Science.gov

Sample records for conventional laparoscopic hysterectomy

  1. 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. PMID:26023674

  2. 257 Incidental Appendectomies During Total Laparoscopic Hysterectomy

    PubMed Central

    Fisher, Deidre T.; O'Holleran, Michael S.

    2007-01-01

    Objective: This retrospective observational report analyzes the demographics, blood loss, length of surgical duration, number of days in the hospital, and complications for 821 consecutive patients undergoing total laparoscopic hysterectomy over a 11-year period stratified by incidental appendectomy. Methods: A retrospective chart abstraction was performed. ANOVA and chi-square tests were performed with significance preset at P<0.05. Results: Of 821 consecutive patients undergoing total laparoscopic hysterectomy, 257 underwent elective appendectomy with the ultrasonic scalpel, either as part of their staging, treatment for pelvic pain, or prophylaxis against appendicitis. Comparing the 2 groups, no difference existed in mean age of 50±10 years or mean BMI of 27.6±6.7. Both groups had a similar mean blood loss of 130 mL. Surgery took less time (137 vs 118 minutes, P<0.0012) and the hospital stay was shorter in the appendectomy group (1.5 vs 1.2, P<0.0001) possibly because it was performed incidentally in most cases. No complications were attributable to the appendectomy, and complication types and rates in both groups were similar. Though all appendicies appeared normal, pathology was documented in 9%, including 3 carcinoid tumors. Conclusions: Incidental appendectomy during total laparoscopic hysterectomy is not associated with significant risk and can be routinely offered to patients planning elective gynecologic laparoscopic procedures, as is standard for open procedures. PMID:18237505

  3. Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy.

    PubMed

    Winter, Marc L; Leu, Szu-Yun; Lagrew, David C; Bustillo, Gerardo

    2015-12-01

    The aim of the study was to assess if the cost of robotic-assisted total laparoscopic hysterectomy is similar to the cost of standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve. A retrospective chart review of all hysterectomies was performed for benign indications without concomitant major procedures at Orange Coast Memorial Medical Center (OCMMC) and Saddleback Memorial Medical Center between January 1, 2013 and September 30, 2013. Robotic-assisted total laparoscopic hysterectomies (RTLH) and standard laparoscopic hysterectomies (LAVH and TLH) were compared. Data analyzed included only those hysterectomies performed by surgeons past their initial learning curve (minimum of 30 previous robotic cases). The primary outcome was the direct total cost of patient's hospitalization related to hysterectomy. The secondary outcomes were estimated blood loss, surgery time, and days in hospital post-surgery. A multiple linear regression model was applied to evaluate the difference between RTLH and LAVH/TLH in hospital cost, blood loss, and surgery time, while adjusting for hospital, patient's age, body mass index (BMI), whether or not the patient had previous abdominal/pelvic surgery, and uterine weight. The ? (2) test was applied to examine the association between hospital stay and surgery type. There were 93 hysterectomies (5 LAVH, 88 RTLH) performed at OCMMC and 90 hysterectomies (6 LAVH, 17 TLH, 67 RTLH) performed at Saddleback Memorial Medical Center. The hospitalization total cost result showed that, after adjusting for hospital, age, BMI, previous abdominal/pelvic surgery, and uterine weight, RTLH was not significantly more expensive than LAVH/TLH (mean diff. = $283.1, 95 % CI = [-569.6, 1135.9]; p = 0.51) at the 2 study hospitals. However, the cost at OCMMC was significantly higher than Saddleback Memorial Medical Center (mean diff. = $2008.7, 95 % CI = [1380.6, 2636.7]; p < 0.0001); and the cost increased significantly with uterine weight (? = 3.8, 95 % CI = [2.3, 5.3]; p < 0.0001). Further analysis showed significantly less blood loss (mean diff. = -78.5 ml, 95 % CI = [-116.8, -40.3]; p < 0.0001) and shorter surgery time (mean diff. = -21.9 min., 95 % CI = [-39.6, -4.2]; p = 0.016) for RTLH versus LAVH/TLH. There was no significant association between hospital stay and surgery type (p = 0.43). After adjusting for patient-level covariates, there was no statistically significant cost difference of performing robotically assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve at two community hospitals. PMID:26530837

  4. Recognition and Management of Urologic Injuries With Laparoscopic Hysterectomy.

    PubMed

    Dassel, Mark W; Adelman, Marisa R; Sharp, Howard T

    2015-12-01

    Injuries to the urinary tract during laparoscopic hysterectomy are quite rare, but are among the most serious injuries that occur during gynecologic surgery. Injury rates among subtypes of laparoscopic hysterectomy have been found to be similar. The most effective way to avoid urinary tract injury is knowledge of urinary tract anatomy and careful and thoughtful dissection. PMID:26457852

  5. Infection Prevention and Evaluation of Fever After Laparoscopic Hysterectomy

    PubMed Central

    Moulton, Laura J.; Jaiyeoba, Oluwatosin

    2015-01-01

    Background: Surgical site infection (SSI) is a common complication of hysterectomy. Minimally invasive hysterectomy has lower infection rates than abdominal hysterectomy. The lower SSI rates reflect the role and benefit in infection control of having minimal incisions, rather than a large anterior abdominal wall incision. Despite the lower rates, SSI after laparoscopic hysterectomy is not uncommon. In this article, we review pre-, intra-, and postoperative risk factors for infection. Rates of postoperative fever after laparoscopic hysterectomy and when evaluation for infection is warranted in a febrile patient are also reviewed. Database: PubMed was searched for English-only articles using National Library of Medicine Medical Subject Headings (MESH) terms and keywords including but not limited to “postoperative,” “surgical site,” “infection,” “fever,” “laparoscopic,” “laparoscopy,” and “hysterectomy.” Conclusions: Reducing hospital-acquired infections such as SSI is one of the more effective ways of improving patient safety. Knowledge and understanding of risk factors for infection following laparoscopic hysterectomy enable the gynecologic surgeon or hospital to implement targeted preventive measures. PMID:26390531

  6. Total Laparoscopic Hysterectomy: Our 5-Year Experience (1998–2002)

    PubMed Central

    Bonilla, David J.; Mains, Lindsay; Rice, Janet; Crawford, Benjamin

    2010-01-01

    Purpose: To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. Methods: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. Results: Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ?30 kg/m2), patients with enlarged uteri (?300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. Conclusions: Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances. PMID:21603347

  7. Barbed Suture for Vaginal Cuff Closure in Laparoscopic Hysterectomy

    PubMed Central

    Medina, Byron Cardoso; Riaño, Giovanni; Hoyos, Luis R.; Otalora, Camila

    2014-01-01

    Background and Objectives: Our aim was to evaluate whether the use of barbed suture for vaginal cuff closure is associated with a decrease in postoperative vaginal bleeding compared with cuff closure with polyglactin 910 in patients who have undergone laparoscopic hysterectomy. Methods: We performed a cohort study of patients who underwent laparoscopic hysterectomy between January 2008 and July 2012 by the minimally invasive gynecologic surgery division of the Gynecology, Obstetrics and Human Reproduction Department at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia. Results: A total of 232 women were studied: 163 were in the polyglactin 910 group, and 69 were in the barbed suture group. The main outcome, postoperative vaginal bleeding, was documented in 53 cases (32.5%) in the polyglactin 910 group and in 13 cases (18.8%) in the barbed suture group (relative risk, 0.57; 95% confidence interval, 0.34–0.9; P = .03). No statistically significant differences were found in other postoperative outcomes, such as emergency department admission, vaginal cuff dehiscence, infectious complications, and the presence of granulation tissue. Conclusion: In this study an inverse association was observed between the use of barbed suture for vaginal cuff closure during laparoscopic hysterectomy and the presence of postoperative vaginal bleeding. PMID:24680149

  8. Total laparoscopic hysterectomy of very enlarged uterus (3030 g): case report and review of the literature

    PubMed Central

    Roviglione, Giovanni; Pesci, Anna; Quintana, Sara; Bruni, Francesco; Clarizia, Roberto

    2014-01-01

    Fibromatosis is the most frequent benign uterine pathology of fertile women, rarely causing anomalous enlargement of the uterus. Traditionally the surgical treatment has been abdominal hysterectomy. However, development of minimally invasive techniques has led to major safeness of the laparoscopic route. We report a case of total laparoscopic hysterectomy performed on a uterus weighting more than 3,000 g and present a review of the literature about the laparoscopic approach to very enlarged uteri. PMID:25097706

  9. Combined spinal and general anesthesia is better than general anesthesia alone for laparoscopic hysterectomy

    PubMed Central

    Ghodki, Poonam S.; Sardesai, Shalini P.; Naphade, Ramesh W.

    2014-01-01

    Context: Spinal anesthesia (SA) was combined with general anesthesia (GA) for achieving hemodynamic stability in laparoscopic hysterectomy. Aims: The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile. Settings and Design: We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study. Materials and Methods: Patients were randomly assigned to receive SA with GA (group SGA) or plain GA (group GA). Group SGA received 10 mg bupivacaine (heavy) for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied. Statistical analysis used: Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance (ANOVA) was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate (HR), mean arterial pressure (MAP), SPO2, and etCO2 was done with Student's t-test or Mann–Whitney test, wherever applicable. Results: Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant (P < 0.01). Group GA showed additional requirement of metoprolol (53.33%) and higher concentration of isoflurane (P < 0.001) to combat the increased MAP. Recovery was early and quick in group SGA as against group GA (P = 0.000). There were no adverse/residual effects of SA. Conclusion: The hemodynamic repercussions during pneumoperitoneum can be effectively attenuated by combining SA and GA, without any adverse effects. PMID:25422608

  10. Laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our instruments and technique.

    PubMed

    Malzoni, Mario; Tinelli, Raffaele; Cosentino, Francesco; Perone, Ciro; Iuzzolino, Domenico; Rasile, Marianna; Tinelli, Andrea

    2009-12-01

    The purpose of this study is to describe the technique of total laparoscopic radical hysterectomy (type III procedure) with lymphadenectomy as performed at the Advanced Gynecological Endoscopy Center of the Malzoni Medical Center, Avellino, Italy. Seventy-seven patients underwent total laparoscopic radical hysterectomy (type II, III) with lymphadenectomy between January 2000 and March 2008. FIGO stage included five patients Ia1 with LVSI (lymph-vascular involvement), 24 patients Ia2, and 48 patients Ib1. 60 patients underwent a class III procedure and 17 patients a class II procedure according to the Piver classification. Histological types included squamous cell carcinoma in 65 patients, adenocarcinomas in 10 patients, and adenosquamous carcinoma in two. Para-aortic lymphadenectomy was performed up to the level of the inferior mesenteric artery in eight cases with positive pelvic lymph nodes at frozen section evaluation. Total laparoscopic radical hysterectomy can be considered a safe and effective therapeutic procedure for the management of early stage cervical cancer with a low morbidity; moreover, the laparoscopic route may offer an alternative option for patients undergoing radical hysterectomy, although multicenter studies and long-term follow-up are required to evaluate the oncologic outcomes of this procedure. PMID:18805001

  11. Abdominal Hysterectomy: A New Approach for Conventional Procedure

    PubMed Central

    Dutta, Indranil

    2014-01-01

    Objective: The present comparative study helps in developing a new approach to conventional hysterectomy procedure so as prevent intra-operative and Post-operative complications during the procedure. Methods: Ligation of uterine and ovarian arteries was performed, prior to abdominal hysterectomy procedures, in Group A (n-1000) and conventional method of abdominal hysterectomy in Group B (n-450) from January 2000 to December 2009. It was a prospective study. Results: In Group A it was noted that traumatic injury to (L) uterine vessel was present in 4 (0.4%) cases and (R) uterine vessel in 3 (0.3%) cases without any noticeable injury to the ovarian vessels, ureters or bladder as compared to in Group B where injury to (L) uterine was noted in 11 (2.4%) cases, ureters in 1 (0.1%) case, bladder in 6(1.5%) cases, hematoma in 10 (2.2%). Post-operative complications were found to be uneventful in Group A. Conclusion: The Present study concludes that ligation of uterine and ovarian arteries, prior to conventional abdominal hysterectomy procedures is found to be extremely safe procedure thereby reducing the risk of intra-operative and post- operative complications. PMID:24959484

  12. From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve

    PubMed Central

    Zweemer, R. P.; van Baal, W. M.; van de Lande, J.; Dijkstra, J. C.; Verheijen, R. H. M.

    2010-01-01

    We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery. PMID:20700514

  13. Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) Following Total Laparoscopic Hysterectomy.

    PubMed

    Cebola, Monique; Eddy, Eliza; Davis, Suzanne; Chin-Lenn, Laura

    2015-01-01

    Rapid identification of acute colonic pseudo-obstruction (ACPO), or Ogilvie's syndrome, is paramount in the management of this condition, which, if unresolved, can progress to bowel ischemia and perforation with significant morbidity and mortality. We present the first case report, to our knowledge, of ACPO following total laparoscopic hysterectomy. We describe the presentation and management of ACPO in a patient who underwent uncomplicated total laparoscopic hysterectomy to treat menorrhagia and dysmenorrhea after declining conservative treatment. Following initial conservative management, the patient rapidly deteriorated and required laparotomy for clinically suspected cecal ischemia. Cecal resection, colonic decompression, and end ileostomy formation were performed. A brief review of the current literature is presented with respect to the case report. PMID:26164536

  14. Strategies to optimize the performance of Robotic-assisted ­laparoscopic hysterectomy

    PubMed Central

    Lambrou, N.; Diaz, R.E.; Hinoul, P.; Parris, D.; Shoemaker, K.; Yoo, A.; Schwiers, M.

    2014-01-01

    A hybrid technique of robot-assisted, laparoscopic hysterectomy using the ENSEAL® Tissue Sealing Device is described in a retrospective, consecutive, observational case series. Over a 45 month period, 590 robot-assisted total laparoscopic hysterectomies +/- oophorectomy for benign and malignant indications were performed by a single surgeon with a bedside assistant at a tertiary healthcare center. Patient demographics, indications for surgery, comorbidities, primary and secondary surgical procedures, total operative and surgical time, estimated blood loss (EBL), length of stay (LOS), complications, transfusions and subsequent readmissions were analyzed. The overall complication rate was 5.9% with 35 patients experiencing 69 complications. Mean (SD) surgery time, operating room (OR) time, EBL, and LOS for the entire cohort were 75.5 (39.42) minutes, 123.8 (41.15) minutes, 83.1 (71.29) millilitres, and 1.2 (0.93) days, respectively. Mean surgery time in the first year (2009) was 91.6 minutes, which declined significantly each year by 18.0, 19.0, and 24.3 minutes, respectively. EBL and LOS did not vary ­significantly across the entire series. Using the cumulative sum method, an optimization curve for surgery time was evaluated, with three distinct optimization phases observed. In summary, the use of an advanced laparoscopic tissue-sealing device by a bedside surgical assistant provided an improved operative efficiency and reliable vessel sealing during robotic hysterectomy. PMID:25374656

  15. Total Laparoscopic Versus Laparotomic Radical Hysterectomy and Lymphadenectomy in Cervical Cancer

    PubMed Central

    Xiao, Meizhu; Zhang, Zhenyu

    2015-01-01

    Abstract This article aims to review our 13-year experience in the treatment of patients with cervical cancer by comparing total laparoscopic radical hysterectomy and lymphadenectomy with laparotomy. We reviewed all patients undergoing total laparoscopic or laparotomic radical hysterectomy and lymphadenectomy because of cervical cancer between 2001 and 2014 in our hospital. In total, 154 eligible patients with International Federation of Gynecology and Obstetrics Ia–IIb were enrolled, including 106 patients undergoing total laparoscopic procedure and 48 patients undergoing laparotomic procedure. In the present study, patients in total laparoscopy group were associated with superior surgical outcomes, such as significantly lower blood transfusion compared to those in laparotomy group. Furthermore, patients had significantly lower postoperative complication rate in total laparoscopy group compared with that in laparotomy group (24.5% vs 52.1%) (P?=?0.001). Three patients (2.8%) in total laparoscopy group had unplanned conversion to laparotomy. Disease-free survival rates were 89.7% and 88.9% in total laparoscopy and laparotomy groups (P?=?0.39), respectively, and overall survival rates were 90.2% in total laparoscopy group and 91.3% in laparotomy group (P?=?0.40). Total laparoscopic procedure is a surgically and oncologically safe and reliable alternative to laparotomic procedure in the treatment for cervical cancer. PMID:26222868

  16. Postoperative Nausea and Vomiting: Palonosetron with Dexamethasone vs. Ondansetron with Dexamethasone in Laparoscopic Hysterectomies

    PubMed Central

    Sharma, Anish N. G.; Shankaranarayana, Paniye

    2015-01-01

    Objectives Postoperative nausea and vomiting (PONV) is the most common complication seen following laparoscopic surgery. Our study sought to evaluate the efficacy of the newer drug palonosetron with that of ondansetron, in combination with dexamethasone, for PONV in patients undergoing laparoscopic hysterectomies.? Methods A total of 90 patients, aged between 30–50 years old, posted for elective laparoscopic hysterectomies under general anesthesia belonging to the American Society of Anesthesiologist (ASA) physical status I and II were included in the study. Patients were randomly divided into one of two groups (n=45). Before induction, patients in the first group (group I) received 0.075mg palonosetron with 8mg dexamethasone and patients in the second group (group II) received 4mg ondansetron with 8mg dexamethasone. Postoperatively, any incidences of early or delayed vomiting, requirement of rescue antiemetic, and side effects were recorded. Patient’s hemodynamics were also monitored. Statistical analysis was done using Student’s t-test, chi-square test, and Fisher’s exact test.? Results Preoperative, intraoperative, and postoperative heart rate, mean arterial pressure, peripheral capillary oxygen saturation were statistically not significant (p>0.050) in either group. In group II, eight patients had nausea in the first two hours and three patients had nausea in the two to six-hour postoperative period. In group I, three patients experienced nausea in the first six hours period. Eight patients in group II had vomited in the first two-hour period compared to one patient in group I (p=0.013). The requirement of rescue antiemetic was greater in group II than group I (20% vs. 4%). No side effects of antiemetic use were observed in either group.? Conclusion The combination of palonosetron with dexamethasone is more effective in treating early, delayed, and long term PONV compared to ondansetron with dexamethasone in patients undergoing elective laparoscopic hysterectomies under general anesthesia. PMID:26366258

  17. 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

  18. 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

  19. Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials.

    PubMed

    Albright, Benjamin B; Witte, Tilman; Tofte, Alena N; Chou, Jeremy; Black, Jonathan D; Desai, Vrunda B; Erekson, Elisabeth A

    2016-01-01

    We conducted a systematic review and meta-analysis to assess the safety and effectiveness of robotic vs laparoscopic hysterectomy in women with benign uterine disease, as determined by randomized studies. We searched MEDLINE, EMBASE, the Cochrane Library, ClinicalTrials.gov, and Controlled-Trials.com from study inception to October 9, 2014, using the intersection of the themes "robotic" and "hysterectomy." We included only randomized and quasi-randomized controlled trials of robotic vs laparoscopic hysterectomy in women for benign disease. Four trials met our inclusion criteria and were included in the analyses. We extracted data, and assessed the studies for methodological quality in duplicate. For meta-analysis, we used random effects to calculate pooled risk ratios (RRs) and weighted mean differences. For our primary outcome, we used a modified version of the Expanded Accordion Severity Grading System to classify perioperative complications. We identified 41 complications among 326 patients. Comparing robotic and laparoscopic hysterectomy, revealed no statistically significant differences in the rate of class 1 and 2 complications (RR, 0.66; 95% confidence interval [CI], 0.23-1.89) or in the rate of class 3 and 4 complications (RR, 0.99; 95% CI, 0.22-4.40). Analyses of secondary outcomes were limited owing to heterogeneity, but showed no significant benefit of the robotic technquie over the laparoscopic technique in terms of length of hospital stay (weighted mean difference, -0.39 day; 95% CI, -0.92 to 0.14 day), total operating time (weighted mean difference, 9.0 minutes; 95% CI, -31.27 to 47.26 minutes), conversions to laparotomy, or blood loss. Outcomes of cost, pain, and quality of life were reported inconsistently and were not amenable to pooling. Current evidence demonstrates neither statistically significant nor clinically meaningful differences in surgical outcomes between robotic and laparoscopic hysterectomy for benign disease. The role of robotic surgery in benign gynecology remains unclear. PMID:26272688

  20. Hysterectomy

    MedlinePLUS

    ... hysterectomy is performed with the help of a robotic machine controlled by the surgeon. In general, it ... in a better outcome than laparoscopy performed without robotic assistance. What are the benefits and risks of ...

  1. Laparoscopic hysterectomy with bilateral orchidectomy for Persistent Mullerian duct syndrome with seminoma testes: Case report

    PubMed Central

    Palanisamy, Senthilnathan; Patel, Nikunj D.; Sabnis, Sandeep C.; Palanisamy, Nalankilli; Vijay, Anand; Chinnusamy, Palanivelu

    2015-01-01

    Persistent Mullerian duct syndrome (PMDS) is one of the three rare intersex disorders caused by defective anti-mullerian hormone or its receptor, characterized by undescended testes with presence of underdeveloped derivatives of mullerian duct in genetically male infant or adult with normal external genitals and virilization. This population will essentially have normal, 46(XY), phenotype. We hereby present a case of PMDS, presented with incarcerated left inguinal hernia associated with cryptorchidism and seminoma of right testes. Patient underwent laparoscopic hernia repair with bilateral orchidectomy and hysterectomy with uneventful postoperative recovery. Here we highlight the importance of minimal access approach for this scenario in terms of better visualization, less blood loss, combining multiple procedures along with early return to work and excellent cosmetic outcome.

  2. Learning curve analysis of laparoscopic radical hysterectomy for gynecologic oncologists without open counterpart experience

    PubMed Central

    Kong, Tae-Wook; Paek, Jiheum; Park, Hyogyeong; Kang, Seong Woo; Ryu, Hee-Sug

    2015-01-01

    Objective To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwent residency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radical hysterectomy (ARH). Methods We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervical cancer who underwent LRH (Piver type III) between April 2006 and March 2014. The patients were divided into two groups (surgeon A group, 42 patients; surgeon B group, 42 patients) according to the surgeon with or without ARH experience. Clinico-pathologic data were analyzed between the 2 groups. Operating times were analyzed using the cumulative sum technique. Results The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeply decreased with operative experience (Pearson correlation coefficient=-0.508, P=0.001). Surgeon B, however, showed a gentle slope of learning curve within 2 standard deviations of mean operating time (Pearson correlation coefficient=-0.225, P=0.152). Approximately 18 cases for both surgeons were required to achieve surgical proficiency for LRH. Multivariate analysis showed that tumor size (>4 cm) was significantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% confidence interval, 1.187 to 18.352). Conclusion After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, even without ARH experience, might reach an acceptable level of surgical proficiency in LRH after approximately 20 cases and showed a gentle slope of learning curve, taking less effort to initially perform LRH. PMID:26430662

  3. Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section

    PubMed Central

    Ko, Jung Hwa; Bae, Jaeman; Lee, Won Moo; Koh, A Ra; Boo, Hyeyeon; Lee, Eunhyun; Hong, Jin Hwa

    2015-01-01

    Objective To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. Methods We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. Results The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group. Conclusion LAVH is effective and safe for women with anterior wall adherence after cesarean section. PMID:26623415

  4. Hysterectomy

    MedlinePLUS

    ... cuts in the belly, in order to perform robotic surgery You and your doctor will decide which ... through the vagina using a laparoscope or after robotic surgery. When a larger surgical cut (incision) in ...

  5. Prognostic and Safety Roles in Laparoscopic Versus Abdominal Radical Hysterectomy in Cervical Cancer: A Meta-analysis

    PubMed Central

    Cao, Tiefeng; Feng, Yanling; Huang, Qidan; Wan, Ting

    2015-01-01

    Abstract Objective: Studies comparing the prognostic results between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in cervical cancer reported contradictory results. We aimed to evaluate the prognostic and safety roles of LRH by pooling studies in a meta-analysis. Materials and Methods: Original articles were searched in PubMed, EMBASE, and the Cochrane Library. The survival results (5-year disease-free survival [DFS], 5-year overall survival [OS], and recurrence rate [RR]), safety parameters (intra-, peri-, and postoperative complication rates and postoperative bowel or bladder recovery days), efficiency parameters (pelvic/para-aortic lymph nodes removed), and other parameters (operative time, estimated blood loss, and hospital of stay) between the two approaches were reviewed. Results: For the 2922 cases identified, DFS, OS, and RR did not differ in balanced prognostic factors, including lymph node metastasis, Stage IIB or above, non–squamous cancer histology, grade G3, lymphovascular space invasion, tumor size ?4?cm, and positive parametrial and vaginal margin rates. Meanwhile, LRH was associated with higher complication rates and a shorter time to the recovery of bowel or bladder function than for ARH. The number of removed pelvic or para-aortic lymph nodes did not significantly differ. Other parameters showed LRH was associated with a longer operative time, less blood loss, and a shorter length of hospital stay. The survival and prognostic results did not differ in balanced prognostic factors. Conclusions: LRH is safe and has lower operative complication rates than ARH. PMID:26584414

  6. 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 ...

  7. A Prospective, double-blinded randomized controlled study comparing two different Trendelenburg tilts in laparoscopically assisted vaginal hysterectomy positioning

    PubMed Central

    Mallick, Shibananda; Das, Anjan; Dutta, Sanjib; Chattopadhyay, Surajit; Das, Tanuka; Banu, Rezina

    2015-01-01

    Background: Bispectral index (BIS) used for intra-operative depth assessment under general anesthesia (GA) can be altered by different factors. This study was designed to detect the alteration in BIS reading with two different Trendelenburg (TBG) tilt in laparoscopically assisted vaginal hysterectomy (LAVH) procedure. Materials and Methods: A prospective, double-blinded, randomized controlled study was designed involving 40 American Society of Anesthesiologists Grade I and II female patients, aged 35-60 years, scheduled to undergo LAVH under GA. Patients were divided into two groups with TBG >30° and TBG <30°. BIS readings; systolic and diastolic blood pressure, heart rate were recorded in supine position. Patients were then shifted to desired TBG position either (>30°) or (<30°) as per group allotment. Data were recorded at 30 min intervals and all the patients were followed upto 24 h postoperatively for any recall. Results: A rise in BIS value was noticed, when position was changed from supine to head down in both groups. During comparison between two groups with different angulations, TBG >30° showed a higher BIS value than TBG <30°. This statistically significant (P < 0.05) trend was observed at all the 30, 60, 90, and 120th min interval. Interestingly, BIS values returned to preoperative levels following adopting final supine position. No incidence of awareness was reported in both the series throughout the study. Conclusion: Though awareness remains unaltered BIS value gets increased with higher angle of inclination in TBG position during LAVH operation. PMID:25810654

  8. Laparoscopic versus conventional open resection of rectal carcinoma: A clinical comparative study

    PubMed Central

    Wu, Wen-Xi; Sun, Yao-Min; Hua, Yi-Bin; Shen, Li-Zong

    2004-01-01

    AIM: To evaluate the feasibility of laparoscopic resection of rectal carcinoma and to compare the short-term outcome of laparoscopic procedure with conventional open surgery for rectal cancer. METHODS: Thirty-eight patients with rectal cancer were included in a prospective non-randomized study. The patients were assigned to laparoscopic (n = 18) or open (n = 18) colorectal resection. Case selection, surgical technique, and clinical and pathological results were reviewed. RESULTS: The operative time was longer in laparoscopic resection group (LAP) than in open resection group (189 ± 18 min vs 146 ± 22 min, P < 0.05). Intraoperative blood loss and postoperative complications were less in LAP resection group than in open resection group. An earlier return of bowel motility was observed after laparoscopic surgery. The overall postoperative morbidity was 5.6% in the LAP resection group and 27.8% in open resection group (P < 0.05). No anastomotic leakage was found in both groups. The pathologic examination showed that the length of the resected specimen, the mean number of harvested lymph nodes in laparoscopic resection group were comparable to those in open resection group. CONCLUSION: Laparoscopic total mesorectal excision (TME) for rectal cancer is a feasible but technically demanding procedure. The present study demonstrates the safety of the procedure, while oncologic results are comparable to the open surgery, with a favorable short-term outcome. PMID:15069719

  9. Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair

    PubMed Central

    Kwon, Ki-Hwak; Han, Won-Kon

    2011-01-01

    Purpose We have treated 24 patients through laparoscopic totally extraperitoneal (TEP) repair without suprapubic port by using reliability and reducing the invasiveness of two surgery. This study is aimed to assess the safety and feasibility of the TEP repair without suprapubic port compared to conventional TEP repair. Methods From September 2007 to 11 May 2010, we compared two groups that suffer from inguinal hernias. One is comprised of 24 patients who were treated without suprapubic port laparoscopic totally extraperitoneal repair (Group A), and the other is comprised of 100 patients who were treated with conventional laparoscopic totally extraperitoneal repair (Group B). Data regarding patient demographics (sex, age, site of hernia, and the type of hernia), operating time, postoperative hospital stay, the use of analgesics, and complications were prospectively collected. Results There was no significant difference noted between two groups in relation to sex, age, site, and the type of hernia. The mean operating time and postoperative hospital stay was longer for the Group B (62.9 minutes, 3.55 days) than for the Group A (59.0 minutes, 2.54 days) (P = 0.389, P < 0.001). Postoperative urinary retention, seroma, wound infection were respectively 4.2%, 8.3%, 0% in Group A, and 12.0%, 8.0%, 7% in group B. There was difference between the two groups, but not statistical significance. Group B used more analgesics than Group A (0.33 vs. 0.48), but it wasn't significant statistically (P = 0.234). Conclusion Although prospective randomized studies with long-term follow-up evaluation are needed to confirm our study between laparoscopic totally extraperitoneal repair without suprapubic-port and conventional laparoscopic totally extraperitoneal repair, our method have some advantages in postoperative pain, urinary retention, operating time, postoperative hospital stay, and cosmetic effect. PMID:22066055

  10. Laparoscopic Supracervical Hysterectomy

    MedlinePLUS

    ... the ideal patient for this new technique? The robot can be used…has been used more for ... and behind the peritoneum. But, yes, definitely the robot, which is not what we demonstrated here today. ...

  11. Laparoendoscopic single-site versus conventional laparoscopic surgery for ovarian mature cystic teratoma

    PubMed Central

    Park, Jeong-Yeol; Kim, Dae-Yeon; Suh, Dae-Shik; Kim, Jong-Hyeok

    2015-01-01

    Objective To compare the intraoperative and postoperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery in women with ovarian mature cystic teratoma. Methods A retrospective review of 303 women who underwent LESS (n=139) or conventional laparoscopic surgery (n=164) due to ovarian mature cystic teratoma was performed. Intra- and postoperative outcomes were compared between the two groups. Results There was no intergroup difference in age, body weight, height, body mass index, comorbidities, tumor size, bilaterality of tumor, or the type of surgery. However, more patients in the LESS group had a history of previous abdominal surgery (19.4% vs. 6.7%, P=0.001). Surgical outcomes including operating time (89 vs. 87.8 minutes, P=0.734), estimated blood loss (69.4 vs. 68.4 mL, P=0.842), transfusion requirement (2.2% vs. 0.6%, P=0.336), perioperative hemoglobin level change (1.3 vs. 1.2 g/dL, P=0.593), postoperative hospital stay (2.0 vs. 2.1 days, P=0.119), and complication rate (1.4% vs. 1.8%, P=0.999) did not differ between LESS and conventional groups. Postoperative pain scores measured using a visual analogue scale were significantly lower in the LESS group at 8 hours (P=0.021), 16 hours (P=0.034), and 32 hours (P=0.004) after surgery, and 32 of 139 patients (23%) in the LESS group and 78 of 164 patients (47.6%) in the conventional group required at least one additional analgesic (P<0.001). Conclusion LESS was feasible and showed comparable surgical outcomes with conventional laparoscopic surgery for women with ovarian mature cystic teratoma. LESS was associated with less postoperative pain and required less analgesia. PMID:26217600

  12. 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

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

    PubMed Central

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

    2014-01-01

    Background Laparoscopic surgery has become the standard for treating appendicitis. The cosmetic benefits of using single-incision laparoscopy are well known, but its duration, complications and time to recovery have not been well documented. We compared 2 laparoscopic approaches for treating appendicitis and evaluated postoperative pain, complications and time to full recovery. Methods We retrospectively reviewed the cases of consecutive patients with appendicitis and compared those who underwent conventional laparoscopic appendectomy (CLA) performed using 3 incisions and those who underwent single-incision laparoscopic appendectomy (SILA). During SILA, the single port was prepared to increase visibility of the operative site. Results Our analysis included 688 consecutive patients: 618 who underwent CLA and 70 who underwent SILA. Postsurgical complications occurred more frequently in the CLA than the SILA group (18.1% v. 7.1%, p = 0.018). Patients who underwent SILA returned to oral feeding sooner than those who underwent CLA (median 12 h v. 22 h, p < 0.001). These between-group differences remained significant after controlling for other factors. Direct comparison of only nonperforated cases, which was determined by pathological examination, revealed that SILA was significantly longer than CLA (60 min v. 50 min, p < 0.001). Patients who underwent SILA had longer in-hospital stays than those who underwent CLA (72 v. 55 h, p < 0.001); however, they had significantly fewer complications (3.0% v. 14.4%, p = 0.006). Conclusion In addition to its cosmetic advantages, SILA led to rapid recovery and no increase in postsurgical pain or complications. PMID:24869622

  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. Comparison of the ability of veterinary medical students to perform laparoscopic versus conventional open ovariectomy on live dogs.

    PubMed

    Levi, Ohad; Kass, Philip H; Lee, Lyon Y; Cantrell, Valerie M; Clark, David E; Griffon, Dominique J

    2015-12-01

    Objective-To compare the feasibility of training veterinary medicine students to perform laparoscopic versus conventional open ovariectomy in live dogs. Design-Randomized prospective parallel-group experiment. Population-25 students completing the second year of their veterinary curriculum. Procedures-Students were randomly assigned to 2 groups to receive 14 hours of specific training in either open ovariectomy (n = 13) or laparoscopic ovariectomy (12). Confidence, basic surgical skills, and basic laparoscopic skills were evaluated before and after training, prior to live surgical procedures. Results-Scores related to basic surgical skills were high in both groups and did not improve with either training program. Before live animal surgeries, student confidence and basic laparoscopic skills improved after training in laparoscopic ovariectomy and were higher than after training in open ovariectomy. Surgery time was higher for the students who received training in laparoscopic ovariectomy (129 minutes; range, 84 to 143 minutes), compared with students who received training in open ovariectomy (80 minutes; range, 62 to 117 minutes). On a 55-point scoring system, ovariectomy scores were similar between students who received training in open ovariectomy (34.5; range, 16.5 to 45) and students who received training in laparoscopic ovariectomy (34.5; range, 25 to 44.5). Conclusions and Clinical Relevance-The training programs were effective in improving student confidence and skills in laparoscopic ovariectomy. Results of this study suggested that veterinary medical students, with assistance from an instructor, may be taught to perform laparoscopic ovariectomies with performance equivalent to that for students performing open ovariectomies. PMID:26594811

  16. Hysterectomy: a historical perspective.

    PubMed

    Sutton, C

    1997-03-01

    In the relatively long history of man, surgery has been a comparatively recent development; the abdomen was first deliberately opened to remove an ovarian cyst by Ephraim McDowell in Kentucky in 1809. The first abdominal hysterectomy was performed by Charles Clay in Manchester, England in 1843; unfortunately the diagnosis was wrong and the patient died in the immediate post-operative period. The following year, Charles Clay was almost the first to claim a surviving patient, however she died post-operatively and it was not until 1853 that Ellis Burnham from Lowell, Massachusetts achieved the first successful abdominal hysterectomy although again the diagnosis was wrong. Vaginal hysterectomy dates back to ancient times. The procedure was performed by Soranus of Ephesus 120 years after the birth of Christ, and the many reports of its use in the middle ages were nearly always for the extirpation of an inverted uterus and the patients rarely survived. The early hysterectomies were fraught with hazard and the patients usually died of haemorrhage, peritonitis, and exhaustion. Early procedures were performed without anaesthesia with a mortality of about 70%, mainly due to sepsis from leaving a long ligature to encourage the drainage of pus. Thomas Keith from Scotland realized the danger of this practice and merely cauterized the cervical stump and allowed it to fall internally, thereby bringing the mortality down to about 8%. Hysterectomy became safer with the introduction of anaesthesia, antibiotics and antisepsis, blood transfusions and intravenous therapy. During the 1930s, Richardson introduced the total abdominal hysterectomy to avoid serosanguineous discharge from the cervical remnant and the risk of cervical carcinoma developing in the stump. Apart from this innovation, and the transverse incision introduced by Johanns Pfannenstiel in the 1920s, there was little advance in hysterectomy techniques until the advent of endoscopic surgery and the performance of the first laparoscopic hysterectomy by Harry Reich in Kingston, Pennsylvania in 1988. The refinement and increasing safety of laparoscopic hysterectomy suggests that it will be used increasingly in the future, although developments in pharmacology and photodynamic therapy and interventional radiology may reduce the traditional indications for the operation. PMID:9155933

  17. Single port laparoscopic orchidopexy in children using surgical glove port and conventional rigid instruments

    PubMed Central

    Mahdi, Ben Dhaou; Mohamed, Jallouli; Hayet, Zitouni; Riadh, Mhiri

    2015-01-01

    Purpose We review the literature and describe our technique for laparoendoscopic single-site orchidopexy using a glove port and rigid instruments. We assessed the feasibility and outcomes of this procedure. Materials and Methods We retrospectively reviewed the case records of all children who had undergone laparoendoscopic single-site orchidopexy by use of a surgical glove port and conventional rigid instruments for a nonpalpable intraabdominal testis between January 2013 and September 2014. Results Data from a total of 20 patients were collected. The patients' mean age was 18 months. All cases had a nonpalpable unilateral undescended testis. Fourteen patients (70%) had an undescended testis on the right side and six patients (30%) had an undescended testis on the left side. Seventeen patients underwent primary orchidopexy. Three patients underwent single-port laparoscopic Fowler-Stephens orchidopexy for the first and the second stage. Average operating time was 57 minutes (range, 40 to 80 minutes). No patient was lost to follow-up. At follow-up, 2 testes were found to have retracted out of the scrotum and these were successfully dealt with in a second operation. One testis was hypoplastic in the scrotal pouch. There were no signs of umbilical hernia. Conclusions Single-port laparoscopic orchidopexy using a glove port and rigid instruments is technically feasible and safe for various nonpalpable intraabdominal testes. However, surgical experience and long-term follow-up are needed to confirm the superiority of this technique. PMID:26568797

  18. Fast track surgery vs. conventional management in the perioperative care of retroperitoneal laparoscopic adrenalectomy

    PubMed Central

    Tang, Chaopeng; Xu, Zhenyu; Yi, Xiaoming; Li, Ping; He, Haowei; Zhang, Zhengyu; Shen, Tianyi; Liu, Xiang; Zhou, Yulin; Zhou, Wenquan

    2015-01-01

    Objective: It has been demonstrated that fast track (FT) surgery can accelerate the recovery of the patients in limited urologic procedures, but there are no reports regarding FT surgery within retroperitoneal laparoscopic adrenalectomy (RLA). This study aims at evaluating the impact of FT surgery on recovery after RLA. Methods: One hundred patients in our centre are randomly assigned to FT group and conventional group. The patients who have undergone RLA receive either conventional care or an FT recovery program. Surgical outcome, complications, gastrointestinal function, visual analogue scale (VAS) general state and VAS pain scores are compared between the two groups. In addition, white blood cell count, serum interleukin-6 and C-reactive protein levels are measured. Patients are discharged home when they meet discharge criteria. Results: Compared with the conventional group, the time of first flatus (18.97±8.45 vs. 37.66±17.17 h), initiation of normal diet (18.76±4.94 vs. 53.15±15.99 h), the time of first ambulation (19.64±6.23 vs. 51.89±18.19 h), length of post-operation hospital stay (2.35±0.87 vs. 5.23±1.62 d), duration of drainage (18.19±5.19 vs. 68.10±18.06 h) and catheter (17.19±4.49 vs. 60.83±25.53 h) are markedly shorter in FT group (P<0.01). Post-operative coughing pain scores at 2 h (1.00±0.61 vs. 1.42±1.18), 12 h (0.96±0.78 vs. 2.00±1.40), 24 h (1.10±0.97 vs. 4.22±1.53) and resting pain scores at 12 h (0.64±0.56 vs. 1.44±0.91), 24 h (0.66±0.63 vs. 1.22±0.86) are consistently lower in the FT group. The level of CRP, IL-6 at 2 h and 24 h post-operation are lower than that of control group, and white blood cell count is lower than conventional group at 24 h after surgery (P<0.01). FT patients have a overall higher level of post-operative VAS general state than conventional groups (P<0.01). Age, sex, tumor size and side, BMI, ASA score, operation time, blood loss and complications are similar in both groups. Conclusions: FT surgery within RLA shortens the length of post-operative hospital stay without increasing the postoperative complication, lowers patients’ VAS pain scores, and reduces inflammatory response intensity and improves the general state. Therefore, FT can be applied feasibly and safely in RLA. PMID:26629135

  19. Laparoscopic herniorrhaphy.

    PubMed

    Filipi, C J; Fitzgibbons, R J; Salerno, G M; Hart, R O

    1992-10-01

    Laparoscopic inguinal hernia repair could represent an attractive alternative to conventional inguinal herniorrhaphy if it can be shown to result in less perioperative morbidity (primarily postoperative pain) or a decreased long-term recurrence rate. The data addressing either of these concerns will be forthcoming in ensuing years. The variations in the laparoscopic approach to the preperitoneal space and the differences in dissection and fixation techniques outlined in this article reflect the fact that the procedure is still evolving, and there is not yet a consensus on the best laparoscopic herniorrhaphy. It is likely that there will not be one laparoscopic technique applicable to all inguinal hernias. Rather, the patient's body habitus and the type of hernia encountered at laparoscopy will persuade the surgeon to use one of several techniques. Once a consensus is reached among surgeons as to the optimal laparoscopic hernia repair(s), it will be possible to begin gathering data concerning perioperative morbidity and recurrence rates. Only then can the question be answered whether laparoscopic inguinal herniorrhaphy has any advantages over the conventional extraperitoneal operation. A multicenter prospective nonrandomized trial has been initiated by our group in an attempt to determine whether laparoscopic inguinal herniorrhaphy has efficacy. The exact technique employed by the individual centers has not been strictly regulated, but general guidelines have been given. It is hoped that this project will provide information on whether laparoscopic inguinal herniorrhaphy is a useful alternative to conventional repair. Most of the laparoscopic inguinal herniorrhaphy techniques described in this article expose the patients to the inherent risks of initial laparoscopic penetration of the abdomen and the long-term possibility of adhesions to the sites where the peritoneum has been breached. Because these risks are not present in a conventional repair, the laparoscopic technique must have other advantages if it truly is to obtain a place in the armamentarium of general surgeons. PMID:1388300

  20. Comparison of efficacy and safety of conventional laparoscopic radical prostatectomy by the transperitoneal versus extraperitoneal procedure.

    PubMed

    De Hong, Cao; Liang Ren, Liu; Qiang, Wei; Jia, Wang; Ying Chun, Hu; Lu, Yang; Zheng Hua, Liu; Heng Ping, Li; Shi Bing, Yan; Yun Xiang, Li

    2015-01-01

    Worldwide, prostate cancer (PCa) is the second most common malignancy in males. We undertook a meta-analysis to compare the efficacy and safety of conventional laparoscopic radical prostatectomy with a transperitoneal (TLRP) approach, versus that of an extraperitoneal (ELRP) approach, for treatment of localized PCa. A comprehensive literature search retrieved 14 publications, with a total of 1715 patients. Meta-analysis of these studies showed that an ELRP approach was associated with a significantly shorter postoperative catheterization time (MD: 1.99; 95% CI: 0.52 to 3.54; P?=?0.008), less blood transfusion rate (OR: 2.05; 95% CI: 1.03 to 4.06; P?=?0.04), shorter intestinal function recovery time (MD: 0.08; 95% CI: 0.52 to 1.09; P?

  1. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis

    PubMed Central

    Lee, Seon Heui; Lim, Sungwon; Kim, Jin Hee

    2015-01-01

    Purpose Robotic surgery (RS) overcomes the limitations of previous conventional laparoscopic surgery (CLS). Although meta-analyses have been published recently, our study evaluated the latest comparative surgical, urologic, and sexual results for rectal cancer and compares RS with CLS in patients with rectal cancer only. Methods We searched three foreign databases (Ovid-MEDLINE, Ovid-Embase, and Cochrane Library) and five Korean databases (KoreaMed, KMbase, KISS, RISS, and KisTi) during July 2013. The Cochrane Risk of Bias and the Methodological Index for Non-Randomized were utilized to evaluate quality of study. Dichotomous variables were pooled using the risk ratio (RR), and continuous variables were pooled using the mean difference (MD). All meta-analyses were conducted with Review Manager, V. 5.3. Results Seventeen studies involving 2,224 patients were included. RS was associated with a lower rate of intraoperative conversion than that of CLS (RR, 0.28; 95% confidence interval [CI], 0.15-0.54). Time to first flatus was short (MD, -0.13; 95% CI, -0.25 to -0.01). Operating time was longer for RS than that for CLS (MD, 49.97; 95% CI, 20.43-79.52, I2 = 97%). International Prostate Symptom Score scores at 3 months better RS than CLS (MD, -2.90; 95% CI, -5.31 to -0.48, I2 = 0%). International Index of Erectile Function scores showed better improvement at 3 months (MD, -2.82; 95% CI, -4.78 to -0.87, I2 = 37%) and 6 months (MD, -2.15; 95% CI, -4.08 to -0.22, I2 = 0%). Conclusion RS appears to be an effective alternative to CLS with a lower conversion rate to open surgery, a shorter time to first flatus and better recovery in voiding and sexual function. RS could enhance postoperative recovery in patients with rectal cancer. PMID:26448918

  2. 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

  3. Comparison of efficacy and safety of conventional laparoscopic radical prostatectomy by the transperitoneal versus extraperitoneal procedure

    PubMed Central

    De Hong, Cao; Liang Ren, Liu; Qiang, Wei; Jia, Wang; Ying Chun, Hu; Lu, Yang; Zheng Hua, Liu; Heng Ping, Li; Shi Bing, Yan; Yun Xiang, Li

    2015-01-01

    Worldwide, prostate cancer (PCa) is the second most common malignancy in males. We undertook a meta-analysis to compare the efficacy and safety of conventional laparoscopic radical prostatectomy with a transperitoneal (TLRP) approach, versus that of an extraperitoneal (ELRP) approach, for treatment of localized PCa. A comprehensive literature search retrieved 14 publications, with a total of 1715 patients. Meta-analysis of these studies showed that an ELRP approach was associated with a significantly shorter postoperative catheterization time (MD: 1.99; 95% CI: 0.52 to 3.54; P?=?0.008), less blood transfusion rate (OR: 2.05; 95% CI: 1.03 to 4.06; P?=?0.04), shorter intestinal function recovery time (MD: 0.08; 95% CI: 0.52 to 1.09; P?

  4. Minimally Invasive Hysterectomy: An Analysis of Different Techniques.

    PubMed

    Ridgeway, Beri M; Buechel, Megan; Nutter, Benjamin; Falcone, Tommaso

    2015-12-01

    To compare conventional minimally invasive (MIS) approaches and newer technology approaches in women undergoing hysterectomy for benign disease. PubMed was searched for all pertinent randomized-controlled trials (RCTs). Selected outcomes were compared using standard meta-analysis methods. Three RCTs compared conventional MIS to robotic-assisted hysterectomy and 5 RCTs compared conventional laparoscopy to single-incision hysterectomy. There were no significant differences in outcomes. A subanalysis comparing conventional to robotic-assisted laparoscopy found an association between conventional laparoscopy and shorter operative time. Newer technology approaches do not confer an advantage over conventional MIS approaches in women undergoing hysterectomy for benign disease. PMID:26457851

  5. Laparoscopic Surgery

    MedlinePLUS

    ... tissue when the laparoscopic instrument contacts the tumor. Recent research presented at various national and international conferences by experienced laparoscopic surgeons indicates that laparoscopic ...

  6. 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

  7. A Comparison of Open Surgery, Robotic-Assisted Surgery and Conventional Laparoscopic Surgery in the Treatment of Morbidly Obese Endometrial Cancer Patients

    PubMed Central

    Mendivil, Alberto A.; Rettenmaier, Mark A.; Abaid, Lisa N.; Brown, John V.; Micha, John P.; Lopez, Katrina L.

    2015-01-01

    Background and Objectives: The intent of this retrospective study was to assess the operative outcomes of morbidly obese endometrial cancer patients who were treated with either open surgery (OS) or a minimally invasive procedure. Methods: Morbidly obese (body mass index [BMI] > 40 kg/m2) patients with endometrial cancer who underwent OS, robotic-assisted laparoscopic surgery (RS), or conventional laparoscopic surgery (LS) were eligible. We sought to discern any outcome differences with regard to operative time, perioperative complications, and hospital stay. Results: Sixteen patients were treated with LS (BMI = 47.9 kg/m2), 13 were managed via RS (BMI = 51.2 kg/m2), and 24 underwent OS (BMI = 53.7 kg/m2). The OS (1.35 hours) patients had a significantly shorter operative duration than the LS (1.82 hours) and RS (2.78 hours) patients (P < .001); blood loss was greater in the OS (250 mL) group in comparison with the RS (100 mL) and LS (175 mL) patients (P = .002). Moreover, the OS (4 days) subjects had a significantly longer hospital stay than the LS (2 days) and RS (2 days) patients (P = .002). Conclusion: In the present study, we ascertained that minimally invasive surgery was associated with longer operative times but lower rates of blood loss and shorter hospital stay duration compared with treatment comprising an open procedure. PMID:25848196

  8. Virtual reality in laparoscopic surgery.

    PubMed

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

    Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery. PMID:15747974

  9. Comparison of a flexible-tip laparoscope with a rigid straight laparoscope for single-incision laparoscopic cholecystectomy.

    PubMed

    Matsui, Yoichi; Ryota, Hironori; Sakaguchi, Tatsuma; Nakatani, Kazuyoshi; Matsushima, Hideyuki; Yamaki, So; Hirooka, Satoshi; Yamamoto, Tomohisa; Kwon, A-Hon

    2014-12-01

    This study assessed whether a flexible-tip laparoscope improves operative outcomes including operative length while performing single-incision laparoscopic cholecystectomy (SILC) compared with the use of a conventional straight laparoscope. The flexible-tip laparoscope decreased the operative time compared with the straight laparoscope. Although SILC has potential benefits, surgeons experience problems for in-line viewing through a laparoscope and from contact of instruments with the laparoscope, resulting in longer operative times and the need for additional ports. The aim of this study was to determine whether a flexible-tip laparoscope improves operative outcomes, including operative length and the rate of insertion of additional ports, while performing SILC compared with the use of a conventional rigid straight laparoscope. We reviewed data on patients for whom we performed SILC at the Department of Surgery, Kansai Medical University, for the period from November 1, 2009, to February 28, 2013. The information was assessed with respect to patient characteristics, types of laparoscope used, operative data as well as postoperative outcomes. Operating time for SILC using the flexible-tip laparoscope was significantly shorter than with the straight laparoscope (81.5 ± 23.2 vs 94.4 ± 21.1 minutes) as a result of a better view of the operating field without contact with working instruments. Although a trend was shown toward a reduced rate of the need for extra ports in the flexible-tip laparoscope group, the difference did not reach statistical significance. Using the flexible-tip laparoscope solved the problem of in-line viewing and decreased the operative time for SILC. PMID:25513924

  10. 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) ...

  11. An Audit of Indications, Complications, and Justification of Hysterectomies at a Teaching Hospital in India

    PubMed Central

    Sehgal, Kriti; Hebbar, Shripad; Nambiar, Jayaram; Bhat, Rajeshwari G.

    2014-01-01

    Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus. PMID:25763395

  12. PSYCHIATRIC REACTIONS IN HYSTERECTOMY

    PubMed Central

    Bhatia, M.S.; Kaur, Nirmaljit; Bohra, Neena; Goyal, Uma

    1990-01-01

    SUMMARY 50 women undergoing hysterectomy at Smt. Surheta Kriplani Hospital, New Delhi, when compared with age and parity matched 25 control cases on neuroticism and depression scales showed statistically insignificant difference at various points of time. The improvement in both groups was insignificant one week after procedure but became significant after I weeks (p< 0.01). The neuroticism or depression in study cases was hardly attributable to hysterectomy. The marital as well as social adjustments after 4 weeks of procedure were either unchanged or improved. It is emphasized that an attempt should be made to identify the patients who are more prone to get psychiatric disturbance in order to prevent or minimise these psychiatric disturbances. PMID:21927427

  13. Parasitic myoma after laparoscopic surgery: a mini-review

    PubMed Central

    Erenel, Hakan; Temizkan, Osman; Mathyk, Begüm Aydo?an; Karata?, Suat

    2015-01-01

    The aim of this review is to summarize the cases of parasitic myomas after laparoscopic surgery. A literature search was performed using the PubMed database for the period of January 1997 to December 2014. We used the following keywords: “laparoscopic hysterectomy,” “laparoscopic myomectomy,” “morcellation,” “parasitic fibroids,” “parasitic myomas,” and “leiomyomatosis.” A total of 29 articles meeting the selection criteria were included in our review, describing 53 patients who underwent surgery for parasitic myomas. Parasitic myoma is a rare condition resulting from the small fibroid fragments left after morcellation and can be either asymptomatic or symptomatic. Although it is rare, patients should be informed about the risk of this condition after laparoscopic surgery. It is important for surgeons to look for small fibroid fragments during and after morcellation and make an effort to remove every piece of tissue. PMID:26401114

  14. Appraisal of laparoscopic cholecystectomy.

    PubMed Central

    Graves, H A; Ballinger, J F; Anderson, W J

    1991-01-01

    This paper reports the experience of three general surgeons performing 304 laparoscopic cholecystectomies in three private hospitals between October 1989 and November 1990. Laparoscopic cholecystectomy boasts two major advantages over the conventional procedure: the remarkable reduction in postoperative pain and economic benefit, largely due to the patient's early return to work. Revealing a complication rate of 2% and no deaths, this study has shown that this procedure can offer patients these advantages with a medical risk no greater than that accompanying conventional cholecystectomy. Patient safety must be paramount, and it is the responsibility of the surgical community to ensure that all surgeons receive the highest quality training and that the technique is applied appropriately. Images Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. PMID:1828140

  15. The Impact of Different Surgical Modalities for Hysterectomy on Satisfaction and Patient Reported Outcomes

    PubMed Central

    2014-01-01

    Background There is an ongoing debate regarding the cost-benefit of different surgical modalities for hysterectomy. Studies have relied primarily on evaluation of clinical outcomes and medical expenses. Thus, a paucity of information on patient-reported outcomes including satisfaction, recovery, and recommendations exists. Objective The objective of this study was to identify differences in patient satisfaction and recommendations by approach to a hysterectomy. Methods We recruited a large, geographically diverse group of women who were members of an online hysterectomy support community. US women who had undergone a benign hysterectomy formed this retrospective study cohort. Self-reported characteristics and experiences were compared by surgical modality using chi-square tests. Outcomes over time were assessed with the Jonkheere-Terpstra trend test. Logistic regression identified independent predictors of patient satisfaction and recommendations. Results There were 6262 women who met the study criteria; 41.74% (2614/6262) underwent an abdominal hysterectomy, 10.64% (666/6262) were vaginal, 27.42% (1717/6262) laparoscopic, 18.94% (1186/6262) robotic, and 1.26% (79/6262) single-incision laparoscopic. Most women were at least college educated (56.37%, 3530/6262), and identified as white, non-Hispanic (83.17%, 5208/6262). Abdominal hysterectomy rates decreased from 68.2% (152/223) to 24.4% (75/307), and minimally invasive surgeries increased from 31.8% (71/223) to 75.6% (232/307) between 2001 or prior years and 2013 (P<.001 all trends). Trends in overall patient satisfaction and recommendations showed significant improvement over time (P<.001).There were differences across the surgical modalities in all patient-reported experiences (ie, satisfaction, time to walking, driving and working, and whether patients would recommend or use the same technique again; P<.001). Significantly better outcomes were evident among women who had vaginal, laparoscopic, and robotic procedures than among those who had an abdominal procedure. However, robotic surgery was the only approach that was an independent predictor of better patient experience; these patients were more satisfied overall (odds ratio [OR] 1.31, 95% CI 1.13-1.51) and on six other satisfaction measures, and more likely to recommend (OR 1.64, 95% CI 1.39-1.94) and choose the same modality again (OR 2.07, 95% CI 1.67-2.57). Abdominal hysterectomy patients were more dissatisfied with outcomes after surgery and less likely to recommend (OR 0.36, 95% CI 0.31-0.40) or choose the same technique again (OR 0.29, 95% CI 0.25-0.33). Quicker return to normal activities and surgery after 2007 also were independently associated with better overall satisfaction, willingness to recommend, and to choose the same surgery again. Conclusions Consistent with other US data, laparoscopic and robotic hysterectomy rates increased over time, with a concomitant decline in abdominal hysterectomy. While inherent shortcomings of this retrospective Web-based study exist, findings show that patient experience was better for each of the major minimally invasive approaches than for abdominal hysterectomy. However, robotic-assisted hysterectomy was the only modality that independently predicted greater satisfaction and willingness to recommend and have the same procedure again. PMID:25048103

  16. Gallbladder removal - laparoscopic

    MedlinePLUS

    Cholecystectomy - laparoscopic ... Blunt LM. Laparoscopic cholecystectomy. In: Cameron JL, Cameron AM, eds. Current Surgical Th erapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014. Jackson PG, ...

  17. Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women.

    PubMed

    Orozco, Leonardo J; Tristan, Mario; Vreugdenhil, Maria M T; Salazar, Arturo

    2014-01-01

    Background Prophylactic oophorectomy alongside hysterectomy in premenopausal women is a common procedure. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for additional gynaecological surgical interventions,and is weighed against the perceived risk of negative health effects caused by surgically induced menopause. The evidence needed to recommend either prophylactic bilateral oophorectomy or conservation of ovaries at the time of hysterectomy in premenopausal women is limited. This is an update of the original version of this systematic review published in 2008.Objectives To compare hysterectomy alone versus hysterectomy plus bilateral oophorectomy in women with benign gynaecological conditions,with respect to rates of mortality or subsequent gynaecological surgical interventions.Search methods We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to January 2014) and the following electronic databases: CENTRAL (The Cochrane Library 2013, Issue 12), MEDLINE (January 1966 to January 2014),EMBASE (January 1985 to January 2014), and PsycINFO (1806 to January 2014).Selection criteria Randomised controlled trials (RCTs) of hysterectomy alone versus hysterectomy with bilateral oophorectomy in premenopausal women with benign gynaecological conditions were eligible. Any surgical approach could be used.Data collection and analysis Three review authors independently assessed trials for inclusion. Study authors were contacted if information was unclear.Main results Only one RCT comparing the benefits and risks of hysterectomy with or without oophorectomy was identified. The results of this pilot RCT have not been published and we have not been able to obtain the results. Therefore, no data could be included in this review. Authors' conclusions The conclusions of this review are limited by a lack of RCTs. Although no evidence is available from RCTs, there is growing evidence from observational studies that surgical menopause may impact negatively on cardiovascular health and all cause mortality. PMID:25101365

  18. Laparoscopic splenectomy.

    PubMed

    Kitano, S; Yoshida, T; Bandoh, T; Shuto, K; Ninomiya, K

    1996-09-01

    Laparoscopic splenectomy was carried out for the treatment of patients with splenic disorders; 20 idiopathic thrombocytopenic purpura, 1 hamartoma and 3 hereditary spherocytosis. With the patients in the right lateral position, four trocars were used. Under CO2 pneumoperitoneum with a pressure of 10 mmHg, the surrounding ligaments were divided with electrocautery. At the splenic hilum, the splenic artery and vein were exposed using ultrasonic dissector. After double ligation of these vessels, the spleen was dissected with an autostapler. The resected spleen contained in a nylon bag was fragmented with finger-fracture method and extracted through a port site extended up 2 or 3 cm in length. All the patients tolerated the procedure and no blood transfusion was required. Laparoscopic splenectomy is the preferred choice to resect the spleen because of the short hospital stay, less pain and good cosmesis. PMID:8923999

  19. Risk of Oophorectomy After Hysterectomy

    PubMed Central

    Casiano, Elizabeth R.; Trabuco, Emanuel C.; Bharucha, Adil E.; Weaver, Amy L.; Schleck, Cathy D.; Melton, L. Joseph; Gebhart, John B.

