorectal cancer (CRC) resection have been widely documented, though not specifically for right-sided tumors. We investigated the immunological responses to the different surgical approaches, by comparing postoperative data simultaneously obtained at systemic, local and cellular levels. A total of 25 right-sided CRC patients and controls were managed, assessing -in the immediate followup- the conventional perioperative parameters and a large panel of cytokines on plasma, peritoneal fluids and lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells (PBMC) tissue cultures. A general better recovery for patients operated with laparoscopy compared to conventional procedure, as indicated by the analysis of typical pre- and post-surgical parameters, was observed. The synchronous evaluation of 12 cytokines showed that preoperative plasma levels of the proinflammatory cytokines IL-6, IL-8, IL-1?, TNF? were significantly lower in healthy donors versus CRC patients and that such differences progressively increase with tumor stage. After surgery, the IL-6 and IL-8 increases were significantly higher in open compared to laparoscopic approach only in CRC at early stages. The postsurgical whole panel of cytokine levels were significantly higher in peritoneal fluids compared to corresponding plasma, but with no significant differences depending on kind of surgery or stage of disease. Then we observed that, pre- compared to the corresponding post-surgery derived LPS-stimulated PBMC cultures, produced higher supernatant levels of the whole cytokine panel. In particular IL-6 in vitro production was significantly higher in PBMC derived from patients subjected to laparoscopic versus open intervention, but -again- only in CRC at early stages of disease. Our results thus show that laparoscopy compared to open right resection is associated with a shorter compromission of the immunological homeostasis, mainly in early stages of right-CRC patients. PMID:24040252

  9. Laparoscopic Cholecystectomy and Newer Techniques of Gallbladder Removal

    PubMed Central

    2012-01-01

    Objectives: To describe the surgical complications associated with laparoscopic cholecystectomy, as performed by a single surgeon over an 8-year period and to discuss how this compares to newer methods of cholecystectomy, such as single-incision surgery and natural orifice transluminal endoscopic surgery. Methods: The charts of 1000 consecutive patients who underwent consecutive cholecystectomies were reviewed to gather the following information: age, sex, prior abdominal procedures, type of procedure performed (laparoscopic vs open, with or without cholangiography), pre and postoperative diagnosis, and complications directly related to surgical technique, such as biliary injury, bile leak, infection, trocar-related injury, and incisional hernia. Results: The laparoscopic approach was attempted in all but one patient and was successful in 94.1% of patients. The conversion rate was higher with acute cholecystitis than with other forms of biliary tract disease. Successful cholangiography was accomplished in over 97% of patients. Nineteen complications directly related to the surgical procedure were found, including one bile duct injury. Conclusion: Laparoscopic cholecystectomy continues to offer a safe and effective treatment for patients with symptomatic biliary tract disease. Although other forms of minimally invasive cholecystectomy are being studied, there is little data to suggest any additional benefit, other than a slight improvement in cosmesis. Until larger series demonstrate that these techniques have a complication rate similar to those cited in the surgical literature, traditional 4-port laparoscopic cholecystectomy should remain the standard of care. PMID:23318066

  10. Successful laparoscopic management of an incarcerated obturator hernia

    PubMed Central

    Lynch, Noel P.; Corrigan, Mark A.; Kearney, David E.; Andrews, Emmet J.

    2013-01-01

    Obturator hernia is a rare pelvic hernia that occurs primarily in multiparous, elderly (>70 years of age), thin females. This case highlights the successful laparoscopic mesh repair of an incarcerated obturator hernia in an octogenarian. The authors report a case of an incarcerated obturator hernia in an elderly female with subsequent high-grade small bowel and its successful laparoscopic operative management. A review of the relevant literature was also performed following a search on the online literature databases such as PUBMED and EMBASE. Laparoscopic mesh repair of the incarcerated obturator hernia and an ipsilateral femoral hernia found incidentally was successfully performed. A review of the literature showed a significant burden of morbidity and mortality associated with obturator hernias. Laparoscopic mesh repair has been previously shown to be a safe therapeutic modality. Small bowel obstruction and leg pain in a thin elderly lady should arouse suspicion for an incarcerated obturator hernia. Laparoscopic management of an incarcerated obturator hernia is a feasible and safe therapeutic option. PMID:24964456

  11. Single-incision laparoscopic biliary bypass for malignant obstructive jaundice.

    PubMed

    Yu, Hong; Wu, Shuodong; Yu, Xiaopeng; Han, Jinyan; Yao, Dianbo

    2015-06-01

    Biliary bypass is a major management of resolution to malignant obstructive jaundice. Laparoscopic approach is an ideal alternative to open surgery with the less recurrence compared with endoscopic stenting. Single incision surgery approach has not been applied to biliary bypass due to technical challenge. The aim of this study is to evaluate the safety and feasibility of single-incision laparoscopic biliary bypass. Eighteen patients with periampulla tumor underwent single-incision laparoscopic cholecystojejunostomy. The preoperation and postoperation data were retrospectively analyzed. All the cases underwent surgery successfully without conversion to open or traditional laparoscopic surgery. The operation time and blood loss were 172.8 min and 101.1 ml, respectively. The postoperative hospital stay was 9.9 days. The jaundice was released, and the liver function was improved after the surgery. The mean survival of the patients was 9.5 months. The single-incision laparoscopic cholecystojejunostomy is safe and feasible with acceptable short-term outcomes in selected patients. The benefits still need to be evaluated in comparative study. PMID:25700838

  12. Laparoscopic resection for rectal cancer: what is the evidence?

    PubMed

    Chan, Dedrick Kok-Hong; Chong, Choon-Seng; Lieske, Bettina; Tan, Ker-Kan

    2014-01-01

    Laparoscopic colectomy for colon cancer is a well-established procedure supported by several well-conducted large-scale randomised controlled trials. Patients could now be conferred the benefits of the minimally invasive approach while retaining comparable oncologic outcomes to the open approach. However, the benefits of laparoscopic proctectomy for rectal cancer remained controversial. While the laparoscopic approach is more technically demanding, results from randomised controlled trials regarding long term oncologic outcomes are only beginning to be reported. The impacts of bladder and sexual functions following proctectomy are considerable and are important contributing factors to the patients' quality of life in the long-term. These issues present a delicate dilemma to the surgeon in his choice of operative approach in tackling rectal cancer. This is compounded further by the rapid proliferation of various laparoscopic techniques including the hand assisted, robotic assisted, and single port laparoscopy. This review article aims to draw on the significant studies which have been conducted to highlight the short- and long-term outcomes and evidence for laparoscopic resection for rectal cancer. PMID:24822196

