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Sample records for laparoscopic gastrointestinal surgery

  1. Peritoneal adhesions after laparoscopic gastrointestinal surgery

    PubMed Central

    Mais, Valerio

    2014-01-01

    Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2, N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no greater than

  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

  3. Does elevated intra-abdominal pressure during laparoscopic colorectal surgery cause acute gastrointestinal injury?

    PubMed Central

    Cai, Zhenghao; Malbrain, Manu L.N.G.; Sun, Jing; Pan, Ruijun; Ma, Junjun; Feng, Bo; Dong, Feng

    2015-01-01

    Introduction The incidence of acute gastrointestinal injury (AGI) after colorectal surgery is low when laparoscopic techniques are used. While elevated intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with AGI grade II, little is known about the relation between increased IAP during laparoscopy and subsequent AGI. Aim To assess the impact of increased IAP during laparoscopic colorectal surgery on the incidence of postoperative AGI. Material and methods Sixty-six patients (41 men and 25 women) with colorectal cancer undergoing elective laparoscopic colorectal surgery were randomized into 3 groups, according to different IAP levels during CO2 pneumoperitoneum (10 mm Hg, 12 mm Hg and 15 mm Hg). We recorded the incidence of AGI after surgery by assessing the following parameters: time to first flatus/defecation, time to first bowel movement, time to tolerance of semi-liquid food and the occurrence of vomiting/diarrhea. Moreover, inflammatory mediators were measured before the induction of CO2 pneumoperitoneum and on postoperative day 1. Results Acute gastrointestinal injury occurred in 15 (27.3%) patients. In all 3 study groups, the elevation of IAP during CO2 pneumoperitoneum did not significantly increase the occurrence of symptoms of AGI, vomiting or diarrhea. Lower IAP levels did not significantly accelerate recovery of gastrointestinal function or shorten postoperative hospital stay. The changes in serum IL-6 after surgery did not correlate with the value of IAP. Conclusions The level of IAP elevation during laparoscopic colorectal surgery does not increase the occurrence of AGI after surgery. PMID:26240615

  4. 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

  5. Laparoscopic approach in gastrointestinal emergencies

    PubMed Central

    Jimenez Rodriguez, Rosa M; Segura-Sampedro, Juan José; Flores-Cortés, Mercedes; López-Bernal, Francisco; Martín, Cristobalina; Diaz, Verónica Pino; Ciuro, Felipe Pareja; Ruiz, Javier Padillo

    2016-01-01

    This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go. PMID:26973409

  6. Single-Incision Laparoscopic Surgery for a Small-Intestinal Gastrointestinal Stromal Tumor: Report of a Case

    PubMed Central

    Sakai, Makoto; Wada, Wataru; Kimura, Shintaro; Okada, Akiko; Hirakata, Tomoko; Onozato, Ryoichi; Saito, Kana; Morohara, Koji; Osawa, Hidenobu; Katayama, Kazuhisa; Yasuda, Naokuni; Tanaka, Shigebumi; Kuwano, Hiroyuki

    2014-01-01

    Our report concerns a 64-year-old man with a small-intestinal gastrointestinal stromal tumor (GIST), which was successfully treated with single-incision laparoscopic surgery (SILS). Small-bowel endoscopy detected a submucosal tumor located approximately 10 cm from the ligament of Treitz in the wall of the proximal jejunum. Contrast-enhanced computed tomography revealed a tumor (diameter, 4 cm) containing high- and low-density areas in the proximal jejunum. On 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET), the tumor demonstrated intense FDG uptake (maximum standard uptake value, 3.82), whereas it displayed high signal intensity on diffusion-weighted magnetic resonance images. No metastatic lesions were observed. The patient was diagnosed with a jejunal GIST. Wedge resection of the jejunum was performed using the SILS procedure. The tumor was histopathologically diagnosed as a low-grade malignant GIST. SILS is a useful resection technique for small-intestinal GIST. PMID:25058785

  7. Simulation in laparoscopic surgery.

    PubMed

    León Ferrufino, Felipe; Varas Cohen, Julián; Buckel Schaffner, Erwin; Crovari Eulufi, Fernando; Pimentel Müller, Fernando; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Boza Wilson, Camilo

    2015-01-01

    Nowadays surgical trainees are faced with a more reduced surgical practice, due to legal limitations and work hourly constraints. Also, currently surgeons are expected to dominate more complex techniques such as laparoscopy. Simulation emerges as a complementary learning tool in laparoscopic surgery, by training in a safe, controlled and standardized environment, without jeopardizing patient' safety. Simulation' objective is that the skills acquired should be transferred to the operating room, allowing reduction of learning curves. The use of simulation has increased worldwide, becoming an important tool in different surgical residency programs and laparoscopic training courses. For several countries, the approval of these training courses are a prerequisite for the acquisition of surgeon title certifications. This article reviews the most important aspects of simulation in laparoscopic surgery, including the most used simulators and training programs, as well as the learning methodologies and the different key ways to assess learning in simulation. PMID:25039039

  8. 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.

  9. 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

  10. Advances in Laparoscopic Surgery.

    PubMed

    Wormser, Chloe; Runge, Jeffrey J

    2016-01-01

    Recently, a new platform of abdominal access, called single-port surgery, has emerged in human and veterinary laparoscopy. The single-port platform enables all laparoscopic instruments, including the telescope, to pass individually through the same abdominal incision. Recently, there have been several published reports documenting the efficacy and safety of single-port procedures in veterinary patients. This article discusses the common single-port devices and instrumentation, as well as procedures now routinely offered in veterinary minimally invasive surgery. PMID:26604155

  11. [Robotics and laparoscopic surgery].

    PubMed

    Martínez Ramos, Carlos

    2006-10-01

    Laparoscopic surgery has completely revolutionized modern surgery. In addition to its advantages, however, this approach also presents significant limitations. The most important are loss of the sense of depth, tactile sensation and resistance, as well as loss of natural hand-eye coordination and manual dexterity. The main motivation for the development of surgical robots is the possibility of eliminating all these limitations. Robots have acquired great potential to improve the operative possibilities of surgeons. Given the continual increase in the use of surgical robots, in the near future the structure and appearance of current operating rooms will change. The present article analyzes the origin and development of robotic systems, as well as the characteristics of the latest generation of robots. Because of the strong interest in robotic surgery and its future prospects, surgeons should be familiar with these emerging and innovative techniques. PMID:17040667

  12. Novel Trocarless, Scarless Technique for Left Lobe Liver Retraction in Laparoscopic Upper Gastrointestinal Surgeries: Simple, Cost-effective and with Better Cosmesis.

    PubMed

    Madnani, Manish A; Patel, Tejas J; Gupta, Alankar K; Mistry, Jitendra H; Soni, Harshad N; Shah, Atul J; Patel, Kantilal S; Haribhakti, Sanjiv P

    2015-12-01

    Surgeons always look for ways to reduce the size and number of ports in laparoscopy, where in today's era, we have single-incision laparoscopic surgery (SILS). While doing so, principal 'adequate exposure' should not be compromised. For upper gastrointestinal laparoscopic surgeries, we have adopted a novel technique for retraction of the left lobe of liver, which is described here. Device can be made both single sling and double sling, with help of an infant feeding tube and any routinely used suture material. Placement of device does not require any incision, special energy source, or instrument. It can help in SILS. Detailed technique is described in the text. Operative times did not change significantly. Exposure was excellent. No special instruments or energy devices are required; thus, it is cost-effective. Reducing one port for liver retraction gives better cosmetic results. No liver injury due to the device was noticed in any of the cases. This technique is simpler and cheaper and also gives reasonable cosmetic results compared to other techniques described in the literature. PMID:27011594

  13. Error analysis in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

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

    1998-06-01

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

  14. Thermostasis during laparoscopic urologic surgery.

    PubMed

    Kaynan, Ayal M; Winfield, Howard N

    2002-09-01

    It has been postulated that gaseous insufflation of the abdominal cavity results in temperature elevation, particularly in children, and that the use of heating blankets should be avoided during laparoscopic surgery. On review of the last 102 laparoscopic genitourinary cases, we conclude that the use of nonheated, nonhumidified carbon dioxide for insufflation during laparoscopic surgery under a general anesthetic results in mild hypothermia. The use of warming devices in this setting is both safe and appropriate. Children have a rise in temperature relative to preoperative measurement, although they are explicitly capable of hypothermia. Neither the duration of the procedure, the surgical approach, nor conversion to open exploration had a significant impact on temperature regulation. Adrenalectomy results in more exaggerated temperature changes than do other laparoscopic procedures. PMID:12396438

  15. Pain after laparoscopic antireflux surgery

    PubMed Central

    Szczebiot, L; Peyser, PM

    2014-01-01

    Introduction The benefits of antireflux surgery are well established. Laparoscopic techniques have been shown to be generally safe and effective. The aim of this paper was to review the subject of pain following laparoscopic antireflux surgery. Methods A systematic review of the literature was conducted using the PubMed database to identify all studies reporting pain after laparoscopic antireflux surgery. Publications were included for the main analysis if they contained at least 30 patients. Operations in children, Collis gastroplasty procedures, endoluminal fundoplication and surgery for paraoesophageal hernias were excluded. The frequency of postoperative pain was calculated and the causes/management were reviewed. An algorithm for the investigation of patients with pain following laparoscopic fundoplication was constructed. Results A total of 17 studies were included in the main analysis. Abdominal pain and chest pain following laparoscopic fundoplication were reported in 24.0% and 19.5% of patients respectively. Pain was mild or moderate in the majority and severe in 4%. Frequency of pain was not associated with operation type. The authors include their experience in managing patients with persistent, severe epigastric pain following laparoscopic anterior fundoplication. Conclusions Pain following laparoscopic antireflux surgery occurs in over 20% of patients. Some have an obvious complication or a diagnosis made through routine investigation. Most have mild to moderate pain with minimal effect on quality of life. In a smaller proportion of patients, pain is severe, persistent and can be disabling. In this group, diagnosis is more difficult but systematic investigation can be rewarding, and can enable appropriate and successful treatment. PMID:24780664

  16. Laparoscopic Spine Surgery

    MedlinePlus

    ... to pressure on the nerve. Are There Other Advantages to the Anterior Approach? Inter-vertebral disc height ( ... require removal of any bone. What are the Advantages of the Laparoscopic (Minimally Invasive) Approach? Keep reading... ...

  17. Anesthetic implications of laparoscopic surgery.

    PubMed Central

    Cunningham, A. J.

    1998-01-01

    Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative

  18. Complications of Laparoscopic Gynecologic Surgery

    PubMed Central

    Fuentes, Mariña Naveiro; Naveiro Rilo, José Cesáreo; Paredes, Aida González; Aguilar Romero, María Teresa; Parra, Jorge Fernández

    2014-01-01

    Background and Objectives: To analyze the frequency of complications during laparoscopic gynecologic surgery and identify associated risk factors. Methods: A descriptive observational study was performed between January 2000 and December 2012 and included all gynecologic laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. Results: Of all 2888 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. Conclusion: Laparoscopic gynecologic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications. PMID:25392659

  19. Robotic Versus Laparoscopic Colorectal Surgery

    PubMed Central

    Jackson, Nicole R.; Hauch, Adam T.; Hu, Tian; Kandil, Emad

    2014-01-01

    Background: Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population. Study Design: A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were included. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group. Results: Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes longer (95% confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95% confidence interval: –27.63 to –1.60), and patients were 1.78 times more likely to be converted to an open procedure (95% confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, readmission rate, or perioperative complication rate. Conclusions: The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care. PMID:25489216

  20. LAPAROSCOPIC RESECTION OF GASTROINTESTINAL STROMAL TUMORS (GIST)

    PubMed Central

    LOUREIRO, Marcelo de Paula; de ALMEIDA, Rômulo Augusto Andrade; CLAUS, Christiano Marlo Paggi; BONIN, Eduardo Aimoré; CURY-FILHO,, Antônio Moris; DIMBARRE, Daniellson; da COSTA, Marco Aurélio Raeder; VITAL, Marcílio Lisboa

    2016-01-01

    Background Gastrointestinal mesenchymal or stromal tumors (GIST) are lesions originated on digestive tract walls, which are treated by surgical resection. Several laparoscopic techniques, from gastrectomies to segmental resections, have been used successfully. Aim Describe a single center experience on laparoscopic GIST resection. Method Charts of 15 operated patients were retrospectively reviewed. Thirteen had gastric lesions, of which ten were sub epithelial, ranging from 2-8 cm; and three were pure exofitic growing lesions. The remaining two patients had small bowel lesions. Surgical laparoscopic treatment consisted of two distal gastrectomies, 11 wedge gastric resections and two segmental enterectomies. Mechanical suture was used in the majority of patients except on six, which underwent resection and closure using manual absorbable sutures. There were no conversions to open technique. Results Mean operative time was 1h 29 min±92 (40-420 min). Average lenght of hospital stay was three days (2-6 days). There were no leaks, postoperative bleeding or need for reintervention. Mean postoperative follow-up was 38±17 months (6-60 months). Three patients underwent adjuvant Imatinib treatment, one for recurrence five months postoperatively and two for tumors with moderate risk for recurrence . Conclusion Laparoscopic GIST resection, not only for small lesions but also for tumors above 5 cm, is safe and acceptable technique. PMID:27120729

  1. Laparoscopic Anti-Reflux (GERD) Surgery

    MedlinePlus

    ... Opportunities Sponsorship Opportunities Login Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Print PDF Find a SAGES Surgeon Surgery for “Heartburn” If you suffer from moderate to ...

  2. Enhanced vision system for laparoscopic surgery.

    PubMed

    Tamadazte, Brahim; Fiard, Gaelle; Long, Jean-Alexandre; Cinquin, Philippe; Voros, Sandrine

    2013-01-01

    Laparoscopic surgery offers benefits to the patients but poses new challenges to the surgeons, including a limited field of view. In this paper, we present an innovative vision system that can be combined with a traditional laparoscope, and provides the surgeon with a global view of the abdominal cavity, bringing him or her closer to open surgery conditions. We present our first experiments performed on a testbench mimicking a laparoscopic setup: they demonstrate an important time gain in performing a complex task consisting bringing a thread into the field of view of the laparoscope. PMID:24111032

  3. 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

  4. 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

  5. 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

  6. Collaboration between laparoscopic surgery and endoscopic resection: an evidence-based review.

    PubMed

    Teoh, Anthony Yuen Bun; Chiu, Philip Wai Yan

    2014-01-01

    Developments in endoscopy and laparoscopy have made monumental changes to the way gastrointestinal diseases are being managed. Many diseases that were traditionally managed by open surgical resection could now be treated by endoscopy alone. However, there are still instances where endoscopic treatment alone is inadequate for disease control and laparoscopic surgery is required. In addition, the collaboration between laparoscopic surgery and endoscopic submucosal dissection or other endoscopic resectional techniques represents a new frontier for further research. The present manuscript aims to discuss the complementary role of laparoscopic surgery to endoscopic resection in the traditional context and also its future development. PMID:24188505

  7. Laparoscopic excision of large lower rectal gastrointestinal stromal tumour (GIST): A case report

    PubMed Central

    Somu, Karthik; Dashore, Amit R.; Shah, Aashish R.; Anandh, Rajiv

    2016-01-01

    Gastrointestinal stromal tumour (GIST) involving rectum is rare. No definite method of treatment has been established because of a small number of cases being reported. It is usually managed with invasive or ablative surgery, such as abdominoperineal resection (APR). The acceptance of minimally invasive (laparoscopic) surgery in colorectal disease plays a pivotal role in improving the postoperative quality of life. We report a case of a large lower rectal GIST who underwent laparoscopic excision of tumour through a subserosal approach whilst preserving the anal sphincter and without any rectal resection. PMID:27279404

  8. Gastrointestinal changes after bariatric surgery.

    PubMed

    Quercia, I; Dutia, R; Kotler, D P; Belsley, S; Laferrère, B

    2014-04-01

    Severe obesity is a preeminent health care problem that impacts overall health and survival. The most effective treatment for severe obesity is bariatric surgery, an intervention that not only maintains long-term weight loss but also is associated with improvement or remission of several comorbidies including type 2 diabetes mellitus. Some weight loss surgeries modify the gastrointestinal anatomy and physiology, including the secretions and actions of gut peptides. This review describes how bariatric surgery alters the patterns of gastrointestinal motility, nutrient digestion and absorption, gut peptide release, bile acids and the gut microflora, and how these changes alter energy homeostasis and glucose metabolism. PMID:24359701

  9. Gastrointestinal changes after bariatric surgery

    PubMed Central

    Quercia, I.; Dutia, R.; Kotler, D.P.; Belsley, S.; Laferrère, B.

    2015-01-01

    Severe obesity is a preeminent health care problem that impacts overall health and survival. The most effective treatment for severe obesity is bariatric surgery, an intervention that not only maintains long-term weight loss but also is associated with improvement or remission of several comorbidies including type 2 diabetes mellitus. Some weight loss surgeries modify the gastrointestinal anatomy and physiology, including the secretions and actions of gut peptides. This review describes how bariatric surgery alters the patterns of gastrointestinal motility, nutrient digestion and absorption, gut peptide release, bile acids and the gut microflora, and how these changes alter energy homeostasis and glucose metabolism. PMID:24359701

  10. 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

  11. Therapeutic advances: Single incision laparoscopic hepatopancreatobiliary surgery

    PubMed Central

    Chang, Stephen Kin Yong; Lee, Kai Yin

    2014-01-01

    Single-port laparoscopic surgery (SPLS) is proposed to be a step towards minimizing the invasiveness of surgery, and has since gained popularity in several surgical sub-specialties including hepatopancreatobiliary surgery. SPLS has since been applied to cholecystectomy, liver resection as well as pancreatectomy for a multitude of pathologies. Benefits of SPLS over conventional multi-incision laparoscopic surgery include improved cosmesis and potentially post-operative pain at specific time periods and extra-umbilical sites. However, it is also associated with longer operating time, increased rate of complications, and increased rate of port-site hernia. There is no significant difference between length of hospital stay. SPLS has a significant learning curve that affects operating time, rate of conversion and rate of complications. In this article, we review the literature on SPLS in hepatobiliary surgery - cholecystectomy, hepatectomy and pancreatectomy, and offer tips on overcoming potential technical obstacles and minimizing the complications when performing SPLS - surgeon position, position of port and instruments, instrument crossing position, standard hand grip vs reverse hand grip, snooker cue guide position, prevention of incisional hernia. SPLS is a promising direction in laparoscopic surgery, and we recommend step-wise progression of applications of SPLS to various hepatopancreatobiliary surgeries to ensure safe adoption of the surgical technique. PMID:25339820

  12. Advances in laparoscopic surgery in urology.

    PubMed

    Rassweiler, Jens J; Teber, Dogu

    2016-07-01

    In the past 10 years, laparoscopy has been challenged by robotic surgery; nevertheless, laparoscopic techniques are subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarized glasses. New devices for laparoscopy include advanced sealing devices, instruments with six degrees of freedom, ergonomic platforms with armrests and a chest support, and camera holders. A manually manipulated robot-like device is still at the experimental stage. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, robot-assisted surgery is associated with considerable costs. All technical improvements of laparoscopic surgery are extremely valuable to further simplify the use of classical laparoscopy. PMID:27215426

  13. Laparoscopic surgery for ulcerative colitis: a review of the literature.

    PubMed

    Hata, Keisuke; Kazama, Shinsuke; Nozawa, Hiroaki; Kawai, Kazushige; Kiyomatsu, Tomomichi; Tanaka, Junichiro; Tanaka, Toshiaki; Nishikawa, Takeshi; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Kitayama, Joji; Watanabe, Toshiaki

    2015-08-01

    Despite the development of new therapies, including anti-TNF alpha antibodies and immunosuppressants, a substantial proportion of patients with ulcerative colitis (UC) still require surgery. Restorative proctocolectomy with ileal-pouch anal anastomosis is the standard surgical treatment of choice for UC. With the advent of laparoscopic techniques for colorectal surgery, ileal-pouch anal anastomosis has also been performed laparoscopically. This paper reviews the history and current trends in laparoscopic surgery for UC. The accumulation of experience and improvement of laparoscopic devices have shifted the paradigm of UC surgery towards laparoscopic surgery over the past decade. Although laparoscopic surgery requires a longer operation, it provides significantly better short and long-term outcomes. The short-term benefits of laparoscopic surgery over open surgery include shorter hospital stays and fasting times, as well as better cosmesis. The long-term benefits of laparoscopy include better fecundity in young females. Some surgeons favor laparoscopic surgery even for severe acute colitis. More efforts are being made to develop newer laparoscopic methods, such as reduced port surgery, including single incision laparoscopic surgery and robotic surgery. PMID:25346254

  14. Advances in laparoscopic urologic surgery techniques

    PubMed Central

    Abdul-Muhsin, Haidar M.; Humphreys, Mitchell R.

    2016-01-01

    The last two decades witnessed the inception and exponential implementation of key technological advancements in laparoscopic urology. While some of these technologies thrived and became part of daily practice, others are still hindered by major challenges. This review was conducted through a comprehensive literature search in order to highlight some of the most promising technologies in laparoscopic visualization, augmented reality, and insufflation. Additionally, this review will provide an update regarding the current status of single-site and natural orifice surgery in urology. PMID:27134743

  15. Advances in laparoscopic urologic surgery techniques.

    PubMed

    Abdul-Muhsin, Haidar M; Humphreys, Mitchell R

    2016-01-01

    The last two decades witnessed the inception and exponential implementation of key technological advancements in laparoscopic urology. While some of these technologies thrived and became part of daily practice, others are still hindered by major challenges. This review was conducted through a comprehensive literature search in order to highlight some of the most promising technologies in laparoscopic visualization, augmented reality, and insufflation. Additionally, this review will provide an update regarding the current status of single-site and natural orifice surgery in urology. PMID:27134743

  16. Single port laparoscopic liver surgery: A minireview

    PubMed Central

    Karabicak, Ilhan; Karabulut, Kagan

    2016-01-01

    Nowadays, the trend is to perform surgeries with “scarless” incisions. In light of this, the single-port laparoscopic surgery (SPLS) technique is rapidly becoming widespread due to its lack of invasiveness and its cosmetic advantages, as the only entry point is usually hidden in the umbilicus. The interest in “scarless” liver resections did not grow as rapidly as the interest in other scarless surgeries. Hepatopancreatobiliary surgeons are reluctant to operate a malignant lesion through a narrow incision with limited exposure. There are concerns over adverse oncological outcomes for single-port laparoscopic liver resections (SPL-LR) for hepatocellular carcinoma or metastatic colorectal cancer. In addition, getting familiar with using the operating instruments through a narrow incision with limited exposure is very challenging. In this article, we reviewed the published literature to describe history, indications, contraindications, ideal patients for new beginners, technical difficulty, advantages, disadvantages, oncological concern and the future of SPL-LR. PMID:27358670

  17. 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

  18. Laparoscopic exploration in pediatric surgery emergencies

    PubMed Central

    Drăghici, L; Popescu, M; Liţescu, M

    2010-01-01

    The laparoscopic approach of pediatric surgery emergencies represents a specific preoccupation in hospitals everywhere in the world. Nowadays, when confronted with this pathology, pediatric surgeons are able to apply certain well–defined therapeutic protocols, depending on the technical equipment at their disposal and their laparoscopic expertise and training. We hereby present some of the surgical pediatric emergencies that have been subjected to minimally invasive celioscopic techniques, in the Department of Pediatric Surgery ‘Maria Sklodowska Curie’ Hospital, from August 1999 to July 2007. Out of 83 exploratory laparoscopies, 12 were performed for emergency pathology, other than acute appendicitis (in its various forms, including peritonitis) or acute cholecystitis. However, during the above–mentioned period, the number of therapeutic laparoscopies for emergencies has grown significantly (239 from a total of 663 laparoscopies), reflecting to a large extent the activity of a clinic with an emergency surgery profile. The authors conclude that exploratory laparoscopies in pediatric surgery emergencies are suited for surgical teams with a solid experience in celioscopy and a certain professional maturity, necessary to correctly appreciate the surgical and anesthetic risks involved by each individual case. It is not recommended that inexperienced laparoscopic surgeons embark on the ‘adventure’ of this minimally invasive approach for this type of pathology. Only when the training and learning process is fully and correctly completed, specialists are offered the advantage of continuing a celioscopic exploration by performing a minimally invasive therapeutic procedure, even for a pediatric emergency case. PMID:20302204

  19. An interactive method for achieving ergonomically optimum conditions during laparoscopic surgery.

    PubMed

    Hu, Chang-Lin; Yang, Ching-Yao; Lin, Zhan-Sheng; Yang, Shan-Yi; Kuo, Chien-Hung; Lin, Ming-Tsan

    2013-06-01

    Laparoscopy is widely used during living kidney donation, nephrectomy, bariatric surgery, and surgery for gastrointestinal tumors and colorectal cancer. However, laparoscopic surgery requires prolonged use of instruments and has low mechanical efficiency. In addition, to meet specific surgical demands while visualizing the surgical area on the screen, surgical personnel frequently violate the postures proposed by human factor engineering; this naturally results in a physical burden on the personnel. In this study, using laparoscopic nephrectomy as an example, an auxiliary hoisting device for surgery was designed, and pedals from a variety of equipment were integrated into the auxiliary plant. Both entity testing conducted in the hospital and 3D surgical simulation of the auxiliary plant showed that this device could improve compliance with human factor engineering recommendations during laparoscopic surgery and could also promote interaction and tacit understanding between surgical personnel, thereby providing ergonomically optimum conditions during laparoscopy. PMID:27000902

  20. Successful Retrieval of a Retained Capsule Endoscope with Single Incision Laparoscopic Surgery

    PubMed Central

    Tashiro, Yoshihiko; Kawai, Masaya; Takehara, Kazuhiro; Munakata, Shinya; Ishiyama, Shun; Sugimoto, Kiichi; Takahashi, Makoto; Kojima, Yutaka; Goto, Michitoshi; Tomiki, Yuichi; Shibuya, Tomoyoshi; Osada, Taro; Watanabe, Sumio; Sakamoto, Kazuhiro

    2014-01-01

    Capsule endoscopy (CE) is commonly used for examining and diagnosing gastrointestinal disease, especially small bowel disease. Capsule retention is a well-known and significant complication of CE and requires surgical or endoscopic removal. Most reports described the retrieval of retained CE via laparotomy. We report a case of successful retrieval of the capsule using single incision laparoscopic surgery. PMID:25028577

  1. The evolving role of laparoscopic surgery in paediatric urology

    PubMed Central

    Hidas, Guy; Watts, Blake; Khoury, Antoine E.

    2012-01-01

    Objectives We review the various applications of laparoscopic and robotic-assisted laparoscopy in paediatric urology, as the laparoscopic and robotic approach in this population is gradually being recognised. Methods We searched PubMed for human studies in English that were published between 1990 and the present, focusing on laparoscopic nephrectomies and partial nephrectomies, laparoscopic and robotic pyeloplasties and ureteric reimplantation, laparoscopic orchidopexy and varicocelectomy. We also reviewed robotic-assisted laparoscopic urological major reconstructions. Key articles were reviewed, extracting the indications, techniques, and the advantages and disadvantages. Results and conclusions Laparoscopy has a defined place in modern paediatric urological surgery. Laparoscopic nephrectomies, pyeloplasties and abdominal exploration for the evaluation and management of impalpable undescended testicles have become the standard of care. Robotic-assisted laparoscopic surgery is developing as a safe and effective option even for infant patients. PMID:26558007

  2. Comparison of treatment costs of laparoscopic and open surgery

    PubMed Central

    Piskorz, Łukasz; Koptas, Włodzimierz

    2015-01-01

    Introduction Laparoscopy has been a standard procedure in most medical centres providing surgical services for many years. Both the range and number of laparoscopic procedures performed are constantly increasing. Over the last decade, laparoscopic procedures have been successfully applied both in emergency and oncological surgery. However, treatment costs have become a more important factor in choosing between open or laparoscopic procedures. Aim To present the total real costs of open and laparoscopic cholecystectomy, appendectomy and sigmoidectomy. Material and methods Between 1 May 2010 and 30 March 2015 in the Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, and in the Department of General Surgery of the Saint John of God Hospital, Lodz, doctors performed 1404 cholecystectomies, 392 appendectomies and 88 sigmoidectomies. A total of 97% of the cholecystectomy procedures were laparoscopic and 3% were open. Similarly, 22% of total appendectomies were laparoscopic and 78% were open, while 9% of sigmoidectomies were laparoscopic and 91% open. Results The requirement for single-use equipment in laparoscopic procedures increases the expense. However, after adding up all other costs, surprisingly, differences between the costs of laparoscopic and open procedures ranged from 451 PLN/€ 114 for laparoscopic operations to 611 PLN/€ 153 for open operations. Conclusions Laparoscopic cholecystectomy, considered the standard surgery for treating gallbladder diseases, is cheaper than open cholecystectomy. Laparoscopic appendectomy and sigmoidectomy are safe methods of minimally invasive surgery, slightly more expensive than open operations. Of all the analyzed procedures, one-day laparoscopic cholecystectomy is the most profitable. The costs of both laparoscopic and open sigmoidectomy are greatly underestimated in Poland. PMID:26649092

  3. Haptic rendering for VR laparoscopic surgery simulation.

    PubMed

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

    2006-03-01

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

  4. 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

  5. Laparoscopic Ovarian Surgery in Children and Adolescents

    PubMed Central

    Cho, Hye-yon; Park, Sung-ho; Park, Sung-taek

    2015-01-01

    Background and Objectives: Although laparoscopy is widely used in gynecologic surgery in adults, few studies have been undertaken to examine its use in young and adolescent patients. This study was conducted to investigate the safety and feasibility of laparoscopic surgery for the treatment of benign ovarian disease in children and adolescents. Methods: A retrospective chart review was conducted on 106 patients (age, <20 years) who underwent laparoscopic surgery at Kangnam Sacred Heart Hospital from 2006 through 2012. Results: The mean patient age was 17.1 years, and the youngest one was 8. Pathologic analyses revealed that 32 (30.2%) patients had dermoid cyst, 30 (28.3%) had simple cyst, and 15 (14.2%) had endometrioma. Conservative procedures, such as cystectomy (48.1%), aspiration (5.7%), fulguration (4.7%), and detorsion (3.8%), were performed in 65.1% of all cases. A subanalysis revealed that the surgical outcomes of children (age, ≤15 years), including operative time, estimated blood loss, postoperative hemoglobin decrease, and postoperative length of hospital stay, were comparable to those of adolescents (age, 16–19 years), despite significant differences in mean height between the 2 groups (156.1 ± 10.71 cm in children vs. 162.1 ± 5.14 cm in adolescents; P < .0001). (The age break between the study groups was set at 15 years, because most girls reach their adult height between the ages of 15 and 16 years.) No intra- or perioperative complications were noted. In a comparison study of surgical outcomes in 433 women (age, 20–50 years) and the 106 young and adolescent girls in our sample (age, <20 years), those in our patients were not inferior. Conclusion: In children and adolescents, laparoscopic surgery can be successfully performed with conventional instruments designed for use in adults. PMID:25788824

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

    PubMed

    Chiow, Adrian Kah Heng; Lee, Ser Yee; Chan, Chung Yip; Tan, Siong San

    2015-12-01

    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. PMID:26734626

  7. Evolution and future of laparoscopic colorectal surgery

    PubMed Central

    Kaiser, Andreas M

    2014-01-01

    The advances of laparoscopic surgery since the early 1990s have caused one of the largest technical revolutions in medicine since the detection of antibiotics (1922, Flemming), the discovery of DNA structure (1953, Watson and Crick), and solid organ transplantation (1954, Murray). Perseverance through a rocky start and increased familiarity with the chop-stick surgery in conjunction with technical refinements has resulted in a rapid expansion of the indications for minimally invasive surgery. Procedure-related factors initially contributed to this success and included the improved postoperative recovery and cosmesis, fewer wound complications, lower risk for incisional hernias and for subsequent adhesion-related small bowel obstructions; the major breakthrough however came with favorable long-term outcomes data on oncological parameters. The future will have to determine the specific role of various technical approaches, define prognostic factors of success and true progress, and consider directing further innovation while potentially limiting approaches that do not add to patient outcomes. PMID:25386060

  8. 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

  9. Fluidic lens laparoscopic zoom camera for minimally invasive surgery

    NASA Astrophysics Data System (ADS)

    Tsai, Frank S.; Johnson, Daniel; Francis, Cameron S.; Cho, Sung Hwan; Qiao, Wen; Arianpour, Ashkan; Mintz, Yoav; Horgan, Santiago; Talamini, Mark; Lo, Yu-Hwa

    2010-05-01

    This work reports a miniaturized laparoscopic zoom camera that can significantly improve vision for minimally invasive surgery (MIS), also known as laparoscopic surgery. The laparoscopic zoom camera contains bioinspired fluidic lenses that can change curvature and focal length in a manner similar to the crystalline lenses in human eyes. The traditional laparoscope is long, rigid, and made of fixed glass lenses with a fixed field of view. The constricted vision of a laparoscope is often an inconvenience and plays a role in many surgical injuries. To further advance MIS technology, we developed a new type of laparoscopic camera that has a total length of less than 17 mm, greater than 4× optical zoom, and 100 times higher sensitivity than today's laparoscope allowing it to work under illumination as low as 300 lux. All these unique features are enabled by the technology of bioinspired fluidic lenses having a dynamic range over 100 diopters and being convertible between a convex and concave shape.

  10. [Laparoscopic surgery in regions: problems and ways of development].

    PubMed

    Fedorov, A V; Oloviannyĭ, V E

    2011-01-01

    The modern state of laparoscopic surgery in northern regions (Komi republic, Murmansk, Arkhangelsk and Vologda regions) of Russian Federation was surveyed according to the reports of 1998-2007 and 2009 years. Thus, the investigation revealed, that not more than 30% of general surgeons are handle laparoscopic technique. Laparoscopic procedures comprise about 20% of all abdominal operations in the surveyed regions. Statictically significant differences in the use of laparoscopic surgery were revealed between the regions (p<0,001). In 2009 laparoscopically treated were: 82-98,5% cases of chronic calculous cholecystitis; 37,5-70,3% cases of the acute calculous cholecystitis; 1,0-10,7% of the acute appendicitis and 0,5-7,8% of patients with perforated ulcer. Nevertheless, the increase of the laparoscopic share is statistically expected within 5 next years. PMID:21716211

  11. Laparoscopic Surgery is Useful for Preventing Recurrence of Small Bowel Obstruction After Surgery for Postoperative Small Bowel Obstruction

    PubMed Central

    Nakamura, Takatoshi; Sato, Takeo; Naito, Masanori; Ogura, Naoto; Yamanashi, Takahiro; Miura, Hirohisa; Tsutsui, Atsuko; Yamashita, Keishi

    2016-01-01

    Introduction: Risk factors for recurrence postoperative small bowel obstruction in patients who have postoperative abdominal surgery remain unclear. Materials and Methods: The study group comprised 123 patients who underwent surgery for ileus that developed after abdominal surgery from 1999 through 2013. There were 58 men (47%) and 65 women (53%), with a mean age of 63 years (range, 17 to 92 y). The following surgical procedures were performed: lower gastrointestinal surgery in 47 patients (39%), gynecologic surgery in 39 (32%), upper gastrointestinal surgery in 15 (12%), appendectomy in 9 (7%), cholecystectomy in 5 (4%), urologic surgery in 5 (4%), and repair of injuries caused by traffic accidents in 3 (2%). Laparoscopic surgery was performed in 75 patients (61%), and open surgery was done in 48 (39%). We examined the following 11 potential risk factors for recurrence of small bowel obstruction after surgery for ileus: sex, age, body mass index, the number of episodes of ileus, the number of previously performed operations, the presence or absence of radiotherapy, the previously used surgical technique, the current surgical technique (laparoscopic surgery, open surgery), operation time, bleeding volume, and the presence or absence of enterectomy. Results: The median follow-up was 57 months (range, 7 to 185 mo). Laparoscopic surgery was switched to open surgery in 11 patients (18%). The reason for surgery for postoperative small bowel obstruction was adhesion to the midline incision in 36 patients (29%), band formation in 30 (24%), intrapelvic adhesion in 23 (19%), internal hernia in 13 (11%), small bowel adhesion in 20 (16%), and others in 1 (1%). Postoperative complications developed in 35 patients (28%): wound infection in 12 (10%), recurrence of postoperative small bowel obstruction in 12 (10%), paralytic ileus in 4 (3%), intra-abdominal abscess in 3 (2%), suture failure in 1 (1%), anastomotic bleeding in 1 (1%), enteritis in 1 (1%), and dysuria in 1 (1

  12. 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

  13. Impact of Type of Surgery on Survival Outcome in Patients With Early Gallbladder Cancer in the Era of Minimally Invasive Surgery: Oncologic Safety of Laparoscopic Surgery.

    PubMed

    Jang, Jin-Young; Heo, Jin Seok; Han, Youngmin; Chang, Jihoon; Kim, Jae Ri; Kim, Hongbeom; Kwon, Wooil; Kim, Sun-Whe; Choi, Seong Ho; Choi, Dong Wook; Lee, Kyoungbun; Jang, Kee-Taek; Han, Sung-Sik; Park, Sang-Jae

    2016-05-01

    Laparoscopic surgery has been widely accepted as a feasible and safe treatment modality in many cancers of the gastrointestinal tract. However, most guidelines on gallbladder cancer (GBC) regard laparoscopic surgery as a contraindication, even for early GBC. This study aims to evaluate and compare recent surgical outcomes of laparoscopic and open surgery for T1(a,b) GBC and to determine the optimal surgical strategy for T1 GBC.The study enrolled 197 patients with histopathologically proven T1 GBC and no history of other cancers who underwent surgery from 2000 to 2014 at 3 major tertiary referral hospitals with specialized biliary-pancreas pathologists and optimal pathologic handling protocols. Median follow-up was 56 months. The effects of depth of invasion and type of surgery on disease-specific survival and recurrence patterns were investigated.Of the 197 patients, 116 (58.9%) underwent simple cholecystectomy, including 31 (15.7%) who underwent open cholecystectomy and 85 (43.1%) laparoscopic cholecystectomy. The remaining 81 (41.1%) patients underwent extended cholecystectomy. Five-year disease-specific survival rates were similar in patients who underwent simple and extended cholecystectomy (96.7% vs 100%, P = 0.483), as well as being similar in patients in the simple cholecystectomy group who underwent open and laparoscopic cholecystectomy (100% vs 97.6%, P = 0.543). Type of surgery had no effect on recurrence patterns.Laparoscopic cholecystectomy for T1 gallbladder cancer can provide similar survival outcomes compared to open surgery. Considering less blood loss and shorter hospital stay with better cosmetic outcome, laparoscopic cholecystectomy can be justified as a standard treatment for T1b as well as T1a gallbladder cancer when done by well-experienced surgeons based on exact pathologic diagnosis. PMID:27258495

  14. Critical appraisal of laparoscopic vs open rectal cancer surgery

    PubMed Central

    Tan, Winson Jianhong; Chew, Min Hoe; Dharmawan, Angela Renayanti; Singh, Manraj; Acharyya, Sanchalika; Loi, Carol Tien Tau; Tang, Choong Leong

    2016-01-01

    AIM: To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer. METHODS: An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared. RESULTS: Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin < 2 mm, and postoperative adjuvant chemotherapy. The survival benefit of laparoscopic surgery was no longer significant on multivariate analysis (P = 0.148). Neither 5-year overall survival (70.5% vs 61.8%, P = 0.217) nor 5-year cancer free survival (64.3% vs 66.6%, P = 0.854) were significantly different between the laparoscopic group and the converted group. CONCLUSION: LRR has equivalent long-term oncologic outcomes when compared to OP. Laparoscopic conversion does not confer a worse prognosis. PMID:27358678

  15. CURRENT STATUS OF RESIDENCY TRAINING IN LAPAROSCOPIC SURGERY IN BRAZIL: A CRITICAL REVIEW

    PubMed Central

    NÁCUL, Miguel Prestes; CAVAZZOLA, Leandro Totti; de MELO, Marco Cezário

    2015-01-01

    Introduction The surgeon's formation process has changed in recent decades. The increase in medical schools, new specialties and modern technologies induce an overhaul of medical education. Medical residency in surgery has established itself as a key step in the formation of the surgeon, and represents the ideal and natural way for teaching laparoscopy. However, the introduction of laparoscopic surgery in the medical residency programs in surgical specialties is insufficient, creating the need for additional training after its termination. Objective To review the surgical teaching ways used in services that published their results. Methods Survey of relevant publications in books, internet and databases in PubMed, Lilacs and Scielo through july 2014 using the headings: laparoscopy; simulation; education, medical; learning; internship and residency. Results The training method for medical residency in surgery focused on surgical procedures in patients under supervision, has proven successful in the era of open surgery. However, conceptually turns as a process of experimentation in humans. Psychomotor learning must not be developed directly to the patient. Training in laparoscopic surgery requires the acquisition of psychomotor skills through training conducted initially with surgical simulation. Platforms based teaching problem solving as the Fundamentals of Laparoscopic Surgery, developed by the American Society of Gastrointestinal Endoscopic Surgery and the Laparoscopic Surgical Skills proposed by the European Society of Endoscopic Surgery has been widely used both for education and for the accreditation of surgeons worldwide. Conclusion The establishment of a more appropriate pedagogical process for teaching laparoscopic surgery in the medical residency programs is mandatory in order to give a solid surgical education and to determine a structured and safe professional activity. PMID:25861077

  16. Single incision laparoscopic surgery - trans anal endoscopic microsurgery: A technological innovation.

    PubMed

    Shah, Neha; Sasikumar, Pattabi; Rajkumar, Janavikula Sankaran

    2014-04-01

    Trans anal endoscopic microsurgery (TEM) first burst upon the scene several decades ago and then underwent a period of immersion. We have herein reported our experience in two cases who underwent TEM using laparoscopic techniques. The advent of single incision laparoscopic surgery (SILS) has made great inroads into various fields of general and gastrointestinal (GI) surgery. We decided to make use of the same technique in TEM for two patients who had large sessile villous adenomas of the rectum. We used this port and fixed it transanally to the edge of the anus. Carbon dioxide used for insufflation in laparoscopic surgery was used through one of the ports, and a telescope was inserted to the larger port. We made sure that the entire polyp was cut out completely until the circular muscle of the internal sphincter was clearly exposed. Next, the cut edges of the rectum were undermined between the mucosa and the circular muscles in order to bring the cut edges closer together. We were able to perform this SILS TEM in two cases. In both the cases, well differentiated villous adenoma (colonoscopically, biopsy proven before surgery) was confirmed after excision. The question has been raised whether TEM is the new laparoscopy for anorectal surgery. Increasingly, several reports are showing promise for treatment for early stage cancers and large rectal adenomas using TEM. Adoption of our technique using the SILS port that has not been previously described in medical literature, seems to be a promising tool for the future. TEM first burst upon the scene several decades ago and then under went a period of immersion. In recent years, with the onset of laparoscopic surgery, the thoughts and the ideas of using a laparoscopic surgical technique have invaded the area of colorectal cancer as well. We have herein reported our experience in two cases who underwent TEM using laparoscopic techniques. PMID:24761088

  17. Minimally Invasive Surgery in Gastrointestinal Cancer: Benefits, Challenges, and Solutions for Underutilization

    PubMed Central

    Gusani, Niraj J.; Kimchi, Eric T.; Kavic, Stephen M.

    2014-01-01

    Background and Objectives: After the widespread application of minimally invasive surgery for benign diseases and given its proven safety and efficacy, minimally invasive surgery for gastrointestinal cancer has gained substantial attention in the past several years. Despite the large number of publications on the topic and level I evidence to support its use in colon cancer, minimally invasive surgery for most gastrointestinal malignancies is still underused. Methods: We explore some of the challenges that face the fusion of minimally invasive surgery technology in the management of gastrointestinal malignancies and propose solutions that may help increase the utilization in the future. These solutions are based on extensive literature review, observation of current trends and practices in this field, and discussion made with experts in the field. Results: We propose 4 different solutions to increase the use of minimally invasive surgery in the treatment of gastrointestinal malignancies: collaboration between surgical oncologists/hepatopancreatobiliary surgeons and minimally invasive surgeons at the same institution; a single surgeon performing 2 fellowships in surgical oncology/hepatopancreatobiliary surgery and minimally invasive surgery; establishing centers of excellence in minimally invasive gastrointestinal cancer management; and finally, using robotic technology to help with complex laparoscopic skills. Conclusions: Multiple studies have confirmed the utility of minimally invasive surgery techniques in dealing with patients with gastrointestinal malignancies. However, training continues to be the most important challenge that faces the use of minimally invasive surgery in the management of gastrointestinal malignancy; implementation of our proposed solutions may help increase the rate of adoption in the future. PMID:25489209

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

    PubMed Central

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

    2016-01-01

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

  19. Laparoscopic pancreatic surgery for benign and malignant disease.

    PubMed

    de Rooij, Thijs; Klompmaker, Sjors; Abu Hilal, Mohammad; Kendrick, Michael L; Busch, Olivier R; Besselink, Marc G

    2016-04-01

    Laparoscopic surgery for benign and malignant pancreatic lesions has slowly been gaining acceptance over the past decade and is being introduced in many centres. Some studies suggest that this approach is equivalent to or better than open surgery, but randomized data are needed to assess outcomes. In this Review, we aim to provide a comprehensive overview of the state of the art in laparoscopic pancreatic surgery by aggregating high-quality published evidence. Various aspects, including the benefits, limitations, oncological efficacy, learning curve and latest innovations, are discussed. The focus is on laparoscopic Whipple procedure and laparoscopic distal pancreatectomy for both benign and malignant disease, but robot-assisted surgery is also addressed. Surgical and oncological outcomes are discussed as well as quality of life parameters and the cost efficiency of laparoscopic pancreatic surgery. We have also included decision-aid algorithms based on the literature and our own expertise; these algorithms can assist in the decision to perform a laparoscopic or open procedure. PMID:26882881

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

    PubMed

    Namikawa, Tsutomu; Hanazaki, Kazuhiro

    2015-10-10

    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

  1. Friction characteristics of trocars in laparoscopic surgery.

    PubMed

    Alazmani, Ali; Roshan, Rupesh; Jayne, David G; Neville, Anne; Culmer, Peter

    2015-04-01

    This article investigates the friction characteristics of the instrument-trocar interface in laparoscopic surgery for varying linear instrument velocities, trocar seal design and material, and trocar tilt. Furthermore, the effect of applying lubrication at the instrument-trocar seal interface on friction was studied. A friction testing apparatus was designed and built to characterise the resistance force at the instrument-trocar interface as a function of the instrument's linear movement in the 12-mm trocar (at constant velocity) for different design, seal material, and angle of tilt. The resistance force depended on the trocar seal design and material properties, specifically surface roughness, elasticity, hardness, the direction of movement, and the instrument linear velocity, and varied between 0.25 and 8 N. Lubricating the shaft with silicone oil reduced the peak resistance force by 75% for all trocars and eliminated the stick-slip phenomenon evident in non-lubricated cases. The magnitude of fluctuation in resistance force depends on the trocar design and is attributed to stick-slip of the sealing mechanism and is generally higher during retraction in comparison to insertion. Trocars that have an inlet seal made of rubber/polyurethane showed higher resistance forces during retraction. Use of a lubricant significantly reduced frictional effects. Comparisons of the investigated trocars indicate that a low friction port, providing the surgeon with improved haptic feedback, can be designed by improving the tribological properties of the trocar seal interface. PMID:25825419

  2. [ Ambulatory laparoscopic gynecological surgery in Africa: feasibility].

    PubMed

    Nzoghe Nguema, P; Ogowet Igumu, N; Pither, S; Ngaka Nsafu, D

    2001-09-01

    We report a prospective survey conduced between March 1998 and February 1999 among 100 women classes ASA I and II who underwent laparoscopic surgery for gynecological disorders under general anesthesia. Among these laparoscopies 85 (85%) were performed for operative purposes and 12 (10.7%) for diagnostic purposes. Minimal monitoring was used (no capnography) so prophylacti fluid loading with 0.9% saline was used before insufflation to reduce hemodynamic changes induced by abdominal overpressure and to avoid potential massive air embolism. Insufflation pressure was limited to 14 mmHg. The main agent used for all procedures was propofol. Mean duration of the procedures was 55 minutes. There were no cases of complications or delayed recovery. Complete exsufflation by abdominal compression at the end of the procedures induced minimal abdominal pain and scapulalgia. Ketoprofen as effective postoperatively. Twenty-five patients (25%) complained of nausea and vomiting in the recovery room and were treated effectively with metoclopramide. All patients were discharged and accompanied to their home six hours later after a well-tolerated light meal. The postoperative course was uneventful. PMID:11598560

  3. 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

  4. Single-site Laparoscopic Colorectal Surgery Provides Similar Clinical Outcomes Compared to Standard Laparoscopic Surgery: An Analysis of 626 Patients

    PubMed Central

    Sangster, William; Messaris, Evangelos; Berg, Arthur S.; Stewart, David B.

    2015-01-01

    BACKGROUND Compared to standard laparoscopy, single-site laparoscopic colorectal surgerymay potentially offer advantages by creating fewer surgical incisions and providing a multi-functional trocar. Previous comparisons, however, have been limited by small sample sizes and selection bias. OBJECTIVE To compare 60-day outcomes between standard laparoscopic and single-site laparoscopic colorectal surgery patients undergoing elective and urgent surgeries. DESIGN This was an unselected retrospective cohort study comparing patients who underwent elective and unplanned standard laparoscopic or single-site laparoscopic colorectal resections for benign and malignant disease between 2008 and 2014. Outcomes were compared using univariate analyses. SETTING This study was conducted at a single institution. PATIENTS A total of 626 consecutive patients undergoing laparoscopic colorectal surgery were included. MAIN OUTCOME MEASURES Morbidity and mortality within 60 postoperative days. RESULTS 318 (51%) and 308 (49%) patients underwent standard laparoscopic and single-site laparoscopic procedures, respectively. No significant difference was noted in mean operative time (Standard laparoscopy 182.1 ± 81.3 vs. Single-site laparoscopy 177±86.5, p=0.30) and postoperative length of stay (Standard laparoscopy 4.8±3.4 vs. Single-site laparoscopy 5.5 ± 6.9, p=0.14). Conversions to laparotomy and 60-day readmissions were also similar for both cohorts across all procedures performed. A significant difference was identified in the number of patients who developed postoperative complications (Standard laparoscopy 19.2% vs. Single-site laparoscopy 10.7%, p=0.004), especially with respect to surgical-site infections (Standard laparoscopy 11.3% vs. Single-site laparoscopy 5.8%, p=0.02). LIMITATIONS This was a retrospective, single institution study. CONCLUSIONS Single-site laparoscopic colorectal surgery demonstrates similar results to standard laparoscopic colorectal surgery in regards to

  5. Fast-track laparoscopic surgery: A better option for treating colorectal cancer than conventional laparoscopic surgery

    PubMed Central

    TAUPYK, YERLAN; CAO, XUEYUAN; ZHAO, YINQUAN; WANG, CHAO; WANG, QUAN

    2015-01-01

    Fast-track surgery (FTS), a multimodal rehabilitation technique, has been recommended as surgical therapy for colorectal cancer. The objective of the present study was to compare the outcomes of FTS and conventional laparoscopic surgery. This study was a blinded randomized trial. A total of 70 patients with colorectal cancer were divided into two groups and underwent laparoscopic colorectal resection. The FTS group consisted of 31 patients and the control group consisted of 39 patients. Protocols for the treatment of the FTS group included skipping pre-operative mechanical bowel preparation, early restoration of diet and early post-operative ambulation. Outcome measures, length of hospital stay, post-operative surgical stress response [C-reactive protein (CRP)] and post-operative complications were compared between the two groups. The average length of total hospital stay for the FTS and the control groups was 5.9±0.8 and 10.9±1.3 days, respectively (P<0.05), and the length of post-operative hospital stay for the FTS and control group was 4.3±0.8 and 8.0±1.1 days, respectively. (P<0.05) First flatus time for the FTS and control groups was 1.6±0.8 and 2.5±0.9 days, respectively (P<0.05). Defecation time for the FTS and control groups was 2.2±0.7 and 4.5±0.7 days, respectively (P<0.05). The time to restoration of a solid diet also showed a significant difference between the FTS and control groups (1.1±0.3 vs. 3.6±0.9 days; P<0.05). Following surgery, due to post-operative surgical stress, the two groups CRP levels increased significantly, but the levels of the FTS group were lower than those of the conventional control group (P<0.05). There was no difference in post-operative complications between the FTS and control groups. This study confirms that FTS shortens hospital stay and accelerates the recovery of bowel function without increase of post-operative complications. FTS is safe, improves post-operative recovery and is a better option than conventional

  6. Laparoscopic surgery for gynaecological cancers in obese women.

    PubMed

    Martinek, Igor E; Haldar, Krishnayan; Tozzi, Roberto

    2010-04-01

    The use of laparoscopic surgery in the management of gynaecological malignancies has been growing for over a decade. Concomitantly the incidence of obesity has been increasing worldwide. This review summarizes the available studies on minimal invasive surgery in obese women with gynaecological malignancies. We undertook a literature search to identify the differences between traditional open methods and the laparoscopic approach in terms of intra- and postoperative outcome and patient safety. Only eight relevant studies were identified. Six of these focused on endometrial cancer, one study included early stage cervical and ovarian cancers with other benign conditions, while another paper included cervical and endometrial pre-cancers and only a few malignant conditions. Obesity is generally known to increase the risk of intra- and postoperative complications. However, several studies show that obesity, formerly precluding keyhole surgery, seems now to be an indication for the laparoscopic approach. As compared to laparotomy, laparoscopic surgery has a good postoperative outcome, reduced estimated blood loss (EBL) and pain and in some series an increased lymph node count. Laparoscopy has been shown to be cost effective with a shorter hospital stay and return to normal activity. Survival is reported to be the same with both laparotomy and laparoscopy. The benefits of minimal invasive surgery in gynaecological surgery are starting to be found with robotic surgery. PMID:20079589

  7. Single port/incision laparoscopic surgery compared with standard three-port laparoscopic surgery for appendicectomy - a randomised controlled trial

    PubMed Central

    2012-01-01

    Background Laparoscopic surgery has become the preferred approach for many procedures because of reduced post-operative pain, better recovery, shorter hospital stay and improved cosmesis. Single incision laparoscopic surgery is one of the many recent variants where either standard ports or a specially designed single multi-channel port is introduced through a single skin incision. While the cosmetic advantage of this is obvious, the evidence base for claims of reduced morbidity and better post-operative recovery is weak. This study aims to compare the effectiveness of single port/incision laparoscopic appendicectomy with standard three-port laparoscopic appendicectomy in adult patients at six weeks post-surgery. We also wish to assess the feasibility of a multicentre randomised controlled trial comparing single port/incision laparoscopic surgery with standard three-port laparoscopic surgery for other surgical techniques. Methods and design Patients diagnosed with suspected appendicitis and requiring surgical treatment will be randomised to receive either standard three-port or single incision laparoscopic surgery. Data will be collected from clinical notes, operation notes and patient reported questionnaires. The following outcomes will be considered: 1. Effectiveness of the surgical procedure in terms of: •patient reported outcomes •clinical outcomes •resource use 2. Feasibility of conducting a randomised controlled trial (RCT) in the emergency surgical setting by quantifying: •patient eligibility •randomisation acceptability •feasibility of blinding participants to the intervention received •completion rates of case report forms and patient reported questionnaires Trial registration ISRCTN66443895 (assigned 10 March 2011, first patient randomised 09 January 2011) PMID:23111090

  8. Laparoscopic cancer surgery. Lessons from gallbladder cancer.

    PubMed

    Wade, T P; Comitalo, J B; Andrus, C H; Goodwin, M N; Kaminski, D L

    1994-06-01

    Laparoscopic cholecystectomy (LC) may inhibit the discovery of unsuspected gallbladder cancer, and the effect of LC on the prognosis of gallbladder cancer is unknown. We present two cases of unsuspected gallbladder cancer removed laparoscopically and report the discovery of peritoneal tumor implantation at the umbilical port site 21 days after LC. Although gallbladder carcinoma flow cytometry has been reported to be of prognostic value by Japanese investigators, this technique did not distinguish herein between an invasive adenocarcinoma and carcinoma in situ. A cellular doubling time of 56 h was calculated from one tumor. When unsuspected invasive gallbladder cancer is found after LC, laparoscopic port sites should be inspected at reoperation and, at a minimum, the port site through which the gallbladder was removed should be widely excised. This demonstration of cancer recurrence in laparoscopic port sites may limit the application of laparoscopy to elective cancer resection. PMID:8059312

  9. 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

  10. 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

  11. Development of broad-view camera unit for laparoscopic surgery.

    PubMed

    Kawahara, Tomohiro; Takaki, Takeshi; Ishii, Idaku; Okajima, Masazumi

    2009-01-01

    A disadvantage of laparoscopic surgery is the narrow operative field provided by the endoscope camera. This paper describes a newly developed broad-view camera unit for use with the Broad-View Camera System, which is capable of providing a wider view of the internal organs during laparoscopic surgery. The developed camera unit is composed of a miniature color CMOS camera, an indwelling needle, and an extra-thin connector. The specific design of the camera unit and the method for positioning it are shown. The performance of the camera unit has been confirmed through basic and animal experiments. PMID:19963983

  12. Single-incision laparoscopic surgery for biliary tract disease

    PubMed Central

    Chuang, Shu-Hung; Lin, Chih-Sheng

    2016-01-01

    Single-incision laparoscopic surgery (SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy (SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials (RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration (CBDE) methods have been used for more than one hundred years, laparoscopic CBDE (LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and single-incision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques. PMID:26811621

  13. Robotic versus laparoscopic surgery in gynecology: which should we use?

    PubMed

    Fanfani, Francesco; Restaino, Stefano; Ercoli, Alfredo; Chiantera, Vito; Fagotti, Anna; Gallotta, Valerio; Monterossi, Giorgia; Cappuccio, Serena; Scambia, Giovanni

    2016-08-01

    This review of the literature aims at assessing the safety and effectiveness of robotic versus laparoscopic surgery in benign and malignant gynecological diseases. Robotic-assisted laparoscopy is already widely used in the United States and Europe for the main gynecological procedure - hysterectomy - and has proved feasible and comfortable for other benign and malignant gynecological procedures. However, the clinical effectiveness and safety of robotic surgery compared with standard laparoscopy have not been undoubtedly established. We reviewed the literature by searching in the Ovid/MEDLINE, PubMed, Cochrane Library, and Google Scholar databases for all the articles published from January 1995 to September 2015. More rigorous experimental studies are needed, that compare robotic-assisted surgery and laparoscopic surgery for gynecological diseases. However, current data seem to encourage the use of minimally-invasive surgery to treat benign and malignant gynecological diseases. PMID:26633042

  14. Laparoscopic surgery: a narrative review of pharmacotherapy in pain management.

    PubMed

    Sjövall, Sari; Kokki, Merja; Kokki, Hannu

    2015-11-01

    Laparoscopic surgery is widespread, and an increasing number of surgeries are performed laparoscopically. Early pain after laparoscopy can be similar or even more severe than that after open surgery. Thus, proactive pain management should be provided. Pain after laparoscopic surgery is derived from multiple origins; therefore, a single agent is seldom sufficient. Pain is most effectively controlled by a multimodal, preventive analgesia approach, such as combining opioids with non-opioid analgesics and local anaesthetics. Wound and port site local anaesthetic injections decrease abdominal wall pain by 1-1.5 units on a 0-10 pain scale. Inflammatory pain and shoulder pain can be controlled by NSAIDs or corticosteroids. In some patient groups, adjuvant drugs, ketamine and α2-adrenergic agonists can be helpful, but evidence on gabapentinoids is conflicting. In the present review, the types of pain that need to be taken into account while planning pain management protocols and the wide range of analgesic options that have been assessed in laparoscopic surgery are critically assessed. Recommendations to the clinician will be made regarding how to manage acute pain and how to prevent persistent postoperative pain. It is important to identify patients at the highest risk for severe and prolonged post-operative pain, and to have a proactive strategy in place for these individuals. PMID:26493289

  15. Risk factors for postoperative ileus after urologic laparoscopic surgery

    PubMed Central

    Kim, Myung Joon; Min, Gyeong Eun; Yoo, Koo Han; Chang, Sung-Goo

    2011-01-01

    Purpose Although its incidence has decreased with the widespread use of less invasive surgical techniques including laparoscopic surgery, postoperative ileus remains a common postoperative complication. In the field of urologic surgery, with the major exception of radical cystectomy, few studies have focused on postoperative ileus as a complication of laparoscopic surgery. The present study aims to offer further clues in the management of postoperative ileus following urological laparoscopic surgery through an assessment of the associated risk factors. Methods The medical records of 267 patients who underwent laparoscopic surgery between February 2004 and November 2009 were reviewed. After excluding cases involving radical cystectomy, combined surgery, open conversion, and severe complications, a total of 249 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. The gender and age distribution, duration of anesthesia, American Society of Anesthesiologists Physical Status Classification Score, body mass index, degree of operative difficulty, presence of complications, surgical procedure and total opiate dosage were compared between the two groups. Results Of the 249 patients, 10.8% (n = 27) experienced postoperative ileus. Patients with ileus had a longer duration of anesthesia (P = 0.019), and perioperative complications and blood loss were all correlated with ileus (P = 0.000, 0.004, respectively). Multiple linear regression analysis showed that the modified Clavien classification was an independent risk factor for postoperative ileus (odds ratio, 5.372; 95% confidence interval, 2.084 to 13.845; P = 0.001). Conclusion Postoperative ileus after laparoscopic urologic surgery was more frequent in patients who experienced more perioperative complications. PMID:22066064

  16. Single-port laparoscopic surgery for sigmoid volvulus

    PubMed Central

    Choi, Byung Jo; Jeong, Won Jun; Kim, Say-June; Lee, Sang Chul

    2015-01-01

    AIM: To report our experience with single-port laparoscopic surgery (SPLS) for sigmoid volvulus (SV). METHODS: Between October 2009 and April 2013, 10 patients underwent SPLS for SV. SPLS was performed transumbilically or through a predetermined stoma site. Conventional straight and rigid-type laparoscopic instruments were used. After intracorporeal, segmental resection of the affected sigmoid colon, the specimen was extracted through the single-incision site. Patient demographics and perioperative data were analyzed. RESULTS: SPLS for SV was successful in all 10 patients (4, resection and primary anastomosis; 6, Hartmann’s procedure). The median operative time and postoperative hospitalization period were 168 (range, 85-315) min and 6.5 (range, 4-29) d, respectively. No intraoperative complications were noted; there were 2 postoperative complications, including 1 anastomotic leak. CONCLUSION: SPLS was a safe and feasible therapeutic approach for SV, when performed by a surgeon experienced in conventional laparoscopic surgery. PMID:25741145

  17. An innovative procedure of laparoscope combined with endoscopy for gastrointestinal stromal tumor resection and cholecystectomy: A case report and literature review

    PubMed Central

    YAN, YE; LI, FENG; GAI, YONG-HAO; LIU, QING-WEI

    2016-01-01

    The present study reports a novel approach to laparoscopic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumor (GIST) resection and cholecystectomy, and conducts a review of the associated literature. The novel surgical procedure was performed on one patient who was diagnosed with a GIST and cholecystic polypus. The GIST was resected using an insulation-tipped diathermic electrosurgical knife under the guide of an endoscope. Subsequently, a cholecystectomy was performed by inserting two more 5-mm trocars and instruments transumbilically, guided using an endoscope. The tumor and the gallbladder were exteriorized using a peroral approach and the incision lining of the stomach was sutured laparoscopically. The procedure was successfully performed and the patient experienced no discomfort during the 5-year follow-up. In conclusion, the present study demonstrates that laparoscopic and endoscopic cooperative surgery is feasible and would be an ideal choice for invisible abdominal scar surgery, in particular for multi-visceral resection. PMID:27073455

  18. Improvement in quality of life measures after laparoscopic antireflux surgery.

    PubMed Central

    Trus, T L; Laycock, W S; Waring, J P; Branum, G D; Hunter, J G

    1999-01-01

    OBJECTIVE: To determine if patients with gastroesophageal reflux "well controlled medically" had a different quality of life from those with residual symptoms receiving aggressive medical therapy, and to determine whether laparoscopic antireflux surgery significantly altered quality of life in patients with gastroesophageal reflux. SUMMARY BACKGROUND DATA: Clinical determinants of outcome may not adequately reflect the full impact of therapy. The medical outcomes study short form (SF-36) is a well-validated questionnaire that assays eight specific health concepts in three general fields. It may provide a more sensitive tool for judging the success of antireflux therapy. METHODS: A total of 345 patients undergoing laparoscopic antireflux surgery completed at least one questionnaire during the study period. Preoperative questionnaires were completed by 290 patients, 223 completed a questionnaire 6 weeks after surgery, and 50 completed the same questionnaire 1 year after surgery. A subgroup of 70 patients was divided before surgery into two groups on the basis of their response to standard medical therapy. RESULTS: Preoperative scores were extremely low. All eight SF-36 health categories improved significantly 6 weeks and 1 year after surgery. In the 70-patient subgroup, 53 patients (76%) underwent laparoscopic antireflux surgery because of symptoms refractory to medical therapy and 17 patients (24%) reported that their symptoms were well controlled but elected to have surgery because they wished to be medication-free. The preoperative quality of life scores of these two patient groups were equivalent in all but one category. Postoperative scores were significantly improved in all categories and indistinguishable between the two groups. CONCLUSIONS: Laparoscopic antireflux surgery is an effective therapy for patients with gastroesophageal reflux and may be more effective than medical therapy at improving quality of life. PMID:10077044

  19. Short Hospital Stay after Laparoscopic Colorectal Surgery without Fast Track

    PubMed Central

    Burgdorf, Stefan K.; Rosenberg, Jacob

    2012-01-01

    Purpose. Short hospital stay and equal or reduced complication rates have been demonstrated after fast track open colonic surgery. However, fast track principles of perioperative care can be difficult to implement and often require increased nursing staff because of more concentrated nursing tasks during the shorter hospital stay. Specific data on nursing requirements after laparoscopic surgery are lacking. The purpose of the study was to evaluate the effect of operative technique (open versus laparoscopic operation), but without changing nurse staffing or principles for peri- or postoperative care, that is, without implementing fast track principles, on length of stay after colorectal resection for cancer. Methods. Records of all patients operated for colorectal cancer from November 2004 to December 2008 in our department were reviewed. No specific patients were selected for laparoscopic repair, which was solely dependent on the presence of two specific surgeons at the same time. Thus, the patients were not selected for laparoscopic repair based on patient-related factors, but only on the simultaneous presence of two specific surgeons on the day of the operation. Results. Of a total of 540 included patients, 213 (39%) were operated by a laparoscopic approach. The median hospital stay for patients with a primary anastomosis was significantly shorter after laparoscopic than after conventional open surgery (5 versus 8 days, P < 0.001) while there was no difference in patients receiving a stoma (10 versus 10 days, ns), with no changes in the perioperative care regimens. Furthermore there were significant lower blood loss (50 versus 200 mL, P < 0.001) and lower complication rate (21% versus 32%, P = 0.006) in the laparoscopic group. Conclusion. Implementing laparoscopic colorectal surgery in our department resulted in shorter hospital stay without using fast track principles for peri- and postoperative care in patients not receiving a stoma during the operation

  20. Urological applications of single-site laparoscopic surgery

    PubMed Central

    Symes, Andrew; Rane, Abhay

    2011-01-01

    Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings. PMID:21197251

  1. Interventional multi-spectral photoacoustic imaging in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Hill, Emma R.; Xia, Wenfeng; Nikitichev, Daniil I.; Gurusamy, Kurinchi; Beard, Paul C.; Hawkes, David J.; Davidson, Brian R.; Desjardins, Adrien E.