    2013-01-01

    Objective To compare the risk of subsequent oophorectomy among women who had hysterectomy for benign indications and those who did not. Methods Using Rochester Epidemiology Project resources, we compared the risk of oophorectomy through December 31, 2008 among 4,931 Olmsted County, Minnesota, women who had ovary-sparing hysterectomy for benign indications (cases) between 1965 and 2002 and 4,931 age-matched women who did not have hysterectomy (referents). The cumulative incidence of subsequent oophorectomy was estimated by the Kaplan-Meier method, and comparisons were evaluated by Cox proportional hazard models using age as the time scale to allow for complete age adjustment. Results The median follow-up for cases and referents was 19.6 and 19.4 years, respectively. At 10, 20, and 30 years after hysterectomy, the respective cumulative incidence of subsequent oophorectomy was 3.5%, 6.2%, and 9.2% among cases and 1.9%, 4.8%, and 7.3% among referents. The overall risk of subsequent oophorectomy among cases was significantly higher than among referents (hazard ratio [HR], 1.20; 95% CI, 1.02–1.42; P=.03). Furthermore, among cases, the risk of subsequent oophorectomy was significantly higher (HR, 2.15; 95% CI, 1.51–3.07; P<.001) in women who had both ovaries preserved compared with those who initially had one ovary preserved. Conclusion The incidence of oophorectomy after hysterectomy is only 9.2% at 30-year follow-up and is only 1.9 percentage points higher than the incidence of oophorectomy in referent women with intact reproductive organs. PMID:23635745

  20. Recurrence of endometriosis after hysterectomy

    PubMed Central

    Rizk, B.; Fischer, A.S.; Lotfy, H.A.; Turki, R.; Zahed, H.A.; Malik, R.; Holliday, C.P.; Glass, A.; Fishel, H.; Soliman, M.Y.; Herrera, D.

    2014-01-01

    Aim: Persistent or recurrent pain after hysterectomy is one of the most frustrating clinical scenarios in benign gynaecology. We attempt to review the current evidence regarding the recurrence of pelvic pain after hysterectomy for endometriosis. The impact of ovarian conservation, type of hysterectomy and the extent of surgical excision were analysed. Methods: Peer reviewed published manuscripts in the English language in the period between 1980 and 2014 were reviewed using Pubmed and science direct regarding the incidence, causes and recurrence of endometriosis. Results: Sixty-seven articles were identified. Incomplete excision of endometriosis is the most predominant reason in the literature for the recurrence of endometriosis, and the type of Hysterectomy affects the recurrent symptoms mainly by impacting the extent of excision of the lesion. Ovarian cyst drainage is associated with the highest rate of ovarian cyst reformation within three to six months after surgery. The use of hormone replacement therapy is associated with recurrence of pelvic pain in 3.5% of cases. No studies addressed the recurrence of endometriosis after standard vs robotic assisted hysterectomy. Conclusion: A high recurrence rate of 62% is reported in advanced stages of endometriosis in which the ovaries were conserved. Ovarian conservation carries a 6 fold risk of recurrent pain and 8 folds risk of reoperation. The decision has to be weighed taking into consideration the patient’s age and the impact of early menopause on her life style. The recurrence of endometriosis symptoms and pelvic pain are directly correlated to the surgical precision and removal of peritoneal and deeply infiltrated disease. Surgical effort should always aim to eradicate the endometriotic lesions completely to keep the risk of recurrence as low as possible. PMID:25593697

  1. [Diagnostic measures before laparoscopic cholecystectomy].

    PubMed

    Weimann, A; Wagner, S; Dralle, H; Raab, R

    1995-05-01

    Successful use of laparoscopic cholecystectomy requires good cooperation between surgeon and gastroenterologist. Standard preoperative workup includes detailed history of the patient, blood chemistry of serum bilirubin and liver enzymes as well as sonography for the detection of common bile duct stones. Intravenous cholangiography can be performed to diagnose anatomic variations of the bile ducts. In case of common bile duct stones "therapeutic splitting" by endoscopic retrograde cholangiography with sphincterotomy and gallstone extraction preoperatively may help to avoid unnecessary conventional open cholecystectomy. PMID:7609591

  2. Laparoscopic Spine Surgery

    MedlinePLUS

    ... Opportunities Login Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon Laparoscopic ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  3. 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

  4. 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

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

    PubMed

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

    2014-05-01

    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

  6. Laparoscopic Radiofrequency Thermal Ablation for Uterine Adenomyosis

    PubMed Central

    Pontrelli, Giovanni; Campana, Colette; Steinkasserer, Martin; Ercoli, Alfredo; Minelli, Luca; Bergamini, Valentino; Ceccaroni, Marcello

    2015-01-01

    Background and Objectives: Symptomatic uterine adenomyosis, unresponsive to medical therapy, is a challenging condition for patients who desire to preserve their uterus. This study was an evaluation of the feasibility and efficacy of laparoscopic radiofrequency thermal ablation of symptomatic nodular uterine adenomyosis. Methods: Fifteen women with symptomatic nodular adenomyosis, who had no plans for pregnancy but declined hysterectomy, underwent radiofrequency thermal ablation. Ultrasonography was performed at baseline and at postoperative follow-ups at 3, 6, 9, and 12 months. The impact of uterine adenomyosis–related symptoms was assessed according to the visual analog scale. Results: The median number of nodular lesions treated per patient was 1 (range, 1–2). The median baseline volume of the adenomyosis area was 60 cm3 (range, 18–128). The median reduction in volume was 32, 49.4, 59.6, and 65.4% at 3, 6, 9, and 12 months, respectively. A significant progressive improvement in the symptoms score was observed at the 4 follow-ups. Conclusion: In this study, laparoscopic radiofrequency thermal ablation reduced uterine adenomyosis–related symptoms and volume, with significant relief of symptoms.

  7. A Case of Extrauterine Endometrial Stromal Sarcoma in the Colon Diagnosed Three Decades after Hysterectomy for Benign Disease

    PubMed Central

    Fadare, Oluwole

    2013-01-01

    Extrauterine endometrial stromal sarcoma (ESS) is rare and typified by delayed recurrence of primary ESS. Here, we report an unusual case of colonic ESS in a woman with a remote history of hysterectomy. An 80-year-old woman, with a history of hysterectomy and bilateral salpingo-oophorectomy for abnormal bleeding and endometriosis 37 years prior to presentation, was diagnosed with ESS in the colon. She was treated with laparoscopic low anterior resection, followed by megestrol acetate, and has been in remission for more than 4 years. This case highlights the rarity of extra-uterine ESS in the colon, especially in the absence of a known history of primary uterine ESS. The patient's history of endometriosis may have been a predisposing risk factor. ESS in the colon may be treated successfully with surgical resection and progestin therapy. Indefinite surveillance is recommended to monitor for late recurrences. PMID:23710389

  8. Single Incision Laparoscopic Cholecystectomy for Gallbladder Duplication

    PubMed Central

    Kabul Gürbulak, Esin; Öz?ahin, Hamdi; Düzköylü, Yi?it; Akgün, Ismail Ethem; Battal, Muharrem; Gürbulak, Bünyamin

    2015-01-01

    Duplication of the gallbladder is a rare congenital anomaly of the gallbladder, with an estimated prevalence of 1–3 per 3800 individuals. Unless properly diagnosed preoperatively, it can lead to biliary tract injuries and postoperative complications which may require reoperative surgeries. While previously reported cases have been treated with conventional laparoscopic cholecystectomy (LC), treatment with single incision laparoscopic surgery (SILS) has not been reported yet. We herein present the case of a 58-year-old female with gallbladder duplication who was successfully treated with SILS cholecystectomy. PMID:26266074

  9. The effects of previous hysterectomy on lupus.

    PubMed

    Namjou, B; Scofield, R H; Kelly, J A; Goodmon, E l; Aberle, T; Bruner, G R; Harley, J B

    2009-10-01

    Hysterectomy is one of the most common surgical procedures performed in United States, and currently, one in three women in United States has had a hysterectomy by the age of 60 years. Systemic lupus erythematosus (SLE) is a common autoimmune disease and especially targets women of childbearing age at least 10 times higher than men, which reflects the major role of female sex hormones. In this retrospective study, we evaluate the potential effects of previous hysterectomy in our lupus cohort. Data collected from study subject questionnaires were obtained from the Lupus Family Registry and Repository (LFRR) at the Oklahoma Medical Research Foundation. Hysterectomy data were available from 3389 subjects. SLE patients with a positive history of hysterectomy have been selected and compared with matched lupus patients with a negative history of hysterectomy and healthy controls. Association analyses were performed, and the P values and adjusted odds ratios (ORs) were calculated. SLE patients with a negative history of hysterectomy more likely had kidney nephritis or positive anti-dsDNA than age-matched SLE patients with a history of hysterectomy before disease onset. This effect was independent of ethnicity with an OR of 6.66 (95% CI = 3.09-14.38, P = 1.00 x 10(-8)) in European patients and 2.74 (95% CI = 1.43-5.25, P = 0.001) in African-Americans. SLE patients with a positive history of hysterectomy before disease onset also had a later age of disease onset (P = 0.0001) after adjustment for age and race. Our findings support the notion that the influence of female sex hormones in SLE and various clinical findings are tremendous and that surgical menopause such as this could significantly affect the outcome of disease and clinical manifestations. PMID:19762402

  10. [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

  11. A Novel Technique of Uterine Manipulation in Laparoscopic Pelvic Oncosurgical Procedures: “The Uterine Hitch Technique”

    PubMed Central

    Puntambekar, S. P.; Patil, A. M.; Rayate, N. V.; Puntambekar, S. S.; Sathe, R. M.; Kulkarni, M. A.

    2010-01-01

    Aim. To describe a new technique of uterine manipulation in laparoscopic management of pelvic cancers. Material and Methods. We used a novel uterine hitch technique in 23 patients from May 2008 to October 2008. These patients underwent pelvic oncologic surgery including laparoscopic radical hysterectomy (n = 7), laparoscopic anterior resection (n = 4), laparoscopic abdominoperineal resection (n = 3), laparoscopic posterior exenteration (n = 4), or laparoscopic anterior exenteration (n = 5). The uterus was hitched to the anterior abdominal.wall by either a single suture in the fundus or by sutures through the round ligaments. Results. The uterine hitch technique was successfully accomplished in all procedures. It was performed in less than 5 minutes in all cases. It obviated the need for vaginal manipulation. An extra port for retraction could be avoided. There were no intraoperative complications. Conclusion. A practical, cheap and reproducible method for uterine manipulation, during pelvic oncologic surgery is described. It improves the stability of the uterus and also obviates the need for keeping an additional assistant for vaginal manipulation in any of the procedures. PMID:22091356

  12. Hysterectomies and gender identity among Serbian women 

    E-print Network

    Sukovic, Masa

    2009-05-15

    In this qualitative study, I explore the impact of national culture on the gender identity of Serbian women with hysterectomies, with special emphasis on traditional motherhood discourse and its implications for women who ...

  13. Expanding Patient Options: Minilaparotomy for Hysterectomy

    MedlinePLUS

    Expanding Patient Options: Minilaparotomy for Hysterectomy Covidien Energy Based Devices Concord, California May 26, 2010 Welcome to this OR Live program presented by Covidien energy-based devices. Good evening, and thank ...

  14. Single Incision Laparoscopic Myomectomy

    PubMed Central

    Ramesh, B; Vidyashankar, Madhuri; Bharathi, BV

    2011-01-01

    Single port laparoscopic surgery (SPLS), also called SILS is the natural extension of multi-incisional laparoscopic surgery, in the quest for reduction of traumatic insult and residual scarring to the patient. Today with the evolution of newer instruments, bidirectional self-retaining sutures, and surgical experience we are able to perform many surgeries in gynecology. PMID:22442539

  15. Laparoscopic triple cholecystectomy.

    PubMed

    Mottin, Cláudio Corá; Toneto, Marcelo Garcia; Padoin, Alexandre Vontobel

    2004-06-01

    Gallbladder triplication is an unusual congenital biliary malformation, and its laparoscopic management has not been described. We report the 11th case of gallbladder triplication and the first successfully treated with laparoscopic cholecystectomy. We consider the procedure reliable and safe, after proper identification of the common biliary duct. PMID:15471024

  16. Hysterectomy

    MedlinePLUS

    ... made in either your abdomen or your vagina. Robotic surgery. Your doctor guides a robotic arm to ... made in either your abdomen or your vagina. Robotic surgery. Your doctor guides a robotic arm to ...

  17. Transumbilical pure single-port laparoscopic donor nephrectomy

    PubMed Central

    Kim, Joo Mee; Jeong, Won Jun; Choi, Byung Jo; Yuk, Seung Mo; Hwang, Jeong Kye

    2015-01-01

    Transumbilical single-port laparoscopic donor nephrectomy (SPLDN) is a novel, rapidly evolving, minimally invasive treatment modality for kidney transplantation. This method causes minimal parietal injury, has cosmetic advantages, and allows rapid recovery because of low postoperative pain and short hospital stay. Like other abdominal surgeries, when conducted by experienced laparoscopic surgeons, it can meet the same graft requirements as conventional laparoscopic surgery. Here, we report the first two cases of transumbilical SPLDN at Daejeon St. Mary's Hospital, The Catholic University of Korea. We used the umbilicus as a common path for laparoscopic procedures and as a route for specimen retrieval. The operating times were 230 and 265 minutes in cases 1 and 2, respectively. No intra- or postoperative complications were noted. In case 1, the wound length was 4 cm and duration of hospitalization was 2 days. In case 2, the wound length was only 2.5 cm, and the duration of hospitalization was only 1 day. PMID:26576409

  18. Gallbladder removal - laparoscopic - discharge

    MedlinePLUS

    ... laparoscopic cholecystectomy will take about 1 to 3 weeks for most people. You may have some of ... pain should ease over several days to a week. A sore throat from the breathing tube. Sucking ...

  19. Laparoscopic Spleen Removal (Splenectomy)

    MedlinePLUS

    ... Login Laparoscopic Spleen Removal (Splenectomy) Patient Information from SAGES Download PDF Version Find a SAGES Surgeon What ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  20. Laparoscopic Inguinal Hernia Repair

    MedlinePLUS

    ... Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon About ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  1. Laparoscopic Adrenal Gland Removal

    MedlinePLUS

    ... Laparoscopic Adrenal Gland Removal (Adrenalectomy) Patient Information from SAGES Download PDF Version Find a SAGES Surgeon What ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  2. Laparoscopic Ventral Hernia Repair

    MedlinePLUS

    ... Login Laparoscopic Ventral Hernia Repair Patient Information from SAGES Download PDF Version Find a SAGES Surgeon Approximately ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  3. Laparoscopic Colon Resection

    MedlinePLUS

    ... Login Laparoscopic Colon Resection Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon About ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  4. Hemobilia post laparoscopic cholecystectomy

    PubMed Central

    Bin Traiki, Thamer A.; Madkhali, Ahmad A.; Hassanain, Mazen M.

    2015-01-01

    Hepatic artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. A high index of suspicion and early identification and therapy are important points needed to prevent rupture. We report a case of complex biliary and vascular injuries 4 weeks after a laparoscopic cholecystectomy. The patient had recurrent bleeding from a hepatic artery pseudoaneurysm that has been treated successfully with angiographic stenting and embolization. PMID:25666365

  5. Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

    PubMed Central

    Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair. PMID:21333197

  6. Pancreatic insulinomas: Laparoscopic management.

    PubMed

    Antonakis, Pantelis T; Ashrafian, Hutan; Martinez-Isla, Alberto

    2015-11-10

    Insulinomas are rare pancreatic neuroendocrine tumors that are most commonly benign, solitary, and intrapancreatic. Uncontrolled insulin overproduction from the tumor produces neurological and adrenergic symptoms of hypoglycemia. Biochemical diagnosis is confirmed by the presence of Whipple's triad, along with corroborating measurements of blood glucose, insulin, proinsulin, C-peptide, ?-hydroxybutyrate, and negative tests for hypoglycemic agents during a supervised fasting period. This is accompanied by accurate preoperative localization using both invasive and non-invasive imaging modalities. Following this, careful preoperative planning is required, with the ensuing procedure being preferably carried out laparoscopically. An integral part of the laparoscopic approach is the application of laparoscopic intraoperative ultrasound, which is indispensable for accurate intraoperative localization of the lesion in the pancreatic region. The extent of laparoscopic resection is dependent on preoperative and intraoperative findings, but most commonly involves tumor enucleation or distal pancreatectomy. When performed in an experienced surgical unit, laparoscopic resection is associated with minimal mortality and excellent long-term cure rates. Furthermore, this approach confers equivalent safety and efficacy rates to open resection, while improving cosmesis and reducing hospital stay. As such, laparoscopic resection should be considered in all cases of benign insulinoma where adequate surgical expertise is available. PMID:26566426

  7. Pancreatic insulinomas: Laparoscopic management

    PubMed Central

    Antonakis, Pantelis T; Ashrafian, Hutan; Martinez-Isla, Alberto

    2015-01-01

    Insulinomas are rare pancreatic neuroendocrine tumors that are most commonly benign, solitary, and intrapancreatic. Uncontrolled insulin overproduction from the tumor produces neurological and adrenergic symptoms of hypoglycemia. Biochemical diagnosis is confirmed by the presence of Whipple’s triad, along with corroborating measurements of blood glucose, insulin, proinsulin, C-peptide, ?-hydroxybutyrate, and negative tests for hypoglycemic agents during a supervised fasting period. This is accompanied by accurate preoperative localization using both invasive and non-invasive imaging modalities. Following this, careful preoperative planning is required, with the ensuing procedure being preferably carried out laparoscopically. An integral part of the laparoscopic approach is the application of laparoscopic intraoperative ultrasound, which is indispensable for accurate intraoperative localization of the lesion in the pancreatic region. The extent of laparoscopic resection is dependent on preoperative and intraoperative findings, but most commonly involves tumor enucleation or distal pancreatectomy. When performed in an experienced surgical unit, laparoscopic resection is associated with minimal mortality and excellent long-term cure rates. Furthermore, this approach confers equivalent safety and efficacy rates to open resection, while improving cosmesis and reducing hospital stay. As such, laparoscopic resection should be considered in all cases of benign insulinoma where adequate surgical expertise is available. PMID:26566426

  8. Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States

    PubMed Central

    2015-01-01

    The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system. PMID:25517602

  9. Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States.

    PubMed

    Thiel, Cassandra L; Eckelman, Matthew; Guido, Richard; Huddleston, Matthew; Landis, Amy E; Sherman, Jodi; Shrake, Scott O; Copley-Woods, Noe; Bilec, Melissa M

    2015-02-01

    The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system. PMID:25517602

  10. [A technic for laparoscopic gastrostomy].

    PubMed

    Kala, Z; Vomela, J; Hanke, I

    1995-08-01

    The authors describe the technique of laparoscopic gastrostomy and laparoscopic assisted gastrostomy. It is an alternative method for patients, when PEG (percutaneous endoscopic gastronomy) or other more physiologic way of food administration is not possible to perform. PMID:7482053

  11. Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse

    PubMed Central

    Elbiaa, Assem A.M.; Farghali, Mohamed M.; Hussain, M.; Omu, A.E.

    2015-01-01

    Aim of the study Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Material and methods Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Results Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80) of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst). Also, histopathological examination showed premalignant changes in 33.75% (27/80) of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3), which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Conclusions Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered. PMID:26528108

  12. Laparoscopic surgery in weightlessness

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Jennings, R.; Johnston, S. 3rd

    1996-01-01

    BACKGROUND: Performing a surgical procedure in weightlessness has been shown not to be any more difficult than in a 1g environment if the requirements for the restraint of the patient, operator, and surgical hardware are observed. The feasibility of performing a laparoscopic surgical procedure in weightlessness, however, has been questionable. Concerns have included the impaired visualization from the lack of gravitational retraction of the bowel and from floating debris such as blood. METHODS: In this project, laparoscopic surgery was performed on a porcine animal model in the weightlessness of parabolic flight. RESULTS: Visualization was unaffected due to the tethering of the bowel by the elastic mesentery and the strong tendency for debris and blood to adhere to the abdominal wall due to surface tension forces. CONCLUSIONS: There are advantages to performing a laparoscopic instead of an open surgical procedure in a weightless environment. These will become important as the laparoscopic support hardware is miniaturized from its present form, as laparoscopic technology becomes more advanced, and as more surgically capable crew medical officers are present in future long-duration space-exploration missions.

  13. 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

  14. Management of symptomatic fibroids: conservative surgical treatment modalities other than abdominal or laparoscopic myomectomy.

    PubMed

    Istre, Olav

    2008-08-01

    Approximately 50% of women of reproductive age have fibroids, and at least 50% of these women have significant symptoms. However, until 15 years ago, the only surgical options available were hysterectomy and myomectomy, and as yet there are no proven effective long-term medical therapies. Fortunately, the past decade has witnessed the emergence of highly sophisticated diagnostic and therapeutic technologies for fibroids. Magnetic resonance imaging and high-resolution ultrasound are non-invasive, high-quality diagnostic procedures. The new treatment modalities include: laparoscopic and vaginal myomectomy; uterine artery embolization (UAE); magnetic-resonance-guided focused ultrasound surgery (MRgFUS); hysteroscopic resection where the fibroids are submucous; myolysis by heat, cold coagulation and laser; laparoscopic uterine artery occlusion; and temporary transvaginal uterine artery occlusion. It is, however, abundantly clear that there is no panacea that suits every woman, nor are all treatment types universally available to all women, even in the developed world. Laparoscopic surgery requires skills that are not common place, and there are limitations on the size and number of fibroids that can be treated by this modality. Much the same applies to vaginal myomectomy. UAE is now widely used in the USA and Western Europe, and has been recommended by the National Institute for Clincial Excellence (NICE) in the UK as an alternative therapy to hysterectomy. However, UAE is still under evaluation in terms of comparison with myomectomy. UAE has a range of complications including premature ovarian failure, chronic vaginal discharge and pelvic sepsis, and may have limited efficacy when the fibroids are large. Although there are a number of reports of successful pregnancy following UAE, the experience is limited and research is required in this area. MRgFUS was approved by the US Food and Drug Administration in 2004, while NICE recommended that the procedure should be used in an audit and research setting. Preliminary data following laparoscopic uterine artery occlusion suggest that outcomes are similar to those with UAE, but these data are derived from studies involving relatively small numbers. Temporary uterine artery occlusion is also promising, but has yet to be evaluated robustly. Thus there is no room for complacency; research involving the available treatment modalities is urgently needed, while innovations in search of newer and more effective therapies must continue. This chapter will review surgical treatment modalities other than hysterectomy and abdominal or laparoscopic myomectomy. PMID:18328788

  15. Pediatric laparoscopic dismembered pyeloplasty.

    PubMed

    Peters, C A; Schlussel, R N; Retik, A B

    1995-06-01

    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 patient was discharged home 36 hours after the procedure. The nephrostomy tube was removed 10 days postoperatively after radiographic demonstration of patency and 24 hours of clamping without pain. Followup excretory urography at 6 weeks showed much less hydronephrosis and a widely patent anastomosis. Our case illustrates the technical features and feasibility of laparoscopic pyeloplasty in children, and should encourage further development of pediatric urological reconstructive laparoscopic techniques. PMID:7752371

  16. Clinical significance of single-port laparoscopic splenectomy: comparison of single-port and multiport laparoscopic procedure

    PubMed Central

    Han, Eui Soo; Kim, Dong Goo; Lee, Jun Suh; Kim, Eun Young; Lee, Soo Ho; Hong, Tae Ho; Na, Gun Hyung

    2015-01-01

    Purpose Single-port laparoscopic splenectomy has been performed sporadically. The aim of this study is to assess our experience with single-port laparoscopic splenectomy compared to conventional multiport laparoscopic surgery for the usual treatment modality for various kinds of splenic disease. Methods Between October 2008 to February 2014, 29 patients underwent single-port laparoscopic splenectomy and 32 patients received multiport laparoscopic splenectomy. We retrospectively analyzed the clinical outcomes of single-port group and multiport group. Results The body mass index and disease profiles of the both groups were similar. The operative times of single-port and multiport group were 113.6 ± 39.9 and 95.9 ± 38.9 minutes, respectively (P = 0.946). The operative blood loss of the two groups were 295.8 ± 301.3 and 322.5 ± 254.5 mL (P = 0.582). Postoperative retrieved splenic weight of the single-port and multiport groups were 283.9 ± 300.7 and 362.3 ± 471.8 g, respectively (P = 0.261). One single-port partial splenectomy and 6 multiport partial splenectomies were performed in this study. There was one intraoperative gastric wall injury. It occurred in single-port group, which was successfully managed during the operation. Each case was converted to laparotomy in both groups due to bleeding. There was one mortality case in the multiport laparoscopic splenectomy group, which was not related to the splenectomy. Mean hospital stay of the single-port and multiport group was 5.8 ± 2.5 and 7.3 ± 5.2 days respectively (P = 0.140). Conclusion Single-port laparoscopic splenectomy seems to be a feasible approach for various kinds of splenic disease compared to multiport laparoscopic surgery. PMID:26236693

  17. Laparoscopic Removal of Gossypiboma

    PubMed Central

    Özsoy, Zeki; Okan, Ismail; Daldal, Emin; Das?ran, Mehmet Fatih; Ang?n, Yavuz Selim; ?ahin, Mustafa

    2015-01-01

    Gossypiboma is defined as a mass caused by foreign body reaction developed around the retained surgical item in the operative area. When diagnosed, it should be removed in symptomatic patients. Minimal invasive surgery should be planned for the removal of the retained item. The number of cases treated by laparoscopic approach is rare in the literature. We present a case of forty-year-old woman referred to emergency room with acute abdomen diagnosed as gossypiboma and treated successfully with laparoscopic surgery. PMID:26451270

  18. Recent advances in laparoscopic surgery.

    PubMed

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

    2013-02-01

    Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%-0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence-based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined. PMID:23126424

  19. [Laparoscopic repair of umbilical hernias--initial experience].

    PubMed

    Germanov, G; Tsvetkov, I; Radionov, M; Pozharliev, T

    2006-01-01

    In this study the autors present their initial experience with 8 patients with umbilical hernias, operated laparoscopically in the surgery clinic of the university hospital "Sweta Anna" in Sofia for the period from 2002 to 2005. There were no intraoperative complications as well suppurations detected for a 18 months postoperative follow up. We found out lesser postoperative pain and shorter reccurence period by the laparoscopically operated patients in comparison with these, who had undergone a conventional repair. The autors made a review of the related literature and the conclusion, that LVHR is a effective, suitable method for operative treatment of umbilical hernias greater than 4 cm and recidive ones. PMID:18788109

  20. Multiresolution foveated laparoscope with high resolvability.

    PubMed

    Qin, Yi; Hua, Hong; Nguyen, Mike

    2013-07-01

    A key limitation of the state-of-the-art laparoscopes for minimally invasive surgery is the tradeoff between the field of view and spatial resolution in a single-view camera system. As such, surgical procedures are usually performed at a zoomed-in view, which limits the surgeon's ability to see much outside the immediate focus of interest and causes a situational awareness challenge. We proposed a multiresolution foveated laparoscope (MRFL) aiming to address this limitation. The MRFL is able to simultaneously capture wide-angle overview and high-resolution images in real time; it can scan and engage the high-resolution images to any subregion of the entire surgical field in analogy to the fovea of human eye. The MRFL is able to render equivalently 10 million pixel resolution with a low data bandwidth requirement. The system has a large working distance (WD) from 80 to 180 mm. The spatial resolvability is about 45 ?m in the object space at an 80 mm WD, while the resolvability of a conventional laparoscope is about 250 ?m at a typically 50 mm surgical distance. PMID:23811873

  1. Laparoscopic-Assisted Surgical Procedures.

    PubMed

    Steffey, Michele A

    2016-01-01

    Laparoscopic-assisted procedures allow a balance between the improved patient recoveries often associated with smaller incisions and the need for appropriate visualization of visceral organs/identification of lesions. The organ systems of small animal veterinary patients that are highly amenable to laparoscopic-assisted procedures include the urinary bladder, the gastrointestinal tract, and the reproductive tracts. Laparoscopic-assisted procedures are especially beneficial in the approach to luminal organs, allowing the organ incision to be exteriorized through the body wall, protecting the peritoneal cavity from contamination from luminal contents. Procedure-specific morbidities and patient selection should be considered when choosing between assisted laparoscopic and open approaches. PMID:26410563

  2. 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

  3. 42 CFR 441.255 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Sterilization by hysterectomy. 441.255 Section 441.255 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Sterilizations § 441.255 Sterilization by hysterectomy. (a) FFP is not available in expenditures for...

  4. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Sterilization by hysterectomy. 50.207 Section 50... GENERAL APPLICABILITY Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207 Sterilization by hysterectomy. (a) Programs or projects to which this subpart applies shall not perform...

  5. 42 CFR 441.255 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Sterilization by hysterectomy. 441.255 Section 441.255 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Sterilizations § 441.255 Sterilization by hysterectomy. (a) FFP is not available in expenditures for...

  6. 42 CFR 441.255 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Sterilization by hysterectomy. 441.255 Section 441.255 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Sterilizations § 441.255 Sterilization by hysterectomy. (a) FFP is not available in expenditures for...

  7. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Sterilization by hysterectomy. 50.207 Section 50... GENERAL APPLICABILITY Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207 Sterilization by hysterectomy. (a) Programs or projects to which this subpart applies shall not perform...

  8. 42 CFR 441.255 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Sterilization by hysterectomy. 441.255 Section 441.255 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Sterilizations § 441.255 Sterilization by hysterectomy. (a) FFP is not available in expenditures for...

  9. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Sterilization by hysterectomy. 50.207 Section 50... GENERAL APPLICABILITY Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207 Sterilization by hysterectomy. (a) Programs or projects to which this subpart applies shall not perform...

  10. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Sterilization by hysterectomy. 50.207 Section 50... GENERAL APPLICABILITY Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207 Sterilization by hysterectomy. (a) Programs or projects to which this subpart applies shall not perform...

  11. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Sterilization by hysterectomy. 50.207 Section 50... GENERAL APPLICABILITY Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207 Sterilization by hysterectomy. (a) Programs or projects to which this subpart applies shall not perform...

  12. 42 CFR 441.255 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Sterilization by hysterectomy. 441.255 Section 441.255 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Sterilizations § 441.255 Sterilization by hysterectomy. (a) FFP is not available in expenditures for...

  13. Hysterectomy and Disability Among U.S. Women

    PubMed Central

    Drew, Julia A. Rivera

    2013-01-01

    CONTEXT Hysterectomies are the second most common surgery performed on women in the United States, and most are done for elective reasons. Although women with disabilities appear to have an increased risk of undergoing the procedure, little research has evaluated the relationship between disability and hysterectomy. METHODS Data on 42,842 women aged 18 or older from the 2000, 2005 and 2010 National Health Interview Surveys were used to evaluate the relationship between disability and the risk of having a hysterectomy over the life course. Piecewise exponential event history models were estimated to identify associations between timing of disability onset, type of disability, and the occurrence and timing of hysterectomy. RESULTS Women with multiple disabilities experienced a higher risk of undergoing a hysterectomy than women with no disability (hazard ratio, 1.3), and this heightened risk was concentrated at younger ages. During their 20s, 30s and early 40s, women who had multiple disabilities were more likely to have had a hysterectomy than their same-age counterparts with no or one disability (1.3–2.4). Women with a single type of disability, as well as most women who had multiple disabilities and were aged 46 or older, were not at increased risk of having had a hysterectomy. CONCLUSIONS Additional research is needed to investigate why young women with multiple disabilities appear to face an increased risk of having a hysterectomy, especially because it is major surgery that can carry significant health risks. PMID:24020777

  14. [Preoperative ERCP and laparoscopic cholecystectomy for treatment of choledocholithiasis].

    PubMed

    Metzger, J; Berbig, R; Muller, C

    1993-03-01

    Out of 110 patients suffering from gallstone-related symptoms, 21 underwent ERCP prior to laparoscopic cholecystectomy. Indications for this combined treatment were laboratory signs of cholestasis (36%), pancreatitis (29%), pathological IVC (18%), sonographic evidence for bile duct dilatation (10%) and cholangitis (7%). Local and general complications were not increased neither intraoperatively nor postoperatively. Median duration of postoperative hospital stay was four days for ERCP-treated patients as compared to three days for patients subjected to laparoscopic cholecystectomy only. In summary treatment of choledocholithiasis by a combination of preoperative ERCP and laparoscopic cholecystectomy offers the following advantages: high patient comfort, low incidence of complications and short hospitalization compares favourably with conventional common bile duct exploration. PMID:8473184

  15. Study on an infrared endoscope for energized laparoscopic method

    NASA Astrophysics Data System (ADS)

    Chen, Minghui; Song, Chengli

    2014-11-01

    An infrared endoscopic system has been developed to investigate thermal spread and collateral damage during energized laparoscopic surgery, the system consists of an infrared endoscope and a thermal camera (3-5 ?m) with combined thermal sensitivity of 0.05°C. The system performance was evaluated in live animals with electrosurgical devices to monitor intraoperative thermal changes. During activation periods, the peak temperature of the jaws averaged 100.5 ± 5.8 ° with a thermal spread of 3.0 ± 0.9 mm. For laparoscopic dissections of the esophagus-gastric junction with the 10 mm Atlas, the maximum jaw temperature was 105.2 ± 2.1 ° with a bigger thermal spread of 11.5 ± 7.2 mm). The study has confirmed that infrared endoscopy is a very useful tool adjunct to conventional endoscopy, which may improve the safety of energized laparoscopic dissections.

  16. Laparoscopic Appendicectomy: Calculating the Cost

    PubMed Central

    Needham, PJ; Laughlan, KA; Botterill, ID; Ambrose, NS

    2009-01-01

    INTRODUCTION Laparoscopic appendicectomy is a commonly performed procedure presenting a considerable cost burden. Given the additional operative costs of laparoscopic versus open appendicectomy, it is not clear whether the national tariffs are appropriate for laparoscopic appendicectomy. We conducted a study to establish the institutional costs, and to determine whether re-imbursement according to the national tariffs was sufficient. PATIENTS AND METHODS Data were collected prospectively on patients undergoing laparoscopic appendicectomy within Leeds Teaching Hospitals Trust. Theatre and bed costs were obtained. Cost analysis was performed, and costs were compared to the re-imbursement due. RESULTS Fifty laparoscopic appendicectomies were performed. Median operative time was 60 min. The median total operative cost of laparoscopic appendicectomy was £906. Median equipment cost for laparoscopically completed cases was £254. Median total in-patient cost was £1617 (range, £880–£3360). This compared with a mean re-imbursement of £1981 representing a cost benefit of £233 per case (P = 0.0009). CONCLUSIONS Despite a liberal use of disposable equipment, laparoscopic appendicectomy can still be performed within the confines of the national tariffs. There is a considerable variation in the cost of this procedure, and it may be possible to reduce costs by more stringent use of disposable equipment and standardising recovery protocols. PMID:19558761

  17. Laparoscopic living donor hepatectomy: a review of current status.

    PubMed

    Park, Jeong-Ik; Kim, Ki-Hun; Lee, Sung-Gyu

    2015-11-01

    Over the last two decades, laparoscopic surgery has been adopted in various surgical fields. Its advantages of reduced blood loss, reduced postoperative morbidity, shorter hospital stay, and excellent cosmetic outcome compared with conventional open surgery are well validated. In comparison with other abdominal organs, laparoscopic hepatectomy has developed relatively slowly due to the potential for massive bleeding, technical difficulties and a protracted learning curve. Furthermore, applications to liver graft procurement in living donor liver transplantation (LDLT) have been delayed significantly due to concerns about donor safety, graft outcome and the need for expertise in both laparoscopic liver surgery and LDLT. Now, laparoscopic left lateral sectionectomy in adult-to-pediatric LDLT is considered the standard of care in some experienced centers. Currently, the shift in application has been towards left lobe and right lobe graft procurement in adult LDLT from left lateral section in pediatric LDLT. However, the number of cases is too small to validate the safety and reproducibility. The most important concern in LDLT is donor safety. Even though a few studies reported the technical feasibility and comparable outcomes to conventional open surgery, careful validating through larger sample sized studies is needed to achieve standardization and wide application. PMID:26449392

  18. Comparison of oxycodone and fentanyl for postoperative patient-controlled analgesia after laparoscopic gynecological surgery

    PubMed Central

    Park, Joong-Ho; Lee, Chiu; Shin, Youngmin; Ban, Jong-Seouk; Lee, Ji-Hyang

    2015-01-01

    Background Opioids are widely used in boluses and patient-controlled analgesia (PCA) for postoperative pain control. In this study, we compared the effects of oxycodone and fentanyl on postoperative pain in patients with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecological surgery. Methods Seventy-four patients undergoing elective total laparoscopic hysterectomy or laparoscopic myomectomy were randomly assigned to the administration of either fentanyl or oxycodone using IV-PCA (potency ratio 1 : 60). The cumulative dose administered in the patient-controlled mode during the initial 48 hours after the operation was measured. Patients were also assessed for postoperative pain severity, adverse effects, and patient satisfaction. Results No significant differences were observed in patient satisfaction with the analgesia during the postoperative period. Patients in the oxycodone group experienced significantly more dizziness compared to the fentanyl group. Patients in the oxycodone group showed significantly lower consumption of opioid in the patient-controlled mode (10.1 ± 8.5 ml vs. 16.6 ± 12.0 ml, P = 0.013). Conclusions Our data suggest that oxycodone and fentanyl demonstrated similar effects, and therefore oxycodone may be a good alternative to fentanyl in postoperative pain management. Further studies in various clinical settings will be needed to determine the adequate potency ratio. PMID:25844134

  19. Minilaparoscopic sacrocolpopexy for vaginal prolapse after hysterectomy.

    PubMed

    Ferreira, Helder; Ferreira, Carlos; Braga, Antonio; Pereira, Antonio Tome; Guimaraes, Serafim

    2014-11-01

    Genital prolapse repair is one of the most common indications for benign gynecologic surgery. The lifetime risk of undergoing a single operation for prolapse in the female population is rising. Many different surgical techniques have been described. We report 4 cases of minilaparoscopic sacrocolpopexy to correct vaginal apical prolapse after previous total hysterectomy. For each patient we collected some socio-demographic data, vaginal apical prolapse grade using the Pelvic Organ Prolapse Quantification (POP-Q), intraoperative details and postoperative outcomes. Operative time was recorded as well as difficulties and complications (Clavien-Dindo Classification) at each step of the procedure. The range of women's ages was from 57 to 71 years old. The mean BMI was 24.75 ± 3.2 Kg/m2. Three patients had a stage III POP-Q prolapses and there was one case of a symptomatic stage II POP-Q prolapse. The mean surgical time was 119 minutes and there were no intraoperative complications. The postoperative pain assessment revealed very positive recovery in every patient. An ambulatory consult and an anatomic assessment were done 1 and 3 months after surgery. The incision scars were almost invisible after 1 month, and the anatomic cure rate was 100%. We confirmed the feasibility of a minilaparoscopic surgical approach for vaginal vault prolapse after total hysterectomy. PMID:25433151

  20. Enhanced recovery programme in robotic hysterectomy.

    PubMed

    Iavazzo, Christos; Gkegkes, Ioannis D

    The standard care for endometrial cancer includes total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings with or without bilateral pelvic and/or paraaortic lymph node dissection/sampling with or without omental biopsy or omentectomy. The aim of this narrative review is to present the advantages of robotic surgery in combination with the enhanced recovery programme to offer better care to patients with endometrial cancer. The authors argue that a well-organised service for robotic hysterectomy should be set up in all hospitals. As part of this, an enhanced recovery programme including the following elements should be implemented: patient education, preoperative carbohydrate drinks, spinal or local analgesia, goal-directed fluid therapy, early feeding and intensive early mobilisation. The enhanced recovery programme includes pre, intra and postoperative changes in patient management. A comprehensive enhanced recovery programme starting in the preoperative setting and extending through to the patient's discharge, combined with robotic approach, could lead to optimal care of patients with endometrial cancer. PMID:26355452

  1. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207...life-threatening emergency in which the physician determines that prior acknowledgment...of paragraph (c)(1) exist, the physician who performs the hysterectomy must...

  2. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207...life-threatening emergency in which the physician determines that prior acknowledgment...of paragraph (c)(1) exist, the physician who performs the hysterectomy must...

  3. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207...life-threatening emergency in which the physician determines that prior acknowledgment...of paragraph (c)(1) exist, the physician who performs the hysterectomy must...

  4. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207...life-threatening emergency in which the physician determines that prior acknowledgment...of paragraph (c)(1) exist, the physician who performs the hysterectomy must...

  5. 42 CFR 50.207 - Sterilization by hysterectomy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207...life-threatening emergency in which the physician determines that prior acknowledgment...of paragraph (c)(1) exist, the physician who performs the hysterectomy must...

  6. Uterine bleeding with an IUD requiring emergency hysterectomy.

    PubMed

    Glew, S; Singh, A

    1989-03-01

    A case is described of profuse uterine bleeding with a dislodged Multiload Cu 250 intrauterine device (IUD). Multiple blood transfusions were necessary, and ultimately, an emergency hysterectomy was performed. PMID:2782134

  7. Robot-assisted laparoscopic urological surgery in children.

    PubMed

    Sávio, Luís F; Nguyen, Hiep T

    2013-11-01

    Robot-assisted laparoscopic surgery (RALS) has been proven to be safe and effective for various urological procedures in children, including pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation. The robot system enables delicate and precise movements, which are ideal for the types of reconstructive surgeries that children with urological issues often require, overcoming many of the impediments associated with the conventional laparoscopic approach. RALS helps the relative novice to perform fine surgical techniques and is thought to reduce the learning curve associated with some surgical techniques, such as intracorporeal suturing, owing to the improved freedom of movement of the surgical instruments, the ergonomic positioning of the surgeon, and the 3D vision provided by the robotic system. Given the favourable safety profile and associated benefits of the robot system, including reductions in mean postoperative hospital stay compared with conventional procedures, RALS is becoming more widely adopted by paediatric urologists. PMID:24100517

  8. Exposure of surgeons to extremely low-frequency magnetic fields during laparoscopic and robotic surgeries.

    PubMed

    Park, Jee Soo; Chung, Jai Won; Kim, Nam Kyu; Cho, Min Soo; Kang, Chang Moo; Choi, Soo Beom; Kim, Deok Won

    2015-02-01

    The development of new medical electronic devices and equipment has increased the use of electrical apparatuses in surgery. Many studies have reported the association of long-term exposure to extremely low-frequency magnetic fields (ELF-MFs) with diseases or cancer. Robotic surgery has emerged as an alternative tool to overcome the disadvantages of conventional laparoscopic surgery. However, there has been no report regarding how much ELF-MF surgeons are exposed to during laparoscopic and robotic surgeries. In this observational study, we aimed to measure and compare the ELF-MFs that surgeons are exposed to during laparoscopic and robotic surgery.The intensities of the ELF-MFs surgeons are exposed to were measured every 4 seconds for 20 cases of laparoscopic surgery and 20 cases of robotic surgery using portable ELF-MF measuring devices with logging capability.The mean ELF-MF exposures were 0.6?±?0.1?mG for laparoscopic surgeries and 0.3?±?0.0?mG for robotic surgeries (significantly lower with P?conventional laparoscopic surgery were lower than 2?mG, which is the most stringent level considered safe in many studies. However, we should not overlook the effects of long-term ELF-MF exposure during many surgeries in the course of a surgeon's career. PMID:25674758

  9. Exposure of Surgeons to Extremely Low-Frequency Magnetic Fields During Laparoscopic and Robotic Surgeries

    PubMed Central

    Park, Jee Soo; Chung, Jai Won; Kim, Nam Kyu; Cho, Min Soo; Kang, Chang Moo; Choi, Soo Beom; Kim, Deok Won

    2015-01-01

    Abstract The development of new medical electronic devices and equipment has increased the use of electrical apparatuses in surgery. Many studies have reported the association of long-term exposure to extremely low-frequency magnetic fields (ELF-MFs) with diseases or cancer. Robotic surgery has emerged as an alternative tool to overcome the disadvantages of conventional laparoscopic surgery. However, there has been no report regarding how much ELF-MF surgeons are exposed to during laparoscopic and robotic surgeries. In this observational study, we aimed to measure and compare the ELF-MFs that surgeons are exposed to during laparoscopic and robotic surgery. The intensities of the ELF-MFs surgeons are exposed to were measured every 4 seconds for 20 cases of laparoscopic surgery and 20 cases of robotic surgery using portable ELF-MF measuring devices with logging capability. The mean ELF-MF exposures were 0.6?±?0.1?mG for laparoscopic surgeries and 0.3?±?0.0?mG for robotic surgeries (significantly lower with P?conventional laparoscopic surgery were lower than 2?mG, which is the most stringent level considered safe in many studies. However, we should not overlook the effects of long-term ELF-MF exposure during many surgeries in the course of a surgeon's career. PMID:25674758

  10. Mesh-Based Transperineal Repair of a Perineal Hernia After a Laparoscopic Abdominoperineal Resection

    PubMed Central

    Lee, Taek-Gu

    2014-01-01

    A perineal hernia (PH) is formed by a protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after a conventional abdominoperineal resection (APR). However, the risk of a PH may be increased after a laparoscopic resection because this technique can cause fewer postoperative adhesions, predisposing the small bowel to sliding down toward the pelvis. However, only a few case reports describe the transperineal approach for the repair of a PH after a laparoscopic APR. We present a case of a PH after a laparoscopic APR; the PH was repaired with synthetic mesh by using a transperineal approach. A transperineal approach using a mesh to reconstruct the pelvic floor is less invasive and more effective. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR. PMID:25210690

  11. Relation between hysterectomy and the irritable bowel: a prospective study.

    PubMed Central

    Prior, A; Stanley, K M; Smith, A R; Read, N W

    1992-01-01

    Some women with irritable bowel syndrome date the onset of symptoms to previous hysterectomy. To assess prospectively the incidence of gastrointestinal symptomatology arising de novo after hysterectomy, and to study the effect of surgery on pre-existing symptoms, 205 women completed a symptom questionnaire before and six weeks and six months after surgery. Beforehand, symptoms suggestive of irritable bowel syndrome occurred in 22% of patients. At six months after operation, 60% of these had improved or were symptom free while 20% had increased symptomatology. New gastrointestinal symptoms were present more than once per week in 10% of previously asymptomatic women. Constipation predominant irritable bowel syndrome was the commonest symptom complex seen de novo, occurring more than once per week in 5% of the group. No relation was found between new symptomatology and the type of hysterectomy, oophorectomy, or the administration of perioperative antibiotics. This study suggests that many women with pre-existing gastrointestinal symptomatology improve after hysterectomy. However, symptoms suggestive of irritable bowel syndrome do arise de novo in 10%. As hysterectomy is common, gastroenterologists can expect to see women presenting with post-hysterectomy problems. PMID:1624165

  12. Laparoscopic Surgery - What Is It?

    MedlinePLUS

    ... because the instruments are placed so closely together. “Robotic surgery” or “robotic-assisted surgery” is a newer variation on minimally ... remainder of the operation is usually performed laparoscopically. Robotic surgery is gaining popularity primarily for rectal operations ...

  13. Laparoscopic resection of hilar cholangiocarcinoma

    PubMed Central

    Lee, Woohyung; Yoon, Yoo-Seok; Cho, Jai Young; Choi, YoungRok; Shin, Hong Kyung; Jang, Jae Yool; Choi, Hanlim

    2015-01-01

    Laparoscopic resection of hilar cholangiocarcinoma is technically challenging because it involves complicated laparoscopic procedures that include laparoscopic hepatoduodenal lymphadenectomy, hemihepatectomy with caudate lobectomy, and hepaticojejunostomy. There are currently very few reports describing this type of surgery. Between August 2014 and December 2014, 5 patients underwent total laparoscopic or laparoscopic-assisted surgery for hilar cholangiocarcinoma. Two patients with type I or II hilar cholangiocarcinoma underwent radical hilar resection. Three patients with type IIIa or IIIb cholangiocarcinoma underwent extended hemihepatectomy together with caudate lobectomy. The median (range) age, operation time, blood loss, and length of hospital stay were 63 years (43-76 years), 610 minutes (410-665 minutes), 650 mL (450-1,300 mL), and 12 days (9-21 days), respectively. Four patients had a negative margin, but 1 patient was diagnosed with high-grade dysplasia on the proximal resection margin. The median tumor size was 3.0 cm. One patient experienced postoperative biliary leakage, which resolved spontaneously. Laparoscopic resection is a feasible surgical approach in selected patients with hilar cholangiocarcinoma. PMID:26448923

  14. Laparoscopic herniorrhaphy in children.

    PubMed

    Bertozzi, Mirko; Marchesini, Laura; Tesoro, Simonetta; Appignani, Antonino

    2015-01-01

    The authors report their experience in laparoscopic repair of inguinal hernias in children. From May 2010 to November 2013, 122 patients with inguinal hernia underwent laparoscopic herniorrhaphy (92 males and 30 females). Telescope used was 5 mm, while trocars for the operative instruments were 3 or 2 mm. After introducing the camera at the umbilical level and trocars in triangulation, a 4-0 nonabsorbable monofilament suture was inserted directly through the abdominal wall. The internal inguinal ring was then closed by N or double N suture. All operations were performed in one-day surgery setting. In the case of association of inguinal and umbilical hernia an original technique was performed for positioning and fixing the umbilical trocar and for the primary closure of the abdominal wall defect. The postoperative follow-up consisted of outpatient visits at 1 week and 1, 3, and 6 months. The mean age of patients was 38.5 months. Of all patients, 26 were also suffering from umbilical hernia (19 males and 7 females). A total of 160 herniorrhaphies were performed; 84 were unilateral (66 inguinal hernia, 18 inguinal hernia associated with umbilical hernia), 38 bilateral (30 inguinal hernia, 8 inguinal hernia associated with umbilical hernia). Nine of 122 patients (6 males and 3 females) were operated in emergency for incarcerated hernia. A pre-operative diagnosis of unilateral inguinal hernia was performed in 106 cases. Of these patients, laparoscopy revealed a controlateral open internal inguinal ring in 22 cases (20.7%). The mean operative time was 29.9±15.9 min for the monolateral herniorrhaphies, while in case of bilateral repair the mean operative time was 41.5±10.4 min. The mean operative time for the repair of unilateral inguinal hernia associated with umbilical hernia was 30.1±7.4 while for the correction of bilateral inguinal hernia associated with umbilical hernia 39.5±10.6 min. There were 3 recurrences (1.8%): 2 cases in unilateral repair and 1 case a unilateral recurrence in a bilateral repair. No other complications were seen. Laparoscopic repair of inguinal hernia in children performed in this experience resulted a safe and effective procedure. PMID:26429119

  15. Design of a pressure sensing laparoscopic grasper

    E-print Network

    Reyda, Caitlin J. (Caitlin Jilaine)

    2011-01-01

    With smaller incisions, laparoscopic, or minimally invasive, surgery is considered safer for patients than open surgery. However, the safety of current laparoscopic grasping instruments can still be improved. Current devices ...

  16. Laparoscopic radical prostatectomy.

    PubMed

    Krongrad, A

    2000-05-01

    The radical prostatectomy has been modified over the years. With the introduction to the modern operating room of robots and other tools has come the latest modification: the laparoscopic radical prostatectomy (LRP), first described almost 10 years ago. In the past 2 years, the technique of LRP has been made standard, reproducible, and efficient. The LRP virtually eliminates the physical and emotional toll of radical prostate surgery and reduces blood loss, hospital time, and cost. Published series demonstrate oncologic and functional results comparable with and perhaps better than what is seen with open radical prostatectomy. The LRP is a standard surgical technique in a growing number of medical centers, with world experience estimated at 500 cases. The LRP offers the urologic community a rare opportunity for tangibly improving care. PMID:12084339

  17. Registry of laparoscopic cholecystectomy and new and evolving laparoscopic techniques.

    PubMed

    White, J V

    1993-04-01

    To collect information on the rapid application of laparoscopic surgery, the National Laparoscopic Surgery Registry surveyed more than 4,000 of the 16,000 currently practicing laparoscopic surgeons. Preliminary analysis of the data has revealed that most of the respondents had been trained in general surgery, but a small percentage were certified only in surgical subspecialties. Surgeons acquiring skills in laparoscopic surgery had various levels of experience ranging from less than 1 year to more than 38 years in surgical practice. Nearly 90% of the respondents attended a laparoscopic cholecystectomy course with hands-on training. In those courses, an average of 16 hours was devoted to animal laboratories for acquisition of skills. Additional training in the form of a preceptorship is being undertaken by an increasing number of surgeons. The future of minimally invasive surgery is being supported by rapid advances in technology. New video systems capable of displaying three-dimensional images and miniaturized fiberoptic scopes are now available. Computer enhanced three-dimensional ultrasound images provide the surgeon with the ability to examine the content and consistency of tissues in addition to their appearance. Advances in mechanical retraction may eliminate the need for carbon dioxide insufflation of the abdomen. Tissue repair using tissue glues or laser-mediated processes may reduce the need for endocavitary suturing. These advances in technology and techniques may reduce the morbidity and mortality of these surgical procedures and, ultimately, improve the standard of care for surgical patients. PMID:8480898

  18. Peripartum hysterectomy in a tertiary hospital in Western Sydney.

    PubMed

    Shamsa, A; Harris, A; Anpalagan, A

    2015-05-01

    The aim of this study was to review the incidence, indication, management and complications of peripartum hysterectomy (PH) in a tertiary level hospital over a decade. A retrospective review of all cases of PH performed at Westmead Hospital, Western Sydney, 2003-2012, was undertaken. PH was defined as hysterectomy performed after 20 weeks' gestation or any time after delivery but within 6 weeks' postpartum ( Awan et al. 2011 ). There were 56 cases of peripartum hysterectomy of 46,177 births, a rate of 1.22 per 1,000 births. The most common indication for PH was morbid adherence of the placenta (58.2%) followed by uterine atony. Having a history of both caesarean section and placenta praevia is highly associated with a morbidly adherent placenta in the index pregnancy (p = 0.002). The most common complication was coagulopathy followed by febrile illness and urinary tract injury. Our data showed previous caesarean section and placenta praevia to be associated with abnormal placentation, the leading indication for PH. Since there is an association between a planned caesarean hysterectomy and reduced amount of estimated blood loss and blood transfused, the knowledge of placentation and adequate preoperative planning and consideration for elective hysterectomy could be beneficial. The morbidity associated with PH is considerable. PMID:25264917

  19. 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

  20. Hemostasis in laparoscopic renal surgery

    PubMed Central

    Hassouna, Hussam A.; Manikandan, Ramaswamy

    2012-01-01

    Hemorrhage is a potential risk at any step of laparoscopic nephrectomies (LNs). The advances in surgical equipment and tissue sealants have increased the safety and efficiency of performing LN and laparoscopic partial nephrectomy (LPN). However, hemostasis remains a major issue and there is still scope for further development to improve haemostatic techniques and devices. In this article a literature review of the current methods and techniques of hemostasis was carried out using the MEDLINE ®/PubMed® resources. The results of the review were categorized according to the three main operative steps: Dissection, control of renal pedicle and excision of the renal lesion. PMID:22557709

  1. Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor

    PubMed Central

    Namikawa, Tsutomu; Hanazaki, Kazuhiro

    2015-01-01

    Laparoscopic wedge resection is a useful procedure for treating patients with submucosal tumor (SMT) including gastrointestinal stromal tumor (GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery (LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery. PMID:26468339

  2. UNEXPECTED OVARIAN MALIGNANCY FOUND AFTER LAPAROSCOPIC SURGERY IN PATIENTS WITH ADNEXAL MASSES –A SINGLE INSTITUTIONAL EXPERIENCE–

    PubMed Central

    SAITO, SHIGEKO; KAJIYAMA, HIROAKI; MIWA, YOKO; MIZUNO, MIKA; KIKKAWA, FUMITAKA; TANAKA, SHIHO; OKAMOTO, TOMOMITSU

    2014-01-01

    ABSTRACT Laparoscopy has become the standard surgery for the treatment of benign ovarian tumors. The aim of this study was to evaluate the appropriateness of laparoscopy for ovarian tumors, including those with malignant potential. A total of 487 patients with adnexal masses underwent laparoscopic surgery in Social Insurance Chukyo Hospital from January 2000 to December 2012.We reviewed 471 cases that fulfilled the criteria set for this study, and examined 10 cases with unexpected ovarian malignancy to analyze their preoperative diagnosis, second surgery, postoperative chemotherapy, and prognosis. The ages of the 471 patients ranged from 13 to 50 years, with a median of 31. Nulliparous patients numbered 321(68.1%).Of all, 436 patients mostly consisted of those with endometrioma, benign ovarian neoplasm or functional cyst. In all, we histologically identified 10 women with malignancy: 6 with borderline ovarian tumors (BOT), 2 with ovarian cancer, and 2 with histologically rare tumors (immature teratoma and granulosa cell tumor). All patients with BOT were diagnosed with a mucinous histology. Two patients underwent both second radical surgery (hysterectomy and contra- or bilateral salpingo-oophorectomy) and chemotherapies that consisted of CBDCA and PTX or DTX. Thus, 2 patients underwent staging procedures, but the remaining 8 cases did not. None of them had evidence of recurrences. With accurate staging and careful postoperative follow-up, laparoscopic surgery could be a feasible initial operation for patients with adnexal masses including early-stage ovarian malignancy. PMID:25129994

  3. Laparoscopic management for Seprafilm-induced sterile peritonitis with paralytic ileus: report of 2 cases.

    PubMed

    Huang, Jui-Chien; Yeh, Chun-Chieh; Hsieh, Chi-Hsun

    2012-01-01

    Postoperative adhesions after abdominopelvic surgery can be prevented with the use of mechanical barriers such as Seprafilm membranes. However, this procedure is not without complications. Herein are reported 2 cases of Seprafilm-associated sterile peritonitis after gynecologic surgical procedures. Both patients had symptoms that mimicked intraabdominal abscess formation soon after the initial surgery (1 patient had delivered via cesarean section, and the other had undergone total hysterectomy because of adenomyosis). However, laparoscopic examinations in these 2 patients revealed only gel-like hydrated Seprafilm without evidence of infection. Symptoms resolved after the abdominal cavity was thoroughly irrigated and the Seprafilm residue was completely removed. Both patients had an uneventful recovery. Previous reports suggested that Seprafilm-related complications were most commonly observed in patients who underwent gynecologic debulking surgery because Seprafilm might react with the large area of the injured peritoneum and induce a strong inflammatory response. However, our experience showed that such complications could also be observed in patients who underwent nondebulking surgery. A laparoscopic approach should be considered the treatment of choice under these conditions to avoid unnecessary laparotomy. PMID:22935311

  4. Surgery

    MedlinePLUS

    ... Minimally invasive hysterectomy (laparoscopic-assisted vaginal hysterectomy and robotic total laparoscopic hysterectomy): the uterus and cervix are ... vagina with the assistance of a laparoscope or robotic device (a small tubelike viewing instrument) that is ...

