Sample records for single-port laparoscopic cholecystectomy

  1. Single-port laparoscopic cholecystectomy in situs inversus totalis using the E.K. glove port.

    PubMed

    Khiangte, Elbert; Newme, Iheule; Patowary, Karabi; Phukan, Partha

    2013-10-01

    Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis in patients with situs inversus totalis (SIT). In an effort to reduce morbidity and improve the cosmesis single-port laparoscopic cholecystectomy has recently emerged, where the surgery is done through a single port, typically the patient's navel. This improves the cosmesis, lessens post-operative pain and ensures virtually a "scar less" surgery. We report a case of successful single-port laparoscopic cholecystectomy for a patient with SIT, and describe its technical advantages and review of literature. PMID:24250066

  2. Remains of the day: Biliary complications related to single-port laparoscopic cholecystectomy

    PubMed Central

    Allemann, Pierre; Demartines, Nicolas; Schäfer, Markus

    2014-01-01

    AIM: To assesse the rate of bile duct injuries (BDI) and overall biliary complications during single-port laparoscopic cholecystectomy (SPLC) compared to conventional laparoscopic cholecystectomy (CLC). METHODS: SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery. So far, its safety with respect to bile duct injuries has not been specifically evaluated. A systematic review of the literature published between January 1990 and November 2012 was performed. Randomized controlled trials (RCT) comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included. The quality of RCT was assessed using the Jadad score. Analysis was made by performing a meta-analysis, using Review Manager 5.2. This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A retrospective study including all retrospective reports on SPLC was also performed alongside. RESULTS: From 496 publications, 11 RCT including 898 patients were selected for meta-analysis. No studies were rated as high quality (Jadad score ? 4). Operative indications included benign gallbladder disease operated in an elective setting in all studies, excluding all emergency cases and acute cholecystitis. The median follow-up was 1 mo (range 0.03-18 mo). The incidence of BDI was 0.4% for SPLC and 0% for CLC; the difference was not statistically different (P = 0.36). The incidence of overall biliary complication was 1.6% for SPLC and 0.5% for CLC, the difference did not reached statistically significance (P = 0.21, 95%CI: 0.66-15). Sixty non-randomized trials including 3599 patients were also analysed. The incidence of BDI reported then was 0.7%. CONCLUSION: The safety of SPLC cannot be assumed, based on the current evidence. Hence, this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy. PMID:24574757

  3. [Single-port access cholecystectomy : current status].

    PubMed

    Langwieler, T E; Back, M

    2011-05-01

    Single-port access surgery (SPA), the most recent development in laparoscopic surgery allows operations to be carried out through only a single incision using special multichannel ports. By the use of a smaller access tissue trauma and access-related complications, such as wound infections, adhesions and incisional hernias can be decreased considerably. Because of less postoperative pain earlier mobilization of patients can also be achieved. By placing the access transumbilically, e.g. in SPA cholecystectomy (SPA-CHE), the scar is perfectly covered achieving an optimal cosmetic result. Meanwhile various so-called single ports and camera systems have been developed. Great importance is attached to the development of special (double) bended and/or articulating instruments because with these instrument triangulation is possible through only one incision. Nevertheless the stereoscopic situation in SPA-CHE implicates some factors related to retraction, exposition and release of the gallbladder but some difficult situations can be managed safely with some tips and tricks.Because of the already worldwide spread of SPA-CHE this technique will soon become an established minimally invasive technique. However, appropriate studies confirming the clear advantages of the technique are still lacking. PMID:21455809

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

    PubMed Central

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

    2012-01-01

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

  5. Robotic-assisted laparoscopic cholecystectomy.

    PubMed

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

    2002-01-01

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

  6. [Laparoscopic single port surgery : Is structured training necessary?].