  13. Impact of laparoscopic experience on virtual robotic simulator dexterity

    PubMed Central

    Yoo, Byung Eun; Kim, Jin; Cho, Jae Sung; Shin, Jae Won; Lee, Dong Won; Kwak, Jung Myun; Kim, Seon Hahn

    2015-01-01

    BACKGROUND: Different skills are required for robotic surgery and laparoscopic surgery. We hypothesized that the laparoscopic experience would not affect the performance with the da Vinci® system. A virtual robotic simulator was used to estimate the operator's robotic dexterity. MATERIALS AND METHODS: The performance of 11 surgical fellows with laparoscopic experience and 14 medical students were compared using the dV-trainer®. Each subject completed three virtual endo-wrist modules (“Pick and Place,” “Peg Board,“ and “Match Board”). Performance was recorded using a built-in scoring algorithm. RESULTS: In the Peg Board module, the performance of surgical fellows was better in terms of the number of instrument collisions and number of drops (P < 0.05). However, no significant differences were found in the percentage scores of the three endo-wrist modules between the groups. CONCLUSION: Robotic dexterity was not significantly affected by laparoscopic experience in this study. Laparoscopic experience is not an important factor for learning robotic skills. PMID:25598602

  14. Laparoscopic applications of laser-activated tissue glues

    NASA Astrophysics Data System (ADS)

    Bass, Lawrence S.; Oz, Mehmet C.; Auteri, Joseph S.; Williams, Matthew R.; Rosen, Jeffrey; Libutti, Steven K.; Eaton, Alexander M.; Lontz, John F.; Nowygrod, Roman; Treat, Michael R.

    1991-07-01

    The rapid growth of laparoscopic cholecystectomy and other laparoscopic procedures has created the need for simple, secure techniques for laparoscopic closure without sutures. While laser tissue welding offers one solution to this problem, concerns about adequacy of weld strength and watertightness remain. Tissue solders are proteinaceous materials which are placed on coapted tissue edges of the tissue to be closed or sealed. Laser energy is then applied to fix the glue in place completing the closure. Closure of the choledochotomy following a laparoscopic common duct exploration is one potential application of this technique. Canine longitudinal choledochotomies 5 mm in length were sealed using several laser glues and using the 808 nm diode laser. Saline was then infused until rupture of the closure and peak bursting strength recorded. Fibrinogen glue provided moderately good adhesion but poor burst strength. Handling characteristics were variable. A viscosity adjusted fibrinogen preparation produced good adherence with mean weld strength 264 +/- 7 mm Hg. The clinical endpoint for welding was a whitening and drying of the tissue. New laser solders can provide a watertight choledochotomy closure of adequate immediate strength. This would allow reliable, technically feasible common bile duct exploration via a laparoscopic approach.

  15. Acute colonic pseudo-obstruction after hysterectomy in a patient with Friedreich ataxia.

    PubMed

    Yasa, Cenk; Dural, Ozlem; Ugurlucan, Funda Gungor; Bastu, Ercan; Demir, Omer; Topuz, Samet

    2014-05-01

    Acute colonic pseudo-obstruction is a rare complication of gynecological surgery. Despite the complete description of this condition, diagnosis remains difficult and is often delayed. Due to delay in diagnosis and existence of serious comorbid illnesses, morbidity and mortality approaches higher levels. Early recognition of signs and symptoms of this condition and prompt accurate management are vital to prevent serious mortality. Here, we report a case of acute colonic pseudo-obstruction after total abdominal hysterectomy in a patient with known Friedreich ataxia. PMID:24346123

  16. Common Knowledge and Convention

    Microsoft Academic Search

    Giacomo Sillari

    2008-01-01

    This paper investigates the epistemic assumptions that David Lewis makes in his account of social conventions. In particular,\\u000a I focus on the assumption that the agents have common knowledge of the convention to which they are parties. While evolutionary\\u000a analyses show that the common knowledge assumption is unnecessary in certain classes of games, Lewis’ original account (and,\\u000a more recently, Cubitt

  17. No conventional function for the conventional kinesin?

    PubMed

    Muresan, Virgil; Muresan, Zoia

    2008-11-01

    A paper by DeGiorgis et al. (DeGiorgis JA, Petukhova TA, Evans TA, Reese TS. Kinesin-3 is an organelle motor in the squid giant axon. Traffic 2008; DOI: 10.1111/j.1600-0854.2008.00809.x) in this issue of Traffic reports on the identification and function of a second squid kinesin, a kinesin-3 motor. As expected, the newly discovered motor associates with axoplasmic organelles in situ and powers motility along microtubules of vesicles isolated from squid axoplasm. Less expected was the finding that kinesin-3 may be the predominant motor for anterograde organelle movement in the squid axon, which challenges the so far undisputed view that this function is fulfilled by the conventional kinesin, kinesin-1. These novel findings let us wonder what the real function of kinesin-1--the most abundant motor in squid axons--actually is. PMID:18785923

  18. Laparoscopic sacrocolpopexy: Demonstration of a nerve-sparing technique.

    PubMed

    Sarlos, Dimitri; Aigmueller, Thomas; Magg, Heimo; Schaer, Gabriel

    2015-06-01

    Laparoscopic sacrocolpopexy is a well-established technique to treat apical vaginal prolapse. De novo micturition disorders, pelvic pain, and defecation disorders have been reported and may be due to intraoperative compromise of the superior hypogastric plexus. The video demonstrates our technique for nerve-sparing laparoscopic sacrocolpopexy. The patient is a 62-year-old woman with symptomatic stage III posthysterectomy vaginal vault prolapse. Key steps of the procedure are opening the peritoneum at the level of the promontory, identification of the fibers of the superior hypogastric plexus, deep anterior and posterior dissection with attachment of the mesh to the vagina, displacement of the nerve fibers to the left side during suturing of the mesh to the longitudinal ligament, and complete peritonealization. This technique of the identification and protection of relevant nerve structures appears to be reproducible and can be considered by surgeons who perform laparoscopic sacrocolpopexy. PMID:25499262