  5. Laparoscopic management of appendicular mass

    PubMed Central

    Shindholimath, Vishwanath V; Thinakaran, K; Rao, T Narayana; Veerappa, Yenni Veerabhadrappa

    2011-01-01

    BACKGROUND: Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, its role in the treatment of complicated appendicitis is controversial. This study was undertaken to assess the feasibility of laparoscopic appendectomy for appendicular mass. MATERIALS AND METHODS: A retrospective review was performed of all the patients who were treated laparoscopically for appendicular mass from March 2007 to October 2009. Setting: Tertiary care hospital. RESULTS: A total of 120 patients were treated for appendicitis. A retrospective review of the patients’ records demonstrated that 19 patients (15.8%) had appendicular mass at the time of admission. The average operative time was 95 minutes (range 45-140 minutes). Pathological evidence of appendicitis was present in all the patients. The average length of hospital stay was six days (rang 6-9 days). Three patients (15.7%) had post- operative complications. Two patients developed wound infections and one patient was re-admitted with pain and a lump below the umbilical port. CONCLUSION: The findings suggest that laparoscopic appendectomy is feasible in patients with appendicular mass. The authors propose a prospective, randomized trial to verify this finding. PMID:21523236

  6. Laparoscopic lower urinary tract reconstruction.

    PubMed

    Anderson, K R; Clayman, R V

    2000-10-01

    In the past decade laparoscopy has been successfully utilized for both the obliterative and reconstructive management of urologic disease. We have seen not only an advance in the technology available to perform these procedures, but also an effort on the part of laparoscopic urologists to refine their techniques to allow them to perform more complicated procedures. In the lower urinary tract, the development of reconstructive procedures has been slow. While early interest in laparoscopy prompted several pioneers to perform the initial reconstructive procedures, the difficulties associated with these procedures at that time largely precluded their widespread application or adoption. Recently, improvements in the skills of laparoscopic urologists and the advent of instruments to facilitate suturing (e.g. EndoStitch semi-automatic suturing device, Lapra-Ty clips to replace intracorporeal knotting, and advances in staple and clip technology) have facilitated a renewed interest in laparoscopic reconstructive surgery of the lower urinary tract. At present, almost all types of urologic open reconstructive procedures have been accomplished laparoscopically: urinary diversion (e.g. ureteroileal loop urinary diversion and continent diversion), bladder reconstruction (e.g. ureterovesicostomy, bladder augmentation, bladder diverticulectomy, partial cystectomy), ureteral reimplantation, and, most recently, urethrovesical anastomosis following radical prostatectomy. This article will review the development of these procedures. PMID:11131313

  7. 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

  8. [Laparoscopic treatment of benign ovarian cysts].

    PubMed

    Imme, Antonio; Caglià, Pietro; Gandolfo, Luigi; Cavallaro, Giovanni; Amodeo, Corrado

    2002-01-01

    Laparoscopic surgery is the most frequent indication for the management of benign ovarian cysts in the obstetric and gynaecological field. On the basis of their experience the authors address the clinical classification of benign ovarian pathology and the surgical laparoscopic procedures utilised in the treatment of adnexal cysts. Forty-two patients underwent laparoscopic surgery after a preoperative clinical and biological evaluation and imaging in order to exclude the presence of ovarian malignancies. All surgical procedures were carried out laparoscopically, with a conversion index of 0%. The morbidity was 2.3% (one case of haematoma of the umbilical trocar site) and there was no mortality. No late complications were observed. In conclusion, laparoscopic surgery in the management of ovarian cysts is technically feasible. On the basis of these findings laparoscopic surgery is the treatment of choice for adnexal cystic tumours after careful exclusion of malignancy. PMID:12239764

  9. Efficacy of Laparoscopic Sacrocervicopexy for Apical Support of Pelvic Organ Prolapse

    PubMed Central

    Rosati, Maurizio; Bracale, Umberto; Pignata, Giusto; Azioni, Guglielmo

    2013-01-01

    Background and Objectives: To evaluate the efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse. Methods: One-hundred thirty-five women with symptomatic prolapse of the central compartment (Pelvic Organ Prolapse Quantitative [POP-Q] stage 2) underwent laparoscopic sacrocervicopexy. The operating physicians used synthetic mesh to attach the anterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory with subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow-up examinations 1 month after surgery and then over subsequent years. On follow-up a physician evaluated each patient for the recurrence of genital prolapse and for recurrent or de novo development of urinary or bowel symptoms. We define “surgical failure” as any grade of recurrent prolapse of stage II or more of the POP-Q test. Patients also gave feedback about their satisfaction with the procedure. Results: The mean follow-up period was 33 months. The success rate was 98.4% for the central compartment, 94.2% for the anterior compartment, and 99.2% for the posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (P < .01), and we observed a statistically significant reduction (P < .05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia, and discomfort. The present study showed 70.5% of patients stated they were very satisfied with the operation and 18.8% stated high satisfaction. Conclusion: Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse. PMID:23925017

  10. Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery

    PubMed Central

    Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca

    2014-01-01

    INTRODUCTION Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. PRESENTATION OF CASE We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1 cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10 mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. DISCUSSION Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. CONCLUSION Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner. PMID:24705194

  11. 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

  12. Laparoscopic strategies for resection of insulinomas.

    PubMed

    Fernández-Cruz, Laureano; Cesar-Borges, Gleydson

    2006-05-01

    Sporadic insulinomas are suitable for the laparoscopic approach because they are solitary, resectable, and not metastatic. Laparoscopy and laparoscopic ultrasonography (LapUS) can identify lesions that are undetectable by preoperative imaging techniques. However, it is still worthwhile to attempt preoperative imaging by endoscopic ultrasonography to provide useful information for patient positioning and port placement. Laparoscopic pancreatic resection and laparoscopic enucleation are feasible and safe techniques. Conversion to the open approach should be considered for tumors that cannot be identified accurately by LapUS. In patients with insulinomas in the setting of multiple endocrine neoplasia 1, the laparoscopic approach is slightly different. Laparoscopic subtotal distal pancreatectomy preserving the spleen combined with laparoscopic enucleation of any tumors identified in the pancreatic head should be the standard operation. The advantages of laparoscopic pancreatic procedures should be those of all laparoscopic procedures, which obviously reduce the parietal damage in the abdomen. This may be associated with reductions in postoperative pain and hospital stay and an earlier return to previous activity. A cosmetic advantage is also clear because of the absence of long abdominal incision, and this should be taken into account, especially in young women. PMID:16773762

  13. Laparoscopic Repair of Giant Paraesophageal Hernia: 100 Consecutive Cases

    PubMed Central

    Luketich, James D.; Raja, Siva; Fernando, Hiran C.; Campbell, William; Christie, Neil A.; Buenaventura, Percival O.; Keenan, Robert J.; Schauer, Philip R.

    2000-01-01

    Objective To summarize the authors’ laparoscopic experience for paraesophageal hernia (PEH). Summary Background Data Laparoscopic antireflux surgery and repair of small hiatal hernias are now routinely performed. Repair of a giant PEH is more complex and requires conventional surgery in most centers. Giant PEH accounts for approximately 5% of all hiatal hernias. Medical management may be associated with a 50% progression of symptoms and a significant death rate. Conventional open surgery has a low death rate, but complications are significant and return to routine activities is delayed in this frequently elderly population. Recently, short-term outcome studies have reported that minimally invasive approaches to PEH may be associated with a lower complication rate, a shorter hospital stay, and faster recovery. Methods From July 1995 to February 2000, 100 patients (median age 68) underwent laparoscopic repair of a giant PEH. Follow-up included heartburn scores and quality of life measurements using the SF-12 physical component and mental component summary scores. Results There were 8 type II hernias, 85 type III, and 7 type IV. Sac removal, crural repair, and antireflux procedures were performed (72 Nissen, 27 Collis-Nissen). The 30-day death rate was zero; there was one surgery-related death at 5 months from a perioperative stroke. Intraoperative complications included pneumothorax, esophageal perforation, and gastric perforation. There were three conversions to open surgery. Major postoperative complications included stroke, myocardial infarction, pulmonary emboli, adult respiratory distress syndrome, and repeat operations (two for abscess and one each for hematoma, repair leak, and recurrent hernia). Median length of stay was 2 days. Median follow-up at 12 months revealed resumption of proton pump inhibitors in 10 patients and one repeat operation for recurrence. The mean heartburn score was 2.3 (0, best; 45, worst); the satisfaction score was 91%; physical and mental component summary scores were 49 and 54, respectively (normal, 50). Conclusion This report represents the largest series to date of laparoscopic repair of giant PEH. In the authors’ center with extensive experience in minimally invasive surgery, laparoscopic repair of giant PEH was successfully performed in 97% of patients, with a minimal complication rate, a 2-day length of stay, and good intermediate results. PMID:10998659

  14. Enhanced visualization of the bile duct via parallel white light and indocyanine green fluorescence laparoscopic imaging

    NASA Astrophysics Data System (ADS)

    Demos, Stavros G.; Urayama, Shiro

    2014-03-01

    Despite best efforts, bile duct injury during laparoscopic cholecystectomy is a major potential complication. Precise detection method of extrahepatic bile duct during laparoscopic procedures would minimize the risk of injury. Towards this goal, we have developed a compact imaging instrumentation designed to enable simultaneous acquisition of conventional white color and NIR fluorescence endoscopic/laparoscopic imaging using ICG as contrast agent. The capabilities of this system, which offers optimized sensitivity and functionality, are demonstrated for the detection of the bile duct in an animal model. This design could also provide a low-cost real-time surgical navigation capability to enhance the efficacy of a variety of other image-guided minimally invasive procedures.

  15. 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

  16. Incidence and clinical characteristics of unexpected uterine sarcoma after hysterectomy and myomectomy for uterine fibroids: a retrospective study of 10,248 cases

    PubMed Central

    Zhao, Wan-Cheng; Bi, Fang-Fang; Li, Da; Yang, Qing

    2015-01-01

    Background Uterine fibroids often require a hysterectomy or myomectomy via laparotomy or laparoscopy. Morcellation is often necessary to perform a laparoscopic surgery. The objective of this study is to determine the incidence of unexpected uterine sarcomas (UUSs) after hysterectomy and myomectomy for uterine fibroids and to reduce the occurrence and avoid the morcellation of UUSs by analyzing their characteristics. Methods Women who had a hysterectomy or myomectomy for uterine fibroids in Shengjing Hospital of China Medical University between November 2008 and November 2014 were selected for the study, and their clinical characteristics were analyzed. Results During the period, 48 UUSs were found in 10,248 cases, and the overall incidence was 0.47%. There was no statistical difference (P=0.449) regarding the incidence (0.50% vs 0.33%) between 42 UUSs in 8,456 cases undergoing laparotomy and six UUSs in 1,792 cases undergoing laparoscopy. Most of the UUSs were stage I (89.58%), which occurred more commonly (56.25%) in women aged 40–49. Abnormal uterine bleeding (39.58%) was the main clinical manifestation. Rapidly growing pelvic masses (12.5%), rich blood flow signals (18.75%), and degeneration of uterine fibroids (18.75%) prompted by ultrasonography may suggest the possibility of UUSs. The margins of most UUSs (93.75%) were regular, which may cause UUSs to be misdiagnosed as uterine fibroids. Fifteen cases underwent magnetic resonance imaging examinations. Approximately 73.33% showed heterogeneous and hypointense signal intensity on T1-weighted images, and 80% showed intermediate-to-high signal intensity on T2-weighted images, with necrosis and hemorrhage in 40% of cases. After contrast administration, 80% presented early heterogeneous enhancement. Conclusion The incidence of UUSs after hysterectomy and myomectomy for uterine fibroids was low, and their clinical characteristics are atypical. It is necessary and very critical to make a complete and cautious preoperative evaluation to reduce the occurrence and avoid the morcellation of UUSs. PMID:26508879

  17. Single-port laparoscopic debulking surgery of variant benign metastatic leiomyomatosis with simultaneous lymphatic spreading and intraperitoneal seeding

    PubMed Central

    Chung, Yoo Hyun; Lee, Suk Woo; Shin, So Young; Rhim, Chae Chun; Im, Soyoung; Yoo, Sie Hyeon

    2015-01-01

    Benign metastatic leiomyomatosis (BML) is a rare disease characterized by smooth muscle cell proliferation in extrauterine sites including the lung, abdomen, pelvis, and retroperitoneum. Depending on location, BML is classified as intravenous leiomyomatosis and diffuse peritoneal leiomyomatosis. Pathogenesis of BML can be iatrogenic after previous myomectomy or hysterectomy, hormonal, or coelomic metaplasia. Treatment options are observation, hormonal suppression, and/or surgical debulking via laparotomy or laparoscopy. Laparoscopic surgery is gaining in popularity in the gynecologic field compared to laparotomic surgery and single-port laparoscopy has the benefits of cosmesis and early tissue extraction by transumbilical morcellation. We report a 39-year-old woman with BML who underwent single-port laparoscopy debulking surgery. PMID:26217603

  18. Laparoscopic approach to retrorectal cyst

    PubMed Central

    Gunkova, Petra; Martinek, Lubomir; Dostalik, Jan; Gunka, Igor; Vavra, Petr; Mazur, Miloslav

    2008-01-01

    Retrorectal cysts are rare benign lesions in the presacral space which are frequently diagnosed in middle-aged females. We report here our experience with two symptomatic female patients who were diagnosed as having a retrorectal cyst and managed using a laparoscopic approach. The two patients were misdiagnosed as having an ovarian cystic lesion after abdominal ultrasonography. Computer tomography (CT) scan was mandatory to establish the diagnosis. The trocar port site was the same in both patients. An additional left oophorectomy was done for a coexisting ovarian cystic lesion in one patient in the same setting. There was no postoperative morbidity or mortality and the two patients were discharged on the 5th and 6th post operative days, respectively. Our cases show that laparoscopic management of retrorectal cysts is a safe approach. It reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space. PMID:19030218

  19. Laparoscopic Excision of Retroperitoneal Schwannoma

    PubMed Central

    Rajkumar, J S; Anirudh, J R; Akbar, S; Kishore, C M

    2015-01-01

    Schwannomas are tumours that arise from the myelin sheath of the nerves. A very unusual location for schwannoma is the retro peritoneal areas (less than 2%). We present herewith a patient who had a 4x5cm Schwannoma arising from the nerve root of L2 on the right side, which presented as a lump in the psoas major muscle. This was treated by total laparoscopic excision after splitting open the psoas major. In the published english medical literature we could find only 16 cases of laparoscopic resection of retroperitoneal schwannoma and we believe ours to be the first case that was done through a psoas muscle split technique. Technical and histopathological details are discussed elaborately in this article. PMID:26676094

  20. Laparoscopic colon resection: a case report.

    PubMed

    Cooperman, A M; Katz, V; Zimmon, D; Botero, G

    1991-08-01

    The first case of a villous lesion of the colon removed by laparoscopic-guided surgery is reported. Injection of methylene blue into the lesion facilitated its access and exposure via the laparoscope. A very small skin incision allowed delivery onto the abdominal wall for resection and anastomoses. PMID:1834273

  1. IERS conventions

    NASA Astrophysics Data System (ADS)

    McCarthy, Dennis D.; Petit, Gerard

    2005-01-01

    The International Celestial Reference Frame (ICRF) is currently a radio reference frame accessed through VLBI that is refined with technique-dependent improvements described in this Joint Discussion. An important component of the International Celestial Reference System (ICRS) that is the basis for this frame is the set of conventional models and procedures that are used to define the system. The IERS Conventions Center provided jointly by the U.S. Naval Observatory (USNO) and the Bureau International des Poids et Mesures (BIPM) produces the IERS Conventions that contain the models and procedures needed to realize and access the ICRS. The key elements of the Conventions related to the ICRS are outlined and recent improvements are highlighted. Improvements in the IERS Conventions (models and procedures) should play a role by globally improving IERS products.

  2. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

    Montes, Sergio Fernández-Pello; Rodríguez, Ivan Gonzalez; Ugarteburu, Rodrigo Gil; Villamil, Luis Rodríguez; Mendez, Begoña Diaz; Gil, Patricio Suarez; Madera, Javier Mosquera

    2015-01-01

    AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy). CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications. PMID:25984519

  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. Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy

    PubMed Central

    Pieh-Holder, Kelly L.; DeVente, James E.

    2014-01-01

    Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function. PMID:25379314

  5. Sonographic diagnosis of ectopic pregnancy 2 years after total hysterectomy.

    PubMed

    Barhate, Kishor P; Domkundwar, Shilpa; Patil, Nirupama; Pai, Bhujang

    2009-01-01

    We report a case of a 35-year-old multigravida with a chief complaint of 8 days of mild pain in the lower abdomen with history of vaginal hysterectomy 2 years prior. Ultrasonography and MRI showed a gestational sac-like structure with a fetal pole in the pelvis. Urine pregnancy test was positive with increased beta-HCG levels. Diagnosis of ectopic pregnancy was made. Surgical exploration and subsequent histopathology confirmed the sonographic findings. PMID:19353551

  6. 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.

  7. [Hysterectomy to stop bleeding in obstetrics. Are there still indications for performing hysterectomy immediately post-partum? (author's transl)].

    PubMed

    Boisselier, P; Pigne, A; Jouhet, P; Treisser, A; Delubac, D; Barrat, J

    1981-01-01

    13 cases of hysterectomy carried out to stop bleeding immediately after delivery have been studied. Among these there were : 5 cases of placenta accreta which confirmed histologically. 4 cases of uterine inertia. 2 cases of failure of coagulation, one of which occurred after there had been a retro-placental haematoma and 2 ruptured uteri. After analysing the clinical circumstances surrounding these 13 cases and the technical details in carrying out hysterectomy on the gravid uterus, the authors studied conservative surgical measures that could be used to deal with post-partum uterine haemorrhage : the hypogastric arteries on the one hand the efferent arteries supplying the uterus on the other hand can be ligated. The technique for this last procedure is illustrated in one case. PMID:6976365

  8. A Qualitative Study of Women's Decisions Not to Have a Hysterectomy

    ERIC Educational Resources Information Center

    Fredericks, Erin

    2013-01-01

    In focusing on individual and physician demographics and system characteristics that lead to hysterectomy rate variations, researchers overlook the impact of culturally mediated meanings women assign to their bodies, hysterectomy, and other treatments. In this study I sought to provide a fuller description of this decision-making process by…

  9. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas

    PubMed Central

    Abdikarim, Ikram; Cao, Xue-Yuan; Li, Shou-Zhen; Zhao, Yin-Quan; Taupyk, Yerlan; Wang, Quan

    2015-01-01

    AIM: To study the efficacy of the enhanced recovery after surgery (ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas. METHODS: From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopic-assisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial. (Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed. RESULTS: The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group (n = 30), compared to the conventional group (n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group (6.8 ± 1.1 d) compared to the conventional group (7.7 ± 1.1 d) (P = 0.002). There was no significant difference in postoperative complications between the ERAS (1/30) and conventional care groups (2/31) (P = 1.00). There were no readmissions or mortality during the 30-d follow-up period. CONCLUSION: The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer. PMID:26715818

  10. Dexmedetomidine in Postoperative Analgesia in Patients Undergoing Hysterectomy

    PubMed Central

    Ren, Chunguang; Chi, Meiying; Zhang, Yanwei; Zhang, Zongwang; Qi, Feng; Liu, Zhong

    2015-01-01

    Abstract Both dexmedetomidine and sufentanil modulate spinal analgesia by different mechanisms, and yet no human studies are available on their combination for analgesia during the first 72 hours after abdominal hysterectomy. This CONSORT-prospective, randomized, double-blinded, controlled trial sought to evaluate the safety and efficacy of the combination of dexmedetomidine and sufentanil in intravenous patient-controlled analgesia (PCA) for 72 hours after abdominal hysterectomy. Ninety women undergoing total abdominal hysterectomy were divided into 3 equal groups that received sufentanil (Group C; 0.02??g/kg/h), sufentanil plus dexmedetomidine (Group D1; 0.02??g/kg/h, each), or sufentanil (0.02??g/kg/h) plus dexmedetomidine (0.05??g/kg/h) (Group D2) for 72 hours after surgery in this double-blinded, randomized study. The primary outcome measure was the postoperative sufentanil consumption, whereas the secondary outcome measures were pain intensity (visual analogue scale), requirement of narcotic drugs during the operation, level of sedation, Bruggrmann comfort scale, and concerning adverse effects. The postoperative sufentanil consumption was significantly lower in Groups D1 and D2 than in Group C during the observation period (P?hysterectomy during the first 72 hours after abdominal hysterectomy. PMID:26266386

  11. The association between occupational characteristics and hysterectomies for treating uterine fibroids in Taiwan.

    PubMed

    Ho, Ya-Lee; Hung, Chih-Jen; Lin, Che-Chen; Liu, Chwen-Chi; Li, Chu-Shiu; Kao, Chia-Hung

    2015-01-01

    This study examined the relationship between the occupational characteristics of women with uterine fibroids (UFs) and the decision to have a hysterectomy. Data from the Longitudinal Taiwan Health Insurance Database (LTHID) from 2000 to 2009 were analyzed to investigate the association between occupation and hysterectomies. Multivariable logistic regression analysis showed that, compared with white-collar UF patients, the odds ratio (OR) for hysterectomy surgery was 1.21 (95% confidence interval (CI) = 1.11-1.32) for blue-collar UF patients. Moreover, non-government employees with UFs also had significantly increased odds of having a hysterectomy compared to government employees with UFs (OR = 1.19, 95% CI = 1.04-1.36). This study provides information regarding the extent to which differences in occupation and decision-making processes might affect the marked variations in the use of hysterectomies for UFs. PMID:25531280

  12. Laparoscopic approach to Meckel's diverticulum

    PubMed Central

    Papparella, Alfonso; Nino, Fabiano; Noviello, Carmine; Marte, Antonio; Parmeggiani, Pio; Martino, Ascanio; Cobellis, Giovanni

    2014-01-01

    AIM: To retrospective review the laparoscopic management of Meckel Diverticulum (MD) in two Italian Pediatric Surgery Centers. METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted (TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years (range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was established based on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients’ demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed. RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min (range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d (range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years (range 10 mo-10 years). CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel’s diverticulectomy is safe and effective in the treatment of MD, with excellent results. PMID:25009390

  13. Clinical privileges for laparoscopic surgery.

    PubMed

    Albrink, M H; Rosemurgy, A S

    1993-06-01

    Laparoscopic cholecystectomy has undergone an explosive growth. Its benefits to patients--shortened recovery time and less pain--became immediately obvious. The procedure's development and adaptation have largely been devised and implemented by ingenious and creative private practitioners, not the typical mode of introduction. Most or many new procedures in the past evolved from academic institutions after laboratory and then clinical trials. With rapid development and acceptance has come an additional new burden among medical practitioners: credentialing and granting clinical privileges. PMID:8340775

  14. Role of sonography in assessing complications after laparoscopic cholecystectomy

    PubMed Central

    Starzy?ska, Teresa; Ko?aczyk, Katarzyna; K?adny, Józef

    2014-01-01

    Laparoscopic cholecystectomy, which was introduced to the arsenal of surgical procedures in the middle of the 1980s, is a common alternative for conventional cholecystectomy. Its primary advantage is less invasive character which entails shorter hospitalization and faster recovery. Nevertheless, the complications of both procedures are comparable and encompass multiple organs and tissues. The paper presents ultrasound presentation of the surgical bed after laparoscopic cholecystectomy and of complications associated with this procedure. In the first week following the surgery, the presence of up to 60 ml of fluid in the removed gallbladder bed should be considered normal in certain patients. The fluid will gradually absorb. In single cases, slight amounts of fluid are detected in the peritoneal cavity, which also should not be alarming. Carbon dioxide absorbs from the peritoneal cavity within two days. Ultrasound assessment of the surgical bed after cholecystectomy is inhibited by hemostatic material left during the surgery. Its presentation may mimic an abscess. In such cases, the decisive examination is magnetic resonance imaging but not computed tomography. On the other hand, rapidly accumulating fluid around the liver is an alarming symptom, particularly when there is inadequate blood supply or when peritoneum irritation symptoms develop. Depending on the suspected cause of the patient's deteriorating condition, it is essential to perform urgent computed tomography angiography, celiac angiography or endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography. The character of the fluid collection may be determined by its ultrasound-guided puncture. This procedure allows for aspiration of fluid and placement of a drain. Moreover, transabdominal ultrasound examination after laparoscopic cholecystectomy may contribute to the identification of: dropped stones in the right hypochondriac region, residual fragment of the gallbladder with possible concretions, undiagnosed choledocholithiasis, existing cholestasis, pseudoaneurysm of the hepatic artery, portal vein thrombosis and hematoma as well as hernias of the abdominal walls. Moreover, ultrasound examination helps to identify optimal sites in the abdominal integuments, which enables collision-free access to the peritoneal cavity.

  15. Single-incision laparoscopic surgery - current status and controversies

    PubMed Central

    Rao, Prashanth P; Rao, Pradeep P; Bhagwat, Sonali

    2011-01-01

    Scarless surgery is the Holy Grail of surgery and the very raison d’etre of Minimal Access Surgery was the reduction of scars and thereby pain and suffering of the patients. The work of Muhe and Mouret in the late 80s, paved the way for mainstream laparoscopic procedures and it rapidly became the method of choice for many intra-abdominal procedures. Single-incision laparoscopic surgery is a very exciting new modality in the field of minimal access surgery which works for further reducing the scars of standard laparoscopy and towards scarless surgery. Natural orifice translumenal endoscopic surgery (NOTES) was developed for scarless surgery, but did not gain popularity due to a variety of reasons. NOTES stands for natural orifice translumenal endoscopic surgery, a term coined by a consortium in 2005. NOTES remains a research technique with only a few clinical cases having been reported. The lack of success of NOTES seems to have spurred on the interest in single-incision laparoscopy as an eminently doable technique in the present with minimum visible scarring, rendering a ‘scarless’ effect. Laparo-endoscopic single-site surgery (LESS) is, a term coined by a multidisciplinary consortium in 2008 for single-incision laparoscopic surgery. These are complementary technologies with similar difficulties of access, lack of triangulation and inadequate instrumentation as of date. LESS seems to offer an advantage to surgeons with its familiar field of view and instruments similar to those used in conventional laparoscopy. LESS remains a evolving special technique used successfully in many a centre, but with a significant way to go before it becomes mainstream. It currently stands between standard laparoscopy and NOTES in the armamentarium of minimal access surgery. This article outlines the development of LESS giving an overview of all the techniques and devices available and likely to be available in the future. PMID:21197236

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

    PubMed Central

    Blanco, Felix C.; Kane, Timothy D.

    2012-01-01

    Single-incision laparoscopic surgery (SILS) is emerging as an alternative technique to conventional laparoscopy for the treatment of common surgical diseases. Despite its wide use, the adoption of SILS in children has been slower since the broad application of minimally invasive techniques in children, in general, has historically lagged behind those in adults. This paper reviews the evolution of SILS from its original conception and its application in the field of pediatric surgery. PMID:22778945

  17. Laparoscopic Anti-Reflux (GERD) Surgery

    MedlinePLUS

    ... Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon Surgery ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  18. Laparoscopic appendectomy in the elderly: our experience

    PubMed Central

    2013-01-01

    Background Laparoscopic appendectomy for acute appendicitis is one of the most common surgical procedures performed in the world. We aimed to compare laparoscopic and open appendectomy in the elderly in our experience. Methods We performed a retrospective review of elderly patients who underwent appendectomy for acute appendicitis from 1st of January 2006 to the 31st of July 2012. We analyzed 39 appendectomies in elderly patients: 20 procedures were performed using open technique (Group O) and 19 using laparoscopic technique (Group L). Results In the analysis of intraoperative variables there was no statistically significant difference. In this study there was no statistically significant difference also in peri-operative variables. Conclusion Laparoscopic appendectomy is a safe and feasible technique in acute appendicitis also in the elderly. PMID:24266893

  19. Laparoscopic Management of a Torted Appendix

    PubMed Central

    Rajendran, N; Ameen, S; Rohatgi, A

    2006-01-01

    Torted appendices are a rare occurrence but should be considered when encountering a haemorrhagic congested appendix on laparoscopy. As adhesions are rarely present, laparoscopic excision is usually a feasible option. PMID:17059706

  20. Single-incision bilateral laparoscopic oophorectomy

    PubMed Central

    Bhandarkar, Deepraj; Katara, Avinash; Deshmane, Vinay; Mittal, Gaurav; Udwadia, Tehemton E

    2011-01-01

    Although single-incision laparoscopic surgery made an appearance on the surgical scene only recently, it is being increasingly applied in the treatment of a variety of disorders. We report single-incision bilateral laparoscopic oophorectomy and salpingooophorectomy performed in two patients who had previously undergone breast conservation surgery for early breast cancer. Each procedure was undertaken using two 5-mm and one 3-mm ports inserted through a 2-cm transverse supraumbilical incision and standard laparoscopic instruments. The operative time was 50 and 65 min respectively and the blood loss negligible. The patients were discharged 36 and 24 h after surgery, required minimal postoperative analgesia and remain well at a follow up of 19 and 17 months, respectively. With the benefit of improved cosmesis, the single-incision approach holds the potential to replace the traditional bilateral laparoscopic oophorectomy. PMID:21197250

  1. Single-port laparoscopic cholecystectomy vs standard laparoscopic cholecystectomy: A non-randomized, age-matched single center trial

    PubMed Central

    van der Linden, Yoen TK; Bosscha, Koop; Prins, Hubert A; Lips, Daniel J

    2015-01-01

    AIM: To compare the safety of single-port laparoscopic cholecystectomies with standard four-port cholecystectomies. METHODS: Between January 2011 and December 2012 datas were gathered from 100 consecutive patients who received a single-port cholecystectomy. Patient baseline characteristics of all 100 single-port cholecystectomies were collected (body mass index, age, etc.) in a database. This group was compared with 100 age-matched patients who underwent a conventional laparoscopic cholecystectomy in the same period. Retrospectively, per- and postoperative data were added. The two groups were compared to each other using independent t-tests and ?2-tests, P values below 0.05 were considered significantly different. RESULTS: No differences were found between both groups regarding baseline characteristics. Operating time was significantly shorter in the total single-port group (42 min vs 62 min, P < 0.05); in procedures performed by surgeons the same trend was seen (45 min vs 59 min, P < 0.05). Peroperative complications between both groups were equal (3 in the single-port group vs 5 in the multiport group; P = 0.42). Although not significant less postoperative complications were seen in the single-port group compared with the multiport group (3 vs 9; P = 0.07). No statistically significant differences were found between both groups with regard to length of hospital stay, readmissions and mortality. CONCLUSION: Single-port laparoscopic cholecystectomy has the potential to be a safe technique with a low complication rate, short in-hospital stay and comparable operating time. Single-port cholecystectomy provides the patient an almost non-visible scar while preserving optimal quality of surgery. Further prospective studies are needed to prove the safety of the single-port technique. PMID:26328034

  2. Spontaneous uterine rupture in the 35th week of gestation after laparoscopic adenomyomectomy

    PubMed Central

    Nagao, Yukari; Osato, Kazuhiro; Kubo, Michiko; Kawamura, Takuya; Ikeda, Tomoaki; Yamawaki, Takaharu

    2016-01-01

    Uterine rupture rarely occurs during pregnancy, but it is a critical situation if so. It is already known that a history of uterine surgeries, such as cesarean section or myomectomy, is a risk factor for uterine rupture. Currently, the laparoscopic adenomyomectomy is a widely performed procedure, but associated risks have not been defined. We observed a case of spontaneous uterine rupture in a patient during the 35th week of gestation, after a laparoscopic adenomyomectomy. A 42-year-old, gravida 2, para 0 woman became pregnant after a laparoscopic adenomyomectomy and her pregnancy was conventional. At a scheduled date in the 35th week of gestation, after combined spinal epidural anesthesia and frequent uterine contractions, a weak pain suddenly ensued. After 13 minutes of uterine contractions, vaginal bleeding was evident. A cesarean section was performed, and the uterine rupture was found in the scar. After a laparoscopic adenomyomectomy, a pregnant uterus can easily rupture by rather weak and short uterine contractions, and is characterized by vaginal bleeding. When uterine bleeding is observed in pregnant women that have a history of adenomyomectomy, one should consider uterine rupture. PMID:26719729

  3. Laparoscopic sentinel lymph node mapping after cervical injection of indocyanine green for endometrial cancer – preliminary report

    PubMed Central

    Reinholz-Jaskolska, Malgorzata; Bidzinski, Mariusz

    2015-01-01

    Introduction Endometrial cancer (EC) has an increasing incidence worldwide, with lymph node metastases as the main prognostic factor. Systemic lymphadenectomy is connected with elevated morbidity. Sentinel lymph node (SLN) biopsy is intended to avoid extensive lymphadenectomy and provide significant oncologic information. Aim To evaluate the accuracy of laparoscopic SLN biopsy guided by indocyanine green (ICG) injection into the cervix in EC patients and to develop ideas to improve this method. The optimal time from dye injection to lymph node visualization was assessed. Material and methods This retrospective study was conducted between July 2014 and March 2015 in a group of 9 women with EC, at low and intermediate risk of recurrence, scheduled for total laparoscopic hysterectomy and pelvic lymphadenectomy. All patients underwent cervical ICG injection and SLN biopsy, followed by surgery. Pelvic lymph nodes were located using an ICG endoscopic camera. Results The following data were collected: There were 9 patients with endometrial cancer at low and intermediate risk of recurrence. Median patient age was 59 years, median body mass index (BMI) 28 kg/m2, endometrioid adenocarcinoma in 9 cases, grading: G1 – 1 patient, G2 – 8 patients. No intraoperative or postoperative complications were noted. Median time from ICG injection and SLN detection during surgery was 25 min. There were no lymph nodes metastasis, all identified by the SLN protocol using ICG injection. Conclusions Sentinel lymph node mapping can play a significant role in lymph node assessment and staging in early-stage EC patients with low risk of recurrence according to the ESMO classification. The use of SLN mapping in EC is much needed and the therapeutic benefit is high. PMID:26649087

  4. Laparoscopic Management of Renal Hydatid Cyst

    PubMed Central

    Bansal, Ankur

    2014-01-01

    Introduction: Renal involvement by hydatid disease is uncommon. The patients may be asymptomatic or present with flank pain, hematuria, and hypertension. Surgery is the mainstay of treatment, and options include cyst deroofing, partial nephrectomy, and total nephrectomy. We share our experience of laparoscopic management of 3 patients with large hydatid cysts of the kidney and review the literature. Case Description: Three patients with hydatid cysts of the kidney were treated at our institution between 2008 and 2010. In all 3 patients, hydatid disease involved the left kidney. One of the three cases also had concomitant liver involvement. Abdominal pain was the predominant symptom. A flank mass was palpable in 2 patients. The diagnosis was confirmed on abdominal ultrasonography and computed tomography in all 3 patients. Laparoscopic management was successfully completed in 2 patients. A large intrahepatic cyst in 1 patient prompted conversion to an open procedure. A special hydatid trocar-cannula system helps in eliminating the possibility of spillage from the cyst while puncturing and aspirating the cyst. Discussion: There are few reports on laparoscopic management of this uncommon disease of the kidney. In our series the laparoscopic management was attempted in all 3 cases. The procedures included laparoscopic aspiration of the cyst contents along with subtotal excision of the ectocyst in 2 patients and nephrectomy in 1 patient. The latter case had to be converted to an open procedure because of inaccessibility of the intrahepatic liver hydatid cyst. Laparoscopic management of renal hydatid cysts is feasible and safe. PMID:24960508

  5. The need for counselling of women who undergo hysterectomy: a feminist perspective.

    PubMed

    Le Cornu, J

    1999-06-01

    Many women have hysterectomies in Australia each year, yet the consequences of hysterectomy in women's lives are not well understood. Approximately 36,015 hysterectomies are performed annually in Australia (Australian Institute of Health and Welfare 1998). Recent nursing literature suggests that information regarding hysterectomy is inadequately discussed with the patient, and for whatever reason the patient has made the 'choice' to undergo hysterectomy, it appears little information or counselling is available to many women in this position. Many women view the uterus as their 'function' and with its removal, they may perceive that their femininity is challenged. Nursing literature is gathering momentum, and proposing a greater commitment from nurses to counsel in the gynaecological area (McQueen 1997). Nurses working in all specialities need to develop an awareness of how illness can impact upon the sexuality or sexual health of their client group, and be able to facilitate the provision of appropriate support (Palmer 1998). This paper will explore the symbolic themes of hysterectomy identified in Wood & Giddings' (1991) research, and will consider the reasons why women who undergo hysterectomy are not receiving sufficient information, counselling and follow-up. PMID:11096795

  6. [Anxiety-depressive disorder in women after hysterectomy. Own study].

    PubMed

    Jawor, M; Dimter, A; Marek, K; Dudek, D; Wojty?, A; Szproch, A

    2001-01-01

    Hysterectomy is a surgical procedure that significantly affects the quality in which the operated person views herself, lowers self-esteem and brings about changes in the quality of life. The results of the presented study show the necessity of a more accurate and specific dealing with the problem of affective disorders and anxiety states in women who have undergone such an operation. The course of the post-operative period and the return of the patients to full health are largely affected by their psychological state and the quality of life they experience. A successful (in a medical sense) surgical procedure is not a guarantee of the bringing back health in a holistic sense. The results of studies and clinical observations show that half of the group of women operated suffer from anxiety-depressive disorders as a cause of the operation, and a quarter of all those operated require specialist help. No psychological preparation for the operation, absence of closest people in the decision making before the operation, lack of knowledge on the surgical operational-span, lacking psychological aid after the operation--all these can significantly affect the rehabilitation and the process of regaining the social functions. It appears vital to introduce a psychological programme and special care taking of the women who declare having symptoms which appear to lead to the development of depressive disorders. The appearance of depressive symptoms post-operatively as well as the earlier presence of affective disorder symptoms can be prognostic in the further development of the disorder. The early diagnosis of the affective disorder and the higher level of anxiety in women post-hysterectomy and the fast application of appropriate treatment can inhibit further symptom elevation and persistence. Catamnestic studies on women post-hysterectomy due to non-oncologic causes will allow seeing the dynamics of the changes in the affective disorders at different time intervals from the operation. PMID:11842609

  7. Laparoscopic ventral hernia repair: a community hospital experience.

    PubMed

    Saiz, A A; Willis, I H; Paul, D K; Sivina, M

    1996-05-01

    From October 1993 to April 1994, laparoscopic ventral hernia repair was performed on 10 patients, all of whom had a history of failed ventral hernia repair and at least two prior ventral hernia repair procedures. Patients presented with complaints of abdominal discomfort, painful mass at the hernia site, or vague abdominal discomfort. No operative deaths occurred. Two patients had minor complications: a seroma at the repair site, which resolved spontaneously, and a superficial wound infection at a trochar site, which responded to an oral cephalosporin. Six patients were discharged within 24 hours of surgery and one patient was operated on as an outpatient and discharged the same day. Follow-up of all patients ranged from 10 to 17 months. No evidence of hernia recurrence has been noted. Some recurrent ventral hernias are amenable to laparoscopic repair, and this technique may be preferable in some patients, especially those who have had an earlier failed open repair with mesh. We do not advocate use of our technique for the first repair of a ventral hernia. Long-term follow-up is still needed to determine recurrence rates compared with conventional open techniques. PMID:8615557

  8. [The efficiency of lumbar transperitoneal laparoscopic sympathectomy--100 cases revue].

    PubMed

    Bâtc?, V; Jitea, N; Albita, O; Bîtc?, T; M?nuc, D

    2011-01-01

    Lumbar sympathectomy, classical surgical technique applied in conventional arteriopathy treatment, has acquired new valence by the development of laparoscopic technique. In a period of ten years (2000-2009), a number of 100 patients with different cause of arteriopathy have been operated by transperitoneal lumbar sympathectomy. Mean age was 62 years. Indication establishment has been achieved by an investigation protocol taking into account clinical and Para clinical criteria and methods. Postop evolution has been simple with very low morbidity and mortality zero. Particularly good evolution had patients in stages II and III of the disease, with missing effort claudication and repaos pain. Unfavourably results were recorded in advanced stages of disease, at diabetic patients with plenty of associated disease, therefore 9 patients suffering amputations of limbs. Results immediate and late were coordinated with stage and age of patients. Lumbar laparoscopic transperitoneal sympathectomy represents a viable alternative in artheriopathy treatment because of reduced morbidity--representing a chance for these very delicate patients. PMID:22165057

  9. Single-incision laparoscopic surgery for ingested foreign body removal.

    PubMed

    Yu, Hong; Wu, Shuodong; Yu, Xiaopeng; Zhang, Quan

    2014-03-01

    This report presents a 16-year-old adolescent boy with intentional ingestion of a 6-cm-length iron nail in detention center 6 hours ago. There was no symptom and sign of acute abdominal pain. Abdominal computed tomographic scan was performed, and an iron nail was found in the left upper quadrant abdomen. Considering the size, shape, and location of the foreign body, emergency surgery was performed using single-incision laparoscopic surgery approach. Multiple trocars in umbilical incision technique and conventional instruments were used. After identification of the foreign body in jejunum by alternative clamping of small bowel, enterostomy was made, and extracorporeal suturing was performed. The operation time was 1 hour without blood loss during the surgery. The patient left the bed 6 hours after the surgery. Bowel function recovered, and the gastric tube was removed on postoperative day 2. No painkiller was used after the surgery. The patient was discharged on postoperative day 3 without any complication. To our knowledge, it is the first report on removal of ingested foreign body located in jejunum using single-incision laparoscopic surgery technique. PMID:24211282

  10. 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

  11. Gallstone ileus after laparoscopic cholecystectomy

    PubMed Central

    Ivanov, I; Beuran, M; Venter, MD; Iftimie-Nastase, I; Smarandache, R; Popescu, B; Bostin?, R

    2012-01-01

    Gallstone ileus represents a rare complication (0,3-0,5%) of a serious, but common disease-gallstones, which affect around 10% of the population in the USA and Western Europe. Associated diseases (usually severe), elderly patients, delayed diagnosis and therapy due to late presentation to the hospital, account for the morbidity and mortality rates described in literature. We present the case of a patient with partial colon obstruction due to a large gallstone that was “lost” during an emergency laparoscopic cholecystectomy. The calculus eroded the intestinal wall, partially occluding the lumen, triggering recurrent Kerwsky-like, subocclusive episodes. The intraperitoneal abscess has spontaneously drained through the subhepatic drain and once the tube has been removed, a persistent intermittent fistula became obvious. PMID:23049640

  12. Minimally invasive colon resection (laparoscopic colectomy).

    PubMed

    Jacobs, M; Verdeja, J C; Goldstein, H S

    1991-09-01

    The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of the gastrointestinal (GI) tract. After gaining experience with various laparoscopic skills while performing clinical biliary tract surgery, appendectomy and then in a controlled animal laboratory, a pilot program for laparoscopic colonic surgery was initiated. Twenty patients with ages ranging from 43 to 88 years (mean age of 57 years) underwent laparoscope-assisted colon resection. In nine patients, a right hemicolectomy was performed and a sigmoid colectomy in eight. A low anterior resection, Hartman's procedure, and abdominal perineal resection were each performed in one patient. Indications for surgery were large villous adenomas or adenocarcinoma in 12, diverticular disease in 5, sigmoid endometrioma in 1, cecal volvulus in 1, and inflammatory bowel disease in 1. Eighty percent of patients were able to tolerate a liquid diet on the first postoperative day and 70% were discharged within 96 h eating a regular diet and having normal bowel movements. There were three operative complications: a 3 unit postoperative bleed managed without surgery, one patient developed marked edema of the rectosigmoid anastomosis requiring decompression with a rectal tube, and one individual with metastatic colon cancer was operated on for a mechanical small bowel obstruction 7 days after the initial laparoscopic surgery. Although laparoscope-assisted colonic surgery may still be considered a procedure in evolution, we feel that in time it has the potential to be as popular as laparoscopic cholecystectomy. PMID:1688289

  13. Minireview on laparoscopic hepatobiliary and pancreatic surgery

    PubMed Central

    Tan-Tam, Clara; Chung, Stephen W

    2014-01-01

    The first laparoscopic cholecystectomy was performed in the mid-1980s. Since then, laparoscopic surgery has continued to gain prominence in numerous fields, and has, in some fields, replaced open surgery as the preferred operative technique. The role of laparoscopy in staging cancer is controversial, with regards to gallbladder carcinoma, pancreatic carcinoma, hepatocellular carcinoma and liver metastasis from colorectal carcinoma, laparoscopy in conjunction with intraoperative ultrasound has prevented nontherapeutic operations, and facilitated therapeutic operations. Laparoscopic cholecystectomy is the preferred option in the management of gallbladder disease. Meta-analyses comparing laparoscopic to open distal pancreatectomy show that laparoscopic pancreatectomy is safe and efficacious in the management of benign and malignant disease, and have better patient outcomes. A pancreaticoduodenectomy is a more complex operation and the laparoscopic technique is not feasible for this operation at this time. Robotic assisted pancreaticoduodenectomy has been tried with limited success at this time, but with continuing advancement in this field, this operation would eventually be feasible. Liver resection remains to be the best management for hepatocellular carcinoma, cholangiocarcinoma and colorectal liver metastases. Systematic reviews and meta-analyses have shown that laparoscopic liver resections result in patients with equal or less blood loss and shorter hospital stays, as compared to open surgery. With improving equipment and technique, and the incorporation of robotic surgery, minimally invasive liver resection operative times will improve and be more efficacious. With the incorporation of robotic surgery into hepatobiliary surgery, donor hepatectomies have also been completed with success. The management of benign and malignant disease with minimally invasive hepatobiliary and pancreatic surgery is safe and efficacious. PMID:24634709

  14. 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. PMID:26150871

  15. Impact of Prior Abdominal Surgery on Rates of Conversion to Open Surgery and Short-Term Outcomes after Laparoscopic Surgery for Colorectal Cancer

    PubMed Central

    Kim, Ik Yong; Kim, Bo Ra; Kim, Young Wan

    2015-01-01

    Purpose To evaluate the impact of prior abdominal surgery (PAS) on rates of conversion to open surgery and short-term outcomes after laparoscopic surgery for colon and rectal cancers. Methods We compared three groups as follows: colon cancer patients with no PAS (n = 272), major PAS (n = 24), and minor PAS (n = 33), and rectal cancer patients with no PAS (n = 282), major PAS (n=16), and minor PAS (n = 26). Results In patients with colon and rectal cancers, the rate of conversion to open surgery was significantly higher in the major PAS group (25% and 25%) compared with the no PAS group (8.1% and 8.9%), while the conversion rate was similar between the no PAS and minor PAS groups (15.2% and 15.4%). The 30-day complication rate did not differ among the three groups (28.7% and 29.1% in the no PAS group, 29.2% and 25% in the major PAS group, and 27.3% and 26.9% in the minor PAS group). The mean operative time did not differ among the three groups (188 min and 227 min in the no PAS group, 191 min and 210 min in the major PAS group, and 192 min and 248 min in the minor PAS group). The rate of conversion to open surgery was significantly higher in patients with prior gastrectomy or colectomy compared with the no PAS group, while the conversion rate was similar between the no PAS group and patients with prior radical hysterectomy in patients with colon and rectal cancers. Conclusions Our results suggest that colorectal cancer patients with minor PAS or patients with prior radical hysterectomy can be effectively managed with a laparoscopic approach. In addition, laparoscopy can be selected as the primary surgical approach even in patients with major PAS (prior gastrectomy or colectomy) given the assumption of a higher conversion rate. PMID:26207637

  16. Clinical outcomes and ergonomics analysis of three laparoscopic techniques for Hirschsprung's disease

    PubMed Central

    Aubdoollah, Tajammool Hussein; Li, Kang; Zhang, Xi; Li, Shuai; Yang, Li; Lei, Hai-Yan; Dolo, Ponnie Robertlee; Xiang, Xian-Cai; Cao, Guo-Qing; Wang, Guo-Bin; Tang, Shao-Tao

    2015-01-01

    AIM: To report the clinical outcomes and ergonomics analysis of three laparoscopic approaches in the management of Hirschsprung’s disease (HD). METHODS: There were 90 pediatric patients (63 boys, 27 girls; mean age: 3.6 ± 2.7 mo; range: 1.0-90.2 mo) who underwent laparoscopic endorectal pull-through Soave procedures for short- and long-segment HD in our hospital. Three laparoscopic approaches were used: conventional laparoscopic pull-through (CLP) in 30 patients between 2009 and 2013, single-incision laparoscopic pull-through (SILP) in 28 patients between 2010 and 2013, and hybrid single-incision laparoscopic pull-through (H-SILP) in 32 patients between 2011 and 2013. We applied the hybrid version of the single-incision approach in 2011 to preserve the cosmetic advantage of SILP and the ergonomic advantage of CLP. We retrospectively analyzed the clinical data, cosmetic results, and ergonomics of these three approaches to have a better understanding of the selection of one approach over another. RESULTS: The CLP, SILP, and H-SILP groups were similar in regard to age, sex, transition zone, blood loss, hospital stay, and intraoperative complications. Early and late postoperative results were not different, with equal daily defecation frequency and postoperative complications. No conversion to open technique was needed and none of the patients had recurrent constipation. With proper training, the ergonomics challenges were overcome and similar operative times were registered for the general operative time in the patients < 1 year of age and the short-segment HD patients. However, significantly shorter operative times were registered compared to SILP for patients > 1 year of age (CLP and H-SILP: 120 ± 15 min and 119 ± 12 min, respectively, vs 140 ± 7 min; P < 0.05) and for long-segment HD patients (152 ± 3.5 min and 154 ± 3.6 min, respectively, vs 176 ± 2.3 min; P < 0.05). The best cosmetic result was registered with the SILP (scarless), followed by the H-SILP (near scarless appearance) and the CLP (visible scars) procedures. CONCLUSION: Based on the results, we believed that the laparoscopic approach should be selected according to the age, transition zone, and desired cosmetic result. PMID:26269680

  17. 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.

  18. Laparoscopic Colorectal Resection in Octogenarian Patients

    PubMed Central

    Xie, Minghao; Qin, Huabo; Luo, Qianxin; He, Xiaosheng; Lan, Ping; Lian, Lei

    2015-01-01

    Abstract The population older than 80 years has been increasing. A significant proportion of colorectal diseases that require colorectal resection occur in very elderly patients. However, the benefits of laparoscopy remain controversial in octogenarians. A systematic review and meta-analysis of observational study was performed to compare clinical outcomes between laparoscopic versus open colorectal resection in octogenarians. The PubMed, EMBASE, Ovid, Web of Science, and Cochrane databases from the years 1990 to 2015 were searched for studies that compare surgical outcomes between laparoscopic and open colorectal resection in octogenarians (?80 years old). Seven eligible studies including 528 laparoscopic and 484 open colorectal resections were identified. Laparoscopic approach was associated with lower rate of mortality (odds ratio [OR] 0.48, P?=?0.03), overall complications (OR 0.54, P?Laparoscopic colorectal resection is as safe as open approach, and the short-term outcomes appear to be more favorable in octogenarians. PMID:26496302

  19. Laparoscopic use of laser and monopolar electrocautery

    NASA Astrophysics Data System (ADS)

    Hunter, John G.

    1991-07-01

    Most general surgeons are familiar with monopolar electrocautery, but few are equally comfortable with laser dissection and coagulation. At courses across the country, surgeons are being introduced to laparoscopy and laser use in one and two day courses, and are certified from that day forward as laser laparoscopists. Some surgeons are told that laser and electrosurgery may be equally acceptable techniques for performance of laparoscopic surgery, but that a surgeon may double his patient volume by advertising 'laser laparoscopic cholecystectomy.' The sale of certain lasers has skyrocketed on the basis of such hype. The only surprise is that laparoscopic cholecystectomy complications occurring in this country seem to be more closely related to the laparoscopic access and visualization than to the choice of laser of electrocautery as the preferred instrument for thermal dissection. The purpose of this article is to: 1) Discuss the physics and tissue effects of electrosurgery and laser; 2) compare the design and safety of electrosurgical and laser delivery systems; and 3) present available data comparing laser and electrocautery application in laparoscopic cholecystectomy.

  20. Visual search behaviour during laparoscopic cadaveric procedures

    NASA Astrophysics Data System (ADS)

    Dong, Leng; Chen, Yan; Gale, Alastair G.; Rees, Benjamin; Maxwell-Armstrong, Charles

    2014-03-01

    Laparoscopic surgery provides a very complex example of medical image interpretation. The task entails: visually examining a display that portrays the laparoscopic procedure from a varying viewpoint; eye-hand coordination; complex 3D interpretation of the 2D display imagery; efficient and safe usage of appropriate surgical tools, as well as other factors. Training in laparoscopic surgery typically entails practice using surgical simulators. Another approach is to use cadavers. Viewing previously recorded laparoscopic operations is also a viable additional approach and to examine this a study was undertaken to determine what differences exist between where surgeons look during actual operations and where they look when simply viewing the same pre-recorded operations. It was hypothesised that there would be differences related to the different experimental conditions; however the relative nature of such differences was unknown. The visual search behaviour of two experienced surgeons was recorded as they performed three types of laparoscopic operations on a cadaver. The operations were also digitally recorded. Subsequently they viewed the recording of their operations, again whilst their eye movements were monitored. Differences were found in various eye movement parameters when the two surgeons performed the operations and where they looked when they simply watched the recordings of the operations. It is argued that this reflects the different perceptual motor skills pertinent to the different situations. The relevance of this for surgical training is explored.

  1. HandPort Laparoscopic Surgery-Review and Current Status.

    PubMed

    Goel, Amit

    2015-06-01

    HandPort laparoscopic surgery is a hybrid operation that allows the surgeon to introduce his nondominant hand into abdominal cavity through the port while maintaining pneumoperitoneum. It also helps to gain experience and expertise to learn advanced laparoscopic procedures. The common surgeries where HandPort is useful are laparoscopic splenectomy, colectomies, and donor nephrectomies. HandPort facilitates dissection and extraction of specimens. Hand in abdomen restores tactile sensation which is lacking in laparoscopic procedures. It reduces operative time, increases technical expertise of surgeon, and decreases blood loss. This article reviews the current status of HandPort laparoscopic surgery, the various HandPort devices, and their use. PMID:26246704

  2. Comparison of single port and three port laparoscopic splenectomy in patients with immune thrombocytopenic purpura: Clinical comparative study

    PubMed Central

    Barbaros, Umut; Aksakal, Nihat; Tukenmez, Mustafa; Agcaoglu, Orhan; Bostan, Mustafa Sami; Kilic, Berkay; Kalayci, Murat; Dinccag, Ahmet; Seven, Ridvan; Mercan, Selcuk

    2015-01-01

    AIM: Single-port laparoscopic surgery (SILS) has become increasingly popular during the last decades. This prospective study was undertaken to evaluate the feasibility of single-port laparoscopic splenectomy compared with conventional multiport laparoscopic splenectomy. MATERIALS AND METHODS: Between February 2, 2009 and August 29, 2011, a total of 40 patients with the diagnosis of immune thrombocytopenic purpura were included to study. Patients were alienated into two groups according to the procedure type including SILS and conventional multiport splenectomy. RESULTS: There were 19 patients in group 1, and 21 in group 2. Operative time was significantly shorter in group 1 versus group 2 (112.4 ± 13.56 vs 71.2 ±18.1 minutes, respectively, P < 0.05). One patient in group 1 had converted to laparatomy due to preoperative bleeding. Postoperative pain analyses (VAS Score) revealed superiority of SILS in the early post-operative days (P < 0.05). CONCLUSIONS: SILS splenectomy is a safe and effective alternative to standard laparoscopic splenectomy. PMID:26195874

  3. Ruptured hepatic subcapsular hematoma following laparoscopic cholecystectomy: report of a case.

    PubMed

    Shibuya, Kentaro; Midorikawa, Yutaka; Mushiake, Hiroyuki; Watanabe, Masato; Yamakawa, Tatsuo; Sugiyama, Yasuyuki

    2010-12-01

    Laparoscopic cholecystectomy is now a standard procedure for cholecystolithiasis because of its minimally invasive nature compared to the conventional method. However, severe complications that have never been seen for open surgery have also been reported. Here, we report the case of a 28-year-old woman who underwent laparoscopic cholecystectomy and then developed a ruptured subcapsular hematoma. On postoperative day 1, she developed shock, and postoperative bleeding was suspected. During re-operation, a ruptured subcapsular hematoma of the whole right lobe of the liver with active bleeding was found, and hemostasis was achieved. In this case, it was assumed that the rupture of the subcapsular hematoma was due to compression of the liver by the clamp for retrieving the spilled gallstones during the first operation and perioperative administration of nonsteroidal anti-inflammatory drugs. PMID:21248436

  4. Salpingectomy as standard at hysterectomy? A Danish cohort study, 1977–2010

    PubMed Central

    Guldberg, Rikke; Wehberg, Sonja; Skovlund, Charlotte Wessel; Mogensen, Ole; Lidegaard, Øjvind

    2013-01-01

    Objective To assess if the risk of first-time salpingectomy was affected by prior hysterectomy with retained fallopian tubes and by prior sterilisation. Design A historical cohort study. Setting Denmark. Participants 170?000 randomly selected women born 1947–1963 (10?000/year) were followed from 1977 until the end of 2010. Main outcome measures Effect of hysterectomy with retained fallopian tubes or sterilisation on the risk of salpingectomy. Both were modelled in a Cox proportional hazards model as time-dependent covariates, analysing time to first salpingectomy. End of follow-up period was 31 December 2010. Results Of 9591 hysterectomies, 6456 (67.3%) had both fallopian tubes retained. HRs for salpingectomy after hysterectomy with retained fallopian tubes and sterilisation were 2.13 (95% 1.88 to 2.42) and 2.42 (2.21 to 2.64), as compared with those for non-hysterectomised and non-sterilised women. Conclusions Women undergoing hysterectomy with retained fallopian tubes or sterilisation have at least a doubled risk of subsequent salpingectomy. Removal of the fallopian tubes at hysterectomy should therefore be recommended. PMID:23794553

  5. 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

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

    SciTech Connect

    Goldberg, Jay Bussard, Anne; McNeil, Jean; Diamond, James

    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.

  7. Laparoscopic ovariectomy in two standing llamas.

    PubMed

    King, M R; Hendrickson, D A; Southwood, L L; Trumble, T N; Johnson, L W

    1998-08-15

    Laparoscopic ovariectomy was performed in 2 llamas that were sedated but remained standing, avoiding possible complications associated with general anesthesia. All incisions were made in the left paralumbar fossa. The only intraoperative complications encountered were difficulty in maneuvering the laparoscope ventral to the uterine body in 1 llama because of distension of the urinary bladder, and a tendency to lean on the sidebar of the stocks in the other llama. The only postoperative complication was subcutaneous emphysema, which could be minimized by suctioning excess CO2 from the abdomen at completion of surgery. Laparoscopic ovariectomy was successful in these llamas and allowed direct examination and manipulation of the ovaries even though llamas were standing during surgery. PMID:9713537

  8. Laparoscopic surgery: A qualified systematic review

    PubMed Central

    Buia, Alexander; Stockhausen, Florian; Hanisch, Ernst

    2015-01-01

    AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields. METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria. RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications. CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures. PMID:26713285

  9. 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 ...