    PubMed

    Krajinovic, K; Germer, C T

    2011-05-01

    As essentially all operations performed with open laparotomy can be completed with minimal access, surgeons and industry continue to push the boundaries of minimally invasive surgery. New and controversial approaches, such as natural orifice translumenal endoscopic surgery (NOTES) and single incision or single port surgery are being explored with the goal of reduced surgical morbidity. The fundamental idea of single port surgery is therefore to minimize the number of abdominal wall incisions and allow access for all laparoscopic instruments through one skin incision. Several techniques in use require specialized equipment with multiple ports through one umbilical incision or one multichannel port. For single port surgery to be widely adopted surgeons must demonstrate safety, efficacy and reproducibility of the technique across a wide range of patients and clinical scenarios. In order to meet these requirements concerns about well-founded surgical training and quality monitoring must be addressed as with any major technical advance. PMID:21560057

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

    PubMed

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

    1994-01-01

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

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

    PubMed

    Hahn, Ho-Suap; Kim, Yong-Wook

    2010-11-01

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

  9. [Technical principles of laparoscopic cholecystectomy].

    PubMed

    Kurdo, S A; Ga?dukov, V N

    1995-01-01

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

  10. Is cirrhosis a contraindication to laparoscopic cholecystectomy?

    PubMed

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

    2015-01-01

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

  11. Laparoscopic cholecystectomy in the pregnant patient.

    PubMed

    Comitalo, J B; Lynch, D

    1994-08-01

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

  12. Laparoscopic Cholecystectomy During Pregnancy: Three Case Reports

    PubMed Central

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

    1999-01-01

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

  13. Laparoscopic cholecystectomy: experience of a single surgeon.

    PubMed

    Soper, N J; Dunnegan, D L

    1993-01-01

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

  14. Single-port laparoscopic appendectomy conducted intracorporeally with the aid of a transabdominal sling suture

    Microsoft Academic Search

    O?uz Ate?; Gülce Hakgüder; Mustafa Olguner; Feza M. Akgür

    2007-01-01

    Background\\/PurposeLaparoscopic appendectomy (LA) is becoming popular for the treatment of acute and perforated appendicitis. Since it was first described, LA has been modified various times. We present the results of a new technique of LA conducted through a single port without exteriorizing the appendix to perform the operation.

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

    PubMed

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

    1992-12-01

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

  16. In vivo kinematic measurement during laparoscopic cholecystectomy

    Microsoft Academic Search

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

    2004-01-01

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

  17. Establishment of a laparoscopic cholecystectomy training program.

    PubMed

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

    1991-04-01

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

  18. Evaluation of Fundus-First Laparoscopic Cholecystectomy

    PubMed Central

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

    2004-01-01

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

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

    PubMed Central

    Turingan, Isidro; Zajkowska, Marta; Tran, Kim

    2014-01-01

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

  20. Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer

    PubMed Central

    Ahn, Sang-Hoon; Son, Sang-Yong; Jung, Do Hyun; Park, Young Suk; Shin, Dong Joon; Park, Do Joong

    2015-01-01

    Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer. PMID:26161287

  1. In vivo kinematic measurement during laparoscopic cholecystectomy

    Microsoft Academic Search

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

    2004-01-01

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

  2. 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

  3. 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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  6. Comparison of Surgical Outcomes according to Suturing Methods in Single Port Access Laparoscopic Myomectomy

    PubMed Central

    Jeong, Jae-Heok; Kim, Yu-Ri; Kim, Eun-Jeong; Moon, Soo-Hyeon; Park, Mi-Hwa; Kim, Jeong-Tae; Kim, Jeong-Hye

    2015-01-01

    Objectives This study was performed to consider the clinical experience of surgical outcome of single port access (SPA) laparoscopic myomectomy according to suturing methods. Methods The authors operated with 2 suturing method in SPA laparoscopic myomectomy for 246 patients and compared the surgical outcomes. Results The some significant difference of surgical outcome according to two suturing methods was demonstrated. Operating time was 100.50 minutes (± 42.09 minutes) in interrupted suture method group than 121.04 minutes (± 61.56 minutes) in continuous interlocking suture method group (P = 0.021). Estimated blood loss was less 222.59 mL (± 144.94 mL) in interrupted suture group than 340.11 mL (± 380.62 mL) in continuous interlocking suture method group (P = 0.042). Conclusion This experience suggests that interrupted suture method was effective for operating time and estimated blood loss than continuous interlocking method in SPA laparoscopic myomectomy.