    2016-03-01

    Laparoscopic procedures can be an attractive treatment option for liver resection, with a shortened hospital stay and reduced morbidity compared to open surgery. One of the central challenges of this technique is visualisation of concealed structures within the liver, particularly the vasculature and tumourous tissue. As photoacoustic (PA) imaging can provide contrast for haemoglobin in real time, it may be well suited to guiding laparoscopic procedures in order to avoid inadvertent trauma to vascular structures. In this study, a clinical laparoscopic ultrasound probe was used to receive ultrasound for PA imaging and to obtain co-registered B-mode ultrasound (US) images. Pulsed excitation light was delivered to the tissue via a fibre bundle in dark-field mode. Monte Carlo simulations were performed to optimise the light delivery geometry for imaging targets at depths of 1 cm, 2 cm and 3 cm, and 3D-printed mounts were used to position the fibre bundle relative to the transducer according to the simulation results. The performance of the photoacoustic laparoscope system was evaluated with phantoms and tissue models. The clinical potential of hybrid PA/US imaging to improve the guidance of laparoscopic surgery is discussed.

  2. Single-Site Laparoscopic Surgery for Inflammatory Bowel Disease

    PubMed Central

    Bedros, Nicole; Hakiman, Hekmat; Araghizadeh, Farshid Y.

    2014-01-01

    Background and Objectives: Single-site laparoscopic colorectal surgery has been firmly established; however, few reports addressing this technique in the inflammatory bowel disease population exist. Methods: We conducted a case-matched retrospective review of 20 patients who underwent single-site laparoscopic procedures for inflammatory bowel disease compared with 20 matched patients undergoing multiport laparoscopic procedures. Data regarding these patients were tabulated in the following categories: demographic characteristics, operative parameters, and perioperative outcomes. Results: A wide range of cases were completed: 9 ileocolic resections, 7 cases of proctocolectomy with end ileostomy or ileal pouch anal anastomosis, 2 cases of proctectomy with ileal pouch anal anastomosis, and 2 total abdominal colectomies with end ileostomy were all matched to equivalent multiport laparoscopic cases. No single-incision cases were converted to multiport laparoscopy, and 2 single-incision cases (10%) were converted to an open approach. For single-incision cases, the mean length of stay was 7.7 days, the mean time to oral intake was 3.3 days, and the mean period of intravenous analgesic use was 5.0 days. There were no statistically significant differences between single-site and multiport cases. Conclusions: Single-site laparoscopic surgery is technically feasible in inflammatory bowel disease. The length of stay and period of intravenous analgesic use (in days) appear to be higher than those in comparable series examining outcomes of single-site laparoscopic colorectal surgery, and the outcomes are comparable with those of multiport laparoscopy. This may be because of the nature of inflammatory bowel disease, limiting the benefits of a single-site approach in this population. PMID:24960490

  3. Postoperative Ascites of Unknown Origin following Laparoscopic Appendicectomy: An Unusual Complication of Laparoscopic Surgery

    PubMed Central

    Feretis, M.; Boyd-Carson, H.; Karim, A.

    2014-01-01

    Postoperative ascites is a very rare complication of laparoscopic surgery. Significant iatrogenic injuries to the bowel, the urinary tract, and the lymphatic system should be excluded promptly to avoid devastating results for the patient. In some cases, in spite of investigating patients extensively, no definitive causative factor for the accumulation of fluid can be identified. In such cases, idiopathic allergic or inflammatory reaction of the peritoneum may be responsible for the development of ascites. We present a case of ascites of an unknown origin in a young female patient following a laparoscopic appendicectomy. PMID:24822146

  4. Ovarian Vein Thrombosis as a Complication of Laparoscopic Surgery

    PubMed Central

    Gupta, Anu; Gupta, Natasha; Blankstein, Josef; Trester, Richard

    2015-01-01

    Ovarian vein thrombosis (OVT) is an extremely rare but life-threatening complication of the postpartum period. It has never been reported as a complication of laparoscopic surgery. We report a case of right ovarian vein thrombosis that occurred in the postoperative period after patient underwent laparoscopic salpingectomy for a right side ectopic pregnancy. She presented with 1-week history of abdominal pain and fever. A complete workup for fever was performed and was found negative. Computed tomography of the abdomen and pelvis revealed right ovarian vein thrombosis. The patient was treated with anticoagulant therapy and responded well. PMID:26788386

  5. 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

  6. Laparoscopic urinary stone surgery: an updated evidence-based review.

    PubMed

    Skolarikos, Andreas; Papatsoris, Athanasios G; Albanis, Stefanos; Assimos, Dean

    2010-10-01

    The treatment of urinary lithiasis has been revolutionized during the last three decades. Minimally invasive therapies in the form of endoscopic surgery in companion with the advent of shock wave lithotripsy have diminished the role of open stone surgery. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. We have tried to identify the level of the evidence and grade of recommendation, according to the evidence-based medicine criteria, in studies supporting the laparoscopic approach to stone extraction. The highest level of evidence (IIa) was found for laparoscopic ureterolithotomy. It is technically feasible with the advantage of being minimally invasive and having lower postoperative morbidity compared to open ureterolithotomy. It is mostly recommended (grade B) for large impacted stones or when endoscopic ureterolithotripsy or shock wave stone disintegration have failed. Laparoscopic pyelolithotomy is feasible but rarely indicated in the present era (III/B). Laparoscopic nephrolithotomy may be indicated to remove a stone from an anterior diverticulum or when PNL or flexible ureteroscopy have failed (III/B). PMID:20396871

  7. Effects of intravenously infused lidocaine on analgesia and gastrointestinal function of patients receiving laparoscopic common bile duct exploration

    PubMed Central

    Yang, Wei; Hu, Wei-Lan

    2015-01-01

    Objective: To evaluate the effects of intravenously infused lidocaine on analgesia and gastrointestinal function of patients receiving laparoscopic common bile duct exploration. Methods: Seventy-eight patients with cholelithiasis were randomly divided into a treatment group and a control group (n=39) that all had laparoscopic common bile duct exploration. The treatment group was intravenously infused with 1.5 mg/kg lidocaine by using a venous pump under anesthesia induction at the speed of 2 mg·kg-1 ·h-1 until the end of surgery, while the control group was given normal saline with the same volume. Results: All patients successfully completed the surgery, with similar surgical time, incision length and intraoperative blood loss. The required lidocaine concentrations of the treatment group were 2.64±1.23 μg/ml, 1.14±0.4 μg/ml and 0.93±0.32 μg/ml respectively 2 hour, 12 hour and 48 hour after surgery. Pain score of the treatment group, which was significantly lower than that of the control group at the postoperative 2 hour (P<0.05), was similar to those of the control group at the postoperative 12 hour and 48 hour. With extended time, the pain score significantly decreased (P<0.05). The treatment group had significantly shorter first anal exhaust time and first defecation time than those of the control group (P<0.05). Adverse reactions, such as nausea and vomiting, dizziness, headache, subcutaneous emphysema and fat liquefaction of incision, occurred similarly in the two groups, which were alleviated by symptomatic treatment. Conclusion: Laparoscopic common bile duct exploration is a promising minimally invasive surgery for patients with cholelithiasis, during which intravenously infused lidocaine can rapidly recover the gastrointestinal function and exert short-term analgesic effects, with mild adverse reactions also. PMID:26648989

  8. 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

  9. Sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer.

    PubMed

    Sadatomo, Ai; Miyakura, Yasuyuki; Zuiki, Toru; Koinuma, Koji; Horie, Hisanaga; Lefor, Alan T; Yasuda, Yoshikazu

    2013-08-01

    We report the first case of sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer. The patient is a 75-year-old man who presented with the sudden onset of severe abdominal pain. He had undergone laparoscopic sigmoidectomy for cancer 2 years before presentation. CT scan showed a distended sigmoid colon with a mesenteric twist, or "whirl sign." Colonoscopy showed a mucosal spiral and luminal stenosis with dilated sigmoid colon distally and ischemic mucosa. The diagnosis of ischemic colonic necrosis due to sigmoid volvulus was established. Resection of the necrotic sigmoid colon was performed and a descending colon stoma was created. A long remnant sigmoid colon and chronic constipation may contribute to the development of sigmoid volvulus after laparoscopic sigmoidectomy. Prompt diagnosis is essential for adequate treatment, and colonoscopy aids in the diagnosis of ischemic changes in patients without definitive findings of a gangrenous colon. PMID:23879414

  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. Single-Port Laparoscopic Surgery for Inflammatory Bowel Disease

    PubMed Central

    Rijcken, Emile; Mennigen, Rudolf; Senninger, Norbert; Bruewer, Matthias

    2012-01-01

    Background. Single Port Laparoscopic Surgery (SPLS) is being increasingly employed in colorectal surgery for benign and malignant diseases. The particular role for SPLS in inflammatory bowel disease (IBD) has not been determined yet. In this review article we summarize technical aspects and short term results of SPLS resections in patients with Crohn's disease or ulcerative colitis. Methods. A systematic review of the literature until January 2012 was performed. Publications were assessed for operative techniques, equipment, surgical results, hospital stay, and readmissions. Results. 34 articles, published between 2010 and 2012, were identified reporting on 301 patients with IBD that underwent surgical treatment in SPLS technique. Surgical procedures included ileocolic resections, sigmoid resections, colectomies with end ileostomy or ileorectal anastomosis, and restorative proctocolectomies with ileum-pouch reconstruction. There was a wide variety in the surgical technique and the employed equipment. The overall complication profile was similar to reports on standard laparoscopic surgery in IBD. Conclusions. In experienced hands, single port laparoscopic surgery appears to be feasible and safe for the surgical treatment of selected patients with IBD. However, evidence from prospective randomized trials is required in order to clarify whether there is a further benefit apart from the avoidance of additional trocar incisions. PMID:22619710

  12. Solitary Fibrous Tumor of the Stomach Treated with Laparoscopic and Endoscopic Cooperative Surgery.

    PubMed

    Nabeshima, Kazuhito; Tomioku, Mifuji; Nakamura, Kenji; Yasuda, Seiei

    2015-09-01

    A 43-year-old Japanese woman with melena underwent an upper gastrointestinal endoscopy and was preoperatively diagnosed with sarcoma of the stomach. Physical examination revealed no abnormalities. Findings on the upper gastrointestinal endoscopy showed a pedunculated submucosal tumor measuring 17 mm in the antrum. An enhanced computed tomography showed wall thickening in the gastric antrum. The patient underwent a laparoscopic and endoscopic cooperative surgery (LECS) for wedge resection of the stomach. The excised tumor measured 27 × 20 × 15 mm in size. Histopathology showed spindle-shaped cells in the submucosal layer. Immunohistochemistry showed that the tumor was positive for CD34, bcl-2, and MIC-2. The final diagnosis was solitary fibrous tumor (SFT) of the stomach. The postoperative course was uneventful, and no evidence of recurrence was observed at the 8-month follow-up. We report a case of SFT arising from the stomach that was treated with wedge resection by LECS. PMID:26369266

  13. 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

  14. Laparoscopic surgery in the treatment of nonruptured tubal pregnancy

    NASA Astrophysics Data System (ADS)

    Mutrynowski, Andrzej; Zabielska, Renata

    1996-03-01

    Introduction of the endoscopic techniques into gynecology enabled a change in the procedures in the case of ectopic pregnancy. This paper aims at presenting 76 cases of non-ruptured tubal pregnancies treated conservatively by the laparoscopic surgery with the application of the electrocoagulation or the Nd:YAG laser. The investigated group consisted of 76 patients. Forty-one (54%) of them were operated on using electrocoagulation and 35 (46%) using the Nd:YAG laser. Sixty-three pregnancies (83%) were localized in the ampulla. The ectopic pregnancy was confirmed histopathologically in 74 cases (97%). There were no complications noticed in the postoperative course. There were no differences in the efficacy and the postoperative general condition in cases treated conservatively by the laparoscopic surgery with the application of the electrocoagulation or the laser.

  15. Laparoscopic surgery for inflammatory complications of acute sigmoid diverticulitis.

    PubMed

    Fine, A P

    2001-01-01

    From March 1995 through March 2000, we treated patients with the laparoscopic approach who had emergent and urgent indications for surgery. We report a series of 17 procedures in 16 patients in the acute category excluding those with active bleeding. One case of morbidity (DVT) but no moralities occurred, with 3 of 17 patients converted to an open approach. The postoperative course and subsequent recoveries compare favorably with the open approach to this disease process. Three other series are discussed for comparison, all showing similar favorable results. We concluded that given sufficient experience in minimally invasive colon surgery, surgeons can manage acute inflammatory complications of sigmoid diverticulitis laparoscopically with potential benefit to the patient. PMID:11548828

  16. Laparoscopic Surgery for Inflammatory Complications of Acute Sigmoid Diverticulitis

    PubMed Central

    2001-01-01

    From March 1995 through March 2000, we treated patients with the laparoscopic approach who had emergent and urgent indications for surgery. We report a series of 17 procedures in 16 patients in the acute category excluding those with active bleeding. One case of morbidity (DVT) but no moralities occurred, with 3 of 17 patients converted to an open approach. The postoperative course and subsequent recoveries compare favorably with the open approach to this disease process. Three other series are discussed for comparison, all showing similar favorable results. We concluded that given sufficient experience in minimally invasive colon surgery, surgeons can manage acute inflammatory complications of sigmoid diverticulitis laparoscopically with potential benefit to the patient. PMID:11548828

  17. Indications for liver surgery: laparoscopic or robotic approach.

    PubMed

    Bonapasta, Stefano Amore; Bartolini, Ilenia; Checcacci, Paolo; Guerra, Francesco; Coratti, Andrea

    2015-06-01

    Laparoscopic liver resections have been demonstrated to be safe and effective with the advantages of a shorter hospital stay, less blood loss, less adhesions and better postoperative recovery compared to open surgery. However, indications are usually confined to peripheral, small lesions, due to issues intrinsic to the approach. In the effort to overcome some of these technical limitations, robotic technology has been developed, with encouraging findings. We performed a review of the literature to assess the current indications for laparoscopic hepatic resections and to investigate the role of robotics in broadening the application of minimally invasive liver surgery. Although a paucity of data exists, especially regarding long-term oncological outcomes and specific comparisons with laparoscopy, robotics has been proved to facilitate several complex liver procedures, including parenchyma-saving resections. Thus, the number of patients who can benefit from less invasive, conservative approach is potentially increased. PMID:26227491

  18. Turkish surgeons’ experiences and perception about single-incision laparoscopic surgery

    PubMed Central

    Aktimur, Recep; Çetinkünar, Süleyman; Yıldırım, Kadir

    2016-01-01

    Objective: We aimed to show Turkish surgeons’ current status of experience and perception about single-incision laparoscopic surgery. Material and Methods: The experience and perception of general surgeons, who were members of the Turkish Surgical Association (3.5%, 116/3312), about single-incision laparoscopic surgery were analyzed according to demographic characteristics and a self-report questionnaire with the following four domains: surgeons’ perception regarding the performance of single-incision laparoscopic surgery in their clinical practice; their experience of laparoscopic surgery; education, experience, and attitude for single-incision laparoscopic surgery; and the reason for performing/not performing single-incision laparoscopic surgery in their practice. Results: There were no significant factors affecting Turkish surgeons’ preference of surgical approach. Although, most surgeons performing single-incision laparoscopic surgery were educated (72.2%), the dominant factor driven them to perform this surgery seemed to be personal achievement and satisfaction (57%). Most surgeons who did not perform single-incision laparoscopic surgery were not interested to do so and considered it unnecessary (62.1%). In addition, the need for special equipment and training were dominant barriers (61%). Conclusion: It seems that Turkish surgeons’ perception to perform single-incision laparoscopic surgery was more related to their personal achievement and satisfaction. PMID:27436932

  19. Nutrition support to patients undergoing gastrointestinal surgery.

    PubMed

    Ward, Nicola

    2003-12-01

    Nutritional depletion has been demonstrated to be a major determinant of the development of post-operative complications. Gastrointestinal surgery patients are at risk of nutritional depletion from inadequate nutritional intake, surgical stress and the subsequent increase in metabolic rate. Fears of postoperative ileus and the integrity of the newly constructed anastomosis have led to treatment typically entailing starvation with administration of intravenous fluids until the passage of flatus. However, it has since been shown that prompt postoperative enteral feeding is both effective and well tolerated. Enteral feeding is also associated with specific clinical benefits such as reduced incidence of postoperative infectious complications and an improved wound healing response. Further research is required to determine whether enteral nutrition is also associated with modulation of gut function. Studies have indicated that significant reductions in morbidity and mortality associated with perioperative Total Parenteral Nutrition (TPN) are limited to severely malnourished patients with gastrointestinal malignancy. Meta-analyses have shown that enteral nutrition is associated with fewer septic complications compared with parenteral feeding, reduced costs and a shorter hospital stay, so should be the preferred option whenever possible. Evidence to support pre-operative nutrition support is limited, but suggests that if malnourished individuals are adequately fed for at least 7-10 days preoperatively then surgical outcome can be improved. Ongoing research continues to explore the potential benefits of the action of glutamine on the gut and immune system for gastrointestinal surgery patients. To date it has been demonstrated that glutamine-enriched parenteral nutrition results in reduced length of stay and reduced costs in elective abdominal surgery patients. Further research is required to determine whether the routine supplementation of glutamine is warranted. A

  20. Single-Incision Laparoscopic Colon and Rectal Surgery

    PubMed Central

    Keller, Deborah S.; Haas, Eric M.

    2015-01-01

    Single-incision laparoscopic surgery (SILS) was introduced to further the enhanced outcomes of multiport laparoscopy. Multiple studies have demonstrated the safety and feasibility of SILS for both benign and malignant colorectal disease. SILS provides the potential for improved cosmesis, postoperative outcomes, and patient quality of life. However, widespread use has been limited by technical demands and lack of an evidence and competency-based curriculum. PMID:26491404

  1. Laparoscopic en bloc excision of gastrointestinal stromal tumors of the rectum after neoadjuvant imatinib therapy: anteriorly extended intersphincteric resection combined with partial resection of the prostate.

    PubMed

    Ueki, T; Nagayoshi, K; Manabe, T; Maeyama, R; Yokomizo, A; Yamamoto, H; Oda, Y; Tanaka, M

    2015-04-01

    We herein present a novel technique for laparoscopic en bloc excision involving anteriorly extended intersphincteric resection with partial resection of the posterior lobe of the prostate for large rectal gastrointestinal stromal tumors (GISTs). The sequence of neoadjuvant imatinib therapy and this less invasive surgery for marginally resectable rectal GISTs has the potential to obviate the need for urinary reconstruction and permanent stomas without jeopardizing the tumor margin status. PMID:25550117

  2. Introduction: Robot-assisted laparoscopic surgery.

    PubMed

    Falcone, Tommaso

    2014-10-01

    In this Views and Reviews contribution there are four articles that provide insight into the present and future applications of robot assisted surgery. The potential application of this technology in reproductive surgery, oncology, general gynecology and urology is an ongoing controversy. PMID:24996499

  3. Laparoscopic Surgery in the Elderly: A Review of the Literature

    PubMed Central

    Bates, Andrew T.; Divino, Celia

    2015-01-01

    Laparoscopic techniques are gradually replacing many common surgical procedures that are performed in an increasingly aging population. Laparoscopy places different physiologic demands on the body than in open surgery. PubMed was searched for evidence related to the use of laparoscopy in the elderly population to treat common surgical pathologies. Randomized trials, systematic reviews, and meta-analyses were preferred. Currently, over 40% of all surgeries performed in the U.S. are on patients older than 65 years. By the end of the 21st century, Americans are expected to live 20 years longer than the current average. However, elderly patients clearly show higher rates of surgical morbidity and mortality overall. Laparoscopic techniques show decreased wound complications, post-operative ileus, intraoperative blood loss, and reduced need for post-operative rehabilitation. In conclusion, laparoscopic surgery is safe in the elderly population and affords multiple advantages including decreased pain and convalescence. However, the physiology of laparoscopy places demands on elderly patients that typically present with more medical comorbidities. PMID:25821642

  4. Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases.

    PubMed

    Yang, Yun Seok; Kim, Seung Hyun; Jin, Chan Hee; Oh, Kwoan Young; Hur, Myung Haeng; Kim, Soo Young; Yim, Hyun Soon

    2014-01-01

    The objective of this study was to present the initial operative experience of solo surgeon single-port laparoscopic surgery (SPLS) in the laparoscopic treatment of benign gynecologic diseases and to investigate its feasibility and surgical outcomes. Using a novel homemade laparoscope-anchored instrument system that consisted of a laparoscopic instrument attached to a laparoscope and a glove-wound retractor umbilical port, we performed solo surgeon SPLS in 13 patients between March 2011 and June 2012. Intraoperative complications and postoperative surgical outcomes were determined. The primary operative procedures performed were unilateral salpingo-oophorectomy (n = 5), unilateral salpingectomy (n = 2), adhesiolysis (n = 1), and laparoscopically assisted vaginal hysterectomy (n = 5). Additional surgical procedures included additional adhesiolysis (n = 4) and ovarian drilling (n = 1).The primary indications for surgery were benign ovarian tumors (n = 5), ectopic pregnancy (n = 2), pelvic adhesion (infertility) (n = 1), and benign uterine tumors (n = 5). Solo surgeon SPLS was successfully accomplished in all procedures without a laparoscopic assistant. There were no intraoperative or postoperative complications. Our laparoscope-anchored instrument system obviates the need for an additional laparoscopic assistant and enables SPLS to be performed by a solo surgeon. The findings show that with our system, solo surgeon SPLS is a feasible and safe alternative technique for the treatment of benign gynecologic diseases in properly selected patients. PMID:24509292

  5. Is laparoscopic colorectal cancer surgery equal to open surgery? An evidence based perspective

    PubMed Central

    Künzli, Beat M; Friess, Helmut; Shrikhande, Shailesh V

    2010-01-01

    Laparoscopic colorectal surgery (LCS) is an evolving subject. Recent studies show that LCS can not only offer safe surgery but evidence is growing that this new technique can be superior to classical open procedures. Fewer perioperative complications and faster postoperative recovery are regularly mentioned when studies of LCS are presented. Even though the learning curve of LCS is frequently debated when limitations of laparoscopic surgeries are reviewed, studies show that in experienced hands LCS can be a safe procedure for colorectal cancer treatment. The learning curve however, is associated with high conversion rates and economical aspects such as higher costs and prolonged hospital stay. Nevertheless, laparoscopic colorectal cancer surgery (LCCR) offers several advantages such as less co-morbidity and less postoperative pain in comparison with open procedures. Furthermore, the good exposure of the pelvic cavity by laparoscopy and the magnification of anatomical structures seem to facilitate pelvic dissection laparoscopically. Moreover, recent studies describe no difference in safety and oncological radicalness in LCCR compared to the open total mesorectal excision (TME). The oncological adequacy of LCCR still remains unproven today, because long-term results do not yet exist. To date, only a few studies have described the results of laparoscopic TME combined with preoperative adjuvant treatment for colorectal cancer. The aim of this review is to examine the various areas of development and controversy of LCCR in comparison to the conventional open approach. PMID:21160858

  6. Laparoscopic gastric cancer surgery: Current evidence and future perspectives

    PubMed Central

    Son, Taeil; Hyung, Woo Jin

    2016-01-01

    Laparoscopic gastrectomy has been widely accepted as a standard alternative for the treatment of early-stage gastric adenocarcinoma because of its favorable short-term outcomes. Although controversies exist, such as establishing clear indications, proper preoperative staging, and oncologic safety, experienced surgeons and institutions have applied this approach, along with various types of function-preserving surgery, for the treatment of advanced gastric cancer. With technical advancement and the advent of state-of-the-art instruments, indications for laparoscopic gastrectomy are expected to expand as far as locally advanced gastric cancer. Laparoscopic gastrectomy appears to be promising; however, scientific evidence necessary to generalize this approach to a standard treatment for all relevant patients and care providers remains to be gathered. Several multicenter, prospective randomized trials in high-incidence countries are ongoing, and results from these trials will highlight the short- and long-term outcomes of the approach. In this review, we describe up-to-date findings and critical issues regarding laparoscopic gastrectomy for gastric cancer. PMID:26811620

  7. Usability of Elective Laparoscopic Sigmoidectomy and Feasibility of Single-Incision Laparoscopic Surgery for Sigmoid Volvulus: Report of Three Cases

    PubMed Central

    Ueda, Masami; Onishi, Tadashi; Hata, Taishi; Nishida, Kentaro; Yanagawa, Takehiro; Fujita, Shoichiro; Fujita, Junya; Yoshida, Tetsuya; Tono, Takeshi; Monden, Takushi; Imaoka, Shingi; Mori, Masaki

    2015-01-01

    A therapeutic guideline for sigmoid volvulus (SV) has not been established, and the most recommended surgical procedure for SV has not been determined. Our objective is to assess the usability of elective laparoscopic sigmoidectomy and the feasibility of single-incision laparoscopic surgery for SV following endoscopic reduction. SV typically affects the elderly and accounts for 1% to 7% of intestinal obstructions in Western countries. We report on 3 patients with SV who underwent elective laparoscopic sigmoidectomy following endoscopic reduction, and we first describe single-port surgery for SV. We discuss the 3 patients (a 79-year-old male, an 88-year-old female, and a 67-year-old female) with SV who underwent elective laparoscopic sigmoidectomy following endoscopic reduction. All 3 patients underwent laparoscopic sigmoidectomy, and 2 patients underwent single-port laparoscopic surgery without complications. Recurrence of volvulus was not seen during the course of 12 to 24 months. In experienced hands, elective laparoscopic sigmoidectomy after colonoscopic detorsion is a valuable alternative, and single-port surgery is also feasible. PMID:25785318

  8. Usability of elective laparoscopic sigmoidectomy and feasibility of single-incision laparoscopic surgery for sigmoid volvulus: report of three cases.

    PubMed

    Ueda, Masami; Onishi, Tadashi; Hata, Taishi; Nishida, Kentaro; Yanagawa, Takehiro; Fujita, Shoichiro; Fujita, Junya; Yoshida, Tetsuya; Tono, Takeshi; Monden, Takushi; Imaoka, Shingi; Mori, Masaki

    2015-03-01

    A therapeutic guideline for sigmoid volvulus (SV) has not been established, and the most recommended surgical procedure for SV has not been determined. Our objective is to assess the usability of elective laparoscopic sigmoidectomy and the feasibility of single-incision laparoscopic surgery for SV following endoscopic reduction. SV typically affects the elderly and accounts for 1% to 7% of intestinal obstructions in Western countries. We report on 3 patients with SV who underwent elective laparoscopic sigmoidectomy following endoscopic reduction, and we first describe single-port surgery for SV. We discuss the 3 patients (a 79-year-old male, an 88-year-old female, and a 67-year-old female) with SV who underwent elective laparoscopic sigmoidectomy following endoscopic reduction. All 3 patients underwent laparoscopic sigmoidectomy, and 2 patients underwent single-port laparoscopic surgery without complications. Recurrence of volvulus was not seen during the course of 12 to 24 months. In experienced hands, elective laparoscopic sigmoidectomy after colonoscopic detorsion is a valuable alternative, and single-port surgery is also feasible. PMID:25785318

  9. A Compact Modular Teleoperated Robotic System for Laparoscopic Surgery

    PubMed Central

    Berkelman, Peter; Ma, Ji

    2011-01-01

    Compared with traditional open surgery, minimally invasive surgical procedures reduce patient trauma and recovery time, but the dexterity of the surgeon in laparoscopic surgery is reduced owing to the small incisions, long instruments and limited indirect visibility of the operative site inside the patient. Robotic surgical systems, teleoperated by surgeons from a master control console with joystick-type manipulation interfaces, have been commercially developed yet their adoption into standard practice may be limited owing to their size, complexity, cost and time-consuming setup, maintenance and sterilization procedures. The goal of our research is to improve the effectiveness of robot-assisted surgery by developing much smaller, simpler, modular, teleoperated robotic manipulator systems for minimally invasive surgery. PMID:21743765

  10. Technical feasibility of laparoscopic extended surgery beyond total mesorectal excision for primary or recurrent rectal cancer

    PubMed Central

    Akiyoshi, Takashi

    2016-01-01

    Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer. Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer. PMID:26811619

  11. Laparoscopic reduced port surgery for schwannoma of the sigmoid colon: a case report.

    PubMed

    Tokuhara, Katsuji; Nakatani, Kazuyoshi; Oishi, Masaharu; Iwamoto, Shigeyoshi; Inoue, Kentaro; Kwon, A-Hon

    2014-08-01

    A 74-year-old woman who developed schwannoma of the sigmoid colon was referred to our hospital for colonography to determine the cause of her stool occult blood. Colonoscopy revealed a submucosal tumor, which measured 3 cm in diameter, in the sigmoid colon. Endoscopic ultrasonography revealed a low echoic, homogeneous and demarcated submucosal tumor that continued into the fourth layer of the colonic wall. Gastrointestinal stromal, myogenic or neurogenic tumor was suspected, and thus, laparoscopic sigmoidectomy was carried out. We used two ports during the operation, a SILS Port in the umbilical region and a 12-mm port in the right lower abdominal wall, and performed sigmoidectomy with D2 lymph node dissection. Histological findings revealed spindle-like tumor cells with multiform nuclei. The tumor was diagnosed by immunostaining as benign schwannoma of the sigmoid colon. The conventional surgical treatment for schwannoma of the digestive tract is partial resection, but if preoperative diagnosis is unknown, radical resection with lymphadenectomy is acceptable for submucosal tumors in the digestive tract. In this case, laparoscopic reduced port surgery using only one or two ports may be more feasible and beneficial with regard to cosmesis and reduced postoperative pain than conventional laparoscopic colectomy. PMID:25131324

  12. Learning Kinematic Constraints in Laparoscopic Surgery

    PubMed Central

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

    2012-01-01

    To better understand how kinematic variables impact learning in surgical training, we devised an interactive environment for simulated laparoscopic maneuvers, using either 1) mechanical constraints typical of a surgical “box-trainer” or 2) virtual constraints in which free hand movements control virtual tool motion. During training, the virtual tool responded to the absolute position in space (Position-Based) or the orientation (Orientation-Based) of a hand-held sensor. Volunteers were further assigned to different sequences of target distances (Near-Far-Near or Far-Near-Far). Training with the Orientation-Based constraint enabled much lower path error and shorter movement times during training, which suggests that tool motion that simply mirrors joint motion is easier to learn. When evaluated in physically constrained (physical box-trainer) conditions, each group exhibited improved performance from training. However, Position-Based training enabled greater reductions in movement error relative to Orientation-Based (mean difference: 14.0 percent; CI: 0.7, 28.6). Furthermore, the Near-Far-Near schedule allowed a greater decrease in task time relative to the Far-Near-Far sequence (mean −13:5 percent, CI: −19:5, −7:5). Training that focused on shallow tool insertion (near targets) might promote more efficient movement strategies by emphasizing the curvature of tool motion. In addition, our findings suggest that an understanding of absolute tool position is critical to coping with mechanical interactions between the tool and trocar. PMID:23293709

  13. Effect of Dexmedetomidine Alone for Intravenous Patient-Controlled Analgesia After Gynecological Laparoscopic Surgery

    PubMed Central

    Wang, Xiuqin; Liu, Wenjuan; Xu, Zan; Wang, Fumei; Zhang, Chuanfeng; Wang, Baosheng; Wang, Kaiguo; Yu, Jingui

    2016-01-01

    Abstract Gynecological laparoscopic surgery is minimally invasive compared with open surgical approaches, but postoperative pain is generally undermanaged. Pain management strategies related to the procedure-specific efficacy are needed. Many studies have shown that dexmedetomidine (DEX) has opioid-sparing properties. It is not clear whether DEX used alone for intravenous patient-controlled analgesia (PCA) could reduce postoperative pain after an invasive procedure. We hypothesized that DEX alone would reduce postoperative pain in women patients undergoing an elective gynecological laparoscopic procedure. This CONSORT-prospective randomized controlled clinical study aimed to investigate the effects of DEX alone for intravenous PCA after gynecological laparoscopic operation. Forty women patients scheduled for elective gynecological laparoscopy were enrolled into the study at Shandong Cancer Hospital and Institute and randomly allocated into two groups (n = 20 each). In the DEX group (group D), the intravenous PCA protocol was DEX 0.25 μg/kg/h diluted to 100 mL in 0.9% saline. In the fentanyl group (group F), the PCA protocol was fentanyl 20 μg/kg diluted to 100 mL in 0.9% saline. The primary outcome was the mean pain score on a visual analogue scale (VAS) at 6 hours after the operation. The secondary outcomes included the Ramsay sedation score, the incidence of postoperative nausea and vomiting (PONV), satisfaction with pain control, and time to recovery of gastrointestinal function. There were no significant differences in the patients’ characteristics and intraoperative measurements (P > 0.05). No patients received rescue analgesic. The mean VAS scores at 6 hours post-operatively were not significantly different between the groups (P > 0.05). The incidence of PONV was less in group D than in group F (P < 0.05). The Ramsay sedation scores were not significantly between the groups (P > 0.05). Satisfaction with pain control was

  14. Role of laparoscopic surgery in the management of endometrial cancer.

    PubMed

    Tenney, Meaghan; Walker, Joan L

    2009-05-01

    Minimum surgical treatment for endometrial cancer is removal of the uterus. The operative approach to achieve that goal ranges from vaginal hysterectomy alone to laparotomy with radical hysterectomy, bilateral salpingoophorectomy, bilateral pelvic and para-aortic lymphadenectomy with possible omentectomy, and resection of all metastatic disease. Stratifying the risk factors for predicting presence of metastatic disease has error rates exceeding tolerance for many gynecologic oncologists. Most accept routine laparoscopic surgical staging with hysterectomy, pelvic and para-aortic lymphadenectomy, and removal of adnexa as standard care for patients with endometrial cancer. Modifying the extent of surgical staging for low-risk intrauterine findings or excessive risk for postoperative morbidity is also accepted. Laparoscopic surgery has become the ideal initial surgical approach for this disease, allowing for visual inspection of common metastatic sites, biopsy of abnormal areas, and cytology from peritoneal surfaces. The extent of staging can be altered depending on frozen section findings from the uterus, adnexa, and peritoneal surfaces. Intraoperative medical decision-making can be individualized, encompassing all known risk factors for metastases and balancing comorbidities and potential adverse outcomes. This article documents how laparoscopic surgery satisfies the needs of individual patients and surgeons treating this disease. PMID:19460281

  15. Single-incision laparoscopic surgery for colorectal cancer

    PubMed Central

    Hirano, Yasumitsu; Hattori, Masakazu; Douden, Kenji; Ishiyama, Yasuhiro; Hashizume, Yasuo

    2016-01-01

    AIM: To determine the effect of single-incision laparoscopic colectomy (SILC) for colorectal cancer on short-term clinical and oncological outcomes by comparison with multiport conventional laparoscopic colectomy (CLC). METHODS: A systematic review was performed using MEDLINE for the time period of 2008 to December 2014 to retrieve all relevant literature. The search terms were “laparoscopy”, “single incision”, “single port”, “single site”, “SILS”, “LESS” and “colorectal cancer”. Publications were included if they were randomized controlled trials, case-matched controlled studies, or comparative studies, in which patients underwent single-incision (SILS or LESS) laparoscopic colorectal surgery. Studies were excluded if they were non-comparative, or not including surgery involving the colon or rectum. A total of 15 studies with 589 patients who underwent SILC for colorectal cancer were selected. RESULTS: No significant differences between the groups were noted in terms of mortality or morbidity. The benefit of the SILC approach included reduction in conversion rate to laparotomy, but there were no significant differences in other short-term clinical outcomes between the groups. Satisfactory oncological surgical quality was also demonstrated for SILC for the treatment of colorectal cancer with a similar average lymph node harvest and proximal and distal resection margin length as multiport CLC. CONCLUSION: SILC can be performed safely with similar short-term clinical and oncological outcomes as multiport CLC. PMID:26843918

  16. HPC enabled real-time remote processing of laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Ronaghi, Zahra; Sapra, Karan; Izard, Ryan; Duffy, Edward; Smith, Melissa C.; Wang, Kuang-Ching; Kwartowitz, David M.

    2016-03-01

    Laparoscopic surgery is a minimally invasive surgical technique. The benefit of small incisions has a disadvantage of limited visualization of subsurface tissues. Image-guided surgery (IGS) uses pre-operative and intra-operative images to map subsurface structures. One particular laparoscopic system is the daVinci-si robotic surgical system. The video streams generate approximately 360 megabytes of data per second. Real-time processing this large stream of data on a bedside PC, single or dual node setup, 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 rate, it is required that each 11.9 MB video frame be processed by a server and returned within 1/30th of a second. We have implement and compared performance of compression, segmentation and registration algorithms on Clemson's Palmetto supercomputer using dual NVIDIA K40 GPUs per node. Our computing framework will also enable reliability using replication of computation. We will securely transfer the files to remote HPC clusters utilizing an OpenFlow-based network service, Steroid OpenFlow Service (SOS) that can increase performance of large data transfers over long-distance and high bandwidth networks. As a result, utilizing high-speed OpenFlow- based network to access computing clusters with GPUs will improve surgical procedures by providing real-time medical image processing and laparoscopic data.

  17. Students' Interest in Surgery Affects Laparoscopic Practicing Performance

    PubMed Central

    Mao Wu, Sheng; Kuei Chien, Wen; Sheng Huang, Chen; Cheng Lin, Wei; Chun Chang, Yin

    2016-01-01

    Background and Objective: Earlier exposure to laparoscopic techniques is thought to be beneficial for medical students. Reports have demonstrated that practice improves performance in laparoscopies. In this study, we intended to evaluate whether medical students' interest in surgery is affected by the amount of practice and the performance on a laparoscopic simulator. Methods: A laparoscopic simulation curriculum was introduced at Taipei Medical University, Wan-Fang Medical Center. Study participants included 36 sixth-year and 14 seventh-year students who were divided according to whether they had indicated an interest (group A) or not (group B) in surgery. The students had twice-a-week practice sessions for 2 weeks. They underwent baseline measurement (BM) before training and posttraining measurement (PTM). Self-guided practice on the simulator was allowed. The learning outcomes were assessed comparing the BM and PTM scores by using the interquartile range (IQR) test. We also tested the correlation between total score and number of self-guided practice sessions. Results: All study participants showed improvement. No differences were observed between BM and PTM scores and between 6th- and 7th-year medical students. Significant differences were found in PTM scores between groups A and B (P < .001). Analysis of variance with a post hoc test for different groups revealed that the PTMs were significantly higher for both the 6th- and 7th-year medical students in group A than for those in group B (P < .001). Total performance scores were improved with a higher number of self-guided practice sessions. Linear regression analysis demonstrated a significant correlation between the number of self-guided practice sessions and total performance score (P < .001). Conclusion: Those clerks and interns interested in surgery who had more sessions for self-guided practice, displayed more improvement than those not interested in surgery did. Improvement in performance correlated

  18. 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. PMID:26734626

  19. Ontology-based prediction of surgical events in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Katić, 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. Laparoscopically Assisted Surgery for Colonic Perforation with Peritonitis - A Case Report

    PubMed Central

    1998-01-01

    Elective laparoscopic colonic surgery is increasingly recognized as feasible and perhaps preferential. A case of laparoscopically assisted surgery for trauma to the rectum with bacterial peritonitis is presented. It presents an example of the application of this modality to the treatment of iatrogenic colon perforations and perhaps selected diverticulitis. PMID:9876737

  1. The Implementation of a Standardized Approach to Laparoscopic Rectal Surgery

    PubMed Central

    Aslak, Katrine Kanstrup

    2012-01-01

    Background and Objectives: The purpose of this study was to audit our results after implementation of a standardized operative approach to laparoscopic surgery for rectal cancer within a fast-track recovery program. Methods: From January 2009 to February 2011, 100 consecutive patients underwent laparoscopic surgery on an intention-to-treat basis for rectal cancer. The results were retrospectively reviewed from a prospectively collected database. Operative steps and instrumentation for the procedure were standardized. A standard perioperative care plan was used. Results: The following procedures were performed: low anterior resection (n=26), low anterior resection with loop-ileostomy (n=39), Hartmann's operation (n=14), and abdominoperineal resection (n=21). The median length of hospital stay was 7 days; 9 patients were readmitted. There were 9 cases of conversion to open surgery. The overall complication rate was 35%, including 6 cases (9%) of anastomotic leakages requiring reoperation. The 30-day mortality was 5%. The median number of harvested lymph nodes was 15 (range, 2 to 48). There were 6 cases of positive circumferential resection margins. The median follow-up was 9 (range, 1 to 27) months. One patient with disseminated cancer developed port-site metastasis. Conclusions: The results confirm the safety of a standardized approach, and the oncological outcomes are comparable to those of similar studies. PMID:23477176

  2. Towards scar-free surgery: An analysis of the increasing complexity from laparoscopic surgery to NOTES

    PubMed Central

    Chellali, Amine; Schwaitzberg, Steven D.; Jones, Daniel B.; Romanelli, John; Miller, Amie; Rattner, David; Roberts, Kurt E.; Cao, Caroline G.L.

    2014-01-01

    Background NOTES is an emerging technique for performing surgical procedures, such as cholecystectomy. Debate about its real benefit over the traditional laparoscopic technique is on-going. There have been several clinical studies comparing NOTES to conventional laparoscopic surgery. However, no work has been done to compare these techniques from a Human Factors perspective. This study presents a systematic analysis describing and comparing different existing NOTES methods to laparoscopic cholecystectomy. Methods Videos of endoscopic/laparoscopic views from fifteen live cholecystectomies were analyzed to conduct a detailed task analysis of the NOTES technique. A hierarchical task analysis of laparoscopic cholecystectomy and several hybrid transvaginal NOTES cholecystectomies was performed and validated by expert surgeons. To identify similarities and differences between these techniques, their hierarchical decomposition trees were compared. Finally, a timeline analysis was conducted to compare the steps and substeps. Results At least three variations of the NOTES technique were used for cholecystectomy. Differences between the observed techniques at the substep level of hierarchy and on the instruments being used were found. The timeline analysis showed an increase in time to perform some surgical steps and substeps in NOTES compared to laparoscopic cholecystectomy. Conclusion As pure NOTES is extremely difficult given the current state of development in instrumentation design, most surgeons utilize different hybrid methods – combination of endoscopic and laparoscopic instruments/optics. Results of our hierarchical task analysis yielded an identification of three different hybrid methods to perform cholecystectomy with significant variability amongst them. The varying degrees to which laparoscopic instruments are utilized to assist in NOTES methods appear to introduce different technical issues and additional tasks leading to an increase in the surgical time. The

  3. Context-aware Augmented Reality in laparoscopic surgery.

    PubMed

    Katić, Darko; Wekerle, Anna-Laura; Görtler, Jochen; Spengler, Patrick; Bodenstedt, Sebastian; Röhl, Sebastian; Suwelack, Stefan; Kenngott, Hannes Götz; Wagner, Martin; Müller-Stich, Beat Peter; Dillmann, Rüdiger; Speidel, Stefanie

    2013-03-01

    Augmented Reality is a promising paradigm for intraoperative assistance. Yet, apart from technical issues, a major obstacle to its clinical application is the man-machine interaction. Visualization of unnecessary, obsolete or redundant information may cause confusion and distraction, reducing usefulness and acceptance of the assistance system. We propose a system capable of automatically filtering available information based on recognized phases in the operating room. Our system offers a specific selection of available visualizations which suit the surgeon's needs best. The system was implemented for use in laparoscopic liver and gallbladder surgery and evaluated in phantom experiments in conjunction with expert interviews. PMID:23541864

  4. Perioperative Management of Severe Hypertension during Laparoscopic Surgery for Pheochromocytoma

    PubMed Central

    Erdoğan, Mehmet Ali; Uçar, Muharrem; Özkan, Ahmet Selim; Özgül, Ülkü; Durmuş, Mahmut

    2016-01-01

    Phaeochromocytoma is a catecholamine-secreting vascular tumour that is derived from chromaffin cell. Lethal cardiovascular complications, such as serious hypertension, myocardial infarction and aortic dissection, may occur because of uncontrolled catecholamine release. Each stage of anaesthesia management has vital importance because of this destructive catecholamine secretion that may occur during induction, perioperative stage and surgical manipulation. In this study, we report regarding the preoperative preparation and severe, persistent hypertension attack management with a combination of α-adrenergic blockade, β-adrenergic blockade, sodium nitroprusside and remifentanil in a patient who underwent laparoscopic surgery for phaeochromocytoma. PMID:27366556

  5. Effect of Haptic Feedback in Laparoscopic Surgery Skill Acquisition

    PubMed Central

    Zhou, M.; Tse, S.; Derevianko, A.; Jones, D.B.; Schwaitzberg, S.D.; Cao, C. G. L.

    2012-01-01

    Background The benefits of haptic feedback in laparoscopic surgery training simulators is a topic of debate in the literature. It is hypothesized that novice surgeons may not benefit from the haptic information, especially during the initial phase of learning a new task. Therefore, providing haptic feedback to novice trainees in the early stage of training may be distracting and detrimental to learning. Objective A controlled experiment was conducted to examine the effect of haptic feedback on the learning curve of a complex laparoscopic suturing and knot-tying task. Method The ProMIS and the MIST-VR surgical simulators were used to represent conditions with and without haptic feedback, respectively. Twenty novice subjects (10 per simulator) were trained to perform suturing and knot-tying and practiced the tasks over eighteen one-hour sessions. Results At the end of the 3-week training period, subjects performed equally fast but more consistently with haptics (ProMIS) than without (MIST-VR). Subjects showed slightly higher learning rate and reached the first plateau of the learning curve earlier with haptic feedback. Conclusion In general, learning with haptic feedback was significantly better than without haptic feedback for a laparoscopic suturing and knot-tying task, but only in the first 5 hours of training. Application Haptic feedback may not be warranted in laparoscopic surgical trainers. The benefits of a shorter time to the first performance plateau and more consistent initial performance should be balanced with the cost of implementing haptic feedback in surgical simulators. PMID:22044975

  6. Single Port Transumbilical Laparoscopic Surgery versus Conventional Laparoscopic Surgery for Benign Adnexal Masses: A Retrospective Study of Feasibility and Safety

    PubMed Central

    Wang, Si-Yun; Yin, Ling; Guan, Xiao-Ming; Xiao, Bing-Bing; Zhang, Yan; Delgado, Amanda

    2016-01-01

    Background: Single port laparoscopic surgery (SPLS) is an innovative approach that is rapidly gaining recognition worldwide. The aim of this study was to determine the feasibility and safety of SPLS compared to conventional laparoscopic surgery for the treatment of benign adnexal masses. Methods: In total, 99 patients who underwent SPLS for benign adnexal masses between December 2013 and March 2015 were compared to a nonrandomized control group comprising 104 conventional laparoscopic adnexal surgeries that were performed during the same period. We retrospectively analyzed multiple clinical characteristics and operative outcomes of all the patients, including age, body mass index, size and pathological type of ovarian mass, operative time, estimated blood loss (EBL), duration of postoperative hospital stay, etc. Results: No significant difference was observed between the two groups regarding preoperative baseline characteristics. However, the pathological results between the two groups were found to be slightly different. The most common pathological type in the SPLS group was mature cystic teratoma, whereas endometrioma was more commonly seen in the control group. Otherwise, the two groups had comparable surgical outcomes, including the median operation time (51 min vs. 52 min, P = 0.909), the median decreased level of hemoglobin from preoperation to postoperation day 3 (10 g/L vs. 10 g/L, P = 0.795), and the median duration of postoperative hospital stay (3 days vs. 3 days, P = 0.168). In SPLS groups, the median EBL and the anal exsufflation time were significantly less than those of the conventional group (5 ml vs. 10 ml, P < 0.001; 10 h vs. 22 h, P < 0.001). Conclusions: SPLS is a feasible and safe approach for the treatment of benign adnexal masses. Further study is required to better determine whether SPLS has significant benefits compared to conventional techniques. PMID:27231167

  7. Short-term outcomes after laparoscopic colorectal surgery in patients with previous abdominal surgery: A systematic review

    PubMed Central

    Figueiredo, Marleny Novaes; Campos, Fabio Guilherme; D’Albuquerque, Luiz Augusto; Nahas, Sergio Carlos; Cecconello, Ivan; Panis, Yves

    2016-01-01

    AIM: To perform a systematic review focusing on short-term outcomes after colorectal surgery in patients with previous abdominal open surgery (PAOS). METHODS: A broad literature search was performed with the terms “colorectal”, “colectomy”, “PAOS”, “previous surgery” and “PAOS”. Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS, whether descriptive or comparative. Endpoints of interest were conversion rates, inadvertent enterotomy and morbidity. Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: From a total of 394 citations, 13 full-texts achieved selection criteria to be included in the study. Twelve of them compared patients with and without PAOS. All studies were retrospective and comparative and two were case-matched. The selected studies comprised a total of 5005 patients, 1865 with PAOS. Among the later, only 294 (16%) had history of a midline incision for previous gastrointestinal surgery. Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopy was more prevalent in 3 of 5 studies that disclosed this event. Morbidity was similar in the majority of studies. A quantitative analysis (meta-analysis) could not be performed due to heterogeneity of the studies. CONCLUSION: Conversion rates were slightly higher in PAOS groups, although not statistical significant in most studies. History of PAOS did not implicate in higher morbidity rates. PMID:27462396

  8. 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

  9. 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

  10. Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery

    PubMed Central

    2013-01-01

    Background In the late '80s the successes of the laparoscopic surgery for gallbladder disease laid the foundations on the modern use of this surgical technique in a variety of diseases. In the last 20 years, laparoscopic colorectal surgery had become a popular treatment option for colorectal cancer patients. Discussion Many studies emphasized on the benefits stating the significant advantages of the laparoscopic approach compared with the open surgery of reduced blood loss, early return of intestinal motility, lower overall morbidity, and shorter duration of hospital stay, leading to a general agreement on laparoscopic surgery as an alternative to conventional open surgery for colon cancer. The reduced hospital stay may also decrease the cost of the laparoscopic surgery for colorectal cancer, despite th higher operative spending compared with open surgery. The average reduction in total direct costs is difficult to define due to the increasing cost over time, making challenging the comparisons between studies conducted during a time range of more than 10 years. However, despite the theoretical advantages of laparoscopic surgery, it is still not considered the standard treatment for colorectal cancer patients due to technical limitations or the characteristics of the patients that may affect short and long term outcomes. Conclusions The laparoscopic approach to colectomy is slowly gaining acceptance for the management of colorectal pathology. Laparoscopic surgery for colon cancer demonstrates better short-term outcome, oncologic safety, and equivalent long-term outcome of open surgery. For rectal cancer, laparoscopic technique can be more complex depending on the tumor location. The advantages of minimally invasive surgery may translate better care quality for oncological patients and lead to increased cost saving through the introduction of active enhanced recovery programs which are likely cost-effective from the perspective of the hospital health-care providers

  11. 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

  12. Laparoscopic-Assisted Versus Open Surgery for Colorectal Cancer: Short- and Long-Term Outcomes Comparison

    PubMed Central

    Grosso, Giuseppe; Mistretta, Antonio; Marventano, Stefano; Toscano, Chiara; Gruttadauria, Salvatore; Basile, Francesco

    2013-01-01

    Abstract Background Despite the theoretical advantages of laparoscopic surgery, it is still not considered the standard treatment for colorectal cancer patients because of criticism concerning oncologic stability. This study aimed at examining the short- and long-term follow-up results of laparoscopic surgery versus open surgery for colorectal cancer and at investigating clinical outcomes, oncologic safety, and any potential advantages of laparoscopic colorectal cancer resection. Subjects and Methods We retrospectively analyzed a database containing the information about patients who underwent surgery for stage I–III colorectal cancer from January 2004 to January 2012 at our institution. Results The patients who underwent the laparoscopic-assisted procedure showed a significantly faster recovery than those who underwent open surgery, namely, less time to first passing flatus (P=.041), time of first bowel motion (P=.04), time to resume normal diet (P=.043), and time to walk independently (P=.031). Laparoscopic colorectal surgery caused less pain for patients, leading to lower need of analgesic (P=.002) and less hospital recovery time (P=.034), compared with patients who underwent open surgery. No differences were found in 3- and 5-year overall and disease-free survival rates. Conclusions Our results suggested that the laparoscopic approach was as safe as the open alternative. Laparoscopic-assisted surgery has been shown to be a favorable surgical option with better short-term outcomes and similar long-term oncological control compared with open resection. PMID:23004676

  13. Laparoscopic versus open surgery for colorectal cancer in the older person: A systematic review

    PubMed Central

    Moug, S.J.; McCarthy, K.; Coode-Bate, J.; Stechman, M.J.; Hewitt, J.

    2015-01-01

    Background Laparoscopic surgery is being increasingly offered to the older person. Objective To systematically review the literature regarding laparoscopic colorectal cancer surgery in older people and compare to younger adult populations. Study selection We included randomized controlled trials that compared open to laparoscopic colorectal cancer surgery. Older people were defined as being 65 years and above. Outcome measures Overall survival and post-operative morbidity and mortality. Secondary endpoints were length of hospital stay, wound recurrence, disease-free survival and conversion rate. Results Seven trials included older people, average age of approximately 70 years. Two reported data specific to older patients (over 70 years): The ALCCaS study reported reduced length of stay and short-term complication rates in the laparoscopic group when compared to open surgery (8 versus 10 days, and 36.7% versus 50.6% respectively) and the CLASICC study reported equivalent 5 year survival between arms and a reduction of 2 days length of stay following laparoscopic surgery in older people. In trials which considered data on older and younger participants all five trials reported comparable overall survival and showed comparable or reduced complication rates; two demonstrated significantly shorter length of stay following laparoscopic surgery compared to open surgery. Conclusion Large numbers of older people have been included in well-conducted, multi-centre, randomized controlled trials for laparoscopic and open colorectal cancer surgery. This systematic review suggests that age itself should not be a factor when considering the best surgical option for older patients. PMID:26468376

  14. Forceps insertion supporting system in laparoscopic surgery: image projection onto the abdominal surface

    NASA Astrophysics Data System (ADS)

    Koishi, Takeshi; Ushiki, Suguru; Nakaguchi, Toshiya; Hayashi, Hideki; Tsumura, Norimichi; Miyake, Yoichi

    2007-03-01

    Laparoscopic surgery without ventrotomy has been widely used in recent years for quick recovery and out of pain of patients. However, surgeons are required to accumulate various experiences for this surgery since the difficulty in perceiving the positions of tissues by the limited field of view (FOV) of laparoscopes and the operational difficulties of forceps. In this paper, we propose a new laparoscopic surgery supporting system using projected images. The image of the FOV of a laparoscope is projected directly onto the abdominal surface of a patient. The shape distortion of the projected images produced by the unevenness of the abdominal surface is corrected by grating projection. The distortion due to the viewing angle of the surgeon is also corrected by using an electromagnetic tracking sensor. It is shown that the proposed system is significant to laparoscopic surgery, particularly for forceps insertion, by experiments using a model of the abdomen made with a dry box.