  10. Delayed intrahepatic subcapsular hematoma after laparoscopic cholecystectomy.

    PubMed

    de Castro, Steve M M; Reekers, Jim A; Dwars, Boudewijn J

    2012-01-01

    Intrahepatic subcapsular hematoma after laparoscopic cholecystectomy is a rare complication and is potentially life threatening. When radiologic studies confirm the presence of the hematoma, the decision to follow a conservative treatment should involve clinical monitoring. If there are signs of infection, the collection can safely be drained percutaneously. If there are signs of active bleeding, a selective embolization should be attempted first. If unsuccessful, subsequent surgical evacuation should be performed. We report the case of a patient with an intrahepatic subcapsular hematoma after laparoscopic cholecystectomy, which occurred 6 weeks after surgery, and review the literature concerning the management of these bleedings. PMID:22920379

  11. Current Trends in Laparoscopic Ventral Hernia Repair

    PubMed Central

    Patapis, Paul; Zavras, Nick; Tzanetis, Panagiotis; Machairas, Anastasios

    2015-01-01

    Background and Objectives: The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature. Database: A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair. Conclusions: LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. Incidental enterotomy can be avoided by using a meticulous technique and sharp dissection to avoid thermal injury. PMID:26273186

  12. Laparoscopic excision of infra-renal PEComa

    PubMed Central

    Bhanushali, Amol H; Dalvi, Abhay N; Bhanushali, Harikant S

    2015-01-01

    Perivascular epitheloid cell tumors (PEComas) are rare tumors of malignant potential. There is no normal cell variant to these cells. The family is large and includes angiomyolipoma, clear cell “sugar” tumor amongst others. Imaging modalities are not very diagnostic. The diagnosis hence is often postoperative. A 55-year old female presented to us with ultrasonographic diagnosis of solid mass in the right infrarenal region. Contrast-enhanced computerized sonography (CECT) suggested paraganglioma or a soft tissue retroperitoneal tumor. Laparoscopic excision was successful. The rarity of this pathology and laparoscopic modality of excision prompted us to publish this report.

  13. Laparoscopic Robot-Assisted Diaphragm Plication.

    PubMed

    Zwischenberger, Brittany A; Kister, Nathaniel; Zwischenberger, Joseph B; Martin, Jeremiah T

    2016-01-01

    Minimally invasive approaches to diaphragm plication for eventration include thoracoscopic and laparoscopic techniques. The elevated hemidiaphragm and ribs limit thoracoscopic techniques. We report our modification of the laparoscopic approach using robotic assistance with the da Vinci Surgical System, (Intuitive Surgical Inc, Sunnyvale, CA) to avoid single-lung ventilation, facilitate exposure, and allow more precise placement of plication sutures to achieve an even tension and maximum plication. Critical steps include creation of a small defect in the diaphragm to equalize pressures between cavities and placement of multiple, pledgeted interrupted horizontal mattresses. PMID:26694286

  14. [Laparoscopic and general surgery guided by open interventional magnetic resonance].

    PubMed

    Lauro, A; Gould, S W T; Cirocchi, R; Giustozzi, G; Darzi, A

    2004-10-01

    Interventional magnetic resonance (IMR) machines have produced unique opportunity for image-guided surgery. The open configuration design and fast pulse sequence allow virtual real time intraoperative scanning to monitor the progress of a procedure, with new images produced every 1.5 sec. This may give greater appreciation of anatomy, especially deep to the 2-dimensional laparoscopic image, and hence increase safety, reduce procedure magnitude and increase confidence in tumour resection surgery. The aim of this paper was to investigate the feasibility of performing IMR-image-guided general surgery, especially in neoplastic and laparoscopic field, reporting a single center -- St. Mary's Hospital (London, UK) -- experience. Procedures were carried out in a Signa 0.5 T General Elettric SP10 Interventional MR (General Electric Medical Systems, Milwaukee, WI, USA) with magnet-compatible instruments (titanium alloy instruments, plastic retractors and ultrasonic driven scalpel) and under general anesthesia. There were performed 10 excision biopsies of palpable benign breast tumors (on female patients), 3 excisions of skin sarcoma (dermatofibrosarcoma protuberans), 1 right hemicolectomy and 2 laparoscopic cholecystectomies. The breast lesions were localized with pre- and postcontrast (intravenous gadolinium DPTA) sagittal and axial fast multiplanar spoiled gradient recalled conventional Signa sequences; preoperative real time fast gradient recalled sequences were also obtained using the flashpoint tracking device. During right hemicolectomy intraoperative single shot fast spin echo (SSFSE) and fast spoiled gradient recalled (FSPGR) imaging of right colon were performed after installation of 150 cc of water or 1% gadolinium solution, respectively, through a Foley catheter; imaging was also obtained in an attempt to identify mesenteric lymph nodes intraoperatively. Concerning laparoscopic procedures, magnetic devices (insufflator, light source) were positioned outside scan room, the tubing and light head being passed through penetration panels. Intraoperative MR-cholangiography was performed using fast spin echo (SSFSE) techniques with minimal intensity projection 3-dimensional reconstruction. About skin sarcomas, 2 of them were skin recurrences of previously surgically treated sarcomas (all of them received preoperative biopsy) and the extent of the lesion was then determined using short tau inversion recovery (STIR) sequence. The skin was closed in each case without need for any plastic reconstruction. The breast lesions were visualized with both Signa and real-time imaging and all enhanced with contrast: 2 (20%) were visualized only after contrast enhancement; intraoperative real time imaging clearly demonstrated a resection margin in all cases. Maximum dimensions of breast specimens (range 8-50 mm, median 24.5 mm) were not significantly different from those measured by Signa (p>0.17, Student's paired t-test) or real time images (p>0.4): also there was no significant difference in lesion size between Signa and real time images (p>0.25). All postprocedure scans clearly demonstrated complete excision. The extent of the tumor at MR imaging was greater in each case than suggested by clinical examination. Adequate resection margins were planned using STIR sequences. Histological examination confirmed clear surgical margins of at least 1 cm in each case. During right hemicolectomy, both intraoperative SSFSE and FSPGR contrast imaging revealed the lesion and details of the colonic surface; imaging of the lymph node draining right colon was only partially successful, due to movement artifact. Concerning laparoscopic procedures, both FSE and SSFSE techniques produced reasonable images of the gallbladder and intrahepatic ducts, but the FSE imaging was of poor quality due to respiration artifact; however, SSFSE allowed visualization of the gallbladder and part of the common bile duct. About skin sarcomas, the extent of the tumor at MR imaging was greater in each case than suggested by clinical examination and in each case the com

  15. Laparoscopic revolution in bariatric surgery

    PubMed Central

    Sundbom, Magnus

    2014-01-01

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery. PMID:25386062

  16. Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial

    PubMed Central

    Roh, Ju-Won; Lee, Dong Ock; Lim, Myong Cheol; Seo, Sang-Soo; Chung, Jinsoo; Lee, Sun

    2015-01-01

    Objective A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. Methods From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. Results There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. Conclusion NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety. PMID:25872890

  17. Stump Cholecystitis: Laparoscopic Completion Cholecystectomy with Basic Laparoscopic Equipment in a Resource Poor Setting

    PubMed Central

    Cawich, Shamir O.; Simpson, Lindberg K.; Baker, Akil J.

    2014-01-01

    Introduction. Stump cholecystitis is a recognised condition in which a large gallbladder remnant becomes inflamed after subtotal cholecystectomy. When this occurs, a completion cholecystectomy is indicated. Traditionally, these patients were subjected to open surgery because the laparoscopic approach was anticipated to be technically difficult. We present a case of completion cholecystectomy using basic laparoscopic equipment in a resource poor setting to demonstrate that the laparoscopic approach is feasible. Case Description. A 57-year-old woman presented with right upper quadrant pain and vomiting. She had an elective open cholecystectomy seven years before but reported remarkably similar symptoms. Abdominal ultrasound suggested calculous acute cholecystitis. MRCP confirmed the presence of a large gallbladder remnant with stones. Gastroduodenoscopy excluded other differentials. She had an uneventful laparoscopic completion cholecystectomy performed. Discussion. Although traditional dogma suggested that a completion cholecystectomy should be performed through the open approach, several small studies have demonstrated that laparoscopic completion cholecystectomy is feasible and safe. This report adds to the existing data in support of the laparoscopic approach. PMID:25214849

  18. Surgery for endometrial cancers with suspected cervical involvement: is radical hysterectomy needed (a GOTIC study)?

    PubMed Central

    Takano, M; Ochi, H; Takei, Y; Miyamoto, M; Hasumi, Y; Kaneta, Y; Nakamura, K; Kurosaki, A; Satoh, T; Fujiwara, H; Nagao, S; Furuya, K; Yokota, H; Ito, K; Minegishi, T; Yoshikawa, H; Fujiwara, K; Suzuki, M

    2013-01-01

    Background: Radical hysterectomy is recommended for endometrial adenocarcinoma patients with suspected gross cervical involvement. However, the efficacy of operative procedure has not been confirmed. Methods: The patients with endometrial adenocarcinoma who had suspected gross cervical involvement and underwent hysterectomy between 1995 and 2009 at seven institutions were retrospectively analysed (Gynecologic Oncology Trial and Investigation Consortium of North Kanto: GOTIC-005). Primary endpoint was overall survival, and secondary endpoints were progression-free survival and adverse effects. Results: A total of 300 patients who underwent primary surgery were identified: 74 cases with radical hysterectomy (RH), 112 patients with modified radical hysterectomy (mRH), and 114 cases with simple hysterectomy (SH). Median age was 47 years, and median duration of follow-up was 47 months. There were no significant differences of age, performance status, body mass index, stage distribution, and adjuvant therapy among three groups. Multi-regression analysis revealed that age, grade, peritoneal cytology status, and lymph node involvement were identified as prognostic factors for OS; however, type of hysterectomy was not selected as independent prognostic factor for local recurrence-free survival, PFS, and OS. Additionally, patients treated with RH had longer operative time, higher rates of blood transfusion and severe urinary tract dysfunction. Conclusion: Type of hysterectomy was not identified as a prognostic factor in endometrial cancer patients with suspected gross cervical involvement. Perioperative and late adverse events were more frequent in patients treated with RH. The present study could not find any survival benefit from RH for endometrial cancer patients with suspected gross cervical involvement. Surgical treatment in these patients should be further evaluated in prospective clinical studies. PMID:24002604

  19. Laparoscopic surgery: A pioneer's point of view.

    PubMed

    Périssat, J

    1999-08-01

    For a surgeon who performed some of the first laparoscopic cholecystectomies, laparoscopic surgery is undoubtedly the main revolution in the last decade of this century. It is impossible not to be fascinated by the extraordinary changes introduced in our profession in less than 10 years. However, looking back in history, one realizes that laparoscopy is but one of those leaps forward that have always punctuated the evolution of our profession. Since the last century we have witnessed the advent of painless surgery, infectionless surgery, reconstructive surgery, microsurgery, surgery under extracorporeal circulation, organ replacement, and so on. We are in the time of scarless surgery, with no lengthy postoperative handicap. Maybe tomorrow will see surgery performed by remote-controlled robots and surgery at the molecule level. The laparoscopic revolution is particularly important because for the first time surgery no longer involves any physical contact between the surgeon's hand and the patient. Let us hope that this will not lead to total absence of a human relationship in the surgical operation. To avoid this possibility we must remain resolutely involved in the development of laparoscopic surgery; we must keep our minds open to the future advances of science and technology and integrate them in our operative procedures. PMID:10415213

  20. [Lymphangioma of the retroperitoneum treated laparoscopically].

    PubMed

    Skach, J; Chrenko, M; Hromádka, P

    2014-09-01

    A case report of a female patient with pathological liquid collection in the retroperitoneum with chronic and recurrent pain in the epigastric region and dyspepsia. After a safe laparoscopic approach and removal of a cystic tumour, the finding was histologically described as lymphangioma. PMID:25301348

  1. Augmented Reality Visualization for Laparoscopic Surgery

    E-print Network

    State, Andrei

    Augmented Reality Visualization for Laparoscopic Surgery Henry Fuchs1 , Mark A. Livingston1 Reality Augmented reality (AR) refers to systems that attempt to merge computer graphics and real imagery experience and hand-eye coordination for a surgeon to adjust to this disparity. 1.2 Benefits of Augmented

  2. Postoperative Immunosuppression After Open and Laparoscopic Liver Resection: Assessment of Cellular Immune Function and Monocytic HLA-DR Expression

    PubMed Central

    Haacke, Nadine; Meisel, Christian; Unterwalder, Nadine; Fikatas, Panagiotis; Schmidt, Sven C.

    2013-01-01

    Background and Objectives: Major abdominal procedures are strongly associated with postoperative immunosuppression and subsequent increased patient morbidity. It is believed that laparoscopic surgery causes less depletion of the systemic immune function because of the reduced tissue trauma. Various cytokines and monocytic HLA-DR expression have been successfully implemented to assess postoperative immune function. The aim of our study was to show the difference in immunologic profiles after minimally invasive versus conventional liver resection. Methods: Ten animals underwent either laparoscopic or conventional open left lateral liver resection. Flow cytometric characteristics of HLA-DR expression on monocytes and lipopolysaccharide-stimulated cellular secretion of tumor necrosis factor ?, interferon ?, interleukin 6, and interleukin 8 were measured and analyzed in ex vivo whole blood samples. Intraoperative and postoperative clinical outcome parameters were also documented and evaluated. Results: All animals survived the procedures. Postoperative complications were fever (n = 3), wound infections (n = 2), and biloma (n = 1). Open surgery showed a morbidity rate of 80% compared with 40% after laparoscopic surgery. Laparoscopic liver resection showed no postoperative immunoparalysis. Major histocompatibility complex class II expression in this group was elevated, whereas the open surgery group showed decreased major histocompatibility complex class II expression on postoperative day 1. Postoperative secretion of tumor necrosis factor ?, interleukin 6, and interferon ? was lower in the open surgery group. Elevated transaminase levels after laparoscopy might have resulted from an ischemia/reperfusion injury caused by the capnoperitoneum. Conclusion: Major immunoparalysis depression was not observed in either group. Laparoscopic surgery shows a tendency to improve immunologic recovery after liver resection. PMID:24398205

  3. Single-Port Laparoscopic Cholecystectomy for Gall Bladder Polyps

    PubMed Central

    Joong Choi, Chan; Kim, Min Chan; Choi, Hong Jo; Kim, Young Hoon; Jung, Ghap Joong

    2015-01-01

    Background and Objectives: Single-port laparoscopic cholecystectomy (SPLC) was introduced to improve patients' postoperative quality of life and cosmesis over the conventional approach (CLC). The purpose of this case–control study was to compare the outcome of SPLC with that of CLC in a specific disease: gall bladder (GB) polyps. Methods: Eligible for the study were all patients with GB polyps who underwent laparoscopic cholecystectomy between June 1, 2009, and June 30, 2011. The 112 patients studied (56 each for SPLC and CLC) were matched by using a propensity score that included gender, age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, history of previous abdominal operation, and pathology outcome. To avoid selection bias caused by the surgeon's choice (often dependent on the degree of inflammation) and to investigate the efficacy of SPLC for a single disease, GB polyps, we excluded patients with acute or chronic cholecystitis. Results: Characteristics of the patients matched by a propensity score between SPLC and CLC showed no significant difference. Incidentally detected malignancy was in postoperative pathology in cases in both groups. Although operative time was shorter for SPLC, there was no significant difference in time between the 2 groups. There were 3 open conversions in the CLC group, and an additional port was used in the SPLC group. There was no difference between the groups in hospital stay and postoperative complications. Conclusion: In the management of GB polyps, the operative results of SPLC are comparable to those of CLC. We conclude that SPLC is as safe as CLC and has the potential for greater cosmetic satisfaction for patients than CLC. Further trials for objective appraisal of cosmetic outcomes are needed. PMID:26229419

  4. Laparoscopic Pyeloplasty in the Animal Model

    PubMed Central

    Elashry, Osama M.; Clayman, Ralph V.; Humphrey, Peter A.; Rayah, Heidi J.

    1997-01-01

    Purpose: Laparoscopic pyeloplasty has been associated with long operative times. This study proposed to evaluate the feasibility of two different laparoscopic techniques for the performance of pyeloplasty repair of secondary ureteropelvic junction (UPJ) obstruction. Materials and Methods: Sixteen female Yucatan mini-pigs underwent general anesthesia for cystoscopy, retrograde pyelography, urine culture and a baseline renal scan. Unilateral UPJ obstruction was created by ligating the UPJ over a 5F catheter. Six weeks later a laparoscopic pyeloplasty was performed utilizing an intracorporeal suturing technique and the Lapra-Ty suture clip or the Endostitch device with intracorporeal knot tying. Four control animals underwent only cystoscopy and in/out ureteral catheterization. In the study animals the ureteral stent was maintained for six weeks and at six weeks, three months and six months post-pyeloplasty the animals underwent the previously mentioned studies. At six months post-pyeloplasty the animals were euthanized and the UPJ was calibrated. Histopathology was obtained on the ureter below the anastomosis, at the anastomosis, above the anastomosis and on a renal biopsy. Results: All planned laparoscopic pyeloplasties were completed. However, the stricture model was too severe in that most animals developed 40-45% decrease in renal function in the kidney following ipsilateral UPJ ligation. There was no significant difference between the two pyeloplasty techniques with respect to operative time to perform the pyeloplasty (mean of 40 minutes), post-pyeloplasty ureteral caliber (7.5-8.0 F), serum creatinine or healing scores at, above or below the anastomosis. Conclusion: Laparoscopic pyeloplasty can be performed equally successfully with the Endostitch device and intracorporeal knot tying or with the intracorporeal suturing technique and Lapra-Ty clips. The resultant pyeloplasty is also equivalent for the two techniques. PMID:9876657

  5. 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

  6. A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis.

    PubMed

    Takiguchi, Shuji; Sekimoto, Mitsugu; Fujiwara, Yoshiyuki; Miyata, Hiroshi; Yasuda, Takushi; Doki, Yuichiro; Yano, Masahiko; Monden, Morito

    2005-01-01

    An esophagojejunostomy using a circular stapler requires the fixing of an anvil at the esophageal stump. When this placement procedure is laparoscopically performed, purse-string suturing is difficult, and there is a risk of loosening when a conventional needle driver is used. We herein present a simple but effective technique for performing laparoscopic purse-string suturing of the esophageal stump using a semiautomatic suturing device called the Endostitch. Gastrointestinal anvil placement was laparoscopically performed for 10 patients who underwent an esophagojejunostomy following a total gastrectomy. After the lumen of the esophagus was expanded using bowel forceps, the Endostitch was used to place approximately 12 encircling purse-string sutures. An anvil was positioned with support of the esophageal wall at three points with forceps. The Endostitch was used for the ligation with a sufficient degree of tension applied by extracorporeally pulling the sutures through the abdominal wall. The time for placement of the anvil averaged approximately 8 min. The ring formation following anastomosis was favorable in all patients. As a result, we consider our technique to be simple but very effective. PMID:16175476

  7. Intestinal Obstruction After Totally Extraperitoneal Laparoscopic Inguinal Hernia Repair

    PubMed Central

    Rink, Joanne

    2004-01-01

    Laparoscopic hernia repair is a frequently performed operation. Although it has many advantages over open inguinal hernia repair, laparoscopic surgery is not without complications. Small bowel obstruction is a complication unique to laparoscopic repair of inguinal hernias. It is reported following transabdominal preperitoneal repairs. We present a case of small bowel incarceration through a peritoneal defect after a totally extraperitoneal inguinal hernia repair. Techniques to avoid this complication are presented. The literature is reviewed. PMID:14974673

  8. 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

  9. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study

    PubMed Central

    Badheka, Jigisha Prahladrai; Jadliwala, Rashida Mohammedi; Chhaya, Vrajeshchandra Amrishbhi; Parmar, Vandana Surendrabhai; Vasani, Amit; Rajyaguru, Ajay Maganlal

    2015-01-01

    BACKGROUND: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries. MATERIALS AND METHODS: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel) in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT) in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. RESULTS: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. CONCLUSION: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries.

  10. 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.

  11. Four zoom lens design for 3D laparoscope by using liquid lens

    NASA Astrophysics Data System (ADS)

    Lee, Seungwan; Choi, Minseog; Lee, Eunsung; Jung, Kyu-Dong; Chang, Jong-Hyeon; Kim, Woonbae

    2012-10-01

    Laparoscopic lens module that is capable of zooming is presented. The lens module has a high magnification and a high resolution such as four zoom and 2M pixels full HD image. The lens module consists of two lens sets to get 3-D images. Each lens module has several lenses less than conventional laparoscope but has 8 lenses and two liquid lenses. The total length of module is 19 mm long and the diameter is less than 5 mm. The separated distance of two lens center is 5 mm and two lens modules are inserted into the 11mm diameter laparoscope. The lens module is designed by Code V™ by using the 2M pixels CMOS sensor that the pixel size is 1.75 ?m. The merit of this fluidic lens design is being convertible between a convex and concave shape. The effective focal length of zoom-out and zoom-in modes is 3.24 mm and 12.94 mm respectively. The modulation transfer function of zoom-out and zoom-in modes is 40% and 30% at 140 lp/mm frequency. We have a diffraction of element at near stop to improve image resolution. Also the resolution of zoom-in mode is improved by using liquid iris. The F-number of a two modes is 4.4 and 5.8 and the optical distortion is 10% and 0.5%. It is expected that the z-direction resolution by this laparoscope is less than 2 mm

  12. [Laparoscopic cholecystectomy: 100 consecutive cases without postoperative morbidity].

    PubMed

    Klaiber, C; Metzger, A; Leepin, H; Saager, C

    1991-06-15

    100 consecutive patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. We report our results and the management of choledocholithiasis. In two cases the laparoscopic procedure had to be converted into open cholecystectomy due to bleeding. There were no complications postoperatively. The results show that laparoscopic cholecystectomy is a safe procedure with real benefits. The main advantages are greater comfort for the patient, better cosmetic results, shortening of hospital stay and earlier return to full activity. We feel that, with a proper indication, laparoscopic removal of the gallbladder will establish itself as the procedure of choice in stone disease. PMID:1830401

  13. Laparoscopic assisted total gastrectomy for gastric cancer – operative technique

    PubMed Central

    Salih, Abdelmonim; Kazanowski, Michal; Walsh, Thomas N.

    2015-01-01

    For many years, open gastrectomy with lymphadenectomy was the gold standard treatment for gastric cancer. In recent years, however, laparoscopic assisted total gastrectomy with associated D2 lymphadenectomy has gained in popularity. It has a similar oncological outcome to open resection, but has all of the added advantages of a laparoscopic procedure, such as early mobilisation, less postoperative pain and shorter hospital stay. This article describes the operative techniques, including key procedure steps, as well as a guide for using the new OrVil device for the laparoscopic creation of the oesophago-jejunal anastomosis. A video of a laparoscopic assisted total gastrectomy is presented. PMID:25960805

  14. 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

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

    PubMed

    Pinto, Marco Aurélio Lameirão; Andrade, Raphael Fernando Costa Gomes de; Silva, Luiz Gustavo de Oliveira E; Pinto, Marco Aurélio de Lacerda; Muharre, Roberto Jamil; Leal, Ricardo Ary

    2015-10-01

    The authors describe a surgical technique which allows, without increasing costs, to perform laparoscopic cholecystectomy with a single incision, without using specific materials and with better surgical ergonomics. The technique consists of a longitudinal umbilical incision, navel detachment, use of a permanent 10mm trocar and two clamps directly and bilaterally through the aponeurosis without the use of 5mm trocars, transcutaneous gallbladder repair with straight needle cotton suture, ligation with unabsorbable suture and umbilical incision for the specimen extraction. The presented technique enables the procedure with conventional and permanent materials, improving surgical ergonomics, with safety and aesthetic advantages. PMID:26648153

  16. Impact of a lung-protective ventilatory strategy on systemic and pulmonary inflammatory responses during laparoscopic surgery: is it really helpful?

    PubMed

    Kokulu, Serdar; Günay, Ersin; Baki, Elif Do?an; Ulasli, Sevinc Sarinc; Yilmazer, Mehmet; Koca, Bu?ra; Ar?öz, Dagistan Tolga; Ela, Yüksel; Sivaci, Remziye Gül

    2015-02-01

    Laparoscopic surgery is performed by carbon dioxide (CO2) insufflation, but this may induce stress responses. The aim of this study is to compare the level of inflammatory mediators in patients receiving low tidal volume (VT) versus traditional VT during gynecological laparoscopic surgery. Forty American Society of Anesthesiologists (ASA) physical status 1 and 2 subjects older than 18 years old undergoing laparoscopic gynecological surgery were included. Systemic inflammatory response was assessed with serum IL-6, TNF-alpha, IL-8, and IL-1? in patients receiving intraoperative low VT and traditional VT during laparoscopic surgery [within the first 5 min after endotracheal intubation (T1), 60 min after the initiation of mechanical ventilation (T2), and in the postanesthesia care unit 30 min after tracheal extubation (T3)]. Additionally, inflammatory response was assessed with bronchoalveolar lavage (BAL) at T1 and T3 periods. An increase in the serum levels of IL-6, TNF-alpha, IL-8, and IL-1? was observed in both groups during the time periods of T1, T2, and T3. No significant differences were found in the serum and BAL levels of inflammatory mediators during time periods between groups. The results of the present study suggested that the lung-protective ventilation and traditional strategies are not different in terms of lung injury and inflammatory response during conventional laparoscopic gynecological surgery. PMID:25280837

  17. Laparoscopic cholecystectomy using 2-mm instruments.

    PubMed

    Uranüs, S; Peng, Z; Kronberger, L; Pfeifer, J; Salehi, B

    1998-10-01

    Today, laparoscopic cholecystectomy is the method of choice for treatment of symptomatic gallbladder disorders. It minimizes effects of the operation that are independent of the gallbladder, such as trauma to the abdominal wall and other soft tissue. The surgical wounds were even smaller when 2-mm trocars were used. Laparoscopic cholecystectomy using 2-mm instruments was performed in a consecutive series of 14 patients with symptomatic gallstones. The procedure was completed in 12 cases, with conversion to open surgery in two cases. Intraoperative cholangiography was always performed. The postoperative course was always uneventful. The cosmetic effect was highly satisfactory. The procedure using 2-mm instruments could be indicated in selected patients with uncomplicated gallstone disease. PMID:9820716

  18. Laparoscopic Management of a Complex Adrenal Cyst

    PubMed Central

    Kodama, Koichi; Takase, Yasukazu; Niikura, Susumu; Shimizu, Akiko; Tatsu, Hiroki; Saito, Katsuhiko

    2015-01-01

    Adrenal cysts are rare, and their clinical management remains controversial. We report a case involving an adrenal cyst with a complicated appearance on radiological studies. Unenhanced computed tomography revealed a unilocular, noncalcified, hypoattenuating mass with a thin wall in the left adrenal gland. The lesion gradually increased in size from 10 to 50?mm at two-year follow-up. On contrast-enhanced magnetic resonance imaging, a mural nodule with contrast enhancement was observed. The entire adrenal gland was excised en bloc via a lateral transperitoneal laparoscopic approach without violating the principles of surgical oncology. The pathological diagnosis was an adrenal pseudocyst. Laparoscopic adrenalectomy is a safe option for the treatment of complex adrenal cysts, while maintaining the benefits of minimal invasiveness. PMID:26634170

  19. Laparoscopic surgery for left paraduodenal hernia.

    PubMed

    Fukunaga, Masaki; Kidokoro, Akio; Iba, Toshiaki; Sugiyama, Kazuyoshi; Fukunaga, Tetsu; Nagakari, Kunihiko; Suda, Masaru; Yosikawa, Seiichirou

    2004-04-01

    Paraduodenal hernia is a rare condition but the most common internal hernia. We describe the case of a 51-year-old man who was admitted with a complaint of 2 months' duration of recurrent left lower abdominal pain. Left paraduodenal hernia complicated by bowel malrotation was diagnosed, and the patient underwent laparoscopic surgery since no bowel necrosis was observed. The bowel incarcerated in the hernial sac was reduced, and an Endostitch was used to close the hernial orifice with continuous sutures. The postoperative course was good, and the patient was discharged 7 days after surgery. For paraduodenal hernia without bowel necrosis, particularly a left hernia, reduction of the incarcerated bowel and closure of the hernial orifice are relatively easy in terms of technique, and laparoscopic surgery may be the surgical method of choice because of its minimal invasiveness and aesthetic advantage. PMID:15107222

  20. Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy

    PubMed Central

    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

  1. Laparoscopic Resection of Symptomatic Gastric Diverticula

    PubMed Central

    Zelisko, Andrea; Rodriguez, John; El-Hayek, Kevin

    2014-01-01

    Gastric diverticula are rare and usually asymptomatic. This report, however, describes two examples of symptomatic gastric diverticula successfully treated by laparoscopic resection. Both patients were male and in their sixth decade of life. One patient was relatively healthy with no past medical history, whereas the other patient had chronic pain issues and at presentation was also undergoing evaluation for hyperaldosteronism. The patients presented with gastrointestinal symptoms, including nausea, emesis, abdominal pain, and change in bowel function. In both cases, a gastric diverticulum was identified by CT scan, and precise anatomic position was determined by upper endoscopy. After discussion with the treating teams, including a gastroenterologist and surgeon, surgical treatment and resection was elected. Successful laparoscopic removal was accomplished in both patients, and they were discharged home after tolerating liquid diets. Both patients reported resolution of their abdominal symptoms at follow-up. PMID:24680154

  2. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status

    PubMed Central

    Ntourakis, Dimitrios; Mavrogenis, Georgios

    2015-01-01

    AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors. METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach. RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described. CONCLUSION: Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures. PMID:26604655

  3. Advances in Laparoscopic Skills Training and Management.

    PubMed

    Fransson, Boel A

    2016-01-01

    Veterinarians interested in adding minimally invasive surgery (MIS) to their surgical repertoire need a distinct set of skills. These MIS skills do not transfer from open surgery; they require specific training. Training based solely on practice in live patients becomes limited and inconsistent. In addition, ethical and cost issues arise when advanced procedures are practiced in live patients. This article discusses the Veterinary Applied Laparoscopic Training program, which provides simulation-based training for MIS. PMID:26396055

  4. Core value of laparoscopic colorectal surgery.

    PubMed

    Li, Xin-Xiang; Wang, Ren-Jie

    2015-12-10

    Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor's radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future. PMID:26676111

  5. Laparoscopic and robotic surgical training in urology.

    PubMed

    Hoznek, András; Katz, Ran; Gettman, Matthew; Salomon, Laurent; Antiphon, Patrick; de la Taille, Alexandre; Yiou, René; Chopin, Dominique; Abbou, Clément-Claude

    2003-04-01

    The most important change in urology during the past decade was the development of minimally invasive surgery, particularly laparoscopy. However, the main drawback of laparoscopy is a steep learning curve, which results from the significant changes in the surgical environment. Although laparoscopy can provide important advantages for the patient, including decreased length of hospitalization, decreased analgesic requirement, and a shortened postoperative convalescence, one concern has been whether laparoscopic techniques should be learned solely in the operating room. For example, sports, music, and aviation are practiced before an actual performance is ever undertaken. In this review, the advantages and limitations of all available training modalities in minimally invasive surgery are described. Testing basic laparoscopic skills on inanimate models, becoming familiar with the principles of dissection and hemostasis on living animals, and studying surgical anatomy on cadavers should be considered as indispensable and complementary elements for laparoscopic training in the future. In addition, telementoring with the help of modern image processing and virtual reality eventually may become the basis of tomorrow's surgical instruction. PMID:12648430

  6. Laparoscopic treatment of congenital choledochal cyst.

    PubMed

    Shimura, H; Tanaka, M; Shimizu, S; Mizumoto, K

    1998-10-01

    We describe the laparoscopic treatment of a patient presenting with congenital choledochal cyst. Our patient was a 19-year-old man with a complaint of recurrent abdominal pain due to pancreatitis. The choledochal cyst was type I and had a common channel of pancreatobiliary duct, as revealed by endoscopic retrograde cholangiopancreatography. Under laparoscopic guidance, the dilated bile duct and the gallbladder were excised, and a Roux-en-Y anastomosis was constructed with an endo-EEA. Finally, end-to-side anastomosis was carried out by the continuous suture method, aided by an Endostitch between the stump of the hepatic duct and the Roux-en-Y limb. After the operation, slight hyperamylasemia was observed for several days but further treatment was not necessary. Postoperative symptoms were minimal, and the patient was discharged on the 11th day after the procedure. Although it is difficult and time-consuming, laparoscopic operation is highly beneficial for the patient. The use of such instruments as the endostapler and Endostitch may help to simplify this complex intracorporeal procedure involving division and anastomosis of the digestive tract. PMID:9745070

  7. Core value of laparoscopic colorectal surgery

    PubMed Central

    Li, Xin-Xiang; Wang, Ren-Jie

    2015-01-01

    Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor’s radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future. PMID:26676111

  8. Who is doing laparoscopic appendicectomies and who taught them?

    PubMed Central

    Noble, H.; Gallagher, P.; Campbell, W. B.

    2003-01-01

    BACKGROUND: Laparoscopic appendicectomy offers potential advantages, but its use seems variable and perhaps related to the enthusiasm of individual trainees. There is limited opportunity in many hospitals for consultants to do and teach laparoscopic appendicectomy because of the way emergency work is organised. METHODS: This study investigated the use and teaching of laparoscopic appendicectomy in two health regions, by a questionnaire sent to all specialist registrars (SpRs) in general surgery and completed by 78% (56 of 72). RESULTS: Of the responding SpRs, 43% had performed a laparoscopic appendicectomy (with an average of 2.5 supervised by a consultant and 7.5 with a more junior assistant). Of these, 92% had been taught by a consultant, but only 31% (33 of 108) of the consultants for whom they were currently working had done appendicectomy laparoscopically, and laparoscopic appendicectomy was only being performed on 14% of the SpRs current firms (47% with upper gastrointestinal and 40% with colorectal specialist interest). Some 5-30% of patients on those firms were treated laparoscopically, mostly at the preference of the SpR. CONCLUSIONS: Dedicated consultant time for emergencies would facilitate teaching of laparoscopic appendicectomy but theatre time, costs of disposable instruments, and the inexperience of many consultants in this operation are likely to continue limiting its use. Further debate is needed on its place in the treatment of appendicitis. PMID:14594538

  9. Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments

    PubMed Central

    Hatipoglu, Sinan; Akbulut, Sami; Hatipoglu, Filiz; Abdullayev, Ruslan

    2014-01-01

    With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC. PMID:25561784

  10. EYE MOVEMENTS IN A VIRTUAL LAPAROSCOPIC TRAINING ENVIRONMENT

    E-print Network

    Atkins, M. Stella

    are a promising alternative to traditional surgery training methods es- pecially in minimally-invasive proceduresEYE MOVEMENTS IN A VIRTUAL LAPAROSCOPIC TRAINING ENVIRONMENT by Benjamin Law B.Math, University of thesis: Eye Movements in a Virtual Laparoscopic Training Environment Examining Committee: Dr. John Dill

  11. Visual Tracking of Laparoscopic Instruments in Standard Training

    E-print Network

    Faloutsos, Petros

    Surgery, Surgery Training, Machine Vision Introduction Laparoscopic surgery is the most common and widelyVisual Tracking of Laparoscopic Instruments in Standard Training Environments Brian F. ALLEN, University of California, Los Angeles b Department of Surgery, University of California, Los Angeles Abstract

  12. Laparoscopic vs mini-incision open appendectomy

    PubMed Central

    Çiftçi, Fatih

    2015-01-01

    AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre. METHODS: The data of patients who underwent appendectomy between January 2011 and June 2013 were collected. The data included patients’ demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale of pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded. Patients with surgery converted from laparoscopic appendectomy (LA) to mini-incision open appendectomy (MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physical examination, laboratory values, and radiological tests (abdominal ultrasound or computed tomography). All operations were performed with general anaesthesia. The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients. RESULTS: Of the 243 patients, 121 (49.9%) underwent MOA, while 122 (50.1%) had laparoscopic appendectomy. There were no significant differences in operation time between the two groups (P = 0.844), whereas the visual analog scale of pain was significantly higher in the open appendectomy group at the 1st hour (P = 0.001), 6th hour (P = 0.001), and 12th hour (P = 0.027). The need for analgesic medication was significantly higher in the MOA group (P = 0.001). There were no differences between the two groups in terms of morbidity rate (P = 0.599). The rate of total complications was similar between the two groups (6.5% in LA vs 7.4% in OA, P = 0.599). All wound infections were treated non-surgically. Six out of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient required surgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain. CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients. PMID:26525039

  13. Full robotic assistance for laparoscopic tubal anastomosis: a case report.

    PubMed

    Falcone, T; Goldberg, J; Garcia-Ruiz, A; Margossian, H; Stevens, L

    1999-02-01

    Optical magnification and long instrumentation significantly increase surgical tremor, which makes laparoscopic microsuturing difficult. Therefore, laparoscopic tubal anastomosis has not gained wide acceptance among gynecologic surgeons. Robotic assistance facilitates this type of procedure by filtering tremor, reducing the surgeon's fatigue, and scaling the maneuvers. The authors have successfully completed a case of laparoscopic tubal reanastomosis using a "master-slave" robot to perform the standard microsuturing technique. A 33-year-old woman, gravida 2, para 2, requested reversal of her previous tubal ligature. A right isthmic-isthmic tubal anastomosis was performed laparoscopically, with faithful adherence to the authors' standard technique applied at laparotomy. Full robotic assistance was used to anastomose the tube. A chromotubation test showed anastomotic patency without leak. The patient recovered uneventfully after surgery and was discharged within 24 h after the procedure. Laparoscopic microsurgical tubal anastomosis with full robotic assistance is feasible and safe in humans. PMID:10194702

  14. Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy.

    PubMed

    Jing, Kong; Shuo-Dong, Wu

    2014-01-01

    Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences. Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed. Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period. Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment. PMID:24790609

  15. Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy

    PubMed Central

    Jing, Kong; Shuo-Dong, Wu

    2014-01-01

    Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences. Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed. Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period. Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment. PMID:24790609

  16. Zoom lens design using liquid lens for laparoscope.

    PubMed

    Lee, Seungwan; Choi, Minseog; Lee, Eunsung; Jung, Kyu-Dong; Chang, Jong-Hyeon; Kim, Woonbae

    2013-01-28

    Traditional laparoscopic optical systems consisting of about 30 lenses have low optical magnification. To magnify tissue during surgical operations, one must change from one laparoscope to another or use a magnifying adapter between the laparoscope and the sensor. Our work focuses on how to change the sag of a liquid lens while zooming from 1 × zoom, to 2 × , and 4 × in an optical design for a laparoscope. The design includes several lenses and two liquid lenses with variable focal lengths. A pair of laparoscopes for 3-D stereoscopy is placed within a tube 11 mm in diameter. The predicted depth resolution of tissue is 0.5 mm without interpolation at 4 × zoom. PMID:23389159

  17. Simulation System for Training in Laparoscopic Surgery

    NASA Technical Reports Server (NTRS)

    Basdogan, Cagatay; Ho, Chih-Hao

    2003-01-01

    A computer-based simulation system creates a visual and haptic virtual environment for training a medical practitioner in laparoscopic surgery. Heretofore, it has been common practice to perform training in partial laparoscopic surgical procedures by use of a laparoscopic training box that encloses a pair of laparoscopic tools, objects to be manipulated by the tools, and an endoscopic video camera. However, the surgical procedures simulated by use of a training box are usually poor imitations of the actual ones. The present computer-based system improves training by presenting a more realistic simulated environment to the trainee. The system includes a computer monitor that displays a real-time image of the affected interior region of the patient, showing laparoscopic instruments interacting with organs and tissues, as would be viewed by use of an endoscopic video camera and displayed to a surgeon during a laparoscopic operation. The system also includes laparoscopic tools that the trainee manipulates while observing the image on the computer monitor (see figure). The instrumentation on the tools consists of (1) position and orientation sensors that provide input data for the simulation and (2) actuators that provide force feedback to simulate the contact forces between the tools and tissues. The simulation software includes components that model the geometries of surgical tools, components that model the geometries and physical behaviors of soft tissues, and components that detect collisions between them. Using the measured positions and orientations of the tools, the software detects whether they are in contact with tissues. In the event of contact, the deformations of the tissues and contact forces are computed by use of the geometric and physical models. The image on the computer screen shows tissues deformed accordingly, while the actuators apply the corresponding forces to the distal ends of the tools. For the purpose of demonstration, the system has been set up to simulate the insertion of a flexible catheter in a bile duct. [As thus configured, the system can also be used to simulate other endoscopic procedures (e.g., bronchoscopy and colonoscopy) that include the insertion of flexible tubes into flexible ducts.] A hybrid approach has been followed in developing the software for real-time simulation of the visual and haptic interactions (1) between forceps and the catheter, (2) between the forceps and the duct, and (3) between the catheter and the duct. The deformations of the duct are simulated by finite-element and modalanalysis procedures, using only the most significant vibration modes of the duct for computing deformations and interaction forces. The catheter is modeled as a set of virtual particles uniformly distributed along the center line of the catheter and connected to each other via linear and torsional springs and damping elements. The interactions between the forceps and the duct as well as the catheter are simulated by use of a ray-based haptic-interaction- simulating technique in which the forceps are modeled as connected line segments.

  18. Bilateral tubo-ovarian abscesses four years after total abdominal hysterectomy.

    PubMed Central

    Mendez, L E; Bhoola, S M; Horowitz, I R

    1998-01-01

    BACKGROUND: Pelvic inflammatory disease (PID) is a common gynecologic disorder. One known complication of PID is tubo-ovarian abscess (TOA) formation. The predominant theory on TOA formation postulates that an ascending infection from the cervix through the uterus to the fallopian tubes and ovaries results in abscess formation. Other theories include seeding via a hematogenous infection, diverticular disease, and appendicitis. CASE: A 39-year-old female patient with abdominal pain was referred to our institution and was found to have a pelvic mass. After a thorough evaluation, surgical exploration revealed the presence of TOA. No evidence of gastrointestinal disease was present. The patient's history was significant for an uncomplicated total abdominal hysterectomy for benign disease of the uterus four years prior. Abscess cultures grew Streptococcus intermedius. CONCLUSION: This case reports the rare occurrence of TOA in a patient who had undergone an abdominal hysterectomy four years prior to presentation. If the patient reports a surgical history of prior hysterectomy, TOA is often stricken from consideration. Although unlikely, adnexal abscess formation should be considered in the differential diagnosis of a patient with abdominal pain and a pelvic mass, even with a remote history of hysterectomy. PMID:9785111

  19. 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…

  20. Evaluation of Specialized Laparoscopic Suturing and Tying Devices

    PubMed Central

    Madan, Atul K.; Tebbit, Christopher L.; Park, William C.; Kumari, Nakka V. Aruna; Shervin, Nina

    2004-01-01

    Background: Laparoscopic suturing and tying constitute advanced minimally invasive surgery skills. Developing proficiency in the standard methods with needle drivers is often an arduous process. Recent advances in laparoscopic instrumentations has allowed for easier methods of suturing and tying. This study investigated the hypothesis that the use of a specialized suturing device and a specialized tying device allows inexperienced medical students to suture and tie laparoscopically. Methods: Preclinical medical students who had not received any training in open or laparoscopic surgery were included in this investigation. Each student was given a 5-minute demonstration of a specialized suturing device and a specialized tying device. The medical students were not allowed to deploy either device before actual use. After the demonstration, each student was given the device to use in a porcine model. Times were recorded and a subjective grade was given for each student. Results: Twenty medical students were involved in this study. All medical students were able to complete the task of suturing and tying. The average time to suture was 104.6 seconds and the average time to tying was 31.2 seconds. The average subjective performance grade was 90 (out of 100). Conclusion: Specialized devices are easy to learn and use for laparoscopic suturing and tying with minimal instruction even for inexperienced medical students. Even surgeons who are not well versed in laparoscopic surgery should be able to suture and tie with certain laparoscopic instruments. PMID:15119669

  1. [In vitro development of laparoscopic skills].

    PubMed

    Gödri, Veronika; Haidegger, Tamás; Saftics, György; Sándor, József; Wéber, György

    2012-08-01

    Minimally invasive surgery is a popular alternative to open surgical procedures. Laparoscopic surgeries require highly skilled surgeons with solid theoretical background and significant amount of practice. Pelvitrainers or simulators provide a good opportunity for practicing and developing laparoscopic skills. Laparoscopic training of medical students of the Semmelweis University is performed at the Institute of Experimental Surgery and Surgical Techniques on Apollo pelvitrainers. The trainer, the performed exercises and the time limits have to be validated by several measurements. Statistical evaluation of the results provides a possibility for the numerical evaluation of surgical skills as well as validating the usability of the pelvitrainer. In our study we tested the peg transfer exercise in pelvitrainers on four groups with different surgical background and level of expertise, complete novices (50 persons), medical students (326 persons), surgical residents (15), and experienced surgeons (4), respectively. A time limit of 240 s was defined for novices and 100 s for professionals. During the evaluation of the results the average time and the number of errors were calculated. The mean completion time of amateurs was 365.7 ± 130 s (mean ± standard deviation), with 2.57 errors. The performance of medical students was characterized by 159.3 ± 61.1 s average time with 1.21 errors, the completion time of residents was 257.9 ± 75.7 s with 1.13 error points, and 117.2 ± 29.1 s for the surgeons. These data show significant differences between the group, except between the results of medical students and surgeons. We plan to extend this study with the inclusion of more, experienced surgeons. PMID:22940390

  2. The economic considerations in laparoscopic surgery.

    PubMed

    MacFadyen, B V; Lenz, S

    1994-07-01

    There has been increasing concern in the medical, business, and insurance communities and government agencies about the rising cost of health care. Since 1980 the cost of medical care has increased from $280 billion dollars per year to $670 billion dollars in 1990, and was estimated at $900 billion in 1993. Several factors have contributed to this increase, including the high cost of hospitalization and new expensive technology, such as laparoscopic cholecystectomy. This present cost analysis was undertaken to determine the cost variables in laparoscopic cholecystectomy to see if changes in physician, nursing, and administration work activities could decrease the cost of hospitalization. Fifty-four patients who had an uncomplicated elective cholecystectomy during a five-month period in 1993 were assessed in terms of cost components of hospitalization, including nursing unit labor costs, surgery personnel labor costs, supply/instrument cost, and ancillary costs. Nine general surgeons participated in this study, four of whom accounted for 71% of the annual volume of cases. This analysis was performed with the help of Baxter Corporate Consulting, a Division of Baxter Healthcare Corporation. From this study, it was found that the average cost for uncomplicated laparoscopic cholecystectomy patients was $1589 +/- $223. The operating room and supply/instrument component costs were the two largest expenses, accounting for 42% of the total cost. Reimbursement from various insurance agencies were also evaluated, and it was determined that a contract made with a local HMO caused the hospital to lose an average of $443.00 per patient.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7974099

  3. [Current treatment of endometriosis with laparoscopic surgery].

    PubMed

    Berkes, Eniko; Bokor, Attila; Rigó, János

    2010-07-11

    Surgical treatment of endometriosis aims to remove all visible areas of pelvic endometriosis and restore anatomy by division of adhesions, as well as relieve painful symptoms. In this paper, we summarize the advantages, disadvantages, and efficacy of different laparoscopic surgical procedures in the treatment of endometriosis-associated pelvic pain and infertility. Modern endometrial surgery primarily involves laparoscopy, while indication of previously widespread laparotomy has been restricted to special cases. Surgery for the treatment of peritoneal endometriosis includes several options: electrocoagulation, laser ablation, or excision of the lesions, all of which have similar efficacy in the therapy of endometriosis-associated pelvic pain and infertility. There are two effective techniques for treating ovarian endometrioma: excision (stripping) technique or ablation of the cyst wall. It has been conclusively proven that stripping provides a more favorable outcome than drainage and ablation with regard to alleviating pain symptoms and infertility. The treatment of deeply infiltrating endometriosis involves some of the most challenging dissections in endometrial surgery. Such deeply infiltrating lesions can be most securely removed with laser techniques. For example, rectovaginal septum endometriosis can be completely removed with laser therapy. In case of bowel endometriosis, the affected part of the bowel can be removed by segmental resection, disc resection, or superficial partial-thickness excision. In most cases segmental colorectal resection is employed, because it is the most effective treatment currently available. In case of slight ureteral endometriosis, laparoscopic ureterolysis can be an effective treatment option; however, with obstructive uropathy segmental resection and anastomosis are indicated. Laparoscopic uterosacral nerve ablation and praesacral neurectomy are ancillary procedures meant to further decrease endometriosis-associated pelvic pain symptoms. However, the efficacy of these techniques is not yet proven and currently they appear to offer no added benefits beyond those achievable with conservative surgery alone. The ever improving surgical techniques steadily increase the efficacy of the treatment of endometriosis-associated infertility and pelvic pain, as well as delay recurrence of the disease. PMID:20570794

  4. 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

  5. Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial.

    PubMed

    Schucht, Philippe; Banz, Vanessa; Trochsler, Markus; Iff, Samuel; Krähenbühl, Anna Katharina; Reinert, Michael; Beck, Jürgen; Raabe, Andreas; Candinas, Daniel; Kuhlen, Dominique; Mariani, Luigi

    2015-05-01

    OBJECT In ventriculoperitoneal (VP) shunt surgery, laparoscopic assistance can be used for placement of the peritoneal catheter. Until now, the efficacy of laparoscopic shunt placement has been investigated only in retrospective and nonrandomized prospective studies, which have reported decreased distal shunt dysfunction rates in patients undergoing laparascopic placement compared with mini-laparotomy cohorts. In this randomized controlled trial the authors compared rates of shunt failure in patients who underwent laparoscopic surgery for peritoneal catheter placement with rates in patients who underwent traditional mini-laparotomy. METHODS One hundred twenty patients scheduled for VP shunt surgery were randomized to laparoscopic surgery or mini-laparotomy for insertion of the peritoneal catheter. The primary endpoint was the rate of overall shunt complication or failure within the first 12 months after surgery. Secondary endpoints were distal shunt failure, overall complication/ failure, duration of surgery and hospitalization, and morbidity. RESULTS The overall shunt complication/failure rate was 15% (9 of 60 cases) in the laparoscopic group and 18.3% (11 of 60 cases) in the mini-laparotomy group (p = 0.404). Patients in the laparoscopic group had no distal shunt failures; in contrast, 5 (8%) of 60 patients in the mini-laparotomy group experienced distal shunt failure (p = 0.029). Intraoperative complications occurred in 2 patients (both in the laparoscopic group), and abdominal pain led to catheter removal in 1 patient per group. Infections occurred in 1 patient in the laparoscopic group and 3 in the mini-laparotomy group. The mean durations of surgery and hospitalization were similar in the 2 groups. CONCLUSIONS While overall shunt failure rates were similar in the 2 groups, the use of laparoscopic shunt placement significantly reduced the rate of distal shunt failure compared with mini-laparotomy. PMID:25534231

  6. 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

  7. Laparoscopic cholecystectomy in situs inversus totalis.

    PubMed

    Mn, Raghuveer; S, Mahesh Shetty; Bb, Sunil Kumar

    2014-07-01

    Situs inversus totalis is a rare condition where the organs in the body is placed in the opposite side. When such patient presents with the diseases of the intra abdominal organs the diagnosis is challenging and the operative procedure to be performed will be difficult. This may require the anticipation of variations in anatomy, ergonomic changes required during surgery and mastery over the operative skills in reversed anatomy. Cholelithiasis in situs inversus totalis is one such situation. Herein we report a case of situs inversus totalis who underwent successful laparoscopic cholecystectomy for symptomatic gallbladder calculi. PMID:25177601

  8. Recurrent mucinous cystadenoma: a laparoscopic approach.

    PubMed

    Turkyilmaz, Esengul; Korucuoglu, Umit; Kutlusoy, Fatma; Efeturk, Tunay; Dogan, Hayriye Tatli; Onan, Anil; Guner, Haldun; Taskiran, Cagatay

    2009-03-01

    The second most common epithelial tumor of the ovary is mucinous-type, and it constitutes 8-10% of all ovarian tumors. The recurrence of mucinous cystadenoma is very rare after complete excision. Only four such cases have been reported till date. The case presented in this report is the fifth, who had her initial surgery performed by gynecologic oncology team by laparotomy and was followed up by the same group. After recurrence at the same ovary, the patient underwent laparoscopic evaluation and unilateral salpingoophorectomy was performed. The final histopathological diagnosis was mucinous cystadenoma, just the same as the initial cyst. PMID:18584185

  9. Augmented reality assisted laparoscopic partial nephrectomy.

    PubMed

    Schneider, Adrian; Pezold, Simon; Saner, Andreas; Ebbing, Jan; Wyler, Stephen; Rosenthal, Rachel; Cattin, Philippe C

    2014-01-01

    Computer assisted navigation is a widely adopted technique in neurosurgery and orthopedics. However, it is rarely used for surgeries on abdominal organs. In this paper, we propose a novel, noninvasive method based on electromagnetic tracking to determine the pose of the kidney. As a clinical use case, we show a complete surgical navigation system for augmented reality assisted laparoscopic partial nephrectomy. Experiments were performed ex vivo on pig kidneys and the evaluation showed an excellent augmented reality alignment error of 2.1 mm ± 1.2 mm. PMID:25485399

  10. Breakage of fascial closure device during laparoscopic surgery

    PubMed Central

    Katara, A. N.; Bhandarkar, D. S.; Shah, R. S.; Udwadia, T. E.

    2005-01-01

    Breakage of instruments during laparoscopic surgery is rare. However, when it does occur, locating and retrieving the broken part of the instrument can be cumbersome. Moreover, inability to do so may carry serious medicolegal implications. We report a patient in whom the tip of a fascial closure device broke during laparoscopic surgery. This was located by intraoperative fluoroscopy and retrieved from the extraperitoneal plane via a small incision. The paper discusses the probable factors responsible for breakage of the fascial closure device in our patient and reviews the previously reported cases of the rare complication of breakage of instruments during laparoscopic surgery. PMID:21206652

  11. Laparoscopic Transhiatal Esophagectomy for Barrett's Esophagus with High Grade Dysplasia

    PubMed Central

    Nguyen, Ninh T.; Schauer, Philip R.

    1998-01-01

    Background: A number of case reports have described the application of minimally invasive surgical techniques to accomplish esophagectomy. However, most reports have employed thoracoscopic or laparoscopic techniques to perform esophagectomy in addition to an “access” incision which often approaches a standard laparotomy or thoracotomy. Case Report: This report describes a total laparoscopic transhiatal esophagectomy in a 55 year old female with Barrett's esophagus and high grade dysplasia. Conclusions: The patient had an uneventful recovery and was discharged home on the fourth day after a total laparoscopic esophagectomy. This report demonstrates the technical feasibility of this complex procedure by a minimally invasive approach. PMID:9876716

  12. Single-incision laparoscopic management of a giant hepatic cyst

    PubMed Central

    Willems, Kaitlin; Monsivais, Sharon; Vassaur, Hannah; Buckley, Francis P.

    2015-01-01

    Large symptomatic hepatic cysts may warrant surgical management. Traditional multiport laparoscopic technique is typically preferred over open laparotomy, but the use of the single-incision laparoscopic approach for this diagnosis is not well documented. Here, we describe the case of a 68-year-old woman who underwent complete anterior wall fenestration, excision and cauterization of a simple hepatic cyst via a single-incision laparoscopic technique through an incision at the umbilicus. The objective of this case report is to document single-incision laparoscopy as a safe, feasible and cosmetically appealing approach for the management of a large hepatic cyst. PMID:26224889

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

    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.

  14. 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

  15. Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome

    PubMed Central

    St. Peter, Shawn D.; Hughes, Jenevieve H.; Swain, James M.

    2009-01-01

    Background: Superior mesenteric artery (SMA) syndrome, also called Wilkie's syndrome, is a rare clinical phenomenon believed to be caused by compression of the third portion of the duodenum by the overlying superior mesenteric artery. We present the case of a 32-year-old female who presented with epigastric pain, weight loss, and vomiting. Methods: Her workup included a normal upper endoscopy as well as an abdominal CT scan and upper GI contrast study that confirmed the diagnosis of superior mesenteric artery syndrome. The patient was taken to the operating room and underwent successful treatment with laparoscopic duodenojejunostomy. Results: The patient achieved complete relief of her symptoms and is able to eat a regular diet without difficulty. SMA syndrome is a real anatomic clinical pathology resulting in chronic, consistent obstructive symptoms. An upper GI series and CT scan with contrast can confirm the diagnosis. Conclusion: Laparoscopic duodenojejunostomy should be considered the treatment of choice for these patients, because it offers a high likelihood of excellent outcome based on the current literature. PMID:19660228

  16. International experience for laparoscopic major liver resection.

    PubMed

    Dagher, Ibrahim; Gayet, Brice; Tzanis, Dimitrios; Tranchart, Hadrien; Fuks, David; Soubrane, Olivier; Han, Ho-Seong; Kim, Ki-Hun; Cherqui, Daniel; O'Rourke, Nicholas; Troisi, Roberto I; Aldrighetti, Luca; Bjorn, Edwin; Abu Hilal, Mohammed; Belli, Giulio; Kaneko, Hironori; Jarnagin, William R; Lin, Charles; Pekolj, Juan; Buell, Joseph F; Wakabayashi, Go

    2014-10-01

    Although minor laparoscopic liver resections (LLRs) appear as standardized procedures, major LLRs are still limited to few expert teams. The aim of this study was to report the combined data of 18 international centers performing major LLR. Variables evaluated were number and type of LLR, surgical indications, number of synchronous colorectal resections, details on technical points, conversion rates, operative time, blood loss and surgical margins. From 1996 to 2014, a total of 5388 LLR were carried out including 1184 major LLRs. The most frequent indication for laparoscopic right hepatectomy (LRH) was colorectal liver metastases (37.0%). Seven centers used hand assistance or hybrid approach selectively for LRH mostly at the beginning of their experience. Seven centers apply Pringle's maneuver routinely. The conversion rate for all major LLRs was 10% and mean operative time was 291?min. Mean estimated blood loss for all major LLR was 327?ml and negative surgical margin rate was 96.5%. Major LLRs still remain challenging procedures requiring important experience in both laparoscopy and liver surgery. Stimulating the younger generation to learn and accomplish these techniques is the better way to guarantee further development of this surgical field. PMID:25098667

  17. Preliminary Results for Continence Recovery after Intrafascial Extraperitoneal Laparoscopic Radical Prostatectomy

    PubMed Central

    Choi, Young Hoon; Lee, Jeong Zoo; Chung, Moon Kee

    2012-01-01

    Purpose We present our initial experience and surgical outcomes for the most recent refinement of bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy (nsELRP). Materials and Methods Among 62 patients who underwent laparoscopic radical prostatectomy, 50 patients underwent intrafascial nsELRP by a single surgeon at Pusan National University Hospital from November 2011 to April 2012. As part of the intrafascial technique, the dissection plane is directly on the prostatic capsule to preserve most of the periprostatic fascia containing small vessels and nerves, endopelvic fascia, neurovascular bundle, and puboprostatic ligament. Postoperative continence recovery was established by daily consumption of pads. Follow-up was done at 2 weeks, 6 weeks, and 3 months after surgery. Results The patients' mean age was 66.5±6.2 years. The mean operation time and mean blood loss were 149.3±28.1 minutes and 155.4±168.1 ml, respectively. The mean hospitalization time and mean catheterization time were 6.3±5.1 days and 5.5±4.7 days, respectively. Two weeks after the operation, a total of 14 patients (28.0%) were pad-free but the other incontinent patient group used on average 2.3 pads per day. After 6 weeks, 35 patients (70.0%) achieved pad-free status and 7 patients (14.0%) required more than 2 pads per day. At 3 months after surgery, a total of 31 patients were available for follow-up, and 26 patients (83.9%) were pad-free. Conclusions Compared with conventional laparoscopic prostatectomy, the intrafascial nsELRP procedure enables the preservation of periprostatic structures that are essential to the recovery of surgical structures related to continence. As a result, early postoperative continence can be achieved. PMID:23301127

  18. Robotic-assisted laparoscopic adrenalectomy for an adrenal adenoma

    PubMed Central

    Deniwar, Ahmed; Mohamed, Hossam Eldin; Noureldine, Salem I.