  19. Laparoscopic distal, subtotal gastrectomy for advanced gastric cancer.

    PubMed

    Ben-David, Kfir; Tuttle, Rebecca; Kukar, Moshim; Oxenberg, Jacqueline; Hochwald, Steven N

    2015-02-01

    The objective of this study was to show laparoscopic subtotal, distal gastrectomy with D2 lymphadenectomy as a safe and appropriate method for the resection of advanced gastric cancer. This study was conducted at a designated NCI Cancer Center. Subjects of the study were patients with advanced gastric malignancy, including transmural penetration of the tumor and/or nodal disease, requiring subtotal, distal gastrectomy. The main outcome measure is a description of the technique of a laparoscopic subtotal, distal gastrectomy for antral and distal body tumors. In conclusion, the laparoscopic approach to advanced gastric malignancy with a subtotal, distal gastrectomy and D2 lymphadenectomy is a safe, oncologically appropriate procedure which provides excellent outcomes. PMID:25338659

  20. Laparoscopic distal pancreatectomy: Up-to-date and literature review

    PubMed Central

    Iacobone, Maurizio; Citton, Marilisa; Nitti, Donato

    2012-01-01

    Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffusion. Additional researches are necessary to determine the best technique to improve the procedure results. PMID:23082049

  1. Endoscopically assisted laparoscopic local resection of gastric tumor

    PubMed Central

    2013-01-01

    Background Minimally invasive procedures have been applied in treatment of gastric submucosal tumors. Currently, combined laparoscopic - endoscopic rendezvous resection (CLERR) emerges as a new technique which further reduces operative invasiveness. Case presentation A-57-year-old female patient presented with epigastric pain. She was submitted to gastroscopy, which revealed a tumor located at the angle of His. Biopsy specimens demonstrated a leiomyoma. The patient underwent endoscopically assisted laparoscopic resection of the tumor. The operative time was 45 minutes. Diagnosis of leiomyoma was confirmed by the final histopathological examination. The patient had an uneventful postoperative recovery and was discharged on the 2nd postoperative day. Conclusion Combined laparoscopic and endoscopic rendezvous resection appears as a promising alternative minimally invasive technique. It offers easy recognition of the tumor, regardless of location, safe dissection, and full thickness resection with adequate margins as well as less operative time. PMID:24119820

  2. Extensive liver resection: can it be applicable to laparoscopic surgery?

    PubMed

    Frezza, E E

    2001-06-01

    Due to major technical barriers, the safety and efficacy of laparoscopic hepatic resection is not well established. Laparoscopic liver resection has been described. Wedge resections or marginal resections rather than more formal hepatic resections for benign diseases only have been described lately. Anatomic hepatic resection and nonanatomical resection were also reported. But the technique still needs to be standardized and applied in a large-scale population. During the last 20 years, there has been a trend toward direct control of hepatic injury by adequate debridment of nonviable hepatic tissue along nonanatomical lines. The trauma experience emphasized two important concepts: the search for the most expedient method of hemorrhage control in the nonstable trauma patient, and a hepatic resection that need not be based on precise anatomic planes. The aim of this paper is to present the data and instruments available to apply toward laparoscopic liver resection. PMID:11441990

  3. Laparoscopic splenectomy in a case of blunt abdominal trauma.

    PubMed

    Agarwal, Narendra

    2009-01-01

    Splenic rupture is a frequent consequence of blunt abdominal trauma. Removal of the spleen (splenectomy) or alternative conservative procedures (splenorrhaphy, partial splenectomy and haemostatic collagen application) are surgical treatment options. Splenectomy was first described in 1910 by Sutherland. Laparoscopic splenectomy was first described in 1991 by Delaitre and Maignien. Since then significant improvements in instrumentation and technology such as harmonic scalpel, endovascular staplers have increased its ease of performance. Laparoscopic splenectomy for a ruptured spleen has been reported only in a few cases, in which a hand-assisted technique was used. We present the first reported case from India (to the best of our knowledge) of a successful removal of a ruptured spleen by means of a totally laparoscopic technique. PMID:20040803

  4. Laparoscopic splenectomy in a case of blunt abdominal trauma

    PubMed Central

    Prasad, Arun; Agarwal, Narendra

    2009-01-01

    Splenic rupture is a frequent consequence of blunt abdominal trauma. Removal of the spleen (splenectomy) or alternative conservative procedures (splenorrhaphy, partial splenectomy and haemostatic collagen application) are surgical treatment options. Splenectomy was first described in 1910 by Sutherland. Laparoscopic splenectomy was first described in 1991 by Delaitre and Maignien. Since then significant improvements in instrumentation and technology such as harmonic scalpel, endovascular staplers have increased its ease of performance. Laparoscopic splenectomy for a ruptured spleen has been reported only in a few cases, in which a hand-assisted technique was used. We present the first reported case from India (to the best of our knowledge) of a successful removal of a ruptured spleen by means of a totally laparoscopic technique. PMID:20040803

  5. Safe and rapid laparoscopic access--a new approach.

    PubMed

    Antevil, Jared L; Bhoyrul, Sunil; Brunson, Mathew E; Vierra, Mark A; Swadia, Nayan D

    2005-06-01

    Despite numerous recent technical advances in minimally invasive surgical technique, the potential exists for serious morbidity during initial laparoscopic access. Safe access depends on adhering to well-recognized principles of trocar insertion, knowledge of abdominal anatomy, and recognition of hazards imposed by previous surgery. Applying these principles, we describe a safe, rapid, and cost-effective technique for laparoscopic access using readily available instruments. This technique emphasizes identification and incision of the point at which the midline abdominal fascia is fused with the base of the umbilicus, and the importance of the application of countertraction directly at the point of insertion. This method allows penetration under direct vision with minimal controlled axial force, and without the requirement for fascial sutures or other cumbersome aspects of the traditional open technique. While previous reports describe techniques for laparoscopic access entry based on similar anatomic and surgical principles, we describe an alternative method not yet discussed in the surgical literature. PMID:15895194