  7. Subhepatic Sterile Abscess 10 Years After Laparoscopic Cholecystectomy

    PubMed Central

    Bartels, Anne K.; Zamora, Jose Gonzales

    2015-01-01

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

  8. Outcomes of Laparoscopic Cholecystectomy in Octogenarians

    PubMed Central

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

    2012-01-01

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

  9. 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

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

    PubMed Central

    Rehman, H; Ahmed, I

    2011-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  12. Single port laparoscopic repair of paediatric inguinal hernias: Our experience at a secondary care centre

    PubMed Central

    Kumar, Ameet; Ramakrishnan, T S

    2013-01-01

    BACKGROUND: Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS) has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive – from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital. MATERIALS AND METHODS: Prospective review of 37 hernias in 31 children (29 male and 2 female) (8 months - 13 years) performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), complications, and cosmesis. RESULTS: Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8–25) and 20.66 min (17 -27 min) respectively. Only one of the repairs (2.7%) recurred and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries. CONCLUSION: Single port laparoscopic inguinal hernia repair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The advantage of minimal instrumentation and avoidance of intracorporeal knotting makes it a feasible technique for a secondary care centre. PMID:23626413

  13. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    PubMed Central

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

    2013-01-01

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

  14. Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy.

    PubMed

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

    2015-01-01

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

  15. Laparoscopic cholecystectomy for traumatic gallbladder perforation

    PubMed Central

    Hamilton, C; Carmichael, SP; Bernard, AC

    2012-01-01

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

  16. Single incision laparoscopic cholecystectomy: for what benefit?

    PubMed Central

    Tranchart, Hadrien; Ketoff, Serge; Lainas, Panagiotis; Pourcher, Guillaume; Di Giuro, Giuseppe; Tzanis, Dimitrios; Ferretti, Stefano; Dautruche, Antoine; Devaquet, Niaz; Dagher, Ibrahim

    2013-01-01

    Background A single-incision laparoscopic cholecystectomy (SILC) was developed to improve outcomes as compared with the four-port classic laparoscopic cholecystectomy (CLC). Any potential benefits associated with a SILC have been suggested by previous studies reporting few patients with different surgical techniques. The aim of this study was to describe the experience with a standardized SILC as compared with CLC. Methods From June 2010 to January 2012, 40 patients underwent a SILC [median age: 47.5?years (25–92)] and operative and peri-operative data were prospectively collected. Over the same period, 37 patients underwent a CLC. A 10-point visual analogue scale (VAS) was used for qualitative data. The costs of SILC and CLC were also compared. Results For those patients undergoing a SILC the median operating time was 70?min (24–110). There were no conversions. An additional trocar was necessary in 16 patients. Four patients developed post-operative complications. The median immediate post-operative pain score was 5 (0–10). The median quality of life and cosmetic satisfaction at the initial post-operative visit were 10 (6–10) and 10 (5–10), respectively (VAS). Although the surgical results of both groups were similar, post-operative complications were exclusively reported in the SILC group (two incisional hernias). Conclusion Standardization of SILC is possible but associated with an important rate of additional trocar placement and a disturbing rate of incisional hernias. PMID:23659566