    2015-01-01

    The patient was referred for management of a left adrenal incidentaloma. Preoperative CT scan and MRI showed focal calcification. Here we are presenting this video demonstrating robotic-assisted laparoscopic adrenalectomy for left adrenal mass. PMID:26425459

  19. Laparoscopic gastric surgery for cancer: Where do we stand?

    PubMed Central

    Antonakis, Pantelis T; Ashrafian, Hutan; Isla, Alberto Martinez

    2014-01-01

    Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer. PMID:25339815

  20. Laparoscopic approach for inflammatory bowel disease surgical managment.

    PubMed

    Maggiori, Léon; Panis, Yves

    2012-01-01

    For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach. PMID:23373362

  1. Comparison of transumbilical single-port laparoscopic cholecystectomy and fourth-port laparoscopic cholecystectomy

    PubMed Central

    Ye, Guanxiong; Qin, Yong; Xu, Shengqian; Wu, Chengjun; Wang, Shi; Pan, Debiao; Wang, Xinmei

    2015-01-01

    This work aims to compare the curative effect of transumbilical single-port laparoscopic cholecystectomy (TUSPLC) and four-port laparoscopic cholecystectomy (FPLC). 200 patients with cholecystolithiasis were enrolled in this study. They were randomly divided into TUSPLC group and FPLC group, 100 cases in each group, and the TUSPLC and FPLC was performed, respectively. The surgical time, intraoperative complication, conversions rate, postoperative pain, postoperative analgesic drug use, incision infection, postoperative hospitalization time and postoperative cosmetic results in two groups were compared. The total conversion rate, conversion rate with Nassar grade II, and conversion rate with Nassar grade III in TUSPLC group were significantly higher than FPLC group (P < 0.01), and the incision cosmetic result after 1 month in TUSPLC group was obviously better than FPLC group (P < 0.01), but the surgical time in TUSPLC group was significantly longer than FPLC group (P < 0.01). There was no significant difference of incision infection, intraoperative complication, and postoperative hospitalization time, incision pain in postoperative first and second day, postoperative use of analgesia drug and incision cosmetic result on discharge day between two groups (P > 0.05). TUSPLC has obvious advantage in treatment of Nassar grade I patients with cholecystolithiasis. It can be used as a supplement for standard laparoscopic gallbladder surgery. It is safe and feasible, without abdominal scar, thus achieving to excellent cosmetic result and high satisfaction in patients. PMID:26221325

  2. 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

  3. A Warm-up Laparoscopic Exercise Improves the Subsequent Laparoscopic Performance of Ob-Gyn Residents: a Low-Cost Laparoscopic Trainer

    PubMed Central

    Do, Ann T.; Kerr, Angela; Serur, Eli; Robertazzi, Robert R.; Stankovic, Miljan R.

    2006-01-01

    Introduction: Residents traditionally acquire surgical skills through on-the-job training. Minimally invasive laparoscopic techniques present additional demands to master complex surgical procedures in a remote 2-dimensional venue. We examined the effectiveness of a brief warm-up laparoscopic simulation toward improving operative proficiency. Methods: Using a “Poor-Man's Laparoscopy Simulator,” 12 Ob/Gyn residents and 12 medical students were allocated 10 minutes to transfer 30 tablets with a 5-mm grasper from point A to point B via laparoscopic visualization in a warm-up exercise. Participants repeated the exercise following a 5-minute pause. Mean scores, expressed in seconds/tablet, and overall improvement (percentage difference between warm-up and follow-up) were analyzed according to postgraduate standing (PGY1-4), dexterity skills, and pertinent vocational activities. Results: Significant improvements were noted for both residents (+25%) and medical students (+29%), P<0.0001. Scores between the 2 groups, however, were not significant (P=0.677). Proficiency was not influenced by PGY standing. Interestingly, the best (8.73 sec/pill) and the worst (25 sec/pill) scores were attained by a medical student and a chief resident, respectively, suggesting the contribution of individual aptitude. Conclusion: A brief warm-up exercise before an actual laparoscopic surgical procedure significantly improves subsequent laparoscopic performance. PMID:17212883

  4. 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

  5. Laparoscopic Appendectomy Performed by Residents and Experienced Surgeons

    PubMed Central

    Bernini, Marco; Martini, Francesco; Rossi, Michele; Tommasi, Cinzia; Miranda, Egidio; Sanchez, Luis Josè; Naspetti, Riccardo; Manetti, Roberto; Ferrara, Angelo; Nesi, Silvia; Boffi, Bernardo; Farsi, Marco; Moretti, Renato

    2009-01-01

    Background: Laparoscopic appendectomy is widely performed by surgical residents, but its changing indications and outcomes have been poorly investigated. The aim of this study was to examine whether a difference exists in indications and outcomes between laparoscopic appendectomies performed by residents and those performed by experienced surgeons. Methods: Between 1999 and 2007, 218 laparoscopic appendectomies were performed and recorded. Data were analyzed to compare operations performed by residents with those by experienced surgeons in terms of indications for surgery and severity of disease. Moreover, laparoscopic appendectomies were thoroughly compared regarding outcomes and complications. Results: The residents had fewer conversions with laparoscopic appendectomy (8% vs 17%, P=0.04), and similar complication rates (12% vs 13%, P=0.16), compared with experienced surgeons. The median operating time was also comparable (67 minutes vs 60 minutes, P=0.23). However, patients operated on by residents had more emergencies (86% vs 70%, P=0.009), included more foreigners (27% vs 15%, P=0.03), and had intermediate to severe diseases, (81 vs 52%, P<0.001) than patients did operated on by experienced surgeons. Conclusions: Surgical residents performed more emergency laparoscopic appendectomies on foreign patients suffering from intermediate to severe diseases compared with experienced surgeons, with comparable surgical outcomes and lower conversion rates. PMID:19793482

  6. Fascial Repair of Laparoscopic Ports with Allis-Hemostat Technique.

    PubMed

    Tavassoli, Alireza; Bagheri, Reza; Feizzadeh, Behzad; Tavassoli, Fatemeh; Barekati, Neusha

    2015-12-01

    Port site hernias are one of the most serious complications associated with laparoscopic surgery. In this study, we present a simple and reliable method for port site closure in laparoscopic surgery. From 2005 to 2011, 500 patients who underwent laparoscopic surgery were enrolled for the study. They were evaluated considering age, sex, indication of laparoscopic surgery, and early and late complications of port site and were followed up at least for 1 year after the surgery. In our study, 180 males and 320 females with mean age of 36 years were enrolled. The most common indication for laparoscopic surgery was cholecystectomy in 320 patients (64 %). There were no early or late complications of port site after surgery. Our method is a new modification of the procedure presented by Spalding. Using Allis forceps and putting it under the fascia seems to be a more suitable technique which facilitates the laparoscopic port repair. We found it to be extremely safe, simple, and easy to teach. PMID:26730002

  7. Laparoscopic ischemic conditioning of the stomach prior to esophagectomy.

    PubMed

    Yetasook, A K; Leung, D; Howington, J A; Talamonti, M S; Zhao, J; Carbray, J M; Ujiki, M B

    2013-07-01

    Several complications after esophagectomy with gastric pull-up are associated with ischemia within the gastric conduit. The aim of this study is to assess the feasibility of laparoscopic ischemic preconditioning of the stomach prior to thoracotomy, esophagectomy, and gastric pull-up with an intrathoracic anastomosis. A retrospective review of 24 consecutive patients between October 2008 and July 2011 with esophageal adenocarcinoma (stage I-III) undergoing laparoscopic gastric ischemic conditioning prior to esophagectomy was conducted. Conditioning included laparoscopic ligation of the left and short gastric arteries, celiac node dissection, and jejunostomy tube placement. Formal resection and reconstruction was then performed 4-10 days later. Of the 24 patients, 88% received neoadjuvant chemotherapy/radiation therapy. Twenty-three of the 24 patients underwent successful laparoscopic ischemic conditioning and subsequent esophagectomy. Total mean number of lymph nodes harvested was 21.8 (±8.0), and a mean of 5.3 (±2.4) celiac lymph nodes identified. There were no conversions to an open procedure. Length of stay was 3.8 (±4.8) days with a median length of stay of 2 (1-24) days. Three patients experienced anastomotic leak, six patients experience delayed gastric emptying, and two patients developed anastomotic stricture. There were no surgical site infections. R0 resection was achieved in all patients who underwent laparoscopic ischemic conditioning followed by esophagectomy. Laparoscopic ischemic conditioning of the gastric conduit has been shown to be feasible and safe. PMID:22816598

  8. 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

  9. Innovative technique of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration: A comparative study

    PubMed Central

    Kim, Say-June; Kim, Kee-Hwan; An, Chang-Hyeok; Kim, Jeong-Soo

    2015-01-01

    AIM: To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration (nSIL-CBDE) by comparing the surgical outcomes of this technique with those of conventional laparoscopic CBDE (CL-CBDE). METHODS: We retrospectively analyzed the clinical data of patients who underwent CL-CBDE or nSIL-CBDE for the treatment of common bile duct (CBD) stones between January 2000 and December 2014. For performing nSIL-CBDE, a needlescopic grasper was also inserted through a direct puncture below the right subcostal line after introducing a single-port through the umbilicus. The needlescopic grasper helped obtain the critical view of safety by retracting the gallbladder laterally and by preventing crossing or conflict between laparoscopic instruments. The gallbladder was then partially dissected from the liver bed and used for retraction. CBD stones were usually extracted through a longitudinal supraduodenal choledochotomy, mostly using ?ushing a copious amount of normal saline through a ureteral catheter. Afterward, for the certification of CBD clearance, CBDE was performed mostly using a ?exible choledochoscope. The choledochotomy site was primarily closed without using a T-tube, and simultaneous cholecystectomies were performed. RESULTS: During the study period, 40 patients underwent laparoscopic CBDE. Of these patients, 20 underwent CL-CBDE and 20 underwent nSIL-CBDE. The operative time for nSIL-CBDE was significantly longer than that for CL-CBDE (238 ± 76 min vs 192 ± 39 min, P = 0.007). The stone clearance rate was 100% (40/40) in both groups. Postoperatively, the nSIL-CBDE group required less intravenous analgesic (pethidine) (46.5 ± 63.5 mg/kg vs 92.5 ± 120.1 mg/kg, P = 0.010) and had a shorter hospital stay than the CL-CBDE group (3.8 ± 2.0 d vs 5.1 ± 1.7 d, P = 0.010). There was no significant difference in the incidence of postoperative complications between the two groups. CONCLUSION: The results of this study suggest that nSIL-CBDE could be safe and feasible while improving cosmetic outcomes when performed by surgeons trained in conventional laparoscopic techniques. PMID:26668510

  10. Enhanced recovery programme in gynaecology: outcomes of a hysterectomy care pathway

    PubMed Central

    Mukhopadhyay, Debjani

    2015-01-01

    There was a wide variation in the peri-operative management of women undergoing hysterectomy for both benign and malignant disease at Southend University Hospital NHS Foundation Trust prior to 2010. The median length of stay following a hysterectomy and more radical gynaecological oncology surgery was five days and seven days respectively. The NHS East of England Strategic Health Authority commissioned the development of Enhanced Recovery Programme (ERP) in various surgical specialties including gynaecology and the pathway was implemented from 2012 onward. Dedicated specialist nurses collected data prospectively. The median length of stay was shortened to three days. This difference was statistically significant with a P value = 0.0001. We describe the successful implementation of an ERP in Southend Hospital resulting with no difference in measurable morbidity and mortality, a shorter length of stay, and a high patient satisfaction scores and outcomes.

  11. Acupuncture for Preventing Complications after Radical Hysterectomy: A Randomized Controlled Clinical Trial

    PubMed Central

    Yi, Wei-min; Chen, Qing; Liu, Chang-hao; Hou, Jia-yun; Chen, Liu-dan; Wu, Wei-kang

    2014-01-01

    We aimed to investigate the preventive effects of acupuncture for complications after radical hysterectomy. A single-center randomized controlled single-blinded trial was performed in a western-style hospital in China. One hundred and twenty patients after radical hysterectomy were randomly allocated to two groups and started acupuncture from sixth postoperative day for five consecutive days. Sanyinjiao (SP6), Shuidao (ST28), and Epangxian III (MS4) were selected with electrical stimulation and Zusanli (ST36) without electrical stimulation for thirty minutes in treatment group. Binao (LI14) was selected as sham acupuncture point without any stimulation in control group. The main outcome measures were bladder function and prevalence of postoperative complications. Compared with control group, treatment group reported significantly improved bladder function in terms of maximal cystometric capacity, first voiding desire, maximal flow rate, residual urine, and bladder compliance, and decreased bladder sensory loss, incontinence, and urinary retention on fifteenth and thirtieth postoperative days. Treatment group showed significant advantage in reduction of urinary tract infection on thirtieth postoperative day. But no significant difference between groups was observed for lymphocyst formation. By improving postoperative bladder function, early intervention of acupuncture may provide a valuable alternative method to prevent bladder dysfunctional disorders and urinary tract infection after radical hysterectomy. PMID:24839455

  12. Usefulness of vessel-sealing devices for peripartum hysterectomy: a retrospective cohort study.

    PubMed

    Rossetti, Diego; Vitale, Salvatore Giovanni; Bogani, Giorgio; Rapisarda, Agnese Maria Chiara; Gulino, Ferdinando Antonio; Frigerio, Luigi

    2015-09-01

    To evaluate the feasibility to perform peripartum hysterectomy (PH) with the introduction of LigaSure™ vessels-sealing device (LVSD) and how it influenced the surgical outcomes. We retrospectively evaluated procedures and outcome of women undergoing PH during the period between January 2001 and October 2013. Perioperative surgical results of patients undergoing PH using LVSD were compared to patients undergoing PH without LVSD. Forty-nine subjects had PH during the study period. Twenty (41 %) hysterectomies were performed for placenta accreta, 8 (16 %) for placenta previa, 21 (43 %) for atony. Twenty-three subjects had PH using LVSD and 26 subjects had hysterectomy without the use of this device. We observe significant differences in estimated blood loss (p = 0.001), massive blood transfusions (>10 units RBC) (p = 0.025), operative time (p = 0.06). No difference in term of hospital stay and complications were observed (p = 0.78 and p = 0.35). One patient for each group had intraoperative complication (p = 0.9). The use of LVSD during PH does not increase operative complications, blood loss, and operative time in comparison to standard procedure. PMID:25813428

  13. Late complication of laparoscopic sleeve gastrectomy.

    PubMed

    Dakwar, Anthony; Assalia, Ahmad; Khamaysi, Iyad; Kluger, Yoram; Mahajna, Ahmad

    2013-01-01

    Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The complications encountered nevertheless can result in morbidity and even mortality. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a patient who suffered from a staple-line leak presenting 16 months after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of post-LSG gastric leaks is suggested. PMID:23662218

  14. Late Complication of Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Assalia, Ahmad; Kluger, Yoram

    2013-01-01

    Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The complications encountered nevertheless can result in morbidity and even mortality. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a patient who suffered from a staple-line leak presenting 16 months after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of post-LSG gastric leaks is suggested. PMID:23662218

  15. Laparoscopic rectopexy in solitary rectal ulcer.

    PubMed

    Kargar, Saeed; Salmanroughani, Hassan; Binesh, Fariba; Taghipoor, Shokoh; Kargar, Shady

    2011-01-01

    Patients with Solitary Rectal Ulcer Syndrome (SRUS) come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia (63.8%) was significantly higher than cases without that (P=0.04). Complete recovery rate in cases that had finger defecation (85%) was significantly higher than cases without that (50%) (P=0.03). Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management. PMID:22174170

  16. LAPAROSCOPIC SALPINGECTOMY IN TWO CAPTIVE LEOPARDS (PANTHERA PARDUS) USING A SINGLE PORTAL ACCESS SYSTEM.

    PubMed

    Hartman, Marthinus J; Monnet, Eric; Kirberger, Robert M; Schoeman, Johan P

    2015-12-01

    Laparoscopic salpingectomy was performed in two adult leopards (Panthera pardus) using a single portal access system, with a multicannulated single-incision laparoscopic surgery port, without any complications. The poorly developed ovarian bursa provided easy access to the uterine tube for salpingectomy. Laparoscopic salpingectomy can be safely performed in the leopard using a single portal access system. PMID:26667558

  17. Investigation of Partial Directed Coherence for Hand-Eye Coordination in Laparoscopic training

    E-print Network

    Atallah, Louis

    Abstract. Effective hand-eye coordination is an important aspect of training in laparoscopic surgeryInvestigation of Partial Directed Coherence for Hand- Eye Coordination in Laparoscopic training of the proposed technique for minimally invasive surgery, two laparoscopic experiments have been con- ducted

  18. Laparoscopic Nissen Fundoplication in Children: A Single Surgeon's Experience

    PubMed Central

    Hopkins, Mary Ann

    1999-01-01

    Background and Objectives: Adult laparoscopic Nissen fundoplication has been steadily growing since its introduction to the United States in the 1990s. Its advantage over the traditional open approach is manifold. Application of laparoscopic fundoplication to children is slowly but surely following this trend. This study evaluates our initial experience with pediatric laparoscopic Nissen fundoplications. Patients and Methods: We reviewed the records of 25 consecutive laparoscopic Nissen fundoplications performed by a single surgeon (GS) at our institution in the past three years. The patient ages ranged from 7 months to 18 years (mean, 7 years). All patients had documented gastroesophageal reflux disease. Complications from the reflux included vomiting in 15 patients, failure to thrive in nine, esophagitis in nine, and pulmonary symptoms in six. Results: All Nissen fundoplications were performed laparoscopically without need for conversion to open technique. Blood loss was less than 50 cc in all cases. A tube gastrostomy was concurrently performed in 17. Mean operative time in all cases was 221 minutes. Average postoperative day on which feedings were begun was day 2, with an average resumption of regular feedings on postoperative day 3.5. Average date of discharge was postoperative day 6.8. Complications included difficulty controlling glucose in an insulin-dependent diabetic, and a lost needle, which added an additional hour to the operative time. There were eight admissions to the pediatric intensive care unit, all for observation secondary to their underlying medical problems. There was one postoperative death due to an underlying medical condition. Conclusions: Laparoscopic Nissen fundoplication is a safe and effective treatment option for children suffering from significant reflux. Time to regular feeding, analgesia requirements and hospital stay are decreased when compared to traditional procedures. Laparoscopic Nissen fundoplication may well become the procedure of choice for pediatric gastroesophageal reflux disease. PMID:10694071

  19. Reduced-Port Laparoscopic Surgery for a Tumor-Specific Mesorectal Excision in Patients With Colorectal Cancer: Initial Experience With 20 Consecutive Cases

    PubMed Central

    Bae, Sung Uk; Baek, Se Jin; Min, Byung Soh; Baik, Seung Hyuk; Kim, Nam Kyu

    2015-01-01

    Purpose Single-port plus one-port, reduced-port laparoscopic surgery (RPLS) may decrease collisions between laparoscopic instruments and the camera in a narrow, bony, pelvic cavity while maintaining the cosmetic advantages of single-incision laparoscopic surgery. The aim of this study is to describe our initial experience with and to assess the feasibility and safety of RPLS for tumor-specific mesorectal excisions (TSMEs) in patients with colorectal cancer. Methods Between May 2010 and August 2012, RPLS for TSME was performed in 20 patients with colorectal cancer. A single port with four channels through an umbilical incision and an additional port in the right lower quadrant were used for RPLS. Results The median operation time was 231 minutes (range, 160-347 minutes), and the estimated blood loss was 100 mL (range, 50-500 mL). We transected the rectum with one laparoscopic stapler in 17 cases (85%). The median time to soft diet was 4 days (range, 3-6 days), and the length of hospital stay was 7 days (range, 5-45 days). The median total number of lymph nodes harvested was 16 (range, 7-36), and circumferential resection margin involvement was found in 1 case (5%). Seven patients (35%) developed postoperative complications, and no mortalities occurred within 30 days. During the median follow-up period of 20 months (range, 12-40 months), liver metastasis occurred in 1 patient 10 months after surgery, and local recurrence was nonexistent. Conclusion RPLS for TSME in patients with colorectal cancer is technically feasible and safe without compromising oncologic safety. However, further studies comparing RPLS with a conventional, laparoscopic low-anterior resection are needed to prove the advantages of the RPLS procedure. PMID:25745622

  20. 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

  1. A laparoscopic simulator – maybe it is worth making it yourself

    PubMed Central

    Piotrowski, Piotr; J?drzejczyk, Adam; Pawe?czak, Dariusz; Pasieka, Zbigniew

    2014-01-01

    Introduction Laparoscopic trainers have gained recognition for improving laparoscopic surgery skills and preparing for operations on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for young surgeons in small medical centers. The solution might be for them to construct a device by themselves. Aim To make a relatively cheap and easy to construct laparoscopic trainer for residents who wish to develop their skills at home. Material and methods Two laparoscopic simulators were designed and constructed: 1) a box model with an optical system based on two parallel mirrors, 2) a box model with an HD webcam, a light source consisting of LED diodes placed on a camera casing, and a modeling servo between the webcam and aluminum pipe to allow electronic adjustment of the optical axis. Results The two self-constructed simulators were found to be effective training devices, the total cost of parts for each not exceeding $100. Advice is also given for future constructors. Conclusions Home made trainers are accessible to any personal budget and can be constructed with a minimum of practical skill. They allow more frequent practice at home, outside the venue and hours of surgical departments. What is more, home made trainers have been shown to be comparable to commercial trainers in facilitating the acquisition of basic laparoscopic skills. PMID:25337161

  2. Laparoscopic Resection for Rectal Cancer: What Is the Evidence?

    PubMed Central

    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

  3. [Indications for laparoscopic treatment of large incisional hernias].

    PubMed

    Dietz, U A; Wiegering, A; Germer, C-T

    2015-04-01

    Hernia surgeons and patients have learned to appreciate the advantages of minimally invasive laparoscopic procedures. After overcoming the early learning curve phase, smaller wound surface areas, shorter operation times and briefer hospital stays have become routine. Severe surgery-related complications are rare. Patients with poor risk profiles (e.g. age >70 years, BMI >30 and nicotine consumption) profit especially from these advantages. This positive picture is clouded, however, by the need for an intraperitoneal mesh and specifically by the unchanged recurrence rate. The latter is not significantly lowered even by laparoscopic intraperitoneal on-lay mesh (laparoscopic IPOM) procedures. The current literature shows that irrespective of surgical technique, e.g. retromuscular mesh or laparoscopic IPOM, the risk profile and size of the hernia defect are independent factors that determine the prognosis for recurrence. While a cure of incisional hernia is no longer the only goal, the new indication scenario has two main goals: (a) for young patients at low risk or in patients for whom functional and morphological reconstruction of the abdominal wall are of primary importance, an open retromuscular mesh procedure is indicated (despite the higher morbidity) and (b) for older patients and chiefly for patients with a complex risk profile for whom treatment of the ventral hernia symptoms is paramount, laparoscopic procedures are indicated (due to the lower morbidity). This algorithm assumes that the treating surgeons have the requisite expertise and is discussed using the examples of four complex case reports. PMID:25060397

  4. Breaking Barriers to Successful Implementation of Day Case Laparoscopic Cholecystectomy.

    PubMed

    Reynolds, I; Bolger, J; Al-Hilli, Z; Hill, A D K

    2015-01-01

    Laparoscopic cholecystectomy is a common procedure performed in both emergency and elective settings. Our aim was to analyse the trends in laparoscopic surgery in Ireland in the public and private healthcare systems. In particular we studied the trend in day case laparoscopic cholecystectomy. National HIPE data for the years 2010-2012 was obtained. Similar datasets were obtained from the three main health insurers. 19,214 laparoscopic cholecystectomies were carried out in Ireland over the 3-year period. More procedures were performed in the public system than the private system from 2010-2012. There was a steady increase in surgeries performed in the public sector, while the private sector remained static. Although the ALOS was significantly higher in the public sector, there was an increase in the rate of day case procedures from 416 (13%) to 762 (21.9%). The day case rates in private hospitals increased only slightly from 29 (5.1%) in 2010 to 40 (5.9%) in 2012. Day case laparoscopic cholecystectomy has been shown to be a safe procedure, however significant barriers remain in place to the implementation of successful day case units nationwide. PMID:26349348

  5. Laparoscopic repair of iatrogenic vesicovaginal and rectovaginal fistula

    PubMed Central

    Chu, Lei; Wang, Jian-Jun; Li, Li; Tong, Xiao-Wen; Fan, Bo-Zhen; Guo, Yi; Li, Huai-Fang

    2015-01-01

    Objective: To investigate the clinical efficacy of laparoscopic repair of iatrogenic vesicovaginal fistulas (VVF) and rectovaginal fistulas. Methods: Seventeen female patients with iatrogenic fistulas (11 cases of VVF and 6 cases of high rectovaginal fistulas) were included. All patients were hospitalized and underwent laparoscopic fistula repair in our hospital between 2008 and 2012. The mean age of the patients was 44.8 ± 9.1 years. The fistulas and scar tissue were completely excised by laparoscopy, orifices were tension-free closed using absorbable sutures, omental flaps were interposed between the vagina and the bladder or rectum, and drainage was kept after repair. Results: Laparoscopic repair of fistulas was successful in all 17 patients. No complication was found during or after repair. No reoperation was needed after the repair. The operative time was 80.2 ± 30.0 minutes (range 50-140 minutes). The blood loss was 229.4 ± 101.6 ml (range 100-400 ml). The double J catheters were placed in 7 patients and removed 1-2 months after repair. Eight VVF patients underwent cystoscopy 3 months after laparoscopic repair and there were no abnormal findings. The follow-up time was 17.1 ± 6.5 months (range 8-29 months). Conclusion: Laparoscopic repair of VVF and rectovaginal fistulas is a safe and an effective minimally invasive procedure for treatment of iatrogenic fistula. PMID:25932174

  6. Laparoscopic nephrectomy – Pfannenstiel or expanded port site specimen extraction: a systematic review and meta-analysis

    PubMed Central

    Biju, Rakesh Danny; Hutton, Rachael; Alsawi, Mohammed; Aboumarzouk, Omar; Hasan, Rami; Clark, Ross; Little, Brian

    2015-01-01

    Introduction To anaylse the current evidence regarding the safety, feasibility and advantages of intact specimen extraction via various extraction sites after conventional laparoscopic nephrectomy (LN). Material and methods A comprehensive literature search was performed identifying studies evaluating outcomes from Pfannenstiel (PFN) versus extended port site (EPS) extraction sites, after conventional laparoscopic nephrectomy/nephroureterectomy (LRN/LNU) and donor nephrectomy (LDN). Outcome measures included procedure duration, incision length, duration of inpatient stay, analgesic requirements, complications and warm ischemia time (for donor nephrectomy cases). Results This systematic review of five comparative studies found no significant difference in morbidity, wound length, wound complications or opioid consumption across all studies. Inpatient stay (p = 0.03) and estimated blood loss (p = 0.03) were significantly less in favour of a PFN extraction site. When comparing radical nephrectomy cases alone, the PFN group had a shorter procedure time (NS), less estimated blood loss (p = 0.04), shorter inpatient stay (p <0.05), significantly less morphine use (p <0.006) and fewer wound complications. Conclusions This review demonstrates the viability of retrieving a nephrectomy specimen/graft through a PFN incision in relation to the benefits of cosmesis and reduced pain. As reported in several trials, morbidity is not significantly increased and key outcome measures, such as duration of inpatient stay, pain scores, complications, analgesic requirements and time taken to return to normal activities, remain non-inferior. This study is limited by the small number of generally low quality studies available for analysis. Further well-constructed randomised controlled trials are needed to shed more light on this subject area. PMID:26568875

  7. Single incision transumbilical laparoscopic Roux-en-Y gastric bypass-our technique.

    PubMed

    Ahluwalia, Jasmeet Singh; Chang, Po-Chih; Yeh, Lee-Ren; Lin, Hung-Yu; Chi, Shu-Ching; Huang, Chih-Kun

    2014-09-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard procedure in bariatric surgery but requires 4-7 ports. We have reported the first single incision transumbilical Roux-en-Y gastric bypass (SITU-RYGB) in 2009 (Huang et al. Obes Surg 19:1711-1715, 2009). Over the years, we have standardized our procedure and this video highlights the same by showing both inside and outside views. This video was shot from outside as well to give better understanding of the procedure. A 4.5-cm incision was made according to the contour of umbilicus and space was created over the sheath to give more range of movement to the instruments. The procedure was carried out using conventional laparoscopic instruments and replicating all the steps of the procedure under adequate visualization. Picture-in-picture effect has been used at important steps. Findings were recorded. The procedure took 96 min without any intraoperative complication. Blood loss was 20 cc. The incision was hardly noticeable at the end of the procedure. We have previously compared our results of SITU-RYGB with that of our multiport RYGB where operative time was longer for SITU-RYGB versus multiport technique (101.1 vs. 81.1 min, P?=?0.001) (Huang et al. Surg Obes Relat Dis 8:201-207, 2012). No difference in complications was observed. The SITU-LRYGB patients reported greater satisfaction related to scarring than those who had undergone five-port surgery (P?=?0.005). Difference in analgesia requirement was not statistically significant. There was no mortality. Compared with conventional LRYGB, SITU-RYGB resulted in acceptable complications, the same recovery, comparative weight loss, and better patient satisfaction related to scarring. PMID:25012768

  8. Totally Laparoscopic Roux-en-Y Gastrojejunostomy after Laparoscopic Distal Gastrectomy: Analysis of Initial 50 Consecutive Cases of Single Surgeon in Comparison with Totally Laparoscopic Billroth I Reconstruction

    PubMed Central

    Cho, In; Choi, Yoon Young; Kim, Yoo Min; Noh, Sung Hoon

    2014-01-01

    Purpose Roux-en-Y reconstruction (RY) in laparoscopic distal gastrectomy for gastric cancer is a more complicated procedure than Billroth-I (BI) or Billroth-II. Here, we offer a totally laparoscopic simple RY using linear staplers. Materials and Methods Each 50 consecutive patients with totally laparoscopic distal gastrectomy with RY and BI were enrolled in this study. Technical safety and surgical outcomes of RY were evaluated in comparison with BI. Results In all patients, RY gastrectomy using linear staplers was safely performed without any events during surgery. The mean operation time and anastomosis time were 177.0±37.6 min and 14.4±5.6 min for RY, respectively, which were significantly longer than those for BI (150.4±34.0 min and 5.9±2.2 min, respectively). There were no differences in amount of blood loss, time to flatus passage, diet start, length of hospital stay, and postoperative inflammatory response between the two groups. Although there was no significant difference in surgical complications between RY and BI (6.0% and 14.0%), the RY group showed no anastomosis site-related complications. Conclusion The double stapling method using linear staplers in totally laparoscopic RY reconstruction is a simple and safe procedure. PMID:24339302

  9. Laparoscopic management of intra-abdominal infections: Systematic review of the literature

    PubMed Central

    Coccolini, Federico; Tranà, Cristian; Sartelli, Massimo; Catena, Fausto; Saverio, Salomone Di; Manfredi, Roberto; Montori, Giulia; Ceresoli, Marco; Falcone, Chiara; Ansaloni, Luca

    2015-01-01

    AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections. METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically. RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controlling the source. CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections. PMID:26328036

  10. Need for simulation in laparoscopic colorectal surgery training

    PubMed Central

    Celentano, Valerio

    2015-01-01

    The dissemination of laparoscopic colorectal surgery (LCS) has been slow despite increasing evidence for the clinical benefits, with a prolonged learning curve being one of the main restrictions for a prompt uptake. Performing advanced laparoscopic procedures requires dedicated surgical skills and new simulation methods designed precisely for LCS have been established: These include virtual reality simulators, box trainers, animal and human tissue and synthetic materials. Studies have even demonstrated an improvement in trainees’ laparoscopic skills in the actual operating room and a staged approach to surgical simulation with a combination of various training methods should be mandatory in every colorectal training program. The learning curve for LCS could be reduced through practice and skills development in a riskfree setting. PMID:26425266

  11. Laparoscopic Cystogastrostomy for Pancreatic Pseudocyst: A Case Report

    PubMed Central

    Morisaki, T.; Noshiro, H.; Mizumoto, K.; Yamaguchi, K.; Chijiiwa, K.; Tanaka, M.

    2000-01-01

    A 49-year-old man with a history of acute pancreatitis was hospitalized with a diagnosis of pancreatic pseudocyst. Ultrasonography, computed tomography, and magnetic resonance imaging all demonstrated a homogeneous cyst, 9 × 4 cm in size, at the tail of the pancreas without mural nodules or septa. Because an intestinal structure was identified between the cyst and stomach preoperatively by computed tomography and endoscopic ultrasonography, laparoscopic cystogastrostomy was carried out instead of percutaneous or endoscopic cyst drainage. The cyst was exposed by dissecting the lesser omentum and found to have no adhesion to the surrounding tissues. Anastomosis was performed using an endoscopic linear stapler via small cystotomy and gastrotomy openings on the lesser curvature, which were then sutured laparoscopically. The postoperative course was uneventful. Laparoscopic surgery is recommended as a safe, reliable, and minimally invasive treatment for managing pancreatic pseudocyst. PMID:11051191

  12. Prophylaxis of extrahepatic bile duct injuries during laparoscopic cholecystectomy.

    PubMed

    Rustamov, G; Pashaev, K; Tagiev, S; Rustamov, E

    2009-02-01

    The laparoscopic cholecystectomy is a "gold standard" for the gallstone treatment. But, like in all spheres of human activity it's necessary to perfect the operative technique for improving the results of any operation. Extrahepatic bile duct injuries are the main serious complications of laparoscopic cholecystectomy. The aim of the research is to investigate the causes of extrahepatic bile duct injuries and to work out preventive measures. Retrospective analysis of case histories of 3127 patients who underwent cholecystectomy from October 1994 to January in the minimal invasive surgical department of the Central Hospital of Caspian Shipping Company was conducted. The original method of tissue dissection for different laparoscopic operations was introduced. Advantages of the method: delicate tissue dissection, less time for operation, gentle tissue separation in Calot's triangle, safe separation of the gallbladder from the liver bed, low postoperative complication rate. PMID:19276461

  13. Two pregnancy cases of uterine scar dehiscence after laparoscopic myomectomy

    PubMed Central

    Song, Soo-Youn; Yoo, Hee-Jun; Kang, Byung-Hun; Ko, Young-Bok; Lee, Ki-Hwan

    2015-01-01

    Uterine scar dehiscence following laparoscopic myomectomy rarely occurs but can compromise both maternal and fetal well-being in subsequent pregnancy. We here present two cases of pregnancy complicated by preterm birth that resulted from uterine scar dehiscence following laparoscopic myomectomy. First case was a nulligravida who had scar dehiscence at 26 weeks of gestation after having a laparoscopic myomectomy 3 months prior to conception. Two weeks later, we observed her fetal leg protruding through the defect. The other case was a primigravida with a history of prior cesarean delivery, whose sonography revealed myomectomy scar dehiscence at 31 weeks of gestation. Within a few hours after observing, the patient complained of abdominal pain that was aggravating as fetal leg protruded through the defect. In both cases, babies were born by emergency cesarean section. Conservative management can be one of treatment options for myomectomy scar dehiscence in preterm pregnancy. However, clinicians should always be aware of the possibility of obstetric emergencies.

  14. Need for simulation in laparoscopic colorectal surgery training.

    PubMed

    Celentano, Valerio

    2015-09-27

    The dissemination of laparoscopic colorectal surgery (LCS) has been slow despite increasing evidence for the clinical benefits, with a prolonged learning curve being one of the main restrictions for a prompt uptake. Performing advanced laparoscopic procedures requires dedicated surgical skills and new simulation methods designed precisely for LCS have been established: These include virtual reality simulators, box trainers, animal and human tissue and synthetic materials. Studies have even demonstrated an improvement in trainees' laparoscopic skills in the actual operating room and a staged approach to surgical simulation with a combination of various training methods should be mandatory in every colorectal training program. The learning curve for LCS could be reduced through practice and skills development in a riskfree setting. PMID:26425266

  15. [Laparoscopic tubal coagulation--technic and follow-up results].

    PubMed

    Hopp, H; Rummler, S; Reumuth, J

    1983-01-01

    This report presents 155 cases of laparoscopic electrocoagulation of the fallopian tubes. 53 coagulations were performed with unipolar devices, 102 ones with bipolar technique.--The patency of tubal obliteration was tested 12 weeks after the operation hysterosalpingographically.--In 4 cases the contrast medium was forced through the obliterated part of the fallopian tube, but controlled a half year later the tubes are completely closed. Hysterosalpingographic studies are not suited to criticize the reliability of laparoscopic sterilization. Severe operative and early postoperative complications were not to be seen.--The laparoscopic bipolar coagulation of the fallopian tubes is a method without the high of electric accidents. There is a great efficacy in producing sterility. PMID:6219521

  16. 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

  17. Superconductivity: Extraordinarily conventional

    NASA Astrophysics Data System (ADS)

    Mazin, Igor I.

    2015-09-01

    Attitudes to high-temperature superconductivity have swung from disbelief to a conviction that it occurs only 'unconventionally'. But conventional superconductivity is now reported at record high temperatures. See Letter p.73

  18. 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

  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. [Laparoscopic cholecystectomy--results in the initial 100 cases].

    PubMed

    Frei, E; Middendorp, J; Klaiber, C; Akovbiantz, A

    1990-12-18

    100 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. In seven cases the laparoscopic procedure had to be converted into an open cholecystectomy due to bleeding, injury to the choledochus and acute cholecystitis. There were no postoperative complications. We feel that the indication for this method is broad. Independent of the size, the number and the chemical composition of calculi, this method is used for symptomatic gallbladder stones. All together the main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity. PMID:2148634

  1. 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

  2. Laparoscopic management of ovarian cysts: an endocrinologist view.

    PubMed Central

    Thornton, K. L.; DeCherney, A. H.

    1991-01-01

    The management of certain ovarian cysts has evolved from the traditional and often quite radical surgical approach to a more conservative approach. Much of this change can be attributed to the improvement in laparoscopic surgical technique. After a brief discussion of the differential diagnosis and clinical presentation of ovarian cysts, ultrasonographic features of certain ovarian cysts will be reviewed. Certainly the ability to characterize cysts ultrasonographically has facilitated gynecologists' ability to predict the neoplastic potential of a cyst and therefore to justify the more conservative approach. The various techniques of laparoscopic ovarian cyst aspiration, fenestration, and cystectomy will then be described. PMID:1839754

  3. Laparoscopic decompression as treatment for median arcuate ligament syndrome.

    PubMed

    Rubinkiewicz, M; Ramakrishnan, P K; Henry, B M; Roy, J; Budzynski, A

    2015-09-01

    Median arcuate ligament syndrome (MALS) is a rare disorder due to coeliac trunk compression by the median arcuate ligament, resulting in coeliac artery stenosis characterised by chronic, recurrent abdominal pain. Patients with MALS are often middle-aged females presenting with a triad of postprandial epigastric pain, weight loss and abdominal bruit. It is a diagnosis of exclusion and confirmed by computed tomography or magnetic resonance imaging. Laparoscopic or open surgical decompression are the only treatment options in MALS. We present two cases of MALS treated by laparoscopic decompression as well as a literature review on this treatment. PMID:26320770

  4. Robot-assisted laparoscopic bladder diverticulectomy.

    PubMed

    Eyraud, R; Laydner, H; Autorino, R; Panumatrassamee, K; Haber, G P; Stein, R J

    2013-02-01

    Robot-assisted laparoscopic bladder diverticulectomy (RALBD) has been increasingly reported in recent years. We review the technique of RALBD and the perioperative outcomes. We searched online databases to identify original articles related to RALBD. In the Method section, we describe our technique and reviewe several techniques for identification and robotic management of bladder diverticula. We identified 13 retrospective studies that met our criteria, with a total of 44 patients. The mean diverticulum size was 8.3?±?3.6 cm, mean operative time was 186?±?68 min, mean estimated blood loss was 86?±?64 ml, and mean length of stay was 2.4?±?1.7 days. In the majority of cases, patients with acquired diverticula underwent urethral catheter removal between 7 and 14 postoperative days while in the pediatric population with congenital bladder diverticula, Foley catheter removal usually occurred on postoperative day one. We conclude that a robotic technique is a feasible minimally invasive approach for bladder diverticulectomy. Potential benefits may include precise dissection of adjacent structures, as well as easier intracorporeal suturing. Further studies are needed to compare outcomes and costs versus other existing procedures. PMID:23184623

  5. Laparoscopic complete mesocolic excision: West meets East

    PubMed Central

    Chow, Carina F K; Kim, Seon Hahn

    2014-01-01

    Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units’ routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east. PMID:25339817

  6. Laparoscopic-Assisted Percutaneous Endoscopic Transgastrostomy Jejunostomy

    PubMed Central

    Dimofte, Mihail-Gabriel; Nicolescu, Simona; Ristescu, Irina; Lunca, Sorinel

    2014-01-01

    Background and Objectives: New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure. Methods: In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination. Results: Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day. Conclusions: LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt. PMID:25489214

  7. Laparoscopic and robotic adrenal surgery: transperitoneal approach.

    PubMed

    Okoh, Alexis K; Berber, Eren

    2015-10-01

    Recent advances in technology and the need to decrease surgical morbidity have led a rapid progress in laparoscopic adrenalectomy (LA) over the past decade. Robotics is attractive to the surgeon owing to the 3-dimensional image quality, articulating instruments, and stable surgical platform. The safety and efficacy of robotic adrenalectomy (RA) have been demonstrated by several reports. In addition, RA has been shown to provide similar outcomes compared to LA. Development of adrenal surgery has involved the description of several surgical approaches including the anterior transperitoneal, lateral transperitoneal (LT) and posterior retroperitoneal (PR). Among these, the most frequently preferred technique is LT adrenalectomy, primarily due to the surgeon's familiarity of the operative field, wider working space and visibility. The LT technique is suitable for the resection of larger, unilateral tumors and in scenarios where conversion to an open transperitoneal approach is warranted, it offers a lesser burden. Also, the larger view of the entire abdominal cavity and excellent exposure of both adrenal glands and surrounding structures provided by the LT technique render it safe and feasible in pediatric and pregnant individuals. PMID:26425457

  8. Laparoscopic and robotic adrenal surgery: transperitoneal approach

    PubMed Central

    Okoh, Alexis K.

    2015-01-01

    Recent advances in technology and the need to decrease surgical morbidity have led a rapid progress in laparoscopic adrenalectomy (LA) over the past decade. Robotics is attractive to the surgeon owing to the 3-dimensional image quality, articulating instruments, and stable surgical platform. The safety and efficacy of robotic adrenalectomy (RA) have been demonstrated by several reports. In addition, RA has been shown to provide similar outcomes compared to LA. Development of adrenal surgery has involved the description of several surgical approaches including the anterior transperitoneal, lateral transperitoneal (LT) and posterior retroperitoneal (PR). Among these, the most frequently preferred technique is LT adrenalectomy, primarily due to the surgeon’s familiarity of the operative field, wider working space and visibility. The LT technique is suitable for the resection of larger, unilateral tumors and in scenarios where conversion to an open transperitoneal approach is warranted, it offers a lesser burden. Also, the larger view of the entire abdominal cavity and excellent exposure of both adrenal glands and surrounding structures provided by the LT technique render it safe and feasible in pediatric and pregnant individuals. PMID:26425457

  9. The effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease.

    PubMed

    Lönnerfors, Celine; Reynisson, Petur; Geppert, Barbara; Persson, Jan

    2015-12-01

    The study objective was to assess the effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease. This is a retrospective cohort study. It is a Canadian Task Force classification II-2 study conducted at the University Hospital, Sweden. The patients were 949 women planned for robotic hysterectomy for malignant (75 %) and benign (25 %) gynecological disease between October 2005 and December 2013. They were continuously evaluated for the rate of intraoperative and postoperative complications up to 1-year post-surgery, the latter according to Clavien-Dindo classification following the introduction of robotic surgery with special awareness of complications possibly related to robot-specific risk factors, the description of refinement of practice and assessment of the effect of these measures. The rate of intraoperative complications, the overall rate of complications and the rate of ?grade 3 complications decreased from the first to the last time period (4.8 vs 2.6 %, p = 0.037, 34 vs 19 %, p = 0.003 and 13.5 vs 3.2 %, p = 0.0003, respectively). The rate of intraoperative complications and the rate of postoperative complications possibly related to robot-specific risk factors was reduced from the first to the last time period (3.8 vs 0.6 %, p = 0.028 and 7.7 vs 1.5 %, p = 0.003, respectively). In patients undergoing robotic hysterectomy for malignant and benign gynecological disease intraoperative and postoperative complications and complications possibly related to the robotic approach diminish with training, experience and refinement of practice. PMID:26530844

  10. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

    PubMed Central

    Ghai, Anju; Gupta, Monika; Hooda, Sarla; Singla, Dinesh; Wadhera, Raman

    2011-01-01

    Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1–2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS) ?3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: A single dose of 300 mg pregabalin given 1–2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo. PMID:21957402

  11. Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd International Consensus Conference on Laparoscopic Liver Resection.

    PubMed

    Wakabayashi, Go; Cherqui, Daniel; Geller, David A; Han, Ho-Seong; Kaneko, Hironori; Buell, Joseph F

    2014-10-01

    Six years have passed since the first International Consensus Conference on Laparoscopic Liver Resection was held. This comparatively new surgical technique has evolved since then and is rapidly being adopted worldwide. We compared the theoretical differences between open and laparoscopic liver resection, using right hepatectomy as an example. We also searched the Cochrane Library using the keyword "laparoscopic liver resection." The papers retrieved through the search were reviewed, categorized, and applied to the clinical questions that will be discussed at the 2nd Consensus Conference. The laparoscopic hepatectomy procedure is more difficult to master than the open hepatectomy procedure because of the movement restrictions imposed upon us when we operate from outside the body cavity. However, good visibility of the operative field around the liver, which is located beneath the costal arch, and the magnifying provide for neat transection of the hepatic parenchyma. Another theoretical advantage is that pneumoperitoneum pressure reduces hemorrhage from the hepatic vein. The literature search turned up 67 papers, 23 of which we excluded, leaving only 44. Two randomized controlled trials (RCTs) are underway, but their results are yet to be published. Most of the studies (n = 15) concerned short-term results, with some addressing long-term results (n = 7), cost (n = 6), energy devices (n = 4), and so on. Laparoscopic hepatectomy is theoretically superior to open hepatectomy in terms of good visibility of the operative field due to the magnifying effect and reduced hemorrhage from the hepatic vein due to pneumoperitoneum pressure. However, there is as yet no evidence from previous studies to back this up in terms of short-term and long-term results. The 2nd International Consensus Conference on Laparoscopic Liver Resection will arrive at a consensus on the basis of the best available evidence, with video presentations focusing on surgical techniques and the publication of guidelines for the standardization of procedures based on the experience of experts. PMID:25130985

  12. 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

  13. Massive Hematometra due to Congenital Cervicovaginal Agenesis in an Adolescent Girl Treated by Hysterectomy: A Case Report

    PubMed Central

    Gasim, Turki; Al Jama, Fathia E.

    2013-01-01

    A case of massive hematometra with a bicornuate uterus in a 14-year-old mentally handicapped girl complicated by vaginal agenesis and absent cervix is presented. She was managed by abdominal hysterectomy and right salpingo-oophorectomy that included the ovarian cystadenoma. The left ovary was conserved. This treatment was considered appropriate for this patient. PMID:23533866

  14. Retraction-Related Acute Liver Failure after Urological Laparoscopic Surgery

    PubMed Central

    Nozaki, Tetsuo; Kato, Tomonori; Komiya, Akira; Fuse, Hideki

    2014-01-01

    Liver retraction is necessary for optimal exposure during laparoscopic right renal surgery. We described a patient who developed fulminant liver failure as a result of liver retractor-induced excessive ischemic changes in the right lobe of the liver. A 37-year-old male underwent a right side laparoscopic pyeloplasty for ureteropelvic junction obstruction. At the beginning of the operation, a small snake retractor was placed through a 5-mm port under direct vision. The liver was lifted in the appropriate direction to optimize exposure by using the laparoscope holder. The operation was prolonged. However, we achieved significant improvements in the efficiency of liver retraction using the holder. On the first postoperative day, the patient's serum levels of GOT, GPT and LDH had remarkably increased. A computerized tomogram confirmed the presence of excessive ischemic changes of the right lobe of the liver. Our method which used a laparoscope holder device for liver retraction maintained a better surgical field. However, neglecting to make minor adjustments to the positioning of the retractor can cause significant pressure on the liver parenchyma in a single area. As surgical procedures increase in complexity, the surgeon should keep these potential side effects in mind and shift the retraction point at regular intervals. In this report, we discussed various types of retractor-related liver injuries and their management, and highlighted the importance of intermittent release of retraction during prolonged surgery. PMID:26195951

  15. Laparoscopic pancreatic resection: some benefits of evolving surgical techniques.

    PubMed

    Nakamura, Yoshiharu; Uchida, Eiji; Nomura, Tsutomu; Aimoto, Takayuki; Matsumoto, Satoshi; Tajiri, Takashi

    2009-01-01

    Laparoscopic pancreatic resection began to be reported in the first half of the 1990s, with subsequent reports focusing primarily on the safety and usefulness of laparoscopic distal pancreatectomy (Lap-DP) for benign and low-malignancy lesions of the pancreatic body and tail (such as chronic pancreatitis, neuroendocrine tumor, mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm). Recently we have also begun to see retrospective case-control studies comparing these techniques with open surgery, with Lap-DP showing advantages not only in terms of esthetics related to the surgical wound, but also with regard to reduced intraoperative bleeding, postoperative recovery time, and days of postoperative hospitalization. Prospective randomized controlled trials are still needed for confirmation, but it appears likely that this technique will become a standard surgical procedure for the treatment of diseases of the pancreatic body and tail. In contrast, laparoscopic pancreatoduodenectomy (Lap-PD) remains controversial in the minds of many pancreatic surgeons. This is primarily due to the difficulty of laparoscopic reconstruction following resection. However, there have recently been a number of single-center reports on the use of this procedure in at least 20 patients per center, showing that Lap-PD is associated with considerable reduction in intraoperative bleeding. Our own experience has been similar. In carefully selected patients, we find Lap-PD to be a useful surgical procedure. PMID:19585074

  16. Laparoscopic-assisted lumboperitoneal shunt placement for idiopathic intracranial hypertension.

    PubMed

    Hammers, Ronald; Prabhu, Vikram C; Sarker, Sharfi; Jay, Walter M

    2008-01-01

    Lumboperitoneal (LP) shunting is considered an effective method of cerebrospinal fluid (CSF) diversion in patients with idiopathic intracranial hypertension (IIH). Confirmation of flow out of the distal portion of the catheter once in its final position can be difficult, especially in obese individuals. A new technique to improve placement of the peritoneal catheter involves laparoscopic catheter insertion. We performed laparoscopic-assisted LP shunt placement for IIH on four patients. Improvement in preoperative IIH symptomatology was noted in all patients. No laparoscopic-procedure-related complications were noted. No problems were noted in shunt functioning and none of the shunts have required revision surgery at last follow-up. LP shunt related complications were noted in two of the four patients. Complications included bilateral lower extremity lumbar radiculopathy in one patient that resolved with a short course of gabapentin, spinal headache in one patient that resolved with bed rest and fluids, and development of a small intracranial subdural hygroma without mass effect in one patient that is asymptomatic and being followed without clinical consequence. Laparoscopic insertion of the abdominal catheter is safe and effective and does not appear to independently cause an increased risk of complications. PMID:18432541

  17. [INFULGAN-OPTIMAL ANALGETIC DRUG FOR USE IN LAPAROSCOPIC SURGERY].

    PubMed

    Nichitaylo, M E; Bulik, L M

    2015-06-01

    The experience of the application of 78 patients after various laparoscopic procedures was generalized. As perioperative anesthesia drug Infulgan (production of corporation "Jury-Farm") was applyed. Appointment of Infulgan in standard dose ensured the achievement expressed analgesic effect, reducing the volume of injected opioids and frequency of adverse reactions. PMID:26521456

  18. Laparoscopic first step approach in the two stage hepatectomy

    PubMed Central

    Levi Sandri, Giovanni Battista; Colace, Lidia; Vennarecci, Giovanni; Santoro, Roberto; Lepiane, Pasquale; Colasanti, Marco; Burocchi, Mirco

    2015-01-01

    Resection is the gold standard therapeutic option for patients with colorectal liver metastases. However, only 20-30% of patients are resectable. In patients with a concomitant future liver remnant (FLR) less than 25-30%, a single stage resection is not feasible. The aim of this study is to evaluate the feasibility and the rates of morbidity and mortality of the laparoscopic approach in the first-step of two stage hepatectomy. From 2004 to March 2014, 73 patients underwent a two stage hepatectomy: of these, four underwent a totally laparoscopic first step [wedge left liver resection and right portal vein ligation (PVL)]. All the patients were male. Median age was 55 years. One patient underwent an atypical wedge resection of segment II-III and a laparoscopic PVL (LPVL), one patient had a first wedge resection of segment II and LPVL, and two patients underwent a wedge resection of segment III and LPVL. First step surgical mean time was 189 (range, 160-244) min, mean blood loss was 22 (range, 0-50) cc. No transfusion was required in this series. The results of our study demonstrate that the first step of hepatic resection and PVL is feasible with a laparoscopic approach in patients with bilobar liver metastases. PMID:26605282

  19. Laparoscopic first step approach in the two stage hepatectomy.

    PubMed

    Levi Sandri, Giovanni Battista; Colace, Lidia; Vennarecci, Giovanni; Santoro, Roberto; Lepiane, Pasquale; Colasanti, Marco; Burocchi, Mirco; Ettorre, Giuseppe Maria

    2015-10-01

    Resection is the gold standard therapeutic option for patients with colorectal liver metastases. However, only 20-30% of patients are resectable. In patients with a concomitant future liver remnant (FLR) less than 25-30%, a single stage resection is not feasible. The aim of this study is to evaluate the feasibility and the rates of morbidity and mortality of the laparoscopic approach in the first-step of two stage hepatectomy. From 2004 to March 2014, 73 patients underwent a two stage hepatectomy: of these, four underwent a totally laparoscopic first step [wedge left liver resection and right portal vein ligation (PVL)]. All the patients were male. Median age was 55 years. One patient underwent an atypical wedge resection of segment II-III and a laparoscopic PVL (LPVL), one patient had a first wedge resection of segment II and LPVL, and two patients underwent a wedge resection of segment III and LPVL. First step surgical mean time was 189 (range, 160-244) min, mean blood loss was 22 (range, 0-50) cc. No transfusion was required in this series. The results of our study demonstrate that the first step of hepatic resection and PVL is feasible with a laparoscopic approach in patients with bilobar liver metastases. PMID:26605282

  20. Reducing the Cost of Laparoscopy: Reusable versus Disposable Laparoscopic Instruments

    PubMed Central

    Manatakis, Dimitrios K.; Georgopoulos, Nikolaos

    2014-01-01

    Cost-effectiveness in health care management is critical. The situation in debt-stricken Greece is further aggravated by the financial crisis and constant National Health System expense cut-downs. In an effort to minimize the cost of laparoscopy, our department introduced reusable laparoscopic instruments in December 2011. The aim of this study was to assess potential cost reduction of laparoscopic operations in the field of general surgery. Hospital records, invoice lists, and operative notes between January 2012 and December 2013, were retrospectively reviewed and data were collected on laparoscopic procedures, instrument failures, and replacement needs. Initial acquisition cost of 5 basic instrument sets was €21,422. Over the following 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, projected cost with disposable instruments would amount to €305,270, creating savings of €272,361 over the two-year period under study. Despite the seemingly high purchase price, each set amortized its acquisition cost after only 9 procedures and instrument cost depreciated to less than €55 per case. Disposable instruments cost 9 times more than reusable ones, and their high price would almost equal the total hospital reimbursement by social security funds for many common laparoscopic procedures. PMID:25152814

  1. Lower Esophageal Thickening Due to a Laparoscopic Adjustable Gastric Band

    PubMed Central

    Makker, Jitin; Conklin, Jeffrey

    2015-01-01

    Laparoscopic adjustable gastric band (LAGB) is a surgical device to treat obesity that is widely used and generally considered to be safe. We report an adverse event related to the physiological and mechanical changes that occur after LAGB placement, namely chronic obstruction resulting in marked lower esophageal thickening. PMID:26504870

  2. Role of laryngeal mask airway in laparoscopic cholecystectomy

    PubMed Central

    Beleña, José M; Ochoa, Ernesto Josué; Núñez, Mónica; Gilsanz, Carlos; Vidal, Alfonso

    2015-01-01

    Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway (LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low. PMID:26649155

  3. Laparoscopic liver resection for malignancy: A review of the literature

    PubMed Central

    Alkhalili, Eyas; Berber, Eren

    2014-01-01

    AIM: To review the published literature about laparoscopic liver resection for malignancy. METHODS: A PubMed search was performed for original published studies until June 2013 and original series containing at least 30 patients were reviewed. RESULTS: All forms of hepatic resections have been described ranging from simple wedge resections to extended right or left hepatectomies. The usual approach is pure laparoscopic, but hand-assisted, as well as robotic approaches have been described. Most studies showed comparable results to open resection in terms of operative blood loss, postoperative morbidity and mortality. Many of them showed decreased postoperative pain, shorter hospital stays, and even lower costs. Oncological results including resection margin status and long-term survival were not inferior to open resection. CONCLUSION: In the hands of experienced surgeons, laparoscopic liver resection for malignant lesions is safe and offers some short-term advantages over open resection. Oncologically, similar survival rates have been observed in patients treated with the laparoscopic approach when compared to their open resection counterparts. PMID:25309091

  4. Laparoscopic Ileocolic Resection for Crohn's Disease Associated With Midgut Malrotation

    PubMed Central

    Biancone, Livia; Tema, Giorgia; Porokhnavets, Kristina; Tesauro, Manfredi; Gaspari, Achille L.; Sica, Giuseppe S.