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

    PubMed Central

    2014-01-01

    Background Laparoscopic appendectomy (LA) has become one of the most common surgical procedures to date. To improve and standardize this technique further, cost-effective and reliable animal models are needed. Methods In a pilot study, 30 Wistar rats underwent laparoscopic caecum resection (as rats do not have an appendix vermiformis), to optimize the instrumental and surgical parameters. A subsequent test study was performed in another 30 rats to compare three different techniques for caecum resection and bowel closure. Results Bipolar coagulation led to an insufficiency of caecal stump closure in all operated rats (Group 1, n?=?10). Endoloop ligation followed by bipolar coagulation and resection (Group 2, n?=?10) or resection with a LigaSure™ device (Group 3, n?=?10) resulted in sufficient caecal stump closure. Conclusions We developed a LA model enabling us to compare three different caecum resection techniques in rats. In conclusion, only endoloop closure followed by bipolar coagulation proved to be a secure and cost-effective surgical approach. PMID:24934381

  7. Changing management of suspected appendicitis in the laparoscopic era

    PubMed Central

    Akbar, Fayyaz; Yousuf, Mansoor; Morgan, Richard J; Maw, Andrew

    2010-01-01

    INTRODUCTION The aims of this study were to examine the trends in performance of open and laparoscopic appendicectomy at a district general hospital, and to compare the diagnostic outcomes in the two patient groups. PATIENTS AND METHODS Data were collected prospectively from patients undergoing an open or laparoscopic procedure for cted appendicitis in an 8-year period between January 2000 and December 2007. RESULTS A total of 1700 patients (873 women, 827 men) with a median age of 24 years underwent surgery for suspected appendicitis in the study period. There were 1357 patients (group A) who underwent an open procedure for presumed appendicitis (610 women and 747 men [F:M ratio, 1:1.2]). There were 343 patients (group B) who underwent laparoscopy with or without laparoscopic appendicectomy (82 men and 261 women [F:M ratio, 1:0.31]). Over the study period, there was an increasing trend towards the performance of laparoscopic procedures for suspected appendicitis, increasing from 4% to 39% of the total per year. In group A, 1172 (86%) patients had appendicular pathology, while the appendix was normal histologi-cally in 178 (13%). Other pathologies were diagnosed intra-operatively in 1%. In group B, 193 patients (56%) had appendicular pathology while in 150 (44%) the appendix was normal. In the subgroup with a normal appendix, 56 patients (37%) had another cause for their symptoms identified. CONCLUSIONS Laparoscopic appendicectomy is increasingly being performed. Laparoscopy is often used as a diagnostic tool in general surgical patients, particularly women, with lower abdominal pain. In effect, these patients are undergoing diagnostic laparoscopy, with or without appendicectomy. This has resulted in a lower positive appendicectomy rate, but a higher yield of diagnoses other than appendicitis, in the laparoscopic group. Overall appendicectomy rates, however, have remained unchanged. PMID:20056066

  8. Experience of laparoscopic liver resection for various liver diseases

    PubMed Central

    Park, Juhong; Kim, Seokhwan; Song, Insang

    2014-01-01

    Backgrounds/Aims We present our experience of laparoscopic liver resection for various liver diseases. Methods From April 2008 to August 2012 in Chungnam National University, 68 of 253 liver resections were performed laparoscopically. During the first year, laparoscopy-assisted liver resection was mainly performed and subsequently totally laparoscopic liver resection was the main operative type. Surgery type for treatment purposes was decided preoperatively. Clinical data were collected retrospectively and analyzed. Results Preoperatively, 43 patients (63.2%) were diagnosed with benign disease, 19 patients (27.9%) were malignant liver tumors and 6 patients (8.8%) were indeterminate liver tumor but favorable towards malignancy. Anatomical major liver resection was performed in 58 cases (85.3%) and 10 cases (14.7%) were non-anatomical resection. Left hemihepatectomy was performed in 38 cases (55.8%) followed by left lateral sectionectomy in 18 cases (26.5%), and segment IV and IVa segmentectomy, were each in 1 case. Mean operation time was 235.0 minutes (range, 60-470) and 14 patients (18.6%) had intraoperative transfusion. Mean postoperative hospital stay was 10.2 days (range, 4-32). Mean operation time of laparoscopy-assisted left lobectomy was 317 minutes and totally laparoscopic left lobectomy was 281 minutes, but there was no significant statistical difference between these two operation types. There were 11 episodes of postoperative complications in 8 patients. There was no mortality after laparoscopic liver resection. Conclusions We concluded that laparoscopic liver resection is a feasible operation, but needs to be carefully conducted in malignant tumors.

  9. Robot-Assisted Versus Standard Laparoscopic Colorectal Surgery

    PubMed Central

    Hauch, Adam T.; Buell, Joseph F.; Kandil, Emad

    2014-01-01

    Background and Objectives: Over the years, there has been a continual shift toward more minimally invasive surgical techniques, such as the use of laparoscopy in colorectal surgery. Recently, there has been increasing adoption of robotic technology. Our study aims to compare and contrast robot-assisted and laparoscopic approaches to colorectal operations. Methods: Forty patients undergoing laparoscopic or robotic colorectal surgery performed by 2 surgeons at an academic center, regardless of indication, were included in this retrospective review. Patients undergoing open approaches were excluded. Study outcomes included operative time, estimated blood loss, length of stay, complications, and conversion rate to an open procedure. Results: Twenty-five laparoscopic and fifteen robot-assisted colorectal surgeries were performed. The mean patient age was 61.1 ± 10.7 years in the laparoscopic group compared with 61.1 ± 8.5 years in the robotic group (P = .997). Patients had a similar body mass index and history of abdominal surgery. Mean blood loss was 163.3 ± 249.2 mL and 96.8 ± 157.7 mL, respectively (P = .385). Operative times were similar, with 190.8 ± 84.3 minutes in the laparoscopic group versus 258.4 ± 170.8 minutes in the robotic group (P = .183), as were lengths of hospital stay: 9.6 ± 7.3 and 6.5 ± 3.8 days, respectively (P = .091). In addition, there was no difference in the number of lymph nodes harvested between the laparoscopic group (14.0 ± 6.5) and robotic group (12.3 ± 4.2, P = .683). Conclusions: In our early experience, the robotic approach to colorectal surgery can be considered both safe and efficacious. Furthermore, it also preserves oncologically sufficient outcomes when performed for cancer operations. PMID:25489211