  15. Port site infection in laparoscopic surgery: A review of its management

    PubMed Central

    Sasmal, Prakash K; Mishra, Tushar S; Rath, Satyajit; Meher, Susanta; Mohapatra, Dipti

    2015-01-01

    Laparoscopic surgery (LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection (PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent. PMID:26488021

  16. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study

    PubMed Central

    Kim, Jong Wan; Kim, Jeong Yeon; Kang, Byung Mo; Lee, Bong Hwa; Kim, Byung Chun; Park, Jun Ho

    2016-01-01

    Purpose The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer. Patients and methods We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery. Results Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, P<0.001), but the time to soft food intake (6.0 vs 6.6 days, P=0.036) and the postoperative hospital stay (13.7 vs 15.7 days, P=0.018) were shorter in the laparoscopic group. The number of harvested lymph nodes was lower in the laparoscopic group than in the open group (20.3 vs 24.3, P<0.001). The 5-year overall survival (90.8% vs 88.6%, P=0.540) and disease-free survival (86.1% vs 78.9%, P=0.201) rates were similar in both groups. Conclusion The present study showed that laparoscopic surgery is associated with several perioperative benefits and similar oncologic outcomes to open surgery for the resection of transverse colon cancer. Therefore, laparoscopic surgery offers a safe alternative to open surgery in patients with transverse colon cancer. PMID:27143915

  17. Perioperative Outcomes of Robotic Assisted Laparoscopic Surgery Versus Conventional Laparoscopy Surgery for Advanced-Stage Endometriosis

    PubMed Central

    Sirota, Ido

    2014-01-01

    Background and Objectives: To determine perioperative outcome differences in patients undergoing robotic-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for advanced-stage endometriosis. Methods: This retrospective cohort study at a minimally invasive gynecologic surgery center at 2 academically affiliated, urban, nonprofit hospitals included all patients treated by either robotic-assisted or conventional laparoscopic surgery for stage III or IV endometriosis (American Society for Reproductive Medicine criteria) between July 2009 and October 2012 by 1 surgeon experienced in both techniques. The main outcome measures were extent of surgery, estimated blood loss, operating room time, intraoperative and postoperative complications, and length of stay, with medians for continuous measures and distributions for categorical measures, stratified by body mass index values. Robotically assisted laparoscopy and conventional laparoscopy were then compared by use of the Wilcoxon rank sum, χ2, or Fisher exact test, as appropriate. Results: Among 86 conventional laparoscopic and 32 robotically assisted cases, the latter had a higher body mass index (27.36 kg/m2 [range, 23.90–34.09 kg/m2] versus 24.53 kg/m2 [range, 22.27–26.96 kg/m2]; P < .0079) and operating room time (250.50 minutes [range, 176–328.50 minutes] versus 173.50 minutes [range, 123–237 minutes]; P < .0005) than did conventional laparoscopy patients. After body mass index stratification, obese patients varied in operating room time (282.5 minutes [range, 224–342 minutes] for robotic-assisted laparoscopy versus 174 minutes [range, 130–270 minutes] for conventional laparoscopy; P < .05). No other significant differences were noted between the robotic-assisted and conventional laparoscopy groups. Conclusion: Despite a higher operating room time, robotic-assisted laparoscopy appears to be a safe minimally invasive approach for patients, with all other perioperative

  18. Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy

    PubMed Central

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

    2015-01-01

    AIM: To assess clinical outcomes of laparoscopic hepatectomy (LH) in patients with a history of upper abdominal surgery and repeat hepatectomy. METHODS: This study compared the perioperative courses of patients receiving LH at our institution that had or had not previously undergone upper abdominal surgery. Of the 80 patients who underwent LH, 22 had prior abdominal surgeries, including hepatectomy (n = 12), pancreatectomy (n = 3), cholecystectomy and common bile duct excision (n = 1), splenectomy (n = 1), total gastrectomy (n = 1), colectomy with the involvement of transverse colon (n = 3), and extended hysterectomy with extensive lymph-node dissection up to the upper abdomen (n = 1). Clinical indicators including operating time, blood loss, hospital stay, and morbidity were compared among the groups. RESULTS: Eighteen of the 22 patients who had undergone previous surgery had severe adhesions in the area around the liver. However, there were no conversions to laparotomy in this group. In the 58 patients without a history of upper abdominal surgery, the median operative time was 301 min and blood loss was 150 mL. In patients with upper abdominal surgical history or repeat hepatectomy, the operative times were 351 and 301 min, and blood loss was 100 and 50 mL, respectively. The median postoperative stay was 17, 13 and 12 d for patients with no history of upper abdominal surgery, patients with a history, and patients with repeat hepatectomy, respectively. There were five cases with complications in the group with no surgical history, compared to only one case in the group with a prior history. There were no statistically significant differences in the perioperative results between the groups with and without upper abdominal surgical history, or with repeat hepatectomy. CONCLUSION: LH is feasible and safe in patients with a history of upper abdominal surgery or repeat hepatectomy. PMID:25624731

  19. Laparoscopic Stone Surgery With the Aid of Flexible Nephroscopy

    PubMed Central

    Jung, Jae Hyun; Cho, Sung Yong; Jeong, Chang Wook; Jeong, Hyeon; Son, Hwancheol; Woo, Seung Hyo; Kim, Dae Kyung; Min, Sun-Ho; Oh, Seung-June; Kim, Hyeon-Hoe

    2014-01-01

    Purpose To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. Materials and Methods A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. Results The patients' mean age was 54.7±13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4±9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0±63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. Conclusions Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications. PMID:25045447

  20. Gaze Contingent Cartesian Control of a Robotic Arm for Laparoscopic Surgery

    PubMed Central

    Fujii, Kenko; Salerno, Antonino; Sriskandarajah, Kumuthan; Kwok, Ka-Wai; Shetty, Kunal; Yang, Guang-Zhong

    2014-01-01

    This paper introduces a gaze contingent controlled robotic arm for laparoscopic surgery, based on gaze gestures. The method offers a natural and seamless communication channel between the surgeon and the robotic laparoscope. It offers several advantages in terms of reducing on-screen clutter and efficiently conveying visual intention. The proposed hands-free system enables the surgeon to be part of the robot control feedback loop, allowing user-friendly camera panning and zooming. The proposed platform avoids the limitations of using dwell-time camera control in previous gaze contingent camera control methods. The system represents a true hands-free setup without the need of obtrusive sensors mounted on the surgeon or the use of a foot pedal. Hidden Markov Models (HMMs) were used for real-time gaze gesture recognition. This method was evaluated with a cohort of 11 subjects by using the proposed system to complete a modified upper gastrointestinal staging laparoscopy and biopsy task on a phantom box trainer, with results demonstrating the potential clinical value of the proposed system. PMID:24748999

  1. Laparoscopic Colorectal Surgery: An Update (with Special Reference to Indian Scenario).

    PubMed

    Moirangthem, G S

    2014-04-01

    Laparoscopic cholecystectomy, being already declared as gold standard technique, laparoscopic surgery has advanced far and wide, touching almost every corner of the abdomen. This advancement has gradually expanded to colorectal surgery which is done for malignant diseases as well. However, laparoscopic colorectal surgery has not been accepted as quickly as was laparoscopic cholecystectomy. This is because of its steep learning curve, concerns with oncological outcomes, lack of randomized control trials (RCTs) and initial reports on high port site recurrences which occurred after curative resections. But all these initial concerns have been overcome by doing a series of RCTs globally, in the past decade, that revealed that laparoscopic colorectal surgery for malignant disease offered short term benefits without compromising on oncological principles of radicality of resection, tumour resection margins and completeness of lymph node harvesting as compared to those of open surgery. Favourable post-operative results with respect to less blood loss, less pain, lesser surgical site infections, lesser requirement of analgesics, early return of bowel function and shorter hospital stay in patients who underwent laparoscopic colorectal resections were obtained in studies done on individual series, including those done in India and more recently, in large trials. An update on recent studies done on laparoscopic colorectal surgery by reviewing many RCTs and individual series, including our experiences, was made, to support the advantages of this procedure which were obtained when it was carried out by skilled hands. PMID:24959478

  2. Use of Barbed Sutures in Laparoscopic Gastrointestinal Single-Layer Sutures

    PubMed Central

    Kaji, Masahide; Kinoshita, Jun; Shimizu, Koichi

    2016-01-01

    Background and Objectives: Laparoscopic anastomotic methods are not commonly used because of the cumbersome laparoscopic intracorporeal sutures and tying involved. The barbed suture is one of the various devices developed to simplify the placement of intracorporeal sutures. However, barbed sutures are not commonly used during reconstruction after radical gastrectomy in cancer patients or for single-layer entire-thickness running suturing for intestinal anastomoses. We describe the procedure for using barbed sutures and report on the short-term surgical outcomes. Methods: Between August 2012 and March 2014, 15-cm-long barbed sutures (V-Loc 180; Covidien, Mansfield, MA, USA) were used for laparoscopic intestinal anastomoses, including intestinal hole closure for esophagojejunal and gastrojejunal anastomoses after mechanical anastomoses and gastric wall closure after partial resection. Results: In total, 38 patients underwent 40 laparoscopic anastomoses (esophagojejunostomies, 26; gastrojejunostomies, 7; and simple closure of gastric defect, 7); no cases required conversion to open surgery. Two cases exhibited positive air leak test results during surgery (1 case of esophagojejunostomy and 1 case of simple closure of gastric defect). Two cases of intestinal obstruction were noted; of those, one patient with postoperative intestinal paresis (grade II) was managed conservatively, and the other underwent repeat laparoscopic surgery (grade IIIb) for internal herniation unrelated to V-Loc use. No postoperative complications at the anastomosis site and no surgery-related deaths were noted. Conclusion: Single-layer entire-thickness running suturing with the V-Loc 180 barbed suture after stapled side-to-side intestinal anastomosis was found to be safe and feasible in the reported cases. PMID:27493467

  3. 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

  4. Single-access surgery laparoscopic cholecystectomy and appendectomy.

    PubMed

    Mofid, Hamid; Zornig, Carsten

    2010-04-01

    The objective of this study was to achieve an ideal cosmetic result and minimize the access trauma to the abdominal wall. The authors developed a technique to perform cholecystectomies and appendectomies with only one incision in the umbilicus. With the upcoming idea of Natural Orifice Transluminal Endoscopic Surgery (NOTES) in the recent years and noticing the lack of feasibility of the technique for the daily routine beside the technique described by these authors, another development was raising the interest of the surgeons around the world. The single-access surgery through the umbilicus is a technique, that can be used in the daily routine and provides the best cosmetic results. Furthermore, injury of the abdominal wall is located at only one site, which might reduce the rate of trocar hernias and abdominal wall infections. Two 5.5-mm trocars were inserted through an incision at the upper edge of the umbilicus. After perforation of the abdominal wall with a stylet of a 5.5-mm trocar, a curved grasper was inserted, without the use of a trocar, into the abdominal cavity. The use of curved instruments facilitates better triangulation and instrument handling. No gas leakage was observed due to the nonexistence of a trocar. Dissection of the Calot' s triangle or appendix vessels can be done with standard instruments. The curved grasper allows retraction of the gallbladder or appendix. The specimen can be removed through the umbilical incision. The authors present a single-access surgery technique for cholecystectomies and appendectomies using curved instruments. The single-access surgery with parallel inserted curved instruments is feasible. No additional complications are related to this modification other than those known to be associated with laparoscopic surgery. This method offers an almost scarless surgery. Whether other advantages such as less trocar hernias, wound infections, and/or a faster recovery can be achieved, it has not yet to be proven. PMID

  5. Differences in early outcomes after open or laparoscopic surgery: what is the evidence?

    PubMed

    Papagrigoriadis, Savvas

    2012-01-01

    Laparoscopic surgery has been widely studied in colorectal cancer and its feasibility and safety have been proven to the extent that in the UK a national laparoscopic colorectal surgery programme has been established. The advantages of laparoscopic surgery have been studied less systematically in diverticular disease. Several prospective uncontrolled studies have demonstrated that laparoscopic surgery for diverticular disease is feasible with low morbidity and mortality rates. A large population study in the USA has demonstrated elective laparoscopic surgery for diverticular disease to have reduced hospital stay by 1 day, and a lower rate of intra-operative and post-operative complications over open surgery. Some of the reported differences may be attributable to selection bias of more complex cases to open surgery. A Cochrane systematic review examining 11 non-randomized and 1 randomized study showed laparoscopic surgery to be feasible in diverticular disease, although there might be a higher minor complications rate in laparoscopic resections. Attention has been focused on surgical techniques as means to reduce complications. There is a belief that preservation of the inferior mesenteric and superior rectal artery protects from anastomotic leak, but a study from the USA looking into that point did not find a difference. The application of hand-assisted laparoscopy seems to help cope with complex diverticular masses and colovesical fistulas. New hybrid techniques incorporating specimen extraction via rectum may reduce complications further. Single incision laparoscopic surgery has recently been shown to be feasible. Although minimally invasive techniques appear superior in terms of early outcomes than open surgery the choice of minimally invasive technique seems to be less relevant to outcomes if accompanied by an appropriate level of surgical experience and expertise. Patient-related factors such as comorbidities or degree of disease complexity are more likely to

  6. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations

    PubMed Central

    Pascual, Marta; Salvans, Silvia; Pera, Miguel

    2016-01-01

    The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases. PMID:26811618

  7. Present laparoscopic surgery for colorectal cancer in Japan

    PubMed Central

    Sato, Takeo; Watanabe, Masahiko

    2016-01-01

    In many clinical studies, laparoscopic surgery (LS) for colon cancer has been shown to be less invasive than open surgery (OS) while maintaining similar safety. Furthermore, there are no significant differences between LS and OS in long-term outcomes. Thus, LS has been accepted as one of the standard treatments for colon cancer. In the treatments of rectal cancer as well, LS has achieved favorable outcomes, with many reports showing long-term outcomes comparable to those of OS. Furthermore, the magnification in laparoscopy improves visualization in the pelvic cavity and facilitates precise manipulation, as well as providing excellent educational effects. For these reasons, rectal cancer has seemed to be well indicated for LS, as has been colon cancer. The indication for LS in the treatment of locally advanced rectal cancer, which is relatively unresectable (e.g., cancer invading other organs), remains an open issue. In recent years, new techniques such as single-port and robotic surgery have begun to be introduced for LS. Presently, various clinical studies in our country as well as in most Western countries have demonstrated that LS, with these new techniques, are gradually showing long-term outcomes. PMID:27081638

  8. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study.

    PubMed

    Tolboom, Robert C; Draaisma, Werner A; Broeders, Ivo A M J

    2016-03-01

    Surgery for refractory gastroesophageal reflux disease (GERD) and hiatal hernia leads to recurrence or persisting dysphagia in a minority of patients. Redo antireflux surgery in GERD and hiatal hernia is known for higher morbidity and mortality. This study aims to evaluate conventional versus robot-assisted laparoscopic redo antireflux surgery, with the objective to detect possible advantages for the robot-assisted approach. A single institute cohort of 75 patients who underwent either conventional laparoscopic or robot-assisted laparoscopic redo surgery for recurrent GERD or severe dysphagia between 2008 and 2013 were included in the study. Baseline characteristics, symptoms, medical history, procedural data, hospital stay, complications and outcome were prospectively gathered. The main indications for redo surgery were dysphagia, pyrosis or a combination of both in combination with a proven anatomic abnormality. The mean time to redo surgery was 1.9 and 2.0 years after primary surgery for the conventional and robot-assisted groups, respectively. The number of conversions was lower in the robot-assisted group compared to conventional laparoscopy (1/45 vs. 5/30, p = 0.035) despite a higher proportion of patients with previous surgery by laparotomy (9/45 vs. 1/30, p = 0.038). Median hospital stay was reduced by 1 day (3 vs. 4, p = 0.042). There were no differences in mortality, complications or outcome. Robotic support, when available, can be regarded beneficial in redo surgery for GERD and hiatal hernia. Results of this observational study suggest technical feasibility for minimal-invasive robot-assisted redo surgery after open primary antireflux surgery, a reduced number of conversions and shorter hospital stay. PMID:26809755

  9. [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

  10. Incidence of Port-Site Incisional Hernia After Single-Incision Laparoscopic Surgery

    PubMed Central

    Rainville, Harvey; Ikedilo, Ojinika; Vemulapali, Pratibha

    2014-01-01

    Background and Objectives: Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined. Methods: All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh. Results: A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up. Conclusion: Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid. PMID:24960483

  11. Surgical robot for single-incision laparoscopic surgery.

    PubMed

    Choi, Hyundo; Kwak, Ho-Seong; Lim, Yo-An; Kim, Hyung-Joo

    2014-09-01

    This paper introduces a novel surgical robot for single-incision laparoscopic surgeries. The robot system includes the cone-type remote center-of-motion (RCM) mechanism and two articulated instruments having a flexible linkage-driven elbow. The RCM mechanism, which has two revolute joints and one prismatic joint, is designed to maintain a stationary point at the apex of the cone shape. By placing the stationary point on the incision area, the mechanism allows a surgical instrument to explore the abdominal area through a small incision point. The instruments have six articulated joints, including an elbow pitch joint, which make the triangulation position for the surgery possible inside of the abdominal area. The presented elbow pitch structure is similar to the slider-crank mechanism but the connecting rod is composed of a flexible leaf spring for high payload and small looseness error. We verified the payload of the robot is more than 10 N and described preliminary experiments on peg transfer and suture motion by using the proposed surgical robot. PMID:24835120

  12. Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison

    PubMed Central

    Karakousis, Giorgos C.; Singer, Samuel; Zheng, Junting; Gonen, Mithat; Coit, Daniel; DeMatteo, Ronald P.; Strong, Vivian E.

    2016-01-01

    Background Laparoscopic resection of gastric GISTs appears technically feasible and associated with favorable outcomes. Tumor size however frequently plays a role in surgical approach with larger tumors tending towards laparotomy, raising concern that favorable outcomes reported for the laparoscopic approach may reflect this selection bias. Methods From a prospectively collected sarcoma database, 155 primary gastric GIST resections were identified (1998–2009); 40 patients underwent successful laparoscopic resection for non-GE junction GIST and were randomly matched (1:1) by tumor size (+/− 2.0 cm) to patients with open resection. Clinical, pathologic variables and surgical outcomes were associated with surgery type using conditional logistic regression analyses. Results The two surgical approaches were comparable for clinical and pathologic variables. Median operating room (OR) time was similar, although median length of stay post-surgery was lower in the laparoscopic versus open group (4 vs. 7 d, p=0.002), as was estimated blood loss (EBL) (25 vs. 100 mL, p=0.006). There was no operative mortality, and 30 d morbidity was similar. Oncologic outcomes were also similar with no positive microscopic margins, and 1 recurrence in each group with a median follow-up of 34 months. There were 13 conversions overall, 5 secondary to tumor location at the GE junction or lesser curve. Conclusions When matched for tumor size, laparoscopic resection of primary gastric GISTs ≤ 8 cm results in shorter hospital stays with similar OR time while maintaining sound oncologic outcomes compared to open resection. PMID:21207158

  13. Bilateral simultaneous single-port (LESS) laparoscopic nephrectomy (laparoendoscopic single site surgery)

    PubMed Central

    Page, Toby; Soomro, N. A.

    2010-01-01

    Minimal access surgery is rapidly expanding and currently single-port surgery is at the forefront of laparoscopy. Operating through a single port is technically demanding but through advances in camera design and instrument design, it is now gaining popularity. It offers minimal scar surgery as well as decreased postoperative pain and swift recovery. Here we present a case of bilateral simultaneous single-port laparoscopic nephrectomy (LESS) laparoendoscopic single site surgery in a 51-year-old man. Illustrating that LESS can be used by surgeons with laparoscopic skills outside of a few major international centers. PMID:21369399

  14. 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 < 0.001 by Mann-Whitney U test).Our results show that the ELF-MF exposure levels of surgeons in both robotic and 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

  15. 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

  16. Laparoscopic Antireflux Surgery in Patients with Connective Tissue Diseases.

    PubMed

    Menezes, Mariano A; Herbella, Fernando A M; Patti, Marco G

    2016-04-01

    Different connective tissue diseases (CTDs), such as dermatomyositis, mixed CTD, rheumatoid arthritis, polymyositis, lupus, and Behçet's, may affect the esophagus, impairing its motor function. The muscular atrophy and fibrosis caused by the autoimmune vasculitis and neuronal dysfunction affect the esophageal body and the lower esophageal sphincter, leading to a clinical presentation of dysphagia and gastroesophageal reflux disease (GERD). The belief that the impaired esophageal motility may negatively affect surgical outcome has led to the common recommendation of avoiding laparoscopic antireflux surgery (LARS) for fear of creating or worsening dysphagia. This review focuses on the evaluation of the outcome of LARS in patients with CTD. Specifically, this review shows that the literature on LARS and CTDs is scarce and most studies have a small number of patients and a short follow-up. Furthermore, a subanalysis of the outcome based on the type of CTD or the manometric profile is still elusive. In the setting of these limitations, it appears that results are good and comparable to those of patients with GERD and without a CTD. Morbidity and mortality are insignificant even considering the systemic manifestations of the CTD. LARS should not be denied to patients with CTD and GERD. PMID:27027697

  17. The laparoscopic hiatoplasty with antireflux surgery is a safe and effective procedure to repair giant hiatal hernia

    PubMed Central

    2014-01-01

    Background Although minimally invasive repair of giant hiatal hernias is a very surgical challenge which requires advanced laparoscopic learning curve, several reports showed that is a safe and effective procedure, with lower morbidity than open approach. In the present study we show the outcomes of 13 patients who underwent a laparoscopic repair of giant hiatal hernia. Methods A total of 13 patients underwent laparoscopic posterior hiatoplasty and Nissen fundoplication. Follow-up evaluation was done clinically at intervals of 3, 6 and 12 months after surgery using the Gastro-oesophageal Reflux Health-Related Quality of Life scale, a barium swallow study, an upper gastrointestinal endoscopy, an oesophageal manometry, a combined ambulatory 24-h multichannel impedance pH and bilirubin monitoring. Anatomic recurrence was defined as any evidence of gastric herniation above the diaphragmatic edge. Results There were no intraoperative complications and no conversions to open technique. Symptomatic GORD-HQL outcomes demonstrated a statistical significant decrease of mean value equal to 3.2 compare to 37.4 of preoperative assessment (p < 0.0001). Combined 24-h multichannel impedance pH and bilirubin monitoring after 12 months did not show any evidence of pathological acid or non acid reflux. Conclusion All patients were satisfied of procedure and no hernia recurrence was recorded in the study group, treated respecting several crucial surgical principles, e.g., complete sac excision, appropriate crural closure, also with direct hiatal defect where possible, and routine use of antireflux procedure. PMID:24401085

  18. A Systematic Review and Meta-Analysis of Open vs. Laparoscopic Resection of Gastric Gastrointestinal Stromal Tumors.

    PubMed

    Pelletier, Jean-Sebastien; Gill, Richdeep S; Gazala, Sayf; Karmali, Shahzeer

    2015-05-01

    Gastric gastrointestinal stromal tumors (GISTs) are the most common sarcoma of the gastrointestinal tract, and surgical resection is the primary treatment of early disease. Limited data exist concerning laparoscopic resections of these neoplasms. This systematic review was designed to evaluate the literature comparing laparoscopic and open surgical resection of gastric GISTs and to assess the effectiveness and safety of this minimally invasive technique. We performed a systematic search of MEDLINE, the Cochrane Library, PubMed, Embase, Scopus, Web of Science, Google Scholar, the clinical trials database and ProQuest Dissertations and Theses as well as the past 3 years of conference abstracts from the Society of American Gastrointestinal and Endoscopic Surgeons Annual Meetings. Studies comparing the open and the laparoscopic approaches to the resection of gastric GISTs were included in this systematic review. Two reviewers independently performed the screen of titles and abstracts, the full manuscript review, the data extraction and the risk of bias assessment. A quantitative analysis was performed. Of the 189 studies identified, seven studies were included. The laparoscopic approach was associated with a significantly lower length of hospital stay (3.82 days (2.14 - 5.49)). There was no observed difference in operative time, adverse events, estimated blood loss, overall survival and recurrence rates. This study supports that laparoscopic resection is safe and effective for gastric GISTs and is associated with a significantly lower length of hospital stay. Further trials are needed for cost analysis and to rigorously assess oncologic outcomes. PMID:25780475

  19. 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

  20. Umbilical incision laparoscopic surgery with one assist port for an elderly patient with recurrent sigmoid volvulus

    PubMed Central

    Matsuoka, Tasuku; Osawa, Naoshi; Yoh, Taiho; Hirakawa, Kosei

    2012-01-01

    Single-port access laparoscopic surgery has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. Herein, we report the experience of transumbilical incision laparoscopic sigmoidectomy with one assist port in a 71-year-old man who had developed recurrent sigmoid volvulus in these several years since his first visit to the hospital. The patient presented abdominal distension and severe constipation. A plain x-ray film and CT of the abdomen showed grossly distended sigmoid colon loops and stenosis of recto-sigmoid colon. Sigmoid volvulus associated with megacolon was diagnosed and emergence endoscopic decompression was performed. After his condition improved, transumbilical incision laparoscopic sigmoidectomy was carried out as the minimally invasive approach, due to the several risk of patient such as aging and pulmonary disorder. Postoperative course was uneventful and on postoperative visit to the hospital he reported resolution of abdominal distension. PMID:23235104

  1. Umbilical incision laparoscopic surgery with one assist port for an elderly patient with recurrent sigmoid volvulus.

    PubMed

    Matsuoka, Tasuku; Osawa, Naoshi; Yoh, Taiho; Hirakawa, Kosei

    2012-01-01

    Single-port access laparoscopic surgery has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. Herein, we report the experience of transumbilical incision laparoscopic sigmoidectomy with one assist port in a 71-year-old man who had developed recurrent sigmoid volvulus in these several years since his first visit to the hospital. The patient presented abdominal distension and severe constipation. A plain x-ray film and CT of the abdomen showed grossly distended sigmoid colon loops and stenosis of recto-sigmoid colon. Sigmoid volvulus associated with megacolon was diagnosed and emergence endoscopic decompression was performed. After his condition improved, transumbilical incision laparoscopic sigmoidectomy was carried out as the minimally invasive approach, due to the several risk of patient such as aging and pulmonary disorder. Postoperative course was uneventful and on postoperative visit to the hospital he reported resolution of abdominal distension. PMID:23235104

  2. ONE WEEK VERSUS FOUR WEEK HEPARIN PROPHYLAXIS AFTER LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER.

    ClinicalTrials.gov

    2012-04-28

    The Primary Study Objective is to Assess the Efficacy and; Safety of Extended 4-week Heparin Prophylaxis Compared to; Prophylaxis Given for 8±2 Days After Planned Laparoscopic; Surgery for Colorectal Cancer.; The Clinical Benefit Will be Evaluated as the Difference in; the Incidence of VTE or VTE-related Death Occurring Within 30 Days; From Surgery in the Two Study Groups.

  3. First steps of laparoscopic surgery in Lubumbashi: problems encountered and preliminary results.

    PubMed

    Arung, Willy; Dinganga, Nathalie; Ngoie, Emmanuel; Odimba, Etienne; Detry, Olivier

    2015-01-01

    For many reasons, laparoscopic surgery has been performed worldwide. Due to logistical constraints its first steps occurred in Lubumbashi only in 2008. The aim of this presentation was to report authors' ten-month experience of laparoscopic surgery at Lubumbashi Don Bosco Missionary Hospital (LDBMH): problems encountered and preliminary results. The study was a transsectional descriptive work with a convenient sampling. It only took in account patients with abdominal surgical condition who consented to undergo laparoscopic surgery and when logistical constraints of the procedure were found. Independent variables were patients' demographic parameters, staff, equipments and consumable. Dependent parameters included surgical abdominal diseases, intra-operative circumstances and postoperative short term mortality and morbidity. Between 1(st)April 2009 and 28(th) February 2010, 75 patients underwent laparoscopic surgery at the LDBMH making 1.5% of all abdominal surgical activities performed at this institution. The most performed procedure was appendicectomy for acute appendicitis (64%) followed by exploratory laparoscopy for various abdominal chronic pain (9.3%), adhesiolysis for repeated periods of subacute intestinal obstruction in previously laparotomised patients (9.3%), laparoscopic cholecystectomy for post acute cholecystitis on gall stone (5.3%) and partial colectomy for symptomatic redundant sigmoid colon (2.7%). There were 4% of conversion to laparotomy. Laparoscopic surgery consumed more time than laparotomy, mostly when dealing with appendicitis. However, postoperatively, patients did quite well. There was no death in this series. Nursing care was minimal with early discharge. These results are encouraging to pursue laparoscopic surgery with DRC Government and NGO's supports. PMID:26448805

  4. First steps of laparoscopic surgery in Lubumbashi: problems encountered and preliminary results

    PubMed Central

    Arung, Willy; Dinganga, Nathalie; Ngoie, Emmanuel; Odimba, Etienne; Detry, Olivier

    2015-01-01

    For many reasons, laparoscopic surgery has been performed worldwide. Due to logistical constraints its first steps occurred in Lubumbashi only in 2008. The aim of this presentation was to report authors’ ten-month experience of laparoscopic surgery at Lubumbashi Don Bosco Missionary Hospital (LDBMH): problems encountered and preliminary results. The study was a transsectional descriptive work with a convenient sampling. It only took in account patients with abdominal surgical condition who consented to undergo laparoscopic surgery and when logistical constraints of the procedure were found. Independent variables were patients’ demographic parameters, staff, equipments and consumable. Dependent parameters included surgical abdominal diseases, intra-operative circumstances and postoperative short term mortality and morbidity. Between 1stApril 2009 and 28th February 2010, 75 patients underwent laparoscopic surgery at the LDBMH making 1.5% of all abdominal surgical activities performed at this institution. The most performed procedure was appendicectomy for acute appendicitis (64%) followed by exploratory laparoscopy for various abdominal chronic pain (9.3%), adhesiolysis for repeated periods of subacute intestinal obstruction in previously laparotomised patients (9.3%), laparoscopic cholecystectomy for post acute cholecystitis on gall stone (5.3%) and partial colectomy for symptomatic redundant sigmoid colon (2.7%). There were 4% of conversion to laparotomy. Laparoscopic surgery consumed more time than laparotomy, mostly when dealing with appendicitis. However, postoperatively, patients did quite well. There was no death in this series. Nursing care was minimal with early discharge. These results are encouraging to pursue laparoscopic surgery with DRC Government and NGO's supports. PMID:26448805

  5. Diode laser supported partial nephrectomy in laparoscopic surgery: preliminary results

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Hennig, Georg; Zillinberg, Katja; Khoder, Wael Y.

    2011-07-01

    Introduction: Warm ischemia and bleeding during laparoscopic partial nephrectomy place technical constraints on surgeons. Therefore it was the aim to develop a safe and effective laser assisted partial nephrectomy technique without need for ischemia. Patients and methods: A diode laser emitting light at 1318nm in cw mode was coupled into a bare fibre (core diameter 600 μm) thus able to transfer up to 100W to the tissue. After dry lab experience, a total of 8 patients suffering from kidney malformations underwent laparoscopic/retroperitoneoscopic partial nephrectomy. Clinically, postoperative renal function and serum c-reactive protein (CRP) were monitored. Laser induced coagulation depth and effects on resection margins were evaluated. Demographic, clinical and follow-up data are presented. Results: Overall interventions, the mean operative time was 116,5 minutes (range 60-175min) with mean blood loss of 238ml (range 50-600ml) while laser assisted resection of the kidney tissue took max 15min. After extirpation of the tumours all patients showed clinical favourable outcome during follow up period. The tumour size was measured to be 1.8 to 5cm. With respect to clinical safety and due to blood loos, two warm ischemia (19 and 24min) must be performed. Immediate postoperative serum creatinine and CRP were elevated within 0.1 to 0.6 mg/dl (mean 0.18 mg/dl) and 2.1-10 mg/dl (mean 6.24 mg/dl), respectively. The depth of the coagulation on the removed tissue ranged between <1 to 2mm without effect on histopathological evaluation of tumours or resection margin. As the surface of the remaining kidney surface was laser assisted coagulated after removal. The sealing of the surface was induced by a slightly larger coagulation margin, but could not measured so far. Conclusion: This prospective in-vivo feasibility study shows that 1318nm-diode laser assisted partial nephrectomy seems to be a safe and promising medical technique which could be provided either during open surgery

  6. Laparoscopic and robot-assisted surgery in the management of urinary lithiasis

    PubMed Central

    Ganpule, Arvind P.; Prashant, Jain; Desai, Mahesh R.

    2012-01-01

    Objectives To review the current role of laparoscopy and robot-assisted laparoscopy for managing urinary lithiasis. Results The contemporary indications for laparoscopic stone management are: anatomical variations in location or shape of the kidney (pelvic kidney, horseshoe kidney and malrotated kidney); coexisting pathologies, e.g. pelvi-ureteric junction obstruction; and stones in a renal unit with lower ureteric obstruction. The laparoscopic approach allows the simultaneous management of both the pathologies. Symptomatic stones in diverticula not amenable to endourological intervention can be treated with laparoscopy. Large impacted pelvic and ureteric calculi with a functioning renal unit are an indication for laparoscopic ureterolithotomy or pyelolithotomy. This review of current reports suggests that in a selected group of patients with complex stone disease the laparoscopic approach offers good success rates with minimal complications. There are few reports of robotic procedures in stone disease but existing data suggest that it is feasible. Conclusion Laparoscopic surgery is effective for complex renal stones and offers excellent stone clearance rates with minimal morbidity. Laparoscopic surgery is complementary in managing these stones. Robot-assisted laparoscopic technique of urinary tract stone management is in its early stage of implementation and randomised trials that compare robot assisted outcomes with other minimally invasive techniques are needed. PMID:26558002

  7. Robotic surgery

    MedlinePlus

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  8. Transmural gastric migration of dual-sided PTFE/ePTFEE mesh after laparoscopic surgery for a recurrent hiatal hernia with dysphagia: case report.

    PubMed

    Acin-Gandara, D; Miliani-Molina, C; Carneros-Martin, Ja; Martinez-Pineiro, J; Vega, M De; Pereira-Perez, F

    2014-01-01

    Several series have shown that laparoscopic fundoplication is feasible and safe for the treatment of hiatal hernia, although a high recurrence rate of 42% has been published. The use of mesh repair in these hernias has shown fewer recurrences than primary suture with small number of complications reported.Some of these are severe fibrosis within the hiatus, mesh erosion of the intestinal wall, esophageal strictures, mesh migration into the upper gastrointestinal tract and esophageal perforations. We present a case with late erosion and complete transmural gastric migration of the mesh after surgery. In these cases, the patients may require complex surgical intervention.That was not the case in our patient, who did not require further surgery because the mesh migrated completely. It is therefore advisable to use a mesh very selectively for the laparoscopic repair of hiatal hernias, taking into account the surgeon's experience, the anatomy of the hiatus and the symptoms of the patient. PMID:25149620

  9. Hand-Assisted Laparoscopic Surgery (HALS) With the HandPort System

    PubMed Central

    Litwin, Demetrius E. M.; Darzi, Ara; Jakimowicz, Jacek; Kelly, John J.; Arvidsson, Dag; Hansen, Paul; Callery, Mark P.; Denis, Ronald; Fowler, Dennis L.; Medich, David S.; O’Reilly, Michael J.; Atlas, Henry; Himpens, Jacques M.; Swanstrom, Lee L.; Arous, Elias J.; Pattyn, Piet; Yood, Steven M.; Ricciardi, Rocco; Sandor, Andras; Meyers, William C.

    2000-01-01

    Objective To evaluate the feasibility and potential benefits of hand-assisted laparoscopic surgery with the HandPort System, a new device. Summary Background Data In hand-assisted laparoscopic surgery, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic cases. Methods A prospective nonrandomized study was initiated with the participation of 10 laparoscopic surgical centers. Surgeons were free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. Results Sixty-eight patients were entered in the study. Operations included colorectal procedures (sigmoidectomy, right colectomy, resection rectopexy), splenectomy for splenomegaly, living-related donor nephrectomy, gastric banding for morbid obesity, partial gastrectomy, and various other procedures. Mean incision size for the HandPort was 7.4 cm. Most surgeons (78%) preferred to insert their nondominant hand into the abdomen. Pneumoperitoneum was generally maintained at 14 mmHg, and only one patient required conversion to open surgery as a result of an unmanageable air leak. Hand fatigue during surgery was noted in 20.6%. Conclusions The hand-assisted technique appeared to be useful in minimally invasive colorectal surgery, splenectomy for splenomegaly, living-related donor nephrectomy, and procedures considered too complex for a laparoscopic approach. This approach provides excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. Although the data presented here reflect the authors’ initial experience, they compare favorably with series of similar procedures performed purely laparoscopically. PMID:10767793

  10. Annual repeat rates of laparoscopic surgery: a marker of practice variation.

    PubMed

    Jarrell, John

    2010-01-01

    Use of laparoscopy is an area of interest owing to a previous report of significant numbers of repeat laparoscopic surgery in some women in Alberta, Canada. It was hypothesized that analyzing individual-woman rates of annual repeat procedures documents potential overuse of laparoscopic surgery. Administrative data concerning yearly individual specific laparoscopy experiences were obtained from Alberta Health and Wellness for the years 1996 to 2007. Rates of repeat diagnostic and operative laparoscopic procedures were determined for each fiscal year and analyzed using statistical process control methods. The rate of reoperation for an individual woman for both procedures has "special causes" of variation. Rates of reoperation within the fiscal year varied significantly. The reasons could include operating room access, initial clinical enthusiasm for new surgery, changing surgical skills, and changing processes in decision making. The presence of such variation will require policy initiatives to address high rates of annual repeat procedures. PMID:20833984

  11. Review of 500 single incision laparoscopic colorectal surgery cases - Lessons learned

    PubMed Central

    Keller, Deborah S; Flores-Gonzalez, Juan R; Ibarra, Sergio; Haas, Eric M

    2016-01-01

    Single incision laparoscopic surgery (SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery. PMID:26811615

  12. Laparoscopic surgery and polycystic liver disease: Clinicopathological features and new trends in management

    PubMed Central

    Martinez-Perez, Aleix; Alberola-Soler, Antonio; Domingo-del Pozo, Carlos; Pemartin-Comella, Beatriz; Martinez-Lopez, Elias; Vazquez-Tarragon, Antonio

    2016-01-01

    BACKGROUND: Polycystic liver disease (PLD) has a low frequency overall in the worldwide population. As the patient's symptoms are produced by the expansion of hepatic volume, the different therapeutic alternatives are focused on reducing it. Surgery is still considered the most effective treatment for symptomatic PLD. The aim of this study was to evaluate the long-term outcomes of laparoscopic surgery for PLD. MATERIALS AND METHODS: This study included 14 patients who were diagnosed with symptomatic PLD and underwent surgery by a laparoscopic approach between 2004 and 2012. It involved collecting data on the characteristics of those patients and their liver disease, surgical procedures, intra- and postoperative complications, and the long-term follow-up. RESULTS: Twelve laparoscopic multiple-cyst fenestrations and two segmentary liver resections associated with remaining-cyst fenestration were performed. One procedure required conversion to laparotomy and the other was complicated by anhepatic severe bleeding. The rest of the procedures were uneventful. One patient developed persistent self-limited ascites in the immediate postoperative period. Symptoms disappeared after surgical intervention in all patients. During a median follow-up of 62 months (range 14-113 months), there were two clinical recurrences and one asymptomatic radiological recurrence. One patient required further surgery. CONCLUSION: Laparoscopic cystic fenestration and laparoscopic liver resection are safe and long-term, effective procedures for the treatment of symptomatic PLD. Severity and morphological characteristics of the hepatic disease will determine the surgical indication and the optimal approach for each patient. PMID:27279400

  13. [Laparoscopic surgery of colon cancer. State of art and literature review].

    PubMed

    Bianchi, Paolo P; Ceriani, Chiara; Montorsi, Marco

    2006-01-01

    Over the past decade advances in laparoscopic surgery have revolutionized the surgical approach to many diseases. Although the first case series on laparoscopic segmental colectomy in patient with sigmoid cancer was described in 1991, this technique has not been readily accepted. Despite reduced morbidity and improved convalescence after laparoscopic surgery for benign disorders, surgeons have been sceptical about similar advantages of laparoscopic colectomy for cancer. The safety of the procedure has been questioned because of early reports of port-site metastases and there has been uncertainty about whether minimally invasive surgery for colonic malignancies would achieve adequate oncologic resection. Open surgical resection of the primary tumor, until just recently, has been widely considered the most effective treatment of colon cancer. The adherence to the principles of complete abdominal exploration, high ligation of mesenteric vessels, lymphnodal clearance and adequate bowel resection margins is essential. Several randomized trials were initiated in the early 1990s to compare the short- and long-term outcomes of patients undergoing minimally invasive and conventional open surgery for colon cancer. Today the results of this large multiinstitutional randomized trials have been reported. This review examines recent data from randomized, controlled trials and meta-analysis, that report the short- and long-term outcomes after laparoscopic colectomy for cancer. PMID:17139955

  14. Three-dimensional computed tomography in laparoscopic surgery for colorectal carcinoma

    PubMed Central

    Ohtani, Hiroshi; Ohta, Kohei; Arimoto, Yuichi; Kim, Eui-Chul; Oba, Hiroko; Adachi, Kenji; Terakawa, Shoichi; Tsubakimoto, Mitsuo

    2005-01-01

    AIM: To evaluate the usefulness of three-dimensional computed tomography (3DCT) in laparoscopic surgery for colorectal carcinoma. METHODS: Seventy-two patients with colorectal cancer who underwent curative operation at our hospital were enrolled in this study. They were classified into two groups by operative procedures. Sixteen patients underwent laparoscopic surgery, laparoscopic group (LG), while 56 patients underwent conventional open surgery, open group (OG). At our institution, contrast-enhanced CT is routinely performed as part of intra-abdominal screening and the 3D images of the major regional vessels are described. We have previously described about the preoperative visualization of the inferior mesenteric artery (IMA) by 3DCT. This time we newly acquired 3D images of the superior mesenteric artery (SMA)/superior mesenteric vein (SMV), ileocecal artery (ICA), middle colic artery (MCA), and inferior mesenteric vein (IMV). We have compared our two study groups with regard to five items, including clinical anastomotic leakage. We have discussed here the role of 3DCT in laparoscopic surgery for colorectal carcinoma. RESULTS: The mean length of the incision in LG was 4.625±0.89 cm, which was significantly shorter than that in OG (P<0.001). The association between ICA and SMV and SMA was described in the right-sided colectomy. The preoperative imaging of IMA and IMV was created in the rectosigmoidectomy. There was no significant difference in anastomotic leakage between the two groups, but no patients in LG experienced anastomotic leakage. CONCLUSION: Most of the patients are satisfied with the shorter incisional length following laparoscopic surgery. Preoperative visualization of the major regional vessels may be helpful for the secure treatment of the anastomosis in laparoscopic surgery for colorectal carcinoma. PMID:16437595

  15. Current Status of Robot-Assisted Laparoscopic Surgery in Pediatric Urology

    PubMed Central

    Song, Sang Hoon

    2014-01-01

    Laparoscopic procedures for urological diseases in children have been proven to be safe and effective. However, the availability of laparoscopic procedures is still partly limited to experienced, high-volume centers because the procedures are technically demanding. The da Vinci robot system is being used for an increasing variety of reconstructive procedures because of the advantages of this approach, such as motion scaling, greater optical magnification, stereoscopic vision, increased instrument tip dexterity, and tremor filtration. Particularly in pediatric urologic surgery, where the operational field is limited owing to the small abdominal cavity of children, robotic surgical technology has its own strengths. Currently, robots are used to perform most surgeries in children that can be performed laparoscopically. In this review, we aimed to provide a comprehensive overview of the current role of robot-assisted laparoscopic surgery in Pediatric Urology by analyzing the published data in this field. A growing body of evidence supports the view that robotic technology is technically feasible and safe in pediatric urological surgery. Robotic technology provides additional benefits for performing reconstructive urologic surgery, such as in pyeloplasty, ureteral reimplantation, and enterocystoplasty procedures. The main limitations to robotic surgery are its high purchase and maintenance costs and that the cost-effectiveness of this technology remains to be validated. PMID:25132942

  16. Current status of robot-assisted laparoscopic surgery in pediatric urology.

    PubMed

    Song, Sang Hoon; Kim, Kun Suk

    2014-08-01

    Laparoscopic procedures for urological diseases in children have been proven to be safe and effective. However, the availability of laparoscopic procedures is still partly limited to experienced, high-volume centers because the procedures are technically demanding. The da Vinci robot system is being used for an increasing variety of reconstructive procedures because of the advantages of this approach, such as motion scaling, greater optical magnification, stereoscopic vision, increased instrument tip dexterity, and tremor filtration. Particularly in pediatric urologic surgery, where the operational field is limited owing to the small abdominal cavity of children, robotic surgical technology has its own strengths. Currently, robots are used to perform most surgeries in children that can be performed laparoscopically. In this review, we aimed to provide a comprehensive overview of the current role of robot-assisted laparoscopic surgery in Pediatric Urology by analyzing the published data in this field. A growing body of evidence supports the view that robotic technology is technically feasible and safe in pediatric urological surgery. Robotic technology provides additional benefits for performing reconstructive urologic surgery, such as in pyeloplasty, ureteral reimplantation, and enterocystoplasty procedures. The main limitations to robotic surgery are its high purchase and maintenance costs and that the cost-effectiveness of this technology remains to be validated. PMID:25132942

  17. The Laparosound{trade mark, serif}-an ultrasonic morcellator for use in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Malinowski, Igor; Łobodzinski, Suave S.; Paśniczek, Roman

    2012-05-01

    The laparoscopic surgery has gained presence in the operating room in cases where it is feasible to spare patient trauma and minimize the hospital stay. One unique challenge in laparoscopic/endoscopic surgery is operating and removing tissue volume through keyhole - trocar. The removal of tissues by fragmentation is generally termed morcellation. We proposed a new method for soft tissue morcellation using laparoscopy. A unique ultrasonic laparoscopic surgical device, termed Laparosound{trade mark, serif}, utilizing laparoscopic high amplitude ultrasonic waveguides, operating in edge mode, has been developed that uses the principle of ultrasonic cavitation phenomenon for excision and morcellation of a variety of tissue types. The local ultrasonic acoustic intensity at the distal waveguide tip is sufficiently high that the liquefaction of moist tissue occurs. The mechanism of tissue morcellation is deemed to be cavitation based, therefore is dependant on water content in tissue, and thus its effectiveness depends on tissue type. This results in ultrasound being efficient in moist tissue and sparing dry, collagen rich blood vessels and thus minimizes bleeding. The applications of such device in particular, commonly encountered, could lay in general and ob/gyn laparoscopic surgery, whereas other applications could emerge. The design of power ultrasonic instruments for mass clinical applications poses however unique challenges, such as ability to design and build ultrasonic resonators that last in conditions of ultrasonic fatigue. These highly non-linear devices, whose behavior is hard to predict, have become the challenge of the author of the present paper. The object of work is to design and build an operating device capable of ultrasonic soft tissue morcellation in laparoscopic surgery. This includes heavy computational ultrasonics verified by testing and manufacturing feasibility using titanium biomedical alloys. The prototype Laparosound{trade mark, serif} device

  18. Outcomes After Kidney injury in Surgery (OAKS): protocol for a multicentre, observational cohort study of acute kidney injury following major gastrointestinal and liver surgery

    PubMed Central

    2016-01-01

    Introduction Acute kidney injury (AKI) is associated with increased morbidity and mortality following cardiac surgery. Data focusing on the patterns of AKI following major gastrointestinal surgery could inform quality improvement projects and clinical trials, but there is a lack of reliable evidence. This multicentre study aims to determine the incidence and impact of AKI following major gastrointestinal and liver surgery. Methods and analysis This prospective, collaborative, multicentre cohort study will include consecutive adults undergoing gastrointestinal resection, liver resection or reversal of ileostomy or colostomy. Open and laparoscopic procedures in elective and emergency patients will be included in the study. The primary end point will be the incidence of AKI within 7 days of surgery, identified using an adaptation of the National Algorithm for Detecting Acute Kidney Injury, which is based on the Kidney Disease Improving Global Outcomes (KDIGO) AKI guidelines. Secondary outcomes will include persistent renal dysfunction at discharge and 1 year postoperatively. The 30-day adverse event rate will be measured using the Clavien-Dindo scale. Data on factors that may predispose to the development of AKI will be collected to identify variables associated with AKI. Based on our previous collaborative studies, a minimum of 114 centres are expected to be recruited, contributing over 6500 patients in total. Ethics and dissemination This study will be registered as clinical audit at each participating hospital. The protocol will be disseminated through local and national medical student networks in the UK and Ireland. PMID:26769786

  19. Laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery for adnexal preservation: a randomized controlled study

    PubMed Central

    Cho, Yeon Jean; Kim, Mi-La; Lee, Soo Yoon; Lee, Hee Suk; Kim, Joo Myoung; Joo, Kwan Young

    2012-01-01

    Objective To compare the operative outcomes, postoperative pain, and subsequent convalescence after laparoendoscopic single-site surgery (LESS) or conventional laparoscopic surgery for adnexal preservation. Study design From December 2009 to September 2010, 63 patients underwent LESS (n = 33) or a conventional laparoscopic surgery (n = 30) for cyst enucleation. The overall operative outcomes including postoperative pain measurement using the visual analog scale (VAS) were evaluated (time points 6, 24, and 24 hours). The convalescence data included data obtained from questionnaires on the need for analgesics and on patient-reported time to recovery end points. Results The preoperative characteristics did not significantly differ between the two groups. The postoperative hemoglobin drop was higher in the LESS group than in the conventional laparoscopic surgery group (P = 0.048). Postoperative pain at each VAS time point, oral analgesic requirement, intramuscular analgesic requirement, and the number of days until return to work were similar in both groups. Conclusion In adnexa-preserving surgery performed in reproductive-age women, the operative outcomes, including satisfaction of the patients and convalescence after surgery, are comparable for LESS and conventional laparoscopy. LESS may be a feasible and a promising alternative method for scarless abdominal surgery in the treatment of young women with adnexal cysts PMID:22448110

  20. Fast-track program in laparoscopic liver surgery: Theory or fact?

    PubMed Central

    Sánchez-Pérez, Belinda; Aranda-Narváez, José Manuel; Suárez-Muñoz, Miguel Angel; elAdel-delFresno, Moises; Fernández-Aguilar, José Luis; Pérez-Daga, Jose Antonio; Pulido-Roa, Ysabel; Santoyo-Santoyo, Julio

    2012-01-01

    AIM: To analyze our results after the introduction of a fast-track (FT) program after laparoscopic liver surgery in our Hepatobiliarypancreatic Unit. METHODS: All patients (43) undergoing laparoscopic liver surgery between March 2004 and March 2010 were included and divided into two consecutive groups: Control group (CG) from March 2004 until December 2006 with traditional perioperative cares (17 patients) and fast-track group (FTG) from January 2007 until March 2010 with FT program cares (26 patients). Primary endpoint was the influence of the program on the postoperative stay, the amount of re-admissions, morbidity and mortality. Secondarily we considered duration of surgery, use of drains, conversion to open surgery, intensive cares needs and transfusion. RESULTS: Both groups were homogeneous in age and sex. No differences in technique, time of surgery or conversion to open surgery were found, but more malignant diseases were operated in the FTG, and then transfusions were higher in FTG. Readmissions and morbidity were similar in both groups, without mortality. Postoperative stay was similar, with a median of 3 for CG vs 2.5 for FTG. However, the 80.8% of patients from FTG left the hospital within the first 3 d after surgery (58.8% for CG). CONCLUSION: The introduction of a FT program after laparoscopic liver surgery improves the recovery of patients without increasing complications or re-admissions, which leads to a reduction of the stay and costs. PMID:23493957

  1. Single incision laparoscopic surgery approach for obscure small intestine bleeding localized by CT guided percutaneous injection of methylene blue

    PubMed Central

    Martinez, Juan Carlos; Thomas, Jamie L.; Lukaszczyk, John J.

    2014-01-01

    INTRODUCTION Traditionally, localization of small intestine sources of obscure gastrointestinal bleeding has been a challenge. Advances in the field of endoscopy with the introduction of capsule endoscopy and radiographic imaging with computed tomography angiography and visceral angiography have facilitated more accurate visualization of the small intestine. If a bleeding lesion is identified on angiography and surgery is indicated, the use of methylene blue for enteric mapping is very effective to aid intraoperative localization of the culprit. However, when this is not an option, more invasive surgical techniques are required. PRESENTATION OF CASE We present a new technique used in a patient with angiodysplasia of the small intestine, in where preoperative localization was done using percutaneous computed tomography (CT) guided injection of methylene blue dye. This allowed us to perform a single incision laparoscopic small intestine resection of the culprit. PMID:25460480

  2. Overview of single-port laparoscopic surgery for colorectal cancers: past, present, and the future.

    PubMed

    Kim, Say-June; Choi, Byung-Jo; Lee, Sang Chul

    2014-01-28

    Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilization of a camera without a separate external light, and instruments with different lengths has brought the favorable environment for SPLS. However, performing SPLS still creates several hardships compared to multiport laparoscopic surgery; a single-port system inevitably leads to clashing of surgical instruments due to crowding. To overcome such difficulties, investigators has developed novel concepts and maneuvers, including the concept of inverse triangulation and the maneuvers of pivoting, spreading out dissection, hanging suture, and transluminal traction. The final destination of SPLS is expected to be a completely seamless operation, maximizing the minimal invasiveness. Specimen extraction through the umbilicus can undermine cosmesis by inducing a larger incision. Therefore, hybrid laparoscopic technique, which combined laparoscopic surgical technique with natural orifice specimen extraction (NOSE)--i.e., transvaginal or transanal route-, has been developed. SPLS and NOSE seemed to be the best combination in pursuit of minimal invasiveness. In the near future, robotic SPLS with natural orifice transluminal endoscopic surgery's way of specimen extraction seems to be pursued. It is expected to provide a completely or nearly complete seamless operation regardless of location of the lesion in the abdomen. PMID:24574772

  3. [A Case of Extrahepatic Hepatocellular Cancer Discovered during Gynecological Laparoscopic Surgery].

    PubMed

    Koga, Chikato; Murakami, Masayuki; Shimizu, Junzo; Yasuyama, Akinobu; Hitora, Toshiki; Oda, Naofumi; Kawabata, Ryohei; Hirota, Masaki; Yoshikawa, Masato; Morishima, Hirotaka; Ikenaga, Masakazu; Matsunami, Nobuki; Miwa, Hideaki; Hasegawa, Junichi

    2015-11-01

    Recently, laparoscopic surgery has become increasingly popular because of its lesser invasiveness, including smaller incisions, and fewer post-operative complications. It is also possible to observe the abdominal cavity by laparoscopy. We report a hepatocellular carcinoma arising in an accessory liver lobe detected during gynecological laparoscopic surgery. A 48-year-old woman who was undergoing laparoscopic hysterectomy for uterine fibroids was found to have a protruding, extrahepatic pedunculated tumor by intraoperative observation of the abdominal cavity during the fibroid procedure. We suspected FNH based on preoperative imaging findings, including abdominal ultrasound, computed tomographic scanning, and magnetic resonance imaging. We performed a laparoscopic partial hepatectomy. The cut surface of the tumor was similar to normal liver tissue. The pathological findings identified normal liver tissue and vessels, suggesting it was the accessory liver lobe. It also included a well-differentiated hepatocellular carcinoma. The final diagnosis was hepatocellular carcinoma arising in the accessory liver lobe. There have been no prior reports of extrahepatic liver tissue detected during gynecological surgery. This case reminded us of the importance of intra-abdominal observation during laparoscopic procedures. The opportunities to discover other cases of extrahepatic liver tissue by laparoscopy will increase. PMID:26805199

  4. The Role of Laparoscopic Surgery in the Management of Children and Adolescents With Inflammatory Bowel Disease

    PubMed Central

    Page, Anna E.; Sashittal, Shikha G.; Chatzizacharias, Nikolaos A.; Davies, R. Justin

    2015-01-01

    Abstract Although laparoscopic surgery is readily used in the management of inflammatory bowel disease (IBD) in adults, its role in the surgical treatment of IBD in the pediatric population is not well established. The aim of this narrative review was to analyze the published evidence comparing laparoscopic and open resection in the management of children and adolescents with IBD. The Pubmed and Embase databases were searched using the terms “inflammatory bowel disease,” “children,” “adolescents,” “laparoscopic,” and “colectomy.” The review identified 10 appropriate studies. Even though laparoscopic surgery generally resulted in longer operating times (between a mean of 40 and 140 min), benefits included reduced postoperative pain (mean duration of opiate use 3 vs 6 days) and reduced length of stay (median length of stay 5–8 vs 10.5–19 days) compared with open surgery. Postoperative complication rates were similar following both approaches. Due to the limited available data and the small sample size of the published series, definite recommendations are not able to be drawn. Nevertheless, current evidence indicates that laparoscopic colorectal resection is safe and feasible in the management of IBD in the paediatric population, with reductions in postoperative pain and length of hospital stay achievable. PMID:26020394

  5. Obese patients have similar short-term outcomes to non-obese in laparoscopic colorectal surgery

    PubMed Central

    Chand, Manish; De’Ath, Henry D; Siddiqui, Muhammed; Mehta, Chetanya; Rasheed, Shahnawaz; Bromilow, James; Qureshi, Tahseen

    2015-01-01

    AIM: To determine whether obese patients undergoing laparoscopic surgery within an enhanced recovery program had worse short-term outcomes. METHODS: A prospective study of consecutive patients undergoing laparoscopic colorectal resection was carried out between 2008 and 2011 in a single institution. Patients were divided in groups based on body mass index (BMI). Short-term outcomes including operative data, length of stay, complications and readmission rates were recorded and compared between the groups. Continuous data were analysed using t-test or one-way Analysis of Variance. χ2 test was used to compare categorical data. RESULTS: Two hundred and fifty four patients were included over the study period. The majority of individuals (41.7%) recruited were of a healthy weight (BMI < 25), whilst 50 patients were classified as obese (19.6%). Patients were matched in terms of the presence of co-morbidities and previous abdominal surgery. Obese patients were found to have a statistically significant difference in The American Society of Anesthesiologists grade. Length of surgery and intra-operative blood loss were no different according to BMI. CONCLUSION: Obesity (BMI > 25) does not lead to worse short-term outcomes in laparoscopic colorectal surgery and therefore such patients should not be precluded from laparoscopic surgery. PMID:26527560

  6. Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour

    PubMed Central

    Wachter, Nicolas; Wörns, Marcus-Alexander; dos Santos, Daniel Pinto; Lang, Hauke; Huber, Tobias; Kneist, Werner

    2016-01-01

    Gastrointestinal stromal tumours (GISTs) are rarely found in the rectum. Large rectal GISTs in the narrow pelvis sometimes require extended abdominal surgery to obtain free resection margins, and it is a challenge to preserve sufficient anal sphincter and urogenital function. Here we present a 56-year-old male with a locally advanced juxta-anal non-metastatic GIST of approximately 10 cm in diameter. Therapy with imatinib reduced the tumour size and allowed partial intersphincteric resection (pISR). The patient underwent an electrophysiology-controlled nerve-sparing hybrid of laparoscopic and transanal minimally invasive surgery (TAMIS) in a multimodal setting. The down-to-up approach provided sufficient dissection plane visualisation and allowed the confirmed nerve-sparing. Lateroterminal coloanal anastomosis was performed. Follow-up showed preserved urogenital function and good anorectal function, and the patient remains disease-free under adjuvant chemotherapy as of 12 months after surgery. This report suggests that the TAMIS approach enables extraluminal high-quality oncological and function-preserving excision of high-risk GISTs. PMID:27279406

  7. [A case of esophageal cancer with sigmoid colon tumor treated by laparoscopic surgery].

    PubMed

    Arita, Tomohiro; Shiozaki, Atsushi; Fujiwara, Hitoshi; Kokuba, Yukihito; Kuriu, Yoshiaki; Kubota, Takeshi; Ichikawa, Daisuke; Okamoto, Kazuma; Ishii, Hiromichi; Ikoma, Hisashi; Nakanishi, Masayoshi; Ochiai, Toshiya; Sakakura, Chohei; Sonoyama, Teruhisa; Otsuji, Eigo

    2010-11-01

    We performed a subtotal esophagectomy with gastric tube reconstruction by hand assisted laparoscopic surgery and laparoscopic sigmoidectomy simultaneously for the patient with middle thoracic esophageal cancer and lateral spreading tumor in the sigmoid colon. Upper abdominal and transumbilical incisions were made and Lap Discs (regular, mini) were set respectively. Two 12 mm ports were inserted in the right flank and lower quadrant, and two 5 mm ports were inserted in the left flank and lower quadrant. First, by using video-scope from upper Lap Disc, laparoscopic sigmoidectomy was performed. Anastomosis was performed via lower Lap Disc. For the gastric tube reconstruction, upper Lap Disc was used for hand assistance, and video-scope was inserted from lower Lap Disc. The patient was discharged at 26 days after surgery without complications. In conclusion, our surgical procedure provided a good surgical view and decreased a surgical stress. PMID:21224582

  8. Laparoscopic versus Open Surgery for Colorectal Cancer: A Retrospective Analysis of 163 Patients in a Single Institution

    PubMed Central

    Bedirli, Abdulkadir; Salman, Bulent; Yuksel, Osman

    2014-01-01

    Background. The present study aimed to compare the clinical outcomes of laparoscopic versus open surgery for colorectal cancers. Materials and Methods. The medical records from a total of 163 patients who underwent surgery for colorectal cancers were retrospectively analyzed. Patient's demographic data, operative details and postoperative early outcomes, outpatient follow-up, pathologic results, and stages of the cancer were reviewed from the database. Results. The patients who underwent laparoscopic surgery showed significant advantages due to the minimally invasive nature of the surgery compared with those who underwent open surgery, namely, less blood loss, faster postoperative recovery, and shorter postoperative hospital stay (P < 0.05). However, laparoscopic surgery for colorectal cancer resulted in a longer operative time compared with open surgery (P < 0.05). There were no statistically significant differences between groups for medical complications (P > 0.05). Open surgery resulted in more incisional infections and postoperative ileus compared with laparoscopic surgery (P < 0.05). There were no differences in the pathologic parameters between two groups (P < 0.05). Conclusions. These findings indicated that laparoscopic surgery for colorectal cancer had the clear advantages of a minimally invasive surgery and relative disadvantage with longer surgery time and exhibited similar pathologic parameters compared with open surgery. PMID:25506425

  9. Retroperitoneal Laparoendoscopic Single-Site Ureterolithotomy: A Comparison with Conventional Laparoscopic Surgery

    PubMed Central

    Liu, Xiaopeng; Huang, Huaiqiu; Wu, Jieying; Huang, Wentao; Cai, Songwang; Li, Xiaojuan; Ye, Chunwei; Zhu, Baoyi; Cai, Yi; Gao, Xin

    2012-01-01

    Abstract Background and Purpose Laparoendoscopic single-site (LESS) surgery through the retroperitoneal approach has been seldom reported. We aimed to compare the feasibility and outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large, impacted ureteral stones. Patients and Methods From June 2010 to May 2011, LESS ureterolithotomy through the retroperitoneal approach was performed in 10 patients (the LESS group). Another 15 patients who underwent conventional retroperitoneal laparoscopic ureterolithotomy (the conventional laparoscopic group) by the same surgeon were involved and compared. The operative time, complications, and surgical outcomes were evaluated. Results All the operations were completed successfully, without conversion to conventional laparoscopic or open surgeries. The operative time of the LESS group and of the conventional laparoscopic group were 132.7±16.3 and 128.1±20.1 minutes, respectively (P=0.782). The estimated blood loss were 30.7±5.9 vs 28.0±4.5 mL (P=0.620). Duration of analgesia postoperatively was 2.0±0.8 vs 3.5±0.5 days (P=0.005). All targeted stones were successfully extracted without major complications. Postoperative urine leakage was noted in one patient in each group. Cosmetic results were superior in the LESS group according to both the study nurse's and the patients' assessments (8.5 vs 5.3; P=0.012, and 8.3 vs 5.6; P=0.025, respectively). All patients showed no obstructions or stricture formations on postoperative follow-up. Conclusions In experienced hands, LESS for ureterolithotomy through the retroperitoneal approach is feasible and can acquire outcomes equal to those of conventional multiport laparoscopic surgery. Prospective long-term follow-up studies with a larger number of patients are needed to further evaluate its benefits. PMID:22103789

  10. Laparoscopic Surgery for Acute Appendicitis in Children With Cancer

    PubMed Central

    Singer, Julia; Stringel, Gustavo; Ozkaynak, Mehmet Fevzi; McBride, Whitney; Pandya, Samir

    2015-01-01

    Introduction: Abdominal pain during cancer chemotherapy may be caused by medical or surgical conditions. A retrospective review of 5 children with cancer who had appendicitis while receiving chemotherapy was performed. Case Descriptions: Three had acute lymphoblastic leukemia, and 1 each had T-cell lymphoblastic lymphoma and rhabdomyosarcoma. Two of the patients had a Pediatric Appendectomy Score of 6, and 1 each had a score of 7, 5, and 2. All had evidence of appendicitis on computed tomography. Laparoscopic appendectomy was performed without any perioperative complication. Discussion: Appendicitis is an important diagnosis in children with cancer, and laparoscopic appendectomy is safe and the procedure of choice. PMID:26390529

  11. Single-port access laparoscopic hysterectomy: a new dimension of minimally invasive surgery.

    PubMed

    Liliana, Mereu; Alessandro, Pontis; Giada, Carri; Luca, Mencaglia

    2011-01-01

    The fundamental idea is to have all of the laparoscopic working ports entering the abdominal wall through the same incision. Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus and reduces morbidity of minimally invasive surgery. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. This review summarizes the history of SPAL hysterectomy (single-port access laparoscopy), and emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes. Specific gynecological applications of single-port hysterectomy to date are summarized. Using the PubMed database, the English-language literature was reviewed for the past 40 years. Keyword searches included scarless, scar free, single-port/trocar/incision, single-port access laparoscopic hysterectomy. Within the bibliography of selected references, additional sources were retrieved. The purpose of the present article was to review the development and current status of SPAL hysterectomy and highlight important advances associated with this innovative approach. PMID:22442528

  12. Gastrointestinal Hormones and Bariatric Surgery-induced Weight Loss

    PubMed Central

    Ionut, Viorica; Burch, Miguel; Youdim, Adrienne; Bergman, Richard N.

    2015-01-01

    Obesity continues to be a major public health problem in the United States and worldwide. While recent statistics have demonstrated that obesity rates have begun to plateau, more severe classes of obesity are accelerating at a faster pace with important implications in regards to treatment. Bariatric surgery has a profound and durable effect on weight loss, being to date one of the most successful interventions for obesity. Objective To provide updates to the possible role of gut hormones in post bariatric surgery weight loss and weight loss maintenance. Design and Methods The current review examines the changes in gastro-intestinal hormones with bariatric surgery and the potential mechanisms by which these changes could result in decreased weight and adiposity. Results The mechanism by which bariatric surgery results in body weight changes is incompletely elucidated, but it clearly goes beyond caloric restriction and malabsorption. Conclusion Changes in gastro-intestinal hormones, including increases in GLP-1, PYY, and oxyntomodulin, decreases in GIP and ghrelin, or the combined action of all these hormones might play a role in induction and long-term maintenance of weight loss. PMID:23512841

  13. Positioning of the anaesthetised patient during robotically assisted laparoscopic surgery: perioperative staff experiences.