    2014-01-01

    Midgut malrotation is an anomaly of fetal intestinal rotation. Its incidence in adults is rare. A case of midgut malrotation in a 51-year-old man with complicated Crohn's disease of the terminal ileum is presented. Symptoms, diagnosis, and treatment are reviewed. Preoperative workup led to correct surgical planning that ultimately allowed a successful laparoscopic resection. PMID:25419109

  5. Laparoscopic natural orifice specimen extraction-colectomy: A systematic review

    PubMed Central

    Wolthuis, Albert M; de Buck van Overstraeten, Anthony; D’Hoore, André

    2014-01-01

    Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbidity and shortens hospital stay. In the quest to optimize outcomes after laparoscopic colorectal surgery, reduction of access trauma could be a way to improve recovery. To date, one method to reduce access trauma is natural orifice specimen extraction (NOSE). NOSE aims to reduce access trauma in laparoscopic colorectal surgery. The specimen is delivered via a natural orifice and the anastomosis is created intracorporeally. Different methods are used to extract the specimen and to create a bowel anastomosis. Currently, specimens are delivered transcolonically, transrectally, transanally, or transvaginally. Each of these NOSE-procedures raises specific issues with regard to operative technique and application. The presumed benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional and oncologic outcomes. These issues need to be studied in prospective randomized controlled trials. The aim of this systematic review is to describe the role of NOSE in minimally invasive colorectal surgery. PMID:25278692

  6. Radio frequency leakage current from unipolar laparoscopic electrocoagulators.

    PubMed

    DiNovo, J A

    1983-09-01

    Radio frequency (RF) leakage current has been suspected of causing accidental tissue burns associated with laparoscopic electrocoagulation used for tubal sterilization. A study was done to determine the levels of capacitively coupled RF leakage current from six unipolar laparoscopes manufactured by five companies. Leakage current values ranging from less than 100 mA to over 550 mA were measured at electrosurgical unit power settings of up to 150 w into 1,000 ohms. These levels represent 24-62% of the total electrosurgical current generated by the electrosurgical units. Using a criterion for tissue injury of 100 mA/sq cm applied for ten seconds, leakage current levels exceeding 400 mA are capable of producing burns either at the abdominal wall or to internal organs that accidentally come into contact with the body of the laparoscope. One of the six devices tested had leakage current levels higher than 400 mA at power settings lower than 100 w. Capacitance measurements between the unipolar laparoscope body and the forceps ranged from 53 to 140 picofarads. PMID:6226780

  7. Use of CO2 laser flexible waveguides during laparoscopic cholecystectomy

    NASA Astrophysics Data System (ADS)

    Lanzafame, Raymond J.

    1992-06-01

    Laparoscopic cholecystectomy has revolutionized the management of symptomatic cholelithiasis and cholecystitis. Although electrosurgery devices are used by a majority of surgeons, laser technology is a valued addition to the armamentarium of the skilled laser laparoscopist. A variety of fiberoptic capable wavelengths have been applied successfully during this procedure. Use of the CO2 laser for this purpose has lagged due to difficulties encountered with free-beam and rigid waveguide dissections via the laparoscope. Recent developments in flexible waveguide technology have the potential to expand the role of the CO2 laser for laparoscopic cholecystectomy and other procedures. Twelve laparoscopic cholecystectomies were performed using Luxar (Bothell, WA) flexible microwaveguides of various configurations. In each case, dissection of the gallbladder from the gallbladder bed was accomplished with acceptable speed and hemostasis. There were no complications. Shortcomings include coupling and positioning with an articulated arm and occasional clogging of some waveguide tips with debris. Modifications of this technology are suggested. Flexible waveguides make the CO2 laser a practical alternative for surgical laparoscopy.

  8. Role of laryngeal mask airway in laparoscopic cholecystectomy.

    PubMed

    Beleña, José M; Ochoa, Ernesto Josué; Núñez, Mónica; Gilsanz, Carlos; Vidal, Alfonso

    2015-11-27

    Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway (LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low. PMID:26649155

  9. SYSTEM FOR LAPAROSCOPIC TISSUE TRACKING Darin Knaus1

    E-print Network

    Miga, Michael I.

    measured during laboratory testing, and shows data obtained from use of the system during surgery on an experimental animal. 1. INTRODUCTION The goal of this work is the development of a laparoscopic system-guided surgery (Figure 1). The clinical objective of the system is to bring the benefits of image-guided surgery

  10. Obstructive jaundice: a rare complication of laparoscopic greater curvature plication

    PubMed Central

    Almulaifi, Abdullah; Mohammad, Waleed M.

    2013-01-01

    Laparoscopic greater curvature plication (LGCP) is relatively a new procedure. We report a novel complication of obstructive jaundice in a 24-year-old patient post LGCP. This was secondary to gastric mucosa prolapse with obstruction of the ampulla of Vater. A literature review revealed no previous reports of similar complication. PMID:24964469

  11. Patients awaiting laparoscopic cholecystectomy--can preoperative complications be predicted?

    PubMed Central

    Thornton, D. J. A.; Robertson, A.; Alexander, D. J.

    2004-01-01

    AIMS: To determine the nature and incidence of gallstone-related complications arising in patients awaiting laparoscopic cholecystectomy and to formulate a strategy to detect those most in need of urgent intervention. PATIENTS AND METHODS: A retrospective analysis of the case notes of 337 consecutive patients undergoing laparoscopic cholecystectomy under a single surgeon in a district general hospital between 1995 and 1999. RESULTS: Of patients awaiting laparoscopic cholecystectomy, 65 (19.3%) were documented as suffering significant on-going symptoms, of whom 19 (5.6%) required hospital admission or urgent surgical review at median 8.9 weeks (range 0.1-32.3 weeks) after being placed on the waiting list. Factors predictive of symptom recurrence included: (i) initial acute presentation; (ii) diagnoses of jaundice, pancreatitis, or acute cholecystitis; (iii) elevation of amylase or liver function tests; and (iv) small stones on ultrasonography examination. CONCLUSIONS: A significant proportion of patients awaiting laparoscopic cholecystectomy experience stone-related complications requiring hospital admission. We feel it is possible to reduce this number by selecting those most at risk on the basis of their history and pre-operative investigations for more urgent intervention. PMID:15005924

  12. Novel device to assist urethrovesical anastomosis during laparoscopic radical prostatectomy.

    PubMed

    Ramani, Anup P; Braasch, Matthew; Monga, Manoj; Ryndin, Igor; Botnaru, Andrei

    2005-11-01

    We evaluated a novel urethral sound (Benique sound-Karl Storz) to assist suturing during laparoscopic radical prostatectomy. This sound provides for a more secure grip compared with the traditional sound, thereby affording controlled traction of the gland during the procedure and smooth coordinated movements of the sound during the anastomosis. PMID:16286135

  13. Advanced Training in Laparoscopic Abdominal Surgery (Atlas): A Systematic Review

    PubMed Central

    Beyer-Berjot, Laura; Palter, Vanessa; Grantcharov, Teodor; Aggarwal, Rajesh

    2014-01-01

    Background Simulation has widely spread this last decade, especially in laparoscopic surgery, and training out of the operating room (OR) has proven its positive impact on basic skills during real laparoscopic procedures. However, few articles dealing with advanced training in laparoscopic abdominal surgery (ATLAS) have been published so far. Such training may reduce learning curves in the OR for junior surgeons with limited access to complex laparoscopic procedures as a primary operator. Methods Two reviewers, using MEDLINE, EMBASE, and The Cochrane Library, conducted a systematic research with combinations of the following keywords: (teaching OR education OR computer simulation) AND laparoscopy AND (gastric OR stomach OR colorectal OR colon OR rectum OR small bowel OR liver OR spleen OR pancreas OR advanced surgery OR advanced procedure OR complex procedure). Additional studies were searched in the reference lists of all included articles. Results Fifty-four original studies were retrieved. Their level of evidence was low: most of the studies were case series, one fifth purely descriptive, and there were 8 randomized trials. Porcine models and video trainers, as well as gastric and colorectal procedures were mainly assessed. The retrieved studies showed some encouraging trends in terms of trainees' satisfaction, improvement after training (but mainly on the training tool itself). Some tools have been proven to be construct-valid. Conclusions Higher quality studies are required to appraise ATLAS educational value. PMID:24947643

  14. Reducing the Cost of Laparoscopy: Reusable versus Disposable Laparoscopic Instruments.

    PubMed

    Manatakis, Dimitrios K; Georgopoulos, Nikolaos

    2014-01-01

    Cost-effectiveness in health care management is critical. The situation in debt-stricken Greece is further aggravated by the financial crisis and constant National Health System expense cut-downs. In an effort to minimize the cost of laparoscopy, our department introduced reusable laparoscopic instruments in December 2011. The aim of this study was to assess potential cost reduction of laparoscopic operations in the field of general surgery. Hospital records, invoice lists, and operative notes between January 2012 and December 2013, were retrospectively reviewed and data were collected on laparoscopic procedures, instrument failures, and replacement needs. Initial acquisition cost of 5 basic instrument sets was €21,422. Over the following 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, projected cost with disposable instruments would amount to €305,270, creating savings of €272,361 over the two-year period under study. Despite the seemingly high purchase price, each set amortized its acquisition cost after only 9 procedures and instrument cost depreciated to less than €55 per case. Disposable instruments cost 9 times more than reusable ones, and their high price would almost equal the total hospital reimbursement by social security funds for many common laparoscopic procedures. PMID:25152814

  15. Magnetic link design for a robotic laparoscopic camera

    NASA Astrophysics Data System (ADS)

    Simi, Massimiliano; Ciuti, Gastone; Tognarelli, Selene; Valdastri, Pietro; Menciassi, Arianna; Dario, Paolo

    2010-05-01

    The use of magnetic fields to control and steer assistive and operative devices is increasing in minimally invasive surgical applications. The design of the magnetic link between an external permanent magnet, maneuvered by an industrial robot, and a robotic laparoscopic camera was investigated in this paper, with the objective to obtain accurate positioning and steering in visualization.

  16. Laparoscopic Transhiatal Esophagectomy at a Low-Volume Center

    PubMed Central

    Price, Phillip

    2011-01-01

    Background and Objectives: Surgical treatment of esophageal cancer is associated with a high rate of morbidity, even in specialized centers. Minimally invasive esophageal resection has become increasingly feasible and is gaining popularity in some high-volume institutions. This study assesses the short-term outcomes of laparoscopic transhiatal esophagectomy performed by a single surgeon at a single low-volume institution over a 20-month period. Methods: Over the study period, 16 patients underwent laparoscopic transhiatal esophagectomy. All patients were men with an average age of 70 years (range, 50 to 81). Results: Two patients required intraoperative conversion to alternative surgical techniques, 1 to an Ivor-Lewis esophagectomy and 1 to an open transhiatal approach. Average operative time was 198 minutes (range, 147 to 303). Mean hospital stay was 16.7 days (range, 9 to 30). The average number of resected lymph nodes was 11.7, and 2 patients had benign pathology. No deaths occurred in the 30-day postoperative period. Conclusion: Laparoscopic transhiatal esophagectomy is an advanced laparoscopic procedure that can be performed with equivalent morbidity and mortality by a low-volume surgeon in a low-volume center with results comparable to those of high-volume centers. While several authors have demonstrated a correlation between lower mortality rates and high-volume esophagectomy hospitals, our results support surgeon experience as more important than the absolute number of procedures performed each year. PMID:21902941

  17. Visuospatial Ability Factors and Performance Variables in Laparoscopic Simulator Training

    ERIC Educational Resources Information Center

    Luursema, Jan-Maarten; Verwey, Willem B.; Burie, Remke

    2012-01-01

    Visuospatial ability has been shown to be important to several aspects of laparoscopic performance, including simulator training. Only a limited subset of visuospatial ability factors however has been investigated in such studies. Tests for different visuospatial ability factors differ in stimulus complexity, in their emphasis on identifying…

  18. Laparoscopic Surgical Robot for Remote In Vivo Training Brian Allena

    E-print Network

    Faloutsos, Petros

    and for performing the in vivo surgery, thereby providing a realistic training platform for non-robotic laparoscopic, surgical training 1 Introduction Minimally invasive surgery (MIS) provides significant benefits to patients@cs.ucla.edu 1 #12;Surgery (FLS) program [5]. To train higher-level skills, simplistic models may be insufficient

  19. The early outcome of single-incision versus multi-port laparoscopic cholecystectomy

    PubMed Central

    Hosseini, Seyed Vahid; Solhjou, Zhabiz; Pourahmad, Saeedeh; Rahimikazerooni, Salar; Gabash, Khairallah Muzhir; Bagherpourjahromi, Ali; Rezaianzadeh, Abbas; Bahrami, Faranak

    2015-01-01

    Background: Single-incision laparoscopic cholecystectomy (SILC) is a newly developed method of performing cholecystectomy and has been increasingly used. The aim of this study is to see if SILC has any advantages over conventional (three-port) laparoscopic cholecystectomy (CLC). Materials and Methods: In this cross-sectional study, 52 patients who underwent SILC (group A) during the period from May 2011 to March 2013 were compared with 62 patients who underwent CLC (group B) at two centers affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. Data were gathered on operation time, pre- and postoperative complications, patients’ postoperative pain, pain reliever use, duration of hospital stay, and return to work, and these data were compared using SPSS software version 16. Results: The mean age of patients was 38.01 ± 13.24 in group A and 44.82 ± 15.11 in group B. Mean body mass index (BMI) was 23.97 ± 4.78 and 26.22 ± 4.67 in groups A and B, respectively. The mean operation time was 76.4 ± 29.0 min in group A and 72.9 ± 24.1 min in group B (P = 0.496). Preoperative complications were 3.8% in group A and 0 in group B (P = 0.206). Postoperative complications were 17.3% in group A and 11.3% in group B (P = 0.423). The mean for early postoperative pain revealed no significant difference (P = 0.814), but the mean pain on discharge was significantly higher in group A patients (P = 0.034). Regarding the mean admission time and return to normal activity, we found no significant differences. Conclusion: SILC does not have any special advantages over CLC with regard to surgical outcomes, but it can be a safe alternative to CLC, especially in patients concerned about cosmoses. PMID:26430654

  20. Risk factors for prolonged operative time in single-incision laparoscopic cholecystectomy

    PubMed Central

    Cheon, Seong Uk; Choi, In Seok

    2015-01-01

    Purpose We performed 3-channel single incision laparoscopic cholecystectomy (SILC) in earlier period of this study and modified our method to 4-channel SILC using a snake retractor for better operative field in later period. This study has been designed to evaluate the risk factors for prolonged operative time in SILC. Methods From April 2010 to August 2014, 323 cases of 3-channel SILC (Konyang standard method [KSM] group) and 399 cases of 4-channel SILC (modified KSM [mKSM] group) using a snake retractor were performed. Results The clinical characteristics were not significantly different between KSM and mKSM group except preoperative percutaneous transhepatic gallbladder drainage (PTGBD) treatment (9.6% vs. 16.5%, P < 0.007). The mean operation time was longer in mKSM group than KSM group (55.8 ± 19.7 minutes vs. 51.7 ± 20.1 minutes, P = 0.006). The estimated blood loss of KSM group was more than mKSM group (24.6 ± 54.1 mL vs. 16.9 ± 27.0 mL, P = 0.013). According to the histopathologic findings, acute cholecystitis or empyema were confirmed more in mKSM group as compared with KSM group (28% vs. 14.0%, P = 0.025). In multivariate analysis, the risk factors for prolonged operation time were drainage insertion, histopathologic findings (acute cholecystitis or empyema), surgeons' technical expertise, body mass index > 30 kg/m2 as well as the 4-channel SILC. Conclusion Among patients with these risk factors, conventional laparoscopic cholecystectomy could be considered as well although SILC might be safe and feasible modality for benign gallbladder disease. PMID:26576404

  1. Laparoscopic pyeloplasty. Indications, technique, and long-term outcome.

    PubMed

    Chen, R N; Moore, R G; Kavoussi, L R

    1998-05-01

    Laparoscopic pyeloplasty is one of several minimally invasive treatment options for UPJ obstruction. In fact, several endoscopically and fluoroscopically controlled methods of incising the obstructed UPJ are now available that are significantly less invasive and less morbid in comparison with open pyeloplasty. However, the long-term success rates of these incisional techniques are less than the rates reported for open pyeloplasty. Several causes of obstruction may be present in the primarily obstructed UPJ, including kinking or compression related to crossing vessels or intrinsic narrowing at the UPJ. One potential reason for the inferior success rates of incisional methods in comparison with open pyeloplasty is that the former techniques address the intrinsically narrowed UPJ but may not address extrinsic problems such as kinking of the ureter associated with fibrotic bands or compression from crossing vessels. Laparoscopic pyeloplasty addresses all potential causes of obstruction. Any fibrotic bands kinking the ureter are divided, and the ureter is spatulated through the level of the UPJ prior to completion of the anastomosis. If a crossing vessel is encountered, a dismembered pyeloplasty is performed, the ureter and renal pelvis are transposed to the opposite side of the vessels, and the anastomosis is completed. An additional disadvantage of incisional techniques is the significant risk of hemorrhage following incision of the UPJ, with as many as 3% to 11% of patients requiring blood transfusion. Hemorrhage may occur owing to an errant anterior incision, the presence of a crossing vessel, incision into the renal parenchyma adjacent to the UPJ, or as the result of bleeding from the percutaneous access site. In contrast, mean estimated blood loss in the authors' series of 57 laparoscopic pyeloplasties was 139 mL, and none of the patients required blood transfusion. Although it is more morbid in comparison with retrograde or fluoroscopically controlled endopyelotomy, laparoscopic pyeloplasty seems at least comparable to antegrade percutaneous endopyelotomy in terms of the length of hospitalization and patient convalescence. Laparoscopic pyeloplasty, however, offers a higher success rate than with incisional techniques, not only from a radiographic standpoint but from a subjective standpoint as determined by the results of the analogue pain and activity questionnaire. The major disadvantage of laparoscopic pyeloplasty is the need for proficiency in laparoscopic techniques and for a longer operative time. As a result, the literature on laparoscopic pyeloplasty consists primarily of small series. Janetschek and co-workers reported on a series of 17 patients who underwent laparoscopic pyeloplasty, including 14 via a transperitoneal approach and 3 via a retroperitoneal approach. Procedures performed included ureterolysis alone, dismembered pyeloplasty, and nondismembered (Fenger) pyeloplasty. "Fenger-plasty" is similar to Y-V pyeloplasty and is performed by incising the UPJ longitudinally and closing the incision transversely in a Heineke-Mikulicz fashion. Janetschek and colleagues reported a 100% success in the eight patients who underwent dismembered pyeloplasty but believed that this technique was too cumbersome and should be reserved for patients with long stenoses, dorsally crossing vessels, or large renal pelvis. Because two of the four patients undergoing ureterolysis alone failed treatment, Janetschek and colleagues have abandoned this technique. They now prefer the Fenger-plasty technique, even in the setting of ventrally crossing vessels, because the technique can be performed quickly with one to three sutures, and the anastomosis can be sealed with fibrin glue and a flap of Gerota's fascia. Their experience with this technique, however, remains relatively limited. Technologic advances such as the Endostitch device have facilitated reconstructive laparoscopic procedures such as pyeloplasty. (ABSTRACT TRUNCATED) PMID:9633588

  2. Comparison of Characteristics of Fibroids in African American and White Women Undergoing Pre-Menopausal Hysterectomy

    PubMed Central

    Moorman, Patricia G.; Leppert, Phyllis; Myers, Evan R.; Wang, Frances

    2012-01-01

    Objective To compare pathologic characteristics and epidemiologic risk factors for uterine fibroids in African American and white women undergoing hysterectomy. Design Cross-sectional analysis of women undergoing pre-menopausal hysterectomy. Setting Two university-associated hospitals in North Carolina. Patients African American (n=225) and white women (n=135) with fibroid diagnosis. Interventions None Main Outcome Measures Data were obtained from an in-person interview and abstracted from operative and pathologic reports. Analysis of variance and multiple linear regression models were used to identify characteristics associated with higher uterine weight, greater number of fibroids and size of largest fibroid. Results African American women had substantially more fibroids (9.9 versus 4.5) with a concomitant higher mean uterine weight (477 versus 267 grams). Although African American women had a higher prevalence of established risk factors for fibroids such as high body mass index and hypertension, these factors were not associated with larger uteri or more numerous fibroids. In multiple linear regression models, the only factors statistically significantly associated with higher uterine weight, larger fibroids and more numerous fibroids were race and nulligravidity. Conclusions The presentation of fibroids as measured by uterine size or number of fibroids is more severe in African American women as compared to white women. The differences in presentation cannot be explained by racial differences in the prevalence of known risk factors; additional research is needed on environmental and genetic factors that may increase risk for fibroids. PMID:23199610

  3. 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

  4. Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable?

    PubMed Central

    Postlewait, Lauren M.

    2015-01-01

    As a result of technological advances during the past two decades, surgeons now use minimally invasive surgery (MIS) approaches to pancreatic resection more frequently, yet the role of these approaches for pancreatic ductal adenocarcinoma resections remains uncertain, given the aggressive nature of this malignancy. Although there are no controlled trials comparing MIS technique to open surgical technique, laparoscopic distal pancreatectomy for pancreatic adenocarcinoma is performed with increasing frequency. Data from retrospective studies suggest that perioperative complication profiles between open and laparoscopic distal pancreatectomy are similar, with perhaps lower blood loss and fewer wound infections in the MIS group. Concerning oncologic outcomes, there appear to be no differences in the rate of achieving negative margins or in the number of lymph nodes (LNs) resected when compared to open surgery. There are limited recurrence and survival data on laparoscopic compared to open distal pancreatectomy for pancreatic adenocarcinoma, but in the few studies that assess long term outcomes, recurrence rates and survival outcomes appear similar. Recent studies show that though laparoscopic distal pancreatectomy entails a greater operative cost, the associated shorter length of hospital stay leads to decreased overall cost compared to open procedures. Multiple new technologies are emerging to improve resection of pancreatic cancer. Robotic pancreatectomy is feasible, but there are limited data on robotic resection of pancreatic adenocarcinoma, and outcomes appear similar to laparoscopic approaches. Additionally fluorescence-guided surgery represents a new technology on the horizon that could improve oncologic outcomes after resection of pancreatic adenocarcinoma, though published data thus far are limited to animal models. Overall, MIS distal pancreatectomy appears to be a safe and reasonable approach to treating selected patients with pancreatic ductal adenocarcinoma, though additional studies of long-term oncologic outcomes are merited. We review existing data on MIS distal pancreatectomy for pancreatic ductal adenocarcinoma. PMID:26261727

  5. Laparoscopic Cerclage as a Treatment Option for Cervical Insufficiency

    PubMed Central

    Bolla, D.; Raio, L.; Imboden, S.; Mueller, M. D.

    2015-01-01

    Background: The traditional surgical treatment for cervical insufficiency is vaginal placement of a cervical cerclage. However, in a small number of cases a vaginal approach is not possible. A transabdominal approach can become an option for these patients. Laparoscopic cervical cerclage is associated with good pregnancy outcomes but comes at the cost of a higher risk of serious surgical complications. The aim of the present study was to evaluate intraoperative and long-term pregnancy outcomes after laparoscopic cervical cerclage, performed either as an interval procedure or during early pregnancy, using a new device with a blunt grasper and a flexible tip. Methods: All women who underwent laparoscopic cervical cerclage for cervical insufficiency in our institution using the Goldfinger® device (Ethicon Endo Surgery, Somerville, NJ, USA) between January 2008 and March 2014 were included in the study. Data were collected from the patients? medical records and included complications during and after the above-described procedure. Results: Eighteen women were included in the study. Of these, six were pregnant at the time of laparoscopic cervical cerclage. Mean duration of surgery was 55?±?10 minutes. No serious intraoperative or postoperative complications occurred. All patients were discharged at 2.6?±?0.9 days after surgery. One pregnancy ended in a miscarriage at 12 weeks of gestation. All other pregnancies ended at term (>?37 weeks of gestation) with good perinatal and maternal outcomes. Summary: Performing a laparoscopic cervical cerclage using a blunt grasper device with a flexible tip does not increase intraoperative complications, particularly in early pregnancy. We believe that use of this device, which is characterized by increased maneuverability, could be an important option to avoid intraoperative complications if surgical access is limited due to the anatomical situation. However, because of the small sample size, further studies are needed to confirm our findings. PMID:26366003

  6. 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,…

  7. [Contemporary views on perioperative complications and adhaesion formation after vaginal hysterectomy, in relation to peritoneal closure vs. non-closure in combination with open vs. closed vaginal cuff].

    PubMed

    Watrowski, Rafa?; Friebe, Zbigniew

    2006-12-01

    There exists few evidence about peritoneal closure vs. non-closure at vaginal hysterectomy as well as only scanty evidence for open vs. sutured vaginal cuff. It seems that non-closure of the peritoneum at vaginal hysterectomy holds no risks and probably some advantages, e.g. faster resumption of bowel function. In the light of the rare direct evidence from vaginal surgery and the strong evidence from cesarean section and abdominal hysterectomy, we recommend abandoning the routine closure of the peritoneum at vaginal hysterectomy. The vaginal cuff left open is probably also a safe procedure, if the hemostasis has been done carefully. The most promising modification of the vaginal incision-and-closure seems to be the "Benenden-Hospital technique" (V-shaped posterior incision and running longitudinal closure of the vaginal skin with partially non-sutured peritoneum). PMID:17373125

  8. Laparoscopic ureteroureterostomy in children with a duplex collecting system plus obstructed ureteral ectopia.

    PubMed

    Olguner, Mustafa; Akgür, Feza M; Türkmen, Mehmet Atilla; Siyve, Serdar; Hakgüder, Gulce; Ate?, O?uz

    2012-04-01

    One of the complex upper urinary tract anomalies is a duplicated collecting system. In cases with a functioning upper moiety, ureteroureterostomy (UU) is the preferred operation to redirect the urine to the normal collecting system. Although open UU is a well-described operation, experience with laparoscopic repair pediatric patients is scarce. We describe the successful application of laparoscopic UU in 2 children and suggest that laparoscopic UU for the duplicated collecting system is a promising minimally invasive procedure. PMID:22498412

  9. The laparoscopic pyeloplasty: is there a role in the age of robotics?

    PubMed

    Reddy, Mallikarjun N; Nerli, Rajendra B

    2015-02-01

    Ureteropelvic junction (UPJ) obstruction is a common anomaly, and presents clinically in all pediatric age groups. The past 3 decades have witnessed an evolution in the surgical correction of UPJ obstruction on several fronts, with open surgical techniques yielding way to endoscopic, laparoscopic, and robotic-assisted approaches. Robotic-assisted surgery has several advantages in complex laparoscopic reconstructive procedures such as pyeloplasty. Comparative studies of laparoscopic and robot-assisted repairs have demonstrated similar success rates. Laparoscopic pyeloplasty is here to stay because of its advantages of safety, efficacy, decreased morbidity, reduced hospital stay, and, perhaps most importantly, cost-effectiveness. PMID:25455171

  10. Immersive training and mentoring for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Nistor, Vasile; Allen, Brian; Dutson, E.; Faloutsos, P.; Carman, G. P.

    2007-04-01

    We describe in this paper a training system for minimally invasive surgery (MIS) that creates an immersive training simulation by recording the pathways of the instruments from an expert surgeon while performing an actual training task. Instrument spatial pathway data is stored and later accessed at the training station in order to visualize the ergonomic experience of the expert surgeon and trainees. Our system is based on tracking the spatial position and orientation of the instruments on the console for both the expert surgeon and the trainee. The technology is the result of recent developments in miniaturized position sensors that can be integrated seamlessly into the MIS instruments without compromising functionality. In order to continuously monitor the positions of laparoscopic tool tips, DC magnetic tracking sensors are used. A hardware-software interface transforms the coordinate data points into instrument pathways, while an intuitive graphic user interface displays the instruments spatial position and orientation for the mentor/trainee, and endoscopic video information. These data are recorded and saved in a database for subsequent immersive training and training performance analysis. We use two 6 DOF DC magnetic trackers with a sensor diameter of just 1.3 mm - small enough for insertion into 4 French catheters, embedded in the shaft of a endoscopic grasper and a needle driver. One sensor is located at the distal end of the shaft while the second sensor is located at the proximal end of the shaft. The placement of these sensors does not impede the functionally of the instrument. Since the sensors are located inside the shaft there are no sealing issues between the valve of the trocar and the instrument. We devised a peg transfer training task in accordance to validated training procedures, and tested our system on its ability to differentiate between the expert surgeon and the novices, based on a set of performance metrics. These performance metrics: motion smoothness, total path length, and time to completion, are derived from the kinematics of the instrument. An affine combination of the above mentioned metrics is provided to give a general score for the training performance. Clear differentiation between the expert surgeons and the novice trainees is visible in the test results. Strictly kinematics based performance metrics can be used to evaluate the training progress of MIS trainees in the context of UCLA - LTS.

  11. Systematic Review of Surgical Approaches for Adrenal Tumors: Lateral Transperitoneal versus Posterior Retroperitoneal and Laparoscopic versus Robotic Adrenalectomy

    PubMed Central

    Chai, Young Jun; Kwon, Hyungju; Yu, Hyeong Won; Kim, Su-jin; Choi, June Young; Lee, Kyu Eun; Youn, Yeo-Kyu

    2014-01-01

    Background. Laparoscopic lateral transperitoneal adrenalectomy (LTA) has been the standard method for resecting benign adrenal gland tumors. Recently, however, laparoscopic posterior retroperitoneal adrenalectomy (PRA) has been more popular as an alternative method. This systematic review evaluates current evidence on adrenalectomy techniques, comparing laparoscopic LTA with PRA and laparoscopic adrenalectomy with robotic adrenalectomy. Methods. PubMed, Embase, and ISI Web of Knowledge databases were searched systematically for studies comparing surgical outcomes of laparoscopic LTA versus PRA and laparoscopic versus robotic adrenalectomy. The studies were evaluated according to the PRISMA statement. Results. Eight studies comparing laparoscopic PRA and LTA showed that laparoscopic PRA was superior or at least comparable to laparoscopic LTA in operation time, blood loss, pain score, hospital stay, and return to normal activity. Conversion rates and complication rates were similar. Six studies comparing robotic and laparoscopic adrenalectomy found that outcomes and complications were similar. Conclusion. Laparoscopic PRA was more effective than LTA, especially in reducing operation time and hospital stay, but there was no evidence showing that robotic adrenalectomy was superior to laparoscopic adrenalectomy. Cost reductions and further technical advances are needed for wider application of robotic adrenalectomy. PMID:25587275

  12. A rare case of subcapsular liver haematoma following laparoscopic cholecystectomy.

    PubMed

    Brown, Victoria; Martin, Jennifer; Magee, Damian

    2015-01-01

    Laparoscopic cholecystectomy is a commonly performed surgical procedure for the treatment of symptomatic cholelithiasis. As with all surgical procedures, it carries risk, with the most commonly reported complications including infection, bile leak and bleeding. One unusual complication is subcapsular liver haematoma, the diagnosis presented here. This is a rare occurrence; only a small number of cases have been reported in the literature and as yet no conclusive cause or management plan has been found. Iatrogenic liver trauma, the use of oral and intravenous non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants have all been named as possible contributing factors. Particularly, the use of ketorolac has been associated with four reported cases of subcapsular haematoma following laparoscopic cholecystectomy. The case reported here refutes that hypothesis, as neither NSAIDs nor anticoagulants were used during the treatment of this patient. PMID:26113588

  13. Three Trocars Laparoscopic Resection of Angiomyolipoma of the Liver

    PubMed Central

    Ramia, J. M.; De la Plaza, R.; Quiñones, J.; Sanchez-Tembleque, M. D.; Caminoa, A.; Veguillas, P.; García Parreño, J.

    2011-01-01

    Angiomyolipoma of the liver (AML) is an infrequent neoplasm composed of three tissues (adipose, muscle and vessels). In spite of advances in radiology, preoperative correct diagnosis is difficult. Clasically, a conservative management strategy was adopted in patients with asymptomatic tumors less than 5?cm with undoubtful diagnosis. But after publishing some few cases of malignant angiomyolipoma a more radical has been advocated. Laparoscopic resection of liver tumors is becoming a excellent approach for operating on benign liver tumors. Usually is performed using five trocars but in some cases a less invasive technique with three trocars could be used. We present a laparoscopic resection of liver angiomyolipoma in a 65 year-old male using only three trocars and also discuss the optimal management of AML and technical tips of three-trocar technique. PMID:22135749

  14. Three trocars laparoscopic resection of angiomyolipoma of the liver.

    PubMed

    Ramia, J M; De la Plaza, R; Quiñones, J; Sanchez-Tembleque, M D; Caminoa, A; Veguillas, P; García Parreño, J

    2011-01-01

    Angiomyolipoma of the liver (AML) is an infrequent neoplasm composed of three tissues (adipose, muscle and vessels). In spite of advances in radiology, preoperative correct diagnosis is difficult. Clasically, a conservative management strategy was adopted in patients with asymptomatic tumors less than 5?cm with undoubtful diagnosis. But after publishing some few cases of malignant angiomyolipoma a more radical has been advocated. Laparoscopic resection of liver tumors is becoming a excellent approach for operating on benign liver tumors. Usually is performed using five trocars but in some cases a less invasive technique with three trocars could be used. We present a laparoscopic resection of liver angiomyolipoma in a 65 year-old male using only three trocars and also discuss the optimal management of AML and technical tips of three-trocar technique. PMID:22135749

  15. Adoption of Laparoscopic Colorectal Surgery: It Was Quite a Journey.

    PubMed

    Senagore, Anthony J

    2015-09-01

    The adoption of laparoscopic colorectal surgery has been a slow but steady progress. The first adopters rapidly expanded the application of the technology to all colorectal pathology. Issues related to extraction and port site recurrence of cancer delayed widespread adoption until incontrovertible data from well-powered prospective randomized studies confirmed equipoise with open surgery. Since that time, the data has consistently demonstrated patient-care benefits related to reductions in both short- and long-term complications historically associated with open colectomy. The potential for further improvement related to single-port access, robotic assistance, and natural orifice access for both the surgery and/or extraction will await the test of time. However, it is clear now that laparoscopic colorectal surgery is the new standard of care and a key enabler of enhanced recovery programs. PMID:26491403

  16. Vertebral discitis after laparoscopic resection rectopexy: a rare differential diagnosis

    PubMed Central

    Probst, Pascal; Knoll, Sarah-Noemi; Breitenstein, Stefan; Karrer, Urs

    2014-01-01

    Vertebral discitis usually arises from haematogenous spread of pathogens to the discs and bones. Vertebral discitis can rarely occur as a complication after laparoscopic operations with fixating sutures on the promontory. We report the case of an 81-year-old woman who underwent a laparoscopic resection rectopexy because of rectal prolapse. Weeks after the operation, the patient developed lower back pain with radiation to both legs not responding to symptomatic therapy. Two months later, a magnetic resonance imaging of the lumbar spine showed vertebral osteomyelitis and discitis. A fixation on the promontory may be sufficiently traumatic to the spine to pave the way for subsequent infection. A high index of suspicion should be raised in patients with persistent, severe back pain. Anamnesis, imageing and an adequate specimen from the affected area for microbiological analysis are crucial for timely diagnosis and appropriate management involving targeted and prolonged antimicrobial therapy. PMID:25084791

  17. Profound bilateral visual loss after hysterectomy indicated for severe postpartum haemorrhage

    PubMed Central

    Ostri, Christoffer; Zibrandtsen, Nathalie; Larsen, Michael; Hamann, Steffen

    2014-01-01

    We present a case of a patient with bilateral posterior ischaemic optic neuropathy in the previously unreported setting of hysterectomy indicated for severe postpartum haemorrhage. The diagnosis was based on clinical and paraclinical examinations, including MRI of the head, electroretinography (ERG) and visual evoked potentials (VEP) testing. During 1?year of follow-up, repeated optical coherence tomography (OCT) scans demonstrated optic disc atrophy, which was interpreted as a sign of direct retrograde ganglion cell degeneration after ischaemic damage to the retrolaminar part of the optic nerves. The diagnosis of perioperative posterior ischaemic optic neuropathy is mostly a clinical diagnosis. However, MRI plays a major role in excluding other causes of visual loss, and VEP, ERG and OCT are valuable supplemental diagnostic tools. PMID:24395872

  18. Comparison between Preoperative Rectal Diclofenac Plus Paracetamol and Diclofenac Alone for PostoperativePain of Hysterectomy

    PubMed Central

    Samimi Sede, Saghar; Davari Tanha, Fateme; Valadan, Mehrnaz; Modaressi, Zeinab

    2014-01-01

    Objective: To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy. Materials and methods: Ninety female patients (American Society of Anesthesiologists (ASA) physical status I-II), scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8, 16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A 10 cm visual analog scale (VAS ) was used to assess pain intensity at rest. Results: In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower (13.9 ± 2.7 mg) compared to diclofenac group (16.8± 2.8 mg) and placebo group (20.1 ± 3.6 mg) (p<0.05). VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours (p<0.05). There had been a significant difference between combination group and the two other groups in terms of the first request of morphine (p<0.05). Conclusion: According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone. PMID:25628716

  19. Laparoscopic Repair of Morgagni Hernia Using Polyvinylidene Fluoride (PVDF) Mesh

    PubMed Central

    Godazandeh, Gholamali; Mortazian, Meysam

    2012-01-01

    We report the cases of two patients diagnosed with Morgagni hernia who presented with nonspecific abdominal symptoms. Both underwent laparoscopic surgery that used a dual-sided mesh, polyvinylidene fluoride (PVDF; Dynamesh IPOM®). The procedures were successful and both patients were discharged with no complications. There was no recurrence in 18 months of follow up.Herein is the report of these cases and a literature review. PMID:24829663

  20. Indocyanine green-enhanced fluorescence in laparoscopic sleeve gastrectomy.

    PubMed

    Frattini, Francesco; Lavazza, Matteo; Mangano, Alberto; Amico, Francesco; Rausei, Stefano; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

    2015-05-01

    The aim of this study is to present our preliminary experience with indocyanine green fluorescence (IGF) imaging in laparoscopic sleeve gastrectomy. After dissection of the greater curve sleeve, gastrectomy is performed using a linear articulated stapler. Once the stomach is resected, an indocyanine green solution is prepared and injected in a periferic vein. A laparoscopic system with a high-definition camera system connected to a laparoscope equipped with a specific filter for optimal detection of the near-infrared fluorescence was used at all times as previously reported in a paper of Boni et al. A methylene blue test is routinely performed after near-infrared fluorescence, and a routine gastrografin upper gastrointestinal study is performed on postoperative day 2. We retrospectively identified 15 patients undergoing laparoscopic sleeve gastrectomy between April and October 2014. IGF imaging was used for all patients. A regular and homogeneous perfusion was observed along the entire gastric sleeve including the esophago-gastric junction. On the contrary, the excised specimen appeared devascularized at IGF imaging as expected. Intraoperative methylene blue test was negative in all cases. The contrast swallow did not document any leak. Neither clinical leak nor other complications occurred postoperatively (minimum follow-up of 2 months). IGF is a recent development in minimally invasive surgery. In this preliminary experience, IGF results resemble to intraoperative methylene blue test and postoperative contrast swallow ones. IGF allows a real-time assessment and gives a direct image of tissue perfusion and vascularization. Moreover, IGF may be helpful to explain the exact pathogenesis of gastric leak. PMID:25736231

  1. The advantages of laparoscopic assisted bipolar high-frequency surgery.

    PubMed

    Mueller, W

    1993-04-01

    Monopolar and bipolar application techniques of high-frequency surgery are compared concerning safety regulations, functional and energetic aspects and aspects of application. The availability of newly developed bipolar and multipolar surgical instruments for cutting and coagulating without instrument change and at low high-frequency power opens up a new dimension in laparoscopic assisted electrosurgery. The well-known risks of using monopolar instruments in laparoscopy have been eliminated with the new instrumentation presented. PMID:8055307

  2. Single-incision laparoscopic cholecystectomy: How I do it?

    PubMed Central

    Bhandarkar, Deepraj; Mittal, Gaurav; Shah, Rasik; Katara, Avinash; Udwadia, Tehemton E

    2011-01-01

    Single-incision laparoscopic cholecystectomy (SILC) is a relatively new technique that is being increasingly used by surgeons around the world. Unlike the multi-port cholecystectomy, a standardised technique and detailed description of the operative steps of SILC is lacking in the literature. This article provides a stepwise account of the technique of SILC aimed at surgeons wishing to learn the procedure. A brief review of the current literature on SILC follows. PMID:21197237

  3. Surgical repair of intractable chylous ascites following laparoscopic anterior resection

    PubMed Central

    Ha, Gi Won; Lee, Min Ro

    2015-01-01

    Chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides and it is an unusual complication following surgical treatment of colorectal cancer. Conservative management is usually sufficient in patients with chylous ascites after surgery. However, we describe a patient with intractable chylous ascites after laparoscopic anterior resection for sigmoid colon cancer who failed initial conservative treatment. This patient was successfully managed by surgery. PMID:26019476

  4. Transition From Hand-Assisted to Pure Laparoscopic Donor Nephrectomy

    PubMed Central

    Lee, Chunwoo; Jeong, In Gab; Han, Duck Jong; Hong, Bumsik

    2015-01-01

    Background and Objectives: We compared perioperative donor outcomes and early graft function of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure laparoscopic donor nephrectomy (PLDN) performed by a single surgeon, to define the feasibility of technical transition from HALDN to PLDN. Methods: From October 1, 2012, through June 30, 2014, 60 donor nephrectomies were performed by a single surgeon who lacked experience with laparoscopic renal surgery: the first 30 by HALDN and the last 30 by PLDN. Operative and convalescence parameters were compared, as were intra- and postoperative complications within 90 days according to the Satava and Clavien-Dindo classifications, respectively. Binary logistic regression analysis was used to estimate the association of baseline characteristics with complications. Results: Baseline characteristics were similar in the 2 groups, except for American Society of Anesthesiologists score II (10.0% vs 43.3%; P = .007). All procedures were completed as planned. All operative and convalescence parameters of donors and graft outcomes were similar in the 2 groups, as were overall rates of intraoperative (43.3% vs 36.7%, P = .598) and postoperative (86.7% vs 70.0%; P = .209) complications. No factor was significantly predictive of intraoperative complications, whereas sex (female vs male, odds ratio, 0.183; P = .029) and learning curve (odds ratio, 0.602; P = .036) were significant determinants of postoperative complication. Conclusion: The technical transition from HALDN to PLDN does not involve a steep learning curve for surgeons less experienced with laparoscopic renal surgery and maintains similar perioperative donor and graft outcomes. PMID:26229420

  5. Laparoscopic versus open resection of gastric gastrointestinal stromal tumors

    PubMed Central

    Shu, Zhen-Bo; Li, Jun-Peng; Li, Yong-Chao; Ding, Da-Yong

    2013-01-01

    The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors (GISTs) would produce better perioperative and similar oncologic outcomes compared with open surgical resection in Chinese patients. Thirty-six gastric GISTs cases were divided into a minimally invasive laparoscopic group and open resection group, depending on the surgical approach that was used. The general preoperative information, operative time, incision length, intraoperative blood loss, postoperative time to first flatulence, postoperative complications, postoperative hospital stay, total hospitalization costs, and such follow-up data as recurrence, metastasis, and mortality rates were compared between two groups. Among the 36 gastric GISTs, 15 received laparoscopic surgical treatment (laparoscopy group, n=15), and 21 received routine open resection treatment (open resection group, n=21). The laparoscopy group and the open resection group showed statistically significant differences (P<0.05) in incision length (7.8±2.3 vs. 16.9±3.8 cm), postoperative time to first flatulence (3.8±1.3 vs. 5.1±2.1 d), postoperative hospitalization time (7.6±2.5 vs. 11.3±3.7 d), and total cost of hospitalization (RMB 28,239±5,521 vs. RMB 23,761±5,362). There were no statistically significant differences (P>0.05) between the laparoscopy group and the open resection group in operative time (147.8±59.3 vs. 139.2±62.1 min) and intraoperative blood loss (149.8±98.9 vs. 154.2±99.3 mL). Both groups had no postoperative complications, no recurrence and metastasis, and no postoperative mortality. There were no statistically significant differences between the two groups in postoperative complications, postoperative recurrence and metastasis, and postoperative mortality. In conclusion, compared with open resection, the laparoscopic resection of gastric GISTs offers the advantages of less trauma, faster recovery, and shorter hospital stay. PMID:23592898

  6. Toward real-time remote processing of laparoscopic video.

    PubMed

    Ronaghi, Zahra; Duffy, Edward B; Kwartowitz, David M

    2015-10-01

    Laparoscopic surgery is a minimally invasive surgical technique where surgeons insert a small video camera into the patient's body to visualize internal organs and use small tools to perform surgical procedures. However, the benefit of small incisions has a drawback of limited visualization of subsurface tissues, which can lead to navigational challenges in the delivering of therapy. Image-guided surgery uses the images to map subsurface structures and can reduce the limitations of laparoscopic surgery. One particular laparoscopic camera system of interest is the vision system of the daVinci-Si robotic surgical system (Intuitive Surgical, Sunnyvale, California). The video streams generate approximately 360 MB of data per second, demonstrating a trend toward increased data sizes in medicine, primarily due to higher-resolution video cameras and imaging equipment. Processing this data on a bedside PC has become challenging and a high-performance computing (HPC) environment may not always be available at the point of care. To process this data on remote HPC clusters at the typical 30 frames per second (fps) rate, it is required that each 11.9 MB video frame be processed by a server and returned within 1/30th of a second. The ability to acquire, process, and visualize data in real time is essential for the performance of complex tasks as well as minimizing risk to the patient. As a result, utilizing high-speed networks to access computing clusters will lead to real-time medical image processing and improve surgical experiences by providing real-time augmented laparoscopic data. We have performed image processing algorithms on a high-definition head phantom video (1920 × 1080 pixels) and transferred the video using a message passing interface. The total transfer time is around 53 ms or 19 fps. We will optimize and parallelize these algorithms to reduce the total time to 30 ms. PMID:26668817

  7. Towards real-time remote processing of laparoscopic video

    NASA Astrophysics Data System (ADS)

    Ronaghi, Zahra; Duffy, Edward B.; Kwartowitz, David M.

    2015-03-01

    Laparoscopic surgery is a minimally invasive surgical technique where surgeons insert a small video camera into the patient's body to visualize internal organs and small tools to perform surgical procedures. However, the benefit of small incisions has a drawback of limited visualization of subsurface tissues, which can lead to navigational challenges in the delivering of therapy. Image-guided surgery (IGS) uses images to map subsurface structures and can reduce the limitations of laparoscopic surgery. One particular laparoscopic camera system of interest is the vision system of the daVinci-Si robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). The video streams generate approximately 360 megabytes of data per second, demonstrating a trend towards increased data sizes in medicine, primarily due to higher-resolution video cameras and imaging equipment. Processing this data on a bedside PC has become challenging and a high-performance computing (HPC) environment may not always be available at the point of care. To process this data on remote HPC clusters at the typical 30 frames per second (fps) rate, it is required that each 11.9 MB video frame be processed by a server and returned within 1/30th of a second. The ability to acquire, process and visualize data in real-time is essential for performance of complex tasks as well as minimizing risk to the patient. As a result, utilizing high-speed networks to access computing clusters will lead to real-time medical image processing and improve surgical experiences by providing real-time augmented laparoscopic data. We aim to develop a medical video processing system using an OpenFlow software defined network that is capable of connecting to multiple remote medical facilities and HPC servers.

  8. Laparoscopic Gastric Plication in the Morbidly Obese Adolescent Patient

    PubMed Central

    Vanguri, Poornima; Brengman, Matthew; Oiticica, Claudio; Wickham, Edmond; Bean, Melanie; Lanning, David

    2014-01-01

    Childhood obesity is a significant problem. Due in part to suboptimal weight loss with lifestyle intervention alone, bariatric surgery, combined with ongoing lifestyle changes, has become a favorable approach in adolescents with severe obesity and weight-related comorbidities and is associated with effective weight loss and reducing weight-related comorbidities. Laparoscopic greater curvature plication is a promising new bariatric surgical procedure that has been shown to be effective in adults with severe obesity but has not been evaluated in the adolescent population. Gastric plication may be a particularly attractive approach for the adolescent patient as it is potentially reversible, does not involve the surgical removal of tissue and is without a significant malabsorptive component. Our team has obtained approval from our Institutional Review Board to perform a laparoscopic greater curvature plication on 30 adolescent patients with severe obesity and study its effect on weight loss, metabolic effects, and psychological functioning in the setting of a multidisciplinary program. Results of this study, including comprehensive clinical and psychological data collected over a three and a half year span, will inform larger prospective investigations comparing the laparoscopic greater curvature plication and other bariatric operations in the adolescent population. PMID:24491365

  9. Endoscopic Web Localization for Laparoscopic Duodenal Web Excision.

    PubMed

    Bruns, Nicholas E; Gibbons, Alexander T; Wyneski, Matthew J; Ponsky, Todd A

    2015-12-01

    When performing an open duodenal web excision, it is helpful to identify the web using a nasogastric tube because it is often difficult to determine where the web origin is located when looking at the serosal side of the bowel. However, it may be challenging to navigate the nasogastric tube to the web during laparoscopy. We present a novel technique that utilizes intraoperative endoscopy to precisely identify the location of the duodenal web, facilitating laparoscopic excision. Intraoperative endoscopy was implemented in the case of a 3-month-old boy undergoing laparoscopic excision of a duodenal web. With endoscopic visualization and transillumination, the duodenal web was precisely identified and excised laparoscopically. A supplemental video of the case presentation and technique is provided in the online version of this manuscript (Supplemental Digital Content 1, http://links.lww.com/SLE/A134). The procedure was completed successfully and the patient did well postoperatively. Flexible endoscopy is a useful adjunct for duodenal web localization during laparoscopy, improving on the previous method of estimating the location based on a change in duodenal caliber. PMID:26551236

  10. Fertility Considerations in Laparoscopic Treatment of Infiltrative Bowel Endometriosis

    PubMed Central

    Mohr, Catherine; Nezhat, Farr R.; Nezhat, Ceana H.; Seidman, Daniel S.

    2005-01-01

    Objective: The purpose of this study was to examine our experience with laparoscopic and laparoscopically assisted management of bowel endometriosis and to recommend treatment approaches, considering patient goals for both pain mitigation or fertility, or both. Methods: The medical records of 187 women treated laparoscopically for intestinal endometriosis were reviewed retrospectively for presenting symptoms, methods of surgical treatment, complications, and efficacy of treating pain and infertility. The extent of resection was determined by the severity of the endometriotic lesion, tempered by the patient's fertility goals. Results: The most common patient complaint preceding surgery was pelvic pain. In addition, 58 (31%) patients experienced impaired fertility. Of the patients available for long-term follow-up, 152 (85%) reported complete or significant long-term pain relief. Complete pain relief in the immediate postoperative period was significantly more likely with partial bowel resection compared with shaving only, 92% vs 80%, respectively, P<0.04. The least invasive procedure, shaving, was associated with a significantly lower complication rate, 6%, compared with 23% for disc excision (P<0.007) and 38% for segmental resection (P<0.001), and higher pregnancy rates. The incidence of pregnancy in patients with a history of infertility was 34% during the follow-up period. PMID:15791964

  11. Laparoscopic right hepatectomy for hepatocellular carcinoma in cirrhotic patient.

    PubMed

    Levi Sandri, Giovanni Battista; Colasanti, Marco; Santoro, Roberto; Ettorre, Giuseppe Maria

    2015-12-01

    Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor worldwide and the most common primary liver cancer. Liver resection or liver transplantation is the therapeutic gold standards in patient with HCC related with or without underline liver disease. We present a video case of a 68-year-old woman admitted to our surgical and liver transplantation unit for HCC on liver segment VII. Patient has HCV cirrhosis. Patient underwent to previous right portal vein embolization. Model of end staged liver disease was 7. Body mass index (BMI) was 26.3 and ASA score was 2. Alpha-fetoprotein was 768. According with our multidisciplinary group, we suggest a laparoscopic right hepatectomy for the patient. Operation time was 343 min and blood loss estimation was 200 CC. No transfusion was required. Post-operative course was uneventful, grade 0 of Clavien-Dindo Classification. Patient was discharged in day 7. Pathology report describes a 17 mm × 15 mm HCC grade 4, pT2N0. Laparoscopic liver resection (LLR) for HCC should be performed by dedicated surgical teams in hepatobiliary and laparoscopic surgery. The use of LLR in cirrhotic patients is in many centers proposed as the first-line treatment for HCC or as bridge treatment before liver transplantation. PMID:26734630

  12. Speech recognition for embedded automatic positioner for laparoscope

    NASA Astrophysics Data System (ADS)

    Chen, Xiaodong; Yin, Qingyun; Wang, Yi; Yu, Daoyin

    2014-07-01

    In this paper a novel speech recognition methodology based on Hidden Markov Model (HMM) is proposed for embedded Automatic Positioner for Laparoscope (APL), which includes a fixed point ARM processor as the core. The APL system is designed to assist the doctor in laparoscopic surgery, by implementing the specific doctor's vocal control to the laparoscope. Real-time respond to the voice commands asks for more efficient speech recognition algorithm for the APL. In order to reduce computation cost without significant loss in recognition accuracy, both arithmetic and algorithmic optimizations are applied in the method presented. First, depending on arithmetic optimizations most, a fixed point frontend for speech feature analysis is built according to the ARM processor's character. Then the fast likelihood computation algorithm is used to reduce computational complexity of the HMM-based recognition algorithm. The experimental results show that, the method shortens the recognition time within 0.5s, while the accuracy higher than 99%, demonstrating its ability to achieve real-time vocal control to the APL.

  13. Data analyses and perspectives on laparoscopic surgery for esophageal achalasia

    PubMed Central

    Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

    2015-01-01

    In general, the treatment methods for esophageal achalasia are largely classified into four groups, including drug therapy using nitrite or a calcium channel blocker, botulinum toxin injection, endoscopic therapy such as endoscopic balloon dilation, and surgery. Various studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy. The basic concept of this surgical therapy has not changed since Heller proposed esophageal myotomy for the purpose of resolution of lower esophageal obstruction for the first time in 1913, but the most common approach has changed from open-chest surgery to laparoscopic surgery. Currently, the laparoscopic surgery has been the procedure of choice for the treatment of esophageal achalasia. During the process of the transition from open-chest surgery to laparotomy, to thoracoscopic surgery, and to laparoscopic surgery, the necessity of combining antireflux surgery has been recognized. There is some debate as to which type of antireflux surgery should be selected. The Toupet fundoplication may be the most effective in prevention of postoperative antireflux, but many medical institutions have selected the Dor fundoplication which covers the mucosal surface exposed by myotomy. Recently, a new endoscopic approach, peroral endoscopic myotomy (POEM), has received attention. Future studies should examine the long-term outcomes and whether POEM becomes the gold standard for the treatment of esophageal achalasia. PMID:26478674

  14. Data analyses and perspectives on laparoscopic surgery for esophageal achalasia.

    PubMed

    Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

    2015-10-14

    In general, the treatment methods for esophageal achalasia are largely classified into four groups, including drug therapy using nitrite or a calcium channel blocker, botulinum toxin injection, endoscopic therapy such as endoscopic balloon dilation, and surgery. Various studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy. The basic concept of this surgical therapy has not changed since Heller proposed esophageal myotomy for the purpose of resolution of lower esophageal obstruction for the first time in 1913, but the most common approach has changed from open-chest surgery to laparoscopic surgery. Currently, the laparoscopic surgery has been the procedure of choice for the treatment of esophageal achalasia. During the process of the transition from open-chest surgery to laparotomy, to thoracoscopic surgery, and to laparoscopic surgery, the necessity of combining antireflux surgery has been recognized. There is some debate as to which type of antireflux surgery should be selected. The Toupet fundoplication may be the most effective in prevention of postoperative antireflux, but many medical institutions have selected the Dor fundoplication which covers the mucosal surface exposed by myotomy. Recently, a new endoscopic approach, peroral endoscopic myotomy (POEM), has received attention. Future studies should examine the long-term outcomes and whether POEM becomes the gold standard for the treatment of esophageal achalasia. PMID:26478674

  15. Laparoscopic right hepatectomy for hepatocellular carcinoma in cirrhotic patient

    PubMed Central

    Colasanti, Marco; Santoro, Roberto; Ettorre, Giuseppe Maria

    2015-01-01

    Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor worldwide and the most common primary liver cancer. Liver resection or liver transplantation is the therapeutic gold standards in patient with HCC related with or without underline liver disease. We present a video case of a 68-year-old woman admitted to our surgical and liver transplantation unit for HCC on liver segment VII. Patient has HCV cirrhosis. Patient underwent to previous right portal vein embolization. Model of end staged liver disease was 7. Body mass index (BMI) was 26.3 and ASA score was 2. Alpha-fetoprotein was 768. According with our multidisciplinary group, we suggest a laparoscopic right hepatectomy for the patient. Operation time was 343 min and blood loss estimation was 200 CC. No transfusion was required. Post-operative course was uneventful, grade 0 of Clavien-Dindo Classification. Patient was discharged in day 7. Pathology report describes a 17 mm × 15 mm HCC grade 4, pT2N0. Laparoscopic liver resection (LLR) for HCC should be performed by dedicated surgical teams in hepatobiliary and laparoscopic surgery. The use of LLR in cirrhotic patients is in many centers proposed as the first-line treatment for HCC or as bridge treatment before liver transplantation.

  16. [CRITERIONS OF EFFICACY OF THE SOFT TISSUES ELECTRIC WELDING FOR THE HEMOSTASIS GUARANTEEING IN LAPAROSCOPIC OPERATIONS].

    PubMed

    Shapovalova, Yu A

    2015-08-01

    Possibilities of application of generator for electric welding of soft tissues, used for hemostasis in laparoscopic operations, were studied. There was established, that while doing laparoscopic operation a biological welding of tissues secures a safe intra- and postoperative hemostasis, reduction of intra- and postoperative morbidity rate. PMID:26591856

  17. Applications of lasers in laparoscopic cholecystectomy: technical considerations and future directions

    NASA Astrophysics Data System (ADS)

    Lanzafame, Raymond J.

    1991-07-01

    Interest in lasers has increased exponentially due to the meteoric growth of laparoscopic cholecystectomy. This paper reviews the laser technologies available for laparoscopic use. The relative merits and liabilities for each wavelength and delivery system are discussed. Considerations for future developments of these technologies are provided.

  18. Laparoscopic Distal Pancreatectomy with or without Preservation of the Spleen for Solid Pseudopapillary Neoplasm

    PubMed Central

    Hori, Tomohide; Masui, Toshihiko; Kaido, Toshimi; Ogawa, Kohei; Yasuchika, Kentaro; Yagi, Shintaro; Seo, Satoru; Takaori, Kyoichi; Mizumoto, Masaki; Iida, Taku; Fujimoto, Yasuhiro; Uemoto, Shinji

    2015-01-01

    Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas. Laparoscopic distal pancreatectomy (DP) is a feasible and safe procedure, and successful spleen preservation rates are higher using a laparoscopic approach. We hypothesized that certain patients with SPN would be good candidates for laparoscopic surgery; however, few surgeons have reported laparoscopic DP for SPN. We discuss the preoperative assessment and surgical simulation for two SPN cases. A simulation was designed because we consider that a thorough preoperative understanding of the procedure based on three-dimensional image analysis is important for successful laparoscopic DP. We also discuss the details of the actual laparoscopic DP with or without splenic preservation that we performed for our two SPN cases. It is critical to use appropriate instruments at appropriate points in the procedure; surgical instruments are numerous and varied, and surgeons should maximize the use of each instrument. Finally, we discuss the key techniques and surgical pitfalls in laparoscopic DP with or without splenic preservation. We conclude that experience alone is inadequate for successful laparoscopic surgery. PMID:26587305

  19. Computer Aided Surgery, November 2012; 17(6): 269283 Sensor fusion for laparoscopic surgery skill acquisition

    E-print Network

    Alberta, University of

    process. Training for laparoscopic surgery is typically performed by having trainees practice on syntheticComputer Aided Surgery, November 2012; 17(6): 269­283 Sensor fusion for laparoscopic surgery skill of Computer Science and 2 Department of Surgery, University of Alberta, Edmonton, Alberta, Canada (Received 15

  20. High resolution imaging of endometriosis and ovarian carcinoma with optical coherence tomography: feasibility for laparoscopic-based imaging.