  10. Absent organs—Present selves: Exploring embodiment and gender identity in young Norwegian women's accounts of hysterectomy

    PubMed Central

    Solbrække, Kari Nyheim; Bondevik, Hilde

    2015-01-01

    In this paper, we explore how younger women in Norway construct their embodiment and sense of self after hysterectomy. To do this, we conducted in-depth interviews with eight ethnic Norwegian women aged between 25 and 43 who had undergone hysterectomy. In line with a broad phenomenological approach to illness, the study was designed to explore the trajectories of the women's illness with a specific focus on concrete human experience and identity claims from a subjective point of view. In analysing the stories, we encountered feelings of suffering due to the loss of the uterus as well as profound side-effects, such as menopause. However, we also found evidence of relief from being treated for heavy bleeding and serious illness. In order to accentuate the individual voices in these illness stories, we chose a case-oriented analysis in line with Radley and Chamberlain (2001) and Riessman (2008). From this, two main seemingly contradictory storylines stood out: They have removed what made me a woman versus Without a uterus, I feel more like a woman. We also identified heteronormativity as an unstated issue in both these storylines and in the research data as a whole. Acknowledging diversity in the way women experience hysterectomy is important for a better understanding of the ways in which hysterectomy may affect women as humans as well as for developing more cultural competent healthcare services for this group. PMID:25937002

  11. Laparoscopic cholecystectomy with a three-trocar 5-mm instrument approach.

    PubMed

    Agresta, Ferdinando; Trentin, Giuseppe; Ciardo, Luigi Francesco; Michelet, Ivan; Mazzarolo, Giorgio; Bedin, Natalino

    2007-01-01

    The natural evolution of laparoscopy seems to be the use of miniature instruments and, where possible, a reduction of the number of trocars used. We report the results of our experience with all 5-mm instrument three-trocar cholecystectomy vs. the conventional laparoscopy approach. From July 2002 to July 2005 a total of 518 patients underwent laparoscopic cholecystectomy: 268 of them (51.7%) were operated on with a 5-mm three-trocar approach. The primary end point was the feasibility rate of the technique. Secondary end points were safety and the impact of the technique on the duration of laparoscopy. There were two conversions to laparotomy--one in each group--while a conversion to the classical approach for the three-trocar group was registered in 9.3% of the cases. Occurrence of minor complications was 3.6% (9 cases) with the conventional approach as against 3.7% (10 cases) with the three-trocar approach. The present experience shows that 5-mm three-trocar cholecystectomy is a safe, easy, effective and reproducible approach for gallbladder disease. Such features make the technique a challenging alternative to conventional laparoscopy in the treatment of cholecystopathy, in both the acute and elective setting. PMID:17663379

  12. Spontaneous intrahepatic portosystemic shunt managed by laparoscopic hepatic vein closure

    PubMed Central

    Kwon, Jung-Nam; Jeon, Yong Sun; Cho, Soon-Gu; Lee, Keon-Young; Hong, Kee Chun

    2014-01-01

    Intrahepatic portosystemic shunt (IPSS) is uncommon and usually follows trauma or iatrogenic injury, but spontaneous shunts may also occur, in patients without the evidence of chronic liver disease. Although interventional endovascular management of the shunts is the treatment of choice, a surgical approach can be used when the percutaneous approach fails. We report here a case of symptomatic spontaneous IPSS between the posteroinferior branch of right portal vein and the right inferior hepatic vein, which was successfully managed with laparoscopic closure of the hepatic vein. To the best of our knowledge, this is the first case report of laparoscopic management of spontaneous IPSS. PMID:25336823

  13. Clostridial gas gangrene of the abdominal wall after laparoscopic cholecystectomy.

    PubMed

    Samel, S; Post, S; Martell, J; Becker, H

    1997-08-01

    Laparoscopic cholecystectomy is associated with a considerable rate of infectious complications of up to 2.8%. Such infections are usually of minor clinical importance. However, we observed a case of life-threatening Clostridial gas gangrene centering around the right lateral port site and developing across all of the right-sided abdominal wall, causing septic shock and severe multi-organ failure. Considering the overall infection rate and the possibility of even severe morbidity, we advocate perioperative antibiotics in laparoscopic cholecystectomy. PMID:9448120

  14. Elective laparoscopically assisted sigmoidectomy for the sigmoid volvulus

    Microsoft Academic Search

    J.-T. Liang; H.-S. Lai; P.-H. Lee

    2006-01-01

    Background  The laparoscopic approach for the treatment of sigmoid volvulus has been a rare surgical indication. This phase 2 study investigated\\u000a the feasibility and surgical outcomes of elective laparoscopic surgery for sigmoid volvulus.\\u000a \\u000a \\u000a \\u000a Methods  Patients with sigmoid volvulus were first offered colonoscopic decompression for their acute colonic obstruction. If the colonic\\u000a decompression was successful, complete bowel preparation was performed, followed by elective

  15. Amyand's hernia: Our experience in the laparoscopic era

    PubMed Central

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

  16. Amyand's hernia: Our experience in the laparoscopic era.

    PubMed

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

  17. Postoperative Care of Patients Undergoing Same-Day Laparoscopic Cholecystectomy.

    PubMed

    Brenner, Patricia; Kautz, Donald D

    2015-07-01

    Elective laparoscopic cholecystectomies are common outpatient surgical procedures. After briefly discussing cholecystectomy and its indications, best practices in phase I, phase II, and phase III recovery are discussed. Typical pharmaceutical regimens for controlling pain and postoperative nausea and vomiting are summarized. By implementing best practices, nurses can prevent and recognize complications. The criteria for discharge, extended recovery, and inpatient admission are discussed, along with the required patient discharge teaching using the teach-back technique, as well as patient and family teaching needs in the immediate postoperative period. Nurses can optimize the patient's surgical experience and promote safety by implementing best practices in all phases of recovery from laparoscopic cholecystectomy. PMID:26119606