    PubMed

    Mangham, M

    2016-03-01

    Safe, patient centred care is a large part of our trust values at the Royal Wolverhampton NHS Trust. Robotic assisted laparoscopic surgery (RALS) is still in its infancy within our trust, and we decided to look at what we have learned so far regarding patient positioning during robotic surgery for gynae-oncology and uro-gynae procedures. We also considered what we believe needs to be achieved in order to deliver high standards of care in positioning patients during robotic surgery, not only now, but also for the future of robotic surgery. PMID:27149834

  14. [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

  15. Overview of single-port laparoscopic surgery for colorectal cancers: Past, present, and the future

    PubMed Central

    Kim, Say-June; Choi, Byung-Jo; Lee, Sang Chul

    2014-01-01

    Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilization of a camera without a separate external light, and instruments with different lengths has brought the favorable environment for SPLS. However, performing SPLS still creates several hardships compared to multiport laparoscopic surgery; a single-port system inevitably leads to clashing of surgical instruments due to crowding. To overcome such difficulties, investigators has developed novel concepts and maneuvers, including the concept of inverse triangulation and the maneuvers of pivoting, spreading out dissection, hanging suture, and transluminal traction. The final destination of SPLS is expected to be a completely seamless operation, maximizing the minimal invasiveness. Specimen extraction through the umbilicus can undermine cosmesis by inducing a larger incision. Therefore, hybrid laparoscopic technique, which combined laparoscopic surgical technique with natural orifice specimen extraction (NOSE) - i.e., transvaginal or transanal route-, has been developed. SPLS and NOSE seemed to be the best combination in pursuit of minimal invasiveness. In the near future, robotic SPLS with natural orifice transluminal endoscopic surgery’s way of specimen extraction seems to be pursued. It is expected to provide a completely or nearly complete seamless operation regardless of location of the lesion in the abdomen. PMID:24574772

  16. Laparoscopic Nissen Rossetti fundoplication: Possibility towards day care anti-reflux surgeries

    PubMed Central

    Bharatam, Kaundinya Kiran; Raj, Rajiv; Subramanian, Jayantan Bhaskar; Vasudevan, Anjana; Bodduluri, Sudeep; Sriraman, K.B.; Abineshwar, N.J.

    2015-01-01

    Introduction As we proceed towards more and more day care surgeries we always need to choose patients and procedures within a great deal of safety margin. Anti reflux surgeries are gaining more popularity and awareness and Laparoscopic Nissen Rosetti fundoplication is a safe and effective method of performing them. Methods and observations Our case series of 25 patients who underwent day care Laparoscopic Nissen Rossetti fundoplication done over a period of 3 years suggests the feasibility and safety of performing day care anti reflux surgeries with no complications. Discussion Surgical outcomes of procedure are unaffected and the main challenge faced remains pain relief and which can be effectively tackled by local blocks or plain NSAIDs. Results Laparoscopic Nissen Rossetti fundoplication is a safe procedure to be offered as day care anti-reflux surgery. We encourage more studies in this regards with appropriate blinding to enforce its possibility as day care surgery and help patients with early recovery and decreasing cost of surgeries. PMID:26594356

  17. Re-admission after gastro-intestinal surgery.

    PubMed

    Gauduchon, L; Sabbagh, C; Regimbeau, J M

    2015-12-01

    Re-admission is a new concept in France, born with the advent of day-case surgery, and defined as any re-admission occurring within 30 days after surgery. The re-admission rate has increasingly come to be considered a criterion of the quality of medical care, by both the medical profession and by insurance companies. This report outlines the generalities and definitions related to re-admission after gastro-intestinal surgery, describes the current situation, rationalizes the value of re-admission rates as a measure of quality of care, details the risk factors for re-admission according to the type of intervention, exposes the possible means of prevention and what to do when a patient comes to the emergency room within 30 days after an operation. PMID:26527260

  18. Laparoscopically assisted colorectal surgery provides better short-term clinical and inflammatory outcomes compared to open colorectal surgery

    PubMed Central

    Korać, Tina; Kodre, Anamarija Rebolj; Jelenc, Franc; Ihan, Alojz

    2015-01-01

    Introduction Changes in immune function after surgery may influence overall outcome, length of hospital stay, susceptibility to infection and perioperative tumour dissemination in cancer patients. Our aim was to elaborate on postoperative differences in the immune status and the intensity of the systemic inflammatory response between two groups of prospectively enrolled patients with colorectal cancer, namely patients undergoing laparoscopically assisted or open colorectal surgery. Material and methods Blood samples from 77 patients were taken before surgery and then 3 h, 24 h and 4 days after surgery. The inflammatory response was determined by leukocyte counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin levels (PCT). Immune status was determined by phenotypic analysis of lymphocyte populations and the activation of mononuclear cells. CD64 expression and cytokine expression were also determined. Results Patients undergoing laparoscopically assisted surgery had less intraoperative blood loss (p = 0.002), earlier resumption of diet (p = 0.002) and shorter hospital stay (p = 0.02). Numbers of total leukocytes (p = 0.12), CRP (p = 0.002) and PCT (p = 0.23) were remarkably higher 4 days after surgery in patients who underwent an open colorectal procedure. There was an important decrease in monocyte HLA-DR expression 3 h after surgery in patients undergoing laparoscopically assisted surgery (p = 0.03). Conclusions Our study suggests that minimally invasive surgery provides better short-term clinical outcomes for patients with resectable colorectal cancer. The acute inflammatory response is less pronounced. Post-surgical immunological disturbance in both groups is similar, but we observed a divergent effect of different surgical approaches on the expression of HLA-DR on monocytes. However, our results corroborate the results of previous studies. PMID:26788083

  19. Factors affecting recovery of postoperative bowel function after pediatric laparoscopic surgery

    PubMed Central

    Michelet, Daphnée; Andreu-Gallien, Juliette; Skhiri, Alia; Bonnard, Arnaud; Nivoche, Yves; Dahmani, Souhayl

    2016-01-01

    Background and Aims: Laparoscopic pediatric surgery allows a rapid postoperative rehabilitation and hospital discharge. However, the optimal postoperative pain management preserving advantages of this surgical technique remains to be determined. This study aimed to identify factors affecting the postoperative recovery of bowel function after laparoscopic surgery in children. Material and Methods: A retrospective analysis of factors affecting recovery of bowel function in children and infants undergoing laparoscopic surgery between January 1, 2009 and September 30, 2009, was performed. Factors included were: Age, weight, extent of surgery (extensive, regional or local), chronic pain (sickle cell disease or chronic intestinal inflammatory disease), American Society of Anaesthesiologists status, postoperative analgesia (ketamine, morphine, nalbuphine, paracetamol, nonsteroidal anti-inflammatory drugs [NSAIDs], nefopam, regional analgesia) both in the Postanesthesia Care Unit and in the surgical ward; and surgical complications. Data analysis used classification and regression tree analysis (CART) with a 10-fold cross validation. Results: One hundred and sixty six patients were included in the analysis. Recovery of bowel function depended upon: The extent of surgery, the occurrence of postoperative surgical complications, the administration of postoperative morphine in the surgical ward, the coadministration of paracetamol and NSAIDs and/or nefopam in the surgical ward and the emergency character of the surgery. The CART method generated a decision tree with eight terminal nodes. The percentage of explained variability of the model and the cross validation were 58% and 49%, respectively. Conclusion: Multimodal analgesia using nonopioid analgesia that allows decreasing postoperative morphine consumption should be considered for the speed of bowel function recovery after laparoscopic pediatric surgery.

  20. Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series

    PubMed Central

    Donatelli, Gianfranco; Dumont, Jean-Loup; Cereatti, Fabrizio; Dhumane, Parag; Tuszynski, Thierry; Vergeau, Bertrand Marie; Meduri, Bruno

    2016-01-01

    Background and study aims: Leaks following gastrointestinal surgery are a dreadful complication burdened by high morbidity and not irrelevant mortality. Endoscopic internal drainage (EID) has showed optimal results in the treatment of leaks following bariatric surgery. We report our experience with EID as first-line treatment for fistulas following surgery along all gastrointestinal tract. PMID:27556072

  1. Results of laparoscopic reoperation for failed antireflux surgery: does the indication for redo surgery affect the outcome?

    PubMed

    Safranek, P M; Gifford, C J; Booth, M I; Dehn, T C B

    2007-01-01

    Short and medium term outcomes from laparoscopic antireflux surgery are generally excellent. A small number of patients suffer recurrent reflux or intolerable side-effects and may require reoperation. In this paper we describe our experience of 35 laparoscopic reoperations from a single center. Data on patients undergoing antireflux surgery in our unit has been prospectively collected and includes more than 600 primary laparoscopic antireflux operations since 1993. Laparoscopic reoperations have been performed between 1996 and 2005 for patients suffering recurrent reflux, dysphagia or severe gas bloat symptomatic despite medical treatment. All patients underwent preoperative barium studies and endoscopy with selective manometry and pH studies. Symptomatic outcomes were evaluated at 6 weeks and 12 months with Visick scores. Anatomical results were assessed with barium studies at between 6 and 12 months. Thirty-five laparoscopic reoperations were performed in 20 women and 13 men (median age 56 years). Primary surgery had been performed in our unit in 27 (77%) and elsewhere in eight (23%). Median time from primary surgery was 28.5 months (5-360). Two patients underwent a second reoperation. Indication was recurrent reflux in 28 (80%), dysphagia in five (14%) and gas bloat in two (6%). Thirty-two of the 35 reoperations (91.4%) were completed laparoscopically, median operating time was 120.5 min (65-210) and median hospital stay 2 days. There was no mortality and there were only five minor complications. Twelve-month follow-up was available for 32 reoperations (91%). Overall good symptomatic outcomes were obtained in 26 (74%) Visick I or II at 6 weeks and 24 of 32 (75%) at 12 months. In reoperations for dysphagia/gas bloat there was a relative risk of 4.26 of a poor symptomatic outcome (Visick III or IV) at 12 months compared to those for recurrent reflux (P < 0.05, Fisher's exact test). Laparoscopic reoperation is feasible with low conversion rates and minimal

  2. Superpixel-based structure classification for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Bodenstedt, Sebastian; Görtler, Jochen; Wagner, Martin; Kenngott, Hannes; Müller-Stich, Beat Peter; Dillmann, Rüdiger; Speidel, Stefanie

    2016-03-01

    Minimally-invasive interventions offers multiple benefits for patients, but also entails drawbacks for the surgeon. The goal of context-aware assistance systems is to alleviate some of these difficulties. Localizing and identifying anatomical structures, maligned tissue and surgical instruments through endoscopic image analysis is paramount for an assistance system, making online measurements and augmented reality visualizations possible. Furthermore, such information can be used to assess the progress of an intervention, hereby allowing for a context-aware assistance. In this work, we present an approach for such an analysis. First, a given laparoscopic image is divided into groups of connected pixels, so-called superpixels, using the SEEDS algorithm. The content of a given superpixel is then described using information regarding its color and texture. Using a Random Forest classifier, we determine the class label of each superpixel. We evaluated our approach on a publicly available dataset for laparoscopic instrument detection and achieved a DICE score of 0.69.

  3. One-handed knot tying technique in single-incision laparoscopic surgery

    PubMed Central

    Thanakumar, John; John, Pravin Hector

    2011-01-01

    In an open surgery, two-handed as well as one-handed knot tying is commonplace. Knot tying in laparoscopic surgery traditionally involves the use of two instruments (for fashioning an intracorporeal knot) or passing of a ligature around a tubular structure, exteriorising it, fashioning a knot, and sliding it down with a knot-pusher (external slip knot). With increasing interest in expanding applications of single-incision laparoscopic surgery (SILS), surgeons are faced with new challenges. In SILS it is not usually possible to utilise two instruments for knot tying as they lie almost parallel. We describe a novel one-handed knot tying technique devised specifically for use in SILS. PMID:21197256

  4. One-handed knot tying technique in single-incision laparoscopic surgery.

    PubMed

    Thanakumar, John; John, Pravin Hector

    2011-01-01

    In an open surgery, two-handed as well as one-handed knot tying is commonplace. Knot tying in laparoscopic surgery traditionally involves the use of two instruments (for fashioning an intracorporeal knot) or passing of a ligature around a tubular structure, exteriorising it, fashioning a knot, and sliding it down with a knot-pusher (external slip knot). With increasing interest in expanding applications of single-incision laparoscopic surgery (SILS), surgeons are faced with new challenges. In SILS it is not usually possible to utilise two instruments for knot tying as they lie almost parallel. We describe a novel one-handed knot tying technique devised specifically for use in SILS. PMID:21197256

  5. Anaesthesia Management of a Patient with Incidentally Diagnosed Diaphragmatic Hernia During Laparoscopic Surgery

    PubMed Central

    Özdemir, Mehtap; Yanlı, Pınar Yonca; Tomruk, Şenay Göksu; Bakan, Nurten

    2015-01-01

    Diaphragmatic hernia is usually congenital. However, it is rarely traumatic and can stay asymptomatic. In this report, we aimed to present the anaesthetic management of a patient with diaphragmatic hernia due to previous trauma (14 years ago), which was diagnosed incidentally during surgery for rectal cancer. The patient (53 years, 56 kg, 165 cm, American Society of Anaesthesiologist (ASA) II), to whom laparoscopic surgery was planned because of rectal cancer, had a history of falling from a height 14 years ago. Preoperatively, the patient did not have any sign except small right diaphragmatic elevation on the chest x-ray. After induction, maintenance of anaesthesia was continued with sevoflurane and O2/N2O. The patient was given a 30° Trendelenburg position. When the trochars were inserted by the surgeon, the diaphragmatic hernia was seen on the right part of the diaphragm, which was hidden by the liver. The surgery was continued laparoscopically but with low pressure (12 mmHg), because the patient did not have any haemodynamic and respiratory instability. The patient, who had stable haemodynamic parameters and no respiratory complications during the operation, was transferred to the ward for monitorised care. Traumatic diaphragmatic hernias can be detected incidentally after a long period of acute event. In our case, it was diagnosed during laparoscopic surgery. The surgery was completed with appropriate and careful haemodynamic monitoring and low intra-abdominal pressure under inhalational anaesthesia without any impairment in the patient’s haemodynamic and respiratory parameters. PMID:27366465

  6. Jain point: A new safe portal for laparoscopic entry in previous surgery cases

    PubMed Central

    Jain, Nutan; Sareen, Sweta; Kanawa, Swati; Jain, Vandana; Gupta, Sunil; Mann, Sonika

    2016-01-01

    INTRODUCTION: The present study was performed to assess the safety and feasibility of a new laparoscopic entry site in cases suspected of adhesions due to previous surgery. MATERIALS AND METHODS: It is a retrospective study undertaken at a tertiary care referral center for advanced gynecological laparoscopic surgery from January 2011 to December 2014. RESULTS: In 624 patients with a history of previous abdominal surgeries, the laparoscopic entry site was through a newly devised point. It is a point in the left paraumbilical region at the level of umbilicus, in a straight line drawn vertically upward from a point 2.5 cm medial to anterior superior iliac spine. Intra-abdominal adhesions were found in 487 (78.0%) patients, and umbilical adhesions in 404 (64.7%) patients with past abdominal surgeries. CONCLUSION: There were no significant entry-related, intra-operative, or postoperative complications with the use of this entry point. It is also suitable as a main working port during the course of surgery. PMID:27110072

  7. [Laparoscopic diagnosis and treatment of early adhesive small bowel obstruction after gynecological surgery].

    PubMed

    Timofeev, M E; Breusenko, V G; Shapoval'iants, S G; Fedorov, E D; Larichev, S E; Kretsu, V N

    2015-01-01

    It is presented the results of diagnostic and curative laparoscopic interventions in 33 patients with acute early adhesive small bowel obstruction. Ileus developed after surgical treatment (laparotomy) of different gynecological diseases. Laparoscopy appeared as the most informative diagnostic method to confirm diagnosis in all patients, to estimate state of abdominal cavity and small pelvis organs what can help to determine method of surgical treatment. Contraindications for laparoscopic surgery were identified in 12 (36.4%) patients and conversion to laparotomy was applied in this group. Postoperative complications were diagnosed in 1 (8.3%) patient. 2 (16.6%) patients died. Early adhesive ileus was resolved laparoscopically in 21 (63.6%) of 33 patients. Recurrent acute early adhesive ileus was detected in 1 (4.7%) patient. PMID:26031952

  8. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    PubMed Central

    Thomas, Jimmy

    2014-01-01

    This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed. PMID:25593443

  9. Two-port laparoscopic appendectomy as transition to laparoendoscopic single site surgery

    PubMed Central

    Olijnyk, José Gustavo; Pretto, Guilherme Gonçalves; da Costa Filho, Omero Pereira; Machado, Fernando Koboldt; Silva Chalub, Sidney Raimundo; Cavazzola, Leandro Totti

    2014-01-01

    BACKGROUND: According to the precepts of reduced surgical trauma and better cosmesis, an intermediate laparoscopic appendectomy technique between the conventional three-trocar procedure and Laparoendoscopic Single Site Surgery (LESS) was performed, based on literature review and experience of the surgical team. PATIENTS AND METHODS: Patients with early stage acute appendicitis and a favourable anatomical presentation were selected. The procedure was performed with two ports: A 10 mm trocar at the umbilicus site for laparoscope and a 5 mm one just above the pubic bone for grasper. The appendix was secured by external wire traction through a right iliac fossa puncture with 14-gauge intravenous catheter. RESULTS: From August 2009 to December 2012, we performed 42 cases; two required conversion to a conventional laparoscopic technique. There were no complications in the remaining, no wound infections and a mean operation time of 64.5 minutes. CONCLUSION: The use of two-port laparoscopic appendectomy can act as a LESS intermediate step procedure, without loss of instrumental triangulation and maintenance of appropriate counter-traction. This technique can be used as an alternative to the three-port laparoscopic procedure in patients with initial presentation of appendicitis and a favourable anatomical position. PMID:24501505

  10. An alternative port for use in hand-assisted laparoscopic surgery: a design using a stoma ring and a glove.

    PubMed

    Kumar, Pradeep; Kumar, Senthil

    2005-04-01

    Hand-assisted laparoscopic surgery (HALS) has widened the range of laparoscopic surgery. An appropriate port allowing the passage of the hand while maintaining pneumoperitoneum is mandatory for HALS to be performed. Commercially available ports are expensive and may not be universally available. An inexpensive 2-component port using the flange of a stoma appliance and a glove, which could be readily assembled at short notice, is described. PMID:15821629

  11. Laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy

    PubMed Central

    Minig, Lucas; Otaño, Lucas; Cruz, Pilar; Patrono, María Guadalupe; Botazzi, Cecilia; Zapardiel, Ignacio

    2016-01-01

    OBJECTIVE: To evaluate the feasibility and safety of laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy. STUDY DESIGN: An observational study of a prospective collection of data of all pregnant women who underwent laparoscopic surgery for adnexal masses during the first trimester of pregnancy between January 1999 and November 2012 at the Obstetrics and Gynecology Department of the Italian Hospital of Buenos Aires, Buenos Aires, Argentina was performed. RESULTS: A total of 13 women were included. The median (range) gestational age at the moment of surgical procedure was 7 weeks (range: 5-12 weeks). The main indication of surgery was cyst torsion in four cases (30.7%) and rupture of ovarian cysts in four cases (30.7%). Other indications included persistent ovarian cyst in three patients (23%) and heterotopic pregnancy in two cases (15.3%). Neither surgical complications nor spontaneous abortions occurred in any of the cases and the post-operative period was uneventful in all the cases. No cases of intrauterine growth retardation, preterm delivery, congenital defects, or neonatal complications were registered. CONCLUSION: The treatment of complicated adnexal masses by laparoscopic surgery during the first trimester of pregnancy appears to be a safe procedure both for the mother and for the foetus. Additional research on a larger number of cases is still needed to support these conclusions. PMID:26917915

  12. Evaluation of the complications in transperitoneal laparoscopic renal and adrenal surgery with Clavien-Dindo classification

    PubMed Central

    Balcı, Melih; Tuncel, Altuğ; Güzel, Özer; Aslan, Yılmaz; Keten, Tanju; Köseoğlu, Ersin; Erkan, Anıl; Atan, Ali

    2016-01-01

    Objective To evaluate our complications in renal and adrenal transperitoneal laparoscopic surgeries with Clavien-Dindo classification. Material and methods Two hundred and eight patients to whom renal and adrenal laparoscopic surgeries were performed between January 2008 and June 2015 were included the study. One hundred and twenty one (58.2%) patients were female and 87 (41.8%) of them were male. Laparoscopic procedures were performed as radical nephrectomy (n=49; 23.6%), simple nephrectomy (n=56; 26.9%), and partial nephrectomy (n=7; 3.4%), renal cyst decortication (n=27; 13%), pyelopasty (n=14; 6.7%) and adrenalectomy (n=55; 26.4%). Complications were classified according to Clavien-Dindo classification. Results The mean age of the patients was 48.01±14.9 years. The mean duration of hospital stay was 3.5±1.9 days. According to European Scoring System for Laparoscopic Operations the procedures were graded based on procedural difficulty as simple (n=27; 12.9%), difficult (n=172; 82.8%), and highly difficult (n=9; 4.3%). Complications were observed in 13 (6.3%) interventions. One of these occurred during very hard and 14 during difficult procedures. According to Clavien-Dindo Classification; Grades 1, 2, and 3 A complications developed in 3 (1.4%), 9 (4.3%), and 1(0.5%) patient, respectively. Conclusion Laparoscopic surgery is an efficient procedure in well-chosen patients for renal and adrenal diseases with low complication rates. PMID:27274890

  13. Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery

    PubMed Central

    Feroci, Francesco; Vannucchi, Andrea; Bianchi, Paolo Pietro; Cantafio, Stefano; Garzi, Alessia; Formisano, Giampaolo; Scatizzi, Marco

    2016-01-01

    AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer. METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared. RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups. CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies. PMID:27053852

  14. Development of virtual environments for training skills and reducing errors in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Tendick, Frank; Downes, Michael S.; Cavusoglu, Murat C.; Gantert, Walter A.; Way, Lawrence W.

    1998-06-01

    In every surgical procedure there are key steps and skills that, if performed incorrectly, can lead to complications. In conjunction with efforts, based on task and error analysis, in the Videoscopic Training Center at UCSF to identify these key elements in laparoscopic surgical procedures, the authors are developing virtual environments and modeling methods to train the elements. Laparoscopic surgery is particularly demanding of the surgeon's spatial skills, requiring the ability to create 3D mental models and plans while viewing a 2D image. For example, operating a laparoscope with the objective lens angled from the scope axis is a skill that some surgeons have difficulty mastering, even after using the instrument in many procedures. Virtual environments are a promising medium for teaching spatial skills. A kinematically accurate model of an angled laparoscope in an environment of simple targets is being tested in courses for novice and experienced surgeons. Errors in surgery are often due to a misinterpretation of local anatomy compounded with inadequate procedural knowledge. Methods to avoid bile duct injuries in cholecystectomy are being integrated into a deformable environment consisting of the liver, gallbladder, and biliary tree. Novel deformable tissue modeling algorithms based on finite element methods will be used to improve the response of the anatomical models.

  15. Role of Epidural and Patient-Controlled Analgesia in Site-Specific Laparoscopic Colorectal Surgery

    PubMed Central

    Kamiński, Jan P.; Pai, Ajit; Ailabouni, Luay; Marecik, Slawomir J.; Prasad, Leela M.; Abcarian, Herand

    2014-01-01

    Background and Objectives: Limited data are available comparing epidural and patient-controlled analgesia in site-specific colorectal surgery. The aim of this study was to evaluate 2 modes of analgesia in patients undergoing laparoscopic right colectomy (RC) and low anterior resection (LAR). Methods: Prospectively collected data on 433 patients undergoing laparoscopic or laparoscopic-assisted colon surgery at a single institution were retrospectively reviewed from March 2004 to February 2009. Patients were divided into groups undergoing RC (n = 175) and LAR (n = 258). These groups were evaluated by use of analgesia: epidural analgesia, “patient-controlled analgesia” alone, and a combination of both. Demographic and perioperative outcomes were compared. Results: Epidural analgesia was associated with a faster return of bowel function, by 1 day (P < .001), in patients who underwent LAR but not in the RC group. Delayed return of bowel function was associated with increased operative time in the LAR group (P = .05), patients with diabetes who underwent RC (P = .037), and patients after RC with combined analgesia (P = .011). Mean visual analogue scale pain scores were significantly lower with epidural analgesia compared with patient-controlled analgesia in both LAR and RC groups (P < .001). Conclusion: Epidural analgesia was associated with a faster return of bowel function in the laparoscopic LAR group but not the RC group. Epidural analgesia was superior to patient-controlled analgesia in controlling postoperative pain but was inadequate in 28% of patients and needed the addition of patient-controlled analgesia. PMID:25419110

  16. 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.

  17. Anaesthesia for laparoscopic surgery: General vs regional anaesthesia

    PubMed Central

    Bajwa, Sukhminder Jit Singh; Kulshrestha, Ashish

    2016-01-01

    The use of laparoscopy has revolutionised the surgical field with its advantages of reduced morbidity with early recovery. Laparoscopic procedures have been traditionally performed under general anaesthesia (GA) due to the respiratory changes caused by pneumoperitoneum, which is an integral part of laparoscopy. The precise control of ventilation under controlled conditions in GA has proven it to be ideal for such procedures. However, recently the use of regional anaesthesia (RA) has emerged as an alternative choice for laparoscopy. Various reports in the literature suggest the safety of the use of spinal, epidural and combined spinal-epidural anaesthesia in laparoscopic procedures. The advantages of RA can include: Prevention of airway manipulation, an awake and spontaneously breathing patient intraoperatively, minimal nausea and vomiting, effective post-operative analgesia, and early ambulation and recovery. However, RA may be associated with a few side effects such as the requirement of a higher sensory level, more severe hypotension, shoulder discomfort due to diaphragmatic irritation, and respiratory embarrassment caused by pneumoperitoneum. Further studies may be required to establish the advantage of RA over GA for its eventual global use in different patient populations. PMID:26917912

  18. 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

  19. 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

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

    PubMed

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

    2014-07-01

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

  1. A case of giant ileal duplication in an adult, successfully treated with laparoscope-assisted surgery.

    PubMed

    Matsumoto, Yasunori; Tohma, Takayuki; Miyauchi, Hideaki; Suzuki, Kazufumi; Nishimori, Takanori; Ohira, Gaku; Narushima, Kazuo; Muto, Yorihiko; Maruyama, Tetsuro; Matsubara, Hisahiro

    2015-12-01

    Alimentary tract duplication is a rare congenital malformation but can occur anywhere along the digestive tract. Most patients become symptomatic in early childhood, and only a few cases of adult patients have been reported in the literature. We herein report a unique case of a giant ileal duplication in an adult, which was successfully treated with laparoscope-assisted surgery. A 60-year-old male was admitted because of abdominal pain. Imaging studies revealed a well-defined cystic mass, measuring 15 cm, in the ileocecal region. We diagnosed it as a duplicated ileum and performed laparoscope-assisted surgery. The duplication was successfully resected with attached normal ileum, and there were no major complications in the postoperative course. PMID:26943378

  2. Acupuncture for postoperative pain in laparoscopic surgery: a systematic review protocol

    PubMed Central

    Lee, Seunghoon; Park, Jimin; Kim, Jihye; Kang, Jung Won; Choi, Do-Young; Park, Sun Jin; Nam, Dongwoo; Lee, Jae-Dong

    2014-01-01

    Introduction This review aims to evaluate the effectiveness and safety of acupuncture for patients with postoperative pain after laparoscopic surgery. Methods and analysis We will search the following databases from their inception to October 2014: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), three Chinese databases (China National Knowledge Infrastructure (CNKI), the Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and the Wanfang database), one Japanese database (Japan Science and Technology Information Aggregator, Electronic (J-STAGE)) and eight Korean databases (Korean Association of Medical Journal Edition, Korean Medical Database, Korean Studies Information Service System, National Discovery for Science Leaders, Database Periodical Information Academic, Korean National Assembly Digital Library, Oriental Medicine Advanced Searching Integrated System and Korean Traditional Knowledge Portal). All randomised controlled trials of acupuncture for postoperative pain after laparoscopic surgery will be considered for inclusion. The risk of bias and reporting quality will be assessed using the Cochrane risk of bias tool, the Consolidated Standards of Reporting Trials (CONSORT) and the revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The risk ratio for dichotomous data and mean difference or standard mean difference for continuous data will be calculated with 95% CIs. Dissemination The results of this review will be disseminated through peer-reviewed publication or conference presentation. Our findings will summarise the current evidence of acupuncture to treat postoperative pain after laparoscopic surgery, and may provide important guidance for acupuncture usage after laparoscopic surgery for clinicians and patients. Trial registration number

  3. Single-port laparoscopic surgery in children: A new alternative in developing countries

    PubMed Central

    Mahdi, Ben Dhaou; Rahma, Chtourou; Mohamed, Jallouli; Riadh, Mhiri

    2015-01-01

    Background: Single-incision laparoscopic surgery (SILS) is a technique in laparoscopic surgery, which is based on the idea that all the laparoscopic trocars are inserted through a single umbilical incision. This paper documents a single-centre experience, which performed the single-port surgery in children using an improvised trans-umbilical glove-port with conventional rigid instruments. Materials and Methods: We prospectively studied the outcomes of SILS procedures between January 2013 and June 2014. Materials required making our homemade trans-umbilical port consisted on: A flexible ring, a rigid larger ring, one powder-free surgical glove, a wire-to-skin and standard standards laparoscopic trocars. Results: A total of 90 consecutive procedures had been done in our institution: 15 girls and 75 boys (mean age: 7.5 years). We used SILS on 59 appendectomies with an average operative time of 48 minutes. We needed conversion to conventional surgery in three cases (two with perforated appendicitis and one for difficulty to mobilize the appendix). SIL cholecystectomy was performed for four patients with symptomatic cholelithiasis; mean operative time was 60 min. All patients were discharged on postoperative day 2. Eighteen boys with non-palpable testis were explored and treated. Other procedures included: Varicocelectomy (n = 2), intra-abdominal lymph node biopsies (n = 2), ovarian cystectomy (n = 1), ovarian transposition (n = 1), aspiration of renal hydatid cyst (n = 1), explorative laparoscopy in research to Meckel's diverticulum (n = 1) and intestinal intussusceptions (n = 1). No post-operative complications were seen in all cases. Conclusions: SILS in the paediatric population using conventional rigid instruments is feasible, safe and effective. It may be an alternative to the costly commercially available single-port systems especially in a developing country like Tunisia. PMID:26168750

  4. LAPAROSCOPIC ANTIREFLUX SURGERY IN PATIENTS WITH EXTRA ESOPHAGEAL SYMPTOMS RELATED TO ASTHMA

    PubMed Central

    da SILVA, Amanda Pinter Carvalheiro; TERCIOTI-JUNIOR, Valdir; LOPES, Luiz Roberto; COELHO-NETO, João de Souza; BERTANHA, Laura; RODRIGUES, Paulo Rodrigo de Faria; ANDREOLLO, Nelson Adami

    2014-01-01

    Background Asthma, laryngitis and chronic cough are atypical symptoms of the gastroesophageal reflux disease. Aim To analyze the efficacy of laparoscopic surgery in the remission of extra-esophageal symptoms in patients with gastroesophageal reflux, related to asthma. Methods Were reviewed the medical records of 400 patients with gastroesophageal reflux disease submitted to laparoscopic Nissen fundoplication from 1994 to 2006, and identified 30 patients with extra-esophageal symptoms related to asthma. The variables considered were: gender, age, gastroesophageal symptoms (heartburn, acid reflux and dysphagia), time of reflux disease, treatment with proton pump inhibitor, use of specific medications, treatment and evolution, number of attacks and degree of esophagitis. Data were subjected to statistical analysis, comparing the pre- and post-surgical findings. Results The comparative analysis before surgery (T1) and six months after surgery (T2) showed a significant reduction on heartburn and reflux symptoms. Apart from that, there was a significant difference between the patients with daily crises of asthma (T1 versus T2, 45.83% to 16.67%, p=0.0002) and continuous crises (T1, 41.67% versus T2, 8.33%, p=0.0002). Conclusion Laparoscopic Nissen fundoplication was effective in improving symptoms that are typical of reflux disease and clinical manifestations of asthma. PMID:25004284

  5. [Laparoscopic surgery and adjuvant therapy for colon cancer].

    PubMed

    Kubicka, Stefan; Geissler, Michael; Bruch, Hans-Peter; Trarbach, Tanja

    2009-01-01

    At present, about 10% of all oncological procedures in the colon are carried out laparoscopically. Acceptance is increasing. After successful R0 resection, the rule for stage III patients is: adjuvant therapy is indicated regardless of age. Regimens containing oxaliplatin should be used. If there are contraindications for oxaliplatin, then fluoropyrimidine monotherapy is indicated, with oral fluoropyrimidines (capecitabine) being given precedence over infusional schemes. The use of 5-FU bolus regimens is regarded as obsolete. For stage II, the following applies: If an adjuvant chemotherapy is planned in these patients on the basis of the QUASAR data, then fluoropyrimidine monotherapy (e. g. capecitabine) can be given. Since patients whose tumours show a high frequency of microsatellite instability (MSI) do not benefit from a fluoropyrimidine monotherapy, the MSI status should be determined before choosing therapy. PMID:19546595

  6. Learning Experiences in Robotic-Assisted Laparoscopic Surgery.

    PubMed

    Nezhat, Ceana; Lakhi, Nisha

    2016-08-01

    With the use and adoption of computer-assisted laparoscopic technology gaining more prominence, important issues pertaining to the learning process are raised. Several modalities can be incorporated into a training program for robotic surgical development. The role and utility of various methods, including didactic instruction, virtual reality simulators, dry and wet laboratories, bedside assistance, mentoring, as well as proctorship, are still in the process of being assessed and validated. Integration of robotic training in residency and fellowship programs as well as the formation of a structured didactic robotic curriculum continues to be a challenge. Finally, methods to assess competency of training and the process for credentialing robotic surgeons still require further structuring and codification. PMID:26707192

  7. 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.

  8. Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature

    PubMed Central

    Suda, Koichi; Nakauchi, Masaya; Inaba, Kazuki; Ishida, Yoshinori; Uyama, Ichiro

    2016-01-01

    Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO2 insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature. PMID:27217695

  9. Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature.

    PubMed

    Suda, Koichi; Nakauchi, Masaya; Inaba, Kazuki; Ishida, Yoshinori; Uyama, Ichiro

    2016-05-21

    Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO2 insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature. PMID:27217695

  10. Pico Lantern: Surface reconstruction and augmented reality in laparoscopic surgery using a pick-up laser projector.

    PubMed

    Edgcumbe, Philip; Pratt, Philip; Yang, Guang-Zhong; Nguan, Christopher; Rohling, Robert

    2015-10-01

    The Pico Lantern is a miniature projector developed for structured light surface reconstruction, augmented reality and guidance in laparoscopic surgery. During surgery it will be dropped into the patient and picked up by a laparoscopic tool. While inside the patient it projects a known coded pattern and images onto the surface of the tissue. The Pico Lantern is visually tracked in the laparoscope's field of view for the purpose of stereo triangulation between it and the laparoscope. In this paper, the first application is surface reconstruction. Using a stereo laparoscope and an untracked Pico Lantern, the absolute error for surface reconstruction for a plane, cylinder and ex vivo kidney, is 2.0 mm, 3.0 mm and 5.6 mm, respectively. Using a mono laparoscope and a tracked Pico Lantern for the same plane, cylinder and kidney the absolute error is 1.4 mm, 1.5 mm and 1.5 mm, respectively. These results confirm the benefit of the wider baseline produced by tracking the Pico Lantern. Virtual viewpoint images are generated from the kidney surface data and an in vivo proof-of-concept porcine trial is reported. Surface reconstruction of the neck of a volunteer shows that the pulsatile motion of the tissue overlying a major blood vessel can be detected and displayed in vivo. Future work will integrate the Pico Lantern into standard and robot-assisted laparoscopic surgery. PMID:26024818

  11. Radioguided localization of neuroblastomas in laparoscopic surgery using (123)I- radiolabeled metaiodobenzylguanidine.

    PubMed

    Hishiki, Tomoro; Saito, Takeshi; Terui, Keita; Mitsunaga, Testuya; Nakata, Mitsuyuki; Hayashi, Hideki; Yoshida, Hideo

    2015-07-01

    Minimally invasive surgery has become widely recognized and is commonly used for the diagnosis and treatment of neuroblastoma. However, in post-chemotherapy status or during reoperations, it is occasionally difficult to precisely locate small neuroblastoma lesions, and this becomes prominent in endoscopic surgeries, in which tactile sense is essentially lost. Herein, we report our preliminary experience in two abdominal neuroblastoma cases undergoing laparoscopic tumor resection with aid of intraoperative (123)I- metaiodobenzylguanidine (MIBG) radioguidance using a specifically designed gamma-probe. The procedure enables easier localization of viable neuroblastoma tissue, provided that the tumor shows moderate to high MIBG uptake. PMID:25788044

  12. Effect of preemptive ketamine administration on postoperative visceral pain after gynecological laparoscopic surgery.

    PubMed

    Lin, Hong-Qi; Jia, Dong-Lin

    2016-08-01

    The pain following gynecological laparoscopic surgery is less intense than that following open surgery; however, patients often experience visceral pain after the former surgery. The aim of this study was to determine the effects of preemptive ketamine on visceral pain in patients undergoing gynecological laparoscopic surgery. Ninety patients undergoing gynecological laparoscopic surgery were randomly assigned to one of three groups. Group 1 received placebo. Group 2 was intravenously injected with preincisional saline and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. Group 3 was intravenously injected with preincisional ketamine (0.3 mg/kg) and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. A standard anesthetic was used for all patients, and meperidine was used for postoperative analgesia. The visual analogue scale (VAS) scores for incisional and visceral pain at 2, 6, 12, and 24 h, cumulative analgesic consumption and time until first analgesic medication request, and adverse effects were recorded postoperatively. The VAS scores of visceral pain in group 3 were significantly lower than those in group 2 and group 1 at 2 h and 6 h postoperatively (P<0.05 and P<0.01, respectively). At 2 h and 6 h, the VAS scores of incisional pain did not differ significantly between groups 2 and 3, but they were significantly lower than those in group 1 (P<0.01). Groups 1 and 2 did not show any differences in visceral pain scores at 2 h and 6 h postoperatively. Moreover, the three groups showed no statistically significant differences in visceral and incisional pain scores at 12 h and 24 h postoperatively. The consumption of analgesics was significantly greater in group 1 than in groups 2 and 3, and the time to first request for analgesics was significantly longer in groups 2 and 3 than in group 1, with no statistically significant difference between groups 2 and 3. However, the three groups showed no significant difference

  13. [The first experiences with colorectal laparoscopic surgery in Spain. Valencia, November 1991].

    PubMed

    Cuesta, Miguel A; Alonso-Poza, Alfredo; Planells-Roig, Manuel; García-Espinosa, Rafael; Rodero-Rodero, David

    2016-04-01

    The development of laparoscopic colon surgery in Spain has spread quickly since its beginnings at the end of 1991. Colorectal Minimally Invasive Surgery is widely implemented and has changed the way we treat our patients, specially due to the short-term advantages such as lower morbidity with a better quality of life with the same oncological outcomes in the long term. A huge number of Spanish surgeons have contributed to the implementation of techniques and spreading the knowledge of these concepts by means of courses, controlled randomized studies, scientific papers, and books, and have obtained international recognition. PMID:26314547

  14. Stereoscopic augmented reality using ultrasound volume rendering for laparoscopic surgery in children

    NASA Astrophysics Data System (ADS)

    Oh, Jihun; Kang, Xin; Wilson, Emmanuel; Peters, Craig A.; Kane, Timothy D.; Shekhar, Raj

    2014-03-01

    In laparoscopic surgery, live video provides visualization of the exposed organ surfaces in the surgical field, but is unable to show internal structures beneath those surfaces. The laparoscopic ultrasound is often used to visualize the internal structures, but its use is limited to intermittent confirmation because of the need for an extra hand to maneuver the ultrasound probe. Other limitations of using ultrasound are the difficulty of interpretation and the need for an extra port. The size of the ultrasound transducer may also be too large for its usage in small children. In this paper, we report on an augmented reality (AR) visualization system that features continuous hands-free volumetric ultrasound scanning of the surgical anatomy and video imaging from a stereoscopic laparoscope. The acquisition of volumetric ultrasound image is realized by precisely controlling a back-and-forth movement of an ultrasound transducer mounted on a linear slider. Furthermore, the ultrasound volume is refreshed several times per minute. This scanner will sit outside of the body in the envisioned use scenario and could be even integrated into the operating table. An overlay of the maximum intensity projection (MIP) of ultrasound volume on the laparoscopic stereo video through geometric transformations features an AR visualization system particularly suitable for children, because ultrasound is radiation-free and provides higher-quality images in small patients. The proposed AR representation promises to be better than the AR representation using ultrasound slice data.

  15. Treatment of Early Stage Endometrial Cancer by Transumbilical Laparoendoscopic Single-Site Surgery Versus Traditional Laparoscopic Surgery

    PubMed Central

    Cai, Hui-hua; Liu, Mu-biao; He, Yuan-li

    2016-01-01

    Abstract To compare the outcomes of transumbilical laparoendoscopic single-site surgery (TU-LESS) versus traditional laparoscopic surgery (TLS) for early stage endometrial cancer (EC). We retrospectively reviewed the medical records of patients with early stage EC who were surgically treated by TU-LESS or TLS between 2011 and 2014 in a tertiary care teaching hospital. We identified 18 EC patients who underwent TU-LESS. Propensity score matching was used to match this group with 18 EC patients who underwent TLS. All patients underwent laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic lymphadenectomy by TU-LESS or TLS without conversion to laparoscopy or laparotomy. Number of pelvic lymph nodes retrieved, operative time and estimated blood loss were comparable between 2 groups. Satisfaction values of the cosmetic outcome evaluated by the patient at day 30 after surgery were significantly higher in TU-LESS group than that in TLS group (9.6 ± 0.8 vs 7.5 ± 0.7, P < 0.001), while there was no statistical difference in postoperative complications within 30 days after surgery, postoperative hospital stay, and hospital cost. For the surgical management of early stage EC, TU-LESS may be a feasible alternative approach to TLS, with comparable short-term surgical outcomes and superior cosmetic outcome. Future large-scale prospective studies are needed to identify these benefits. PMID:27057851

  16. Single-port versus multi-port laparoscopic surgery for colon cancer in elderly patients

    PubMed Central

    Tokuoka, Masayoshi; Ide, Yoshihito; Takeda, Mitsunobu; Hirose, Hajime; Hashimoto, Yasuji; Matsuyama, Jin; Yokoyama, Shigekazu; Fukushima, Yukio; Sasaki, Yo

    2016-01-01

    The safety of single-incision laparoscopic surgery (SLS) in elderly patients with colorectal cancer has not been established. The aim of the current study was to compare the outcomes of SLS and multi-port laparoscopic surgery (MLS) and to assess the feasibility of SLS in colorectal cancer patients aged ≥70 years. A retrospective case-control study of colon cancer patients undergoing elective surgical intervention between 2011 and 2014 was conducted. A total of 129 patients with colon cancer underwent surgery and were included in the analysis. Data regarding patient demographics, surgical variables, oncological outcomes and short-term outcomes were evaluated for statistical significance to compare MLS (n=79) and SLS (n=50) in colon cancer patients. No significant differences were observed in patient characteristics. No case required re-admission within 30 days post surgery. The mean surgery times were similar for the MLS and SLS groups when cases with left and right hemicolectomies were combined (207.7 and 215.9 min, respectively; P=0.47). In addition, overall perioperative outcomes, including blood loss, number of lymph nodes harvested, size of the surgical margin and complications, were similar between these groups. Thus, we suggest that SLS can be performed safely in elderly patients with colon cancer. PMID:27446454

  17. Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

    PubMed Central

    Chand, Manish; Siddiqui, Muhammed RS; Gupta, Ashish; Rasheed, Shahnawaz; Tekkis, Paris; Parvaiz, Amjad; Mirnezami, Alex H; Qureshi, Tahseen

    2014-01-01

    Laparoscopic surgery has become well established in the management of both and malignant colorectal disease. The last decade has seen increasing numbers of surgeons trained to a high standard in minimally-invasive surgery. However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery. There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes. The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery (LCS) in the emergency setting. The literature is broadly divided by the underlying pathology; that is, inflammatory bowel disease, diverticulitis and malignant obstruction. There were no randomized trials and the majority of the studies were case-matched series or comparative studies. The overall trend was that LCS is associated with shorter hospital stay, par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection, the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation. PMID:25493008

  18. Reduced port laparoscopic surgery for colon cancer in a patient with tuberculous kyphosis and dwarfism: a rare case and literature review

    PubMed Central

    Ikeda, Atsushi; Tada, Yoichiro

    2015-01-01

    With accumulated surgical experience, the contraindications to laparoscopic surgery have been decreasing. Reduced port laparoscopic surgery has been widely adopted for a variety of diseases. However, surgery in patients with anatomic deformities are still a challenge for surgeons, specifically abdominal surgery in patients with severe kyphosis. A 71-year-old man with a diagnosis of ascending colon cancer had severe kyphosis with extremely short stature, secondary to tuberculous spondylitis. Laparoscopic right hemicolectomy was successfully performed with a single umbilical incision plus one port. This is the first reported case involving laparoscopic surgery in a patient with tuberculous kyphosis. The purpose of this report is to describe the surgical skills of reduced port laparoscopic surgery in a patient with altered habitus. With proper planning and a meticulous operation, minimally invasive surgery could be safely achieved. PMID:26240628

  19. Single-incision laparoscopic colorectal surgery for cancer: State of art

    PubMed Central

    Cianchi, Fabio; Staderini, Fabio; Badii, Benedetta

    2014-01-01

    A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery. During the last years, a great effort has been made to research for minimizing parietal trauma, yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity. New techniques, such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy (SIL) have been developed in order to reach the goal of “scarless” surgery. Although NOTES may seem not fully suitable or safe for advanced procedures, such as colectomies, SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use. The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus, perform even complex procedures which require extraction of large surgical specimens or intestinal anastomosis. The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation. However, SIL raises a number of specific new challenges compared with the laparoscopic conventional approach. A reduced capacity for triangulation, the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues. The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement, especially for oncologic cases. PMID:24876729

  20. A modified technique for the laparoscopic management of large gastric bezoars.

    PubMed

    Ulukent, Suat C; Ozgun, Yigit M; Şahbaz, Nuri A

    2016-09-01

    Bezoar is an intraluminal mass formed by the accumulation of undigested material anywhere in the gastrointestinal system. Most of small bezoars are removed by gastrointestinal endoscopy, while the best approach for the larger ones is surgical removal. Currently, laparoscopic technique is successfully used in the treatment of bezoars, which are used to be managed by open surgery. In the laparoscopic treatment of bezoars, contamination of peritoneal cavity is a major problem. We describe a modified laparoscopic technique in which an endobag is placed in the stomach instead of the peritoneal cavity in order to avoid spillage of the bezoar during laparoscopic removal. PMID:27570860

  1. Laparoscopic versus open obesity surgery: a meta-analysis of pulmonary complications.

    PubMed

    Antoniou, Stavros Athanasios; Antoniou, George Athanasios; Koch, Oliver Owen; Köhler, Gernot; Pointner, Rudolph; Granderath, Frank-Alexander

    2015-01-01

    The clinical effects of laparoscopy in the pulmonary function of obese patients have been poorly investigated in the past. A systematic review was undertaken, with the objective to identify published evidence on pulmonary complications in laparoscopic surgery in the obese. Outcome measures included pulmonary morbidity, pulmonary infection and mortality. The random effects model was used to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) with 95% confidence interval (CI). A total of 6 randomized and 14 observational studies were included, which reported data on 185,328 patients. Pulmonary complications occurred in 1.6% of laparoscopic and in 3.6% of open procedures (OR 0.45, 95% CI 0.34-0.60). Pneumonia was reported in 0.5% and in 1.1%, respectively (OR 0.45, 95% CI 0.40-0.51). Available evidence suggests lower pulmonary morbidity for laparoscopic surgery in obese patients; further quality studies are however necessary to consolidate these findings. PMID:25765889

  2. Open versus Laparoscopic Surgery: Does the Surgical Technique Influence Pain Outcome? Results from an International Registry

    PubMed Central

    Allvin, Renée; Rawal, Narinder; Johanzon, Eva; Bäckström, Ragnar

    2016-01-01

    Postoperative pain management relevant for specific surgical procedures is debated. The importance of evaluating pain with consideration given to type of surgery and the patient's perspective has been emphasized. In this prospective cohort study, we analysed outcome data from 607 patients in the international PAIN OUT registry for assessment and comparison of postoperative pain outcome within the 24 first hours after laparoscopic and open colonic surgery. Patients from the laparoscopic group scored minimum pain at a higher level than the open group (P = 0.012). Apart from minimum pain, no other significant differences in patient reported outcomes were observed. Maximum pain scores >3 were reported from 77% (laparoscopic) and 68% (open) patients (mean ≥ 5 in both groups). Pain interference with mobilization was reported by 87–93% of patients. Both groups scored high levels of patient satisfaction. In the open group, a higher frequency of patients received a combination of general and regional anaesthesia, which had an impact of the minimum pain score. Our results from registry data indicate that surgical technique does not influence the quality of postoperative pain management during the first postoperative day if adequate analgesia is given. PMID:27127649

  3. Laparoscopic surgery for small-bowel obstruction caused by Meckel’s diverticulum

    PubMed Central

    Matsumoto, Takatsugu; Nagai, Motoki; Koike, Daisuke; Nomura, Yukihiro; Tanaka, Nobutaka

    2016-01-01

    A 26-year-old woman was referred to our hospital because of abdominal distention and vomiting. Contrast-enhanced computed tomography showed a blind loop of the bowel extending to near the uterus and a fibrotic band connecting the mesentery to the top of the bowel, suggestive of Meckel’s diverticulum (MD) and a mesodiverticular band (MDB). After intestinal decompression, elective laparoscopic surgery was carried out. Using three 5-mm ports, MD was dissected from the surrounding adhesion and MDB was divided intracorporeally. And subsequent Meckel’s diverticulectomy was performed. The presence of heterotopic gastric mucosa was confirmed histologically. The patient had an uneventful postoperative course and was discharged 5 d after the operation. She has remained healthy and symptom-free during 4 years of follow-up. This was considered to be an unusual case of preoperatively diagnosed and laparoscopically treated small-bowel obstruction due to MD in a young adult woman. PMID:26981191

  4. [A case of laparoscopic surgery for a rectal carcinoid after ALTA therapy for an internal hemorrhoid].

    PubMed

    Aomatsu, Naoki; Nakamura, Masanori; Hasegawa, Tsuyoshi; Nakao, Shigetomi; Uchima, Yasutake; Aomatsu, Keiho

    2014-11-01

    We report a case of laparoscopic surgery for a rectal carcinoid after aluminum potassium and tannic acid (ALTA) therapy for an internal hemorrhoid. A 66-year-old man was admitted to our hospital because of bleeding during defecation. He was diagnosed via anoscopy with Goligher grade II internal hemorrhoids. Examination via colonoscopy revealed 2 yellowish submucosal tumors in the lower rectum that were 5mm and 10mm in diameter. A rectal carcinoid tumor was diagnosed based on histopathology. Abdominal computed tomography demonstrated no metastases to the liver or lymph nodes. First, we performed ALTA therapy for the internal hemorrhoids. Two weeks later, we performed laparoscopic-assisted low anterior resection (D2) for the rectal carcinoid. The patient was discharged without complications and has not experienced recurrence during the 2 years of follow-up care. PMID:25731340

  5. Laparoscopic resection of a gastrointestinal stromal tumor of the lower rectum in a patient with coronary artery disease following long-term neoadjuvant imatinib treatment and anticoagulation therapy

    PubMed Central

    2014-01-01

    Surgery is the mainstay of treatment for gastrointestinal stromal tumors (GISTs). However, complete resection of rectal GISTs is sometimes difficult because of bulkiness and/or anatomical reasons. Neoadjuvant imatinib therapy has gained attention as an alternative treatment to increase the chance of en bloc resection of rectal GISTs, although it usually takes several months. In this case report, we first demonstrated that neoadjuvant imatinib therapy can be performed safely not only to downsize tumors, but also to allow adequate time for the effective treatment of major comorbid illnesses. A 74-year-old man was diagnosed with a 45 mm GIST of the lower rectum. He also had severe stenosis in the proximal segment of the left anterior descending coronary artery. Following the implantation of a drug-eluting stent, the patient received imatinib together with dual anti-platelet therapy for 12 months without obvious side effects. Follow-up image studies revealed tumor shrinkage as well as stent patency. En bloc resection of the GIST was performed laparoscopically, which preserved the anus. The patient is currently alive without any evidence of relapse for 12 months after surgery. PMID:25022862

  6. Design and Validation of an Augmented Reality System for Laparoscopic Surgery in a Real Environment

    PubMed Central

    López-Mir, F.; Naranjo, V.; Fuertes, J. J.; Alcañiz, M.; Bueno, J.; Pareja, E.

    2013-01-01

    Purpose. This work presents the protocol carried out in the development and validation of an augmented reality system which was installed in an operating theatre to help surgeons with trocar placement during laparoscopic surgery. The purpose of this validation is to demonstrate the improvements that this system can provide to the field of medicine, particularly surgery. Method. Two experiments that were noninvasive for both the patient and the surgeon were designed. In one of these experiments the augmented reality system was used, the other one was the control experiment, and the system was not used. The type of operation selected for all cases was a cholecystectomy due to the low degree of complexity and complications before, during, and after the surgery. The technique used in the placement of trocars was the French technique, but the results can be extrapolated to any other technique and operation. Results and Conclusion. Four clinicians and ninety-six measurements obtained of twenty-four patients (randomly assigned in each experiment) were involved in these experiments. The final results show an improvement in accuracy and variability of 33% and 63%, respectively, in comparison to traditional methods, demonstrating that the use of an augmented reality system offers advantages for trocar placement in laparoscopic surgery. PMID:24236293

  7. Enteroscopic Tattooing for Better Intraoperative Localization of a Bleeding Jejunal GIST Facilitates Minimally Invasive Laparoscopically-assisted Surgery.

    PubMed

    Iacob, Razvan; Dimitriu, Anca; Stanciulea, Oana; Herlea, Vlad; Popescu, Irinel; Gheorghe, Cristian

    2016-03-01

    We present the case of a 63-year-old man that was admitted for melena and severe anemia. Upper GI endoscopy and colonoscopy failed to identify the lesion responsible for bleeding, and enteroCT scan was also non-contributive to the diagnosis. Capsule endoscopy indicated possible jejunal bleeding but could not indicate the source of bleeding, recommending anterograde enteroscopy. Single balloon enteroscopy identified a 2 cm submucosal tumour in the distal part of the jejunum, with a macroscopic appearance suggesting a gastrointestinal stromal tumour (GIST). The tumor location was marked using SPOT tattoo and subsequently easily identified by the surgeon and resected via minimally invasive laparoscopic-assisted approach. Histological and immunohistochemical analysis indicated a low risk GIST. The unusual small size of the GIST as a modality of presentation, with digestive bleeding and anemia and the ability to use VCE/enteroscopy to identify and mark the lesion prior to minimally invasive surgery, represent the particularities of the presented case. PMID:27014761

  8. Gallbladder removal - laparoscopic

    MedlinePlus

    Laparoscopic gallbladder removal is surgery to remove the gallbladder using a medical device called a laparoscope. ... lets the doctor see inside your belly. Gallbladder removal surgery is done while you are under general ...

  9. The effects of sevoflurane and propofol anesthesia on cerebral oxygenation in gynecological laparoscopic surgery

    PubMed Central

    Kim, Sung-Jin; Cho, Ah-Reum; Kim, Hae Kyu; Kim, Tae Kyun

    2011-01-01

    Background Both the Trendelenburg position and pneumoperitoneum with carbon dioxide have been reported to increase intracranial pressure (ICP) and to alter cerebral blood flow or cerebral blood volume. Also anesthetic agents have variable effects on cerebral hemodynamics and ICP. The present study was conducted to determine whether regional cerebral oxygen saturation (rSO2) values differ between propofol and sevoflurane anesthesia during laparoscopic surgery in the Trendelenburg position. Methods Thirty-two adult women undergoing gynecological laparoscopic surgery were divided into sevoflurane and propofol groups. rSO2 values were recorded at 10 min after induction in the neutral position (Tpre), 10 min after the pneumoperitoneum in the Trendelenburg position (Tpt) and 10 min after desufflation in the neutral position (Tpost). For analysis of rSO2, we did ANOVA and univariate two-way ANCOVA with covariates being mean arterial pressure and end tidal carbon dioxide tension. Results Between sevoflurane and propofol groups, the change in rSO2 was significantly different even after ANCOVA. rSO2 at Tpt (76.3 ± 5.9% in sevoflurane vs 69.4 ± 5.8% in propofol) and Tpost (69.5 ± 7.1% in sevoflurane vs 63.8 ± 6.6% in propofol) were significantly higher in the sevoflurane group compared with the propofol group. In the propofol group, rSO2 at Tpost was significantly lower than at Tpre (71.1 ± 4.8%) and cerebral oxygen desaturation occurred in two patients (14.3%). Conclusions Significantly lower rSO2 values were observed in the propofol group during gynecological laparoscopic surgery. The possibility of cerebral oxygen desaturation should not be overlooked during propofol anesthesia even after desufflation of the abdomen in the neutral position. PMID:22025945

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

    PubMed Central

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

    2015-01-01

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

  11. Early experience with laparoscopic surgery in children in Ile-Ife, Nigeria

    PubMed Central

    Talabi, Ademola Olusegun; Adisa, Adewale Oluseye; Adefehinti, Olufemi; Sowande, Oludayo Adedapo; Etonyeaku, Amarachukwu Chiduziem; Adejuyigbe, Olusanya

    2015-01-01

    Background: Laparoscopy is not yet routinely employed in many Paediatric Surgical Units in Nigeria despite the advantages it offers. This study describes the preliminary experience with laparoscopic procedures in a single centre. Patients and Methods: A retrospective analysis of all children who had laparoscopic surgery between January 2009 and December 2013 at the Paediatric Surgical Unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis. Results: Eleven (44%) diagnostic and 14 (56%) therapeutic procedures were performed on 25 children whose age ranged from 5 months to 15 years (Median: 84 months, Mean: 103 ± 64.1 months), including eight (32%) females and 17 (68%) males. Indications included acute appendicitis in 12 (48%), intra-abdominal masses in six (24%), three (12%) disorders of sexual differentiation, two (8%) ventriculoperitoneal shunt malfunctions and impalpable undescended testes in two (8%) children. The procedures lasted 15-90 minutes (Mean = 54 (±21.6) minutes). Conversion rate was 17% for two patients who had ruptured retrocaecal appendices. No intra operative complications were recorded while three (12%) patients had superficial port site infections post-operatively. All diagnostic (11) and two therapeutic procedures were done as day case surgery. The mean duration of hospital stay was 3.1 (±3.3) days for those who had appendectomies. Conclusion: Laparoscopic surgery in children is safe and feasible in our hospital. We advocate increased use of laparoscopy in paediatric surgical practice in Nigeria and similar developing settings. PMID:25659546

  12. Gao’s double-way approach for laparoscopic D2 radical surgery for gastric cancer

    PubMed Central

    Gao, Yong-Shun; Sun, Jian-Gang; Huang, Jing-Jing; Chen, Peng

    2016-01-01

    Laparoscopic D2 radical surgery for gastric cancer is minimally invasive but complex. In this path: (1) Repeated operation of lesser curvature side; (2) The gastrohepatic ligament is relatively fixed. Hence, it is not easy to expose the suprapancreatic area; and (3) It is not easy to dissect No. 1, 12 lymph nodes. This area may not be sufficiently cleaned or surrounding vessels may be injured during a resection. So it is critical to choose position fixing, and a clear, fast and convenient operation path. The author, based on his experience, has established a set of procedural steps called “Gao’s double-way”, lesser omentum approach and traditional greater omentum approach, which are described in detail in this article. The path of this first approach is described as a “W” type of dissection. The second way is the traditional greater omentum approach, whose path is described as a “M” type of dissection. This will enable laparoscopic surgeons to select a suitable path. This new approach not only simplifies the surgery but also provides more space for the subsequent operation, thereby making the surgery more simple, safe and easy. PMID:27358674

  13. A user-friendly automated port placement planning system for laparoscopic robotic surgery

    NASA Astrophysics Data System (ADS)

    Torres, Luis G.; Azimian, Hamidreza; Enquobahrie, Andinet

    2014-03-01

    Laparoscopic surgery is a minimally invasive surgical approach in which surgical instruments are passed through ports placed at small incisions. This approach can benefit patients by reducing recovery times and scars. Surgeons have gained greater dexterity, accuracy, and vision through adoption of robotic surgical systems. However, in some cases a preselected set of ports cannot be accommodated by the robot; the robot's arms may cause collisions during the procedure, or the surgical targets may not be reachable through the selected ports. In this case, the surgeon must either make more incisions for more ports, or even abandon the laparoscopic approach entirely. To assist in this, we are building an easytouse system which, given a surgical task and preoperative medical images of the patient, will recommend a suitable port placement plan for the robotic surgery. This work bears two main contributions: 1) a high level user interface that assists the surgeon in operating the complicated underlying planning algorithm; and 2) an interface to assist the surgical team in implementation of the recommended plan in the operating room. We believe that such an automated port placement system would reduce setup time for robotic surgery and reduce the morbidity to patients caused by unsuitable surgical port placement.

  14. Carcinoembryonic antigen-producing adrenal adenoma resected using combined lateral and anterior transperitoneal laparoscopic surgery

    PubMed Central

    Hori, Tomohide; Taniguchi, Kentaro; Kurata, Masashi; Nakamura, Kenji; Kato, Kenji; Ogura, Yoshifumi; Iwasaki, Makoto; Okamoto, Shinya; Yamakado, Koichiro; Yagi, Shintaro; Iida, Taku; Kato, Takuma; Saito, Kanako; Wang, Linan; Kawarada, Yoshifumi; Uemoto, Shinji

    2007-01-01

    A 74-year-old woman presented with symptoms consistent with hyperadrenocorticism and hyperca-techolaminism. She had a cushingoid appearance and her cortisol level was elevated. Her serum dopamine and noradrenalin levels were also elevated. Computed tomography detected a left adrenal mass measuring 3.5 cm × 3.0 cm in diameter. Metaiodobenzylguanidine scintigraphy was negative. Unexpectedly, the serum Serum carcinoembryonic antigen (CEA) level was elevated. Fluorodeoxyglucose positron emission tomography showed increased uptake in the adrenal tumor only, with a maximum standardized uptake value of 2.8. Selective venography and blood sampling revealed that the concentrations of cortisol, catecholamines and CEA were significantly elevated in the vein draining the tumor. A diagnosis of CEA-producing benign adenoma was made. After preoperative management, we performed a combined lateral and anterior transperitoneal laparoscopic adrenectomy. Her vital signs remained stable during surgery. Histopathological examination revealed a benign adenoma. Her cortisol, catecholamine and CEA levels normalized immediately after surgery. We present, to the best of our knowledge, the first case of CEA-producing adrenal adenoma, along with a review of the relevant literature, and discuss our laparoscopic surgery techniques. PMID:18023107

  15. Design of a 4 DOF laparoscopic surgery robot for manipulation of large organs.

    PubMed

    Alamdar, Alireza; Mirbagheri, Alireza; Farahmand, Farzam; Durali, Mohammad

    2012-01-01

    In this paper, a 4-DOF robotic arm for tool handling in laparoscopic surgery is introduced. The robot provides sufficient force to handle endoscopic tools used for large organ manipulation and is capable of measuring the tool-tissue forces. The RCM constraint is achieved using a spherical mechanism and roll and insertion motions are provided using time pulley and spindle-drive, respectively. The forward and inverse kinematics of the robot was solved and the dimensions of its links were determined, using particle swarm optimization method, so that the maximum kinematic and dynamic performance could be achieved. PMID:22356948

  16. Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery

    PubMed Central

    2012-01-01

    Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac arrest due to a venous carbon dioxide (CO2) embolism as identified by transthoracic echocardiography and aspiration of approximately 7 ml of gas from a central venous catheter. She was resuscitated and subsequently treated with hyperbaric oxygen to reduce the size of remaining gas bubbles. Subsequently the patient developed one more episode of cardiac arrest but still made a full recovery. The courses of events indicate that bubbles had persisted in the circulation for a prolonged period. We speculate whether insufficient CO2 flushing of the laparoscopic tubing, causing air to enter the peritoneal cavity, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient. PMID:22862957

  17. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery.