    PubMed

    Boppart, S A; Goodman, A; Libus, J; Pitris, C; Jesser, C A; Brezinski, M E; Fujimoto, J G

    1999-10-01

    High resolution imaging of gynaecological tissue offers the potential for identifying pathological changes at early stages when interventions are more effective. Optical coherence tomography (OCT) is a high resolution high speed optical imaging technology which is analogous to ultrasound B-mode imaging except reflections of light are detected rather than sound. The OCT technology is capable of being integrated with laparoscopy for real-time subsurface imaging. In this report, the feasibility of OCT for differentiating normal and pathologic laparoscopically-accessible gynaecologic tissue is demonstrated. Differentiation is based on architectural changes of in vitro tissue morphology. OCT has the potential to improve conventional laparoscopy by enabling subsurface imaging near the level of histopathology. PMID:10519434

  1. Educational level, prevalence of hysterectomy, and age at amenorrhoea: a cross-sectional analysis of 9536 women from six population-based cohort studies in Germany

    PubMed Central

    2014-01-01

    Background Hysterectomy prevalence has been shown to vary by education level. Hysterectomy influences age at amenorrhoea. The aim of this study was to examine these associations in Germany within population-based data sets. Methods Baseline assessments in six population-based cohorts took place from 1997 through 2006 and included 9,548 women aged 20–84 years. All studies assessed hysterectomy history, school and professional degrees. Degrees were categorized into three levels each. Adjusted prevalence ratios and 95% confidence intervals (95% CI) were estimated. Results Prevalences were higher in West Germany than East Germany, increased by age, and leveled off starting at 55–64 years. The age- and study-adjusted prevalence ratio (lowest versus highest school level) was 2.61 (95% CI: 1.28-5.30), 1.48 (95% CI: 1.21-1.81), and 1.01 (95% CI: 0.80-1.28) for women aged 20–45, 45–64, and 65 and more years respectively. The estimated adjusted prevalence ratios per one unit decrement of the educational qualification score (range 1?=?lowest, 8?=?highest) were 1.29 (95% CI: 1.02-1.64), 1.08 (95% CI: 1.04-1.12), and 0.98 (95% CI: 0.93-1.03) for women aged 20–44, 45–64, and 65–84 years respectively. Age at amenorrhoea was on average 6.2 years lower (43.5 years versus 49.7 years) among women with a history of hysterectomy than those without. Conclusions Lower educational level was associated with a higher hysterectomy prevalence among women aged 20–64 years. Several mediators associated with educational level and hysterectomy including women’s disease risk, women’s treatment preference, and women’s access to uterus-preserving treatment may explain this association. At population level, hysterectomy decreases the age of amenorrhoea on average by 6.2 years. PMID:24433474

  2. Vaginal Vault Suspension at Hysterectomy for Prolapse – Myths and Facts, Anatomical Requirements, Fixation Techniques, Documentation and Cost Accounting

    PubMed Central

    Graefe, F.; Marschke, J.; Dimpfl, T.; Tunn, R.

    2012-01-01

    Vaginal vault suspension during hysterectomy for prolapse is both a therapy for apical insufficiency and helps prevent recurrence. Numerous techniques exist, with different anatomical results and differing complications. The description of the different approaches together with a description of the vaginal vault suspension technique used at the Department for Urogynaecology at St. Hedwig Hospital could serve as a basis for reassessment and for recommendations by scientific associations regarding general standards. PMID:25278621

  3. Pelvic peritonization after laparoscopic abdominoperineal resection for low-rectal carcinoma treatment: surgical technique.

    PubMed

    Druzijani?, Nikica; Perko, Zdravko; Srsen, Darko; Pogoreli?, Zenon; Schwarz, Dragan; Jurici?, Josko

    2009-01-01

    Abdominoperineal resection is a standard method of low-rectum carcinoma treatment. It is associated with significant morbidity and mortality rates, which decreased with the development of preoperative diagnostic procedures, new surgical techniques and new surgical instruments. In this article, laparoscopic pelvic peritonization was used after laparoscopic rectum amputation for low-rectum carcinoma treatment. Pelvic peritonization is performed after laparoscopic recto-sigmoid extirpation, using the extended absorbable intracorporeal suture with titanic clip application after every second suture. The role of titanic clip is to grasp the extended suture and to mark the postoperative irradiation field. Laparoscopic pelvic peritonization after laparoscopic abdominoperineal rectum amputation is a simple procedure with clinical importance in possible adhesion and postirradiatic enteritis prevention. This procedure can satisfy all oncological requirements and minimally invasive surgery principles and is acceptable for every patient in which rectum amputation is indicated. PMID:19760934

  4. Reformed gallbladder after laparoscopic subtotal cholecystectomy: correlation of surgical findings with ultrasound and CT imaging†

    PubMed Central

    Di Sano, Suzanne J.; Bull, Nicholas B.

    2015-01-01

    Laparoscopic subtotal cholecystectomy is a technique that is becoming increasingly prevalent in modern surgery. It avoids the cystic duct and artery where acute or chronic cholecystitis prevents a safe laparoscopic dissection of these structures. There are numerous reports of symptomatic cystic duct remnants after subtotal cholecystectomy in the literature on post-cholecystectomy syndrome. We present a case report of a 62-year-old man who underwent emergent laparoscopic subtotal cholecystectomy complicated by the development of a persistent, controlled bile leak. This was followed on serial ultrasound examinations and managed with multiple drain insertions and endoscopic retrograde cholangiopancreatography. The patient represented 4 months later with right upper quadrant pain and was found to have an apparently normal gallbladder on CT abdomen. Repeat laparoscopic cholecystectomy demonstrated a reformed gallbladder wall and was completed in the standard fashion. This case demonstrates an unexpected complication of laparoscopic cholecystectomy with correlation of radiological and surgical findings. PMID:25650389

  5. Laparoscopic resection for rectal cancer and cholecystectomy for patient with situs inversus totalis

    PubMed Central

    Fang, Jia-Feng; Zheng, Zong-Heng; Wei, Bo; Chen, Tu-Feng; Lei, Pu-Run; Huang, Jiang-Long; Huang, Li-Jun; Wei, Hong-Bo

    2015-01-01

    Situs inversus totalis (SIT) is a rare congenital anomaly presenting with complete transposition of thoracic and abdominal viscera. Laparoscopic surgery for either rectal cancer or gallbladder diseases with SIT is rarely reported in the literature. A 39-year-old woman was admitted to hospital owing to rectal cancer. She was diagnosed with SIT by performing radiography and abdominal computed tomography scan as a routine preoperative investigation. We performed laparoscopic resection for rectal cancer successfully in spite of technical difficulties caused by abnormal anatomy. One year later, she was diagnosed with cholecysticpolyp, and we performed laparoscopic cholecystectomy for her uneventfully. With this case, we believe that performance by an experienced laparoscopic surgeon, either laparoscopic resection for rectal cancer or cholecystectomy with SIT is safe and feasible. PMID:26195883

  6. Learning curve in laparoscopic liver surgery: a fellow’s perspective

    PubMed Central

    Lee, Ser Yee; Chan, Chung Yip; Tan, Siong San

    2015-01-01

    The learning curve for laparoscopic liver surgery is infrequently addressed in current literature. In this paper, we explored the challenges faced in embarking on laparoscopic liver surgery in a unit that did predominantly open liver surgery. In setting up our laparoscopic liver surgery program, we adopted skills and practices learnt during fellowships at various high volume centers in North America and Australia, with modifications to suit our local patients’ disease patterns. We started with simple minor resections in anterolateral segments to build confidence, which allowed us to train the surgical and nursing team before progressing to more difficult resections. Inter institutional collaboration and exchange of skills also enabled the synergistic development of techniques for safe progression to more complex surgeries. Multimedia resources and international guidelines for laparoscopic liver surgery are increasingly accessible, which further guide the practice of this emerging field, as evidence continues to validate the laparoscopic approach in well selected cases.

  7. 'Stepped procedure' in laparoscopic cyst decortication during the learning period of laparoscopic surgery: Detailed evaluation of initial experiences

    PubMed Central

    Emre, Huri; Turgay, Akgül; Ali, Ayyildiz; Murat, Ba?cio?lu; Özgür, Yücel; Cankon, Germiyano?lu

    2010-01-01

    BACKGROUND: We evaluated the importance and efficacy of 'stepped procedure' in laparoscopic cyst decortication as an initial experience in it. MATERIALS AND METHODS: A 36 renal cyst cases were included. The stepped retroperitonoscopic cyst excision divided into three groups. First step, doing the incisions to place the ports and expanding the retroperitoneal space with balloon distension, second step, placement of trocars and reach to the cyst, third step, aspiration and decortication of the cyst. The difficulty of the sessions was measured with the Visual Analog Scale (VAS) scoring system. Score was determined according to the difficulty of the surgical step ranging from '0' to '10', '0', too easy, '10' too difficult'. The durations were measured. One-way ANOVA test was used for statistical analysis. RESULTS: The mean age was 52.0 (20-75) years. The mean operation time was 52.0 min. The mean duration of the first step was 12.5, second, 26.0 and third, 22.5 min. The mean VAS of first step, 3.2, second, 6.0 and third, 3.6 There were only significant differences in duration time and VAS score for second step among the surgeons (P<0.05). CONCLUSIONS: Laparoscopic cyst decortication may provide gaining experience to approach the kidney laparoscopically. The side, size and localization of cysts were not found associated with the difficulty of the method. PMID:20814509

  8. Laparoscopic surgery inhibits the proliferation and metastasis of cervical cancer cells

    PubMed Central

    Huang, Shouguo; Qin, Jie; Chen, Jin; Cheng, Hong; Meng, Qiu; Zhang, Jing; Wang, Haiyan; Li, Huaying

    2015-01-01

    Aims: The present study is to investigate the effect of laparoscopic surgery on the proliferation and metastasis of cervical cancer cells. Methods: A total of 40 patients with phase I squamous cell carcinoma of the cervix were enrolled in the study, and divided evenly into laparoscopic surgery group and laparotomy group. In addition, another 20 patients with benign uterine lesions received laparoscopic panhysterectomy using celoscopes and were enrolled as control group. Cell apoptotic rates were determined using flow cytometry. The expression of N-myc, Fas, metastasis-associated gene 1, and nm23-H1 genes in tissues were measured using quantitative real-time polymerase chain reaction. Results: Cervical cancer cell apoptosis was promoted by laparoscopic surgery, but not affected by laparotomy. The expression of apoptosis suppressor gene N-myc in cervical cancer cells was reduced by laparoscopic surgery, but not affected by laparotomy. In addition, the expression of apoptosis promoting gene Fas in cervical cancer cells was enhanced by laparoscopic surgery, but not affected by laparotomy. Similarly, the expression of metastasis promoting gene MTA1 in cervical cancer cells was lowered by laparoscopic surgery, but not affected by laparotomy. Moreover, the expression of metastasis suppressor gene nm23-H1 in cervical cancer cells was increased by laparoscopic surgery, but not affected by laparotomy. Of note, laparoscopic panhysterectomy had no effect on the apoptosis or the expression of N-myc, Fas, MTA1 and nm23-H1 genes in normal cervical cells. Conclusions: Laparoscopic surgery is a safe treatment method for cervical cancer. It inhibits the proliferation and metastasis of cancer cells, but has no such effects on normal cells. PMID:26629182

  9. Current status of robot-assisted laparoscopic radical prostatectomy: how does it compare with other surgical approaches?

    PubMed

    Lim, Sey Kiat; Kim, Kwang Hyun; Shin, Tae-Young; Rha, Koon Ho

    2013-03-01

    The aim was to review the current status and evaluate the outcomes of robot-assisted laparoscopic radical prostatectomy in comparison with open radical prostatectomy and laparoscopic radical prostatectomy. Between January 2008 and June 2012, published English language comparative studies comparing robot-assisted laparoscopic radical prostatectomy with either open radical prostatectomy and/or laparoscopic radical prostatectomy were reviewed. End-points for this review include oncological, functional and perioperative outcomes, and complications. Compared with laparoscopic radical prostatectomy and/or open radical prostatectomy, robot-assisted laparoscopic radical prostatectomy offered at least equivalent oncological control. Current evidence seems to suggest a superiority of robot-assisted laparoscopic radical prostatectomy over open radical prostatectomy and laparoscopic radical prostatectomy in terms of functional outcomes, such as urinary continence and potency. Risks of perioperative complications were also low after robot-assisted laparoscopic radical prostatectomy. Robot-assisted laparoscopic radical prostatectomy offers at least equivalent oncological and functional outcomes with low risks of complications when compared with open radical prostatectomy and laparoscopic radical prostatectomy. However, there is a paucity of high-level evidence available in current literature. PMID:23106163

  10. ESD and the Rio Conventions

    ERIC Educational Resources Information Center

    Sarabhai, Kartikeya V.; Ravindranath, Shailaja; Schwarz, Rixa; Vyas, Purvi

    2012-01-01

    Chapter 36 of Agenda 21, a key document of the 1992 Earth Summit, emphasised reorienting education towards sustainable development. While two of the Rio conventions, the Convention on Biological Diversity (CBD) and the United Nations Framework Convention on Climate Change (UNFCCC), developed communication, education and public awareness (CEPA)…

  11. Radical Hysterectomy

    MedlinePLUS

    ... and chemotherapy Sex and hormone therapy Surgery for breast cancer can affect sexuality, too Summary table of ... sex Chemotherapy changes the way you look Changing negative thoughts Overcoming depression Dealing with grief and loss ...

  12. Laparoscopic splenectomy: a single center experience. Unusual cases and expanded inclusion criteria for laparoscopic approach.

    PubMed

    Marte, Gianpaolo; Scuderi, Vincenzo; Rocca, Aldo; Surfaro, Giuseppe; Migliaccio, Carla; Ceriello, Antonio

    2013-06-01

    Laparoscopic splenectomy (LS) is nowadays considered as the gold standard for most hematological diseases where splenectomy is necessary, but many questions still remain. The aim of this study was to analyze our 5-years experiences consisting of 48 consecutive LS cases in order to assess the optimal approach and the feasibility of the procedure also in malignant diseases and unusual cases such as a primary spleen lymphoma, a big splenic artery aneurism, or a spleen infarct due to a huge pancreatic pseudo-cyst. Forty-eight consecutive patients underwent LS from January 2006 to January 2011 with at least 1-year follow-up. Clinical data and immediate outcome were retrospectively recorded; age, diagnosis, operation time, perioperative transfusion requirement, conversion rate, accessory incision, hospital stay, and complications were analyzed. We had 14 cases of malignant splenic disease, the most frequent malignant diagnosis was non-Hodgkin's lymphoma (12/14, 85.7 %). Splenomegaly (interpole diameter (ID) >20 cm) was observed in 12 cases (25 %) and massive splenomegaly (ID >25 cm) in 3 cases (6.25 %). Conversion to laparotomy occurred in two patients (4.16 %), both associated to uncontrollable bleeding in patients with splenomegaly. Mean operative time was 138 ± 22 min. Mean hospital stay was 4.5 days. Postoperative morbidity rate was 8.8 % for the benign group and 35.7 % in the malignant group. Mortality occurred in 1/48 patients (2.08 %), as a result of overwhelming post-splenectomy infection (OPSI). LS can be performed safely for malignant splenic disease and splenomegaly without any statistically significant increase of morbidity and mortality rate. Conversion rate is increased for massive splenomegaly. LS should be considered as the preferential approach even in patients with malignant disease, splenomegaly, or unusual cases. Massive splenomegaly should be considered as relative contraindication to LS even at experienced centers. PMID:23355349

  13. Conventional mechanical ventilation

    PubMed Central

    Tobias, Joseph D.

    2010-01-01

    The provision of mechanical ventilation for the support of infants and children with respiratory failure or insufficiency is one of the most common techniques that are performed in the Pediatric Intensive Care Unit (PICU). Despite its widespread application in the PICUs of the 21st century, before the 1930s, respiratory failure was uniformly fatal due to the lack of equipment and techniques for airway management and ventilatory support. The operating rooms of the 1950s and 1960s provided the arena for the development of the manual skills and the refinement of the equipment needed for airway management, which subsequently led to the more widespread use of endotracheal intubation thereby ushering in the era of positive pressure ventilation. Although there seems to be an ever increasing complexity in the techniques of mechanical ventilation, its successful use in the PICU should be guided by the basic principles of gas exchange and the physiology of respiratory function. With an understanding of these key concepts and the use of basic concepts of mechanical ventilation, this technique can be successfully applied in both the PICU and the operating room. This article reviews the basic physiology of gas exchange, principles of pulmonary physiology, and the concepts of mechanical ventilation to provide an overview of the knowledge required for the provision of conventional mechanical ventilation in various clinical arenas. PMID:20927268

  14. A Comparison of Single-, Two- and Three-Port Laparoscopic Myomectomy

    PubMed Central

    Kim, Su Mi; Baek, Jong Min; Park, Eun Kyung; Jeung, In Cheul; Choi, Ji Hyang; Kim, Chan Joo

    2015-01-01

    Background and Objective: A recent FDA safety communication has discouraged the use of a power morcellator for myoma extraction and has called for a change in surgical techniques for myomectomy. The objective of this study was to compare surgical outcomes of laparoscopic single-, two-, and conventional three-port myomectomy and to evaluate the feasibility of contained manual morcellation for uterine myoma. Methods: This retrospective study was a review and analysis of data from 191 consecutive women who underwent single-, two-, or three-port myomectomy for the management of uterine myoma from January 1, 2009, through December 31, 2014. Results: The 3 study groups did not differ demographically. Apart from operative time, the single- and two-port groups showed operative outcomes comparable to those of the multiport group. The single-port group had significantly longer operative times (P = .0053) than the two- and three-port groups. However, in the latter half of the single-port cases, the operative time was similar to those in the three-port group. The two-port surgery group showed a consistent operative time without a learning period. Conclusion: Single- or two-port myomectomy with transumbilical myoma morcellation is feasible and safe, with outcomes comparable to those of three-port myomectomy. These results suggest the potential for minimally invasive management of symptomatic uterine myoma, without the use of a power morcellator.

  15. Pain and Return to Daily Activities after Uterine Artery Embolization and Hysterectomy in the Treatment of Symptomatic Uterine Fibroids: Results from the Randomized EMMY Trial

    SciTech Connect

    Hehenkamp, Wouter J.K. Volkers, Nicole A.; Birnie, Erwin; Reekers, Jim A.; Ankum, Willem M.

    2006-04-15

    Purpose. To evaluate the safety and efficacy of uterine artery embolization (UAE) and hysterectomy for symptomatic uterine fibroids by means of a randomized controlled trial. The present paper analyses short-term outcomes, i.e., pain and return to daily activities. Methods. Patients were randomized (1:1) to UAE or hysterectomy. Pain was assessed during admission and after discharge, both quantitatively and qualitatively, using a numerical rating scale and questionnaires. Time to return to daily activities was assessed by questionnaire. Results. Seventy-five patients underwent hysterectomy and 81 patients underwent UAE. UAE patients experienced significantly less pain during the first 24 hr after treatment (p = 0.012). Non-white patients had significantly higher pain scores. UAE patients returned significantly sooner to daily activities than hysterectomy patients (for paid work: 28.1 versus 63.4 days; p < 0.001). In conclusion, pain appears to be less after UAE during hospital stay. Return to several daily activities was in favor of UAE in comparison with hysterectomy.

  16. Cost-Effectiveness of Global Endometrial Ablation vs. Hysterectomy for Treatment of Abnormal Uterine Bleeding: US Commercial and Medicaid Payer Perspectives

    PubMed Central

    Lenhart, Gregory M.; Bonafede, Machaon M.; Lukes, Andrea S.; Laughlin-Tommaso, Shannon K.

    2015-01-01

    Abstract Cost-effectiveness modeling studies of global endometrial ablation (GEA) for treatment of abnormal uterine bleeding (AUB) from a US perspective are lacking. The objective of this study was to model the cost-effectiveness of GEA vs. hysterectomy for treatment of AUB in the United States from both commercial and Medicaid payer perspectives. The study team developed a 1-, 3-, and 5-year semi-Markov decision-analytic model to simulate 2 hypothetical patient cohorts of women with AUB—1 treated with GEA and the other with hysterectomy. Clinical and economic data (including treatment patterns, health care resource utilization, direct costs, and productivity costs) came from analyses of commercial and Medicaid claims databases. Analysis results show that cost savings with simultaneous reduction in treatment complications and fewer days lost from work are achieved with GEA versus hysterectomy over almost all time horizons and under both the commercial payer and Medicaid perspectives. Cost-effectiveness metrics also favor GEA over hysterectomy from both the commercial payer and Medicaid payer perspectives—evidence strongly supporting the clinical-economic value about GEA versus hysterectomy. Results will interest clinicians, health care payers, and self-insured employers striving for cost-effective AUB treatments. (Population Health Management 2015;18:373–382) PMID:25714906

  17. Cost-Effectiveness of Global Endometrial Ablation vs. Hysterectomy for Treatment of Abnormal Uterine Bleeding: US Commercial and Medicaid Payer Perspectives.

    PubMed

    Miller, Jeffrey D; Lenhart, Gregory M; Bonafede, Machaon M; Lukes, Andrea S; Laughlin-Tommaso, Shannon K

    2015-10-01

    Cost-effectiveness modeling studies of global endometrial ablation (GEA) for treatment of abnormal uterine bleeding (AUB) from a US perspective are lacking. The objective of this study was to model the cost-effectiveness of GEA vs. hysterectomy for treatment of AUB in the United States from both commercial and Medicaid payer perspectives. The study team developed a 1-, 3-, and 5-year semi-Markov decision-analytic model to simulate 2 hypothetical patient cohorts of women with AUB-1 treated with GEA and the other with hysterectomy. Clinical and economic data (including treatment patterns, health care resource utilization, direct costs, and productivity costs) came from analyses of commercial and Medicaid claims databases. Analysis results show that cost savings with simultaneous reduction in treatment complications and fewer days lost from work are achieved with GEA versus hysterectomy over almost all time horizons and under both the commercial payer and Medicaid perspectives. Cost-effectiveness metrics also favor GEA over hysterectomy from both the commercial payer and Medicaid payer perspectives-evidence strongly supporting the clinical-economic value about GEA versus hysterectomy. Results will interest clinicians, health care payers, and self-insured employers striving for cost-effective AUB treatments. (Population Health Management 2015;18:373-382). PMID:25714906

  18. Pure laparoscopic management of a giant ovarian cyst in an adolescent

    PubMed Central

    Kilincaslan, Huseyin; Cipe, Gokhan; Aydogdu, Ibrahim; Sarac, Fatma; Toprak, Huseyin; Ari, Engin

    2014-01-01

    Patient: Female, 16 Final Diagnosis: Ovarian cyst Symptoms: — Medication: — Clinical Procedure: Laparoscopic surgery Specialty: Surgery Objective: Rare disease Background: The use of the laparoscopic approach versus open approach for the management of giant ovarian cysts is controversial. Exclusion of malignant conditions has critical importance in the laparoscopic management of these cases. However, in some cases, the possibility of malignancy and the ovarian origin of a cyst cannot be excluded during the preoperative period. Case Report: Herein we present the case of a 16-year-old girl with a giant ovarian cyst. The abdominal cavity was laparoscopically explored, and no signs suggestive of malignancy were encountered; the ovarian origin of the cyst was confirmed. A Veress needle was inserted percutaneously, and the cyst was drained and laparoscopically excised. No complications were encountered at follow-up visits 3 and 6 months after surgery. Conclusions: In addition to the well-known advantages of laparoscopic surgery (e.g., decreased postoperative pain, length of hospital stay, and wound infection), perfect cosmetic results are particularly important for young women. The pure laparoscopic management of giant ovarian cysts is safe and feasible. PMID:24427377

  19. Total laparoscopic subtotal gastrectomy with transvaginal specimen extraction is feasible in advanced gastric cancer

    PubMed Central

    Sumer, Fatih; Kayaalp, Cuneyt; Ertugrul, Ismail; Yagci, Mehmet Ali; Karagul, Servet

    2015-01-01

    Purpose Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer. Case A 72-year-old woman with a 2 cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy. Conclusions Transvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo–radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy. PMID:26413924

  20. Laparoscopic surgery for benign and malign diseases of the digestive system: Indications, limitations, and evidence

    PubMed Central

    Küper, Markus Alexander; Eisner, Friederike; Königsrainer, Alfred; Glatzle, Jörg

    2014-01-01

    The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s. Since then, the development of this technique has been extraordinary. Triggered by technical innovations (stapling devices or coagulation/dissecting devices), nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient’s condition. This summary gives an overview over 30 years of laparoscopic surgery with focus on today’s indications and evidence. Main indications remain the more common procedures, e.g., appendectomy, cholecystectomy, bariatric procedures or colorectal resections. For all these indications, the laparoscopic approach has become the gold standard with less perioperative morbidity. Regarding oncological outcome there have been several high-quality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections. Less common procedures like esophagectomy, oncological gastrectomy, liver and pancreatic resections can be performed successfully as well by an experienced surgeon. However, the evidence for these special indications is poor and a general recommendation cannot be given. In conclusion, laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery. PMID:24803799

  1. Comparative analysis of epidural bupivacaine versus bupivacaine with dexmedetomidine for vaginal hysterectomy

    PubMed Central

    Karhade, Seema Shreepad; Acharya, Shilpa Amol; Harnagale, Kalpana

    2015-01-01

    Background: Dexmedetomidine a new drug, which is alpha-two agonist, is recommended by manufacturers as an adjuvant in epidural analgesia and anesthesia. Aims: To study the effects of dexmedetomidine on quality and efficacy of the epidural bupivacaine 0.5% for vaginal hysterectomies, by studying the onset of action, duration of action, highest dermatomal level achieved, degree of motor blockade, intraoperative and postoperative anesthesia and analgesia achieved. Setting and Design: Prospective randomized study. Materials and Methods: In this study, 60 American Society of Anesthesiologists I and II patients requiring vaginal hysterectomy were enrolled. Patients were randomly divided into two groups - Group I: Control group receiving epidural bupivacaine 0.5% 15–20 ml only. Group II: Group receiving of epidural bupivacaine 0.5% 15–20 ml with dexmedetomidine 05 mcg/kg. Following parameters were noted: Time to onset of T10 dermatomal level, maximum sensory level achieved, time for complete motor block, time for two segmental dermatomes regression, regression to S1 dermatome, time for first rescue analgesic and total top ups required during study. Statistical Analysis: Mean and standard deviation was calculated. We used two independent sample t-test to find the P value. Software used STATA 13.0. Results: The demographic profile was comparable between the groups. There was significant difference between two groups (P < 0.001) regarding onset of analgesia to T10 (17.12 ± 2.44 vs. 10.14 ± 2.94), time to achieve complete motor block (27.16 ± 4.52 vs. 22.98 ± 4.78), which was earlier in dexmedetomidine with bupivacaine group. Prolonged postoperative analgesia, less rescue top ups and adequate sedation score was found with dexmedetomidine group. The intraoperative hemodynamic changes were comparable in both the groups. The incidence of dry mouth, shivering and nausea was more with the dexmedetomidine group. Conclusion: We conclude that epidural dexmedetomidine 0.5 µg/kg is a good adjuvant providing early onset of sensory and motor block, adequate sedation and prolonged postoperative analgesia with minimal side-effects. PMID:26712965

  2. Virtual Reality Training Versus Blended Learning of Laparoscopic Cholecystectomy

    PubMed Central

    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.

    2015-01-01

    Abstract 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

  3. Intraabdominal abscess managed successfully via the laparoscopic approach.

    PubMed

    Bálint, A; Bátorfi, J; Máté, M; Sándor, J; Romics Jr, L; Ihász, M

    2000-06-01

    A rare complication of laparoscopic fundoplication-an intraabdominal abscess located between the fundus and the caudate lobe of the liver-is described. A 41-year-old man had undergone a laparoscopic Nissen-Rossetti fundoplication for longstanding gastroesophageal reflux disease. On the 5th postoperative day, the patient's general condition became worse, and he developed intermittent-remittent fever (40 degrees C), an elevated white blood cell count (WBC), and an accelerated sedimentation rate. Evidence of leakage was excluded by Gastrografin swallow. The diagnosis was finally revealed by means of ultrasound and computed tomography (CT) scan, which showed an intraabdominal fluid collection with an air cap of ~10 cm in diameter situated between the diaphragmatic crura, the caudate lobe of the liver, and the gastric fundus. The location did not allow semi-invasive management of the abscess, such as ultrasound or CT-guided puncture and drainage. On the 8th postoperative day, a laparoscopic exploration was performed utilizing the previous port sites. The adhesions were easily dissected, and evacuation of ~300 ml of white, dense fluid, and lavage and drainage were performed without intraabdominal dissemination of pus. The patient was discharged on the 12th postoperative day free of symptoms. Microbiological examination of the pus showed the presence of Peptostreptococcus. The patient remained symptom free. At 8 weeks postoperatively, barium swallow, endoscopy, 24-h pH monitoring, and stationary manometry of the esophagus yielded normal results. Because there was no direct evidence of leakage at the fundus, the development of the abscess was concluded to be due to the use of deep transmucosal stitches rather than seromuscular ones to create the wrap. The nonabsorbable multifilament suture material passing through the entire gastric wall could have facilitated bacterial contamination of the operative field. PMID:11265065

  4. Laparoscopic optical coherence tomography imaging of human ovarian cancer

    PubMed Central

    Hariri, Lida P.; Bonnema, Garret T.; Schmidt, Kathy; Winkler, Amy M.; Korde, Vrushali; Hatch, Kenneth D.; Davis, John R.; Brewer, Molly A.; Barton, Jennifer K.

    2011-01-01

    Objectives Ovarian cancer is the fourth leading cause of cancer-related death among women in the US largely due to late detection secondary to unreliable symptomology and screening tools without adequate resolution. Optical coherence tomography (OCT) is a recently emerging imaging modality with promise in ovarian cancer diagnostics, providing non-destructive subsurface imaging at imaging depths up to 2 mm with near-histological grade resolution (10–20 ?m). In this study, we developed the first ever laparoscopic OCT (LOCT) device, evaluated the safety and feasibility of LOCT, and characterized the microstructural features of human ovaries in vivo. Methods A custom LOCT device was fabricated specifically for laparoscopic imaging of the ovaries in patients undergoing oophorectomy. OCT images were compared with histopathology to identify preliminary architectural imaging features of normal and pathologic ovarian tissue. Results Thirty ovaries in 17 primarily peri or post-menopausal women were successfully imaged with LOCT: 16 normal, 5 endometriosis, 3 serous cystadenoma, and 4 adenocarcinoma. Preliminary imaging features developed for each category reveal qualitative differences in the homogeneous character of normal post-menopausal ovary, the ability to image small subsurface inclusion cysts, and distinguishable features for endometriosis, cystadenoma, and adenocarcinoma. Conclusions We present the development and successful implementation of the first laparoscopic OCT probe. Comparison of OCT images and corresponding histopathology allowed for the description of preliminary microstructural features for normal ovary, endometriosis, and benign and malignant surface epithelial neoplasms. These results support the potential of OCT both as a diagnostic tool and imaging modality for further evaluation of ovarian cancer pathogenesis. PMID:19481241

  5. A totally mini-invasive approach for colorectal laparoscopic surgery

    PubMed Central

    Anania, Gabriele; Santini, Mirco; Scagliarini, Lucia; Marzetti, Alice; Vedana, Laura; Marino, Serafino; Gregorio, Claudio; Resta, Giuseppe; Cavallesco, Giorgio

    2012-01-01

    AIM: To study the short-term outcome of patients treated with laparoscopic right colectomy and how intracorporeal anastomosis has improved the outcome. METHODS: We retrospectively examined all patients affected by colorectal cancer who underwent a laparoscopic right colectomy between January 2006 and December 2010 in our department. Our evaluation criteria were: diagnosis of colorectal carcinoma at presurgical biopsy, elective surgery, and the same surgeon. We excluded: emergency surgery, conversions from laparotomic colectomy, and other surgeons. The endpoints we examined were: surgical time, number of lymph nodes removed, length of stay (removal of nasogastric tube, bowel movements, gas evacuation, solid and liquid feeding, hospitalization), and major complications. Seventy-two patients were divided into two groups: intracorporeal anastomosis (39 patients) and extracorporeal anastomosis (33 patients). RESULTS: Significant differences were observed between intracorporeal vs extracorporeal anastomosis, respectively, for surgical times (186.8 min vs 184.1 min, P < 0.001), time to resumption of gas evacuation (3 d vs 3.5 d, P < 0.001), days until resumption of bowel movements (3.8 d vs 4.9 d, P < 0.001), days until resumption of liquid diet (3.5 d vs 4.5 d, P < 0.001), days until resuming a solid diet (4.6 d vs 5.7 d, P < 0.001), and total hospitalization duration (7.4 d vs 8.5 d, P < 0.001). In the intracorporeal group, on average, 19 positive lymph nodes were removed; in the extracorporeal group, on average, 14 were removed P < 0.001). Thus, intracorporeal anastomosis for right laparoscopic colectomy improved patient outcome by providing faster recovery of nutrition, faster recovery of intestinal function, and shorter hospitalization than extracorporeal anastomosis. CONCLUSION: Short-term outcomes favor intracorporeal anastomosis, confirming that a less traumatic surgical approach improves patient outcome. PMID:22876039

  6. Contamination Resulting From Aerosolized Fluid During Laparoscopic Surgery

    PubMed Central

    Nowak, Brent M.; Seger, Michael V.; Duperier, Frank D.

    2014-01-01

    Background and Objectives: Aerosolized droplets of blood can travel considerable distances on release of intra-abdominal pressure during laparoscopic surgery. This creates an environmental hazard for members of the surgical team. This study describes and provides a method of measurement of aerosolized blood contamination during evacuation of the pneumoperitoneum in laparoscopic surgery. Methods: Samples were measured by removing a trocar from the abdomen while a pneumoperitoneum of 15 mm Hg was present. A white poster board was placed 24 inches above the incision to catch the released blood spatter. By use of machine vision, luminol fluorescence, and computerized spatial analysis, data from the boards were recorded, analyzed, and scored based on the distance, size, and quantity of particulate contamination. Results: We analyzed 27 boards. Spatter was present on every board. The addition of luminol to the boards increased the amount of visible spatter. Most tests created <1000 blood spatters. Fluids are typically ejected as a fine mist. Every test included at least 1 blood spatter. The range of the average blood spatter size was 0.53 × 10–3 to 7.11 × 10–3 sq in. The amount of spatter detected did not show any apparent correlation with the patient's body mass index, the estimated blood loss, or the type of operation performed. Conclusions: Evacuation of the pneumoperitoneum during laparoscopic surgery results in consistent contamination. Most blood spatter is not visible to the naked eye. Our results suggest that all surgical participants should wear appropriate protective barriers and conscious measures should be undertaken to prevent environmental contamination during pneumoperitoneal evacuation. PMID:25392644

  7. Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

    PubMed Central

    Khalil, Mostafa; Omar, Rabea; Abdel-baky, Shabieb; Mohey, Ahmed; Sebaey, Ahmed

    2015-01-01

    Objective This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter. Material and methods A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed. Results There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p=0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery. Conclusion Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake. PMID:26623147

  8. Intravenous Paracetamol for Postoperative Analgesia in Laparoscopic Cholecystectomy

    PubMed Central

    Gousheh, Sayed Mohamadreza; Nesioonpour, Sholeh; Javaher foroosh, Fatemeh; Akhondzadeh, Reza; Sahafi, Sayed Ali; Alizadeh, Zeinab

    2013-01-01

    Background Although opioids are the main choice for acute postoperative pain control, many side effects have been reported for them. NSAIDs and paracetamol have been used extensively as alternatives, and it seems that they are more effective for minor to moderate pain control postoperatively when have been used alone or in combination with opioids. As laparoscopic cholecystectomy poses moderate pain postoperatively, this study was planned to assess whether paracetamol is able to provide effective analgesia as a sole analgesic at least in the first few hours post operatively. Objectives We evaluated the effect of intravenous Paracetamol on postoperative pain in patients undergoing laparoscopic cholecystectomy. Patients and Methods This is a randomized double- blind clinical trial study. 30 patients ASA class I, aged 18 to 50 years, candidate for laparoscopic cholecystectomy were recruited, and randomly divided into two equal groups. Group A (paracetamol group) received 1 gr paracetamol and group B received placebo ten minutes after the induction of anesthesia. 0.1 mg/Kg Morphine was administered intravenously based on patients compliant and pain score >3. Pain score and the opioids consumption were recorded in the first six hours postoperative. Patient's pain was measured by the VAS (Visual Analog Scale). Results The pain score was lower in group A (P= 0.01), but the morphine consumption showed no significant difference between the groups (P= 0.24) during the first 6 hours postoperatively. Conclusions Although paracetamol (1gr) has caused a better pain relief quality but it is not a suitable analgesic for moderate pain control in acute phase after surgery alone. PMID:24223365

  9. The analysis of 146 patients with difficult laparoscopic cholecystectomy

    PubMed Central

    Bat, Orhan

    2015-01-01

    Introduction: Laparoscopic cholecystectomy (LC) is very commonly performed surgical intervention. Acute or chronic cholecystitis, adhesions due to previous upper abdomen surgeries, Mirrizi’s syndrome and obesity are common clinical conditions that can be associated with difficult cholecystectomy. In this study, we evaluated and scored the patients with difficult surgical exploration during laparoscopic cholecystectomy. Material and Method: All patients who underwent LC from 2010 to 2015 were retrospectively rewieved. According to intraoperative findings DLC cases were described and classified. Class I difficulty: Adhesion of omentum majus, transverse colon, duodenum to the fundus of the gallbladder. Class II difficulty: Adhesions in Calot’s triangle and difficulty in dissection of cystic artery and cystic duct Class III difficulty: Difficulty in dissection of gallbladder bed (scleroathrophic gallbladder, hemorrhage from liver during dissection of gallbladder, chirotic liver). Class IV difficulty: Difficulty in exploration of gallbladder due to intraabdominal adhesions including technical problems. Results: A total of 146 patients were operated with DLC. The most common difficulty type was Class I difficulty (88 patients/60.2%). Laparoscopic cholecystectomy was converted to laparotomy in 98 patients. Operation time was found to be related with conversion to open surgery (P<0.05). Wound infection rate was also statistically higher in conversion group (P<0.05). The opertion time was found to be longest with Class II difficulty. Conversion rate to open surgery was also highest with Class II difficulty group. Conclusion: Class II difficulty characterized by severe adhesions in calot’s triangle is most serious problem among all DLC cases. They have longer operation time and higher conversion rate. PMID:26629124

  10. Robot-assisted laparoscopic excision of a retroperitoneal paracaval tumor.

    PubMed

    Wei, Tzu-Chun; Chung, Hsiao-Jen; Lin, Alex T L; Chen, Kuang-Kuo

    2013-12-01

    During the past few years, robotic surgical systems have been rapidly developed. The progress and advantages of these systems include three-dimensional vision and enhanced ergonomics. These advantages have helped a new generation of minimally invasive surgery to evolve. The da Vinci Surgical System seems to greatly resolve problems (e.g., wide exposure and retraction of peritoneal organs) that are confronted by traditional laparoscopic surgeries for retroperitoneal tumors that are near great vessels. There have been few reported cases concerning laparoscopic excision of retroperitoneal tumors situated between the inferior vena cava, the right renal vessel, and the kidney. We report the use of a robotic surgical system for this type of treatment. A 54-year-old female patient had a hypoechoic lesion near the inferior vena cava and superior to the right renal vessels. It was incidentally found by ultrasound during a health check-up examination. The computed tomography (CT) scan revealed a heterogeneous contrast-enhanced retroperitoneal mass approximately 4.4 cm medial to the right kidney with the inferior vena cava slightly deviated to the left. Robot-assisted laparoscopic excision of the retroperitoneal tumor was performed on October 15, 2010 with an operation time of 135 minutes and an estimated blood loss of less than 30 mL. The J-Vac drainage tube was removed on postoperative Day 3, and the patient was discharged in a stable condition the following day. The pathology of the tumor was retroperitoneal schwannoma. A re-evaluation was arranged postoperatively for the 15-month ambulatory visit. No local recurrence or distal metastasis was present. PMID:24079977

  11. Robot-assisted laparoscopic hiatal hernia and antireflux surgery.

    PubMed

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

    2015-09-01

    Gastroesophageal reflux disease is a common disorder of the GE-junction that allows gastric acid to enter the esophagus. Surgery is indicated when the presence of the disease is objectively documented. The laparoscopic Toupet fundoplication is the preferred treatment of GERD. There is no clear advantage in robotic assistance for primary antireflux surgery. In our center we find the robot to be of added value for redo surgery or large and giant hiatal repair. J. Surg. Oncol. 2015; 112:266-270. © 2015 Wiley Periodicals, Inc. PMID:25997926

  12. Two rare cases of intrahepatic subcapsular hematoma after laparoscopic cholecystectomy.

    PubMed

    Minaya Bravo, Ana María; González González, Enrique; Ortíz Aguilar, Manuel; Larrañaga Barrera, Eduardo

    2010-12-01

    The appearance of subcapsular liver hematoma after a laparoscopic cholecystectomy (LC) is an infrequent complication and seldom studied. Some cases have been connected to ketorolac given during surgery and after surgery. Other described causes are : hemangiomas or small iatrogenic lesions that could be aggravated by administration of ketorolac. Coagulation dysfunction like circulating heparin as seen in hemathological diseases is cause of bleeding after aggressive procedures. We describe two cases of subcapsular liver hematoma after LC, both of them have been given intravenous ketorolac and one of them had multiple myeloma. We discuss the causes and treatment of it. PMID:22131659

  13. Laparoscopic surgery: surgical education in the People's Republic of China.

    PubMed

    Unger, S W; Olsen, D O; Nagy, A G; Zucker, K A; Fitzgibbons, R J; Soper, N J; Petelin, J B; Sackier, J M; Katkhouda, N; Edelman, D S

    1994-08-01

    In 1991, because of the international emphasis on laparoscopic surgery, a large contingency of surgeons took on the task of introducing laparoscopy to the People's Republic of China. This trip was a technological feat, since all of the equipment and instrumentation had to be carried into the country. This necessitated a major coordinated effort among professional teaching staff and industry representatives with their transported equipment. This unique educational opportunity is detailed in this article, which highlights, in particular, the contrast between the new "high-tech" surgery and the reality of a developing country. PMID:7952438

  14. Laparoscopic Transcystic Choledochotomy with Primary Suture for Choledocholith

    PubMed Central

    Zhu, Andong; Zhang, Zhibo

    2015-01-01

    Background and Objectives: To investigate the possibility of extracting common bile duct (CBD) stones by laparoscopically inserting choledochoscope through the natural orifice of the cystic duct and a mini-incision on the CBD, and the safety of laparoscopic primary double-layer suture of the cystic duct and CBD. Methods: Laparoscopic transcystic choledochotomy and extraction of stones with primary suture was performed on 194 patients with gallbladder and CBD stones from October 1, 2009, through April 30, 2012. The cystic duct was left at a diameter of 1 to 1.5 cm after removal of the gallbladder. The duct was longitudinally cut at its ventral side to the confluence with the CBD, and the anterior wall of the CBD was also cut longitudinally. A choledochoscope was then inserted via the enlarged opening, and the stones were extracted from the CBD. Finally, the CBD and cystic duct were closed by continuous mucous layer suture and seromuscular Lembert suture, respectively. The cystic duct was ligated close to the CBD and an abdominal drainage tube was placed. Results: All surgical procedures were successfully performed. The caliber at the confluence between the cystic duct and the CBD was 0.3 to 0.8 cm (SD 0.4 ± 0.1 cm), and the mini-incision of the CBD was 0.1 to 1.1 cm (SD 0.3 ± 0.2 cm). Abdominal drainage lasted 3 to 5 days. Magnetic resonance cholangiopancreatography (MRCP) in 55 patients showed no abnormal change in the CBD diameter. Two patients had bile leakage. Another patient had intermittent abdominal pain and jaundice 5 to 7 days postoperatively, and the retained stones spontaneously passed. The postoperative hospital stay was 6 to 13 days (SD 8 ± 2.1 days). Observation of 176 patients (90%) lasting 1 to 30 months (SD 11 ± 8 months) showed no recurrent stones or stricture of the CBD. Conclusion: The surgical procedure of laparoscopic transcystic choledochotomy and extraction of stones with primary suture is feasible and safe. PMID:25848193

  15. Transfascial suture in laparoscopic ventral hernia repair; friend or foe?

    PubMed

    Sahu, Diwakar; Das, Somak; Wani, Majid Rasool; Reddy, Prasanna Kumar

    2015-01-01

    'Suture hernia' is fairly a new and rare type of ventral hernia. It occurs at the site of transfascial suture, following laparoscopic ventral hernia repair (LVHR). Employment of transfascial sutures in LVHR is still debatable in contrast to tackers. Prevention of mesh migration and significant post-operative pain are the pros and cons with the use of transfascial sutures, respectively. We report an unusual case of suture hernia or transfascial hernia, which can further intensify this dispute, but at the same time will provide insight for future consensus. PMID:25883460

  16. Laparoscopic Treatment of Hypertension After Micturition: Bladder Pheochromocytoma

    PubMed Central

    Bozbora, Alp; Erb?l, Yesim; Kiliçarslan, Isin; Yildizhan, Esra; Ozarmagan, Selcuk

    2006-01-01

    Bladder pheochromocytomas are extremely rare and constitute less than 5% of bladder tumors. The initial symptoms of the patient are mostly nonspecific caused by hypertension. The postmicturition hypertensive crisis is the typical warning sign of this disease. In this article, we present a 29-year-old female having hypertensive attacks following micturition. Radiological imaging techniques revealed a 3x3x4-cm bladder tumor that was hormonally active. This is the first case reported of bladder pheochromocytoma that was laparoscopically treated without using the adjunct transurethral resection. The postoperative follow-up of the patient confirms the success of the surgical procedure. PMID:16882435

  17. Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt

    PubMed Central

    Grigorean, VT; Onose, G; Popescu, M; Strambu, V; Sandu, AM

    2009-01-01

    The aim of this study is the evaluation of laparoscopic treatment in abdominal complications following ventriculoperitoneal (VP) shunt. Methods: We report a retrospective study including 17 patients with abdominal complications secondary to VP shunt for hydrocephalus, laparoscopically treated in our department, between 2000 and 2007. Results: Patients' age ranged from 1 to 72 years old (mean age 25.8 years old). Male: female ratio was 1.4. Abdominal complications encountered were: shunt disconnection with intraperitoneal distal catheter migration 47.05% (8/17), infections 23.52% (4/17) such as abscesses and peritonitis, pseudocysts 11.76% (2/17), CSF ascites 5.88% (1/17), inguinal hernia 5.88% (1/17), and shunt malfunction due to excessive length of intraperitoneal tube 5.88% (1/17). Free–disease interval varies from 1 day to 21 years, depending on the type of complication, short in peritoneal irritation syndrome and abscesses (days) and long in ascites, pseudocysts(months– years). Laparoscopic treatment was: extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the tube in shunt malfunction due to excessive length of intraperitoneal tube a nd hernioraphy. One diagnostic laparoscopy was performed in a peritoneal irritation syndrome, which found only CSF ascites. There were no conversions to open surgery. The overall mortality was of 5.88% and postoperative morbidity was of 11.76%. In 7 patients operated for abscesses, peritonitis, pseudocysts, and CSF ascites the shunting system was converted in to a ventriculocardiac shunt. Conclusions: Abdominal complication following VP shunt can be successfully performed laparoscopically. Abdominal surgery required, in selected cases, the repositioning of the distal catheter, frequently as a ventriculocardiac shunt. There are abdominal complications with no indication of surgery, like peritoneal irritation syndrome and CSF ascites. Free– disease interval varies from days (peritoneal irritation syndrome, abscesses) to month–years (pseudocyst, ascites), according to type of complication. PMID:20108757

  18. Utility of fluorescent cholangiography during laparoscopic cholecystectomy: A systematic review

    PubMed Central

    Pesce, Antonio; Piccolo, Gaetano; La Greca, Gaetano; Puleo, Stefano

    2015-01-01

    AIM: To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system. METHODS: MEDLINE and PubMed searches were performed using the key words “fluorescent cholangiography”, “fluorescent angiography”, “intraoperative fluorescent imaging”, and “laparoscopic cholecystectomy” in order to identify relevant articles published in English, French, German, and Italian during the years of 2009 to 2014. Reference lists from the articles were reviewed to identify additional pertinent articles. For studies published in languages other than those mentioned above, all available information was collected from their English abstracts. Retrieved manuscripts (case reports, reviews, and abstracts) concerning the application of fluorescent cholangiography were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. In contrast to classic meta-analyses, statistical analysis was performed where the outcome was calculated as the percentages of an event (without comparison) in pseudo-cohorts of observed patients. RESULTS: A total of 16 studies were found that involved fluorescent cholangiography during standard laparoscopic cholecystectomies (n = 11), single-incision robotic cholecystectomies (n = 3), multiport robotic cholecystectomy (n = 1), and single-incision laparoscopic cholecystectomy (n = 1). Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of important biliary anatomy and could facilitate the prevention of bile duct injuries. The structures effectively identified before dissection of Calot’s triangle included the cystic duct (CD), the common hepatic duct (CHD), the common bile duct (CBD), and the CD-CHD junction. A review of the literature revealed that the frequencies of detection of the extrahepatic biliary system ranged from 71.4% to 100% for the CD, 33.3% to 100% for the CHD, 50% to 100% for the CBD, and 25% to 100% for the CD-CHD junction. However, the frequency of visualization of the CD and the CBD were reduced in patients with a body mass index > 35 kg/m2 relative to those with a body mass index < 35 kg/m2 (91.0% and 64.0% vs 92.3% and 71.8%, respectively). CONCLUSION: Fluorescent cholangiography is a safe procedure enabling real-time visualization of bile duct anatomy and may become standard practice to prevent bile duct injury during laparoscopic cholecystectomy. PMID:26167088

  19. Review of single incision laparoscopic surgery in colorectal surgery

    PubMed Central

    Madhoun, Nisreen; Keller, Deborah S; Haas, Eric M

    2015-01-01

    As surgical techniques continue to move towards less invasive techniques, single incision laparoscopic surgery (SILS), a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery, was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis, postoperative pain, recovery time, and quality of life at the drawback of higher technical skill required. In this article, we review the history, describe the available technology and techniques, and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature. PMID:26478673

  20. Visual tracking of da Vinci instruments for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Speidel, S.; Kuhn, E.; Bodenstedt, S.; Röhl, S.; Kenngott, H.; Müller-Stich, B.; Dillmann, R.

    2014-03-01

    Intraoperative tracking of laparoscopic instruments is a prerequisite to realize further assistance functions. Since endoscopic images are always available, this sensor input can be used to localize the instruments without special devices or robot kinematics. In this paper, we present an image-based markerless 3D tracking of different da Vinci instruments in near real-time without an explicit model. The method is based on different visual cues to segment the instrument tip, calculates a tip point and uses a multiple object particle filter for tracking. The accuracy and robustness is evaluated with in vivo data.

  1. Risks of laparoscopic fulguration and transection of the fallopian tube.

    PubMed

    Loffer, F D; Pent, D

    1977-02-01

    The more common methods of laparoscopic sterilization involve transection of the fallopian tubes. There are, however, a number of cases accumulating in which coagulation without transection has been employed. The risks of bleeding requiring the use of laparotomy are considerably reduced with this technic. There is no increased risk of electrical injury. The pregnancy rate is essentially the same in both methods. It is suggested that failures with tubal transection may be secondary to fistula formation and an inherent problem, whereas the failures with coagulation without transection are secondary to inadequate coagulation and are therefore more easily prevented. PMID:138104

  2. Laparoscopic surgery and muscle relaxants: is deep block helpful?

    PubMed

    Kopman, Aaron F; Naguib, Mohamed

    2015-01-01

    It has been hypothesized that providing deep neuromuscular block (a posttetanic count of 1 or more, but a train-of-four [TOF] count of zero) when compared with moderate block (TOF counts of 1-3) for laparoscopic surgery would allow for the use of lower inflation pressures while optimizing surgical space and enhancing patient safety. We conducted a literature search on 6 different medical databases using 3 search strategies in each database in an attempt to find data substantiating this proposition. In addition, we studied the reference lists of the articles retrieved in the search and of other relevant articles known to the authors. There is some evidence that maintaining low inflation pressures during intra-abdominal laparoscopic surgery may reduce postoperative pain. Unfortunately most of the studies that come to these conclusions give few if any details as to the anesthetic protocol or the management of neuromuscular block. Performing laparoscopic surgery under low versus standard pressure pneumoperitoneum is associated with no difference in outcome with respect to surgical morbidity, conversion to open cholecystectomy, hemodynamic effects, length of hospital stay, or patient satisfaction. There is a limit to what deep neuromuscular block can achieve. Attempts to perform laparoscopic cholecystectomy at an inflation pressure of 8 mm Hg are associated with a 40% failure rate even at posttetanic counts of 1 or less. Well-designed studies that ask the question "is deep block superior to moderate block vis-à-vis surgical operating conditions" are essentially nonexistent. Without exception, all the peer-reviewed studies we uncovered which state that they investigated this issue have such serious flaws in their protocols that the authors' conclusions are suspect. However, there is evidence that abdominal compliance was not increased by a significant amount when deep block was established when compared with moderate neuromuscular block. Maintenance of deep block for the duration of the pneumoperitoneum presents a problem for clinicians who do not have access to sugammadex. Reversal of block with neostigmine at a time when no response to TOF stimulation can be elicited is slow and incomplete and increases the potential for postoperative residual neuromuscular block. The obligatory addition of sugammadex to any anesthetic protocol based on the continuous maintenance of deep block is not without associated caveats. First, monitoring of neuromuscular function is still essential and second, antagonism of deep block necessitates doses of sugammadex of ?4.0 mg/kg. Thus, maintenance of deep block has substantial economic repercussions. There are little objective data to support the proposition that deep neuromuscular block (when compared with less intense block; TOF counts of 1-3) contributes to better patient outcome or improves surgical operating conditions. PMID:25625254

  3. Anesthetic management of infants with palliated hypoplastic left heart syndrome undergoing laparoscopic nissen fundoplication.

    PubMed

    Mariano, Edward R; Boltz, M Gail; Albanese, Craig T; Abrajano, Claire T; Ramamoorthy, Chandra

    2005-06-01

    The safety of laparoscopic surgery in infants with single ventricle physiology has been a subject of controversy despite potential benefits over open surgery. We present the anesthetic management of five infants with palliated hypoplastic left heart syndrome that underwent laparoscopic Nissen fundoplication. After anesthetic induction and tracheal intubation, an intraarterial catheter was placed for hemodynamic monitoring. Insufflation pressure was limited to 12 mm Hg and was well tolerated by all patients. There were no intraoperative or postoperative complications. In patients with hypoplastic left heart syndrome, laparoscopic Nissen fundoplication can be safely performed with careful patient selection and close intraoperative monitoring. PMID:15920186

  4. Partial splenectomy using a laparoscopic bipolar radiofrequency device: A case report

    PubMed Central

    Wang, Wei-Dong; Lin, Jie; Wu, Zhi-Qiang; Liu, Qing-Bo; Ma, Jing; Chen, Xiao-Wu

    2015-01-01

    We report a 51-year-old female patient with a solitary lymphangioma located in the upper splenic pole which was managed successfully with laparoscopic partial splenectomy. Surgery lasted 170 min and did not require blood transfusions. The patient recovered well post-operatively and was asymptomatic at the 3-mo follow-up. She had a normal platelet count and no recurrence on ultrasonography or computed tomography. Laparoscopic partial splenectomy is a safe, minimally invasive technique for the treatment of solitary splenic lymphangiomas in the splenic pole. We performed the procedure using the HabibTM 4X device. This laparoscopic bipolar radiofrequency device ensured a “bloodless” splenic parenchymal resection. PMID:25805954

  5. Laparoscopic Pyelolithotomy in a Pelvic Kidney: A Case Report and Review of the Literature

    PubMed Central

    Hoenig, David M.; Shalhav, Arieh L.; Elbahnasy, Abdelhamid M.; McDougall, Elspeth M.

    1997-01-01

    Background and Objectives: Laparoscopic pyelolithotomy was performed in a pelvic kidney with a large renal pelvis calculus. Methods and Results: Laparoscopic pyelolithotomy was successfully performed in a pelvic kidney with an operative time of 310 minutes. The use of intraoperative fluoroscopy and a semi-automatic suturing device greatly facilitated the procedure. The patient's operative pain was managed with 3 doses of ketorolac; she resumed a regular diet the day after surgery, and was discharged on the first postoperative day. Conclusions: For patients with a large stone in the renal pelvis of an ectopic kidney, laparoscopic pyelolithotomy provides an effective approach. PMID:9876666

  6. Laparoscopic surgery in a paediatric patient with Down’s syndrome and patent foramen ovale

    PubMed Central

    Singh, Sarita; Verma, Reetu; Pandey, Anand; Tandon, Chetna; Wakhlu, Ashish; Agarwal, Aman

    2011-01-01

    The safety of laparoscopic surgery in infants with congenital heart disease has been a subject of controversy despite potential benefits over open surgery. The authors present the anaesthetic management of a 6-month-old female infant with Down’s syndrome with a small patent foramen ovale with left to right shunt who successfully underwent laparoscopic coloplasty. There were no intraoperative or postoperative complications. In addition to the routine anaesthetic considerations for any surgical patient, the choice of the anaesthetic technique in patients undergoing laparoscopic procedures should consider the effect on the patient’s underlying cardiorespiratory function of pneumoperitoneum and carbon dioxide insufflation. PMID:22691594

  7. Advancements in Laparoscopic Partial Nephrectomy: Expanding the Feasibility of Nephron-Sparing

    PubMed Central

    Pietzak, Eugene J.; Guzzo, Thomas J.

    2012-01-01

    Partial nephrectomy (PN) offers equivalent oncologic outcomes to radical nephrectomy (RN) but has greater preservation of renal function and less risk of chronic kidney disease and cardiovascular disease. Laparoscopic PN remains underutilized likely because it is a technically challenging operation with higher rates of perioperative complications compared to open PN and laparoscopic RN. A review of the latest PN literature demonstrates that recent advancements in laparoscopic approaches, imaging modalities, ischemic mitigating strategies, renorrhaphy techniques, and hemostatic agents will likely allow greater utilization of LPN and expand its usage to increasingly more complex tumors. PMID:22645606

  8. A Case of Congenital Uterine Arterio-Venous Malformation Managed by Hysterectomy

    PubMed Central

    Bhoil, Rohit; Raghuvanshi, Vandana; Basavaiah, Suhas

    2015-01-01

    Summary Background A uterine arteriovenous malformation (AVM) is a rare cause of uterine bleeding. It may have varied presentations ranging from being completely asymptomatic; to features of congestive heart failure to vaginal bleeding which may at times life be threatening. Clinical findings in such cases are often un-reliable; requiring a high index of suspicion to make the diagnosis. Sonographic gray scale features are non-specific requiring confirmation with colour and spectral Doppler. Case Report We report a case of a 46-year-old lady who presented with heavy vaginal bleeding and ultrasound/colour Doppler evidence of uterine AVM managed by abdominal hysterectomy, describing the imaging features on ultrasound and Doppler. We also discuss in brief about this uncommon but serious condition which the radiologist/gynaecologist may encounter in thier practise. Conclusions Uterine AV Malformation is a rare but potentially life-threatening cause of menorrhagia which must be kept in the differential diagnosis of sudden and massive vaginal bleeding. Ultrasound remains the modality of choice in diagnosing the condition which requires a high index of clinical suspicion. Color and spectral Doppler ultrasound should be used to supplement the findings and to confirm the diagnosis. PMID:25922626

  9. Errors in laparoscopic surgery: what surgeons should know.

    PubMed

    Galleano, R; Franceschi, A; Ciciliot, M; Falchero, F; Cuschieri, A

    2011-04-01

    Some two decades after its introduction, minimal access surgery (MAS) is still evolving. Undoubtedly, its significant uptake world wide is due to its clinical benefits to patient outcome. These benefits include reduced traumatic insult, reduction of pain, earlier return to bowel function, decrease disability, shorter hospitalization and better cosmetic results. Nonetheless complications due to the laparoscopic approach are not rare as documented by several studies on task specific or procedure related MAS morbidity. In all these instances, error analysis research has demonstrated that an understanding of the underlying causes of these complications requires a comprehensive approach addressing the entire system related to the procedure for identification and characterization of the errors ultimately responsible for the morbidity. The present review covers definition, taxonomy and incidence of errors in medicine with special reference to MAS. In addition, possible root causes of adverse events in laparoscopy are explored and existing methods to study errors are reviewed. Finally specific areas requiring further human factors research to enhance safety of patients undergoing laparoscopic operations are identified. The hope is that awareness of causes and mechanisms of errors may reduce incidence of errors in clinical practice for the final benefit of the patients. PMID:21593712

  10. Laparoscopic management of a two staged gall bladder torsion

    PubMed Central

    Sunder, Yadav Kamal; Akhilesh, Sali Priyanka; Raman, Garg; Deborshi, Sharma; Shantilal, Mehta Hitesh

    2015-01-01

    Gall bladder torsion (GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel’s lobe (part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful post-operative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot’s triangle. Laparoscopic cholecystectomy has the benefit of early recovery.