  18. Laparoscopic orchiopexy and varicocelectomy: is there really an advantage?

    PubMed

    Fine, Ronnie G; Franco, Israel

    2015-02-01

    The role of laparoscopy in the case of nonpalpable cryptorchidism is both diagnostic and therapeutic. Laparoscopic orchiopexy for nonpalpable testes in the pediatric population has become the preferred surgical approach among pediatric urologists over the last 20 years. In contrast, laparoscopic varicocelectomy is considered one of several possible approaches to the treatment of a varicocele in an adolescent; however, it has many challengers and it has not gained universal acceptance as the gold standard. This article reviews the published evidence regarding these surgical techniques. PMID:25455169

  19. Monolimb Paralysis after Laparoscopic Appendectomy Due to Conversion Disorder

    PubMed Central

    Song, Sung Hyuk; Lee, Kyeong Hwan

    2014-01-01

    Limb paralysis can develop for various reasons. We found a 13-year-old patient who became paralyzed in her lower extremities after laparoscopic appendectomy. Some tests, including electrodiagnostic studies and magnetic resonance imaging, were performed to evaluate the cause of lower limb paralysis. None of the tests yielded definite abnormal findings. We subsequently decided to explore the possibility of psychological problems. The patient was treated with simultaneous rehabilitation and psychological counseling. Paralysis of the patient's lower extremity improved gradually and the patient returned to normal life. Our findings indicate that psychological problems can be related to limb paralysis without organ damage in patients who have undergone laparoscopic surgical procedures. PMID:25426280

  20. Factors predictive of dysphagia after laparoscopic Nissen fundoplication

    Microsoft Academic Search

    D. M. Herron; L. L. Swanström; N. Ramzi; P. D. Hansen

    1999-01-01

    Background: Persistent postoperative dysphagia occurs in up to 24% of patients who undergo a laparoscopic Nissen fundoplication for reflux\\u000a disease [7]. We hypothesized that patient history, pH testing, and esophageal manometry could be used to preoperatively identify\\u000a patients at risk for this complication.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Of 156 laparoscopic Nissen fundoplications performed over a 27-month period, we identified 19 patients (12%) who

  1. Millimetric laparoscopic surgery training on a physical trainer using rats

    Microsoft Academic Search

    Arturo Minor Martinez; Alberto Chouleb Kalach; Daniel Lorias Espinoza

    2008-01-01

    Purpose  To demonstrate the possibility of laparoscopic technique training and refinement at the millimetric level.\\u000a \\u000a \\u000a \\u000a Material and Methods  A physical trainer and Winstar rats were used.\\u000a \\u000a \\u000a \\u000a Results  The training system is visually similar to pneumoperitoneum. The laparoscopic technique is perfected in a visual space illuminated\\u000a by white light, with two-dimensional feedback and at a geometric level that allows for refinement of the technique.

  2. Results of laparoscopic treatment of hydatid cysts of the liver

    Microsoft Academic Search

    G. Khoury; S. Jabbour-Khoury; K. Bikhazi

    1996-01-01

    Background  We have previously reported on the laparoscopic treatment of hydatid cysts of the liver. We now report the successful treatment\\u000a of 18 cysts in 12 patients with a median follow-up of 12 months.\\u000a \\u000a \\u000a \\u000a Methods  The standard treatment in the open technique was performed laparoscopically. The main concern was to prevent spillage of the\\u000a hydatid fluid, for which the puncture and evacuation

  3. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy

    PubMed Central

    Taran, F. A.; Stewart, E. A.; Brucker, S.

    2013-01-01

    Adenomyosis is an important clinical challenge in gynecology and healthcare economics; in its fully developed form, hysterectomy is often used to treat it in premenopausal and perimenopausal women. Symptoms of adenomyosis typically include menorrhagia, pelvic pain and dysmenorrhea. Moreover, adenomyosis and leiomyomas commonly coexist in the same uterus, and differentiating the symptoms for each pathological process can be problematic. Although it has been recognized for over a century, reliable epidemiological studies on this condition are limited, because only postoperative diagnoses were possible in the past. Minimally invasive surgical techniques (endometrial ablation/resection, myometrial excision/reduction, myometrial electrocoagulation, uterine artery ligation) have had limited success in the treatment of adenomyosis, and the reported data for these procedures have been obtained from case reports or small case series with only short follow-up times. However, newer techniques including uterine artery embolization (UAE) and magnetic resonance imaging guided focused ultrasound (MRgFUS) show promise in treating adenomyosis. The data is strongest for UAE; these studies have the largest patient cohorts. However, none of the UAE studies were randomized or controlled. Thus, despite the clinical importance of adenomyosis, there is little evidence on which to base treatment decisions. The objective of this review is to summarize the epidemiology, risk factors, clinical phenotype and to evaluate the accrued experience with surgical and interventional alternatives to hysterectomy. PMID:24771944

  4. A prospective randomized controlled comparison of immediate versus late removal of urinary catheter after abdominal hysterectomy

    PubMed Central

    Joshi, Bharti; Aggarwal, Neelam; Chopra, Seema; Taneja, Neelam

    2014-01-01

    Objective: Indwelling transurethral catheter is frequently used after gynecological surgeries in order to prevent urinary retention. There is controversy about the ideal time to remove the catheter after surgery. This randomized controlled study was undertaken to determine whether the immediate removal of urinary catheter after abdominal hysterectomy affects the rate of symptomatic urinary tract infection (UTI), recatheterization, subjective pain perception and febrile morbidity. Study Design: This prospective randomized controlled trial included 70 women undergoing abdominal hysterectomy with or without salpingoophrectomy for benign diseases. Patients were divided into two equal groups on the basis of timing of removal of urinary catheter (Group I — Immediate removal after surgery, Group II — Removal after 24 h and evaluated for benefits versus risks of immediate catheter removal. The results were compared by the Chi-square test. Results: Recatheterization was required in three patients of immediate removal group and none in late removal group (P = 0.07). Higher incidence of positive urine cultures (25.9%) and febrile morbidity (10%) was found in Group II when compared to immediate removal group (8%). Pain perception was not statistically different in both groups (P = 0.567). Conclusions: The early removal of an indwelling catheter after surgery was not associated with an increased rate of febrile events, UTI. Pain perception was also lower in early removal group. Although need of recatheterization was higher in early removal group, but not statistically significant. PMID:24970984

  5. Emergency Obstetric Hysterectomy: A Retrospective Study from a Teaching Hospital in North India over Eight Years

    PubMed Central

    Chawla, Jaya; Arora, D.; Paul, Mohini; Ajmani, Sangita N.