    PubMed

    Doger, Cihan; Kahveci, Kadriye; Ornek, Dilsen; But, Abdulkadir; Aksoy, Mustafa; Gokcinar, Derya; Katar, Didem

    2016-01-01

    Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n = 30) and low-flow sevoflurane anesthesia group (Group L, n = 30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy. PMID:27413741

  18. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

    PubMed Central

    Doger, Cihan; Kahveci, Kadriye; Ornek, Dilsen; But, Abdulkadir; Aksoy, Mustafa; Gokcinar, Derya; Katar, Didem

    2016-01-01

    Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n = 30) and low-flow sevoflurane anesthesia group (Group L, n = 30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy. PMID:27413741

  19. 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

  20. Laparoscopic surgery for patients with colorectal cancer produces better short-term outcomes with similar survival outcomes in elderly patients compared to open surgery.

    PubMed

    Moon, Soo Yun; Kim, Sohee; Lee, Soo Young; Han, Eon Chul; Kang, Sung-Bum; Jeong, Seung-Yong; Park, Kyu Joo; Oh, Jae Hwan

    2016-06-01

    The number of operations on elderly colorectal cancer (CRC) patients has increased with the aging of the population. The aim of this study was to evaluate surgical outcomes in elderly patients who underwent laparoscopic or open surgery for CRC. We analyzed the data of 280 patients aged 80 or over who underwent surgery for CRC between January 2001 and December 2010. Seventy-one pairs were selected after propensity score matching for laparoscopic or open surgery. Operative time, return to normal bowel function, length of hospital stay, postoperative complications, overall survival (OS), recurrence-free survival (RFS), and prognostic factors affecting survival were investigated. In matched cohorts, operative time in the laparoscopic group was longer than in the open group (P < 0.001). In the laparoscopic group, time to flatus passage (P < 0.001) and length of postoperative hospital stay (P = 0.037) were shorter than in the open group. The rate of operation-related morbidity was higher in the open group (P = 0.019). There was no difference in OS and RFS between two groups. This study suggests that laparoscopic surgery for CRC in elderly patients may be safe and feasible, with better short-term outcomes. OS and RFS, however, were not different in both groups. PMID:26923309

  1. Segmentation of Uterus Using Laparoscopic Ultrasound by an Image-Based Active Contour Approach for Guiding Gynecological Diagnosis and Surgery.

    PubMed

    Gong, Xue-Hao; Lu, Jun; Liu, Jin; Deng, Ying-Yuan; Liu, Wei-Zong; Huang, Xian; Yang, Yong-Heng; Xu, Qin; Yu, Zhi-Ying

    2015-01-01

    In laparoscopic gynecologic surgery, ultrasound has been typically implemented to diagnose urological and gynecological conditions. We applied laparoscopic ultrasonography (using Esaote 7.5~10MHz laparoscopic transducer) on the retrospective analyses of 42 women subjects during laparoscopic extirpation and excision of gynecological tumors in our hospital from August 2011 to August 2013. The objective of our research is to develop robust segmentation technique for isolation and identification of the uterus from the ultrasound images, so as to assess, locate and guide in removing the lesions during laparoscopic operations. Our method enables segmentation of the uterus by the active contour algorithm. We evaluated 42 in-vivo laparoscopic images acquired from the 42 patients (age 39.1 ± 7.2 years old) and selected images pertaining to 4 cases of congenital uterine malformations and 2 cases of pelvic adhesions masses. These cases (n = 6) were used for our uterus segmentation experiments. Based on them, the active contour method was compared with the manual segmentation method by a medical expert using linear regression and the Bland-Altman analysis (used to measure the correlation and the agreement). Then, the Dice and Jaccard indices are computed for measuring the similarity of uterus segmented between computational and manual methods. Good correlation was achieved whereby 84%-92% results fall within the 95% confidence interval in the Student t-test) and we demonstrate that the proposed segmentation method of uterus using laparoscopic images is effective. PMID:26516767

  2. Segmentation of Uterus Using Laparoscopic Ultrasound by an Image-Based Active Contour Approach for Guiding Gynecological Diagnosis and Surgery

    PubMed Central

    Gong, Xue-Hao; Lu, Jun; Liu, Jin; Deng, Ying-Yuan; Liu, Wei-Zong; Huang, Xian; Yang, Yong-Heng; Xu, Qin; Yu, Zhi-Ying

    2015-01-01

    In laparoscopic gynecologic surgery, ultrasound has been typically implemented to diagnose urological and gynecological conditions. We applied laparoscopic ultrasonography (using Esaote 7.5~10MHz laparoscopic transducer) on the retrospective analyses of 42 women subjects during laparoscopic extirpation and excision of gynecological tumors in our hospital from August 2011 to August 2013. The objective of our research is to develop robust segmentation technique for isolation and identification of the uterus from the ultrasound images, so as to assess, locate and guide in removing the lesions during laparoscopic operations. Our method enables segmentation of the uterus by the active contour algorithm. We evaluated 42 in-vivo laparoscopic images acquired from the 42 patients (age 39.1 ± 7.2 years old) and selected images pertaining to 4 cases of congenital uterine malformations and 2 cases of pelvic adhesions masses. These cases (n = 6) were used for our uterus segmentation experiments. Based on them, the active contour method was compared with the manual segmentation method by a medical expert using linear regression and the Bland-Altman analysis (used to measure the correlation and the agreement). Then, the Dice and Jaccard indices are computed for measuring the similarity of uterus segmented between computational and manual methods. Good correlation was achieved whereby 84%–92% results fall within the 95% confidence interval in the Student t-test) and we demonstrate that the proposed segmentation method of uterus using laparoscopic images is effective. PMID:26516767

  3. Gastrointestinal surgery and the acquired immune deficiency syndrome

    PubMed Central

    Weledji, Elroy P.; Nsagha, Dickson; Chichom, Alain; Enoworock, George

    2015-01-01

    Acquired immune-deficiency syndrome (AIDS) is becoming an increasing problem to the surgeon. The impact of HIV/AIDS on surgical practice include the undoubted risk to which the surgeon will expose him or herself, the atypical conditions that may be encountered and the outcome and long term benefit of the surgical treatment in view of disease progression. The two factors most associated with surgical outcome and poor wound healing were AIDS and poor performance status (ASA score). This article questions whether gastrointestinal surgical procedures can be safe and effective therapeutic measures in HIV/AIDS patients and if surgical outcome is worthy of the surgeon's ethical responsibility to treat. As HIV/AIDS patients are not a homogeneous group, with careful patient selection, emergency laparotomy for peritonitis confers worthwhile palliation. However, aggressive surgical intervention must be undertaken with caution and adequate peri-operative care is required. Symptomatic improvement of anorectal pathology may make delayed wound healing an acceptable complication. Alternatives to surgery can be contemplated for diagnosis, prophylaxis or palliation. PMID:25685343

  4. Measurement of the Physical Properties during Laparoscopic Surgery Performed on Pigs by Using Forceps with Pressure Sensors.

    PubMed

    Yamanaka, Hiroyuki; Makiyama, Kazuhide; Osaka, Kimito; Nagasaka, Manabu; Ogata, Masato; Yamada, Takahiro; Kubota, Yoshinobu

    2015-01-01

    Objectives. Here we developed a unique training system, a patient specific virtual reality simulator, for laparoscopic renal surgery. To develop the simulator, it was important to first identify the physical properties of the organ. Methods. We recorded the force measured during laparoscopic surgery performed on pigs by using forceps with pressure sensors. Several sensors, including strain gauges, accelerometers, and a potentiometer, are attached to the forceps. Results. Throughout the experiment, we measured the reaction force in response to the forceps movement in real time. Conclusions. The experiment showed the possibility of digitizing these physical properties in humans as well. PMID:25784932

  5. Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma.

    PubMed

    Hur, Hoon; Son, Sang-Yong; Cho, Yong Kwan; Han, Sang-Uk

    2016-01-01

    Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during totally laparoscopic gastrectomy (TLG). The aim of this protocol is to introduce a procedure for intraoperative gastroscopy, in order to directly mark tumors during TLG for gastric cancer in the middle third of the stomach. Patients who were diagnosed with adenocarcinoma in the middle third of the stomach were enrolled in this case series. Before surgery, additional gastroscopy for tumor localization is not performed. Under general anesthesia, laparoscopic mobilization of the stomach is performed first. After the first portion of the duodenum is mobilized from the pancreas and clamped, the surgeon moves to the other side for the gastroscopic procedure. On the insertion of a gastroscope through the oral cavity into the stomach, 2 - 3 cc of indigo carmine is administered via an endoscopic injector into the gastric muscle layer at the proximal margin of the stomach. The location of stained serosa in the laparoscopic view is used to guide distal subtotal gastrectomy, however, total gastrectomy is performed if the tumor is too close to the esophagogastric junction. A specimen is sampled after distal gastrectomy to confirm sufficient length from resection margin to tumor before reconstruction. In our case series, all patients had tumor-free margins and required no additional resection. There was no morbidity related to the gastroscopic procedure, and the time required for the procedure has gradually decreased to about five minutes. Intraoperative gastroscopy for tumor localization is an accurate and tolerated method for gastric cancer patients undergoing totally laparoscopic distal gastrectomy. PMID:27584713

  6. A single-institution review of the absorbable clips used in laparoscopic colorectal and gallbladder surgery: feasibility, safety, and effectiveness.

    PubMed

    Feroci, Francesco; Lenzi, Elisa; Kröning, Katrin C; Scatizzi, Marco

    2011-06-01

    This retrospective study was conducted to examine the safety and effectiveness of polymeric absorbable clips in laparoscopic gallbladder and colorectal surgery. The prospectively maintained database review included all patients undergoing elective laparoscopic cholecystectomy and colorectal resection at the institution between November 2004 and December 2009. In each patient, absorbable clips were used as the only system of vascular and cystic duct ligation. Of the 911 patients who satisfied the inclusion criteria, 664 underwent laparoscopic cholecystectomy and 247 underwent laparoscopic colonic resection. No intra-operative or post-operative bleeding related to absorbable clip use occurred in either procedure. No bile duct injuries or cystic duct leakages were observed. There were no peri-operative deaths with either procedure. In this experience, absorbable clips demonstrated easy handling and high reliability. They provided safe hemostasis and permitted complete and adequate oncologic resection. PMID:21394536

  7. [Mutual influence and development between Gastrointestinal surgery and hernia and abdominal wall surgery].

    PubMed

    Chen, Shuang

    2015-11-25

    The aim of this article is to expound on the crossing and influence each other of gastrointestinal surgery and abdominal wall hernia surgery. Although these two departments are independent respectively, but due to the existence of association among anatomy, physiology and pathology, so they are also overlapping. First of all, the abdominal wall and digestive tract are interdependent, and the abdominal wall provides "protection" for gut. In case of large abdominal wall defect, intra-abdominal viscera, breathing, circulation system and spine will change accordingly. In addition, when intra-abdominal pressure increases due to various reasons, laparotomy is an effective way. But laparotomy is not an easy case, but a crisis. One of the most difficult problems is "enteroatmospheric fistulae". Therefore, to avoid serious complications after laparotomy, the concept of planned ventral hernia is proposed. When life safety is threatened by inter-abdominal hypertension, planned abdominal wall hernia is the style to save life. This is a kind of concept of innovation, and is the concrete practice of the theory of damage control surgery. For a planned abdominal wall hernia patient, it is better to wait and watch, and after making a comprehensive assessment, multidisciplinary collaboration mode should be applied to ensure the safety of surgery. PMID:26616795

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

    PubMed

    Evans, Luke; Manley, Kate

    2016-06-01

    Single-incision laparoscopic surgery represents an evolution of minimally invasive techniques, but has been a controversial development. A cosmetic advantage is stated by many authors, but has not been found to be universally present or even of considerable importance by patients. This systematic review and meta-analysis demonstrates that there is a cosmetic advantage of the technique regardless of the operation type. The treatment effect in terms of cosmetic improvement is of the order of 0.63. PMID:27213788

  9. Recovery of gastrointestinal function with thoracic epidural vs. systemic analgesia following gastrointestinal surgery.

    PubMed

    Shi, W-Z; Miao, Y-L; Yakoob, M Y; Cao, J-B; Zhang, H; Jiang, Y-G; Xu, L-H; Mi, W-D

    2014-09-01

    The objective of this review was to systematically assess the effect of thoracic epidural analgesia (TEA) vs. systemic analgesia (SA) on the recovery of gastrointestinal (GI) function in patients following GI surgery. We performed a comprehensive literature search to identify randomized controlled trials of adult patients undergoing GI surgery, comparing the effect of two postoperative analgesia regimens. Patients postoperatively receiving local anesthesia-based TEA with or without opioids were compared to patients receiving opioid-based SA. The outcomes considered were times to GI function recovery, GI complications, and specific side effects. Twelve studies with 331 patients in the TEA group and 319 in the SA group were included. Compared to SA, TEA improved the GI recovery after GI procedures by shortening the time to first passage of flatus by 31.3 h, 95% confidence intervals (CIs): -33.2 to -29.4, P < 0.01; and shortening the time to first passage of stool by 24.1 h, 95% CIs: -27.2 to -20.9, P < 0.001. There was no difference between the groups in the incidence of anastomotic leakage and ileus. The occurrence of postoperative hypotension was relatively higher in the TEA group, risk ratio: 7.9, 95% CIs: 2.4 to 26.5, P = 0.001; other side effects (such as pruritus and vomiting) were similar in the two groups. There is evidence that TEA (compared to SA) improves the recovery of GI function after GI procedures without any increased risk of GI complications. To further confirm these effects, larger, better quality randomized controlled trials with standard outcome measurements are needed. PMID:25060245

  10. Changes in cerebral oxygen saturation and early postoperative cognitive function after laparoscopic gastrectomy: a comparison with conventional open surgery

    PubMed Central

    Jo, Youn Yi; Kim, Jong Yeop; Lee, Mi Geum; Lee, Seul Gi

    2016-01-01

    Background Laparoscopic gastrectomy requires a reverse-Trendelenburg position and prolonged pneumoperitoneum and it could cause significant changes in cerebral homeostasis and lead to cognitive dysfunction. We compared changes in regional cerebral oxygen saturation (rSO2), early postoperative cognitive function and hemodynamic variables in patients undergoing laparoscopic gastrectomy with those patients that underwent conventional open gastrectomy. Methods Sixty patients were enrolled in this study and the patients were distributed to receive either laparoscopic gastrectomy (laparoscopy group, n = 30) or open conventional gastrectomy (open group, n = 30). rSO2, end-tidal carbon dioxide tension, hemodynamic variables and arterial blood gas analysis were monitored during the operation. The enrolled patients underwent the mini-mental state examination 1 day before and 5 days after surgery for evaluation of early postoperative cognitive function. Results Compared to baseline value, rSO2 and end-tidal carbon dioxide tension increased significantly in the laparoscopy group after pneumoperitoneum, whereas no change was observed in the open group. No patient experienced cerebral oxygen desaturation or postoperative cognitive dysfunction. Changes in mean arterial pressure over time were significantly different between the groups (P < 0.001). Conclusions Both laparoscopic and open gastrectomy did not induce cerebral desaturation or early postoperative cognitive dysfunction in patients under desflurane anesthesia. However, rSO2 values during surgery favoured laparoscopic surgery, which was possibly related to increased cerebral blood flow due to increased carbon dioxide tension and the effect of a reverse Trendelenburg position. PMID:26885301

  11. Prospective Study of Laparoscopic Nissen Fundoplication in a Community Hospital and Its Effect on Typical, Atypical, and Nonspecific Gastrointestinal Symptoms

    PubMed Central

    Danielson, Amanda; Maxwell, J. Gary; Harris, James A.

    2007-01-01

    Background: Laparoscopic Nissen fundoplication (LNF) provides long-term improvement in the typical symptoms of gastroesophageal reflux disease. Few studies have prospectively addressed LNF in the community hospital or the effect of LNF on specific atypical symptoms, other related gastrointestinal symptoms, and weight change. Methods: Data were collected prospectively on consecutive patients having LNF. Three typical, 6 atypical, and 3 other gastrointestinal symptoms were studied. Results: Short-term data on 91 patients and long-term data on 84 patients were studied. Overall long-term improvement was 98%. Regarding typical symptoms, the greatest improvement occurred in heartburn and regurgitation. Regarding atypical symptoms, the greatest improvement occurred in cough and sore throat, but chest pain, hoarseness, and throat clearing also showed significant durable improvement. Bloating, nausea, and diarrhea showed no significant change from preoperative to postoperative surveys. Mild weight loss was common. Conclusion: LNF can be safely performed in a community hospital with results equal to those of university hospitals. Improvement in typical symptoms was greater than improvement in atypical symptoms, but results for both were significant and durable. Nonspecific gastrointestinal symptoms, such as nausea, bloating, and diarrhea, may be unrelated to Nissen fundoplication. PMID:17651559

  12. The MITK image guided therapy toolkit and its application for augmented reality in laparoscopic prostate surgery

    NASA Astrophysics Data System (ADS)

    Baumhauer, Matthias; Neuhaus, Jochen; Fritzsche, Klaus; Meinzer, Hans-Peter

    2010-02-01

    Image Guided Therapy (IGT) faces researchers with high demands and efforts in system design, prototype implementation, and evaluation. The lack of standardized software tools, like algorithm implementations, tracking device and tool setups, and data processing methods escalate the labor for system development and sustainable system evaluation. In this paper, a new toolkit component of the Medical Imaging and Interaction Toolkit (MITK), the MITK-IGT, and its exemplary application for computer-assisted prostate surgery are presented. MITK-IGT aims at integrating software tools, algorithms and tracking device interfaces into the MITK toolkit to provide a comprehensive software framework for computer aided diagnosis support, therapy planning, treatment support, and radiological follow-up. An exemplary application of the MITK-IGT framework is introduced with a surgical navigation system for laparos-copic prostate surgery. It illustrates the broad range of application possibilities provided by the framework, as well as its simple extensibility with custom algorithms and other software modules.

  13. Laparoscopic surgery on broken points for uterine sarcoma in the early stage decrease prognosis

    PubMed Central

    Liu, Hong; Zhu, Yi; Zhang, Guo-Nan; Wang, Chang; Li, Chao; Shi, Yu

    2016-01-01

    Uterine sarcoma, a rare solid tumor in uterus, is difficult to identify in the early stage from some benign uterine tumors, such as uterine fibroids. Hence, uterine sarcoma may be treated in the same way as uterine fibroids; and this may not be found until pathological diagnosis. Consequently, this can lead to tumor’s abdominal spread, planting and local invasive growth, resulting in an early uterine sarcoma, an increased relapse rate after surgery and a decreased survival. Therefore, it’s important to avoid these unintended and iatrogenic complications through an accurate diagnosis and an appropriate surgical approach. The surgical staging and a complete resection of the tumor are both important for patients’ prognosis. In this review, we will discuss the laparoscopic surgery for uterine sarcoma in the early stage and patients’ prognosis. PMID:27503773

  14. Laparoscopic surgery on broken points for uterine sarcoma in the early stage decrease prognosis.

    PubMed

    Liu, Hong; Zhu, Yi; Zhang, Guo-Nan; Wang, Chang; Li, Chao; Shi, Yu

    2016-01-01

    Uterine sarcoma, a rare solid tumor in uterus, is difficult to identify in the early stage from some benign uterine tumors, such as uterine fibroids. Hence, uterine sarcoma may be treated in the same way as uterine fibroids; and this may not be found until pathological diagnosis. Consequently, this can lead to tumor's abdominal spread, planting and local invasive growth, resulting in an early uterine sarcoma, an increased relapse rate after surgery and a decreased survival. Therefore, it's important to avoid these unintended and iatrogenic complications through an accurate diagnosis and an appropriate surgical approach. The surgical staging and a complete resection of the tumor are both important for patients' prognosis. In this review, we will discuss the laparoscopic surgery for uterine sarcoma in the early stage and patients' prognosis. PMID:27503773

  15. [Laparoscopic Surgery for Adult Intussusception Due to Rectal Cancer--A Case Report].

    PubMed

    Ishikawa, Akira; Higuchi, Ichiro; Akiyama, Yosuke; Tanigawa, Takahiko; Hasuike, Yasunori

    2015-11-01

    An 87-year-old woman with the chief complaint of bloody stool was referred to our hospital from an institution for the aged. The abdomen was soft and flat, and a tumor was not palpable on digital rectal examination. Tumor markers were within normal ranges. Abdominal enhanced CT scan showed a multiple concentric ring sign at the rectum. Colonoscopic and barium examination led to a diagnosis of rectal intussusception due to rectal cancer. We first tried to reposition it preoperatively, but it was impossible. She fortunately had no symptoms of ileus; therefore, we chose to perform laparoscopic surgery. We achieved the reposition intraoperatively and performed Hartmann's operation with D2 lymph node dissection because she was a very elderly patient with high-risk comorbidities. The pathological diagnosis was as follows: RS, 40×40 mm, type 2, tub2, pT3 (SS), pN0, ly0, v0, pStageⅡ, R0, Cur A. Adult intussusception due to rectal cancer is extremely rare. We report that in this case that laparoscopic surgery was possible, along with a review of the relevant literature. PMID:26805342

  16. Retrocecal hernia successfully treated with laparoscopic surgery: A case report and literature review of 15 cases in Japan

    PubMed Central

    Sasaki, Kazuhito; Kawasaki, Hiroshi; Abe, Hideki; Nagai, Hideo; Yoshimi, Fuyo

    2015-01-01

    Introduction Retrocecal hernia is rare and involves strangulation ileus, and therefore, frequently requires emergency surgery following conservative therapy. Presentation of case We report an interesting case of a retrocecal hernia in a 65-year-old man, with a history of diabetes mellitus. The patient was admitted to our hospital with severe periumbilical pain and nausea. Abdominal computed tomography revealed an intestinal obstruction at a pericecal site, and dilatation of the small bowel at the oral side of the obstruction. The patient was initially treated with conservative therapy using long intestinal tube placement. On the 12th hospital day, the patient’s symptoms had not resolved, and laparoscopic surgery was performed. We diagnosed a retrocecal hernia based on laparoscopic findings and repaired it. The patient was discharged without complications on the 7th postoperative day. Discussion and conclusion Using laparoscopic exploration and suturing, we were able to perform a minimally invasive operation that may have promoted an earlier hospital discharge. PMID:26688512

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

    PubMed

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

    2015-01-01

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

  18. Proximal anastomosis using the OrVil circular stapler in major upper gastrointestinal surgery.

    PubMed

    Knight, Benjamin C; Rice, Samuel J; Devitt, Peter G; Lord, Andrew; Game, Philip A; Thompson, Sarah K

    2014-07-01

    Anastomoses in major upper gastrointestinal surgery can be technically demanding, especially handsewn anastomoses traversing the diaphragmatic hiatus. The OrVil stapler is a unique circular stapler that allows rapid creation of various upper gastrointestinal anastomoses in technically challenging circumstances, particularly if additional proximal clearance is desirable. Little is reported in the literature regarding its outcomes and complication rates. In this 'How I do It' article, we describe our technique and experience with the OrVil in major upper gastrointestinal surgery. PMID:24553876

  19. Elective surgery for gastrointestinal tumours in the elderly.

    PubMed

    Audisio, R A; Veronesi, P; Ferrario, L; Cipolla, C; Andreoni, B; Aapro, M

    1997-04-01

    The geriatric population is expanding and clinical decision-making is often complicated by the effects of ageing. Age should not be the only parameter considered when addressing medical problems. Elderly subjects have been denied surgery because of their presumed higher mortality and morbidity. The present review summarises the physiology of the aged and discusses operative risks, mortality and morbidity rates as well as therapeutic results for the different gastrointestinal sites when affected by cancer. Reports on surgical treatments are revisited and compared to the same procedures delivered to younger patients in the context of the ethical issue of offering the best care to every patient. Elective operations by surgical oncologists are found to be safe with the exception of major liver resections. Complication rates and mean hospital stay do not differ between the two age groups provided the procedure is conducted with the best-known technique in expert hands. A drop in operative morbidity has occurred in the past three decades. Several investigators have emphasised the marked increase in morbidity and mortality experienced by elderly patients when undergoing emergency procedures. Associated diseases have to be properly assessed, as the elderly have a frail physiological balance with a reduced capacity for recovery from traumatic events including major surgical procedures. Careful preoperative evaluation, intraoperative conduct and postoperative care are presently achieved in almost every major hospital. Good clinical practice is based on the balance between probability of cure and toxic effects. Treatment of the elderly should no longer be based on untested beliefs and personal opinions. The elderly should be accrued for prospective clinical evaluation and should not be denied optimal surgical treatment. PMID:9209660

  20. Laparoscopic vs conventional tension free inguinal herniorrhaphy: 2005 society of American Gastrointestinal Endoscopic Surgeons (SAGES) annual meeting debate.

    PubMed

    Puri, V; Felix, E; Fitzgibbons, R J

    2006-12-01

    This report summarizes the 2005 Society of American Gastrointestinal and Endoscopic Surgeons' inguinal herniorrhaphy debate. Most inguinal herniorrhaphies in the United States are performed using one of several prosthesis-based, tension-free (TFR) procedures. Approximately 15% of the procedures used are laparoscopic inguinal herniorrhaphies (LIH). Technical ease, lower cost, and local anesthesia are the major advantages attributed to TFR, whereas superior cosmesis, less perioperative pain, and a faster return to normal activity is attributed to LIH. The overall cost-benefit ratio, incidence of chronic pain syndromes, and relevance of a recent major trial could not be entirely settled in this debate. The importance of adequate training for surgeons undertaking LIH cannot be overemphasized. Experienced surgeons displaying equivalent results for LIH and TFR are justified in offering LIH to patients with primary unilateral inguinal hernias. PMID:17024526

  1. Multicenter Analysis of Long-Term Oncologic Impact of Anastomotic Leakage After Laparoscopic Total Mesorectal Excision: The Korean Laparoscopic Colorectal Surgery Study Group.

    PubMed

    Kang, Jeonghyun; Choi, Gyu-Seog; Oh, Jae Hwan; Kim, Nam Kyu; Park, Jun Seok; Kim, Min Jung; Lee, Kang Young; Baik, Seung Hyuk

    2015-07-01

    This study aims to validate the oncologic outcomes of anastomotic leakage (AL) after laparoscopic total mesorectal excision (TME) in a large multicenter cohort. The impact of AL after laparoscopic TME for rectal cancer surgery has not yet been clearly described. This was a multicenter retrospective study of 1083 patients who underwent laparoscopic TME for nonmetastatic rectal cancer (stage 0-III). AL was defined as an anastomotic complication within 30 days of surgery irrespective of requiring a reoperation or interventional radiology. Estimated local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were compared between the leakage group and the no leakage group using the log-rank method. Multivariate Cox-regression analysis was used to adjust confounding for survival. The incidence of AL was 6.4%. Mortality within 30 days of surgery occurred in 1 patient (1.4%) in the leakage group and 2 patients (0.2%) in the no leakage group. The leakage group showed a higher LR rate (6.4% vs 1.8%, P = 0.011). Five-year DFS and OS were significantly lower in the leakage group than the no leakage group (DFS 71.7% vs 82.1%, P = 0.016, OS 81.8% vs 93.5%, P = 0.007). Multivariate analysis showed that AL was an independent poor prognostic factor for DFS and OS (hazard ratio [HR] = 1.6; 95% confidence intervals [CI]: 1.0-2.6; P = 0.042, HR = 2.1; 95% CI: 1.0-4.2; P = 0.028, respectively). AL after laparoscopic TME was significantly associated with an increased rate of LR, systemic recurrence and poor OS. PMID:26200636

  2. Single-incision laparoscopic surgery using a homemade transumbilical port for synchronous colon and hepatic lesions: a case report.

    PubMed

    Chen, Chuang-Wei; Hsiao, Koung-Hong; Chang, Yao-Jen; Lai, Chieh-Wen

    2013-08-01

    Single-incision laparoscopic surgery (SILS) is an emerging technique and has been utilized in various abdominal surgeries. Herein, we reported a case of synchronous colon and hepatic lesions that underwent right hemicolectomy and wedge resection of the liver by SILS. To the best of our knowledge, this is the first case report of synchronous colon and liver resection with SILS using homemade transumbilical port. PMID:23917608

  3. Laparoscopic fertility-sparing surgery for early stage ovarian cancer: a single-centre case series and systematic literature review

    PubMed Central

    2014-01-01

    Background There is as yet limited evidence about fertility-sparing surgery for early ovarian cancer (EOC) carried out laparoscopically. We sought to analyze recurrence patterns and fertility outcome in a cohort of ovarian cancer patients who underwent fertility-saving laparoscopic surgical staging. Methods We conducted a retrospective analysis of prospectively collected data on all patients undergoing fertility-sparing laparoscopic staging procedures for presumed EOC at a single gynecologic oncology service. Oncologic safety and reproductive outcome were the main outcome measures. The pertinent literature is reviewed. Results The study cohort consisted of 12 women. Cases included 5 invasive epithelial tumors and 7 nonepithelial tumors. The disease was reclassified to a higher stage in one woman. After a median follow up period of 38 months (range: 14–108), the overall survival was 100% and recurrence-free survival 90.9%. Five (100%) of patients who attempted pregnancy conceived spontaneously. Three of them had uneventful term pregnancy delivering healthy babies. The literature search yielded 62 cases of laparoscopic fertility conserving surgery for ovarian cancer. There were 4 (6.2%) recurrences. Cumulative pregnancy and live birth rate were not estimable as earlier publications lack essential data. Conclusions Laparoscopic staging may represent a viable option for premenopausal women seeking fertility preservation in the setting of early ovarian cancer. More research is needed to determine whether laparoscopy may offer reproductive benefits to this particular population. PMID:24917888

  4. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery.

    PubMed

    Jeanne, M; Clément, C; De Jonckheere, J; Logier, R; Tavernier, B

    2012-08-01

    The analgesia nociception index (ANI) is an online heart rate variability analysis proposed for assessment of the antinociception/nociception balance. In this observational study, we compared ANI with heart rate (HR) and systolic blood pressure (SBP) during various noxious stimuli in anaesthetized patients. 15 adult patients undergoing laparoscopic appendectomy or cholecystectomy were studied. Patients received target controlled infusions of propofol (adjusted to maintain the Bispectral index in the range [40-60]) and remifentanil (with target increase in case of haemodynamic reactivity [increase in HR and/or SBP >20% of baseline]), and cisatracurium. Medical staff was blind to the ANI monitor. ANI and haemodynamic data were recorded at predefined times before and during surgery, including tetanic stimulation of the ulnar nerve before start of surgery. Anaesthesia induction decreased HR and SBP, while high ANI values (88 [17]) were recorded, indicating parasympathetic predominance. In 10 out of 11 patients, tetanic stimulation led to a transient (<5 min) decrease in ANI to 48 (40) whereas HR and SBP did not change. After start of surgery, ANI decreased to 60 (39) and decreased further to 50 (15) after the pneumoperitoneum was inflated, while there was no significant change in HR or SBP. When haemodynamic reactivity occurred, ANI had further decreased to 40 (15). After completion of surgery, ANI returned to 90 (34). ANI seems more sensitive than HR and SBP to moderate nociceptive stimuli in propofol-anaesthetized patients. Whether ANI monitoring may allow preventing haemodynamic reactivity to noxious stimuli remains to be demonstrated. PMID:22454275

  5. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial

    PubMed Central

    Andersson, J; Angenete, E; Gellerstedt, M; Angerås, U; Jess, P; Rosenberg, J; Fürst, A; Bonjer, J; Haglind, E

    2013-01-01

    Background Previous studies comparing laparoscopic and open surgical techniques have reported improved health-related quality of life (HRQL). This analysis compared HRQL 12 months after laparoscopic versus open surgery for rectal cancer in a subset of a randomized trial. Methods The setting was a multicentre randomized trial (COLOR II) comparing laparoscopic and open surgery for rectal cancer. Involvement in the HRQL study of COLOR II was optional. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38, and EuroQol – 5D (EQ-5D™) before surgery, and 4 weeks, 6, 12 and 24 months after operation. Analysis was done according to the manual for each instrument. Results Of 617 patients in hospitals participating in the HRQL study of COLOR II, 385 were included. The HRQL deteriorated to moderate/severe degrees after surgery, gradually returning to preoperative values over time. Changes in EORTC QLQ-C30 and QLQ-CR38, and EQ-5D™ were not significantly different between the groups regarding global health score or any of the dimensions or symptoms at 4 weeks, 6 or 12 months after surgery. Conclusion In contrast to previous studies in patients with colonic cancer, HRQL after rectal cancer surgery was not affected by surgical approach. Registration number: NCT0029779 (http://www.clinicaltrials.gov). PMID:23640671

  6. Outcomes of laparoscopic fertility-sparing surgery in clinically early-stage epithelial ovarian cancer

    PubMed Central

    Park, Jin-Young; Lee, Yoo-Young; Kim, Tae-Joong; Kim, Byoung-Gie; Bae, Duk-Soo

    2016-01-01

    Objective Fertility-sparing surgery (FSS) is becoming an important technique in the surgical management of young women with early-stage epithelial ovarian cancer (EOC). We retrospectively evaluated the outcome of laparoscopic FSS in presumed clinically early-stage EOC. Methods We retrospectively searched databases of patients who received laparoscopic FSS for EOC between January 1999 and December 2012 at Samsung Medical Center. Women aged ≤40 years were included. The perioperative, oncological, and obstetric outcomes of these patients were evaluated. Results A total of 18 patients was evaluated. The median age of the patients was 33.5 years (range, 14 to 40 years). The number of patients with clinically stage IA and IC was 6 (33.3%) and 12 (66.7%), respectively. There were 7 (38.9%), 5 (27.8%), 3 (16.7%), and 3 patients (16.7%) with mucinous, endometrioid, clear cell, and serous tumor types, respectively. Complete surgical staging to preserve the uterus and one ovary with adnexa was performed in 4 patients (22.2%). Two out of them were upstaged to The International Federation of Gynecology and Obstetrics stage IIIA1. During the median follow-up of 47.3 months (range, 11.5 to 195.3 months), there were no perioperative or long term surgical complications. Four women (22.2%) conceived after their respective ovarian cancer treatments. Three (16.7%) of them completed full-term delivery and one is expecting a baby. One patient had disease recurrence. No patient died of the disease. Conclusion FSS in young patients with presumed clinically early-stage EOC is a challenging and cautious procedure. Further studies are urgent to determine the safety and feasibility of laparoscopic FSS in young patients with presumed clinically early-stage EOC. PMID:26768783

  7. Managing acute colorectal obstruction by "bridge stenting" to laparoscopic surgery: Our experience

    PubMed Central

    Bonfante, Pierfrancesco; D’Ambra, Luigi; Berti, Stefano; Falco, Emilio; Cristoni, Massimo Vittorio; Briglia, Romolo

    2012-01-01

    AIM: To verify the clinical results of the endoscopic stenting procedure for colorectal obstructions followed by laparoscopic colorectal resection with “one stage anastomosis”. METHODS: From March 2003 to March 2009 in our surgical department, 48 patients underwent endoscopic stenting for colorectal occlusive lesion: 30 males (62.5%) and 18 females (37.5%) with an age range from 40 years to 92 years (median age 69.5). All patients enrolled in our study were diagnosed with an intestinal obstruction originating from the colorectal tract without bowel perforation signs. Obstruction was primitive colorectal cancer in 45 cases (93.7%) and benign anastomotic stricture in 3 cases (6.3%). RESULTS: Surgical resection was totally laparoscopic in 69% of cases (24 patients) while 17% (6 patients) of cases were video-assisted due to the local extension of cancer with infiltrations of surrounding structures (urinary bladder in 2 cases, ileus and iliac vessels in the others). In 14% of cases (5 patients), resection was performed by open surgery due to the high American Society of Anesthesiologists score and the elderly age of patients (median age of 89 years). We performed a terminal stomy in only 7 patients out of 35, 6 colostomies and one ileostomy (in a total colectomy). In the other 28 cases (80%), we performed bowel anastomosis at the same time as resection, employing a temporary ileostomy only in 5 cases. CONCLUSION: Colorectal stenting transforms an emergency operation in to an elective operation performable in a totally laparoscopic manner, limiting the confection of colostomy with its correlated complications. PMID:23493809

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

    PubMed

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

    2016-08-01

    OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted. PMID:27439347

  9. Laparoscopic Surgery

    MedlinePlus

    ... January 2006. Updated December 2012. Return to Top GI Health Centers Colorectal Cancer Hepatitis C Inflammatory Bowel ... GI Symptoms Gastroparesis See All Topics (A-Z) GI Procedures Colonoscopy Colorectal Cancer Screening See All Procedures ( ...

  10. Patient factors predisposing to complications following laparoscopic surgery for colorectal cancers.

    PubMed

    Ishihara, Soichiro; Matsuda, Keiji; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Kawai, Kazushige; Nozawa, Hiroaki; Kazama, Shinsuke; Kanazawa, Takamitsu; Yamaguchi, Hironori; Sunami, Eiji; Kitayama, Joji; Hashiguchi, Yojiro; Watanabe, Toshiaki

    2015-04-01

    The aim of this study was to clarify patient factors contributing to complications after laparoscopic surgery for colorectal cancers. A total of 333 colorectal cancer patients who underwent laparoscopic colorectal resection between January 2007 and December 2012 were enrolled. The association between patient factors and the incidence of complications were analyzed. Postoperative complications were divided into 2 categories: infectious complications and noninfectious complications. The overall complication rate was 13% and mortality rate 0%. Multivariate analysis showed that body mass index >25 kg/m [odds ratio (OR)=3.02, P=0.0254] and tumor location (right colon cancer/rectal cancer: OR=0.11, P=0.0083) were risk factors for infectious complications; in addition, male sex (OR=3.91, P=0.0102) and cancer stage (stage 2/stage 4: OR=0.17, P=0.0247) were risk factors for noninfectious complications. This study shows that different patient factors are associated with the risk of different types of complications. PMID:25383941

  11. Laparoscopic anti-reflux surgery for idiopathic pulmonary fibrosis at a single centre.

    PubMed

    Raghu, Ganesh; Morrow, Ellen; Collins, Bridget F; Ho, Lawrence A T; Hinojosa, Marcelo W; Hayes, Jennifer M; Spada, Carolyn A; Oelschlager, Brant; Li, Chenxiang; Yow, Eric; Anstrom, Kevin J; Mart, Dylan; Xiao, Keliang; Pellegrini, Carlos A

    2016-09-01

    We sought to assess whether laparoscopic anti-reflux surgery (LARS) is associated with decreased rates of disease progression in patients with idiopathic pulmonary fibrosis (IPF).The study was a retrospective single-centre study of IPF patients with worsening symptoms and pulmonary function despite antacid treatment for abnormal acid gastro-oesophageal reflux. The period of exposure to LARS was September 1998 to December 2012. The primary end-point was a longitudinal change in forced vital capacity (FVC) % predicted in the pre- versus post-surgery periods.27 patients with progressive IPF underwent LARS. At time of surgery, the mean age was 65 years and mean FVC was 71.7% pred. Using a regression model, the estimated benefit of surgery in FVC % pred over 1 year was 5.7% (95% CI -0.9-12.2%, p=0.088) with estimated benefit in FVC of 0.22 L (95% CI -0.06-0.49 L, p=0.12). Mean DeMeester scores decreased from 42 to 4 (p<0.01). There were no deaths in the 90 days following surgery and 81.5% of participants were alive 2 years after surgery.Patients with IPF tolerated the LARS well. There were no statistically significant differences in rates of FVC decline pre- and post-LARS over 1 year; a possible trend toward stabilisation in observed FVC warrants prospective studies. The ongoing prospective randomised controlled trial will hopefully provide further insights regarding the safety and potential efficacy of LARS in IPF. PMID:27492835

  12. 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

  13. Gas emission during laparoscopic colorectal surgery using a bipolar vessel sealing device: A pilot study on four patients

    PubMed Central

    Hübner, Martin; Sigrist, Markus W; Demartines, Nicolas; Gianella, Michele; Clavien, Pierre A; Hahnloser, Dieter

    2008-01-01

    Background Dissection during laparoscopic surgery produces smoke containing potentially toxic substances. The aim of the present study was to analyze smoke samples produced during laparoscopic colon surgery using a bipolar vessel sealing device (LigaSure™). Methods Four consecutive patients undergoing left-sided colectomy were enrolled in this pilot study. Smoke was produced by the use of LigaSure™. Samples (5,5l) were evacuated from the pneumoperitoneum in a closed system into a reservoir. Analysis was performed with CO2-laser-based photoacoustic spectroscopy and confirmed by a Fourier-transform infrared spectrum. The detected spectra were compared to the available spectra of known toxins. Results Samples from four laparoscopic sigmoid resections were analyzed. No relevant differences were noted regarding patient and operation characteristics. The gas samples were stable over time proven by congruent control measurements as late as 24 h after sampling. The absorption spectra differed considerably between the patients. One broad absorption line at 100 ppm indicating H2O and several unknown molecules were detected. With a sensitivity of alpha min ca 10-5 cm-1 no known toxic substances like phenol or indole were identified. Conclusion The use of a vessel sealing device during laparoscopic surgery does not produce known toxic substances in relevant quantity. Further studies are needed to identify unknown molecules and to analyze gas emission under various conditions. PMID:18803818

  14. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries.

    PubMed

    Khetarpal, Ranjana; Bali, Kusum; Chatrath, Veena; Bansal, Divya

    2016-01-01

    The aim of this study was to review the various anesthetic options which can be considered for laparoscopic surgeries in the patients with the chronic obstructive pulmonary disease. The literature search was performed in the Google, PubMed, and Medscape using key words "analgesia, anesthesia, general, laparoscopy, lung diseases, obstructive." More than thirty-five free full articles and books published from the year 1994 to 2014 were retrieved and studied. Retrospective data observed from various studies and case reports showed regional anesthesia (RA) to be valid and safer option in the patients who are not good candidates of general anesthesia like patients having obstructive pulmonary diseases. It showed better postoperative patient outcome with respect to safety, efficacy, postoperative pulmonary complications, and analgesia. So depending upon disease severity RA in various forms such as spinal anesthesia, paravertebral block, continuous epidural anesthesia, combined spinal epidural anesthesia (CSEA), and CSEA with bi-level positive airway pressure should be considered. PMID:26957682

  15. Laparoscopic Surgery in Nonparasitic Cysts of the Liver: Results Observed in a Series of Consecutive Cases.

    PubMed

    Manterola, Carlos; Otzen, Tamara

    2016-08-01

    The purpose of this study was to report the results of laparoscopic treatment of nonparasitic cysts of the liver (NPCL) in terms of postoperative morbidity (POM) and recurrence. Prospective case series of patients operated on for NPCL at the Clínica Mayor in Temuco, Chile (2008 to 2015). The preoperative study consisted of general examinations, abdominal ultrasound or computed tomographic scan. The outcome variable was POM. Other variables of interest were surgical time, need for conversion, hospital stay, mortality, and recurrence. In the study period, 41 patients with NPCL underwent surgery. Median age of the series was 58 years, and 75.6% of the cases were female. The median ultrasound diameter of the lesions was 10 cm and surgical time was 50 minutes. All patients underwent a cystectomy. There was no conversion, no record of POM, mortality or recurrence. The treatment applied in this series of NPCL is associated with an adequate postoperative evolution. PMID:27403620

  16. Perioperative risk stratification for a patient with severe obstructive sleep apnoea undergoing laparoscopic banding surgery.

    PubMed

    Weinberg, Laurence; Tay, Stan; Lai, Chung Fei; Barnes, Maree

    2013-01-01

    Despite the increasing prevalence of obstructive sleep apnoea (OSA), there is limited evidence to guide appropriate preoperative investigations, inpatient or outpatient surgery allocation, and the anticipated level of postoperative care. With reference to our institution's perioperative risk stratification, we describe the case of a 46-year-old Caucasian male with a body mass index of 51 kg/m(2) admitted for laparoscopic band insertion. Management based on our guidelines involved a preoperative polysomnography where the patient was confirmed to have severe OSA. His postoperative care was then managed in the high dependency care unit. He was discharged home on day 2 with no further sequelae. We provide evidence that adoption of this model of care can simplify clinical decision making and resource allocation with favourable patient outcomes. PMID:23370960

  17. Electrical Impedance Tomography-guided PEEP Titration in Patients Undergoing Laparoscopic Abdominal Surgery.

    PubMed

    He, Xingying; Jiang, Jingjing; Liu, Yuli; Xu, Haitao; Zhou, Shuangqiong; Yang, Shibo; Shi, Xueyin; Yuan, Hongbin

    2016-04-01

    The aim of the study is to utilize electrical impedance tomography (EIT) to guide positive end-expiratory pressure (PEEP) and to optimize oxygenation in patients undergoing laparoscopic abdominal surgery.Fifty patients were randomly assigned to the control (C) group and the EIT (E) group (n = 25 each). We set the fraction of inspired oxygen (FiO2) at 0.30. The PEEP was titrated and increased in a 2-cm H2O stepwise manner, from 6 to 14 cm H2O. Hemodynamic variables, respiratory mechanics, EIT images, analysis of blood gas, and regional cerebral oxygen saturation were recorded. The postoperative pulmonary complications within the first 5 days were also observed.We chose 10 cm H2O and 8 cm H2O as the "ideal" PEEP for the C and the E groups, respectively. EIT-guided PEEP titration led to a more dorsal shift of ventilation. The PaO2/FiO2 ratio in the E group was superior to that in the C group in the pneumoperitoneum period, though the difference was not significant (330 ± 10 vs 305.56 ± 4 mm Hg; P = 0.09). The C group patients experienced 8.7% postoperative pulmonary complications versus 5.3% among the E group patients (relative risk 1.27, 95% confidence interval 0.31-5.3, P = 0.75).Electrical impedance tomography represents a new promising technique that could enable anesthesiologists to assess regional ventilation of the lungs and optimize global oxygenation for patients undergoing laparoscopic abdominal surgery. PMID:27057904

  18. A Dual-Valve System to Minimize Loss of Pneumoperitoneum in Laparoscopic Surgery

    PubMed Central

    Lawrence, Matthew; Guest, Rachel Victoria

    2015-01-01

    Background and Objectives: Loss of visualization of the surgical field due to pneumoperitoneum deflation when CO2 insufflator cylinders become empty can occur at key moments during laparoscopic surgery. The purpose of this study was to examine the incidence of intraoperative cylinder exhaustion in the United Kingdom, determine its impact on patient safety, and design and test a novel device to minimize the phenomenon. Methods: We performed a national cross-sectional survey of U.K. surgeons, inviting all members of the Association of Surgeons of Great Britain and Ireland (ASGBI) and the Association of Upper GI Surgeons (AUGIS) to participate. We designed and tested a novel dual-valve system to allow rapid intraoperative exchange of CO2 cylinders. Results: Eighty-five percent of the U.K. surgeons surveyed reported loss of surgical visualization at critical times during laparoscopic surgery, caused by the decrease in pneumoperitoneum during CO2 cylinder exchange. Eighty-four percent said that the process contributed to the surgeon's stress, and 63% said that a device that maintains uninterrupted pneumoperitoneum would reduce the risk of intraoperative complications. In our locale, a timed cylinder exchange was, on average, 30 times quicker with the novel dual valve than by conventional cylinder exchange (mean conventional exchange time, 61.3 ± 7.3 s vs. novel device, 2.0 ± 0.2 s; P ≤ .0001) and could be performed just as rapidly by staff unfamiliar with the device (2.2 ± 0.3 s vs. 1.9 ± 0.4 s P = .1945). We suggest that this simple, low-cost system could be developed for use in a clinical setting to enhance patient safety. PMID:26005321

  19. Technical and instrumental prerequisites for single-port laparoscopic solo surgery: State of art

    PubMed Central

    Kim, Say-June; Lee, Sang Chul

    2015-01-01

    With the aid of advanced surgical techniques and instruments, single-port laparoscopic surgery (SPLS) can be accomplished with just two surgical members: an operator and a camera assistant. Under these circumstances, the reasonable replacement of a human camera assistant by a mechanical camera holder has resulted in a new surgical procedure termed single-port solo surgery (SPSS). In SPSS, the fixation and coordinated movement of a camera held by mechanical devices provides fixed and stable operative images that are under the control of the operator. Therefore, SPSS primarily benefits from the provision of the operator’s eye-to-hand coordination. Because SPSS is an intuitive modification of SPLS, the indications for SPSS are the same as those for SPLS. Though SPSS necessitates more actions than the surgery with a human assistant, these difficulties seem to be easily overcome by the greater provision of static operative images and the need for less lens cleaning and repositioning of the camera. When the operation is expected to be difficult and demanding, the SPSS process could be assisted by the addition of another instrument holder besides the camera holder. PMID:25914453

  20. Laparoscopic treatment of gastric and duodenal perforation in children after blunt abdominal trauma.

    PubMed

    Tytgat, S H A J; Zwaveling, S; Kramer, W L M; van der Zee, D C

    2012-09-01

    Minimal invasive surgery has not yet gained wide acceptation for the care of patients that sustained an abdominal trauma. We describe the complete laparoscopic surgical treatment of two patients after a single blunt abdominal trauma. One patient sustained a handle bar injury and presented with a gastric perforation. The other sustained a duodenal rupture by falling on a sharp edge of a table. The patients were assessed and treated laparoscopically. The perforations were identified and closed. Both patients had an uneventful postoperative recovery. Therapeutic laparoscopic treatment of patients with upper gastrointestinal perforation is feasible. We would recommend this approach to experienced laparoscopic surgeons in hemodynamically stable patients. PMID:21129741

  1. Xylitol Gum Chewing to Achieve Early Postoperative Restoration of Bowel Motility After Laparoscopic Surgery.

    PubMed

    Gong, Yunhui; Zhang, Qianwen; Qiao, Lin; Lv, Donghao; Ruan, Jiaying; Chen, Hongqin; Gong, Junming; Shi, Gang

    2015-08-01

    Our objective was to evaluate the effects of postoperative xylitol gum chewing on gastrointestinal functional recovery after laparoscopy. Altogether, 120 patients undergoing elective gynecologic laparoscopy were randomly divided into 2 groups of 60 each (final numbers: 53 controls, 56 patients). Controls underwent a routine postoperative regimen. Starting 6 hour after surgery, study patients chewed mint-flavored, sugarless xylitol gum until flatus occurred thrice a day. Other postoperative management was routine. First bowel sounds, first flatus, first bowel movement, and discharge times were recorded. Symptoms included abdominal distension, nausea, and vomiting. First flatus and first bowel sounds occurred significantly (P<0.001) earlier in the study patients. No significant differences were found for first defecation time, hospitalization duration, or mild/severe intestinal obstruction (all P>0.05). Thus, xylitol gum chewing after laparoscopy can effectively shorten the time to first flatus and helps with postoperative gastrointestinal functional recovery. It is simple, convenient, and well tolerated. PMID:26121546

  2. Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

    PubMed Central

    2013-01-01

    Background Previous meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn’s Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn’s disease undergoing laparoscopic or open surgical resection. Methods A literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health’s Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia. Results 34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 – 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 – 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 – 0.82, P = 0.02). Conclusions This is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made. PMID:23705825

  3. The effects of dexmedetomidine on attenuation of hemodynamic changes and there effects as adjuvant in anesthesia during laparoscopic surgeries

    PubMed Central

    Vora, Kalpana S.; Baranda, Ushma; Shah, Veena R.; Modi, Manisha; Parikh, Geeta P.; Butala, Bina P.

    2015-01-01

    Background: As an anesthetic adjuvant dexmedetomidine has been shown to provide good perioperative hemodynamic stability with minimum alveolar concentration sparing effect on inhalational anesthetic agents during laparoscopic surgeries performed under general anesthesia. Aim: The study was planned to investigate the effects of dexmedetomidine on attenuation of hemodynamic changes and requirements of intra-operative analgesic and inhalational anesthetic during laparoscopic surgeries and its postoperative side effects. Materials and Methods: A total of 70 patients scheduled for elective laparoscopic surgeries were randomized to receive bolus infusion of dexmedetomidine (group D) or saline (group S) 1 mcg/kg/h, followed by continuous infusion of the same, at the rate of 0.5 mcg/kg/h. Anesthesia was maintained with nitrous oxide in oxygen, muscle relaxant and isoflurane. Supplementation with end-tidal isoflurane was considered when heart rate (HR) and mean arterial blood pressure (BP) exceeded 20% of the baseline value. Hemodynamics, end-tidal isoflurane concentration and adverse events were recorded. Results: Intra-operative mean HR and mean BP in group D were lower than group S (P < 0.05) throughout the laparoscopy surgery. Requirement of intra-operative fentanyl, end-tidal isoflurane and postoperative tramadol were significantly more in group S compared to group D (P < 0.05) Statistically significant nausea and vomiting were noted in group S. Undue sedation and other adverse effects are comparable in both the groups. Conclusion: Dexmedetomidine as an adjuvant in general anesthesia for laparoscopic surgeries provided a stable hemodynamic profile in the perioperative period and effectively blunted pressor response to intubation and extubation, leading to minimal requirements for additional analgesics and potent inhalational agents. There were less adverse events. PMID:26543454

  4. Comparison of the proseal, supreme, and i-gel SAD in gynecological laparoscopic surgeries.

    PubMed

    Mukadder, Sanli; Zekine, Begec; Erdogan, Kayhan Gulay; Ulku, Ozgul; Muharrem, Ucar; Saim, Yologlu; Mahmut, Durmus

    2015-01-01

    We compared proseal, supreme, and i-gel supraglottic airway devices in terms of oropharyngeal leak pressures and airway morbidities in gynecological laparoscopic surgeries. One hundred and five patients undergoing elective surgery were subjected to general anesthesia after which they were randomly distributed into three groups. Although the oropharyngeal leak pressure was lower in the i-gel group initially (mean ± standard deviation; 23.9 ± 2.4, 24.9 ± 2.9, and 20.9 ± 3.5, resp.), it was higher than the proseal group and supreme group at 30 min of surgery after the trendelenburg position (25.0 ± 2.3, 25.0 ± 1.9, and 28.3 ± 2.3, resp.) and at the 60 min of surgery (24.2 ± 2.1, 24.8 ± 2.2, and 29.5 ± 1.1, resp.). The time to apply the supraglottic airway devices was shorter in the i-gel group (12.2 (1.2), 12.9 (1.0), and 6.7 (1.2), resp., P = 0.001). There was no difference between the groups in terms of their fiber optic imaging levels. pH was measured at the anterior and posterior surfaces of the pharyngeal region after the supraglottic airway devices were removed; the lowest pH values were 5 in all groups. We concluded that initial oropharyngeal leak pressures obtained by i-gel were lower than proseal and supreme, but increased oropharyngeal leak pressures over time, ease of placement, and lower airway morbidity are favorable for i-gel. PMID:25802890

  5. Intraoperative on-the-fly organ-mosaicking for laparoscopic surgery.

    PubMed

    Reichard, Daniel; Bodenstedt, Sebastian; Suwelack, Stefan; Mayer, Benjamin; Preukschas, Anas; Wagner, Martin; Kenngott, Hannes; Müller-Stich, Beat; Dillmann, Rüdiger; Speidel, Stefanie

    2015-10-01

    The goal of computer-assisted surgery is to provide the surgeon with guidance during an intervention, e.g., using augmented reality. To display preoperative data, soft tissue deformations that occur during surgery have to be taken into consideration. Laparoscopic sensors, such as stereo endoscopes, can be used to create a three-dimensional reconstruction of stereo frames for registration. Due to the small field of view and the homogeneous structure of tissue, reconstructing just one frame, in general, will not provide enough detail to register preoperative data, since every frame only contains a part of an organ surface. A correct assignment to the preoperative model is possible only if the patch geometry can be unambiguously matched to a part of the preoperative surface. We propose and evaluate a system that combines multiple smaller reconstructions from different viewpoints to segment and reconstruct a large model of an organ. Using graphics processing unit-based methods, we achieved four frames per second. We evaluated the system with in silico, phantom, ex vivo, and in vivo (porcine) data, using different methods for estimating the camera pose (optical tracking, iterative closest point, and a combination). The results indicate that the proposed method is promising for on-the-fly organ reconstruction and registration. PMID:26693166

  6. Intraoperative on-the-fly organ-mosaicking for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Bodenstedt, S.; Reichard, D.; Suwelack, S.; Wagner, M.; Kenngott, H.; Müller-Stich, B.; Dillmann, R.; Speidel, S.

    2015-03-01

    The goal of computer-assisted surgery is to provide the surgeon with guidance during an intervention using augmented reality (AR). To display preoperative data correctly, soft tissue deformations that occur during surgery have to be taken into consideration. Optical laparoscopic sensors, such as stereo endoscopes, can produce a 3D reconstruction of single stereo frames for registration. Due to the small field of view and the homogeneous structure of tissue, reconstructing just a single frame in general will not provide enough detail to register and update preoperative data due to ambiguities. In this paper, we propose and evaluate a system that combines multiple smaller reconstructions from different viewpoints to segment and reconstruct a large model of an organ. By using GPU-based methods we achieve near real-time performance. We evaluated the system on an ex-vivo porcine liver (4.21mm+/- 0.63) and on two synthetic silicone livers (3.64mm +/- 0.31 and 1.89mm +/- 0.19) using three different methods for estimating the camera pose (no tracking, optical tracking and a combination).

  7. Cholecystectomy by single incision laparoscopic surgery (SILS): early experience and technique standardization.

    PubMed

    Ceci, F; Di Grazia, C; Cipriani, B; Nicodemi, S; Corelli, S; Pecchia, M; Martellucci, A; Costantino, A; Stefanelli, F; Salvadori, C; Napoleoni, A; Parisella, M; Spaziani, E; Stagnitti, F

    2012-01-01

    Single Incision Laparoscopic Surgery (SILS) is a recent surgical technique, first described in the 1990s. Its aim is to optimize the esthetic result offered by laparoscopy by minimizing the number of abdominal incisions. Various preliminary studies have been carried out on the application of SILS, especially in cholecystectomy and appendectomy. This study evaluates the preliminary results of cholecystectomy by SILS (SILS™ Port) conducted between October 2009 and February 2011 on 21 patients (4 men and 17 women) with a mean age of 49.9 years and a mean Body Mass Index (BMI) of 22.8. All patients were treated by the same team, which had previously undergone six months' simulator training. There were two main selection criteria, both evaluated intraoperatively: absence of adhesions and of significant inflammatory sequelae from previous cholecystitis; and suitable distance between gallbladder and SILS access port. Conversion to traditional laparoscopy was necessary in just two cases, while an accessory trocar was introduced in another two cases. Conversion to open surgery was not necessary in any case. One case of SILS cholecystectomy was complicated by postoperative bile leakage, which was treated conservatively, as the fistula had a low output. The mean duration of hospitalization was 3.6 days. This preliminary experience led us to conclude that SILS is safe and highly satisfactory in the postoperative phase, thanks to the reduced need for painkillers and the improved esthetic result. PMID:23017290

  8. Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients

    PubMed Central

    Fujii, Shoichi; Tsukamoto, Mitsuo; Fukushima, Yoshihisa; Shimada, Ryu; Okamoto, Koichi; Tsuchiya, Takeshi; Nozawa, Keijiro; Matsuda, Keiji; Hashiguchi, Yojiro

    2016-01-01

    AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients. METHODS: A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy (LAC) in elderly colorectal cancer patients with open colectomy (OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups. RESULTS: Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC (mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss (mean difference = -93.3738, 95%CI: -132.3437 to -54.4039, P < 0.0001), overall morbidity (OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection (OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus (OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications (OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes (median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival (mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival (mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes (mean difference = -0.1360, 95%CI: -4.0553-3.7833, P = 0.9458). CONCLUSION: LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC

  9. Robotic surgery

    MedlinePlus

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

  10. Laparoscopic drainage of an intramural duodenal hematoma.

    PubMed

    Maemura, T; Yamaguchi, Y; Yukioka, T; Matsuda, H; Shimazaki, S

    1999-02-01

    A 21-year-old man was admitted with vomiting and abdominal pain 3 days after sustaining blunt abdominal trauma by being tackled in a game of American football. A diagnosis of intramural hematoma of the duodenum was made using computed tomography and upper gastrointestinal tract contrast radiography. The hematoma caused obstructive jaundice by compressing the common bile duct. The contents of the hematoma were laparoscopically drained. A small perforation was then found in the duodenal wall. The patient underwent laparotomy and repair of the injury. Laparoscopic surgery can be used as definitive therapy in this type of abdominal trauma. PMID:10204621

  11. Renal and Gastrointestinal Considerations in Joint Replacement Surgery

    PubMed Central

    Voss, Benjamin; Kurdi, Alexander; Skopec, Alexander; Saleh, Jasmine; El-Othmani, Mouhanad M; Lane, Joseph M; Mihalko, William M; Saleh, Khaled J

    2015-01-01

    Renal and gastrointestinal diseases affect a significant portion of the general population. The process of decision making regarding surgical clearance and pre-operative management of the various complexities and medical conditions associated with these diseases hence becomes crucial. To optimize postoperative outcomes, the considerations for the care of this patient population revolve around effective management of hemostasis and electrolyte status. This subset of conditions is uniquely important with regard to the negative impact of improper administration of medications and perioperative care on patients’ prognoses. A thorough understanding and knowledge of standards of care and treatment guidelines for patients with renal dysfunction and gastrointestinal disease assures comprehensive preoperative planning and surgical clearance. This may ultimately lead to improvement of surgical outcomes and potential decrease in postoperative morbidity and mortality. PMID:25811046

  12. The INCH-Trial: a multicentre randomized controlled trial comparing the efficacy of conventional open surgery and laparoscopic surgery for incisional hernia repair

    PubMed Central

    2013-01-01

    Background Annually approximately 100.000 patients undergo a laparotomy in the Netherlands. About 15,000 of these patients will develop an incisional hernia. Both open and laparoscopic surgical repair have been proven to be safe. However, the most effective treatment of incisional hernias remains unclear. This study, the ‘INCH-trial’, comparing cost-effectiveness of open and laparoscopic incisional hernia repair, is therefore needed. Methods/Design A randomized multi-center clinical trial comparing cost-effectiveness of open and laparoscopic repair of incisional hernias. Patients with a symptomatic incisional hernia, eligible for laparoscopic and open incisional hernia repair. Only surgeons, experienced in both open and laparoscopic incisional hernia repair, will participate in the INCH trial. During incisional hernia repair, a mesh is placed under or on top of the fascia, with a minimal overlap of 5 cm. Primary endpoint is length of hospital stay after an incisional hernia repair. Secondary endpoints are time to full recovery within three months after index surgery, post-operative complications, recurrences, mortality and quality of life. Our hypothesis is that laparoscopic incisional hernia repair comes with a significant shorter hospital stay compared to open incisional hernia repair. A difference of two days is considered significant. One-hunderd-and-thirty-five patients are enrolled in each treatment arm. The economic evaluation will be performed from a societal perspective. Primary outcomes are costs per patient related to time-to-recovery and quality of life. The main goal of the trial is to establish whether laparoscopic incisional hernia repair is superior to conventional open incisional hernia repair in terms of cost-effectiveness. This is measured through length of hospital stay and quality of life. Secondary endpoints are re-operation rate due to post-operative complications or recurrences, mortality and quality of life. Discussion The difference

  13. Anaesthetic management of laparoscopic surgery for rectal cancer in patients of dilated cardiomyopathy with poor ejection fraction: a case report

    PubMed Central

    Wu, Yao-Hua; Hu, Liang; Xia, Jin; Hao, Quan-Shui; Feng, Li; Xiang, Hong-Bing

    2015-01-01

    A patient with dilated cardiomyopathy with poor ejection fraction posted for laparoscopic surgery for rectal cancer which was successfully performed under general anesthesia with endotracheal intubation and mechanical ventilation was reported. Our observations strongly indicate that detailed preoperative assessment, watchful intraoperative monitoring, and skillful optimization of fluid status and hemodynamic play important role in the high risk patient under general anesthesia with endotracheal intubation and mechanical ventilation. PMID:26309623

  14. The application of laparoscopic bariatric surgery for treatment of severe obesity in adolescents using a multidisciplinary adolescent bariatric program.