  17. Competence Acquisition for Single-Incision Laparoscopic Cholecystectomy

    PubMed Central

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

    2015-01-01

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

  18. Postoperative Care of Patients Undergoing Same-Day Laparoscopic Cholecystectomy.

    PubMed

    Brenner, Patricia; Kautz, Donald D

    2015-07-01

    Elective laparoscopic cholecystectomies are common outpatient surgical procedures. After briefly discussing cholecystectomy and its indications, best practices in phase I, phase II, and phase III recovery are discussed. Typical pharmaceutical regimens for controlling pain and postoperative nausea and vomiting are summarized. By implementing best practices, nurses can prevent and recognize complications. The criteria for discharge, extended recovery, and inpatient admission are discussed, along with the required patient discharge teaching using the teach-back technique, as well as patient and family teaching needs in the immediate postoperative period. Nurses can optimize the patient's surgical experience and promote safety by implementing best practices in all phases of recovery from laparoscopic cholecystectomy. PMID:26119606

  19. Laparoscopic Cholecystectomy and Newer Techniques of Gallbladder Removal

    PubMed Central

    2012-01-01

    Objectives: To describe the surgical complications associated with laparoscopic cholecystectomy, as performed by a single surgeon over an 8-year period and to discuss how this compares to newer methods of cholecystectomy, such as single-incision surgery and natural orifice transluminal endoscopic surgery. Methods: The charts of 1000 consecutive patients who underwent consecutive cholecystectomies were reviewed to gather the following information: age, sex, prior abdominal procedures, type of procedure performed (laparoscopic vs open, with or without cholangiography), pre and postoperative diagnosis, and complications directly related to surgical technique, such as biliary injury, bile leak, infection, trocar-related injury, and incisional hernia. Results: The laparoscopic approach was attempted in all but one patient and was successful in 94.1% of patients. The conversion rate was higher with acute cholecystitis than with other forms of biliary tract disease. Successful cholangiography was accomplished in over 97% of patients. Nineteen complications directly related to the surgical procedure were found, including one bile duct injury. Conclusion: Laparoscopic cholecystectomy continues to offer a safe and effective treatment for patients with symptomatic biliary tract disease. Although other forms of minimally invasive cholecystectomy are being studied, there is little data to suggest any additional benefit, other than a slight improvement in cosmesis. Until larger series demonstrate that these techniques have a complication rate similar to those cited in the surgical literature, traditional 4-port laparoscopic cholecystectomy should remain the standard of care. PMID:23318066

  20. Laparoscopic cholecystectomy in-patient with situs inversus.

    PubMed

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

    2006-03-01

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

  1. Safety and effectiveness of three-port laparoscopic cholecystectomy

    PubMed Central

    Mayir, Burhan; Dogan, Ugur; Koc, Umit; Aslaner, Arif; B?lec?k, Tuna; Ensar?, Cemal Ozben; Cakir, Tugrul; Oruc, Mehmet Tahir

    2014-01-01

    Most commonly performed laparoscopic surgery is laparoscopic cholecystectomy. Although cholecystectomy through three port is not commonly preferred, researches have shown that it is a safe and feasible way of surgery. Material and Methods. We evaluate 100 patient that have undergone elective laparoscopic cholecystectomy through three port (group one). These patients were compared with 50 patients that have undergone laparoscopic cholecystectomy through four port (group two). Complications, lenght of stay in hospital, operation time, conversion to open surgery rate were compared in two group. Results: In group one, fourth port was necessary for nine (9%) patients. Duration of operation in group one was in average 31 min and in group two, 31, 3 min. Operation time, lenght of stay in hospital, complication rate, conversion to open surgery rate was similar in both groups. Conclusion: Three port laparoscopic cholecystectomy is a safer method when performed by experienced surgeons. Laparoscopic cholecyctectomy can be tried through three ports firstly and can be continued with addition of fourth port if necessary. PMID:25232432

  2. Laparoscopic cholecystectomy: technique, safety, and results

    NASA Astrophysics Data System (ADS)