    2015-01-01

    Objectives We sought to determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency peripartum hysterectomy in an easily accessible urban center. Methods We conducted a retrospective, observational, and analytical study over a period of eight years, from August 2006 to July 2014. A total of 56 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, Kasturba Hospital, New Delhi. Results The incidence of EOH in our study was 30 per 100,000 following vaginal delivery and 270 per 100,000 following cesarean section. The overall incidence was 83 per 100,000 deliveries. Atonic postpartum hemorrhage (25%) was the most common indication followed by placenta accreta (21%) and uterine rupture (17.5%). The most frequent sequelae were febrile morbidity (19.2%) and disseminated intravascular coagulation (13.5%). Maternal mortality was 17.7% whereas perinatal mortality was 37.5%. Conclusions A balanced approach to EOH can prove to be lifesaving at times when conservative surgical modalities fail and interventional radiology is not immediately available. Our study highlights the place of extirpative surgery in modern obstetrics in the face of rising rates of cesarean section and multiple pregnancies particularly in urban settings in developing countries. PMID:26171124

  6. Complicated Gallstones after Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Sioka, Eleni; Zacharoulis, Dimitris; Zachari, Eleni; Katsogridaki, Georgia; Tzovaras, George

    2014-01-01

    Background. The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established. Methods. A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed. Results. Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3–8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwent cholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect. Conclusion. A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy. PMID:25105023

  7. Robot Assisted Laparoscopic Partial Adrenalectomy: Initial Experience

    PubMed Central

    Boris, Ronald S.; Gupta, Gopal; Linehan, W. Marston; Pinto, Peter A.; Bratslavsky, Gennady

    2010-01-01

    Objectives We evaluated the feasibility of performing robot assisted laparoscopic partial adrenalectomy (RALPA) in patients seen at the National Cancer Institute and report the results of our initial experience. Methods We reviewed the records of patients with adrenal masses who underwent attempted RALPA from July of 2008 until January of 2010. Demographic, perioperative, and pathologic data were collected. The functional and early oncologic outcomes were examined by the need for steroid replacement and development of recurrent disease, respectively. Results Ten patients underwent a total of 13 attempted RALPA for removal of 19 adrenal tumors. There was one open conversion with successful completion of partial adrenalectomy. Of the patients, 80% had a known hereditary syndrome predisposing them to adrenal tumors. One patient had bilateral multifocal adrenal masses with unknown germ line genetic alteration and one patient had a sporadic adrenal mass. Of the 19 tumors removed, 17 were pheochromocytoma and 2 were adrenal-cortical hyperplasia. Two patients underwent partial adrenalectomy on a solitary adrenal gland with one subsequently requiring steroid replacement post-operatively. On postoperative imaging all but one operated adrenal gland demonstrated contrast enhancement. No patient developed local recurrence at a median follow-up of 16.2 months (range 2- 29). Conclusions RALPA appears safe and feasible in our early experience. Only one patient in our series required steroid replacement. Local recurrence rates are low but will require longer follow up. PMID:21122898

  8. Laparoscopic Splenectomy Following Embolization for Blunt Trauma

    PubMed Central

    Ransom, Kenneth J.

    2008-01-01

    Background: Grade III through V splenic injuries as defined by the American Association for the Surgery of Trauma (AAST) grading scale are associated with hemorrhage and nonoperative failure. Embolization has been reported to reduce splenic bleeding in 50% to 75% of patients with a high-grade injury. However, splenectomy following embolization may be necessary in patients who continue to bleed or develop splenic infarction with abscess formation. Methods: We present the case of a 15-year-old female who demonstrated a Grade V splenic laceration with moderate hemoperitoneum following an all terrain vehicle crash. Central splenic artery embolization was performed. Because of signs of continued bleeding, laparoscopic splenectomy was performed. Results: The patient had a satisfactory postoperative result and returned to normal activity in 2 weeks. Conclusion: Our experience suggests that in cases of high-grade splenic injury or angiographic extravasation associated with moderate to large hemoperitoneum, embolization may serve as a bridge to operative therapy and make laparoscopy a safe, less-invasive option for splenectomy. PMID:18435899

  9. Cyber Weapons Convention

    Microsoft Academic Search

    Kenneth Geers

    2010-01-01

    World leaders are beginning to look beyond temporary fixes to the challenge of securing the Internet. One possible solution may be an international arms control treaty for cyberspace. The 1997 Chemical Weapons Convention (CWC) provides national security planners with a useful model. CWC has been ratified by 98% of the world’s governments, and encompasses 95% of the world’s population. It

  10. Convention Problems - 1787.

    ERIC Educational Resources Information Center

    Hanson, Deroy L.

    Designed to motivate eighth-grade civics students in the study of the United States Constitution, this game is intended to simulate the basic problems faced by the delegates to the Philadelphia Convention of 1787. The four parts of the game introduce the governmental concepts of the bicameral legislature, the executive branch, the judicial branch,…

  11. Single port laparoscopic repair of paediatric inguinal hernias: Our experience at a secondary care centre

    PubMed Central

    Kumar, Ameet; Ramakrishnan, T S

    2013-01-01

    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 advantage of minimal instrumentation and avoidance of intracorporeal knotting makes it a feasible technique for a secondary care centre. PMID:23626413

  12. Two ports laparoscopic inguinal hernia repair in children.

    PubMed

    Ibrahim, Medhat M

    2015-01-01

    Introduction. Several laparoscopic treatment techniques were designed for improving the outcome over the last decade. The various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, and mode of dissection of the hernia sac. Patients and Surgical Technique. 90 children were subjected to surgery and they undergone two-port laparoscopic repair of inguinal hernia in children. Technique feasibility in relation to other modalities of repair was the aim of this work. 90 children including 75 males and 15 females underwent surgery. Hernia in 55 cases was right-sided and in 15 left-sided. Two patients had recurrent hernia following open hernia repair. 70 (77.7%) cases were suffering unilateral hernia and 20 (22.2%) patients had bilateral hernia. Out of the 20 cases 5 cases were diagnosed by laparoscope (25%). The patients' median age was 18 months. The mean operative time for unilateral repairs was 15 to 20 minutes and bilateral was 21 to 30 minutes. There was no conversion. The complications were as follows: one case was recurrent right inguinal hernia and the second was stitch sinus. Discussion. The results confirm the safety and efficacy of two ports laparoscopic hernia repair in congenital inguinal hernia in relation to other modalities of treatment. PMID:25785196