    PubMed

    Warman, Juanita L

    2005-01-01

    The evolution of laparoscopic surgery has made bariatric surgery acceptable for weight loss; however, much controversy exists about its appropriateness for adolescents. Despite the controversial issues, the growing epidemic in adolescent obesity has resulted in rising numbers of applications for bariatric surgery. There are few bariatric surgical programs designed for adolescents. Pediatric settings face high start-up costs and poor reimbursement and lack established bariatric surgeons. Even so, bariatric surgery is increasingly being performed on adolescents in alarming numbers. To avoid adverse physical and psychosocial outcomes, the application of the principles of growth and development is essential. The program should be established as a multidisciplinary approach to management of adolescents and should be in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery. To prevent postoperative complication, a multidisciplinary team of experienced medical and surgical specialists is needed for optimal preoperative decision making and postoperative management and long-term follow-up. Laparoscopic Roux-en-Y gastric bypass is a safe procedure and an effective means to treat obesity-related morbidity in the adolescent. Results have been excellent and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population. PMID:16041228

  15. Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database.

    PubMed

    Bhama, Anuradha R; Wafa, Abdullah M; Ferraro, Jane; Collins, Stacey D; Mullard, Andrew J; Vandewarker, James F; Krapohl, Greta; Byrn, John C; Cleary, Robert K

    2016-06-01

    Robotic colorectal surgery has been shown to have lower rates of unplanned conversion to open surgery when compared to laparoscopic surgery. Risk factors associated with conversion from robotic to open colectomy and comparisons of the risk factors between robotic and laparoscopic approaches have not been previously reported. Patients who underwent elective laparoscopic and robotic colorectal surgeries between July 1, 2012 and April 28, 2015, were identified in the Michigan Surgical Quality Collaborative registry. Candidate covariates were identified, and hierarchical logistic regression models were used to identify risk factors for conversion. There were 4796 cases that met study inclusion criteria. Conversion was required in 18.2 % of laparoscopic and 7.7 % of robotic cases (p < 0.0001). Risk factors for conversion in the laparoscopic group included the following: moderate/severe adhesions, obesity, colorectal cancer, hypertension, rectal operations, urgent priority, and tobacco use. Risk factors for conversion in the robotic group included the following: severe adhesions, bleeding disorder, presence of cancer, cirrhosis, and use of statins. Higher surgeon volume was protective in both groups. Conversion rates are lower for robotic than for laparoscopic colorectal surgery with fewer predictors of conversion. Recognition of factors predicting conversion may allow surgeons to choose an operative approach that optimizes the benefits of the available technologies. PMID:26847352

  16. Development of new devices for detection of gastric cancer on laparoscopic surgery using near-infrared light

    NASA Astrophysics Data System (ADS)

    Inada, Shunko A.; Fuchi, Shingo; Mori, Kensaku; Hasegawa, Junichi; Misawa, Kazunari; Nakanishi, Hayao

    2015-03-01

    In recent year, for the treatment of gastric cancer the laparoscopic surgery is performed, which has good benefits, such as low-burden, low-invasive and the efficacy is equivalent to the open surgery. For identify location of the tumor intraperitoneally for extirpation of the gastric cancer, several points of charcoal ink is injected around the primary tumor. However, in the time of laparoscopic operation, it is difficult to estimate specific site of primary tumor, because the injected charcoal ink diffusely spread to the area distant from the tumor in the stomach. Therefore, a broad area should be resected which results in a great stress for the patients. To overcome this problem, we focused in the near-infrared wavelength of 1000nm band which have high biological transmission. In this study, we developed a fluorescent clip which was realized with glass phosphor (Yb3+, Nd3+ doped to Bi2O3-B2O3 based glasses. λp: 976 nm, FWHM: 100 nm, size: 2x1x3 mm) and the laparoscopic fluorescent detection system for clip-derived near-infrared light. To evaluate clinical performance of a fluorescent clip and the laparoscopic fluorescent detection system, we used resected stomach (thickness: 13 mm) from the patients. Fluorescent clip was fixed on the gastric mucosa, and an excitation light (λ: 808 nm) was irradiated from outside of stomach for detection of fluorescence through stomach wall. As a result, fluorescence emission from the clip was successfully detected. Furthermore, we confirmed that detection sensitivity of the emission of fluorescence from the clip depends on the output power of the excitation light. We conformed that the fluorescent clip in combination with laparoscopic fluorescent detection system is very useful method to identify the exact location of the primary gastric cancer.

  17. 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

  18. Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials

    PubMed Central

    2014-01-01

    Background Robotic-assisted laparoscopy is popularly performed for colorectal disease. The objective of this meta-analysis was to compare the safety and efficacy of robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS) for colorectal disease based on randomized controlled trial studies. Methods Literature searches of electronic databases (Pubmed, Web of Science, and Cochrane Library) were performed to identify randomized controlled trial studies that compared the clinical or oncologic outcomes of RCS and LCS. This meta-analysis was performed using the Review Manager (RevMan) software (version 5.2) that is provided by the Cochrane Collaboration. The data used were mean differences and odds ratios for continuous and dichotomous variables, respectively. Fixed-effects or random-effects models were adopted according to heterogeneity. Results Four randomized controlled trial studies were identified for this meta-analysis. In total, 110 patients underwent RCS, and 116 patients underwent LCS. The results revealed that estimated blood losses (EBLs), conversion rates and times to the recovery of bowel function were significantly reduced following RCS compared with LCS. There were no significant differences in complication rates, lengths of hospital stays, proximal margins, distal margins or harvested lymph nodes between the two techniques. Conclusions RCS is a promising technique and is a safe and effective alternative to LCS for colorectal surgery. The advantages of RCS include reduced EBLs, lower conversion rates and shorter times to the recovery of bowel function. Further studies are required to define the financial effects of RCS and the effects of RCS on long-term oncologic outcomes. PMID:24767102

  19. ERAS protocol in laparoscopic surgery for colonic versus rectal carcinoma: are there differences in short-term outcomes?

    PubMed

    Pędziwiatr, Michał; Pisarska, Magdalena; Kisielewski, Michał; Major, Piotr; Mydlowska, Anna; Rubinkiewicz, Mateusz; Winiarski, Marek; Budzyński, Andrzej

    2016-06-01

    Most of the studies concerning enhanced recovery after surgery (ERAS) protocols in colorectal surgery include heterogeneous groups of patients undergoing open or laparoscopic surgery, both due to colonic and rectal cancer, thus creating a potential bias. The data investigating the differences between patients operated for either colonic or rectal cancer are sparse. The aim of the study was to compare short-term outcomes of laparoscopic surgery for colonic and rectal cancer with ERAS protocol. The analysis included consecutive prospectively registered patients operated for a colorectal cancer between January 2012 and September 2015. Patients were divided into two groups (colon vs. rectum). The measured outcomes were: length of stay (LOS), complication rate, readmission rate, compliance with ERAS protocol elements and recovery parameters (tolerance of early oral diet, mobilization and time to first flatus). Group 1 (colon) consisted of 150 patients and Group 2 (rectum) of 82 patients. Patients in Group 1 (150 patients) were discharged home earlier than in Group 2 (82 patients)-median LOS 4 versus 5 days, respectively. There was no statistical difference in complication rate (27.3 vs. 36.6 %) and readmissions (7.3 vs. 6.1 %). Compliance with the protocol was 86.9 and 82.6 %, respectively. However, in Group 1, the following procedures were used less frequently: bowel preparation (24 vs. 78.3 %) and postoperative drainage (23.3 vs. 71.0 %). There were no differences in recovery parameters between the groups. Univariate logistic regression showed that the type of surgery, drainage and stoma creation significantly prolonged LOS. In a multivariate logistic regression model, only a bowel preparation and drainage were shown to be significant. Although functional recovery and high compliance with ERAS protocol are possible irrespective of the type of surgery, laparoscopic rectal resections are associated with a longer LOS. PMID:27154634

  20. Simulation of tissue cutting and bleeding for laparoscopic surgery using auxiliary surfaces.

    PubMed

    Basdogan, C; Ho, C H; Srinivasan, M A

    1999-01-01

    Realistic simulation of tissue cutting and bleeding is important components of a surgical simulator that are addressed in this study. Surgeons use a number of instruments to perform incision and dissection of tissues during minimally invasive surgery. For example, a coagulating hook is used to tear and spread the tissue that surrounds organs and scissors are used to dissect the cystic duct during laparoscopic cholecystectomy. During the execution of these procedures, bleeding may occur and blood flows over the tissue surfaces. We have developed computationally fast algorithms to display (1) tissue cutting and (2) bleeding in virtual environments with applications to laparoscopic surgery. Cutting through soft tissue generates an infinitesimally thin slit until the sides of the surface are separated from each other. Simulation of an incision through tissue surface is modeled in three steps: first, the collisions between the instrument and the tissue surface are detected as the simulated cutting tool passes through. Then, the vertices along the cutting path are duplicated. Finally, a simple elastic tissue model is used to separate the vertices from each other to reveal the cut. Accurate simulation of bleeding is a challenging problem because of the complexities of the circulatory system and the physics of viscous fluid flow. There are several fluid flow models described in the literature, but most of them are computationally slow and do not specifically address the problem of blood flowing over soft tissues. We have reviewed the existing models, and have adapted them to our specific task. The key characteristics of our blood flow model are a visually realistic display and real-time computational performance. To display bleeding in virtual environments, we developed a surface flow algorithm. This method is based on a simplified form of the Navier-Stokes equations governing viscous fluid flow. The simplification of these partial differential equations results in a wave

  1. Characterization and in-vivo evaluation of a multi-resolution foveated laparoscope for minimally invasive surgery

    PubMed Central

    Qin, Yi; Hua, Hong; Nguyen, Mike

    2014-01-01

    The state-of-the-art laparoscope lacks the ability to capture high-magnification and wide-angle images simultaneously, which introduces challenges when both close- up views for details and wide-angle overviews for orientation are required in clinical practice. A multi-resolution foveated laparoscope (MRFL) which can provide the surgeon both high-magnification close-up and wide-angle images was proposed to address the limitations of the state-of-art surgical laparoscopes. In this paper, we present the overall system design from both clinical and optical system perspectives along with a set of experiments to characterize the optical performances of our prototype system and describe our preliminary in-vivo evaluation of the prototype with a pig model. The experimental results demonstrate that at the optimum working distance of 120mm, the high-magnification probe has a resolution of 6.35lp/mm and image a surgical area of 53 × 40mm2; the wide-angle probe provides a surgical area coverage of 160 × 120mm2 with a resolution of 2.83lp/mm. The in-vivo evaluation demonstrates that MRFL has great potential in clinical applications for improving the safety and efficiency of the laparoscopic surgery. PMID:25136485

  2. Multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor successfully treated by laparoscopic surgery: Report of a case

    PubMed Central

    Wakasugi, Masaki; Ueshima, Shigeyuki; Tei, Mitsuyoshi; Tori, Masayuki; Yoshida, Ken-ichi; Tsujimoto, Masahiko; Akamatsu, Hiroki

    2015-01-01

    Introduction Hepatic sclerosing hemangioma is a very rare benign tumor, characterized by fibrosis and hyalinization occurring in association with degeneration of a hepatic cavernous hemangioma. We report here a rare case of multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor that was successfully treated using laparoscopic surgery. Presentation of case A 67-year-old woman with multiple liver tumors underwent single-incision laparoscopic sigmoidectomy under a diagnosis of advanced sigmoid cancer with multiple liver metastases. Examination of surgical specimens of sigmoid colon revealed moderately differentiated adenocarcinoma invading the serosa, and no lymph node metastases. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 remained within normal limits throughout the course. Two months after sigmoidectomy, the patient underwent laparoscopic partial hepatectomy of S1 and S6 of the liver and cholecystectomy. Histopathological examination showed that the tumors mainly comprised hyalinized tissue and collagen fibers with sporadic vascular spaces on hematoxylin and eosin-stained sections, yielding a diagnosis of multiple hepatic sclerosing hemangioma. No evidence of recurrence has been seen as of 21 months postoperatively. Discussion Differentiating multiple sclerosing hemangiomas from metastatic liver tumors was quite difficult because the radiological findings were closely compatible with liver metastases. Laroscopic hepatectomy provided less blood loss, a shorter duration of hospitalization, and good cosmetic results. Conclusion Sclerosing hemangioma should be included among the differential diagnoses of multiple liver tumors in patients with colorectal cancer. Laparoscopic hepatectomy is useful for diagnostic therapy for undiagnosed multiple liver tumors. PMID:25679307

  3. A comparison of clinical and surgical outcomes between laparo-endoscopic single-site surgery and traditional multiport laparoscopic surgery for adnexal tumors

    PubMed Central

    Lee, In Ok; Yoon, Jung Won; Chung, Dawn; Yim, Ga Won; Nam, Eun Ji; Kim, Sunghoon; Kim, Sang Wun

    2014-01-01

    Objective The purpose of this study was to compare clinical and surgical outcomes between laparo-endoscopic single-site (LESS) surgery and traditional multiport laparoscopic (TML) surgery for treatment of adnexal tumors. Methods Medical records were reviewed for patients undergoing surgery for benign adnexal tumors between January 2008 and April 2012 at our institution. All procedures were performed by the same surgeon. Clinical and surgical outcomes for patients undergoing LESS surgery using Glove port were compared with those patients undergoing TML surgery. Results A review of 129 patient cases undergoing LESS surgery using Glove port and 100 patient cases undergoing TML surgery revealed no significant differences in the baseline characteristics of the two groups. The median operative time was shorter in the LESS group using Glove port at 44 minutes (range, 19-126 minutes) than the TML group at 49 minutes (range, 20-196 minutes) (P=0.0007). There were no significant differences between in the duration of postoperative hospital stay, change in hemoglobin levels, pain score or the rate of complications between the LESS and TML groups. Conclusion LESS surgery showed comparable clinical and surgical outcomes to TML surgery, and required less operative time. Future prospective trials are warranted to further define the benefits of LESS surgery for adnexal tumor treatment. PMID:25264529

  4. Total Laparoscopic Restorative Proctocolectomy: Are There Advantages Compared with the Open and Hand-Assisted Approaches?

    PubMed Central

    Polle, Sebastiaan W.; van Berge Henegouwen, Mark I.; Slors, J. Frederik M.; Cuesta, Miguel A.; Gouma, Dirk J.

    2008-01-01

    Purpose A randomized, controlled trial comparing hand-assisted laparoscopic restorative proctocolectomy with open surgery did not show an advantage for the laparoscopic approach. The trial was criticized because hand-assisted laparoscopic restorative proctocolectomy was not considered a true laparoscopic proctocolectomy. The objective of the present study was to assess whether total laparoscopic restorative proctocolectomy has advantages over hand-assisted laparoscopic restorative proctocolectomy with respect to early recovery. Methods Thirty-five patients underwent total laparoscopic restorative proctocolectomy and were compared to 60 patients from a previously conducted randomized, controlled trial comparing hand-assisted laparoscopic restorative proctocolectomy and open restorative proctocolectomy. End points included operating time, conversion rate, reoperation rate, hospital stay, morbidity, quality of life, and costs. The Medical Outcomes Study Short Form 36 and the Gastrointestinal Quality of Life Index were used to evaluate general and bowel-related quality of life. Results Groups were comparable for patient characteristics, such as sex, body mass index, preoperative disease duration, and age. There were neither conversions nor intraoperative complications. Median operating time was longer in the total laparoscopic compared with the hand-assisted laparoscopic group (298 vs. 214 minutes; P < 0.001). Morbidity and reoperation rates in the total laparoscopic, hand-assisted laparoscopic, and open groups were comparable (29 vs. 20 vs. 23 percent and 17 vs.10 vs. 13 percent, respectively). Median hospital-stay was 9 days in the total laparoscopic group compared with 10 days in the hand-assisted laparoscopic group and 11 days in the open group (P = not significant). There were no differences in quality of life and total costs. Conclusions There were no significant short-term benefits for total laparoscopic compared with hand-assisted laparoscopic

  5. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries

    PubMed Central

    Khetarpal, Ranjana; Bali, Kusum; Chatrath, Veena; Bansal, Divya

    2016-01-01

    The aim of this study was to review the various anesthetic options which can be considered for laparoscopic surgeries in the patients with the chronic obstructive pulmonary disease. The literature search was performed in the Google, PubMed, and Medscape using key words “analgesia, anesthesia, general, laparoscopy, lung diseases, obstructive.” More than thirty-five free full articles and books published from the year 1994 to 2014 were retrieved and studied. Retrospective data observed from various studies and case reports showed regional anesthesia (RA) to be valid and safer option in the patients who are not good candidates of general anesthesia like patients having obstructive pulmonary diseases. It showed better postoperative patient outcome with respect to safety, efficacy, postoperative pulmonary complications, and analgesia. So depending upon disease severity RA in various forms such as spinal anesthesia, paravertebral block, continuous epidural anesthesia, combined spinal epidural anesthesia (CSEA), and CSEA with bi-level positive airway pressure should be considered. PMID:26957682

  6. Ergonomic evaluation of laparoendoscopic single-site surgery ports in a validated laparoscopic training model.

    PubMed

    McCrory, Bernadette; Lowndes, Bethany R; Wirth, Laura M; de Laveaga, Adam E; LaGrange, Chad A; Hallbeck, M Susan

    2012-01-01

    Although laparoendoscopic single-site surgery (LESS) is feasible among expert laparoscopic surgeons, it poses many technical challenges not seen in conventional laparoscopy (CL). Recent technological advancements in single-incision instrumentation have created more interest and widespread usage of LESS. However, neither LESS nor its novel instrumentation have been thoroughly studied or evaluated using human factors and ergonomics techniques. Consequently, the aim of this study was to compare the physical performance of LESS to CL using a standardized task. Wrist and elbow angular movements, range of motion and physical discomfort were assessed for 24 novice participants. There were no significant differences for physical comfort/discomfort ratings or elbow and wrist flexion/extension range of motion between CL and LESS. However, wrist radial/ulnar range of motion was significantly greater in LESS compared to CL (p < 0.05). Additionally, wrist radial/ ulnar range of motion was significantly greater using the SILS Port compared to the GelPOINT (p < 0.05). Although further investigation is needed, LESS resulted in greater wrist deviation and range of motion due to the close proximity of the instruments, restrictive nature of the single-port devices, and the need to achieve adequate instrument triangulation and visualization. PMID:22316990

  7. Patient-specific port placement for laparoscopic surgery using atlas-based registration

    NASA Astrophysics Data System (ADS)

    Enquobahrie, Andinet; Shivaprabhu, Vikas; Aylward, Stephen; Finet, Julien; Cleary, Kevin; Alterovitz, Ron

    2013-03-01

    Laparoscopic surgery is a minimally invasive surgical approach, in which abdominal surgical procedures are performed through trocars via small incisions. Patients benefit by reduced postoperative pain, shortened hospital stays, improved cosmetic results, and faster recovery times. Optimal port placement can improve surgeon dexterity and avoid the need to move the trocars, which would cause unnecessary trauma to the patient. We are building an intuitive open source visualization system to help surgeons identify ports. Our methodology is based on an intuitive port placement visualization module and atlas-based registration algorithm to transfer port locations to individual patients. The methodology follows three steps:1) Use a port placement visualization module to manually place ports in an abdominal organ atlas. This step generates port-augmented abdominal atlas. This is done only once for a given patient population. 2) Register the atlas data with the patient CT data, to transfer the prescribed ports to the individual patient 3) Review and adjust the transferred port locations using the port placement visualization module. Tool maneuverability and target reachability can be tested using the visualization system. Our methodology would decrease the amount of physician input necessary to optimize port placement for each patient case. In a follow up work, we plan to use the transferred ports as starting point for further optimization of the port locations by formulating a cost function that will take into account factors such as tool dexterity and likelihood of collision between instruments.

  8. How Predictable Is the Operative Time of Laparoscopic Surgery for Ovarian Endometrioma?

    PubMed Central

    Gambadauro, Pietro; Campo, Vincenzo; Campo, Sebastiano

    2015-01-01

    Endometriosis is a tricky albeit common disease whose management largely relies on laparoscopy. We have studied the operative times of laparoscopic endometrioma surgery in order to assess their predictability and possible predictors. One hundred forty-eight laparoscopies were included, with a median operative time of 70 minutes (mean 75.14; 95% CI: 70.03–80.24). Half of the cases had a duration within 15–20 minutes above or below the median (IQR: 55–93.75), but the whole dataset ranged from 20 to 180 minutes, and the standard deviation was relatively large (31.4). Surgical times were significantly related to technical (number and size of the cysts) and nontechnical factors (age, parity, dysmenorrhea, and family history). At multiple logistic regression, after adjusting for number and size of the cysts, surgical times below the first quartile were associated with older age (>30 years old: aOR: 3.590; 95% CI: 1.417–9.091) and parity (≥1 delivery: aOR: 3.409; 95% CI: 1.343–8.651). Longer times, above the third quartile, were instead predicted by a familial anamnesis of endometriosis (aOR: 3.639; 95% CI: 1.246–10.627). Our findings indicate highly variable surgical times, which are predicted by unexpected nontechnical factors. This is consistent with the complexity of endometriosis and its treatment. Productivity and efficiency in endometriosis surgery should focus on the quality of healthcare outcomes rather than on the time spent in the operating theatres. PMID:26417455

  9. Laparoscopic adrenal surgery: ten-year experience in a single institution

    PubMed Central

    2013-01-01

    Background Minimal invasive adrenalectomy has become the procedure of choice to treat adrenal tumors with a benign appearance, ≤ 6 cm in diameter and weighing < 100 g. Authors evaluated medium- and long-term outcomes of laparoscopic adrenalectomy (LA), performed for ten years in a single endocrine surgery unit. Methods We retrospectively reviewed 88 consecutive patients undergone LA for lesions of adrenal glands from 2003 to 2013. The first 30 operations were considered part of the learning curve. Doxazosin was preoperatively administered in case of pheochromocytoma (PCC), while spironolactone and potassium were employed to treat Conn's disease. Perioperative cardiovascular status modifications and surgical and medium- and long-term results were analyzed. Results Forty nine (55.68%) functioning tumors, and one (1.13%) bilateral adrenal disease were identified. In 2 patients (2.27%) a supposed adrenal metastasis was postoperatively confirmed, while in no patients a diagnosis of incidental primitive malignancy was performed. There was no mortality or major post operative complication. The mean operative time was higher during the learning curve. Conversion and morbidity rates were respectively 1.13% and 5.7%. Intraoperative hypertensive crises (≥180/90 mmHg) were observed in 23.5% (4/17) of PCC patients and were treated pharmacologically with no aftermath. There was no influence of age, size and operative time on the occurrence of PCC intraoperative hypertensive episodes. Surgery determined a normalization of the endocrine profile. One single PCC persistence was observed, while in a Conn's patient, just undergone right LA, a left sparing adrenalectomy was performed for a contralateral metachronous aldosteronoma. Conclusions LA, a safe, effective and well tolerated procedure for the treatment of adrenal neoplasms ≤ 6 cm, is feasible for larger lesions, with a similar low morbidity rate. Operative time has improved along with the increase of the experience and of

  10. Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial☆

    PubMed Central

    Ratti, Francesca; Cipriani, Federica; Reineke, Raffaella; Catena, Marco; Paganelli, Michele; Comotti, Laura; Beretta, Luigi; Aldrighetti, Luca

    2015-01-01

    Background Central venous pressure (CVP) is used as a marker of cardiac preload to control intraoperative blood loss in open hepatectomies, while its reliability in laparoscopy is less certain. The aim of this randomized prospective trial was to evaluate the outcome of laparoscopic resections performed with stroke volume variation (SVV) or CVP monitoring. Methods All candidates for laparoscopic liver resection were assigned randomly to SVV or to CVP groups. Outcome was evaluated included conversion rate, cause of conversion, intraoperative blood loss, need for transfusions, length of surgery and postoperative results. Results Ninety consecutive patients were enrolled: both SVV and CVP groups included 45 patients each and were comparable in terms of patient and disease characteristics. A reduced rate of conversion was recorded in the SVV compared to the CVP group (6.7% and 17.8% respectively, p = 0.02). Blood loss was lower in the SVV group (150 mL), compared to the CVP group (300 mL, p = 0.04). Morbidity, mortality, length of stay and functional recovery were comparable. On multivariate analysis, lesion location, extent of hepatectomy and type of cardiac preload monitoring were associated significantly to risk of conversion. Conclusion SVV monitoring in laparoscopic liver surgery improves intraoperative outcome, thus enhancing the benefits of the minimally-invasive approach and fast-track protocols. PMID:26902132

  11. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery.

    PubMed

    Hadjianastassiou, V G; Johnson, R J; Rudge, C J; Mamode, N

    2007-11-01

    The worldwide expansion of laparoscopic, at the expense of open, donor nephrectomy (DN) has been driven on the basis of faster convalescence for the donor. However, concerns have been expressed over the safety of the laparoscopic procedure. The UK Transplant National Registry collecting mandatory information on all living kidney donations in the country was analyzed for donations between November 2000 (start of living donor follow-up data reporting) to June 2006 to assess the safety of living DN, after the recent introduction of the laparoscopic procedure in the United Kingdom. Twenty-four transplant units reported data on 2509 donors (601 laparoscopic, 1800 open and 108 [4.3%] unspecified); 46.5% male; mean donor age: 46 years. There was one death 3 months postdischarge and a further five deaths beyond 1 year postdischarge. The mean length of stay was 1.5 days less for the laparoscopic procedure (p < 0.001). The risk of major morbidity for all donors was 4.9% (laparoscopic = 4.5%, open = 5.1%, p = 0.549). The overall rate of any morbidity was 14.3% (laparoscopic = 10.3%, open = 15.7%, p = 0.001). Living donation has remained a safe procedure in the UK during the learning curve of introduction of the laparoscopic procedure. The latter offers measurable advantages to the donor in terms of reduced length of stay and morbidity. PMID:17868058

  12. Caudal bupivacaine and morphine provides effective postoperative analgesia but does not prevent hemodynamic response to pneumoperitoneum for major laparoscopic surgeries in children.

    PubMed

    Kundu, Riddhi; Baidya, Dalim K; Arora, Mahesh Kumar; Maitra, Souvik; Darlong, Vanlal; Goswami, Devalina; Mohanaselvi, S; Bajpai, Minu

    2015-08-01

    The use of a caudal block in laparoscopic surgery in children is limited to minor procedures like inguinal hernia repair, and intravenous opioids remain the analgesic modality of choice in major laparoscopic surgery. However, a caudal block is frequently performed at our institute even for laparoscopic surgery. Therefore, we planned to evaluate the analgesic efficacy of caudal bupivacaine and morphine in major laparoscopic surgery as compared to intravenous opioids. Our hypothesis was that a single-shot caudal block would increase the duration of analgesia and minimize the hemodynamic response to pneumoperitoneum. After institutional ethics committee clearance, data were collected for 65 ASA I-II children aged 6 months to 12 years who underwent laparoscopic surgery in the last 14 months. Demographic, surgical, and perioperative anesthetic and analgesic data were noted and analyzed. Twenty-four children received a caudal block with 0.25 % bupivacaine (1-1.25 ml/kg) with morphine (30-50 mcg/kg). In the caudal group, the time to first analgesic request was increased (165 vs. 45 min; p = 0.00) and tachycardia response to port site incision was less observed (33 vs. 63 % children; p = 0.019). Hemodynamic response to pneumoperitoneum was equal in both of the groups. Single-shot caudal injection of local anesthetic with morphine reduces port site skin incision response and increases the duration of postoperative analgesia but fails to prevent hemodynamic response to pneumoperitoneum. PMID:25686563

  13. 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 Doğan; Ulasli, Sevinc Sarinc; Yilmazer, Mehmet; Koca, Buğra; Arıöz, 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-1β 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-1β 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

  14. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    PubMed Central

    Liu, Guozheng; Jian, Fengguo; Wang, Xiuqin; Chen, Lin

    2016-01-01

    Aim To study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients. Methods Eighty-four elderly patients diagnosed with GC between September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21), FTS + laparotomy group (Group B, n=21), conventional perioperative care (CC) + laparoscopic group (Group C, n=21), and CC + laparotomy group (Group D, n=21). Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators. Results Preoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05). There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05). Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest. Conclusion FTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more effectively reduce postoperative stress reaction, and hence is safe and effective for elderly GC patients. PMID:27330314

  15. Gastrointestinal Endoscopy-Assisted Minimally Invasive Surgery for Superficial Cancer of the Uvula

    PubMed Central

    Odagiri, Hiroyuki; Iizuka, Toshiro; Kikuchi, Daisuke; Kaise, Mitsuru; Takeda, Hidehiko; Ohashi, Kenichi; Yasunaga, Hideo

    2016-01-01

    Previous studies reported that endoscopic resection is effective for the treatment of superficial pharyngeal cancers, as for digestive tract cancers. However, the optimal treatment for superficial cancer of the uvula has not been established because of the rarity of this condition. We present two male patients in their 70s with superficial cancer of the uvula, detected with upper gastrointestinal endoscopy. Both patients underwent surgical resection of the uvula under general anesthesia. The extent of the lesions was determined by means of gastrointestinal endoscopy by using magnifying observation with narrow-band imaging, enabling the performance of minimally invasive surgery. Endoscopic submucosal dissection was performed to achieve en bloc resection of the intramucosal carcinoma that had infiltrated the area adjacent to the uvula. Gastrointestinal endoscopists should carefully examine the laryngopharynx to avoid missing superficial cancers. Our minimally invasive treatment for superficial cancer of the uvula had favorable postoperative outcomes, and prevented postoperative loss of breathing, swallowing, and articulation functions. PMID:27040382

  16. Comparison between Training Models to Teach Veterinary Medical Students Basic Laparoscopic Surgery Skills.

    PubMed

    Levi, Ohad; Michelotti, Kurt; Schmidt, Peggy; Lagman, Minette; Fahie, Maria; Griffon, Dominique

    2016-01-01

    The objective of this study was to compare the effectiveness of two different laparoscopic training models in preparing veterinary students to perform basic laparoscopic skills. Sixteen first- and second-year veterinary students were randomly assigned to a box trainer (Group B) or tablet trainer (Group T). Training and assessment for both groups included two tasks, "peg transfer" and "pattern cutting," derived from the well-validated McGill University Inanimate System for Training and Evaluation of Laparoscopic Skills. Confidence levels were compared by evaluating pre- and post-training questionnaires. Performance of laparoscopic tasks was scored pre- and post-training using a rubric for precision and speed. Results revealed a significant improvement in student confidence for basic laparoscopic skills (p<.05) and significantly higher scores for both groups in both laparoscopic tasks (p<.05). No significant differences were found between the groups regarding their assessment of the video quality, lighting, and simplicity of setup (p=.34, p=.15, and p=.43, respectively). In conclusion, the low-cost tablet trainer and the more expensive box trainer were similarly effective in preparing pre-clinical veterinary students to perform basic laparoscopic skills on a model. PMID:26752022

  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. Maintaining Optimal Surgical Conditions With Low Insufflation Pressures is Possible With Deep Neuromuscular Blockade During Laparoscopic Colorectal Surgery

    PubMed Central

    Kim, Myoung Hwa; Lee, Ki Young; Lee, Kang-Young; Min, Byung-Soh; Yoo, Young Chul

    2016-01-01

    Abstract Carbon dioxide (CO2) absorption and increased intra-abdominal pressure can adversely affect perioperative physiology and postoperative recovery. Deep muscle relaxation is known to improve the surgical conditions during laparoscopic surgery. We aimed to compare the effects of deep and moderate neuromuscular block in laparoscopic colorectal surgery, including intra-abdominal pressure. In this prospective, double-blind, parallel-group trial, 72 adult patients undergoing laparoscopic colorectal surgery were randomized using an online randomization generator to achieve either moderate (1–2 train-of-four response, n = 36) or deep (1–2 post-tetanic count, n = 36) neuromuscular block by receiving a continuous infusion of rocuronium. Adjusted intra-abdominal pressure, which was titrated by a surgeon with maintaining the operative field during pneumoperitoneum, was recorded at 5-minute intervals. Perioperative hemodynamic parameters and postoperative outcomes were assessed. Six patients from the deep and 5 from the moderate neuromuscular block group were excluded, leaving 61 for analysis. The average adjusted IAP was lower in the deep compared to the moderate neuromuscular block group (9.3 vs 12 mm Hg, P < 0.001). The postoperative pain scores (P < 0.001) and incidence of postoperative shoulder tip pain were lower, whereas gas passing time (P = 0.002) and sips of water time (P = 0.005) were shorter in the deep neuromuscular block than in the moderate neuromuscular block group. Deep neuromuscular blocking showed several benefits compared to conventional moderate neuromuscular block, including a greater intra-abdominal pressure lowering effect, whereas surgical conditions are maintained, less severe postoperative pain and faster bowel function recovery. PMID:26945393

  19. Comparison of different postoperative paın managements in patients submitted to transperitoneal laparoscopic renal and adrenal surgery

    PubMed Central

    Tuncel, Altug; Balci, Melih; Postaci, Aysun; Aslan, Yilmaz; Atan, Ali

    2015-01-01

    ABSTRACT Purpose: We compared the effects of local levobupivacaine infiltration, intravenous paracetamol, intravenous lornoxicam treatments on postoperative analgesia in patients submitted to transperitoneal laparoscopic renal and adrenal surgery. Materials and Methods: Sixty adult patients 26 and 70 years who underwent laparoscopic renal and adrenal surgery were randomized into three groups with 20 patients each: Group 1 received local 20mL of levobupivacaine 0.25% infiltration to the trocar incisions before skin closure. In group 2, 1g paracetamol was given to the patients intravenously 30 minutes before extubation and 5g paracetamol was given intravenoulsy in the 24 postoperative period. In group 3, 8mg lornoxicam i.v. was given 30 minutes before extubation and 8mg lornoxicam i.v. was given in the 24 postoperative period. In the postoperative period, pain scores, cumulative tramadol, and additional pethidine consumption were evaluated. Results: Postoperative pain scores significantly reduced in each group (p < 0.05). Although pain levels of the groups were not significantly different at 1, 2, 4, 8, 12 and 24 hours postoperatively, cumulative tramadol consumptions were higher in group 1 than the others. (Group 1 = 370.6 ± 121.6mg, Group 2: 220.9 ± 92.5mg, Group 3 = 240.7 ± 100.4mg.) (p < 0.005). The average dose of pethidine administered was significantly lower in groups 2 and 3 compared with group 1 (Group 1: 145mg, Group 2: 100mg, Group 3: 100mg) (p = 0.024). Conclusions: Levobupivacaine treated group required significantly more intravenous tramadol when compared with paracetamol and lornoxicam groups in patients submitted to transperitoneal laparoscopic renal and adrenal surgery. PMID:26401858

  20. Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques.

    PubMed

    Dion, Joanna M; McKee, Chris; Tobias, Joseph D; Herz, Daniel; Sohner, Paul; Teich, Steven; Michalsky, Marc

    2015-02-01

    Various factors including severe obesity or increases in intra-abdominal pressure during laparoscopy can lead to inaccuracies in end-tidal carbon dioxide (PETCO2) monitoring. The current study prospectively compares ET and transcutaneous (TC) CO2 monitoring in severely obese adolescents and young adults during laparoscopic-assisted bariatric surgery. Carbon dioxide was measured with both ET and TC devices during insufflation and laparoscopic bariatric surgery. The differences between each measure (PETCO2 and TC-CO2) and the PaCO2 were compared using a non-paired t test, Fisher's exact test, and a Bland-Altman analysis. The study cohort included 25 adolescents with a mean body mass index of 50.2 kg/m2 undergoing laparoscopic bariatric surgery. There was no difference in the absolute difference between the TC-CO2 and PaCO2 (3.2±3.0 mmHg) and the absolute difference between the PETCO2 and PaCO2 (3.7±2.5 mmHg). The bias and precision were 0.3 and 4.3 mmHg for TC monitoring versus PaCO2 and 3.2 and 3.2 mmHg for ET monitoring versus PaCO2. In the young severely obese population both TC and PETCO2 monitoring can be used to effectively estimate PaCO2. The correlation of PaCO2 to TC-CO2 is good, and similar to the correlation of PaCO2 to PETCO2. In this population, both of these non-invasive measures of PaCO2 can be used to monitor ventilation and minimize arterial blood gas sampling. PMID:24916514

  1. A feasibility study to investigate the use of a bupivacaine-collagen implant (XaraColl) for postoperative analgesia following laparoscopic surgery

    PubMed Central

    Hemsen, Lisa; Cusack, Susan L; Minkowitz, Harold S; Kuss, Michael E

    2013-01-01

    Background XaraColl, a collagen-based implant that delivers bupivacaine to sites of surgical trauma, has been shown to reduce postoperative pain and use of opioid analgesia in patients undergoing open surgery. We therefore designed and conducted a preliminary feasibility study to investigate its application and ease of use for laparoscopic surgery. Methods We implanted four XaraColl implants each containing 50 mg of bupivacaine hydrochloride (200 mg total dose) in ten men undergoing laparoscopic inguinal or umbilical hernioplasty. Postoperative pain intensity and use of opioid analgesia were recorded through 72 hours for comparison with previously reported data from efficacy studies performed in men undergoing open inguinal hernioplasty. Safety was assessed for 30 days. Results XaraColl was easily and safely implanted via a laparoscope. The summed pain intensity and total use of opioid analgesia through the first 24 hours were similar to the values observed in previously reported studies for XaraColl-treated patients after open surgery, but were lower through 48 and 72 hours. Conclusion XaraColl is suitable for use in laparoscopic surgery and may provide postoperative analgesia in laparoscopic patients who often experience considerable postoperative pain in the first 24–48 hours following hospital discharge. Randomized controlled trials specifically to evaluate its efficacy in this application are warranted. PMID:23390367

  2. Aortoenteric fistula at the site of esophagojejunostomy after laparoscopic total gastrectomy: report of a case.

    PubMed

    Gunji, Shutaro; Okabe, Hiroshi; Obama, Kazutaka; Sakai, Yoshiharu

    2014-11-01

    A fistula between the aorta and the digestive tract is a rare complication of gastrointestinal tract or vascular surgery. There are occasional reports of aortoesophageal fistula as a fatal complication after esophagectomy or esophageal stent implantation and of aortoenteric fistula (AEF) as a complication after aortic or other vascular procedures. However, AEF after gastrointestinal surgery is rare. We report a case of AEF after laparoscopic total gastrectomy for advanced gastric cancer, using the so-called overlap method of esophagojejunal anastomosis. The patient was a 77-year-old Japanese woman who underwent laparoscopic total gastrectomy and esophagojejunal anastomosis with Roux-en-Y reconstruction for advanced gastric cancer. Bacterial peritonitis was diagnosed 5 days after the operation, manifesting as partial necrosis and perforation of the small intestine. The patient was treated successfully with laparoscopic partial resection of the small intestine, but ultimately died of massive hematemesis caused by the AEF 30 days after her primary surgery. PMID:24468742

  3. Is the advanced age a contraindication to GERD laparoscopic surgery? Results of a long term follow-up

    PubMed Central

    2013-01-01

    Background In this prospective non randomized observational cohort study we have evaluated the influence of age on outcome of laparoscopic total fundoplication for GERD. Methods Six hundred and twenty consecutive patients underwent total laparoscopic fundoplication for GERD. Five hundred and twenty-four patients were younger than 65 years (YG), and 96 patients were 65 years or older (EG). The following parameters were considered in the preoperative and postoperative evaluation: presence, duration, and severity of GERD symptoms, presence of a hiatal hernia, manometric and 24 hour pH-monitoring data, duration of operation, incidence of complications and length of hospital stay. Results Elderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in comparison with younger patients. The duration of the operation was similar between the two groups. The incidence of intraoperative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 93.0% of young patients and in 88.9% of elderly patients (p = NS). Conclusions Laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients. PMID:24267613

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

    PubMed

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

    2014-11-01

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

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

    PubMed Central

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

    2014-01-01

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

  6. Functional Abdominal Pain Syndrome in Morbidly Obese Patients Following Laparoscopic Gastric Bypass Surgery

    PubMed Central

    Eidy, Mohammad; Pazouki, Abdolreza; Raygan, Fahimeh; Ariyazand, Yazdan; Pishgahroudsari, Mohadeseh; Jesmi, Fatemeh

    2014-01-01

    Background: Roux-en-Y gastric bypass surgery (RYGBP) is one of the most common bariatric surgeries, which is being performed using various techniques like gastrojejunostomy by hand swen, linear or circular stapler. Abdominal pain is a common complaint following laparoscopic gastric bypass procedure (LGBP), which has different aetiologies, such as overeating, adhesion, internal herniation, bile reflux and many more. In this study LGBP was performed in an ante-colic ante-gastric pattern in a double loop manner and the prevalence and distribution of pain in morbidly obese patients undergoing LGBP was assessed. Objectives: The aim of this study was to analyze the distribution and frequency of post LGBP pain in morbidly obese patients. Patients and Methods: This study was performed on 190 morbidly obese patients referred to Hazrat Rasoul Hospital in Tehran. After LGBP, pain was measured in the following intervals: 24 hours, one week and one month after the operation. Before the operation onset, 2 mg Keflin and 5000 IU subcutaneous heparin were administered as prophylaxis. LGBP was performed using five ports including: one 11 mm port was placed 15-20 cm far from the xiphoid, one 12-mm port in mid-clavicular line at the level of camera port, one 5-mm port in subcostal area in ante-axillary region in the left, another 5-mm port in the right mid-clavicular area and a 5-mm port in sub-xyphoid. All operations were done by the same team. Staple was used for all anastomoses and hand sewn technique to close the staple insertion site. The mesenteric defect was left open and no effort was made to repair it. Results: The results of this study showed that 99.94 % of the patients had complains of pain in the first 24 hours of post operation, about 60% after one week and 29.5 % still had pain after one month. In addition, left upper quadrant (LUQ) was found to be the most prevalent site for the pain in 53.7% of the patients in the first 24 hours, 59.6% after one week and 16.8% after

  7. Normothermia to Prevent Surgical Site Infections After Gastrointestinal Surgery: Holy Grail or False Idol?

    PubMed Central

    Lehtinen, Simon J.; Onicescu, Georgiana; Kuhn, Kathy M.; Cole, David J.; Esnaola, Nestor F.

    2012-01-01

    Objective To analyze the association between perioperative normothermia (temperature ≥36°C) and surgical site infections (SSIs) after gastrointestinal (GI) surgery. Summary of Background Data Although active warming during colorectal surgery reduces SSIs, there is limited evidence that perioperative normothermia is associated with lower rates of SSI. Nonetheless, hospitals participating in the Surgical Care Improvement Project must report normothermia rates during major surgery. Methods We conducted a nested, matched, case-control study; cases consisted of GI surgery patients enrolled in our National Surgical Quality Improvement Program database between March 2006 and March 2009 who developed SSIs. Patient/surgery risk factors for SSI were obtained from the National Surgical Quality Improvement Program database. Perioperative temperature/antibiotic/glucose data were obtained from medical records. Cases/controls were compared using univariate/random effects/logistic regression models. Independent risk factors for SSIs were identified using multivariate/random effects/logistic regression models. Results A total of 146 cases and 323 matched controls were identified; 82% of patients underwent noncolorectal surgery. Cases were more likely to have final intraoperative normothermia compared with controls (87.6% vs. 77.8%, P = 0.015); rates of immediate postoperative normothermia were similar (70.6% vs. 65.3%, respectively, P = 0.19). Emergent surgery/higher wound class were associated with higher rates of intraoperative normothermia. Independent risk factors for SSI were diabetes, surgical complexity, small bowel surgery, and nonlaparoscopic surgery. There was no independent association between perioperative normothermia and SSI (adjusted odds ratio, 1.05; 95% confidence interval, 0.48–2.33; P = 0.90). Conclusions Pay-for-reporting measures focusing on perioperative normothermia may be of limited value in preventing SSI after GI surgery. Studies to define the benefit

  8. Laparoscopic Spleen Removal (Splenectomy)

    MedlinePlus

    ... Login Laparoscopic Spleen Removal (Splenectomy) Patient Information from SAGES Download PDF Version Find a SAGES Surgeon What ... 2017 Meeting Information Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  9. Laparoscopic repair of paraesophageal hernia.

    PubMed Central

    Willekes, C L; Edoga, J K; Frezza, E E

    1997-01-01

    OBJECTIVE: The purpose of this report is to describe the authors' technique for the laparoscopic repair of paraesophageal hernias and the outcome in their series of patients. METHODS: Thirty patients underwent elective laparoscopic repair of paraesophageal hernias. All were pure type II paraesophageal hernias as defined by upper gastrointestinal contrast studies. All operations were performed by a single surgeon (JKE) assisted by five different chief surgical residents. The authors have used various prototypes of a laparoscopic utility belt to reduce the physician requirement to the surgeon and a first assistant. The operative setup and specific techniques of the repair are described and illustrated. A concomitant anti-reflux procedure was performed in the last 23 patients. RESULTS: Satisfactory repair using video-laparoscopic techniques was achieved in all cases. There were no deaths. Complications occurred in 8 of 30 patients. Postoperative gastroesophageal reflux developed in three of the first seven patients in whom fundoplication was not performed. Three consecutive patients had left lower lobe atelectasis believed to be related to endotracheal tube displacement during the passage of the bougie. One patient had postoperative dysphagia. There was one case of major deep venous thrombosis with pulmonary embolism. Twenty-eight of 30 patients were discharged home by postoperative day 3. Twenty-four of 30 patients had returned to normal activity by the time of their first postoperative office visit 1 week after surgery. Images Figure 9. Figure 10. PMID:8998118

  10. Large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe anemia treated by laparoscopic surgery

    PubMed Central

    2014-01-01

    Background The Meigs' syndrome is a rare but well-known syndrome defined as the triad of benign solid ovarian tumor, ascites, and pleural effusion. Meigs' syndrome always requires surgical treatment. However, the optimal approach for its management has not been sufficiently investigated. Case presentation We report a patient with a large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe hemolytic anemia that was treated by laparoscopic surgery. This case highlights the difficulties that may be encountered in the management of patients with Meigs’ syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach and the adverse impact that Meigs’ syndrome can have on the patient’s condition, especially if it is associated with acute pain and severe anemia. Considering the patient’s serious clinical condition and assuming that she had Meigs' syndrome with a twisted large ovarian mass and possible hemolytic anemia, we first concentrated on effective medical management of our patient and chose the most appropriate surgical treatment after laparoscopic examination. The main aim of our initial approach was preoperative management of the anemia. Blood transfusions and glucocorticoid therapy resulted in stabilization of the hemoglobin level and normalization of the bilirubin levels, which confirmed the appropriateness of this approach. Laparoscopic surgery 4 days after admission enabled definitive diagnosis of the tumor, confirmed torsion and removed the bulky ovarian fibroma, resulting in timely resolution of symptoms, short hospitalization, relatively low morbidity and a rapid return to her social and professional life. Conclusions This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and

  11. The comparison of Proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia

    PubMed Central

    Saraswat, Namita; Kumar, Aditya; Mishra, Abhijeet; Gupta, Amrita; Saurabh, Gyan; Srivastava, Uma

    2011-01-01

    Aims to compare the efficacy of Proseal laryngeal mask airway(PLMA) and endotracheal tube (ETT) in patients undergoing laparoscopic surgeries under general anaesthesia. This prospective randomised study was conducted on 60 adult patients, 30 each in two groups, of ASA I-II who were posted for laparoscopic procedures under general anaesthesia. After preoxygenation, anaesthesia was induced with propofol, fentanyl and vecuronium. PLMA or ETT was inserted and cuff inflated. Nasogastric tube (NGT) was passed in all patients. Anaesthesia was maintained with N2 O, O2, halothane and vecuronium. Ventilation was set at 8 ml/kg and respiratory rate of 12/min. The attempts and time taken for insertion of devices, haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal morbidity (LPM) were noted. There was no failed insertion of devices. Time taken for successful passage of NGT was 9.77 s (6-16 s) and 11.5 s (8-17 s) for groups P and E, respectively. There were no statistically significant differences in oxygen saturation (SpO2) or end-tidal carbon dioxide (EtCO2) between the two groups before or during peritoneal insufflation. Median (range) airway pressure at which oropharyngeal leak occurred during the leak test with PLMA was 35 (24-40) cm of H2O. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. No significant difference in laryngopharyngeal morbidity was noted. A properly positionedPLMA proved to be a suitable and safe alternative to ETT for airway management in elective fasted, adult patients undergoing laparoscopic surgeries. It provided equally effective pulmonary ventilation despite high airway pressures without gastric distention, regurgitation, and aspiration. PMID:21712868

  12. Redo Surgery after Failed Open VBG: Laparoscopic Minigastric Bypass versus Laparoscopic Roux en Y Gastric Bypass—Which Is Better?

    PubMed Central

    Salama, Tamer M. S.; Sabry, Karim

    2016-01-01

    Background. Long-term studies have reported that the rate of conversion surgeries after open VBG ranged from 49.7 to 56%. This study is aiming to compare between LMGB and LRYGB as conversion surgeries after failed open VBG with respect to indications and operative and postoperative outcomes. Methods. Sixty patients (48 females and 12 males) presenting with failed VBG, with an average BMI of 39.7 kg/m2 ranging between 26.5 kg/m2 and 53 kg/m2, and a mean age of 38.7 ranging between 24 and 51 years were enrolled in this study. Operative and postoperative data was recorded up to one year after the operation. Results. MGB is a simple procedure that is associated with short operative time and low rate of complications. However, MGB may not be applicable in all cases with failed VBG and therefore RYGB may be needed in such cases. Conclusion. LMGB is a safe and feasible revisional bariatric surgery after failed VBG and can achieve early good weight loss results similar to that of LRYGP. However, the decision to convert to lap RYGB or MGB should be taken intraoperatively depending mainly on the actual intraoperative pouch length. PMID:27313885

  13. Proximal segmentation of the dorsal mesogastrium reveals new anatomical implications for laparoscopic surgery

    PubMed Central

    Xie, Daxing; Gao, Chun; Lu, An; Liu, Liang; Yu, Chaoran; Hu, Junbo; Gong, Jianping

    2015-01-01

    Generally, the gold standard of radical surgery for gastrointestinal (GI) tumors is en bloc resection of primary lesions and their related tissues. For gastric cancer, the ideal surgical treatment should be D2 radical gastrectomy plus complete mesogastrium excision. Complete mesogastrium excision is rarely done or mentioned since little is known about the mesogastrium and its presence is still with controversy. Topographically, the “mesogastrium” refers to a peri-gastric structure composed of “fascia propria”, enveloping lymph nodes, blood vessels and adipose tissues, which by connecting to the stomach, suspends from the posterior abdominal wall. In this study, by employing video laparoscopy, a number of proximal segments of dorsal mesogastrium were found being extensively scattered around the pancreas. The structure of the mesogastrium was further identified intraoperatively and then confirmed both grossly and histologically after the operation. Our results demonstrated the existence of mesogastrium (gastric mesentery) and its architecture. We suggest for the first time a “Table model” to describe the relationship between the stomach and gastric mesenteries enveloped by fascia propria, which might provide an improvement in the surgical methods for excision of gastric cancer. PMID:26542081

  14. Symposium on the management of inguinal hernias: 3. Laparoscopic groin hernia surgery: the TAPP procedure

    PubMed Central

    Litwin, Demetrius E.M.; Pham, Quynh N.; Oleniuk, Fredrick H.; Kluftinger, Andreas M.; Rossi, Ljubomir

    1997-01-01

    Objective To describe the technique and results of laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Design A case series, with a detailed description of the operative technique. Setting A university affiliated hospital. Patients A consecutive series of 554 patients (494 male, 60 female) who underwent laparoscopic hernia repair in a single institution. The mean follow-up was 14 months. Interventions Laparoscopic TAPP hernia repair was performed in almost all patients. Simple closure was performed in a patient with a strangulated hernia, and a mesh-based repair was used in a patient with bilateral obturator hernias. Main outcome measures Complications and recurrence. Results The laparoscopic TAPP repair was successful in 550 of the 554 patients who underwent 632 hernia repairs. Conversion was necessary in 4 patients. Complications were infrequent and there were no recurrences. Only 3.4% of patients were lost to follow-up. The most frequent complications were urinary retention (27) and hematoma and seroma (38) in the early postoperative period. Neuralgia (11) and hydrocele (10) also occurred. Mesh infection occurred in only 1 patient and port-site hernias in 3 patients. There was 1 death from an acute myocardial infarction. Conclusion Laparoscopic TAPP hernia repair is associated with an exceedingly low recurrence rate and an acceptable complication rate. PMID:9194780

  15. In-vitro investigations on laser-induced smoke generation mimicking the laparoscopic laser surgery purposes.

    PubMed

    Khoder, Wael Y; Stief, Christian G; Fiedler, Sebastian; Pongratz, Thomas; Beyer, Wolfgang; Hennig, Georg; Rühm, Adrian; Sroka, Ronald

    2015-09-01

    Intraoperative smoke-generation limits the quality of vision during laparoscopic/endoscopic laser-assisted surgeries. The current study aimed at the evaluation of factors affecting this phenomenon. As a first step, a suitable experimental setup and a test tissue model were established for this investigation. The experimental setup is composed of a specific sample container, a laser therapy component suitable for the ablation of model tissue at different treatment wavelengths (λ = 980 nm, 1350 nm, 1470 nm), a suction unit providing continuous smoke extraction, and a detection unit for smoke quantification via detection of light (λ = 633 nm) scattered from smoke particles. The ablation rate (AR) was calculated by dividing the ablated volume by the ablation time (60 sec). The laser-induced scattering signal intensity of the smoke (SI) was determined from time-charts of the signal intensity as a measure for vision, in addition a delay-time tdelay could be derived defining the onset of SI after the laser was switched on. The ratio SI/AR is used as a measure for smoke generation in relation to the ablation rate. Additionally the light transmission of the tissue samples was used to estimate their optical properties. In this set-up, smoke generation using λ = 980 nm as ablation laser wavelength was detected after a delay-time tdelay = (121.6 ± 24.8) sec which is significantly longer compared to the wavelengths λ = 1350 nm with tdelay = (89.8 ± 19.3) sec and λ = 1470 nm with tdelay = (24.7 ± 5.4) sec. Thus, the delay Experimental set-up consisting of sample container, laser therapy component, suction unit and scattered-light detection compartment. time is wavelength-dependent. The SI/AR ratio was significantly different (p < 0.001) for 1470 nm irradiation compared to 980 nm irradiation [SI/AR(1470) = (11.8 ± 2.6) · 10(3) vs. SI/AR(980) = (8.6 ± 2.0) · 10(3) ]. The ablation crater for 980 nm irradiation was comparable with 1470 nm irradiation, but the

  16. Preoperative endoscopy may reduce the need for revisional surgery for gastro-oesophageal reflux disease following laparoscopic sleeve gastrectomy.

    PubMed

    Madhok, B M; Carr, W R J; McCormack, C; Boyle, M; Jennings, N; Schroeder, N; Balupuri, S; Small, P K

    2016-08-01

    Laparoscopic sleeve gastrectomy is a safe and effective bariatric operation, but postoperative reflux symptoms can sometimes necessitate revisional surgery. Roux-en-Y gastric bypass is the preferred operation in morbidly obese patients with gastro-oesophageal reflux disease. In 2011, we introduced preoperative endoscopy to assess for hiatus hernia or evidence of oesophagitis in conjunction with an assessment of gastro-oesophageal reflux symptoms for all patients undergoing bariatric surgery with a view to avoid sleeve gastrectomy for these patients. A prospectively maintained database was used to identify patients who underwent sleeve gastrectomy before and after we changed the unit policy. The need for revisional surgery in patients with troublesome gastro-oesophageal reflux disease was examined. Prior to 2011, 130 patients underwent sleeve gastrectomy, and 11 (8.5%) of them required conversion to Roux-en-Y gastric bypass for symptomatic reflux disease. Following the policy change, 284 patients underwent sleeve gastrectomy, and to date, only five (1.8%) have required revisional surgery (p = 0.001). Baseline demographics were comparable between the groups, and average follow-up period was 47 and 33 months, respectively, for each group. Preoperative endoscopy and a detailed clinical history regarding gastro-oesophageal reflux symptoms may improve patient selection for sleeve gastrectomy. Avoiding sleeve gastrectomy in patients with reflux disease and/or hiatus hernia may reduce the incidence of revisional surgery. PMID:27400631

  17. Laparoscopic surgery for sigmoidocutaneous fistula due to diverticulitis: A case report.

    PubMed

    Hidaka, Eiji; Nakahara, Kenta; Maeda, Chiyo; Takehara, Yusuke; Ishida, Fumio; Kudo, Shin-ei

    2015-08-01

    Sigmoidocutaneous fistulas due to sigmoid colon diverticulitis are very rare. Here we report a case in which laparoscopic sigmoidectomy was used to successfully treat a sigmoidocutaneous fistula due to diverticulitis. A 41-year-old man was admitted to our hospital because of redness and swelling of the left inguinal skin. Enhanced abdominal CT revealed a subcutaneous abscess in the left lower abdomen. Percutaneous drainage was performed, and fistulography revealed a fistula between the sigmoid colon and left inguinal skin. Therefore, a sigmoidocutaneous fistula was diagnosed, and laparoscopic sigmoidectomy and fistulectomy were performed. The sigmoid colon had several diverticula, and a pathological examination revealed that the sigmoidocutaneous fistula was due to diverticulitis. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. In cases of sigmoidocutaneous fistula, laparoscopic treatment can be safely performed. PMID:26303733

  18. Cost-effectiveness of palliative surgery versus nonsurgical procedures in gastrointestinal cancer patients.

    PubMed

    Kim, Bradford J; Aloia, Thomas A

    2016-09-01

    Palliative care is an essential component to multidisciplinary cancer care. Improved symptom control, quality of life (QOL), and survival have resulted from its utilization. Cost-effectiveness and utility analyses are significant variables that should be considered in comparing benefits and costs of medical interventions to determine if certain treatments are economically justified. This is a review on the cost-effectiveness of palliative surgery compared to other nonsurgical palliative procedures in patients with unresectable gastrointestinal cancers. J. Surg. Oncol. 2016;114:316-322. © 2016 Wiley Periodicals, Inc. PMID:27132654

  19. Comparative study of postoperative analgesic effect of intraperitoneal instillation of dexmedetomidine with bupivacaine and bupivacaine alone after laparoscopic surgery

    PubMed Central

    Oza, Vrinda P; Parmar, Vandana; Badheka, Jigisha; Nanavati, Dharam S; Taur, Pradip; Rajyaguru, Ajay M

    2016-01-01

    AIMS: This prospective double-blinded study was designed with the aim of comparing the analgesic effect of intraperitoneal instillation of dexmedetomidine with bupivacaine with that with bupivacaine alone in patients undergoing laparoscopic surgeries. MATERIALS AND METHODS: A total of 100 patients of either sex undergoing elective laparoscopic surgery were randomly divided into two groups containing 50 patients in each group. Group B received intraperitoneal instillation with 50 mL of bupivacaine 0.25% (125 mg) and groups B + D received 50 mL of bupivacaine 0.25% (125 mg) + 1 μg/kg of dexmedetomidine. Pain was assessed using visual analogue scale (VAS) at 0.5 h, 1 h, 2 h, 4 h, 6 h, and 24 h after the surgery. The requirement of rescue analgesics were recorded. RESULT: Duration of analgesia was longer in group B+D (14.5 hr) compared to group B (13.06 hr). The requirement of rescue analgesic in 24 hours was less in group B+D (1.76) compared to group B (2.56) which were statistically significant (P < 0.05). The mean number of total rescue analgesia given in 24 h was less in group B+D was 1.76 whereas in group B was 2.56 that were statistically significant. CONCLUSION: Intraperitoneal instillation of dexmedetomidine with bupivacaine prolongs the duration of postoperative analgesia as compared to that with bupivacaine alone. And also there is less number of rescue analgesics that are required postoperatively when dexmedetomidine is supplemented as an adjuvant to bupivacaine. PMID:27279399

  20. Determinants of Weight Loss following Laparoscopic Sleeve Gastrectomy: The Role of Psychological Burden, Coping Style, and Motivation to Undergo Surgery

    PubMed Central

    Figura, Andrea; Ahnis, Anne; Stengel, Andreas; Hofmann, Tobias; Elbelt, Ulf; Ordemann, Jürgen; Rose, Matthias

    2015-01-01

    Background. The amount of excess weight loss (%EWL) among obese patients after bariatric surgery varies greatly. However, reliable predictors have not been established yet. The present study evaluated the preoperative psychological burden, coping style, and motivation to lose weight as factors determining postoperative treatment success. Methods. The sample included 64 morbidly obese patients with a preoperative BMI of 51 ± 8 kg/m2 who had undergone laparoscopic sleeve gastrectomy (LSG). Well-established questionnaires were applied before surgery to assess the psychological burden in terms of “perceived stress” (PSQ-20), “depression” (PHQ-9), “anxiety” (GAD-7), and “mental impairment” (ISR) as well as coping style (Brief COPE) and motivation to lose weight. %EWL as an indicator for treatment success was assessed on average 20 months after surgery. Results. Based on the %EWL distribution, patients were classified into three %EWL groups: low (14–39%), moderate (40–59%), and high (60–115%). LSG patients with high %EWL reported significantly more “active coping” behavior prior to surgery than patients with moderate and low %EWL. Patients' preoperative psychological burden and motivation to lose weight were not associated with %EWL. Conclusion. An “active coping” style might be of predictive value for better weight loss outcomes in patients following LSG intervention. PMID:26649192

  1. The importance of radiological controls of anastomoses after upper gastrointestinal tract surgery - a retrospective cohort study

    PubMed Central

    2010-01-01

    Introduction This study was designed to analyze whether routine radiological controls of anastomoses in the upper gastrointestinal tract an early detection of anastomotic leaks. Patients and Methods 135 patients who underwent upper gastrointestinal tract surgery were retrospectively analyzed. Patients in the first group (n = 55) underwent routine radiological control of the anastomoses. In the second group (n = 80) the radiological control was only performed in case of clinical symptoms or signs of anastomotic leaks. Results The incidence of anastomotic leaks in the patients seen by us was 5.2%, equivalent to 7 of 135 patients In Group 1 leaks were seen in 4 of 55 patients (7,2%) in group 2 leaks were seen in 3 of 80 (3,8%). The radiological control of the anastomoses with contrast swallow showed the leakage in two cases. Twice the results were false negative. The sensitivity of computed tomography was 100%. Discussion Routine radiological control of anastomoses with contrast swallow only has low sensitivity. This procedure should not be performed routinely any more. The radiological control should be used in cases with signs of anastomotic leakage or with postoperatively impaired gastrointestinal passage. PMID:21070633

  2. [Perioperative Management of Emergency Gastrointestinal Surgery in a Patient with Left Ventricular Non-compaction].