  11. Dual multispectral and 3D structured light laparoscope

    NASA Astrophysics Data System (ADS)

    Clancy, Neil T.; Lin, Jianyu; Arya, Shobhit; Hanna, George B.; Elson, Daniel S.

    2015-03-01

    Intraoperative feedback on tissue function, such as blood volume and oxygenation would be useful to the surgeon in cases where current clinical practice relies on subjective measures, such as identification of ischaemic bowel or tissue viability during anastomosis formation. Also, tissue surface profiling may be used to detect and identify certain pathologies, as well as diagnosing aspects of tissue health such as gut motility. In this paper a dual modality laparoscopic system is presented that combines multispectral reflectance and 3D surface imaging. White light illumination from a xenon source is detected by a laparoscope-mounted fast filter wheel camera to assemble a multispectral image (MSI) cube. Surface shape is then calculated using a spectrally-encoded structured light (SL) pattern detected by the same camera and triangulated using an active stereo technique. Images of porcine small bowel were acquired during open surgery. Tissue reflectance spectra were acquired and blood volume was calculated at each spatial pixel across the bowel wall and mesentery. SL features were segmented and identified using a `normalised cut' algoritm and the colour vector of each spot. Using the 3D geometry defined by the camera coordinate system the multispectral data could be overlaid onto the surface mesh. Dual MSI and SL imaging has the potential to provide augmented views to the surgeon supplying diagnostic information related to blood supply health and organ function. Future work on this system will include filter optimisation to reduce noise in tissue optical property measurement, and minimise spot identification errors in the SL pattern.

  12. Early rehabilitation programs after laparoscopic colorectal surgery: Evidence and criticism

    PubMed Central

    Kim, Duck-Woo; Kang, Sung-Bum; Lee, Soo-Young; Oh, Heung-Kwon; In, Myung-Hoon

    2013-01-01

    During the past several decades, early rehabilitation programs for the care of patients with colorectal surgery have gained popularity. Several randomized controlled trials and meta-analyses have confirmed that the implementation of these evidence-based detailed perioperative care protocols is useful for early recovery of patients after colorectal resection. Patients cared for based on these protocols had a rapid recovery of bowel movement, shortened length of hospital stay, and fewer complications compared with traditional care programs. However, most of the previous evidence was obtained from studies of early rehabilitation programs adapted to open colonic resection. Currently, limited evidence exists on the effects of early rehabilitation after laparoscopic rectal resection, although this procedure seems to be associated with a higher morbidity than that reported with traditional care. In this article, we review previous studies and guidelines on early rehabilitation programs in patients undergoing rectal surgery. We investigated the status of early rehabilitation programs in rectal surgery and analyzed the limitations of these studies. We also summarized indications and detailed protocol components of current early rehabilitation programs after rectal surgery, focusing on laparoscopic resection. PMID:24379571

  13. Laparoscopic approach to gastrointestinal malignancies: Toward the future with caution

    PubMed Central

    Bencini, Lapo; Bernini, Marco; Farsi, Marco

    2014-01-01

    After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts, some surgeons started to treat malignancies by the same way. However, if the limits of laparoscopy for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies. Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy, worsened quality of life due to surgery itself and adjuvant therapies, and challenging psychological impact. All these issues could, potentially, receive a better management with a laparoscopic surgical approach. In order to confirm such aspects, similarly to testing the newest weapons (surgical or pharmacologic) against cancer, long-term follow-up is always recommendable to assess the real benefits in terms of overall survival, cancer-free survival and quality of life. Furthermore, it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies. Therefore, laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences, as compared to those achieved for inflammatory bowel diseases, gastroesophageal reflux disease or diverticular disease. This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district. PMID:24587655

  14. Laparoscopic Appendicectomy Using Endo-Ring Applicator and Fallope Rings

    PubMed Central

    Ali, Iyoob V.; Maliekkal, Joji I.

    2009-01-01

    Background/Aim: Wider adoption of laparoscopic appendicectomy (LA) is limited by problems in securing the appendiceal base as well as the cost and the duration compared with the open procedure. The objective of this study was to assess the feasibility and efficacy of a new method for securing the appendiceal base in LA, so as to make the entire procedure simpler and cheaper, and hence, more popular. Methods: Twenty-five patients who were candidates for appendicectomy (emergency as well as elective) and willing for the laparoscopic procedure were selected for this study. Ports used were 10 mm at the umbilicus, 5 mm at the lower right iliac fossa, and 10 mm at the left iliac fossa. Extremely friable, ruptured, or turgid organs of diameters larger than 8 mm were excluded from the study. The mesoappendix was divided close to the appendix by diathermy. Fallope rings were applied to the appendiceal base using a special ring applicator, and the appendix was divided and extracted through the lumen of the applicator. Results: The procedure was successful in 23 (92%) cases, and the mean duration of the procedure was 20 minutes (15–32 minutes). There were no procedural complications seen during a median follow-up of two weeks. The equipment and rings were cheaper when compared with that of the standard methods of securing the base of the appendix. Conclusion: LA using fallope rings is a safe, simple, easy-to-learn, and economically viable method. PMID:19568554

  15. Laparoscopic Multifunctional Instruments: Design and Testing of Initial Prototypes

    PubMed Central

    Schadler, Jeremy; Haluck, Randy S.; Culkar, Kristin; Dziedzic, Ryan

    2005-01-01

    Background: Advances in minimally invasive surgical techniques will require new types of instrument end-effectors for smaller, longer, and flexible instruments. These include a new class of multifunctional instruments capable of performing more than 1 task with a single set of working jaws. Furthermore, it is desired that multifunctional instruments be designed to provide improved dexterity compared with that in currently commercially available instruments. Methods: Three prototypes of multifunctional laparoscopic surgical instruments are described: (1) a mechanical scissors-grasper, (2) a mechanical scissors-grasper-articulator, and (3) a compliant mechanism scissors-grasper. Methods of baseline analysis, design methods and considerations, and subjective evaluations of interim prototypes are presented. Results: The 3 prototypes demonstrate promising early results. However, based on subjective evaluation, these prototypes do not perform individual functions as well as basic disposable single-function laparoscopic instruments do. Conclusions: The concept of multifunctionality and increased end-effector dexterity is achievable as demonstrated by the prototypes presented. Further work is required to refine, simplify, and improve the multifunctional instruments to a point where they may be useful as surgical tools. PMID:15791983

  16. Investigation on the smoke development during Laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Fiedler, Sebastian; Pongratz, Thomas; Beyer, Wolfgang; Hennig, Georg; Rühm, Adrian; Khoder, Wael

    2014-03-01

    Objective: During laser assisted laparoscopic intervention smoke occurs reducing the clear vision to the target. Simply smoke suction is not possible with respect to deflating / enflating capabilities of the belly. Thus the clinical question arise if the use of different wavelength may show similar smoke development or whether is it possible to reduce the smoke development by wavelength selection. Materials and Methods: Tissue test model was "Bavarian Leberkäse". A special container set-up was created to collect the laser induced smoke. Smoke was suctioned through a capillary. The amount of light scattered by the smoke particles when flowing through this capillary was measured. Ablation parameter was continuous mode and10W at the end of a 400?m bare fibre for the wavelengths 980nm, 1350nm and 1470nm. Additional the optical transmission was measured. The vaporized tissue volume was measured. Results: Light scattering, optical parameters and vaporized tissue volume were correlated. Measurement showed reproducible results. While the time to get first signal of scattered light in case of 1470nm is shorter compared the other wavelength, the ratio of scatter-signal to ablation rate showed only a trend increase when longer wavelength were used. Conclusion: Tissue absorbers and carbonized tissue properties are relevant for smoke development resulting in an increased SI / AR ratio trend. Thus the expert physician in laparoscopic intervention should also be an expert in lasertissue interaction. Cutting without carbonization gained advantages.

  17. One, Two, or Three Ports in Laparoscopic Cholecystectomy?

    PubMed Central

    Justo-Janeiro, Jaime Manuel; Vincent, Gustavo Theurel; Vázquez de Lara, Fernando; de la Rosa Paredes, René; Orozco, Eduardo Prado; Vázquez de Lara, Luis G.

    2014-01-01

    Single-port laparoscopic cholecystectomy (LC) has been compared with 3- or 4-port LC. To our knowledge, there are no studies comparing the 3-, 2-, and 1-port techniques. Patients were randomized into 3 groups: LC 1-port using SILS, LC 2-port using a laparoscope with a working channel, and LC 3-port using the standard ports. Pain was evaluated at recovery, 4 hours, 24 hours, day 5, and day 8, using an analog visual scale. Homogenous groups in their demographic characteristics; all confirmed gallbladder lithiasis. At recovery, there was less pain in group 1 (P = 0.002); at 4 hours pain was similar in all groups (P = 0.899); at 24 hours there was less pain in groups 2 and 3 (P = 0.031); and at days 5 and 8 there was marginal (P = 0.053) and significant (P = 0.003) relevance. In terms of pain perception, LC performed through 1 port does not offer advantages when compared with 2 or 3 ports. More clinical trials are needed to confirm these data. PMID:25437581

  18. Filshie clip sterilization -- single puncture laparoscopic approach (a preliminary report).

    PubMed

    Ismail, M T; Arshat, H; Halim, A J

    1988-12-01

    In 1986, single puncture laparoscopic application of the Filshie clip was introduced into Malaysia's National Population and Family Development Board's female sterilization program for an evaluation. A total of 42 female sterilizations were performed by this method between June 1986 and December 1986. Laparoscopy was performed on an outpatient basis under local anesthesia. In 37 cases, the sterilization was interval. Filshie clips were successfully applied to the fallopian tubes of 40 women; in the remaining 2 cases, the latching mechanism jammed and Falope rings were used instead. The average time from application of 1st clip to skin closure was 10 minutes. During clip application, technical problems (faulty applicator, clip fell into the pelvic cavity, failure of latching mechanism) were encountered in 4 cases and surgical difficulties (poor visualization, hydrosalpinx, and tubal adhesions) occurred in 10 cases. In general, complications were minimal: 1 patient developed cynosis after anesyhesia (Pethidine) injection, the omentum was torn during introduction of the trocar in another, and a 3rd patient developed thrombophlebitis at the intravenous site. Only 1 pregnancy was recorded during the follow-up period; this occurred 15 months postoperatively and was intrauterine. Given the facts that this procedure is easy to learn, fast and simple, associated with no more complications than other laparoscopic procedures, and is cosmetically more acceptable to women, its more widespread application is recommended. PMID:12342172

  19. Single-port laparoscopic fecal diversion: more than cosmetic benefits?

    PubMed

    Aytac, Erman; Stocchi, Luca; Williams, Ryan; Remzi, Feza H; Costedio, Meagan M

    2014-08-01

    Single-port laparoscopic surgery is usually performed on patients with minor comorbidities. The aim of the study was to evaluate feasibility and efficacy of single-port fecal diversion in patients who had previous abdominal operations or comorbidities. Between October 2010 and March 2012, 14 patients with a median age of 57 years were diverted. The reasons for diversion were perianal infection/abscess (n=5), anal incontinence (n=3), radiation proctitis (n=2), colovesical fistula causing sepsis (n=1), outlet obstruction of ileal S pouch (n=1), perforation during pouchoscopy (n=1), and peritoneal carcinomatosis with enterocutaneus fistula (n=1). Median estimated blood loss was 20 mL, operative time was 52 minutes, and length of hospital stay was 4 days. Two patients had ileus postoperatively. One patient had a parastomal hernia 4 months after diversion. Single-port laparoscopic fecal diversion is a safe and feasible operation for patients with significant comorbidities and a history of multiple abdominal operations. PMID:24710240

  20. The chain of postoperative complications after laparoscopic cholecystectomy.

    PubMed

    Karabulut, Mehmet; Gönenç, Murat; Al??, Halil

    2014-01-01

    Bile duct injuries are among the most dreadful complications of cholecystectomy. As laparoscopic cholecystectomy has become increasingly popular, the incidence of this complication increased and has remained unchanged in spite the learning curve being completed. A 50-year-old female underwent elective laparoscopic cholecystectomy for gallstone disease. A complicated bile duct injury occurred during the procedure. As the injury was immediately recognized, it was treated with concomitant hepaticojejunostomy. In the postoperative period, biliary fistula, which was assumed to be the result of an anastomotic leak, was encountered. Diagnostic and therapeutic percutaneous transhepatic biliary drainage was considered. It revealed that the anastomosis was intact and the source of biliary leak was an aberrant right posterior sectorial branch. A severe bleeding through the biliary catheter occurred due to transmigration of the catheter into the portal vein. Bleeding was controlled with embolization by the interventional radiologist. The patient thereafter was re-operated, and the leakage was sealed by ligation of the aberrant right posterior sectorial branch. The postoperative period was uneventful. As long as cholecystectomy is performed, bile duct injuries will always exist. Therefore, every abdominal surgeon should be aware of possible consequences of complications related to this procedure. PMID:25931907

  1. A program of telementoring in laparoscopic bariatric surgery.

    PubMed

    Fuertes-Guiró, Fernando; Vitali-Erion, Enrique; Rodriguez-Franco, Amalia

    2016-02-01

    Background This study proposes a system for teaching and surgical support with the benefits of online Information and Communications Technology (ITC) -based telementoring for laparoscopic bariatric surgery (LBS). Material and methods A system of telementoring was established between a university center and two community hospitals. Telementoring was performed via internet protocol using a direct point-to-point connection, ASDL 1.2 Mbps, time delay 150 ms, 256-bit advanced encryption standard (AES). In the period of time selected, all interventions for LBS in both hospitals were included. When patients agree with telementoring, data outcomes (operating time, hospital stay, conversion to open surgery and complications) were collected. The rest of these interventions were recorded. Results Thirty-six patients underwent elective LBS, 20 of whom were referred and accepted for telementoring. Patients selected without telementoring took longer: 200 (46) min vs 139 (33) min, p?laparoscopic surgery. PMID:26360307

  2. Laparoscope resection of retroperitoneal ectopic insulinoma: a rare case.

    PubMed

    Liu, Jie; Zhang, Cheng-Wu; Hong, De-Fei; Wu, Jia; Yang, Hong-Guo; Chen, Yuan; Zhao, Da-Jian; Zhang, Yu-Hua

    2015-04-14

    Ectopic insulinoma is a very rare and dormant tumor. Here we report the case of a 79-year-old female who presented with repeated episodes of hypoglycemia and was diagnosed with insulinoma based on laboratory and imaging examinations. Computed tomography and positron emission tomography revealed a tumor in the retroperitoneum under and left of the hepatoduodenal ligament, which was resected successfully using a laparoscopic approach. Pathologic results revealed an ectopic insulinoma, which was confirmed immunohistochemically. Ectopic insulinomas are accompanied by hypoglycemia that can be misdiagnosed as drug- or disease-induced. These tumors are difficult to diagnose and locate, particularly in atypical cases or for very small tumors. Synthetic or targeted examinations, including low blood glucose, elevated insulin, proinsulin, and C-peptide levels, 48-h fasting tests, and relevant imaging methods should be considered for suspected cases of insulinoma. Surgery is the treatment of choice for patients with insulinoma, and laparoscopic resection is a feasible and effective method for select ectopic insulinoma cases. PMID:25892896

  3. Laparoscopic surgery for rectal prolapse and pelvic floor disorders

    PubMed Central

    Rickert, Alexander; Kienle, Peter

    2015-01-01

    Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders. PMID:26380050

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

    PubMed Central

    Benzing, Christian; Krenzien, Felix; Atanasov, Georgi; Seehofer, Daniel; Sucher, Robert; Zorron, Ricardo; Pratschke, Johann; Schmelzle, Moritz

    2015-01-01

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

  5. Effects of laparoscopic cholecystectomy on lung function: A systematic review

    PubMed Central

    Bablekos, George D; Michaelides, Stylianos A; Analitis, Antonis; Charalabopoulos, Konstantinos A

    2014-01-01

    AIM: To present and integrate findings of studies investigating the effects of laparoscopic cholecystectomy on various aspects of lung function. METHODS: We extensively reviewed literature of the past 24 years concerning the effects of laparoscopic cholecystectomy in comparison to the open procedure on many aspects of lung function including spirometric values, arterial blood gases, respiratory muscle performance and aspects of breathing control, by critically analyzing physiopathologic interpretations and clinically important conclusions. A total of thirty-four articles were used to extract information for the meta-analysis concerning the impact of the laparoscopic procedure on lung function and respiratory physiopathology. The quality of the literature reviewed was evaluated by the number of their citations and the total impact factor of the corresponding journals. A fixed and random effect meta-analysis was used to estimate the pooled standardized mean difference of studied parameters for laparoscopic (LC) and open (OC) procedures. A crude comparison of the two methods using all available information was performed testing the postoperative values expressed as percentages of the preoperative ones using the Mann-Whitney two-sample test. RESULTS: Most of the relevant studies have investigated and compared changes in spirometric parameters.The median percentage and interquartile range (IQR) of preoperative values in forced vital capacity (FVC), forced expiratory volume in 1 s and forced expiratory flow (FEF) at 25%-75% of FVC (FEF25%-75%) expressed as percentage of their preoperative values 24 h after LC and OC were respectively as follows: [77.6 (73.0, 80.0) L vs 55.4 (50.0, 64.0) L, P < 0.001; 76.0 (72.3, 81.0) L vs 52.5 (50.0, 56.7) L, P < 0.001; and 78.8 (68.8, 80.9) L/s vs 60.0 (36.1, 66.1) L/s, P = 0.005]. Concerning arterial blood gases, partial pressure of oxygen [PaO2 (kPa)] at 24 or 48 h after surgical treatment showed reductions that were significantly greater in OC compared with LC [LC median 1.0, IQR (0.6, 1.3); OC median 2.4, IQR (1.2, 2.6), P = 0.019]. Fewer studies have investigated the effect of LC on respiratory muscle performance showing less impact of this surgical method on maximal respiratory pressures (P < 0.01); and changes in the control of breathing after LC evidenced by increase in mean inspiratory impedance (P < 0.001) and minimal reduction of duty cycle (P = 0.01) compared with preoperative data. CONCLUSION: Laparoscopic cholecystectomy seems to be associated with less postoperative derangement of lung function compared to the open procedure. PMID:25516676

  6. Audio Engineering Society Convention Paper

    E-print Network

    Jackson, Philip JB

    in the spatial quality of reproduced audio, rather than changes in the timbral quality. This contrasts with previous models of audio quality, such as PEAQ (ITU-R BS1387) [16], which have not explicitly con- sideredAudio Engineering Society Convention Paper Presented at the 125th Convention 2008 October 2­5 San

  7. The Emergence of Conventional Writing.

    ERIC Educational Resources Information Center

    Epstein, Maria

    Children in the emergent writing stage write in pre-conventional or emergent forms (scribbling, drawing, non-phonetic letterings, and phonetic spelling) before they write conventionally. A special education teacher in a kindergarten inclusion setting in the Bronx, New York, noticing that her students did not particularly like to write, decided and…

  8. Laparoscopic surgery in the management of complex aortic disease: techniques and lessons learned.

    PubMed

    Cagiannos, Catherine; Kolvenbach, Ralf R

    2009-01-01

    Laparoscopic vascular surgery must be assessed in the context of both open and endovascular interventions. The development of improved laparoscopic equipment and endoscopic techniques makes performance of laparoscopy easier, but endovascular interventions still hold wide appeal because they are minimally invasive and are easier to master by vascular surgeons. Despite decreased morbidity and recovery time, endovascular interventions have inferior durability and higher reintervention rates when compared with open aortoiliac interventions. In particular, after endovascular aneurysm repair, patients need lifelong surveillance because there is potential for delayed endoleaks, aortic neck dilatation, graft migration, and ongoing risk of aneurysmal rupture. These limitations of endovascular therapy are the impetus behind the pursuit of other minimally invasive techniques, such as laparoscopy, in vascular surgery. Currently, two evolving laparoscopic approaches are available for abdominal vascular surgery: total laparoscopic aortic surgery and hybrid techniques that combine laparoscopy with endovascular techniques to treat failing endografts. PMID:19919802

  9. Perioperative advantages of modified laparoscopic vs open splenectomy and azygoportal disconnection

    PubMed Central

    Jiang, Guo-Qing; Chen, Ping; Qian, Jian-Jun; Yao, Jie; Wang, Xiao-Dong; Jin, Sheng-Jie; Bai, Dou-Sheng

    2014-01-01

    AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy or open splenectomy and azygoportal disconnection for portal hypertension. METHODS: This study included 44 patients who underwent modified laparoscopic splenectomy and azygoportal disconnection (MLSD) and 71 who underwent open procedures for portal hypertension. Blood samples were collected before surgery and on days 1, 3, and 7 after surgery. Markers of liver and renal function, C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) were measured, and perioperative variables were compared between the two groups. RESULTS: The modified laparoscopic group showed significantly better and faster recovery, better liver and renal function, and fewer complications than the open group. CRP, IL-6, and PCT concentrations on postoperative days 1, 3, and 7 were significantly lower in the modified laparoscopic group than in the open group. CONCLUSION: MLSD was associated with lower inflammatory immune responses, less impairment of liver and renal function, and faster and better recovery. PMID:25083088

  10. Vascular Map Combined with CT Colonography for Evaluating Candidates for Laparoscopic Colorectal Surgery

    PubMed Central

    Campari, Alessandro; Ravelli, Anna; Lombardi, Maria Antonietta; Pisani Ceretti, Andrea; Maroni, Nirvana; Opocher, Enrico; Cornalba, Gianpaolo

    2015-01-01

    Contrast-enhanced computed tomography colonography (CE-CTC) is a useful guide for the laparoscopic surgeon to avoid incorrectly removing the colonic segment and the failure to diagnose of synchronous colonic and extra-colonic lesions. Lymph node dissection and vessel ligation under a laparoscopic approach can be time-consuming and can damage vessels and organs. Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers. We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates. We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery. PMID:26175581

  11. Design of an endoscope lens shielding device for use in laparoscopic procedures

    E-print Network

    Houston, Emily Faith

    2010-01-01

    Laparoscopic surgical tools and techniques have revolutionized many gynecological and abdominal procedures, leading to dramatic reductions in recovery time and scarring for the patient. While techniques and instruments for ...

  12. Laparoscopic drainage of abdominal wall abscess from spilled stones post-cholecystectomy

    PubMed Central

    Chong, Vincent; Ram, Rishi

    2015-01-01

    We present a case on abdominal wall abscess from spilled stones post-cholecystectomy and describe laparoscopic drainage as our choice of management. Mr M is a 75-year-old male who presented on multiple occasions to the hospital with right upper quadrant pain and fever post-laparoscopic cholecystectomy. He also required multiple courses of antibiotics. Subsequent computed tomography and magnetic resonance imaging scan confirmed a number of retained stone with signs of chronic inflammation. Hence, 6 months after his initial laparoscopic cholecystectomy, he proceeded to an exploratory laparoscopy. We found an abscess cavity measuring 3 × 4 cm over the anterior abdominal wall. The cavity was de-roofed, drained and washed out. The tissue culture grew Klebsiella pneumoniae. Laparoscopic approach is optimal as the abscess cavity can be clearly identified, stones visualized and removed under direct vision. Patient does not require a laparotomy. PMID:26183574

  13. Bladder sparing robot-assisted laparoscopic en bloc resection of urachus and umbilicus for urachal adenocarcinoma.

    PubMed

    Aoun, Fouad; Peltier, Alexandre; van Velthoven, Roland

    2015-06-01

    Urachal adenocarcinoma is a rare and aggressive form of bladder cancer that arises from the urachus. An en bloc resection of the urachus and umbilicus is recommended with either a total or partial cystectomy. However, there is no standard laparoscopic or robotic surgical technique for the operative management of these tumors. In the present report, we describe our robotic-assisted laparoscopic technique for the treatment of a primary malignant urachal tumor. PMID:26531120

  14. Laparoscopic-assisted cryptorchidectomy in 2 Vietnamese pot-bellied pigs (Sus scrofa)

    PubMed Central

    Rosanova, Nadia; Singh, Ameet; Cribb, Nicola

    2015-01-01

    This report describes laparoscopic-assisted cryptorchidectomy in 2 Vietnamese pot-bellied pigs. Abdominal access was obtained by a modified-Hasson technique allowing for placement of a 6 mm laparoscopic trocar-cannula assembly. Following carbon dioxide insufflation, 2 para-preputial 6 mm instrument portals were established. The cryptorchid testicle was extracted from the abdomen following enlargement of the para-preputial instrument portal and cryptorchidectomy was performed extra-corporeally. PMID:25694664

  15. Laparoscopic Bipolar Coagulation of Hypogastric Artery in Postpartum Haemorrhage: A Case Report

    PubMed Central

    Panuccio, Enrico; Volpi, Eugenio; Ferrero, Annamaria; Sismondi, Piero

    2011-01-01

    Background. Postpartum haemorrhage (PPH) is a significant contributor to worldwide maternal morbidity and mortality. When PPH continues despite aggressive medical treatment, early consideration should be given to surgical intervention. Various surgical interventions may be used but conservative interventions are recommended primarily. Case. This case report describes laparoscopic coagulation of hypogastric artery technique in a patient with PPH. Conclusions. Laparoscopic ligature of the hypogastric artery for PPH treatment can be a valid alternative to laparotomy in patients with vaginal delivery. PMID:22567499

  16. Laparoscopic bipolar coagulation of hypogastric artery in postpartum haemorrhage: a case report.

    PubMed

    Panuccio, Enrico; Volpi, Eugenio; Ferrero, Annamaria; Sismondi, Piero

    2011-01-01

    Background. Postpartum haemorrhage (PPH) is a significant contributor to worldwide maternal morbidity and mortality. When PPH continues despite aggressive medical treatment, early consideration should be given to surgical intervention. Various surgical interventions may be used but conservative interventions are recommended primarily. Case. This case report describes laparoscopic coagulation of hypogastric artery technique in a patient with PPH. Conclusions. Laparoscopic ligature of the hypogastric artery for PPH treatment can be a valid alternative to laparotomy in patients with vaginal delivery. PMID:22567499

  17. Prospective Randomized Comparison Between Transperitoneal Laparoscopic Pyeloplasty and Retroperitoneoscopic Pyeloplasty for Primary Ureteropelvic Junction Obstruction

    PubMed Central

    Singh, Vishwajeet; Gupta, Dheeraj Kumar; Kumar, Vikas; Pandey, Mohit; Akhtar, Asif

    2014-01-01

    Background and Objectives: To compare laparoscopic transperitoneal versus retroperitoneoscopic pyeloplasty for primary ureteropelvic junction obstruction in a prospective randomized manner and assess overall results with long-term follow-up. Methods: In this prospective study, from 2008 to 2012, 112 cases of primary ureteropelvic junction obstruction were randomized in a 1:1 ratio into 2 groups. Group I included patients who underwent transperitoneal laparoscopic pyeloplasty, and group II consisted of patients who underwent retroperitoneoscopic laparoscopic pyeloplasty. Demographic and clinical characteristics and postoperative and operative data were collected and analyzed. The statistical analysis was performed with the Fisher exact test, ?2 test, and Mann-Whitney U test for independent groups, and P < .05 was considered statistically significant. Results: The total operative time and intracorporeal suturing time were significantly higher in group II than in group I (P < .001). The visual analog scale score for pain on postoperative day 1 and the requirement for tramadol were significantly higher in group I than in group II (P = .004). The hospital stay and the rate of temporary ileus were significantly greater (P < .036 and P < .02, respectively) in group I than in group II. The success rate of transperitoneal laparoscopic pyeloplasty versus retroperitoneoscopic laparoscopic pyeloplasty was 96.4% versus 96.6% with a mean follow-up period of 30.75 ± 4.85 months versus 30.99 ± 5.59 months (P < .88). Conclusion: Transperitoneal laparoscopic pyeloplasty is associated with significantly greater postoperative pain, a higher tramadol dose, a higher rate of ileus, and a longer hospital stay in comparison with retroperitoneoscopic laparoscopic pyeloplasty. Although the operative time for retroperitoneoscopic laparoscopic pyeloplasty is significantly longer, the success rate remains the same for both procedures. PMID:25392671

  18. Randomized Controlled Trials: A Systematic Review of Laparoscopic Surgery and Simulation-Based Training

    PubMed Central

    Vanderbilt, Allison A.; Grover, Amelia C.; Pastis, Nicholas J.; Feldman, Moshe; Granados, Deborah Diaz; Murithi, Lydia K.; Mainous, Arch G.

    2015-01-01

    Introduction This systematic review was conducted to analyze the impact and describe simulation-based training and the acquisition of laparoscopic surgery skills during medical school and residency programs. Methods This systematic review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills. Searching PubMed from the inception of the databases to May 1, 2014 and specific hand journal searches identified the studies. This current review of the literature addresses the question of whether laparoscopic simulation translates the acquisition of surgical skills to the operating room (OR). Results This systematic review of simulation-based training and laparoscopic surgery found that specific skills could be translatable to the OR. Twenty-one studies reported learning outcomes measured in five behavioral categories: economy of movement (8 studies); suturing (3 studies); performance time (13 studies); error rates (7 studies), and global rating (7 studies). Conclusion Simulation-based training can lead to demonstrable benefits of surgical skills in the OR environment. This review suggests that simulation-based training is an effective way to teach laparoscopic surgery skills, increase translation of laparoscopic surgery skills to the OR, and increase patient safety; however, more research should be conducted to determine if and how simulation can become apart of surgical curriculum. PMID:25716408

  19. Novel 3-D laparoscopic magnetic ultrasound image guidance for lesion targeting

    PubMed Central

    Sindram, David; McKillop, Iain H; Martinie, John B; Iannitti, David A

    2010-01-01

    Objectives: Accurate laparoscopic liver lesion targeting for biopsy or ablation depends on the ability to merge laparoscopic and ultrasound images with proprioceptive instrument positioning, a skill that can be acquired only through extensive experience. The aim of this study was to determine whether using magnetic positional tracking to provide three-dimensional, real-time guidance improves accuracy during laparoscopic needle placement. Methods: Magnetic sensors were embedded into a needle and laparoscopic ultrasound transducer. These sensors interrupted the magnetic fields produced by an electromagnetic field generator, allowing for real-time, 3-D guidance on a stereoscopic monitor. Targets measuring 5 mm were embedded 3–5 cm deep in agar and placed inside a laparoscopic trainer box. Two novices (a college student and an intern) and two experts (hepatopancreatobiliary surgeons) targeted the lesions out of the ultrasound plane using either traditional or 3-D guidance. Results: Each subject targeted 22 lesions, 11 with traditional and 11 with the novel guidance (n = 88). Hit rates of 32% (14/44) and 100% (44/44) were observed with the traditional approach and the 3-D magnetic guidance approach, respectively. The novices were essentially unable to hit the targets using the traditional approach, but did not miss using the novel system. The hit rate of experts improved from 59% (13/22) to 100% (22/22) (P < 0.0001). Conclusions: The novel magnetic 3-D laparoscopic ultrasound guidance results in perfect targeting of 5-mm lesions, even by surgical novices. PMID:21083797

  20. Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis

    PubMed Central

    Angenete, Eva; Thornell, Anders; Burcharth, Jakob; Pommergaard, Hans-Christian; Skullman, Stefan; Bisgaard, Thue; Jess, Per; Läckberg, Zoltan; Matthiessen, Peter; Heath, Jane; Rosenberg, Jacob; Haglind, Eva

    2016-01-01

    Objective: To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial. Background: Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment. Methods: Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively. Results: Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay. Conclusions: In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term. PMID:25489672

  1. A novel reconstruction method for giant incisional hernia: Hybrid laparoscopic technique

    PubMed Central

    Ozturk, G; Malya, FU; Ersavas, C; Ozdenkaya, Y; Bektasoglu, H; Cipe, G; Citgez, B; Karatepe, O

    2015-01-01

    BACKGROUND AND OBJECTIVES: Laparoscopic reconstruction of ventral hernia is a popular technique today. Patients with large defects have various difficulties of laparoscopic approach. In this study, we aimed to present a new reconstruction technique that combines laparoscopic and open approach in giant incisional hernias. MATERIALS AND METHODS: Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm included in this study and separated into two groups. Group 1 (n = 12) identifies patients operated with standard laparoscopic approach, whereas group 2 (n = 16) labels laparoscopic technique combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. RESULTS: There are 12 patients in group 1 and 16 patients in group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in six patients for group 1 and in only 1 patient for group 2. Group 1 had 1 patient who suffered from recurrence where group 2 had no recurrence. DISCUSSION: Laparoscopic technique combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias.

  2. Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases.

    PubMed

    Weber-Sanchez, A; Weber-Alvarez, P; Garteiz-Martinez, D

    2012-02-01

    We report the case of a 4-year-old girl treated by a laparoscopic transabdominal preperitoneal (TAPP) technique with polypropylene mesh in whom a primary contralateral hernia was found and repaired, closing the orifice with a suture. This 4-year-old female had a medical history of clubfoot treated by surgery during her first year of age, ureteral reimplantation because of stenosis, and laparoscopic cholecystectomy because of hydrocholecystis. She had recurrence 1 year after a conventional inguinal herniorraphy and was treated by the TAPP technique with polypropylene mesh. A primary contralateral hernia was found and repaired, and the orifice was closed with a suture. The child's acceptance of the procedure was good, and the postoperative evolution was uneventful, requiring minimal analgesia in the first 24 h. She was discharged the following day. Two years later, there have been no recurrences, and the girl is developing and carrying out activities in a normal way. The open technique remains the gold standard for hernioplasty in children, but laparoscopy may be an option, and it is possible that in some special cases, the use of mesh to reinforce the inguinal wall using the TAPP technique, although it is controversial, may be justified. PMID:20803043

  3. Laparoscopic gastric bypass vs sleeve gastrectomy in obese Korean patients

    PubMed Central

    Park, Ji Yeon; Kim, Yong Jin

    2015-01-01

    AIM: To compare the mid-term outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in obese Korean patients. METHODS: All consecutive patients who underwent either LSG or LRYGB with primary to treat morbid obesity between January 2011 and December 2012 were retrospectively reviewed. Patients with a body mass index (BMI) ? 30 kg/m2 with inadequately controlled obesity-related comorbidities (e.g., diabetes, obstructive sleep apnea, hypertension, or obesity-related arthropathy) or BMI ? 35 kg/m2 were considered for bariatric surgery according to the International Federation for the Surgery of Obesity-Asia Pacific Chapter Consensus statements in 2011. The decision regarding the procedure type was made on an individual basis following extensive discussion with the patient about the specific risks associated with each procedure. All operative procedures were performed laparoscopically by a single surgeon experienced in upper gastrointestinal surgeries. Baseline demographics, perioperative surgical outcomes, and postoperative anthropometric data from a prospectively established database were thoroughly reviewed and compared between the two surgical approaches. RESULTS: One hundred four patients underwent LSG, and 236 underwent LRYGB. Preoperative BMI in the LSG group was significantly higher than that of the LRYGB group (38.6 kg/m2 vs 37.2 kg/m2, P = 0.024). Patients with diabetes were more prevalent in the LRYGB group (18.3% vs 35.6%, P = 0.001). Operating time and hospital stay were significantly shorter in the LSG group compared with the LRYGB group (100 min vs 130 min, P < 0.001; 1 d vs 2 d, P = 0.003), but the incidence of perioperative complications was similar between the groups (P = 0.351). The mean percentage of excess weight loss (%EWL) was 71.2% for LRYGB, while it was 63.5% for LSG, at mean follow-up periods of 18.0 and 21.0 mo, respectively (P = 0.073). The %EWL at 1, 3, 6, 12, 18, 24, and 36 mo was equivalent between the groups. Four patients required surgical revision after LSG (4.8%), while revision was only required in one case following LRYGB (0.4%; P = 0.011). CONCLUSION: Both LSG and LRYGB are effective procedures that induce comparable weight loss in the mid-term and similar surgical risks, except for the higher revision rate after LSG. PMID:26640337

  4. Influence of margin status and radiation on recurrence after radical hysterectomy in Stage IB cervical cancer

    SciTech Connect

    Viswanathan, Akila N. . E-mail: aviswanathan@partners.org; Lee, Hang; Hanson, Emily; Berkowitz, Ross S.; Crum, Christopher P.

    2006-08-01

    Purpose: To examine the relationship between margin status and local recurrence (LR) or any recurrence after radical hysterectomy (RH) in women treated with or without radiotherapy (RT) for Stage IB cervical carcinoma. Methods and Materials: This study included 284 patients after RH with assessable margins between 1980 and 2000. Each margin was scored as negative ({>=}1 cm), close (>0 and <1 cm), or positive. The outcomes measured were any recurrence, LR, and relapse-free survival. Results: The crude rate for any recurrence was 11%, 20%, and 38% for patients with negative, close, and positive margins, respectively. The crude rate for LR was 10%, 11%, and 38%, respectively. Postoperative RT decreased the rate of LR from 10% to 0% for negative, 17% to 0% for close, and 50% to 25% for positive margins. The significant predictors of decreased relapse-free survival on univariate analysis were the depth of tumor invasion (hazard ratio [HR] 2.14/cm increase, p = 0.007), positive margins (HR 3.92, p = 0.02), tumor size (HR 1.3/cm increase, p = 0.02), lymphovascular invasion (HR 2.19, p = 0.03), and margin status (HR 0.002/increasing millimeter from cancer for those with close margins, p = 0.03). Long-term side effects occurred in 8% after RH and 19% after RH and RT. Conclusion: The use of postoperative RT may decrease the risk of LR in patients with close paracervical margins. Patients with other adverse prognostic factors and close margins may also benefit from the use of postoperative RT. However, RT after RH may increase the risk of long-term side effects.

  5. Vaginal Motion and Bladder and Rectal Volumes During Pelvic Intensity-Modulated Radiation Therapy After Hysterectomy

    SciTech Connect

    Jhingran, Anuja; Salehpour, Mohammad; Sam, Marianne; Levy, Larry; Eifel, Patricia J.

    2012-01-01

    Purpose: To evaluate variations in bladder and rectal volume and the position of the vaginal vault during a 5-week course of pelvic intensity-modulated radiation therapy (IMRT) after hysterectomy. Methods and Materials: Twenty-four patients were instructed how to fill their bladders before simulation and treatment. These patients underwent computed tomography simulations with full and empty bladders and then underwent rescanning twice weekly during IMRT; patients were asked to have full bladder for treatment. Bladder and rectal volumes and the positions of vaginal fiducial markers were determined, and changes in volume and position were calculated. Results: The mean full and empty bladder volumes at simulation were 480 cc (range, 122-1,052) and 155 cc (range, 49-371), respectively. Bladder volumes varied widely during IMRT: the median difference between the maximum and minimum volumes was 247 cc (range, 96-585). Variations in rectal volume during IMRT were less pronounced. For the 16 patients with vaginal fiducial markers in place throughout IMRT, the median maximum movement of the markers during IMRT was 0.59 cm in the right-left direction (range, 0-0.9), 1.46 cm in the anterior-posterior direction (range, 0.8-2.79), and 1.2 cm in the superior-inferior direction (range, 0.6-2.1). Large variations in rectal or bladder volume frequently correlated with significant displacement of the vaginal apex. Conclusion: Although treatment with a full bladder is usually preferred because of greater sparing of small bowel, our data demonstrate that even with detailed instruction, patients are unable to maintain consistent bladder filling. Variations in organ position during IMRT can result in marked changes in the position of the target volume and the volume of small bowel exposed to high doses of radiation.

  6. Effects of a single rectal dose of Misoprostol prior to abdominal hysterectomy in women with symptomatic leiomyoma: a randomized double blind clinical trial

    PubMed Central

    Tabatabai, Afsarosadat; Karimi-Zarchi, Mojgan; Meibodi, Bahare; Vaghefi, Marzie; Yazdian, Pouria; Zeidabadi, Mahbube; Dehghani, Atefe; Teimoori, Soraya; Jamali, Azadeh; Akhondi, Mehdi

    2015-01-01

    Background Fibroma, the most common benign pelvic tumor in women, affects 25 to 30% of women of reproductive age. Primary treatment for patients with symptomatic or large fibroma is surgery. Objective The purpose of this study was to investigate the effect of a single rectal dose of Misoprostol on bleeding during abdominal hysterectomy. Methods This double blind randomized clinical trial was conducted with 80 candidates for abdominal hysterectomy, due to uterine myoma, in the Shahid Sadoughi hospital of Yazd in 2012. The aim of this study was to assess the effect of single rectal dose of Misoprostol on peri-operational abdominal hysterectomy bleeding. Following administration of 400 micrograms of Misoprostol in the case group (n=40), predetermined criteria were compared with control group (n=40). Results Volume of bleeding during the operation was significantly lower in cases where Misoprostol was used. (268.71 ± 156.85 vs. 350.38 ± 152.61 cc in the case and control groups, respectively). Our findings also showed that Hemoglobin (Hb) levels before, 8, and 30 hours following the operation differed significantly (p=0.001), but these changes were similar in both groups. Pre-operative Hb levels were 11.90 ± 1.7 and 11.90 ± 2.0 in the case and control groups, respectively. Conclusion A single rectal dose of Misoprostol has positive effect on reducing peri-operational bleeding in women undergoing abdominal hysterectomy due to symptomatic leiomyoma. PMID:26516444

  7. New and conventional charmonium states

    E-print Network

    Xiaolong Wang

    2012-08-20

    There are many exotic properties of the charmonium and charmoniumlike states above $D\\bar{D}$ threshold. The recent experimental results from BaBar and Belle on the new and conventional charmonium states are reviewed in this talk.

  8. ICSI pregnancy outcomes following hysteroscopic placement of Essure devices for hydrosalpinx in laparoscopic contraindicated patients.

    PubMed

    Ozgur, Kemal; Bulut, Hasan; Berkkanoglu, Murat; Coetzee, Kevin; Kaya, Gamze

    2014-07-01

    This study investigated the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following assisted conception treatment with those of patients having had laparoscopic tubal ligation. A total of 102 infertile patients were diagnosed with unilateral or bilateral hydrosalpinges: 26 patients had laparoscopic contraindications and were treated hysterscopically and 76 patients were treated laparoscopically. In total, 66 intracytoplasmic sperm injection (ICSI) and 39 frozen embryo transfer (FET) procedures were performed. In the hysteroscopy group, 13 ICSI and eight FET in 16 patients resulted in 10 pregnancies (pregnancy rates 47.6% per transfer and 62.5% per patient), and in the laparoscopy group, 53 ICSI and 31 FET embryo transfers in 54 patients resulted in 36 pregnancies (pregnancy rates 42.9% per transfer and 66.7% per patient). Live birth rates per assisted reproduction procedure were 23.8% (5/21) in the hysteroscopy group and 32.1% (27/84) for the laparoscopy group. The hysteroscopic placement of Essure devices to isolate hydrosalpinx prior to assisted conception treatment produced pregnancy outcomes comparable to those produced following laparoscopic tubal ligation. The live birth rates indicate that a larger, more comparative, prospectively randomized study is required. Infertile patients with tubal disease require surgical treatment before they can continue with fertility treatment. There are two main surgical methods that can be used, hysteroscopic and laparoscopic, the latter being the standard surgical method. However, some patients have disease that makes the use of laparoscopy inappropriate. For these patients the placement of Essure® devices by hysteroscopic surgery maybe the most suitable treatment method. One hundred and two patients were diagnosed with unilateral or bilateral hydrosalpinges - tubal disease. Twenty six patients had to have hysterscopic surgery and 76 patients had laparoscopic surgery. After their tubal surgery some patients continued to have fertility treatment, 66 ICSI and 39 frozen embryo transfers (FET) were performed. Thirteen ICSI and 8 FET embryo transfers in 16 patients from the hysteroscopy group resulted in 10 pregnancies, a 47.6% per transfer and 62.5% per patient pregnancy rate. Fifty three ICSI and 31 FET embryo transfers in 54 patients from the laparoscopic group resulted in 36 pregnancies, a 42.9% per transfer and 66.7% per patient rate. Live birth rates per ART procedure were 23.8% (5/21) in the hysteroscopic group compared with 32.1% (27/84) for the laparoscopic group. The hysteroscopic placement of Essure® devices for tubal disease prior to fertility treatments resulted in pregnancy outcomes that were comparable to the outcomes obtained following laparoscopic surgery. PMID:24813749

  9. Surgical Margins and Short-Term Results of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer

    PubMed Central

    Yang, Qingqiang; Xiu, Peng; Qi, Xiaolong; Yi, Guoping

    2013-01-01

    Background and Objectives: The confines of the narrow bony pelvis make laparoscopic surgery more challenging in the treatment of low rectal cancer. Macroscopic evaluation of the completeness of the mesorectum provides detailed information about the quality of surgery. This study was performed to observe the short-term outcomes and evaluate the macroscopic quality of specimens acquired from laparoscopic total mesorectal excision versus open total mesorectal excision in patients with low rectal cancer. Methods: A total of 177 patients with low rectal cancer underwent total mesorectal excision by either a laparoscopic (n = 87) or open (n = 90) approach. In all cases the surgical time, blood loss, intraoperative and postoperative complications, postoperative bowel opening, and hospital stay were assessed. Special attention was given to the macroscopic judgment concerning the cut edge of peritoneal reflection, Denonvilliers fascia, completeness of the mesorectum, and bowel wall below the mesorectum. Results: The surgical time was 160 ± 40 minutes in the laparoscopic group. It was not significantly different from that in the open group (P = .782). The operative blood loss was 28 ± 5 mL in the group undergoing laparoscopic surgery and 80 ± 20 mL in the group undergoing open surgery (P < .01). Intraoperative injuries to the pelvic autonomic nervous system were recorded in 4 cases in the laparoscopic group compared with 12 cases in the open group (P < .05). The incidences of chest infection and anastomotic leakage were similar between the 2 approaches. The postoperative bowel opening time was 2.1 ± 1.5 days in the laparoscopic group and 3.5 ± 1.6 days in the open group (P < .01), whereas the hospital stay was 5.2 ± 1.8 days and 7.0 ± 2.1 days, respectively (P < .01). Intact Denonvilliers fascia and complete total mesorectal excision were more likely to be achieved by the laparoscopic approach than the open approach (P < .01). Colorectal anastomoses were located significantly lower in the laparoscopic group than in the open group (P < .01). Conclusion: Laparoscopic total mesorectal excision has consistent advantages over open total mesorectal excision, including similar surgical time, less blood loss, reduced hospital stay, and shorter disability period. A complete macroscopic specimen is more likely to be acquired by laparoscopy because of the better pelvic view offered by the approach. PMID:23925014

  10. System for robot-assisted real-time laparoscopic ultrasound elastography

    NASA Astrophysics Data System (ADS)

    Billings, Seth; Deshmukh, Nishikant; Kang, Hyun Jae; Taylor, Russell; Boctor, Emad M.

    2012-02-01

    Surgical robots provide many advantages for surgery, including minimal invasiveness, precise motion, high dexterity, and crisp stereovision. One limitation of current robotic procedures, compared to open surgery, is the loss of haptic information for such purposes as palpation, which can be very important in minimally invasive tumor resection. Numerous studies have reported the use of real-time ultrasound elastography, in conjunction with conventional B-mode ultrasound, to differentiate malignant from benign lesions. Several groups (including our own) have reported integration of ultrasound with the da Vinci robot, and ultrasound elastography is a very promising image guidance method for robotassisted procedures that will further enable the role of robots in interventions where precise knowledge of sub-surface anatomical features is crucial. We present a novel robot-assisted real-time ultrasound elastography system for minimally invasive robot-assisted interventions. Our system combines a da Vinci surgical robot with a non-clinical experimental software interface, a robotically articulated laparoscopic ultrasound probe, and our GPU-based elastography system. Elasticity and B-mode ultrasound images are displayed as picture-in-picture overlays in the da Vinci console. Our system minimizes dependence on human performance factors by incorporating computer-assisted motion control that automatically generates the tissue palpation required for elastography imaging, while leaving high-level control in the hands of the user. In addition to ensuring consistent strain imaging, the elastography assistance mode avoids the cognitive burden of tedious manual palpation. Preliminary tests of the system with an elasticity phantom demonstrate the ability to differentiate simulated lesions of varied stiffness and to clearly delineate lesion boundaries.

  11. Methods for closure of appendix stump during laparoscopic appendectomy procedure

    PubMed Central

    Mayir, Burhan; Ensari, Cemal Özben; Bilecik, Tuna; Aslaner, Arif; Oruç, Mehmet Tahir

    2015-01-01

    The most frequent abdominal pathology requiring emergent surgery is acute appendicitis. Laparoscopic appendectomy has been performed for the treatment of acute appendicitis since 1983. Closure of the appendix stump is vital to prevent severe postoperative complications. Different methods are described for closure such as stapler, endoloop, titanium clips, non-absorbable polymer clips (hem-o-lok clip), handmade loops, transsection by Ligasure or with bipolar cautery. The ideal method should be safe, applicable and cheap. The most appropriate method remains to be controversial. All methods are reported as safe, but some have higher costs, and some prolong the operation. In this article, we reviewed clinical and experimental studies on different methods of stump closure, and we tried to compare the benefit of these methods over others.

  12. Subcapsular liver haematoma as a complication of laparoscopic cholecystectomy.

    PubMed

    G?uszek, Stanis?aw; Kot, Marta; Nawacki, ?ukasz; Krawczyk, Marek

    2015-07-01

    Cholecystectomy is a common procedure for the treatment of symptomatic cholecystitis. A rare complication is the occurrence of subcapsular haematoma of the liver. In the literature, there are only a few case reports of this type. A 25-year-old woman was admitted to the Surgical Department for surgical treatment of cholecystitis. No complications were observed intra-operatively. On the first day after surgery, the patient manifested symptoms of hypovolaemic shock. The patient was qualified for surgical treatment in the mode of emergency surgery - a giant subcapsular haematoma was found. She was referred to the Clinic of General, Transplant and Liver Surgery of the Medical University of Warsaw for further treatment. This case shows the importance of monitoring the life parameters of patients who have undergone laparoscopic surgery due to symptomatic cholecystitis during the first day after surgery. PMID:26240636

  13. Host response to laparoscopic surgery: mechanisms and clinical correlates

    PubMed Central

    Hackam, David J.; Rotstein, Ori D.

    1998-01-01

    Minimal access surgery has revolutionized the treatment of a variety of surgical diseases, partly because it is associated with less patient morbidity than nonlaparoscopic surgical procedures. Emerging evidence suggests that alteration in the host response after laparoscopic procedures has significantly contributed to the improved postoperative course. Laparoscopy modulates both afferent stimuli (including tissue trauma, pain and wound size) and efferent responses (via neuroendocrine, metabolic, immunologic and cardiorespiratory systems). These effects lead to a decrease in postoperative pain, fever and disability. Laparoscopy mediates these effects through reduced wound size, the activities of endotoxin and immunomodulatory actions of the insufflated gas, resulting in impaired macrophage activity. Although clearly beneficial in reducing postoperative morbidity after elective surgery, this immunosuppression could increase the risk of complications during procedures for infection or neoplasia. PMID:9575992

  14. Automated branching pattern report generation for laparoscopic surgery assistance

    NASA Astrophysics Data System (ADS)

    Oda, Masahiro; Matsuzaki, Tetsuro; Hayashi, Yuichiro; Kitasaka, Takayuki; Misawa, Kazunari; Mori, Kensaku

    2015-05-01

    This paper presents a method for generating branching pattern reports of abdominal blood vessels for laparoscopic gastrectomy. In gastrectomy, it is very important to understand branching structure of abdominal arteries and veins, which feed and drain specific abdominal organs including the stomach, the liver and the pancreas. In the real clinical stage, a surgeon creates a diagnostic report of the patient anatomy. This report summarizes the branching patterns of the blood vessels related to the stomach. The surgeon decides actual operative procedure. This paper shows an automated method to generate a branching pattern report for abdominal blood vessels based on automated anatomical labeling. The report contains 3D rendering showing important blood vessels and descriptions of branching patterns of each vessel. We have applied this method for fifty cases of 3D abdominal CT scans and confirmed the proposed method can automatically generate branching pattern reports of abdominal arteries.

  15. Laparoscopic Ultrasound-Guided Radiofrequency Ablation of Uterine Fibroids

    SciTech Connect

    Milic, Andrea; Asch, Murray R. Hawrylyshyn, Peter A.; Allen, Lisa M.; Colgan, Terence J.; Kachura, John R.; Hayeems, Eran B.

    2006-08-15

    Four patients with symptomatic uterine fibroids measuring less than 6 cm underwent laparoscopic ultrasound-guided radiofrequency ablation (RFA) using multiprobe-array electrodes. Follow-up of the treated fibroids was performed with gadolinium-enhanced magnetic resonance imaging (MRI) and patients' symptoms were assessed by telephone interviews. The procedure was initially technically successful in 3 of the 4 patients and MRI studies at 1 month demonstrated complete fibroid ablation. Symptom improvement, including a decrease in menstrual bleeding and pain, was achieved in 2 patients at 3 months. At 7 months, 1 of these 2 patients experienced symptom worsening which correlated with recurrent fibroid on MRI. The third, initially technically successfully treated patient did not experience any symptom relief after the procedure and was ultimately diagnosed with adenomyosis. Our preliminary results suggest that RFA is a technically feasible treatment for symptomatic uterine fibroids in appropriately selected patients.

  16. Robot-assisted laparoscopic gastrectomy for Menetrier's disease.

    PubMed

    Rodríguez Gonzalez, Omaira; José, Rosciano; Génesis, Jara; Luis, Medina; Liumariel, Vegas; Raquel, Ferrnandez; Alexis, Sánchez

    2015-09-01

    Menetrier's disease, also known as hypoproteinemic hypertrophic gastropathy, is a rare condition characterized by the presence of gastric hypertrophy with foveolar infiltration that replaces the normal glandular architecture. We present a case of a 65-year-old female patient who had epigastric pain after meals which progressed to oral intolerance and weight loss. Upper endoscopy was performed showing prominent folds in the gastric mucosa and stenosis at the antrum-pylorus. Biopsy was taken and showed foveolar reactive hyperplasia and reactive glandular epithelium changes suggestive of Menetrier's disease. An abdominopelvic CT was performed showing a dilated stomach and gastric wall thickening. The patient was taken into the operation room for a robot-assisted total gastrectomy with esophagus-jejunum anastomosis. The patient's progress was satisfactory and he was discharged on the eighth postoperative day. Robot-assisted laparoscopic gastrectomy is a feasible and safe option that facilitates the performance of complex procedures. PMID:26531207

  17. Adrenal pseudocyst: Diagnosis and laparoscopic management – A case report

    PubMed Central

    Ujam, Atheer B.; Peters, Christopher J.; Tadrous, Paul J.; Webster, John Jeff; Steer, Keith; Martinez-Isla, Alberto

    2011-01-01

    Cysts of the adrenal gland are rare and are usually discovered incidentally. Large adrenal cysts can however present with severe abdominal pain and can be complicated by haemorrhage, rupture or infection. Adrenal pseudocysts appear to result from haemorrhage within a normal adrenal gland and can expand to accommodate massive amounts of fluid. We report the case of a 39-year-old woman who presented with worsening right upper quadrant pain. An ultrasound scan of the abdomen confirmed a large 29 cm × 20 cm × 17 cm cyst that appeared to originate in the upper pole of the right kidney causing displacement of the liver and right kidney. Following complete aspiration the cyst re-accumulated and an MRI scan demonstrated a thickened and irregular cyst wall with haemorrhagic fluid. Laparoscopic right adrenalectomy was performed and the histopathological diagnosis was confirmed as an adrenal pseudocyst. PMID:22096761

  18. Subcapsular liver haematoma as a complication of laparoscopic cholecystectomy

    PubMed Central

    G?uszek, Stanis?aw; Kot, Marta; Krawczyk, Marek

    2015-01-01

    Cholecystectomy is a common procedure for the treatment of symptomatic cholecystitis. A rare complication is the occurrence of subcapsular haematoma of the liver. In the literature, there are only a few case reports of this type. A 25-year-old woman was admitted to the Surgical Department for surgical treatment of cholecystitis. No complications were observed intra-operatively. On the first day after surgery, the patient manifested symptoms of hypovolaemic shock. The patient was qualified for surgical treatment in the mode of emergency surgery – a giant subcapsular haematoma was found. She was referred to the Clinic of General, Transplant and Liver Surgery of the Medical University of Warsaw for further treatment. This case shows the importance of monitoring the life parameters of patients who have undergone laparoscopic surgery due to symptomatic cholecystitis during the first day after surgery. PMID:26240636

  19. Ontology-based prediction of surgical events in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Kati?, Darko; Wekerle, Anna-Laura; Gärtner, Fabian; Kenngott, Hannes; Müller-Stich, Beat Peter; Dillmann, Rüdiger; Speidel, Stefanie

    2013-03-01

    Context-aware technologies have great potential to help surgeons during laparoscopic interventions. Their underlying idea is to create systems which can adapt their assistance functions automatically to the situation in the OR, thus relieving surgeons from the burden of managing computer assisted surgery devices manually. To this purpose, a certain kind of understanding of the current situation in the OR is essential. Beyond that, anticipatory knowledge of incoming events is beneficial, e.g. for early warnings of imminent risk situations. To achieve the goal of predicting surgical events based on previously observed ones, we developed a language to describe surgeries and surgical events using Description Logics and integrated it with methods from computational linguistics. Using n-Grams to compute probabilities of followup events, we are able to make sensible predictions of upcoming events in real-time. The system was evaluated on professionally recorded and labeled surgeries and showed an average prediction rate of 80%.

  20. Primary Amyloidosis Manifesting as Cholestatic Jaundice after Laparoscopic Cholecystectomy

    PubMed Central

    Misiakos, Evangelos P.; Bagias, George; Tiniakos, Dina; Roditis, Konstantinos; Zavras, Nick; Papanikolaou, Ioannis; Tsirigotis, Panagiotis; Liakakos, Theodore; Machairas, Anastasios

    2015-01-01

    A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ~6?mg/dL) three months later. An ERCP was performed, in which a gallstone was found, followed by a sphincterotomy and cleansing of the bile duct. Due to deterioration of jaundice (>25?mg/dL), a new, unsuccessful ERCP and stent placement was carried out. Because of ongoing cardiac failure, she underwent an echocardiogram which revealed restrictive cardiomyopathy possibly due to amyloidosis. A liver biopsy was performed, which was positive for amyloid deposits in the liver, and the diagnosis was confirmed by the detection of monoclonal ? IgG protein in urine. The patient's jaundice gradually deteriorated and she died one week later from hepatic insufficiency. PMID:26137342