  13. Effects of artificial force feedback in laparoscopic surgery training simulators

    Microsoft Academic Search

    Audrey K. Bell; Caroline G. L. Cao

    2007-01-01

    The use of haptic devices to provide artificial force feedback in teleoperation has been shown to enhance performance. An experiment was conducted to examine how artificial (simulated) force feedback is utilized, compared with real force feedback, in a laparoscopic tissue-probing task Actual (real) forces in probing a double-layer silicon gel mass were replicated and exaggerated in a virtual environment using

  14. Morbidity associated with laparoscopic repair of suprapubic hernias

    Microsoft Academic Search

    Brandon Varnell; Sharon Bachman; Jacob Quick; Michelle Vitamvas; Bruce Ramshaw; Dmitry Oleynikov

    2008-01-01

    BackgroundLaparoscopic suprapubic hernia repair (LSHR) is frequently a technically difficult procedure. This is often due to extensive adhesions from multiple previous operations, the necessary wide pelvic dissection, and adequate mesh coverage with transfascial suture fixation. The aim of the current study was to document the complications and morbidity associated with the repair of suprapubic hernias.

  15. Single-Incision Laparoscopic Ventral Hernia Repair with Suprapubic Incision

    PubMed Central

    Turingan, Isidro; Tran, Mai

    2013-01-01

    Introduction: Although natural orifice transluminal endoscopic surgery promises truly scarless surgery, this has not progressed beyond the experimental setting and a few clinical cases in the field of ventral hernia repair. This is mainly because of the problem of sterilizing natural orifices, which prevents the use of any prosthetic material because of unacceptable risks of infection. Single-incision laparoscopic ventral hernia repair has gained more widespread acceptance by specialized hernia centers. Even so, there is a special subset of patients who are young and/or scar conscious and find any visible scar unacceptable. This study illustrates an innovative way of performing single-incision laparoscopic ventral hernia repair by a transverse suprapubic incision below the pubic hair/bikini line in 2 young male patients who had both umbilical and epigastric hernias as well as attenuated linea alba in the upper abdomen. Case Description: Both patients underwent successful laparoscopic repair, and both were highly satisfied with the procedure, which produced no visible scars on their abdomen. Discussion: Willingness to adopt new innovative procedures, such as single-incision laparoscopic surgery, has allowed modification of the incision site to produce invisible scars and hence become highly attractive to the young and scar-phobic segment of the population. PMID:23925028

  16. Laparoscopic repair of massive inguinal hernia containing the urinary bladder

    PubMed Central

    Khan, Atif; Beckley, Ian; Dobbins, Brian; Rogawski, Karol M

    2014-01-01

    Inguinal herniation of the urinary bladder is an extremely rare occurrence involving less than 5% of inguinal hernias reported in literature. These hernias require a high index of suspicion for their diagnosis and pose significant challenges to the operating surgeon. The majority of these hernias have been repaired by an open technique. We report two cases managed laparoscopically. PMID:24833832

  17. Seeding from early stage gallbladder carcinoma after laparoscopic cholecystectomy.

    PubMed

    Napolitano, L; Artese, L; Innocenti, P

    2001-01-01

    In the last years laparoscopic cholecystectomy has become the "gold standard therapy" in the treatment of symptomatic cholelitiasis, but it is necessary to keep into account some problems and risks that can arise from laparoscopic technique. One of these risks is represented surely by the disregarding of a gallbladder carcinoma. The authors report a case of peritoneal seeding of an unsuspected gallbladder carcinoma following laparoscopic cholecystectomy. The first histologic diagnosis was chronic ulcerous cholecystitis with adenomiosis but 2 months later the metastasis developed at the umbilical port site, at another port site and to the right lobe of the liver. Another histological sampling of the gallbladder specimen was performed and this time a little intra mucous gallbladder adenocarcinoma was found (T1 stage). While the most part of literature data concern advanced stage of the disease at the time of operation (T2, T3) only few reports regard early stage neoplasm. Therefore this risk is present not only in advanced stages of gallbladder carcinoma but even in cases of early stage cancers. After a laparoscopic cholecystectomy all specimen should be opened and inspected. If there is a gallbladder wall irregularity and if there was a bile spillage it is advisable to perform a preoperative histologic examination. PMID:12061225

  18. Laparoscopic treatment of deep endometriosis located on the uterosacral ligaments

    Microsoft Academic Search

    Charles Chapron; Jean-Bernard Dubuisson

    The goal of this study was to assess the efficiency of laparo- scopic surgical treatment of pain for patients presenting deep endometriosis located on the uterosacral ligaments. To this end we analysed a continuous series of 21 patients treated by laparoscopic surgery between January 1993 and June 1994. In all these cases treatment consisted of resection of all the uterosacral

  19. A Pancreatic Fistula after the Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Özbalc?, Gökhan Selçuk; Polat, Ayfer Kamal?; Tar?m, ?smail Alper; Derebey, Murat; Nural, Mehmet Selim; Tümentemur, Volkan; Karabacak, Ufuk

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) is a popular surgical weight-loss procedure in the treatment of morbid obesity. There are some complications regarding this procedure in the literature. This report presents a pancreatic fistula (PF) case, which has not been previously seen.

  20. VIRTUAL ENVIRONMENTS FOR TRAINING CRITICAL SKILLS IN LAPAROSCOPIC SURGERY

    E-print Network

    Cavusoglu, Cenk

    VIRTUAL ENVIRONMENTS FOR TRAINING CRITICAL SKILLS IN LAPAROSCOPIC SURGERY MICHAEL DOWNES (1), M steadily over the past century, the methods by which surgeons learn how to operate have remained virtually laboratories are expensive, and the anatomy of animals differs significantly from human anatomy. Simply