    PubMed

    Kurazumi, Takuya; Suzuki, Takeshi; Ideno, Satoshi; Sakuma, Takahiro; Nagafuchi, Mari; Sato, Tomoyuki; Oshida, Junya

    2015-02-01

    Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy characterized by heart failure, arrhythmia, and embolic events. A 65-year-old man, previously diagnosed as LVNC, was admitted to the emergency department with severe abdominal pain. He was diagnosed as appendicitis and treated conservatively with antibiotics. The echocardiogram examination showed left ventricular ejection fraction of less than 25%, and his B-type natriuretic peptide assay was > 5,000 pg x ml(-1) on admission. Ten days after admission, he underwent emergency surgery for suspected perforation of vermiform appendix. Transesophageal echocardiography (TEE) was used for real-time evaluation of cardiac function and restrictive fluid management during surgery. He was transferred to intensive care unit (ICU) for postoperative care, and extubated 16 hours after surgery. On the third postoperative day, he was discharged from ICU without any complications. We consider that perioperative hemodynamic management with TEE may be useful for gastrointestinal tract surgeries in patients with severe cardiac disease, such as LVNC. PMID:26121812

  3. Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery

    PubMed Central

    Wagner, Doris; DeMarco, Mara McAdams; Amini, Neda; Buttner, Stefan; Segev, Dorry; Gani, Faiz; Pawlik, Timothy M

    2016-01-01

    According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on PubMed and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia - the loss of muscle mass - is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient’s peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the pre-operative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been

  4. 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

  5. Laparoendoscopic single-site surgery adrenalectomy – own experience and matched case-control study with standard laparoscopic adrenalectomy

    PubMed Central

    Ürge, Tomáš; Stránský, Petr; Trávníček, Ivan; Pitra, Tomáš; Kalusová, Kristýna; Dolejšová, Olga; Petersson, Fredrik; Krčma, Michal; Chlosta, Piotr

    2014-01-01

    Introduction At our institution, laparoendoscopic single-site surgery (LESS) has been established as a technique for laparoscopic nephrectomy since 2011, and since 2012 in selected cases for adrenalectomy (AE) as well. Aim To compare LESS AE with standard laparoscopic AE (SLAE). Material and methods Between 3/2012 and 7/2014, 35 adrenalectomies were performed. In 18 (51.4%), a LESS approach was chosen. Indications were strictly non-complicated cases (body mass index (BMI) < 34 kg/m2, tumour ≤ 7 cm, non-malignant aetiology, no previous surgery). All LESS procedures were done by one surgeon. Standard equipment was a 10 mm rigid 0° camera, Triport+, one pre-bent grasper, and a sealing instrument. The approach was pararectal in all cases except one (transumbilical in a slim man). Three patients with LESS were excluded (2 partial AEs only, one adrenal cancer converted to SLAE and then to open surgery). These 15 LESS AE procedures were compared to 15 SLAEs with similar characteristics chosen among 54 SLAEs performed in the period 1/2008–2/2012. Results In 8 cases (53.3%) of LESS AE, a 3 mm port was added to elevate the liver/spleen. Mean parameters of LESS AE vs. SLAE (Wilcoxon test): maximal tumour diameter 43.7 mm vs. 36.1 mm (p = 0.28), time of surgery 63.3 min vs. 55.3 min (p = 0.22), blood loss 38.0 ml vs. 38.0 ml (p = 0.38), BMI 26.9 kg/m2 vs. 28.5 kg/m2 (p = 0.13), discharge from hospital 5.4 days vs. 3.9 days (p = 0.038). There were no complications in either group. Conclusions The LESS AE is feasible in selected cases, especially small left-sided tumours in thin patients with no history of previous abdominal operations, but requires an additional port in half of the cases. PMID:25561998

  6. The Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics may not correlate with operative performance in a novice cohort

    PubMed Central

    Steigerwald, Sarah N.; Park, Jason; Hardy, Krista M.; Gillman, Lawrence; Vergis, Ashley S.

    2015-01-01

    Background Considerable resources have been invested in both low- and high-fidelity simulators in surgical training. The purpose of this study was to investigate if the Fundamentals of Laparoscopic Surgery (FLS, low-fidelity box trainer) and LapVR (high-fidelity virtual reality) training systems correlate with operative performance on the Global Operative Assessment of Laparoscopic Skills (GOALS) global rating scale using a porcine cholecystectomy model in a novice surgical group with minimal laparoscopic experience. Methods Fourteen postgraduate year 1 surgical residents with minimal laparoscopic experience performed tasks from the FLS program and the LapVR simulator as well as a live porcine laparoscopic cholecystectomy. Performance was evaluated using standardized FLS metrics, automatic computer evaluations, and a validated global rating scale. Results Overall, FLS score did not show an association with GOALS global rating scale score on the porcine cholecystectomy. None of the five LapVR task scores were significantly associated with GOALS score on the porcine cholecystectomy. Conclusions Neither the low-fidelity box trainer or the high-fidelity virtual simulator demonstrated significant correlation with GOALS operative scores. These findings offer caution against the use of these modalities for brief assessments of novice surgical trainees, especially for predictive or selection purposes. PMID:26641071

  7. Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery.

    PubMed

    Lee, Jin Young; Lee, Seung Hwan; Jung, Myung Jae; Lee, Jae Gil

    2016-08-01

    Few studies have evaluated the risk factors for in-hospital mortality in critically ill surgical patients who have undergone emergency gastrointestinal (GI) surgery. The aim of this study was to identify the risk factors associated with in-hospital mortality in critically ill surgical patients after emergency GI surgery.The medical records of 362 critically ill surgical patients who underwent emergency GI surgery, admitted to intensive care unit between January 2007 and December 2011, were reviewed retrospectively. Perioperative biochemical and clinical parameters of survivors and nonsurvivors were compared. Logistic regression multivariate analysis was performed to identify the independent risk factors of mortality.The in-hospital mortality rate was 15.2% (55 patients). Multivariate analyses revealed cancer-related perforation (odds ratio [OR] 16.671, 95% confidence interval [CI] 2.629-105.721, P = 0.003), preoperative anemia (hemoglobin <10 g/dL; OR 6.976, 95% CI 1.376-35.360, P = 0.019), and preoperative hypoalbuminemia (albumin <2.7 g/dL; OR 9.954, 95% CI 1.603-61.811, P = 0.014) were independent risk factors of in-hospital mortality after emergency GI surgery.The findings of this study suggest that in critically ill patients undergoing emergency GI surgery, cancer-related peritonitis, preoperative anemia, and preoperative hypoalbuminemia are associated with in-hospital mortality. Recognizing risk factors at an early stage could aid risk stratification and the provision of optimal perioperative care. PMID:27583863

  8. Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery

    PubMed Central

    Lee, Jin Young; Lee, Seung Hwan; Jung, Myung Jae; Lee, Jae Gil

    2016-01-01

    Abstract Few studies have evaluated the risk factors for in-hospital mortality in critically ill surgical patients who have undergone emergency gastrointestinal (GI) surgery. The aim of this study was to identify the risk factors associated with in-hospital mortality in critically ill surgical patients after emergency GI surgery. The medical records of 362 critically ill surgical patients who underwent emergency GI surgery, admitted to intensive care unit between January 2007 and December 2011, were reviewed retrospectively. Perioperative biochemical and clinical parameters of survivors and nonsurvivors were compared. Logistic regression multivariate analysis was performed to identify the independent risk factors of mortality. The in-hospital mortality rate was 15.2% (55 patients). Multivariate analyses revealed cancer-related perforation (odds ratio [OR] 16.671, 95% confidence interval [CI] 2.629–105.721, P = 0.003), preoperative anemia (hemoglobin <10 g/dL; OR 6.976, 95% CI 1.376–35.360, P = 0.019), and preoperative hypoalbuminemia (albumin <2.7 g/dL; OR 9.954, 95% CI 1.603–61.811, P = 0.014) were independent risk factors of in-hospital mortality after emergency GI surgery. The findings of this study suggest that in critically ill patients undergoing emergency GI surgery, cancer-related peritonitis, preoperative anemia, and preoperative hypoalbuminemia are associated with in-hospital mortality. Recognizing risk factors at an early stage could aid risk stratification and the provision of optimal perioperative care. PMID:27583863

  9. Early Oral Feeding After Surgery for Upper Gastrointestinal Malignancies: A Prospective Cohort Study

    PubMed Central

    Shoar, Saeed; Naderan, Mohammad; Mahmoodzadeh, Habibollah; Hosseini-Araghi, Negin; Mahboobi, Nastaran; Sirati, Freydoon; Khorgami, Zhamak

    2016-01-01

    Objectives Poor nutritional status following abdominal surgeries for esophageal and gastric cancers remains a major challenge in postoperative care. Our study aimed to investigate the efficacy of starting early oral feeding (EOF) in patients undergoing surgical resection of upper gastrointestinal malignancies. Methods A total of 180 consecutive patients with a diagnosis of esophageal or gastric malignancies undergoing elective surgical resection between January 2008 and February 2011 were enrolled in this prospective cohort study. Seventy-two patients were assigned to the EOF group, and 108 patients received late oral feeding (LOF). Postoperative endpoints were compared between the two groups. Results Nasogastric tubes were removed from patients on average 3.3±1.6 days after the surgery in the EOF group and 5.2±2.5 days in the LOF group (p < 0.001). The soft diet regimen was started and tolerated significantly sooner in the EOF group (5.8±1.2 days) than the LOF group (9.5±5.5 days). Hospital stay was significantly shorter in the EOF group compared to the LOF group (6.7±3.1 days vs. 9.1±5.8 days, p < 0.001). Surgical complications and rehospitalization occurred less in EOF group compared with the LOF group. However, the differences were not significant (p > 0.050). Conclusions EOF is safe following esophageal and gastric cancer surgery and results in faster recovery and hospital discharge. PMID:27162588

  10. Differential methylation in glucoregulatory genes of offspring born before vs. after maternal gastrointestinal bypass surgery.

    PubMed

    Guénard, Frédéric; Deshaies, Yves; Cianflone, Katherine; Kral, John G; Marceau, Picard; Vohl, Marie-Claude

    2013-07-01

    Obesity and overnutrition during pregnancy affect fetal programming of adult disease. Children born after maternal bariatric gastrointestinal bypass surgery (AMS) are less obese and exhibit improved cardiometabolic risk profiles carried into adulthood compared with siblings born before maternal surgery (BMS). This study was designed to analyze the impact of maternal weight loss surgery on methylation levels of genes involved in cardiometabolic pathways in BMS and AMS offspring. Differential methylation analysis between a sibling cohort of 25 BMS and 25 AMS (2-25 y-old) offspring from 20 mothers was conducted to identify biological functions and pathways potentially involved in the improved cardiometabolic profile found in AMS compared with BMS offspring. Links between gene methylation and expression levels were assessed by correlating genomic findings with plasma markers of insulin resistance (fasting insulin and homeostatic model of insulin resistance). A total of 5,698 genes were differentially methylated between BMS and AMS siblings, exhibiting a preponderance of glucoregulatory, inflammatory, and vascular disease genes. Statistically significant correlations between gene methylation levels and gene expression and plasma markers of insulin resistance were consistent with metabolic improvements in AMS offspring, reflected in genes involved in diabetes-related cardiometabolic pathways. This unique clinical study demonstrates that effective treatment of a maternal phenotype is durably detectable in the methylome and transcriptome of subsequent offspring. PMID:23716672

  11. Comparison of palonosetron with ondansetron in prevention of postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia after gynecological laparoscopic surgery

    PubMed Central

    Moon, Soo Yeong; Song, Dong Un; Lee, Ki Hyun; Song, Jae Wook; Kwon, Young Eun

    2013-01-01

    Background Postoperative nausea and vomiting (PONV) are common complications after anesthesia and surgery. This study was designed to compare the effects of palonosetron and ondansetron in preventing PONV in high-risk patients receiving intravenous opioid-based patient-controlled analgesia (IV-PCA) after gynecological laparoscopic surgery. Methods One hundred non-smoking female patients scheduled for gynecological laparoscopic surgery were randomly assigned into the palonosetron group (n = 50) or the ondansetron group (n = 50). Palonosetron 0.075 mg was injected as a bolus in the palonosetron group. Ondansetron 8 mg was injected as a bolus and 16 mg was added to the IV-PCA in the ondansetron group. The incidences of nausea, vomiting and side effects was recorded at 2 h, 24 h, 48 h and 72 h, postoperatively. Results There were no significant differences between the groups in the incidence of PONV during 72 h after operation. However, the incidence of vomiting was lower in the palonosetron group than in the ondansetron group (18% vs. 4%, P = 0.025). No differences were observed in use of antiemetics and the side effects between the groups. Conclusions The effects of palonosetron and ondansetron in preventing PONV were similar in high-risk patients undergoing gynecological laparoscopic surgery and receiving opioid-based IV-PCA. PMID:23459499

  12. Laparoscopic Fimbrioplasty and Neosalpingostomy in Female Infertility: A Review of 402 Cases at the Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital in Yaoundé-Cameroon

    PubMed Central

    Kasia, Jean Marie; Ngowa, Jean Dupont Kemfang; Mimboe, Yolande Salome; Toukam, Michel; Ngassam, Anny; Noa, Claude Cyrile; Belinga, Etienne; Medou, Alexis

    2016-01-01

    Background: More than 70 million couples suffer from infertility worldwide. The aim of this study was to evaluate the fertility outcomes after laparoscopic fimbrioplasty and neosalpingostomy in female infertility. Methods: Laparoscopic distal tuboplasty was carried out for 402 cases at the Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital in Yaoundé-Cameroon in Central Africa from December 2002 to December 2007. Laparoscopic fimbrioplasty and neosalpingostomy were done using bipolar electrocoagulation and conventional endoscopic instruments. Log-rank test was used to compare cumulative rate curves of intrauterine pregnancy with respect to the tubal stages. P<0.05 was considered statistically significant. Results: The mean age of the patients was 31.6±5.45 years. Secondary infertility was the most frequent type of infertility (70.14%). The laparoscopic tubal surgery done consisted of fimbrioplasty in 185(46%) cases and neosalpingostomy in 217 (54%) cases. Of 260 women followed up after tuboplasty, there were overall 74 (28.48%) pregnancies; 68(26.1%) intrauterine pregnancies and 6(2.3%) ectopic pregnancies. Pregnancy rates were significantly associated to the tubal stage (63% in stage 1, 15% in stage 3 and 00% in stage 4; p<0.001) and the adnexal adhesion scores (73.91% in the absence of adnexal adhesions and 8.8% in the case of a severe adnexal adhesion score). Of the 68 intrauterine pregnancies, there were 60(88%) live births and 8(12%) spontaneous abortions. Conclusion: It is believed that laparoscopic fimbrioplasty and neosalpingostomy should be the preferred choice when faced with tubal distal occlusion in a context of female infertility. This implies that training in endoscopic surgery should be regarded as an important issue in developing countries. PMID:27141465

  13. 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

  14. Laparoscopic Greater Curve Plication as an Outpatient Weight Loss Procedure

    PubMed Central

    Pacheco, Ilvia

    2015-01-01

    Background and Objectives: Laparoscopic greater curve plication is emerging as a weight loss procedure that avoids many of the complications of other surgeries that require gastrointestinal division, amputation, or use of a foreign body. Cost savings and affordability have also been promoted, as plication does not require the use of stapling devices, adjustable gastric bands, or prolonged hospitalization. The ability to predictably perform plication as an outpatient surgery may further define its role as a therapeutic option for treating morbid obesity. We present the 30-day outcomes and supplementary 12-month data in a series of 141 laparoscopic greater curve plication surgeries performed as outpatient procedures. Methods: Laparoscopic greater curve plication was performed as outpatient surgery in 141 consecutive patients. Outcomes including perioperative complications, incidental 12-month follow-up for weight loss, and change in diabetic and hypertensive medication are reported. Results: Of the 141 plications performed, 138 patients were discharged from the recovery room and 6 were readmitted. There was no conversion to open surgery and no mortality. Conclusions: The ability to reliably perform greater curve plication as an outpatient surgery may further define its role as an additional weight loss surgery technique. PMID:26508824

  15. Assessing surgeon and novice force skill on a haptic stiffness simulator for laparoscopic surgery.

    PubMed

    Singapogu, Ravikiran B; Smith, Dane E; Altenhoff, Bliss M; Long, Lindsay O; Prabhu, Varun V; Pagano, Christopher C; Burg, Timothy C; Burg, Karen J K L

    2012-01-01

    Though several simulators and training methods are available for basic laparoscopic skills, few have addressed force-based skills. In this work, we discuss a haptic simulator that renders virtual materials of different stiffness profiles to be used for haptic skills differentiation. A force-based task was designed on the simulator and the performance of surgeons and novices was analyzed. Results indicate that surgeons and novices differ in their ability to use the haptic device to reproduce target stiffness levels. This work provides an important step towards quantifying haptic skill metrics for the design of surgical skills training simulators. PMID:22357038

  16. NUTRITIONAL ASSESSMENT AND HAND GRIP STRENGTH OF CANDIDATES FOR SURGERY OF THE GASTROINTESTINAL TRACT

    PubMed Central

    SILVEIRA, Thalita Morgana Guimarães; de SOUSA, Juliana Barbosa; STRINGHINI, Maria Luiza Ferreira; FREITAS, Ana Tereza Vaz de Souza; MELO, Paulla Guimarães

    2014-01-01

    Background The assessment of nutritional status in clinical practice must be done with simple, reliable, low cost and easy performance methods. The power of handshake is recognized as a useful tool to evaluate muscle strength, and therefore, it is suggested that can detect malnutrition. Aim To evaluate the nutritional status by subjective global assessment and power of handshake preoperatively in patients going to gastrointestinal surgeries and to compare the diagnosis obtained by subjective global assessment with traditional anthropometric methods and power of handshake. Methods A cross-sectional study was conducted with patients for surgery in the gastrointestinal tract and related organs. Socioeconomic and anthropometric data, applied to subjective global assessment and checked the power of handshake, were collected. The force was obtained by the average of three measurements of the dominant and non-dominant hand and thus compared with reference values ​​of the population by sex and age, for the classification of nutritional risk. Results The sample consisted of 40 patients, 24-83 years, and most women (52.5%) housewives (37,5%) and diagnosed with cancer (45%). According to subjective global assessment, 37.5% were classified as moderately malnourished; 15% were underweight by BMI measurements; 25% had arm circumference at risk for malnutrition (

  17. Stroke Volume Variation for Prediction of Fluid Responsiveness in Patients Undergoing Gastrointestinal Surgery

    PubMed Central

    Li, Cheng; Lin, Fu-qing; Fu, Shu-kun; Chen, Guo-qiang; Yang, Xiao-hu; Zhu, Chun-yan; Zhang, Li-jun; Li, Quan

    2013-01-01

    Background: Stroke volume variation (SVV) has been shown to be a reliable predictor of fluid responsiveness. However, the predictive role of SVV measured by FloTrac/Vigileo system in prediction of fluid responsiveness was unproven in patients undergoing ventilation with low tidal volume. Methods: Fifty patients undergoing elective gastrointestinal surgery were randomly divided into two groups: Group C [n1=20, tidal volume (Vt) = 8 ml/kg, frequency (F) = 12/min] and Group L [n2=30, Vt= 6 ml/kg, F=16/min]. After anesthesia induction, 6% hydroxyethyl starch130/0.4 solution (7 ml/kg) was intravenously transfused. Besides standard haemodynamic monitoring, SVV, cardiac output, cardiac index (CI), stroke volume (SV), stroke volume index (SVI), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) were determined with the FloTrac/Vigileo system before and after fluid loading. Results: After fluid loading, the MAP, CVP, SVI and CI increased significantly, whereas the SVV and SVR decreased markedly in both groups. SVI was significantly correlated to the SVV, CVP but not the HR, MAP and SVR. SVI was significantly correlated to the SVV before fluid loading (Group C: r = 0.909; Group L: r = 0.758) but not the HR, MAP, CVP and SVR before fluid loading. The largest area under the ROC curve (AUC) was found for SVV (Group C, 0.852; Group L, 0.814), and the AUC for other preloading indices in two groups ranged from 0.324 to 0.460. Conclusion: SVV measured by FloTrac/Vigileo system can predict fluid responsiveness in patients undergoing ventilation with low tidal volumes during gastrointestinal surgery. PMID:23329886

  18. Integrating a novel shape memory polymer into surgical meshes to improve device performance during laparoscopic hernia surgery

    NASA Astrophysics Data System (ADS)

    Zimkowski, Michael M.

    About 600,000 hernia repair surgeries are performed each year. The use of laparoscopic minimally invasive techniques has become increasingly popular in these operations. Use of surgical mesh in hernia repair has shown lower recurrence rates compared to other repair methods. However in many procedures, placement of surgical mesh can be challenging and even complicate the procedure, potentially leading to lengthy operating times. Various techniques have been attempted to improve mesh placement, including use of specialized systems to orient the mesh into a specific shape, with limited success and acceptance. In this work, a programmed novel Shape Memory Polymer (SMP) was integrated into commercially available polyester surgical meshes to add automatic unrolling and tissue conforming functionalities, while preserving the intrinsic structural properties of the original surgical mesh. Tensile testing and Dynamic Mechanical Analysis was performed on four different SMP formulas to identify appropriate mechanical properties for surgical mesh integration. In vitro testing involved monitoring the time required for a modified surgical mesh to deploy in a 37°C water bath. An acute porcine model was used to test the in vivo unrolling of SMP integrated surgical meshes. The SMP-integrated surgical meshes produced an automated, temperature activated, controlled deployment of surgical mesh on the order of several seconds, via laparoscopy in the animal model. A 30 day chronic rat model was used to test initial in vivo subcutaneous biocompatibility. To produce large more clinical relevant sizes of mesh, a mold was developed to facilitate manufacturing of SMP-integrated surgical mesh. The mold is capable of manufacturing mesh up to 361 cm2, which is believed to accommodate the majority of clinical cases. Results indicate surgical mesh modified with SMP is capable of laparoscopic deployment in vivo, activated by body temperature, and possesses the necessary strength and

  19. A structured light-based laparoscope with real-time organs' surface reconstruction for minimally invasive surgery.

    PubMed

    Maurice, Xavier; Albitar, Chadi; Doignon, Christophe; de Mathelin, Michel

    2012-01-01

    In this paper we present a new 3-D laparoscopic device based on structured light for minimally invasive surgery. Real-time reconstruction of internal organs' surfaces is very challenging as the numerous geometric and photometric variabilities and disturbances (bloody parts, specularities, smokes,...) often occur during the surgical operation, sometimes with manipulations by several assistants. We then conceived a structured light vision system to illuminate a coded pattern by means of an external video projector device or miniaturized diffractive optical elements and a laser source. Among the structured light techniques, the spatial neighbourhood scheme is the most relevant class of approaches to deal with moving and deformable surfaces, then to capture the depth map with only one shot. Each neighbourhood (a (3 × 3) window) is representing a codeword of length 9, and is unique in the whole pattern, even if there is a lack of information. To do so, a monochromatic subperfect map-based pattern is computed, driven by a desired minimal Hamming distance, H(min), between any couple of codewords. This provides patterns with high correction capabilities (H(min) > 1). For practical considerations, each numerical codeword symbol is associated to a unique visual feature embedding the local orientation of the pattern, which is helpful for the neighbourhood retrieval during the decoding process. Together with the endoscopic device, in vivo real-time reconstructions (in mini-invasive surgical conditions) are presented to assess both the efficiency of the proposed pattern design, the decoding process and the 3-D laparoscope setup realized in the lab. PMID:23367240

  20. Perceived Relevance of Gender-Specific Differences in Gastrointestinal Medicine and Surgery: Results of a Survey

    PubMed Central

    Oertelt-Prigione, Sabine; Klinger, Carsten; Rau, Beate

    2014-01-01

    Summary Background The recognition of the relevance of sex and gender differences in medicine has significantly increased in the last 20 years. Nonetheless, the implementation of these aspects into clinical practice still remains to be attained. In particular, while sex differences – which refer to biological attributes – are widely accepted, gender concepts – which include sociocultural and psychological properties – are frequently treated with diffidence. Methods In December 2012 and January 2013, all members of the German Society for General and Abdominal Surgery (DGAV) were invited to participate in an online-based survey to determine the relevance and incorporation of sex and gender aspects in gastrointestinal medicine and surgery. Results 493 (13.4%) of the 3,689 members of the DGAV participated in the survey. More than 50% of the participants reported including sex and gender aspects into consultation, diagnosis, and management at least occasionally. However, 44% reported no knowledge of the formal definition of ‘gender medicine’, suggesting potential differences in the perception of the notion of gender. Conclusion The participants of the survey demonstrated vast knowledge about sex differences, while gender attributes were generally neglected. Since gender features are critically relevant for prevention as well as during medical consultation, we suggest this area as a potential target for further training initiatives. PMID:26286374

  1. Effects of bariatric surgery on male obesity-associated secondary hypogonadism: comparison of laparoscopic gastric bypass with restrictive procedures.

    PubMed

    Calderón, Berniza; Galdón, Alba; Calañas, Alfonso; Peromingo, Roberto; Galindo, Julio; García-Moreno, Francisca; Rodriguez-Velasco, Gloria; Martín-Hidalgo, Antonia; Vazquez, Clotilde; Escobar-Morreale, Héctor F; Botella-Carretero, José I

    2014-10-01

    Bariatric surgery results in the complete resolution of male obesity-associated secondary hypogonadism (MOSH) in many patients. However, the effects of different bariatric surgical procedures on male sexual hormone profiles and sexual dysfunction have not been compared to date. We compared the pre- and post-operative (at least 6 months after initial surgery) sex hormone profiles of 20 severely obese men submitted to laparoscopic gastric bypass (LGB) with 15 similar patients submitted to restrictive techniques (sleeve gastrectomy in 10 and adjustable gastric banding in 5). We calculated free testosterone (FT) levels from total testosterone (TT) and sex hormone binding globulin (SHBG) concentrations. Fasting glucose and insulin levels served for homeostatic model assessment of insulin resistance (HOMAIR). MOSH was present in 25 and 16 of the 35 patients when considering TT and FT concentrations respectively, resolving after surgery in all but one of them. When considering all obese men as a whole, patients submitted to LGB or restrictive procedures did not differ in terms of excess weight loss, in the decrease of fasting glucose and insulin, HOMAIR and waist circumference, or in the increase of serum 25-hydroxyvitamin D, TT and FT levels. The improvement in TT correlated with the decrease in fasting glucose (r = -0.390, P = 0.021), insulin (r = -0.425, P = 0.015) and HOMAIR (r = -0.380, P = 0.029), and with the increase in SHBG (r = 0.692, P < 0.001). The increase in FT correlated with the decrease in fasting glucose (r = -0.360, P = 0.034). LGB and restrictive techniques are equally effective in producing a remission of MOSH. PMID:24664512

  2. Fiber Optical Improvements for a Device Used in Laparoscopic Hysterectomy Surgery

    NASA Astrophysics Data System (ADS)

    Hernández Garcia, Ricardo; Vázquez Mercado, Liliana; García-Torales, G.; Flores, Jorge L.; Barcena-Soto, Maximiliano; Casillas Santana, Norberto; Casillas Santana, Juan Manuel

    2006-09-01

    Hysterectomy removes uterus from patients suffering different pathologies. One of the most common techniques for performing it is the laparoscopically-assisted vaginal hysterectomy (LAVH). In the final stage of the procedure, surgeons face the need to unambiguously identify the vaginal cuff before uterus removal. The aim of this research is to adapt a local source of illumination to a polymer cup-like device adapted to a stainless steel shaft that surgeons nowadays use to manipulate the uterus in LAVH. Our proposal consists in implementing a set of optical fiber illuminators along the border of the cup-like device to illuminate the exact vaginal cupola, using an external light source. We present experimental results concerning temperature increases in quasi adiabatic conditions in cow meat under different light intensity illumination.

  3. Laparoscopic repair of perforated peptic ulcers. The role of laparoscopy in generalised peritonitis.

    PubMed Central

    Robertson, G. S.; Wemyss-Holden, S. A.; Maddern, G. J.

    2000-01-01

    This non-randomised concurrent cohort study conducted in two teaching hospital Departments of Surgery examined the assumption that the benefits of elective laparoscopic upper gastrointestinal surgery would apply to those with generalised peritonitis due to perforated peptic ulcers. It compared 20 consecutive laparoscopic repairs of perforated peptic ulcers with a concurrent group of 16 consecutive open repairs. There were no differences pre-operatively between the two groups. The mean duration of surgery was similar (P = 0.46). There were no differences in the rate of GI tract recovery, but opiate analgesia requirement in the laparoscopic group was significantly less (P < 0.0001). Intensive care was required in three patients in the laparoscopic group (two with renal failure) and two in the open (no renal failure). Two patients in the laparoscopic and one in the open group died. The median duration of stay was five days in the laparoscopic group and six in the open. This comparison shows that the patho-physiological insult of laparoscopy in the setting of generalised peritonitis does not obviously increase the peri-operative risk of organ failure but objective benefits are small. PMID:10700758

  4. Recurrent Upside-Down Stomach after Endoscopic Repositioning and Gastropexy Treated by Laparoscopic Surgery

    PubMed Central

    Toyota, Kazuhiro; Sugawara, Yuji; Hatano, Yu

    2014-01-01

    Patients with an upside-down stomach usually receive surgical treatment. In high-risk patients, endoscopic repositioning and gastropexy can be performed. However, the risk of recurrence after endoscopic treatment is not known. We treated a case of recurrent upside-down stomach after endoscopic therapy that indicated the limits of endoscopic treatment and risk of recurrence. An 88-year-old woman was treated three times for vomiting in the past. She presented to our hospital with periodic vomiting and an inability to eat, and a diagnosis of upside-down stomach was made. Endoscopic repositioning and gastropexy were performed. The anterior stomach wall was fixed to the abdominal wall in three places as widely as possible. Following treatment, she became symptom-free. Three months later, she was hospitalized again because of a recurrent upside-down stomach. Laparoscopic repair of hernias and gastropexy was performed. Using a laparoscope, two causes of recurrence were found. One cause was that the range of adherence between the stomach and the abdominal wall was narrow (from the antrum only to the lower corpus of stomach), so the upper corpus of stomach was rotated and herniated into the esophageal hiatus. The other cause was adhesion between the omentum and the esophageal hiatus which caused the stomach to rotate and repeatedly become herniated. Although endoscopic treatment for upside-down stomach can be a useful alternative method in high-risk patients, its ability to prevent recurrence is limited. Moreover, a repeated case caused by adhesions has risks of recurrence. PMID:24574947

  5. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery.

    PubMed

    Liu, Shijiang; Sun, Jie; Chen, Xing; Yu, Yingying; Liu, Xuan; Liu, Cunming

    2014-01-01

    To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2) were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2) and. (PTCCO2-PaCO2) were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2), mean 42.1,SD 5.4 kg/m(2)) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD). And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD). The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2) = 0.64, P<0.01), whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2) = 0.89). The LOA (limits of agreement) of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD), while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD). In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery. PMID:24699267

  6. The Application of Transcutaneous CO2 Pressure Monitoring in the Anesthesia of Obese Patients Undergoing Laparoscopic Bariatric Surgery

    PubMed Central

    Liu, Shijiang; Sun, Jie; Chen, Xing; Yu, Yingying; Liu, Xuan; Liu, Cunming

    2014-01-01

    To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m2 were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2–PaCO2) and. (PTCCO2–PaCO2) were calculated. Bland–Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19–54 yr, mean 29, SD 9 yr; weight 86–160 kg, mean119.3, SD 22.1 kg; BMI 35.3–51.1 kg/m2, mean 42.1,SD 5.4 kg/m2) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2–PTCCO2 difference was 0.9±1.3 mmHg (mean±SD). And the average PaCO2–PetCO2 difference was 10.3±2.3 mmHg (mean±SD). The linear regression equation of PaCO2–PetCO2 is PetCO2 = 11.58+0.57×PaCO2 (r2 = 0.64, P<0.01), whereas the one of PaCO2–PTCCO2 is PTCCO2 = 0.60+0.97×PaCO2 (r2 = 0.89). The LOA (limits of agreement) of 95% average PaCO2–PetCO2 difference is 10.3±4.6 mmHg (mean±1.96 SD), while the LOA of 95% average PaCO2–PTCCO2 difference is 0.9±2.6 mmHg (mean±1.96 SD). In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery. PMID:24699267

  7. Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

    PubMed Central

    Kong, Seong-Ho

    2013-01-01

    Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding. PMID:23610714

  8. Ventilation during laparoscopic-assisted bariatric surgery: volume-controlled, pressure-controlled or volume-guaranteed pressure-regulated modes

    PubMed Central

    Dion, Joanna M; McKee, Chris; Tobias, Joseph D; Sohner, Paul; Herz, Daniel; Teich, Steven; Rice, Julie; Barry, N’ diris; Michalsky, Marc

    2014-01-01

    Introduction: Managing ventilation and oxygenation during laparoscopic procedures in severely obese patients undergoing weight loss surgery presents many challenges. Pressure-controlled ventilation, volume-guaranteed (PCV-VG) is a dual-control mode of ventilation and an alternative to pressure (PC) or volume (VC) controlled ventilation. PCV-VG features a user-selected tidal volume target, that is auto-regulated and pressure controlled. We hypothesized that PCV-VG ventilation would provide improved oxygenation and ventilation during laparoscopic bariatric surgery with a lower peak inflating pressure (PIP) than either PC or VC ventilation. Methods: This was a prospective cross-over cohort trial (n = 20). In random sequence each patient received the three modes of ventilation for 20 minutes during the laparoscopic portion of the procedure. For all modes of ventilation the goal tidal volume was 6-8 mL/kg, and the respiratory rate was adjusted to achieve normocarbia. The PIP, exhaled tidal volume, respiratory rate, and oxygen saturation were recorded every five minutes. At the end of 20 minutes, an arterial blood gas was obtained. Data were analyzed using a paired t-test. Results: PCV-VG and PC ventilation both resulted in significantly lower PIP (cmH2O) than VC ventilation (30.5 ± 3.0, 31.6 ± 4.9, and 36.3 ± 3.4 mmHg respectively; p < 0.01 for PCV-VG vs. VC and PC vs. VC). There was no difference in oxygenation (PaO2), ventilation (PaCO2) or hemodynamic variables between the three ventilation modes. Conclusions: In adolescents and young adults undergoing laparoscopic bariatric surgery, PCV-VG and PC were superior to VC ventilation in their ability to provide ventilation with the lowest PIP. PMID:25232415

  9. Prevalence of congenital heart disease in patients undergoing surgery for major gastrointestinal malformations: an Indian study

    PubMed Central

    Gokhroo, Rajendra K; Gupta, Sajal; Arora, Garima; Bisht, Devendra S; Padmanabhan, Deepak; Soni, Varsha

    2015-01-01

    Background The association of congenital heart disease (CHD) with malformations of the gastrointestinal (GI) tract/abdominal wall is known. The rates of cardiac malformations reported in previous studies of these anomalies are highly variable. Objective To find the prevalence and pattern of CHD in patients with major gastrointestinal malformations (anorectal malformations, oesophageal atresia/tracheo-oesophageal fistula, and omphalocoele) undergoing surgery at a tertiary care hospital in India. Methods From July 2012 to December 2013, 43 patients (34 (79%) male, 9 (21%) female) were evaluated by clinical examination, ECG, chest radiography, and colour Doppler echocardiography. Results Of the 43 patients, 26 (60.46%) had CHD. The most common GI malformation was anorectal malformation: 32 cases (74.41%), of whom 16 (50%) had CHD. The second most common malformation was oesophageal atresia/tracheo-oesophageal fistula: 5 cases (11.62%), all (100%) with CHD. The third group comprised patients with omphalocoele: 4 cases (9.3%), 3 of whom (75%) had CHD. The fourth group comprised patients with VACTERAL (vertebral anomalies, anal atresia, cardiovascular malformations, tracheo-oesophageal fistula, renal and limb anomalies) association—2 cases (4.6%), all (100%) with CHD. The most common CHD was isolated atrial septal defect (ASD) (73%), followed by ASD + ventricular septal defect (VSD) + patent ductus arteriosus (PDA) (7.6%), ASD + VSD (3.8%), ASD + PDA (3.8%), VSD (3.8%), PDA (3.8%), and coarctation of the aorta (3.8%). Conclusions We found the frequency of CHD in patients with GI malformations was very high, the most common presentation being ASD. Our study indicates the need for larger scale studies to determine the prevalence of CHD in patients with GI malformations in the Indian population. PMID:27326210

  10. Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

    PubMed Central

    Morneau, Mélanie; Boulanger, Jim; Charlebois, Patrick; Latulippe, Jean-François; Lougnarath, Rasmy; Thibault, Claude; Gervais, Normand

    2013-01-01

    Background Adoption of the laparoscopic approach for colorectal cancer treatment has been slow owing to initial case study results suggesting high recurrence rates at port sites. The use of laparoscopic surgery for colorectal cancer still raises a number of concerns, particularly with the technique’s complexity, learning curve and longer duration. After exploring the scientific literature comparing open and laparoscopic surgery for the treatment of colorectal cancer with respect to oncologic efficacy and short-term outcomes, the Comité de l’évolution des pratiques en oncologie (CEPO) made recommendations for surgical practice in Quebec. Methods Scientific literature published from January 1995 to April 2012 was reviewed. Phase III clinical trials and meta-analyses were included. Results Sixteen randomized trials and 10 meta-analyses were retrieved. Analysis of the literature confirmed that for curative treatment of colorectal cancer, laparoscopy is not inferior to open surgery with respect to survival and recurrence rates. Moreover, laparoscopic surgery provides short-term advantages, including a shorter hospital stay, reduced analgesic use and faster recovery of intestinal function. However, this approach does require a longer operative time. Conclusion Considering the evidence, the CEPO recommends that laparoscopic resection be considered an option for the curative treatment of colon and rectal cancer; that decisions regarding surgical approach take into consideration surgeon experience, tumour stage, potential contraindications and patient expectations; and that laparoscopic resection for rectal cancer be performed only by appropriately trained surgeons who perform a sufficient volume annually to maintain competence. PMID:24067514

  11. Palonosetron has superior prophylactic antiemetic efficacy compared with ondansetron or ramosetron in high-risk patients undergoing laparoscopic surgery: a prospective, randomized, double-blinded study

    PubMed Central

    Kim, Sung-Hoon; Hong, Jeong-Yeon; Kim, Won Oak; Karm, Myong-Hwan; Hwang, Jai-Hyun

    2013-01-01

    Background Postoperative nausea and vomiting (PONV) continues to be a major problem, because PONV is associated with delayed recovery and prolonged hospital stay. Although the PONV guidelines recommended the use of 5-hydroxy-tryptamine (5-HT3) receptor antagonists as the first-line prophylactic agents in patients categorized as high-risk, there are few studies comparing the efficacies of ondansetron, ramosetron, and palonosetron. The aim of present study was to compare the prophylactic antiemetic efficacies of three 5HT3 receptor antagonists in high-risk patients after laparoscopic surgery. Methods In this prospective, randomized, double-blinded trial, 109 female nonsmokers scheduled for elective laparoscopic surgery were randomized to receive intravenous 4 mg ondansetron (n = 35), 0.3 mg ramosetron (n = 38), or 75 µg palonosetron (n = 36) before anesthesia. Fentanyl-based intravenous patient-controlled analgesia was administered for 48 h after surgery. Primary antiemetic efficacy variables were the incidence and severity of nausea, the frequency of emetic episodes during the first 48 h after surgery, and the need to use a rescue antiemetic medication. Results The overall incidence of nausea/retching/vomiting was lower in the palonosetron (22.2%/11.1%/5.6%) than in the ondansetron (77.1%/48.6%/28.6%) and ramosetron (60.5%/28.9%/18.4%) groups. The rescue antiemetic therapy was required less frequently in the palonosetron group than the other groups (P < 0.001). Kaplan-Meier analysis showed that the order of prophylactic efficacy in delaying the interval to use of a rescue emetic was palonosetron, ramosetron, and ondansetron. Conclusions Single-dose palonosetron is the prophylactic antiemetics of choice in high-risk patients undergoing laparoscopic surgery. PMID:23814652

  12. Post-operative intravenous patient-controlled analgesic efficacy of morphine with ketorolac versus nefopam after laparoscopic gynecologic surgery: a randomized non-inferiority trial

    PubMed Central

    Yoon, Ji-Uk; Cheon, Ji-Hyun; Choi, Yoon-Mi; Ri, Hyun-Su; Baik, Seong-Wan

    2016-01-01

    Background Nefopam is a non-opioid non-steroidal centrally acting analgesic. This study was conducted to assess the analgesic efficacy of intravenous patient-controlled analgesia (IV-PCA) using nefopam alone, compared with a combination of morphine and ketorolac, after laparoscopic gynecologic surgery. Methods Sixty patients undergoing laparoscopic gynecologic surgery received IV-PCA. Group A (n = 30) received IV-PCA with a combination of morphine 60 mg and ketorolac 180 mg, while group B (n = 30) received nefopam 200 mg (basal rate 1 ml/h, bolus 1 ml, and lockout time 15 min for both). The primary outcome evaluated was analgesic efficacy using the visual analogue scale (VAS). Other evaluated outcomes included the incidence rate of postoperative nausea and vomiting (PONV), patient satisfaction of pain control, percentage of patients requiring additional opioids, and incidence rate of postoperative adverse effects. Results Group B was not inferior to group A in relation to the VAS in the post-anesthesia care unit, and at 12, 24, and 48 h after surgery (mean difference [95% confidence interval], 0.50 [–0.43 to 1.43], -0.30 [-1.25 to 0.65], -0.05 [-0.65 to 0.55], and 0.10 [-0.55 to 0.75], respectively). The incidence rate of nausea was lower in group B than in group A at 12 and 24 h after surgery (P = 0.004 and P = 0.017, respectively). There were no significant differences in the other outcomes between groups. Conclusions IV-PCA using nefopam alone has a non-inferior analgesic efficacy and produces a lower incidence of PONV in comparison with IV-PCA using a combination of morphine and ketorolac after laparoscopic gynecologic surgery. PMID:27066208

  13. AB121. Laparoendoscopic single-site surgery versus conventional laparoscopic varicocele ligation for varicocele: a meta-analysis

    PubMed Central

    Mo, Chengqiang; Liu, Jinchao; Tan, Wulin; Yu, Zhou; Chen, Xu; Mao, Xiaopeng; Qiu, Shaopeng

    2014-01-01

    Objective To compare perioperative and postoperative outcomes of laparoendoscopic single-site (LESS) surgery and conventional transperitoneal laparoscopic varicocele ligation (CTL-VL) for varicocele. Material and methods PubMed, Medline, EMBASE, ISI Web of Knowledge, Cochrane Library, Chinese biomedicine and China Knowledge Resource Integrated (CNKI) databases were searched for studies released prior to February 2014. References of included studies were also searched to identify additional, potentially relevant studies. We analyzed the data using RevMan 5.1. Results Ten randomized controlled trials (RCTs) and seven non-randomized controlled trials (NRCTs) were included, involving 1,183 patients. LESS group showed longer operative time but shorter hospital stay, shorter time to return to normal activity and lower total postoperative complications incidence. No significant difference was found in terms of blood loss, VAS pain score, pregnancy and improvement of semen parameters. Patients’ satisfaction was significantly better in LESS group. Sensitivity analysis showed similar results to the original analysis, and no evidence of publication bias was showed. Conclusions LESS showed comparable outcomes to that of CTL-VL, but it takes shorter to recover, has fewer postoperative complications and shows advantages in patients’ satisfaction potentially for cosmesis and less pain. More high-quality, multicenter and long-term RCTs are required to verify the findings.

  14. A case of primary adenocarcinoma of the third portion of the duodenum resected by laparoscopic and endoscopic cooperating surgery

    PubMed Central

    Tamaki, Ichiro; Obama, Kazutaka; Matsuo, Koichi; Kami, Kazuhiro; Uemoto, Yusuke; Sato, Teruyuki; Ito, Tetsuo; Tamaki, Nobuyuki; Kubota, Keiko; Inoue, Hidenobu; Yamamoto, Eiji; Morimoto, Taisuke

    2015-01-01

    Introduction We report a case of primary adenocarcinoma in the third portion of the duodenum (D3) curatively resected by laparoscopic and endoscopic cooperating surgery (LECS). Presentation of case A 65-year-old woman had a routine visit to our hospital for a follow-up of rectal cancer resected curatively 2 years ago. A routine screening gastroduodenal endoscopy revealed an elevated lesion of 20 mm in diameter in the D3. The preoperative diagnosis was adenoma with high-grade dysplasia; however, suspicion about potential adenocarcinoma was undeniable. Curative resection was performed by LECS. Pathological examination revealed intramucosal adenocarcinoma arising from normal duodenal mucosa. The tumor was stage I (T1/N0/M0) in terms of the tumor, nodes, metastasis (TNM) classification. LECS for duodenal tumor has seldom been reported previously, and this is the first report of LECS for primary adenocarcinoma in the D3. The transverse mesocolon was removed from the head of pancreas to expose the duodenum, and the accessory right colic vein was cut; this was followed by the Kocher maneuver for mobilization of the lesion site. Discussion LECS enabled en bloc resection with adequate surgical margins and secure intra-abdominal suturing. Thorough mobilization of the mesocolon and pancreas head is essential for this procedure because it facilitates correct resection and suturing. Conclusion LECS is a feasible treatment option for duodenal neoplasms, including intramucosal adenocarcinoma, even though it exists in the D3. PMID:25723745

  15. Dietary assessment of adolescents undergoing laparoscopic Roux-en-Y gastric bypass surgery: macro- and micronutrient, fiber and supplement intake

    PubMed Central

    Jeffreys, Renee M.; Hrovat, Kathleen; Woo, Jessica G.; Schmidt, Marcia; Inge, Thomas H.; Xanthakos, Stavra A.

    2011-01-01

    Background Extremely obese adolescents are increasingly undergoing bariatric procedures, which restrict dietary intake. However, there are as yet no data available which describe the change in caloric density or composition of the adolescent bariatric patient’s diet pre- and post-operatively. Objective Assess the 1-year change in dietary composition of adolescents undergoing bariatric surgery. Setting Tertiary care children’s hospital Methods Twenty-seven subjects [67% female, 77% white, age 16.7 ± 1.4 years, baseline body mass index (BMI) 60.1 ± 14.1 kg/m2] were prospectively enrolled into an observational cohort study one month prior to laparoscopic Roux-en-Y gastric bypass (RYGB) between August 2005 and March 2008. Three-day dietary intake was recorded at baseline (n=24), at 2 weeks (n=16), 3 months (n=11), and 1 year (n=9) post-operatively. Dietary record data were verified by structured interview and compared with Dietary Reference Intake (DRI) values for ages 14–18. Results By 1 year post-surgery, mean caloric intake adjusted for BMI was 1015 ± 182 kcal/day, a 35% reduction from baseline. The proportion of fat, protein and carbohydrate intake did not differ from baseline. However, protein intake was lower than recommended postoperatively. Calcium and fiber intake was also persistently lower than recommended. Calcium and vitamin B12 supplementation increased the likelihood of meeting daily minimal recommendations (p≤0.02). Conclusions One year after RYGB, adolescents’ caloric intake remained restricted with satisfactory macronutrient composition, but with lower than desirable intake of calcium, fiber and protein. PMID:22260884

  16. Application of International Videoconferences for Continuing Medical Education Programs Related to Laparoscopic Surgery

    PubMed Central

    Huang, Ke-Jian; Cen, Gang; Jiang, Tao; Cao, Jun; Fu, Chun-Yu

    2014-01-01

    Abstract Background: Continuing medical education (CME) is an effective way for practicing physicians to acquire up-to-date clinical information. Materials and Methods: We conducted four CME seminars in 2007–2010 endorsed by the Chinese Medical Association Council on Medical Education. Overseas telelectures and live case demonstrations were introduced in each seminar via telemedicine based on a digital video transport system. Network stability and packet loss were recorded. An anonymous mini-questionnaire was conducted to evaluate the satisfaction of attendees regarding the image and sound quality, content selection, and overall evaluation. Results: Four telelectures and five live case demonstrations were successfully conducted. Stability of the network was maintained during each videoconference. High-quality videos of 720×480 pixels at the rate of 30 frames per second were shown to the entire group of attendees. The time delay between Shanghai and Fukuoka, Japan, was only 0.3 s, and the packet loss was 0%. We obtained 129 valid responses to the mini-questionnaire from a total of 146 attendees. The majority of the attendees were satisfied with the quality of transmitted images and voices and with the selected contents. The overall evaluation was ranked as excellent or good. Conclusions: Videoconferences are excellent channels for CME programs associated with laparoscopic training. PMID:23758077

  17. Cardiopulmonary effects of using carbon dioxide for laparoscopic surgery in cats.

    PubMed

    Beazley, Shannon G; Cosford, Kevin; Duke-Novakovski, Tanya

    2011-09-01

    The cardiopulmonary effects of capnoperitoneum were investigated in 8 spontaneously breathing, young adult female cats undergoing laparoscopic pancreatic biopsy (intra-abdominal pressure 12 mmHg). Cats were premedicated with acepromazine and hydromorphone, induced with ketamine and diazepam, and maintained using an end-tidal isoflurane concentration of 1.13% in 100% oxygen. Direct systemic arterial blood pressure, heart and respiratory rates, end-tidal carbon dioxide (CO(2)), and isoflurane were recorded every 5 min before insufflation (baseline), during insufflation of the abdomen with CO(2), and following desufflation. Arterial blood samples were drawn at baseline, at 10 and 30 min of insufflation, and 5 min after desufflation for blood gases. The significant findings (P < 0.05) were as follows: insufflation produced an increase in heart rate (5 to 15 min and at 30 min), mean arterial blood pressure (25 to 30 min), and diastolic arterial blood pressure (10 to 30 min). After desufflation, respiratory rate increased for 15 min. The changes were within physiologically acceptable limits in these healthy, anesthetized cats despite no artificial maintenance of minute ventilation. PMID:22379196

  18. Myomectomy by Robotically Assisted Laparoscopic Surgery: Results at Foch Hospital, Paris

    PubMed Central

    Asmar, Jennifer; Even, Marc; Carbonnel, Marie; Goetgheluck, Julie; Revaux, Aurelie; Ayoubi, Jean Marc

    2015-01-01

    We reported an observational, retrospective chart review of 36 women who underwent robotic myomectomy at the Department of Obstetrics and Gynecology, Foch Hospital. Short- and long-term results were analyzed. We compared our results with literature data. Potential advantages and limits of robotic surgery in myomectomy are discussed. PMID:26347871

  19. Laparoscopic total pelvic exenteration using transanal minimal invasive surgery technique with en bloc bilateral lymph node dissection for advanced rectal cancer.

    PubMed

    Hayashi, Kengo; Kotake, Masanori; Kakiuchi, Daiki; Yamada, Sho; Hada, Masahiro; Kato, Yosuke; Hiranuma, Chikashi; Oyama, Kaeko; Hara, Takuo

    2016-12-01

    A 59-year-old man presenting with fecal occult blood visited our hospital. He was diagnosed with advanced lower rectal cancer, which was contiguous with the prostate and the left seminal vesicle. There were no metastatic lesions with lymph nodes or other organs. We performed laparoscopic total pelvic exenteration (LTPE) using transanal minimal invasive surgery technique with bilateral en bloc lateral lymph node dissection for advanced primary rectal cancer after neoadjuvant chemoradiotherapy. The total operative time was 760 min, and the estimated blood loss was 200 ml. LTPE is not well established technically, but it has many advantages including good visibility of the surgical field, less blood loss, and smaller wounds. A laparoscopic approach may be an appropriate choice for treating locally advanced lower rectal cancer, which requires TPE. PMID:27460130

  20. Muscle Relaxation in Laparoscopic Surgery: What is the Evidence for Improved Operating Conditions and Patient Outcome? A Brief Review of the Literature.

    PubMed

    Ledowski, Thomas

    2015-08-01

    When neuromuscular blocking agents (NMBA) were introduced into clinical practice in 1942, the event was called the "second revolution in anesthesia." Despite some significant side effects, NMBAs have remained in the anesthetists' repertoire, not at least because muscle relaxation has been claimed to allow or facilitate many surgical procedures. Aim of this literature review was to investigate the evidence for the use of NMBA as well as the optimum depth of neuromuscular blockade during laparoscopic surgery. Muscle relaxation may optimize laparoscopic operating conditions by preventing patient movement and achieving more intra-abdominal space for a given intra-abdominal insufflation pressure. In this context, deeper than normally maintained levels of neuromuscular blockade appear to be superior. However, the decision to utilize deeper than standard muscle relaxation should currently be based on a risk-benefit analysis for each individual patient. Thus good communication between surgeon and anesthetist remains crucial to achieve best outcomes. PMID:26121545

  1. [Evaluation of surgical skills of French ophthalmology, orthopedic and gastrointestinal surgery residents: Current status and perspectives].

    PubMed

    Tranchart, H; Aurégan, J C; Gaillard, M; Giocanti-Aurégan, A

    2015-10-01

    The purpose of this study was to evaluate the need for nationwide assessment of surgical skills during residency, and to define ideal methods for assessment in three surgical disciplines: ophthalmology, orthopedics and gastrointestinal surgery. Three online questionnaires were sent by e-mail to 784 residents, fellows and hospital practitioners, and 119 university hospital physican-professors. Questionnaires focused on current assessment methods at the regional level, the roles of the surveyed population in these evaluations, potential obstacles to their development and the most relevant methods for practical evaluations. Nine hundred and three questionnaires were sent; 355 participants replied (response rate: 39%). The establishment of systematic assessment seemed necessary to over 90% of the survey population, and this opinion was equitably distributed among all three specialties. Over 60% of respondents felt that current assessment procedures were not satisfactory. In all three specialties, the ideal evaluation method proposed was a real patient procedure. This "in vivo" evaluation was considered applicable in 80% of cases, potential barriers to its development being the resident's anxiety, medical-legal reasons and the lack of objective criteria. The ideal timing of these assessments was bi-annual. Implementation of surgical skills assessment during residency seems necessary. The survey population appears dissatisfied with current arrangements. A step-by-step evaluation combining surgical simulations, animal training and live patient procedures may be appropriate. PMID:26343276

  2. Margin and complication rates in clampless partial nephrectomy: a comparison of open, laparoscopic and robotic surgeries.

    PubMed

    Mearini, Luigi; Nunzi, Elisabetta; Vianello, Alberto; Di Biase, Manuel; Porena, Massimo

    2016-06-01

    In performing partial nephrectomy (PN), surgeons focus on complete removal of tumor, preservation of renal function, the absence of major perioperative complications, expressed by the formula margin, ischemia and complication (MIC). The aim of current study was to perform a single-institution comparison of clampless open (OPN), laparoscopic (LPN) or robot-assisted (RAPN) PN as well as to evaluate pre-, intra- and postoperative factors that may influence achievement of ideal MIC. All consecutive clampless OPN, LPN or RAPN performed by experienced surgeons between 2006 and 2015 were included in the analysis. MIC was defined as negative surgical margin plus zero-ischemia plus absence of any grade ≥3 complications according to Clavien-Dindo classification. Bivariate and multivariate logistic regression models were fitted to predict the MIC. Odds ratios with 95 % confidence intervals were calculated. 80 patients underwent OPN, 66 LPN and 31 RAPN, and both groups had similar characteristics. The MIC rate was 67.5, 86.3 and 83.3 % in the OPN, LPN and RAPN groups, respectively (p = 0.016). At logistic regression analysis, surgical approach (p = 0.03) and operative time (p = 0.008) were independent predictors of the MIC rate. When stratified according to the surgical approach, preoperative aspects and dimensions used for an anatomical classification (PADUA) score, LPN, RAPN and operative time were independent predictors of MIC rate (p = 0.0488, p = 0.0494, p = 0.0479 and p = 0.0108, respectively). Clampless LPN and RAPN have an efficacy and safety profile that is on par with OPN, offering the additional benefits of a reduced operative time, blood loss, on demand ischemia and rate of high-grade complications. PMID:27083923

  3. Comparison of Ondansetron and Dexamethasone for Prophylaxis of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Surgeries: A Meta-Analysis of Randomized Controlled Trials.

    PubMed

    Maitra, Souvik; Som, Anirban; Baidya, Dalim K; Bhattacharjee, Sulagna

    2016-01-01

    Background. Postoperative nausea and vomiting (PONV) is a significant complication after laparoscopic surgeries. Ondansetron and dexamethasone are most commonly used drugs for PONV prophylaxis. Comparisons of these two drugs have not been systematically reviewed till date. Methods. PubMed, PubMed Central, and CENTRAL databases were searched with the following words: "dexamethasone," "ondansetron," "laparoscopy," and "PONV" to identify randomized trials that compared ondansetron and dexamethasone for PONV prophylaxis after laparoscopic surgeries. Results. Data of 592 patients from 7 RCTs have been included in this meta-analysis. Incidence of postoperative nausea at 4-6 h is significantly lower when dexamethasone was used instead of ondansetron (p = 0.04; OR 0.49, 95% CI 0.24-0.98, M-H fixed). Incidence of nausea is similar at 24 hours (p = 0.08, OR 0.71, 95% CI 0.48, 1.05; M-H fixed); vomiting is also similar at 4-6 h (p = 0.43, OR 1.27, 95% CI 0.70-2.27; M-H fixed) and also at 24 h (p = 0.46, OR 0.92, 95% CI 0.73, 1.16; M-H fixed). Conclusion. Dexamethasone is superior to ondansetron in preventing postoperative nausea after 4-6 h of laparoscopic surgeries. However, both the drugs are of equal efficacy in preventing postoperative vomiting up to 24 h after surgery. However, results should be interpreted with caution due to clinical heterogeneity in the included studies. PMID:27110238

  4. Comparison of Ondansetron and Dexamethasone for Prophylaxis of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Surgeries: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Maitra, Souvik; Som, Anirban; Baidya, Dalim K.; Bhattacharjee, Sulagna

    2016-01-01

    Background. Postoperative nausea and vomiting (PONV) is a significant complication after laparoscopic surgeries. Ondansetron and dexamethasone are most commonly used drugs for PONV prophylaxis. Comparisons of these two drugs have not been systematically reviewed till date. Methods. PubMed, PubMed Central, and CENTRAL databases were searched with the following words: “dexamethasone,” “ondansetron,” “laparoscopy,” and “PONV” to identify randomized trials that compared ondansetron and dexamethasone for PONV prophylaxis after laparoscopic surgeries. Results. Data of 592 patients from 7 RCTs have been included in this meta-analysis. Incidence of postoperative nausea at 4–6 h is significantly lower when dexamethasone was used instead of ondansetron (p = 0.04; OR 0.49, 95% CI 0.24–0.98, M-H fixed). Incidence of nausea is similar at 24 hours (p = 0.08, OR 0.71, 95% CI 0.48, 1.05; M-H fixed); vomiting is also similar at 4–6 h (p = 0.43, OR 1.27, 95% CI 0.70–2.27; M-H fixed) and also at 24 h (p = 0.46, OR 0.92, 95% CI 0.73, 1.16; M-H fixed). Conclusion. Dexamethasone is superior to ondansetron in preventing postoperative nausea after 4–6 h of laparoscopic surgeries. However, both the drugs are of equal efficacy in preventing postoperative vomiting up to 24 h after surgery. However, results should be interpreted with caution due to clinical heterogeneity in the included studies. PMID:27110238

  5. The analgesic efficacy of ultrasound-guided transversus abdominis plane block with mid-axillary approach after gynecologic laparoscopic surgery: A randomized controlled trial

    PubMed Central

    Kawahara, Ryoko; Tamai, Yutaka; Yamasaki, Kyoko; Okuno, Satoko; Hanada, Rumi; Funato, Takao

    2015-01-01

    Background and Aims: The transversus abdominis plane (TAP) block is widely used in clinical practice as a part of the multimodal analgesic regimen after abdominal surgery. The analgesic efficacy of ultrasound (US)-guided TAP block with the mid-axillary approach was investigated in patients undergoing laparoscopic gynecologic surgery in a randomized controlled clinical trial. Materials and Methods: Adult patients (n = 119) undergoing laparoscopic gynecologic surgery were randomized to undergo either TAP block with ropivacaine (Group A, n = 60) or that with saline (Group B, n = 59), in a blinded manner. Following general anesthesia, TAP block was performed bilaterally by infusion of either 20-mL 0.375% ropivacaine/one side in Group A or 20-mL saline/one side in Group B, under US guidance with a mid-axillary approach. Patient-controlled analgesia (PCA) was performed postoperatively with tramadol. The analgesic effect was postoperatively evaluated using a four-grade pain score and the prince Henry pain scale (PHS) at 0, 6, 12, and 24 h. Postoperative tramadol PCA consumption and vomiting/nausea were recorded. Statistical analyses were performed using the Mann-Whitney U-test or Fisher's exact probability test. A P < 0.05 was considered significant. Results: There was no statistically significant difference in background characteristics. The dose of remifentanil was significantly higher in Group B (P = 0.01). The pain score (P = 0.02) and PHS (P = 0.01) were significantly lower in Group A at 0 h. Tramadol PCA consumption in the period of 0-6 h (P = 0.01) and postoperative nausea (P = 0.04) were significantly less in Group A. Conclusion: Postoperative pain/nausea and PCA consumption were significantly lower in patients with TAP block in the early postoperative stage. TAP block with a mid-axillary approach holds considerable promise as a part of a balanced postoperative analgesic regimen following laparoscopic gynecologic surgery. PMID:25788776

  6. Use of extraglottic airways in patients undergoing ambulatory laparoscopic surgery without the need for tracheal intubation

    PubMed Central

    Suhitharan, T.; Teoh, Wendy H.L.

    2013-01-01

    Background: Second generation extraglottic airway devices with gastric access and separate breathing channels have ushered in a new era where their use is increasingly prevalent in surgical patients who would have been traditionally intubated for general anesthesia. New innovations like the i-gel, which is constructed of a thermoplastic elastomer, provide an airtight seal around patient's perilaryngeal anatomy without the inflatable cuff mechanism found in the laryngeal mask airway supreme (LMAS). Methods: We conducted a randomized controlled trial comparing the LMAS with the i-gel in 70 anesthetized paralyzed patients undergoing laparoscopic female sterilization. Our primary outcome measure was the oropharyngeal leak pressure (OLP). We studied secondary outcomes of successful first attempt insertion rates, time and ease of the airway and gastric tube insertion, leak fractions and pharyngeal morbidity. Results: We found no difference in the OLP between LMAS and i-gel, 25.9 (4.2) versus 24.4 (4.3) s, P=0.153. Both devices had similar first attempt insertion rates (LMAS 94% vs. i-gel 91%) with similar ease and comparable times to achieve an effective airway, LMAS 14.7 (2.7) versus i-gel 16.5 (9.6) s, P=0.306, although gastric tube insertion was easier and faster for the LMAS, 7.9 (1.9) versus i-gel 14.8 (7.7) s, P<0.005. Intraoperatively, there was a significantly greater leak fraction with the i-gel of 0.06 (0.03) versus 0.04 (0.02) with the LMAS, P=0.013. Three patients (8.6%) with LMAS had mild sore throat; one patient (2.9%) had mucosal injury. No complications were documented in the i-gel group. Conclusions: Both these extraglottic airway devices offer similar OLPs, high insertion success rates at the first attempt with similar ease and insertion times (albeit longer gastric tube insertion with i-gel). Both provided effective ventilation despite a higher leak fraction with i-gel that was clinically inconsequential. PMID:24348297

  7. The first laparoscopic cholecystectomy.

    PubMed

    Reynolds, W

    2001-01-01

    Prof Dr Med Erich Mühe of Böblingen, Germany, performed the first laparoscopic cholecystectomy on September 12, 1985. The German Surgical Society rejected Mühe in 1986 after he reported that he had performed the first laparoscopic cholecystectomy, yet in 1992 he received their highest award, the German Surgical Society Anniversary Award. In 1990 in Atlanta, at the Society of American Gastrointestinal Surgeons (SAGES) Convention, Perissat, Berci, Cuschieri, Dubois, and Mouret were recognized by SAGES for performing early laparoscopic cholecystectomies, but Mühe was not. However, in 1999 he was recognized by SAGES for having performed the first laparoscopic cholecystectomy-SAGES invited Mühe to present the Storz Lecture. In Mühe's presentation, titled "The First Laparoscopic Cholecystectomy," which he gave in March 1999 in San Antonio, Texas, he described the first procedure. Finally, Mühe had received the worldwide acclaim that he deserved for his pioneering work. One purpose of this article is to trace the development of the basic instruments used in laparoscopic cholecystectomy. The other purpose is to give Mühe the recognition he deserves for being the developer of the laparoscopic cholecystectomy procedure. PMID:11304004

  8. Laparoscopic insertion of gastric electrodes for electrical stimulation.

    PubMed

    Brody, Fred; Nam, Arthur; Drenon, Elizabeth; Ali, Aamir; Soffer, Edy

    2007-02-01

    Gastric electrical stimulation can provide symptomatic relief for patients with refractory gastroparesis. Traditionally, these wires are placed through a midline laparotomy. This paper describes and illustrates, in detail, the laparoscopic technique for successful implantation. Thirty-one consecutive patients from October 2003 to March 2005 underwent laparoscopic insertion of gastric stimulating wires for gastroparesis. Twenty-six patients were female. Four laparoscopic ports were used to insert a pair of electrodes. Anterior, cephalad retraction of the gastric wall is critical for accurate seromuscular placement of gastric leads. Intraoperative endoscopy was used to verify the seromuscular placement of the leads. Both leads were secured to a subcutaneous generator and electrical parameters were immediately established in the operating room. Patient demographics, operative details, and postoperative morbidities were recorded. All procedures were completed laparoscopically. The mean operative time was 114.4 +/- 20.9 minutes (range, 95-140). No perioperative mortality occurred. Two patients developed cellulitis at the generator site postoperatively and oral antibiotics were prescribed for one week postoperatively. No hardware was removed. Two patients had their generators repositioned due to pain at the pocket site. Gastric electrical stimulation is a novel treatment modality for patients with refractory gastroparesis and can be accomplished safely via laparoscopy. Laparoscopic insertion is successful even in patients with prior surgery and intact gastrointestinal tubes. Long-term follow-up and the current prospective multicenter trial continue to assess the efficacy of this treatment modality. PMID:17362169

  9. Successful treatment of a patient with an infected urachal remnant via single-incision laparoscopic surgery: Report of a case.

    PubMed

    Nakamura, Hiroyuki; Oshita, Akihiko; Imamura, Yuji; Sasaki, Masaru; Kohyama, Mohei; Tazaki, Tatsuya; Sugiyama, Yoichi; Daimaru, Yutaka; Nakamitsu, Atsushi

    2016-02-01

    We report on a case of an infected urachal remnant successfully treated via a single-incisional laparoscopic technique. An 18-year-old woman was diagnosed with an infected urachal remnant. The center of the umbilicus was pulled and inverted from the skin, and the cephalic side of the urachus was dissected from the umbilicus. A single-incision laparoscopic technique employing ultrasonic coagulating shears was used to dissect the urachal remnant from the stump of the umbilicus to the caudal end. Single-incision laparoscopic excision of the urachal remnant can be used successfully as a minimally invasive technique with optimal cosmetic outcomes. PMID:26781536

  10. Easy cleaning of the camera port during laparoscopic surgery: three practical techniques.

    PubMed

    Theeuwes, Hilco; Zengerink, Hans; Mannaerts, Guido

    2011-11-01

    Bad vision due to a dirty camera lens is one of the disadvantages and one of the most prominent frustrations in performing endoscopic surgery. Different methods to prevent lens fogging have been described; however, little is published about the prevention of lens contamination due to a dirty port. The authors report three port-cleaning methods: (1) sterile gauze wrapped around an endoscopic dissecting clamp, (2) sterile gauze wrapped around a Pean clamp, and (3) a 10-mm sterile cotton swab, all being simple, adequate, cost-saving solutions. PMID:21978252

  11. Colorectal endometriosis: benefits of long-term follow-up in patients who underwent laparoscopic surgery.

    PubMed

    Stepniewska, Anna; Pomini, Paola; Guerriero, Massimo; Scioscia, Marco; Ruffo, Giacomo; Minelli, Luca

    2010-05-01

    In this retrospective cohort study, three groups of patients were included: 60 women who underwent endometriosis surgery with colorectal segmental resection, 40 women with surgical evidence of bowel endometriosis who underwent endometriosis removal without bowel resection, and 55 women affected by moderate or severe endometriosis with at least one endometrioma and deep infiltrating endometriosis but without bowel involvement. The results of a long-term ambulatory follow-up showed that if colorectal endometriosis was present, postoperative pain regression was more frequent, and among patients with bowel endometriosis the rate of recurrence was lower if segmental resection was performed. PMID:19836731

  12. Hepatic Artery Angiography and Embolization for Hemobilia Following Laparoscopic Cholecystectomy

    SciTech Connect

    Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher

    1999-01-15

    Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication.

  13. Understanding the tissue interaction of new treatment modalities in laparoscopic surgery in view of safe and effective application (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Grimbergen, Matthijs C. M.; Klaessens, John H.; van der Veen, Albert J.; Verdaasdonk, Rudolf M.

    2016-03-01

    During laparoscopic surgery, devices are require to either cut, ablate or coagulate tissue and veins with high precision and controlled lateral damage preferably in an one-for-all modality. The tissue interactions of 3 new treatment modalities were studied using special imaging techniques to obtain a better understanding the working mechanism in view of effective and safe application. The Plasmajet produces a high temperature ionized gas 'flame' directed to the tissue surface at the tip of a 4 mm diameter rigid hand piece. The Lumenis DUO CO2 laser enables endoscopic laser energy delivery through a 1 mm outer diameter flexible hollow waveguide. The 2 µm 'Thulium' laser is delivered by (standard) 400 µm diameter optical fiber. Thermal imaging and Schlieren techniques were used to assess the superficial ablative and coagulation effects these surgical instruments scanning at preset velocities and distances from the surface of biological tissues and phantoms . The CO2 was very effective in tissue ablation even at a distance up to 10 mm due to a very small diverging beam from the hollow waveguide. In contrast, the Thulium laser showed less ablation and increasing coagulation at larger distance to the tissue. The gas 'flame' of the Plasmajet spread the thermal energy over the surface for effective superficial ablation and coagulation. However, the pressure of the gas flow is substantial on the tissue surface creating turbulence and even indirect cooling. The specific ablation and coagulation effects of the three treatment modalities have to be appreciate and the effective and safe application will depend on the preference and skills of the surgeon

  14. Systematic Review and Meta-analysis of Complications in Transvaginal Approach in Laparoscopic Surgery.

    PubMed

    Komorowski, Andrzej L; Alba Mesa, Francisco; Bała, Małgorzata M; Mituś, Jerzy W; Wysocki, Wojciech M

    2015-12-01

    Transvaginal access is the most popular natural orifice translumenal technique in the minimally invasive surgery. Reviews on non-gynecological transvaginal approach morbidities reveal that rates vary greatly. A systematic review of transvaginal approach in non-gynecological intraabdominal procedures was carried out to assess the risk of complications. A systematic search was conducted using MEDLINE, EMBASE, PubMed, and the Cochrane Library from the inception of these databases to March 2012. The following keywords were searched: "transvaginal", "NOTES", "single incision", and "single port". From the total of 231 potentially eligible abstracts, 87 papers were retrieved and evaluated as fulfilling the eligibility criteria. The final analysis included 32 articles. The overall complications rate was 4.4 %, and complications related to the transvaginal port reached 2.4 %. Conversion rate to open surgery was 3.4 %. The incidence of postoperative urinary tract infection was 0.8 %. The mean operative time was 119 min. The mean hospital stay was 3.1 days (range 6 h-12 days). The technique of transvaginal access can offer several advantages for a patient and is associated with an acceptable rate of complications. PMID:27011470

  15. Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial

    PubMed Central

    Anand, R.

    2016-01-01

    Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow Rate (PEFR), and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p < 0.05. Results. Pulmonary function and diaphragm excursion showed a significant decrease on the first postoperative day in all four groups (p < 0.001) but was evident more in the control group than in the experimental groups. On the second postoperative day pulmonary function (Forced Vital Capacity) and diaphragm excursion were found to be better preserved in volume incentive spirometry and diaphragmatic breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity) and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p < 0.05) as compared to that flow incentive spirometry group and the control group. Conclusion. Volume incentive spirometry and diaphragmatic breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of laparoscopic

  16. Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial.

    PubMed

    Alaparthi, Gopala Krishna; Augustine, Alfred Joseph; Anand, R; Mahale, Ajith

    2016-01-01

    Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow Rate (PEFR), and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p < 0.05. Results. Pulmonary function and diaphragm excursion showed a significant decrease on the first postoperative day in all four groups (p < 0.001) but was evident more in the control group than in the experimental groups. On the second postoperative day pulmonary function (Forced Vital Capacity) and diaphragm excursion were found to be better preserved in volume incentive spirometry and diaphragmatic breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity) and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p < 0.05) as compared to that flow incentive spirometry group and the control group. Conclusion. Volume incentive spirometry and diaphragmatic breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of laparoscopic

  17. Development of a novel handheld intra-operative laparoscopic Compton camera for (18)F-Fluoro-2-deoxy-2-D-glucose-guided surgery.

    PubMed

    Nakamura, Y; Shimazoe, K; Takahashi, H; Yoshimura, S; Seto, Y; Kato, S; Takahashi, M; Momose, T

    2016-08-01

    As well as pre-operative roadmapping by (18)F-Fluoro-2-deoxy-2-D-glucose (FDG) positron emission tomography, intra-operative localization of the tracer is important to identify local margins for less-invasive surgery, especially FDG-guided surgery. The objective of this paper is to develop a laparoscopic Compton camera and system aimed at use for intra-operative FDG imaging for accurate and less-invasive dissections. The laparoscopic Compton camera consists of four layers of a 12-pixel cross-shaped array of GFAG crystals ([Formula: see text] mm(3)) and through silicon via multi-pixel photon counters and dedicated individual readout electronics based on a dynamic time-over-threshold method. Experimental results yielded a spatial resolution of 4 mm (FWHM) for a 10 mm working distance and an absolute detection efficiency of 0.11 cps kBq(-1), corresponding to an intrinsic detection efficiency of  ∼0.18%. In an experiment using a NEMA-like well-shaped FDG phantom, a [Formula: see text] mm cylindrical hot spot was clearly obtained even in the presence of a background distribution surrounding the Compton camera and the hot spot. We successfully obtained reconstructed images of a resected lymph node and primary tumor ex vivo after FDG administration to a patient having esophageal cancer. These performance characteristics indicate a new possibility of FDG-directed surgery by using a Compton camera intra-operatively. PMID:27427184

  18. Development of a novel handheld intra-operative laparoscopic Compton camera for 18F-Fluoro-2-deoxy-2-D-glucose-guided surgery

    NASA Astrophysics Data System (ADS)

    Nakamura, Y.; Shimazoe, K.; Takahashi, H.; Yoshimura, S.; Seto, Y.; Kato, S.; Takahashi, M.; Momose, T.

    2016-08-01

    As well as pre-operative roadmapping by 18F-Fluoro-2-deoxy-2-D-glucose (FDG) positron emission tomography, intra-operative localization of the tracer is important to identify local margins for less-invasive surgery, especially FDG-guided surgery. The objective of this paper is to develop a laparoscopic Compton camera and system aimed at use for intra-operative FDG imaging for accurate and less-invasive dissections. The laparoscopic Compton camera consists of four layers of a 12-pixel cross-shaped array of GFAG crystals (2× 2× 3 mm3) and through silicon via multi-pixel photon counters and dedicated individual readout electronics based on a dynamic time-over-threshold method. Experimental results yielded a spatial resolution of 4 mm (FWHM) for a 10 mm working distance and an absolute detection efficiency of 0.11 cps kBq‑1, corresponding to an intrinsic detection efficiency of  ∼0.18%. In an experiment using a NEMA-like well-shaped FDG phantom, a φ 5× 10 mm cylindrical hot spot was clearly obtained even in the presence of a background distribution surrounding the Compton camera and the hot spot. We successfully obtained reconstructed images of a resected lymph node and primary tumor ex vivo after FDG administration to a patient having esophageal cancer. These performance characteristics indicate a new possibility of FDG-directed surgery by using a Compton camera intra-operatively.

  19. A Posterior TAP Block Provides More Effective Analgesia Than a Lateral TAP Block in Patients Undergoing Laparoscopic Gynecologic Surgery: A Retrospective Study

    PubMed Central

    Yoshiyama, Sakatoshi; Ueshima, Hironobu; Sakai, Ryomi; Otake, Hiroshi

    2016-01-01

    Background. There are a few papers that compared the lateral transversus abdominis plane (TAP) block with the posterior TAP block. Our study aimed to compare retrospectively the quality of analgesia after laparoscopic gynecologic surgery using the lateral TAP block with general anesthesia versus the posterior TAP block with general anesthesia. Method. Sixty-seven adult female patients were included in this retrospective study. Of these patients, thirty-four patients received the lateral TAP block with general anesthesia (lat. TAP group), and the rest of thirty-three patients received the posterior TAP block with general anesthesia (pos. TAP group). Pain scores both at rest and at movement and the use of additional analgesic drugs were recorded in the postoperative care unit within twenty-four hours after the operation. Postoperative complications were noted. Results. Patients who received pos. TAP reported lower visual analog scale (VAS) pain scores in all points, within twenty-four hours after the operation, than patients who received lat. TAP. Moreover, with the use of additional analgesic drugs, the incidence of nausea and vomiting during the first twenty-four hours after surgery was lower in the pos. TAP group than in the lat. TAP group. Conclusion. The posterior TAP block provided more effective analgesia than the lateral TAP block in patients undergoing laparoscopic gynecologic surgery. PMID:26941794

  20. [Sacrocolpopexy - pro laparoscopic].

    PubMed

    Hatzinger, M; Sohn, M

    2012-05-01

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

  1. Advanced laparoscopic surgery for the removal of rectovaginal septum endometriotic or adenomyotic nodules.

    PubMed

    Donnez, J; Nisolle, M

    1995-12-01

    lesion originates from the rectovaginal septum tissue and consists essentially of smooth muscle with active glandular epithelium and scanty stroma. In our study, the rectovaginal nodule was histologically similar to an adenomyoma (Zaloudek and Norris, 1987). It was a circumscribed, nodular aggregate of smooth muscle, endometrial glands and endometrial stroma. As in the 'adenomyoma', secretory changes were frequently absent in 'endometriotic' rectovaginal nodules. The invasion of the muscle by a very active glandular epithelium, without stroma, proved that the stroma is not necessary for invasion in this particular type of pathology called adenomyosis. In some instances, it can be seen that the vaginal pluristratified epithelium was replaced by a glandular epithelium. The fact that ciliated cells were present and the co-expression of both vimentin and cytokeratin (Donnez and Nisolle, personal communication) proved the Mullerian origin of the nodule, where certain histological characteristics are completely different to those observed in peritoneal lesions (Nisolle et al, 1990). In our series, deep fibrotic tissue assumed to contain endometriosis was excised or vaporized from the anterior rectum with the aid of multiple rectovaginal examinations. Cul-de-sac dissection was followed by excision of deep fibrotic endometriosis, without cul-de-sac reconstruction. In three cases, the bowel lumen was entered. A comprehensive laparoscopic procedure, while not eradicating all the endometriosis, may result in considerable pain relief or a desired pregnancy.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8821254

  2. [Progress of laparoscopic surgery in adults at the Department of Urology of the First Faculty of Medicine and General Teaching Hospital].

    PubMed

    Safarík, L; Novák, K; Sedlácek, J; Macek, P; Pesl, M; Sobotka, R; Dvorácek, J

    2007-01-01

    Laparoscopy is the most modern operative technique, the main advantage of which is the least invasivity. In urology, the laparoscopy has won its yield only in nineties of 20th century, but it was in urology, where the robots were launched as first, and nowadays using them it is possible to perform ablative/reconstructive surgery in a tiny intracorporeal space. The price of laparoscopic operations is high and has been the only limit up to now, but technical approaches and indications have already been fixed. PMID:18020016

  3. Laparoscopic common bile duct exploration.

    PubMed

    Vecchio, Rosario; MacFadyen, Bruce V

    2002-04-01

    In recent years, laparoscopic common bile duct exploration has become the procedure of choice in the management of choledocholithiasis in several laparoscopic centers. The increasing interest for this laparoscopic approach is due to the development of instrumentation and technique, allowing the procedure to be performed safely, and it is also the result of the revised role of endoscopic retrograde cholangiopancreatography, which has been questioned because of its cost, risk of complications and effectiveness. Many surgeons, however, are still not familiar with this technique. In this article we discuss the technique and results of laparoscopic common bile duct exploration. Both the laparoscopic transcystic approach and choledochotomy are discussed, together with the results given in the literature. When one considers the costs, morbidity, mortality and the time required before the patient can return to work, it would appear that laparoscopic cholecystectomy with common bile duct exploration is more favorable than open surgery or laparoscopic cholecystectomy with preoperative or postoperative endoscopic sphincterotomy. However, the technique requires advanced laparoscopic skills, including suturing, knot tying, the use of a choledochoscope, guidewire, dilators and balloon stone extractor. Although laparoscopic common bile duct exploration appears to be the most cost-effective method to treat common bile duct stones, it should be emphasized that this procedure is very challenging, and it should be performed by well-trained laparoscopic surgeons with experience in biliary surgery. PMID:11981684

  4. Emergency surgery for epidural abcess secondary to sacral fistula after laparoscopic proctectomy

    PubMed Central

    Zeitoun, Jeremie; Menahem, Benjamin; Fohlen, Audrey; Lebreton, Gil; Lubrano, Jean; Alves, Arnaud

    2016-01-01

    A 61-year-old man presented via the emergency department with a few days history of abdominal and colic occlusion symptoms. He presented signs of sepsis, midline lumbar spine tenderness and reduced hip flexion. Computer tomography of the abdomen and pelvis showed a presacral collection contiguous with the posterior part of the colo-rectal anastomosis, and MRI lumbar spine revealed abscess invation into the epidural space. He underwent a laparotomy with washout of the presacral abscess and a colostomy with a prolonged course of intravenous antibiotic therapy. At 3 weeks after initial presentation he had made a full clinical recovery with progressive radiological resolution of the epidural abscess. The objective of the case report is to highlight a unique and clinically significant complication of a rare post-operative complication after rectal surgery and to briefly discuss other intra-abdominal sources of epidural abscess. PMID:27421299

  5. Laparoscopic Single Site Surgery for Repair of Retrocaval Ureter in a Morbidly Obese Patient

    PubMed Central

    Abdel-Karim, Aly M.; Yahia, Elsayed; Hassouna, M.; Missiry, M.

    2015-01-01

    This is to describe a case of a morbidly obese (BMI = 40) female with retrocaval ureter treated with laparoendoscopic single-site surgery. A JJ stent was positioned. A 2 cm umbilical access was created. A single port platform was positioned. The entire ureter was mobilized posterior to the vena cava and transected where the dilated portion ended. The distal ureter was repositioned lateral to the inferior vena cava. Anastomosis was done. A 3 mm trocar was used to assist suturing. At 4-month follow-up, CT revealed no evidence of obstruction of the right kidney and the patient was symptomless. Although challenging, in a morbidly obese patient, LESS repair for retrocaval ureter is feasible. PMID:26793585

  6. Effects of Systemic Administration of Dexmedetomidine on Intraocular Pressure and Ocular Perfusion Pressure during Laparoscopic Surgery in a Steep Trendelenburg Position: Prospective, Randomized, Double-Blinded Study

    PubMed Central

    2016-01-01

    Increased intraocular pressure (IOP) during surgery is a risk factor for postoperative ophthalmological complications. We assessed the efficacy of systemically infused dexmedetomidine in preventing the increase in IOP caused by a steep Trendelenburg position, and evaluated the influence of underlying hypertension on IOP during surgery. Sixty patients undergoing laparoscopic surgery in a steep Trendelenburg position were included. Patients in the dexmedetomidine group received a 1.0 µg/kg IV loading dose of dexmedetomidine before anesthesia, followed by an infusion of 0.5 µg/kg/hr throughout the operation. Patients in the saline group were infused with the same volume of normal saline. IOP and ocular perfusion pressure (OPP) were measured 16 times pre- and intraoperatively. In the saline group, IOP increased in the steep Trendelenburg position, and was 11.3 mmHg higher at the end of the time at the position compared with the baseline value (before anesthetic induction). This increase in IOP was attenuated in the dexmedetomidine group, for which IOP was only 4.2 mmHg higher (P < 0.001 vs. the saline group). The steep Trendelenburg position was associated with a decrease in OPP; the degree of decrease was comparable for both groups. In intragroup comparisons between patients with underlying hypertension and normotensive patients, the values of IOP at every time point were comparable. Dexmedetomidine infusion attenuated the increase in IOP during laparoscopic surgery in a steep Trendelenburg position, without further decreasing the OPP. Systemic hypertension did not seem to be associated with any additional increase in IOP during surgery. (Registration at the Clinical Research Information Service of Korea National Institute of Health ID: KCT0001482) PMID:27247511

  7. Effect of Dexmedetomidine in Preventing Postoperative Side Effects for Laparoscopic Surgery: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis (PRISMA).

    PubMed

    Wang, Guoqi; Zhang, Licheng; Lou, Shenghan; Chen, Yuxiang; Cao, Yanxiang; Wang, Ruirui; Zhang, Lihai; Tang, Peifu

    2016-03-01

    Dexmedetomidine (DEX) has been used extensively for patients during surgery. Some studies found that DEX could reduce the incidence of postoperative side effects in laparoscopic surgical patients. However, no firm conclusions were made about it.The authors searched for randomized controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials testing DEX administrated in laparoscopic surgical patients and reporting on postoperative nausea, vomiting, shivering, heart rate, mean arterial pressure (MAP), or extubation time after surgery or within 1 hour in postoperative care unit. Trial sequential analysis (TSA) was used for RCTs comparing DEX with placebo or no treatment in laparoscopic surgery patients. A protocol for this meta-analysis has been registered on PROSPERO (http://www.crd.york.ac.uk/prospero) and the registration number is CRD42015020226.Fifteen studies (899 patients) were included. DEX could significantly reduce the incidence of postoperative nausea (risk ratio [RR] and 95% confidence interval [CI], 0.43 [0.28, 0.66], P < 0.0001), vomiting (RR and 95% CI, 0.36 [0.18, 0.72], P = 0.004), shivering (RR and 95% CI, 0.19 [0.11, 0.35], P < 0.00001), rescue antiemetic (RR and 95% CI, 0.18 [0.07, 0.47], P = 0.0006), and increase the incidence of dry mouth (RR and 95% CI, 7.40 [2.07, 26.48], P = 0.002) comparing with the control group. In addition, firm conclusions can be made on the results of postoperative nausea according to the TSA. Meta-analysis showed that DEX group had a significantly lower heart rate (mean difference [MD] and 95% CI, -14.21 [-18.85, -9.57], P < 0.00001) and MAP (MD and 95% CI, -12.35 [-15.28, -9.42], P < 0.00001) than the control group, and firm conclusions can be made according to the TSA. No significance was observed on extubation time between 2 groups (MD and 95% CI, 0.70 [-0.89, 2.28], P = 0.39).The results from this meta-analysis indicated that perioperative DEX

  8. Preoperative Chemoradiotherapy (CRT) Followed by Laparoscopic Surgery for Rectal Cancer: Predictors of the Tumor Response and the Long-Term Oncologic Outcomes

    SciTech Connect

    Lee, Jong Hoon; Kim, Sung Hwan; Kim, Jun-Gi; Cho, Hyun Min; Shim, Byoung Yong

    2011-10-01

    Purpose: We have evaluated the predictors of a tumor response to chemoradiotherapy (CRT) and the long-term oncologic outcomes of preoperative CRT and laparoscopic surgery for patients who suffer from rectal cancer. Methods and Materials: The study involved 274 patients with locally advanced rectal cancer and who had been treated with preoperative CRT and curative laparoscopic total mesorectal excision between January 2003 and January 2009. We assessed the long-term oncologic outcomes, in terms of recurrence and survival, of the treated patients. Results: Forty-two (15.3%) of the 274 patients had complete pathologic responses (pCR). The pre-CRT carcinoembryonic antigen level was the only significant predictor of a pCR on the multivariate analysis (p = 0.01). The overall survival at 5 years was 73.1%, with a mean survival period of 59.7 months (95% CI, 57.1-62.3). The disease-free survival at 5 years was 67.3% with a mean survival period of 54.7 months (95% CI, 51.7-57.8). The pCR group had a higher rate of overall survival at 5 years than did the non-pCR group, and the difference was significant (86.0% vs. 71.2%; hazard ratio = 0.87; 95% CI, 0.78-0.96; p = 0.03). The cumulative incidences of local and distant recurrences at 5 years were 5.8% and 28.3%, respectively. A total of 84.5% (234 of 274) of the patients had their anal sphincters preserved. Grade 3 or 4 acute and long-term toxic effects occurred in 22.2% and 8.4% of the patients, respectively. Conclusion: Preoperative CRT and laparoscopic surgery seems safe and feasible with favorable long-term outcomes and a high rate of sphincter preservation for the patients with low-lying tumors of the rectum.

  9. Benefits of post-operative oral protein supplementation in gastrointestinal surgery patients: A systematic review of clinical trials

    PubMed Central

    Crickmer, Mike; Dunne, Colum P; O’Regan, Andrew; Coffey, J Calvin; Dunne, Suzanne S

    2016-01-01

    AIM: To evaluate published trials examining oral post-operative protein supplementation in patients having undergone gastrointestinal surgery and assessment of reported results. METHODS: Database searches (MEDLINE, BIOSIS, EMBASE, Cochrane Trials, Cinahl, and CAB), searches of reference lists of relevant papers, and expert referral were used to identify prospective randomized controlled clinical trials. The following terms were used to locate articles: “oral’’ or “enteral’’ and “postoperative care’’ or “post-surgical’’ and “proteins’’ or “milk proteins’’ or “dietary proteins’’ or “dietary supplements’’ or “nutritional supplements’’. In databases that allowed added limitations, results were limited to clinical trials that studied humans, and publications between 1990 and 2014. Quality of collated studies was evaluated using a qualitative assessment tool and the collective results interpreted. RESULTS: Searches identified 629 papers of which, following review, 7 were deemed eligible for qualitative evaluation. Protein supplementation does not appear to affect mortality but does reduce weight loss, and improve nutritional status. Reduction in grip strength deterioration was observed in a majority of studies, and approximately half of the studies described reduced complication rates. No changes in duration of hospital stay or plasma protein levels were reported. There is evidence to suggest that protein supplementation should be routinely provided post-operatively to this population. However, despite comprehensive searches, clinical trials that varied only the amount of protein provided via oral nutritional supplements (discrete from other nutritional components) were not found. At present, there is some evidence to support routinely prescribed oral nutritional supplements that contain protein for gastrointestinal surgery patients in the immediate post-operative stage. CONCLUSION: The optimal level of protein

  10. Lidocaine versus ropivacaine for postoperative continuous paravertebral nerve blocks in patients undergoing laparoscopic bowel surgery: a randomized, controlled, double-blinded, pilot study

    PubMed Central

    Ghisi, Daniela; Fanelli, Andrea; Jouguelet-Lacoste, Julie; La Colla, Luca; Auroux, Anne-Sophie; Chelly, Jacques E

    2015-01-01

    Background and objectives Lidocaine could provide many advantages in continuous regional anesthesia techniques, including faster onset, greater titratability, and lower cost than long-acting local anesthetics. This prospective, randomized, double-blinded, pilot study is therefore intended to compare lidocaine to ropivacaine in bilateral continuous paravertebral blocks using a multimodal approach for postoperative pain management following laparoscopic bowel surgery. Methods Thirty-five ASA I–III consecutive patients undergoing elective laparoscopic bowel surgery and bilateral thoracic paravertebral continuous blocks were analyzed: bilateral thoracic paravertebral infusions of ropivacaine 0.2% (Group Ropi, n=18) or lidocaine 0.25% (Group Lido, n=17) were started at 7 mL/h in the postanesthesia care unit. For each patient, we collected numerical rating scores (NRS) for pain at rest and during movement at baseline, at postanesthesia care unit discharge, at 24 hours and 48 hours after the end of surgery, as well as hydromorphone patient-controlled analgesia requirements, local anesthetic consumption, side effects, postoperative complications, and functional outcomes. Results No effect of group distribution on NRS scores for pain at rest or at movement (P=0.823 and P=0.146), nor on hydromorphone (P=0.635) or local anesthetic consumption (P=0.063) was demonstrated at any analyzed time point. Hospital length of stay and spontaneous ambulation were comparable between groups (P=0.636 and P=0.148). In the context of a multimodal approach, the two drugs showed comparable safety profiles. Discussion Lidocaine 0.25% and ropivacaine 0.2% provided similar analgesic profiles after elective abdominal surgeries, without any difference in terms of functional outcomes. The easier titratability of lidocaine together with its lower cost induced our clinical practice to definitely switch from ropivacaine to lidocaine for postoperative bilateral paravertebral continuous infusions. PMID

  11. Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Derici, Serhan; Atila, Koray; Bora, Seymen; Yener, Serkan

    2016-01-01

    Background. Laparoscopic sleeve gastrectomy (LSG) has become a popular operation during the recent years. This procedure requires resection of 80–90% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15 mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device.

  12. International Survey on Technical Aspects of Laparoscopic Liver Resection: a web-based study on the global diffusion of laparoscopic liver surgery prior to the 2nd International Consensus Conference on Laparoscopic Liver Resection in Iwate, Japan.

    PubMed

    Hibi, Taizo; Cherqui, Daniel; Geller, David A; Itano, Osamu; Kitagawa, Yuko; Wakabayashi, Go

    2014-10-01

    The technique of laparoscopic liver resection (LLR) has been greatly improved since the first international consensus conference. Our aim was to evaluate the worldwide spread of LLR prior to the 2nd International Consensus Conference on Laparoscopic Liver Resection in Iwate, Japan (4-6 October 2014). The International Survey on Technical Aspects of Laparoscopic Liver resection was designed to assess dissemination of LLR, indications, and the surgical techniques. The anonymous questionnaire was e-mailed to liver surgeons worldwide. A total of 448 liver surgeons responded to the survey. The peak age range of surgeons performing LLR was 41-50 years. Japan had by far the largest number of respondents (n = 223), followed by the US (n = 38) and France (n = 20). In Japan, the majority of surgeons performing LLR belonged to community hospitals, where LLR has been increasingly used since its implementation in 2009 or later, comprising up to 40% of all liver resection cases. In contrast, in North America and Europe, LLR was mostly performed at academic medical centers. LLR has undergone global dissemination after the first international consensus conference in 2008. Japan has experienced unparalleled, explosive diffusion characterized by the adoption of LLR at middle-tier, regional institutions. PMID:25088825

  13. Laparoscopic Ureterolithotomy

    PubMed Central

    Aras, Bekir; Ekşi, Mithat; Şener, Nevzat Can; Tugču, Volkan

    2016-01-01

    Background and Objective: The present study retrospectively analyzed the data of 213 patients who underwent laparoscopic ureterolithotomy. Methods: We retrospectively analyzed the data of 213 patients, in whom we performed conventional laparoscopic ureterolithotomy from April 2006 and January 2015 based on the diagnosis of an upper or middle ureteral stone. Patients with large ureteral stones (>15 mm) or a history of failed shock-wave lithotripsy or ureteroscopy were included in the study. Although the retroperitoneal approach was preferred for 170 patients, the transperitoneal approach was used in the remaining 43 patients. Results: The mean patient age was 39.3 ± 12.0 years (range, 18–73). The study population was composed of 78 (26.7%) female and 135 (63.3%) male patients. The mean stone size was 19.7 ± 2.5 mm. The mean operative time was 80.9 ± 10.9 minutes, and the mean blood loss was 63.3 ± 12.7 mL. Intraoperative insertion of a double-J catheter was performed in 76 patients. The overall stone-free rate was 99%. No major complication was observed in any patient. However, conversion to open surgery was necessary in 1 patient. Conclusion: With high success and low complication rates, laparoscopic ureterolithotomy is an effective and reliable method that ensures quick recovery and may be the first treatment option for patients with large, impacted ureteral stones, as well as for those with a history of failed primary treatment. PMID:27019576

  14. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer—IMIGASTRIC

    PubMed Central

    Desiderio, Jacopo; Jiang, Zhi-Wei; Nguyen, Ninh T; Zhang, Shu; Reim, Daniel; Alimoglu, Orhan; Azagra, Juan-Santiago; Yu, Pei-Wu; Coburn, Natalie G; Qi, Feng; Jackson, Patrick G; Zang, Lu; Brower, Steven T; Kurokawa, Yukinori; Facy, Olivier; Tsujimoto, Hironori; Coratti, Andrea; Annecchiarico, Mario; Bazzocchi, Francesca; Avanzolini, Andrea; Gagniere, Johan; Pezet, Denis; Cianchi, Fabio; Badii, Benedetta; Novotny, Alexander; Eren, Tunc; Leblebici, Metin; Goergen, Martine; Zhang, Ben; Zhao, Yong-Liang; Liu, Tong; Al-Refaie, Waddah; Ma, Junjun; Takiguchi, Shuji; Lequeu, Jean-Baptiste; Trastulli, Stefano; Parisi, Amilcare

    2015-01-01

    Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results. PMID:26482769

  15. [Biocenosis sparing treatment in the surgery of gastro-intestinal tract].

    PubMed

    Lazarev, S M; Voronina, O V

    2009-01-01

    The authors present results of investigation of the state of microbiocenosis of the intestine and immune status of organism of 139 patients after emergency operations on the gastro-intestinal tract organs. Disbiosis and reduced indices of the immune system in the postoperative period was a cause of using biocenosis sparing treatment resulting in stabilization of microecology of the gastro-intestinal tract, higher colonization resistance and general reactivity of organism. PMID:19432155

  16. Hysterectomy - laparoscopic - discharge

    MedlinePlus

    Supracervical hysterectomy - discharge; Removal of the uterus - discharge; Laparoscopic hysterectomy - discharge; Total laparoscopic hysterectomy - discharge; TLH - discharge; Laparoscopic supracervical ...

  17. Combined thoracoscopic and laparoscopic minimally invasive esophagectomy

    PubMed Central

    Zeng, Fuchun; Wang, Youyu; Xue, Yang; Cong, Wei

    2014-01-01

    With the improvement in thoracoscopic and laparoscopic surgery, thoracoscopic and laparoscopic esophagectomy (TLE), a minimally invasive approach, has attracted increasing attention as an alternative to open three-field esophagectomy. From June 2012 to October 2013, 90 patients underwent laparoscopic and thoracoscopic resection of esophageal carcinoma in our department. The VATS esophagectomy technique described here is the approach currently employed in the department of thoracic surgery at Sichuan Provincial People’s Hospital of China. PMID:24605230

  18. Prevention of Incisional Surgical Site Infection Using a Subcuticular Absorbable Suture in Elective Surgery for Gastrointestinal Cancer

    PubMed Central

    Bou, Hideki; Suzuki, Hideyuki; Maejima, Kentarou; Uchida, Eiji; Tokunaga, Akira

    2015-01-01

    This study examined whether subcuticular absorbable sutures actually reduce incisional SSI in patients undergoing surgery for gastrointestinal (GI) cancer. Surgical site infection (SSI) is still a source of major complications in digestive tract surgery. Reportedly, incisional SSI can be reduced using subcuticular suturing. We performed subcuticular suturing using a 4-0 absorbable monofilament in patients undergoing elective surgery for GI cancer beginning in 2008. Using an interrupted technique, sutures were placed 1.5-2.0cm from the edge of the wound, with everted subcuticular sutures created at intervals of 1.5-2.0cm. The control group consisted of cases in which the common subcutaneous suture method using clip. One hundred cases were examined in the subcuticular group. The incidence of SSI was 0% in the subcuticular suture group, compared with 13.9% in the control group; this difference was significant. Incisional SSI can be prevented using the devised subcuticular absorbable sutures in patients undergoing elective surgery for GI cancer. PMID:26414820

  19. Comprehensive evaluation of latest 2D/3D monitors and comparison to a custom-built 3D mirror-based display in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Wilhelm, Dirk; Reiser, Silvano; Kohn, Nils; Witte, Michael; Leiner, Ulrich; Mühlbach, Lothar; Ruschin, Detlef; Reiner, Wolfgang; Feussner, Hubertus

    2014-03-01

    Though theoretically superior, 3D video systems did not yet achieve a breakthrough in laparoscopic surgery. Furthermore, visual alterations, such as eye strain, diplopia and blur have been associated with the use of stereoscopic systems. Advancements in display and endoscope technology motivated a re-evaluation of such findings. A randomized study on 48 test subjects was conducted to investigate whether surgeons can benefit from using most current 3D visualization systems. Three different 3D systems, a glasses-based 3D monitor, an autostereoscopic display and a mirror-based theoretically ideal 3D display were compared to a state-of-the-art 2D HD system. The test subjects split into a novice and an expert surgeon group, which high experience in laparoscopic procedures. Each of them had to conduct a well comparable laparoscopic suturing task. Multiple performance parameters like task completion time and the precision of stitching were measured and compared. Electromagnetic tracking provided information on the instruments path length, movement velocity and economy. The NASA task load index was used to assess the mental work load. Subjective ratings were added to assess usability, comfort and image quality of each display. Almost all performance parameters were superior for the 3D glasses-based display as compared to the 2D and the autostereoscopic one, but were often significantly exceeded by the mirror-based 3D display. Subjects performed the task at average 20% faster and with a higher precision. Work-load parameters did not show significant differences. Experienced and non-experienced laparoscopists profited equally from 3D. The 3D mirror system gave clear evidence for additional potential of 3D visualization systems with higher resolution and motion parallax presentation.

  20. Laparoscopic bypass pyeloureterostomy.

    PubMed

    Noh, Paul H; Shah, Anish K

    2013-02-01

    Minimally invasive surgery has been increasingly applied in paediatric urology, including the treatment of ureteropelvic junction obstruction. To the best of our knowledge, we describe the first laparoscopic bypass pyeloureterostomy in a 3-month-old male infant, with giant hydronephrosis and high insertion of the ureter into the renal pelvis. PMID:22889709

  1. [History and development trend of minimally invasive surgery for colorectal cancer in China].

    PubMed

    Zheng, Minhua; Ma, Junjun

    2016-08-25

    With the development in past 20 years, the utilization of the laparoscopic surgery, which is the main trend in minimally invasive surgery for colorectal cancer, has tremendously changed. Minimally invasive surgery for colorectal cancer is now at a high level platform after going through the exploration at the very beginning and rapid development in the period of standardizing and promoting the regulations. Nowadays, the unique advantage that the laparoscopy owns is high definition and enlargement of the image, along with the establishment of the key note in series of laparoscopic complete mesocolic excision and the improvement of surgical instruments and methods make the operation skills accurate and normative in exploration of correct plane, high ligation of vessels and protection of nerve during the lymph node dissection of colorectal surgery. Currently, the most common procedure widely used in reconstruction of gastrointestinal(GI) tract is still laparoscopy-assisted approach. The frequent reconstruction of GI tract in rectal cancer surgery is double stapling technique, coloanal anastomosis by hand-sewn technique and the laparoscopic reconstruction of GI tract based on NOSE. At present, the most reconstructions of GI tract, including reconstruction by instrument and by hand-sewn are operated extracorporeally by pulling out the colon through the small incision, which is used to extract specimen. Although compared with the traditional reconstruction of GI tract, the complete laparoscopic excision has the advantage that the incision is smaller, it is more expensive. The preference approach of laparoscopic surgery is mainly medial approach, but with further understanding of CME, TME and the basic of medial approach, the new approaches like total medial approach, hybrid medial approach and caudal approach applied in right hemicolectomy and cephalad medial approach applied in rectal cancer have derived. As the introduction of NOTES, transanal TME and transanal

  2. Impact of Type of Surgery on Survival Outcome in Patients With Early Gallbladder Cancer in the Era of Minimally Invasive Surgery

    PubMed Central

    Jang, Jin-Young; Heo, Jin Seok; Han, Youngmin; Chang, Jihoon; Kim, Jae Ri; Kim, Hongbeom; Kwon, Wooil; Kim, Sun-Whe; Choi, Seong Ho; Choi, Dong Wook; Lee, Kyoungbun; Jang, Kee-Taek; Han, Sung-Sik; Park, Sang-Jae

    2016-01-01

    Abstract Laparoscopic surgery has been widely accepted as a feasible and safe treatment modality in many cancers of the gastrointestinal tract. However, most guidelines on gallbladder cancer (GBC) regard laparoscopic surgery as a contraindication, even for early GBC. This study aims to evaluate and compare recent surgical outcomes of laparoscopic and open surgery for T1(a,b) GBC and to determine the optimal surgical strategy for T1 GBC. The study enrolled 197 patients with histopathologically proven T1 GBC and no history of other cancers who underwent surgery from 2000 to 2014 at 3 major tertiary referral hospitals with specialized biliary-pancreas pathologists and optimal pathologic handling protocols. Median follow-up was 56 months. The effects of depth of invasion and type of surgery on disease-specific survival and recurrence patterns were investigated. Of the 197 patients, 116 (58.9%) underwent simple cholecystectomy, including 31 (15.7%) who underwent open cholecystectomy and 85 (43.1%) laparoscopic cholecystectomy. The remaining 81 (41.1%) patients underwent extended cholecystectomy. Five-year disease-specific survival rates were similar in patients who underwent simple and extended cholecystectomy (96.7% vs 100%, P = 0.483), as well as being similar in patients in the simple cholecystectomy group who underwent open and laparoscopic cholecystectomy (100% vs 97.6%, P = 0.543). Type of surgery had no effect on recurrence patterns. Laparoscopic cholecystectomy for T1 gallbladder cancer can provide similar survival outcomes compared to open surgery. Considering less blood loss and shorter hospital stay with better cosmetic outcome, laparoscopic cholecystectomy can be justified as a standard treatment for T1b as well as T1a gallbladder cancer when done by well-experienced surgeons based on exact pathologic diagnosis. PMID:27258495

  3. Salpingo-ureteric fistula—A rare complication following laparoscopic surgery for colorectal cancer: A case report and literature review☆

    PubMed Central

    Nkwam, N.; During, V.; Chen, T.

    2014-01-01

    INTRODUCTION We report the management and outcome of the case of a 57-year old woman with adenocarcinoma of the rectum. Following neo-adjuvant chemo-radiotherapy and laparoscopic-assisted anterior resection of her tumour she developed a right salpingo-ureteric fistula. PRESENTATION OF CASE Three weeks following laparoscopic anterior resection of the tumour she presented with urinary frequency and incontinence. A ureteric stent was inserted and left in-situ for five months but the fistula did not heal. The patient underwent exploration and open repair of the salpingo-ureteric fistula which resolved her symptoms. DISCUSSION There have not been many reported cases in the literature of salpingo-ureteric fistulae but after initial trial of management with ureteric stents all eventually required open exploration and repair. CONCLUSION we advocate open repair of salpingo-ureteric fistulae as the definitive management following intra-operative injury. PMID:24636981

  4. Feasibility and Timing of Cytoreduction Surgery in Advanced (Metastatic or Recurrent) Gastrointestinal Stromal Tumors During the Era of Imatinib

    PubMed Central

    Chang, Shih-Chun; Liao, Chien-Hung; Wang, Shang-Yu; Tsai, Chun-Yi; Chiang, Kun-Chun; Cheng, Chi-Tung; Yeh, Ta-Sen; Chen, Yen-Yang; MA, Ming-Chun; Liu, Chien-Ting; Yeh, Chun-Nan

    2015-01-01

    Abstract The prognosis of advanced gastrointestinal stromal tumors (GISTs) was dramatically improved in the era of imatinib. Cytoreduction surgery was advocated as an additional treatment for advanced GISTs, especially when patients having poor response to imatinib or developing resistance to it. However, the efficacy and benefit of cytoreduction were still controversial. Likewise, the sequence between cytoreduction surgery and imatinib still need evaluation. In this study, we tried to assess the feasibility and efficiency of cytoreduction in advanced GISTs. Furthermore, we analyzed the impact of timing of the cytoreduction surgery on the prognosis of advanced GISTs. We conducted a prospective collecting retrospective review of patients with advanced GISTs (metastatic, unresectable, and recurrent GISTs) treated in Chang Gung memorial hospital (CGMH) since 2001 to 2013. We analyzed the impact of cytoreduction surgery to response to imatinib, progression-free survival (PFS), and overall survival (OS) in patients with advanced GISTs. Moreover, by the timing of cytoreduction to imatinib, we divided the surgical patients who had surgery before imatinib use into early group and those who had surgery after imatinib into late. We compared the clinical response to imatinib, PFS and OS between early and late cytoreduction surgical groups. Totally, 182 patients were enrolled into this study. Seventy-six patients underwent cytoreduction surgery. The demographic characteristics and tumor presentation were similar between surgical and non-surgical groups. The surgical group showed better complete response rate (P < 0.001) and partial response rate (P = 0.008) than non-surgical group. The 1-year, 3-year, and 5-year PFS were significantly superior in surgical group (P = 0.003). The 1-year, 3-year, and 5-year OS were superior in surgical group, but without statistical significance (P = 0.088). Dividing by cytoreduction surgical timing, the demographic

  5. Real-time ultrasound-guided comparison of adductor canal block and psoas compartment block combined with sciatic nerve block in laparoscopic knee surgeries

    PubMed Central

    Messeha, Medhat M.

    2016-01-01

    Background: Lumbar plexus block, combined with a sciatic nerve block, is an effective locoregional anesthetic technique for analgesia and anesthesia of the lower extremity. The aim of this study was to compare the clinical results outcome of the adductor canal block versus the psoas compartment block combined with sciatic nerve block using real time ultrasound guidance in patients undergoing elective laparoscopic knee surgeries. Patients and Methods: Ninety patients who were undergoing elective laparoscopic knee surgeries were randomly allocated to receive a sciatic nerve block in addition to lumbar plexus block using either an adductor canal block (ACB) or a posterior psoas compartment approach (PCB) using 25 ml of bupivacine 0.5% with adrenaline 1:400,000 injection over 2-3 minutes while observing the distribution of the local anesthetic in real time. Successful nerve block was defined as a complete loss of pinprick sensation in the region that is supplied by the three nerves along with adequate motor block, 30 minutes after injection. The degree of motor block was evaluated 30 minutes after the block procedure. The results of the present study showed that the real time ultrasound guidance of PCB is more effective than ACB approach. Although the sensory blockade of the femoral nerve achieved equally by both techniques, the LFC and OBT nerves were faster and more effectively blocked with PCB technique. Also PCB group showed significant complete sensory block without need for general anesthesia, significant decrease in the post-operative VAS and significant increase time of first analgesic requirement as compared to the ACB group. Result and Conclusion: The present study demonstrates that blockade of lumber plexus by psoas compartment block is more effective in complete sensory block without general anesthesia supplementation in addition to decrease post-operative analgesic requirement than adductor canal block. PMID:27212766

  6. Comprehensive Assessment of Quality of Life and Psychosocial Adjustment in Patients with Renal Tumors Undergoing Open, Laparoscopic, and Nephron-Sparing Surgery

    PubMed Central

    Parker, Patricia A.; Swartz, Richard; Fellman, Bryan; Urbauer, Diana; Li, Yisheng; Pisters, Louis L.; Rosser, Charles J.; Wood, Christopher G.; Matin, Surena F.

    2013-01-01

    Purpose We prospectively evaluated the general and cancer-specific quality of life (QOL) and psychosocial adjustment of patients with a renal mass who underwent radical versus partial nephrectomy performed by laparoscopic or open approaches. Materials and Methods 172 patients with renal tumors completed questionnaires before surgery and again at 3 weeks, 2, 3, 6, and 12 months post-surgery. We assessed general QOL (SF-36), cancer-specific-QOL (CARES-SF), intrusive thoughts and avoidance behaviors, and fear of recurrence. We used mixed model regression analyses to compare these measures across surgery types over the course of the study and adjusted for tumor size, histology, stage and renal function. Results The physical component score of the SF-36 different significantly by surgery type over time (p = 0.04). Patients who had laparoscopy improved by month 2 whereas those who had open surgery had poorer QOL until month 3. Better cancer-specific QOL was reported in patients undergoing radical versus partial nephrectomy. Age also had significant effects on outcomes. Conclusions We report on one of the most comprehensive patient-reported prospective QOL studies in RCC patients. There were significant differences in QOL and psychosocial adjustment outcomes over the course of one year among patients who had one of four commonly accepted surgical renal procedures, and we show that these outcomes must be evaluated in the context of tumor characteristics, cancer-specific outcomes and renal function. These QOL issues may be important to consider when choosing surgical procedures for patients with renal tumors. PMID:22245327

  7. Effectiveness of Elective Laparoscopic Treatment for Colonic Diverticulitis

    PubMed Central

    Grillone, Gianluca; Frattini, Paolo; De Luca, Antonio; Girardi, Valerio; Scandroglio, Ildo

    2015-01-01

    Background and Objectives: To analyze the short- and long-term outcomes of laparoscopic sigmoid colectomy for the elective treatment of diverticular disease. Methods: A consecutive unselected series of 94 patients undergoing elective laparoscopic sigmoid colectomy for diverticular disease from 2008 to 2012 was analyzed. We collected patients-, surgery- and hospital stay–related data, as well as the short- and long-term outcomes. Operative steps, instrumentation, and postoperative cares were standardized. Comorbidity was assessed by Charlson comorbidity index. Complications were classified using the Clavien-Dindo classification system. The qualitative long-term assessment was carried out by subjecting patients to the validated gastrointestinal quality of life index questionnaire before and after surgery. Results: The mean age of our cohort was 61.3 ± 11.0 years with a Charlson comorbidity index of 1.2 ± 1.5. Mean operative time was 213.5 ± 60.8 minutes and estimated blood loss was 67.2 ± 94.3 mL. We had 3 cases (3.2%) of conversion to open laparotomy. The rates of postoperative complications were 35.1%, 6.3%, 2.1%, and 1.06%, respectively, for grades 1, 2, 3b, and 5 according to the Clavien-Dindo system. Length of hospital stay was 8.1 ± 1.9 days, and we have not recorded readmissions in patients discharged within 60 days after surgery. Median follow-up was of 9.6 ± 2.7 months. We observed no recurrence of diverticular disease, but there was evidence of 3 cases of incisional hernia (3.19%). The difference between preoperative and late gastrointestinal quality of life index score was statistically significant (97.1 ± 5.8 vs 129.6 ± 8.0). Conclusions: Elective laparoscopic treatment of colonic diverticular disease represents an effective option that produces adequate postoperative results and ensures a satisfactory functional outcome. PMID:26005319

  8. 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

  9. Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: A prospective cohort study

    PubMed Central

    Martos-Benítez, Frank Daniel; Gutiérrez-Noyola, Anarelys; Echevarría-Víctores, Adisbel

    2016-01-01

    Objective This study sought to determine the influence of postoperative complications on the clinical outcomes of patients who underwent thoracic and gastrointestinal cancer surgery. Methods A prospective cohort study was conducted regarding 179 consecutive patients who received thorax or digestive tract surgery due to cancer and were admitted to an oncological intensive care unit. The Postoperative Morbidity Survey was used to evaluate the incidence of postoperative complications. The influence of postoperative complications on both mortality and length of hospital stay were also assessed. Results Postoperative complications were found for 54 patients (30.2%); the most common complications were respiratory problems (14.5%), pain (12.9%), cardiovascular problems (11.7%), infectious disease (11.2%), and surgical wounds (10.1%). A multivariate logistic regression found that respiratory complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001), cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009), gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p < 0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p < 0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p < 0.0001) were independently associated with hospital mortality. The occurrence of at least one complication increased the likelihood of remaining hospitalized (log-rank test, p = 0.002). Conclusions Postoperative complications are frequent disorders that are associated with poor clinical outcomes; thus, structural and procedural changes should be implemented to reduce postoperative morbidity and mortality. PMID:27096675

  10. Does adding ICU data to the POSSUM score improve the prediction of outcomes following surgery for upper gastrointestinal malignancies?

    PubMed

    Butterfield, R; Stedman, W; Herod, R; Aneman, A

    2015-07-01

    Surgery for upper gastrointestinal malignancy carries a high postoperative mortality and morbidity risk. The importance of preoperative physiological reserve and intraoperative events in determining clinical outcomes is recognised in the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) score that comprises variables relevant to both phases. Whether adding variables linked to ICU admission characteristics improves the predictive capacity of POSSUM is unclear, especially in an Australian/New Zealand healthcare context. This study aimed to evaluate the predictive capacity of the POSSUM score for 30-day mortality and in-hospital morbidity in 80 patients undergoing resection of oesophageal (28%), gastric (26%) or pancreatic (46%) malignancies and admitted to ICU. The 30-day mortality was 8.8% and 65% of patients developed some postoperative complication. Receiver operating characteristics generated an area under the curve (95% CI) to predict mortality by Portsmouth POSSUM of 0.87 (0.77 to 0.93) and morbidity by POSSUM of 0.67 (0.55 to 0.77). Multiple regression analysis including biochemical variables and vital signs on admission to ICU identified renal function parameters, fluid balance and need for cardiorespiratory support beyond the first postoperative day as independent factors associated with mortality and morbidity (in addition to the POSSUM score) but the inclusion of these variables in a logistic regression model did not significantly improve the predictive capacity for mortality (to area under the curve 0.93 [0.85 to 0.97]) or morbidity (to area under the curve 0.67 [0.55 to 0.78]). In conclusion, the POSSUM score provides clinically useful predictive capacity in patients undergoing surgery for upper gastrointestinal malignancies. The incorporation of ICU admission variables to the pre- and intraoperative POSSUM variables did not significantly enhance the precision. PMID:26099762

  11. Total Laparoscopic Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy.

    PubMed

    King, Cara R; Giles, Dobie

    2016-09-01

    Vaginal hysterectomy has been shown to have the lowest complication rate, better cosmesis, and decreased cost compared with alternate routes of hysterectomy. However, there are times when a vaginal hysterectomy is not feasible and an open abdominal hysterectomy should be avoided. Minimally invasive surgery has evolved over the last several decades; with the improvement in optics and surgical instruments, laparoscopic hysterectomy is becoming increasingly common. A total laparoscopic hysterectomy is possible with proper training, including sound technique in laparoscopic suturing for closure of the vaginal cuff. PMID:27521879

  12. Comparison of perioperative and short-term outcomes between robotic and conventional laparoscopic surgery for colonic cancer: a systematic review and meta-analysis

    PubMed Central

    Lim, Sungwon; Kim, Jin Hee; Baek, Se-Jin; Kim, Seon-Hahn

    2016-01-01

    Purpose Reports from several case series have described the feasibility and safety of robotic surgery (RS) for colonic cancer. Experience is still limited in robotic colonic surgery, and a few meta-analysis has been conducted to integrate the results for colon cancer specifically. We conducted a systematic review of the available evidence comparing the surgical safety and efficacy of RS with that of conventional laparoscopic surgery (CLS) for colonic cancer. Methods We searched English databases (MEDLINE, Embase, and Cochrane Library), and Korean databases (KoreaMed, KMbase, KISS, RISS, and KisTi). Dichotomous variables were pooled using the risk ratio, and continuous variables were pooled using the mean difference (MD). Results The present study found that the RS group had a shorter time to resumption of a regular diet (MD, –0.62 days; 95% CI, –0.97 to –0.28), first passage of flatus (MD, –0.44 days; 95% CI, –0.66 to –0.23) and defecation (MD, –0.62 days; 95% CI, –0.77 to –0.47). Also, RS was associated with a shorter hospital stay (MD, –0.69 days; 95% CI, –1.12 to –0.26), a lower estimated blood loss (MD, –19.49 mL; 95% CI, –27.10 to –11.89) and a longer proximal margin (MD, 2.29 cm; 95% CI, 1.11-3.47). However, RS was associated with a longer surgery time (MD, 51.00 minutes; 95% CI, 39.38–62.62). Conclusion We found that the potential benefits of perioperative and short-term outcomes for RS than for CLS. For a more accurate understanding of RS for colonic cancer patients, robust comparative studies and randomized clinical trials are required. PMID:27274509

  13. Brain Metastases in Gastrointestinal Cancers: Is there a Role for Surgery?

    PubMed Central

    Lemke, Johannes; Scheele, Jan; Kapapa, Thomas; von Karstedt, Silvia; Wirtz, Christian Rainer; Henne-Bruns, Doris; Kornmann, Marko

    2014-01-01

    About 10% of all cancer patients will develop brain metastases during advanced disease progression. Interestingly, the vast majority of brain metastases occur in only three types of cancer: Melanoma, lung and breast cancer. In this review, we focus on summarizing the prognosis and impact of surgical resection of brain metastases originating from gastrointestinal cancers such as esophageal, gastric, pancreatic and colorectal cancer. The incidence of brain metastases is <1% in pancreatic and gastric cancer and <4% in esophageal and colorectal cancer. Overall, prognosis of these patients is very poor with a median survival in the range of only months. Interestingly, a substantial number of patients who had received surgical resection of brain metastases showed prolonged survival. However, it should be taken into account that all these studies were not randomized and it is likely that patients selected for surgical treatment presented with other important prognostic factors such as solitary brain metastases and exclusion of extra-cranial disease. Nevertheless, other reports have demonstrated long-term survival of patients upon resection of brain metastases originating from gastrointestinal cancers. Thus, it appears to be justified to consider aggressive surgical approaches for these patients. PMID:25247579

  14. Laparoscopic sleeve gastrectomy at a new bariatric surgery centre in Canada: 30-day complication rates using the Clavien–Dindo classification

    PubMed Central

    Falk, Vanessa; Twells, Laurie; Gregory, Deborah; Murphy, Raleen; Smith, Chris; Boone, Darrell; Pace, David

    2016-01-01

    Background Newfoundland and Labrador (NL) has the highest rate of obesity in Canada, prompting the establishment of a bariatric surgery program at the Health Sciences Centre in NL. This retrospective study examined 30-day complication rates in more than 200 consecutive patients who underwent laparoscopic sleeve gastrectomy (LSG) between May 2011 and February 2014. Methods We performed a chart review and collected data on 30-day postoperative complications. Complications were graded and reported using the Clavien–Dindo classification. Grades I and II were defined as minor and grades III and higher were defined as major complications. Results We reviewed the charts of the first 209 patients to undergo LSG. The mean body mass index was 49.2, 81% were women and the average age was 43 years. Comorbidities included hypertension (55.0%), obstructive sleep apnea (46.4%), dyslipidemia (42.1%), diabetes (37.3%), osteoarthritis (36.4%) and cardiovascular disease with previous cardiac stents (5.3%). Furthermore, 38.3% of patients reported psychiatric diagnoses, such as depression and anxiety. The overall 30-day complication rate was 15.3%. The complication rate for minor complications was 13.4% and for major complications was 1.9% (2 leaks, 1 stricture and 1 fistula). Conclusion Our results support the feasibility of safely performing LSG surgery at bariatric centres completing fewer than 125 procedures annually. PMID:27007089

  15. Mucoadhesive polymer films for tissue retraction in laparoscopic surgery: Ex-vivo study on their mechanical properties.

    PubMed

    Wang, Zhigang; Tai, Lik-Ren; McLean, Donald; Wright, Emma J; Florence, Gordon J; Brown, Stuart I; Andre, Pascal; Cuschieri, Alfred

    2014-01-01

    Safe and effective manipulation of soft tissue during laparoscopic procedures can be achieved by the use of mucoadhesive polymer films. A series of novel adhesive polymer films were formulated in house based on either Carbopol or Chitosan modified systems. The mechanical properties of the polymers and their adherence to bowel were evaluated using ex-vivo pig bowel immersed in 37°C water bath and connected to an Instron tensiometer. Young's modulus was 300 kPa for the Carbopol-polymer and 5 kPa for the Chitosan-polymer. The Chitosan-polymer exhibited much larger shear adhesion than its tensile adhesion: 3.4 N vs. 1.2. Both tensile and shear adhesions contributed to the large retraction force (2.6 N) obtained during l polymer-bowel retraction testing. Work of adhesion at the polymer/serosa interface, defined as the area under the force curve, was 64 mJ, which is appreciably larger than that reported with existing polymers. In conclusion, adhesive polymers can stick to the serosal side of the bowel with an adhesive force, which is sufficient to lift the bowel, providing a lower retraction stress than that caused by laparoscopic grasping which induces high localized pressures on the tissue. PMID:24211926

  16. Evaluation of postoperative pain scores following ultrasound guided transversus abdominis plane block versus local infiltration following day surgery laparoscopic cholecystectomy-retrospective study

    PubMed Central

    Kadam, Vasanth Rao; Howell, Stuart; Kadam, V.

    2016-01-01

    Background and Aims: Postoperative pain for day surgery laparoscopic cholecystectomy has traditionally been managed with the surgeon infiltrating the wound with local anesthetic (LA). However, transversus abdominis plane (TAP) block has recently been used, although its superiority over LA remains uncertain. The primary aim was to compare LA and TAP block pain scores and analgesia used. The secondary aim was to assess satisfaction score and cost. Material and Methods: This retrospective study was commenced after ethics committee approval and ANZ clinical trial registry (ACTRN: 12612000737831). The data were collected from the theatre database and medical records of patients presenting for day case laparoscopic cholecystectomy. The sample included patients who received either bilateral port site LA infiltration with 20 ml of 0.25% Bupivacaine or bilateral TAP block with 20 ml of 0.5% ropivacaine and fentanyl postoperative pain protocol. The patients with incomplete medical records were excluded as were those admitted to an inpatient ward. Demographics and clinical characteristics were obtained from the hospital record along with pain score and postsurgery analgesia use. Postoperative pain satisfaction scores were collected by telephonic interview 30-180 days postsurgery. Results: Of 51 patients analyzed, 19 were in TAP group 29 in LA group. There were no significant differences between the LA and TAP groups with respect to postoperative pain scores (P = 0.31) or patient satisfaction scores (1 and 2+) (P = 0.36). However, fentanyl consumption in the recovery room was significantly lower in TAP group (P = 0.0079.). The consumables cost were >3 times higher in the TAP when compared to LA group. Conclusion: The performance of the TAP block with respect to pain management was comparable to LA. However, LA remains more cost effective. PMID:27006547

  17. Prospective Evaluation of Genito-Urinary Function after Laparoscopic Rectal Resection in the Elderly.

    PubMed

    Mari, Giulio; Costanzi, Andrea; Galfrascoli, Elisa; Rosato, Andrea; Crippa, Jacopo; Maggioni, Dario

    2016-01-01

    Laparoscopic anterior rectal resection with total mesorectal excision is related to sexual and urinary disorders. Anastomotic leak and neo-adjuvant radiation therapy are effective factors in worsening pelvic function. We report a series of 50 elderly (age 70) patients who underwent laparoscopic total mesorectal excision inquired about pre and post-operative genito-urinary function. Patients were interviewed preoperatively, 1 and 9 months post-operatively with validated questionnaires about sexual and urinary function and quality of life. They also underwent urofluximetric test with ultrasound measurement of the bladder remnant volume. The geriatric assessment was performed with the BARTHEL index. Urinary and sexual function slightly worsened after surgery although not significantly. Mean Gastrointestinal Quality of Life Indicator score decreased significantly from pre operative levels at 1 month from surgery. BARTHEL index did not change significantly across surgery. Maximum urinary flow, mean urinary flow, bladder residual volume worsened after surgery although not significantly. Laparoscopic anterior rectal resection with total mesorectal excision affects the genito-urinary status of elderly patients. Incidence of severe dysfunctions is similar to normal aged population. PMID:27604669

  18. The role of surgery in the multidisciplinary management of patients with localized gastrointestinal stromal tumors.