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

    1994-12-01

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

  3. Selection criteria for laparoscopic cholecystectomy in an ambulatory care setting

    Microsoft Academic Search

    C. R. Voyles; B. R. Berch

    1997-01-01

    Background: The ambulatory care center offers patient convenience and reduced costs after uneventful laparoscopic cholecystectomy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: A prospectively accumulated database of 1,750 cholecystectomies performed by one surgeon in a hospital setting was analyzed\\u000a to test criteria for ambulatory cholecystectomy. Proposed criteria included age less than 65, absence of upper abdominal operations,\\u000a and elective operations in healthy patients at low risk

  4. Clostridial gas gangrene of the abdominal wall after laparoscopic cholecystectomy.

    PubMed

    Samel, S; Post, S; Martell, J; Becker, H

    1997-08-01

    Laparoscopic cholecystectomy is associated with a considerable rate of infectious complications of up to 2.8%. Such infections are usually of minor clinical importance. However, we observed a case of life-threatening Clostridial gas gangrene centering around the right lateral port site and developing across all of the right-sided abdominal wall, causing septic shock and severe multi-organ failure. Considering the overall infection rate and the possibility of even severe morbidity, we advocate perioperative antibiotics in laparoscopic cholecystectomy. PMID:9448120

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

    Microsoft Academic Search

    A.-Hon Kwon; Hiroyuki Inui; Yasuo Kamiyama

    2001-01-01

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

  6. Fate of lost gallstones during laparoscopic cholecystectomy

    PubMed Central

    Kwon, Jungnam

    2013-01-01

    Backgrounds/Aims The fate of gallstones that remain in the peritoneal cavity due to perforation of the gallbladder during laparoscopic cholecystectomy (LC) has been studied vigilantly since the early 1990s when this surgical procedure started to be used. But the complication statistics vary with each report. So we reviewed our 47 cases of lost stones that were traceable from 1998 to 2007. Methods Stones entered the peritoneal cavity through the perforation site during dissection of the body or Hartmann's pouch of gallbladder from the liver bed, despite trials of stone removal like irrigation and using a glove finger pouch especially in the case of numerous small stones. There were nine cases of lost stones that were caused by fragments of stone breaking from a large stone during its retrieval. Results No patient was forced into revision surgery or intervention for the missing stones but only negative suction drains were inserted, and information to the patients was given. Most of the stones (N=42, 89.4%) remained silent during the follow-up period of 10.4±3.6 years, and 5 patients (10.6%) developed inflammatory complications in the peritoneal cavity and abdominal wall. Two intraperitoneal abscesses were found in the right subhepatic area and a cul-de-sac and these were managed by laparotomy. Subhepatic abscess was later associated with intestinal obstruction. Two patients suffered an umbilical portal site fistula and a right flank portal fistula respectively, requiring prolonged wound care. One patient suffered immediate postoperative peritonitis that was cured by antibiotics. Conclusions Lost stones should be retrieved or fragmented as much as possible for removal through a drain, and caution should be exercised during dissection of the gallbladder to avoid perforating the gallbladder. Considering the approximately 10% incidence of serious inflammatory complications of lost stones, the complications should be explained to patients to allow for earlier diagnosis of complications later.

  7. Laparoscopic cholecystectomy in situs inversus totalis: a case report

    Microsoft Academic Search

    Damian McKay; Geoffrey Blake

    2005-01-01

    BACKGROUND: Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world today. Occasionally patients present with undiagnosed situs inversus and acute cholecystitis. We discuss one such case and outline how the diagnosis was made and the pitfalls encountered during surgery and how they were overcome. CASE PRESENTATION: A 32 year old female presented to our department

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

    PubMed Central

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

    2004-01-01

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

  9. Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy

    Microsoft Academic Search

    Rafael F. Perini; Renan Uflacker; John T. Cunningham; J. Bayne Selby; David Adams

    2005-01-01

    Purpose: Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-upafter treatment by a

  10. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy

    PubMed Central

    Vivek, Mittalgodu Anantha Krishna Murthy; Augustine, Alfred Joseph; Rao, Ranjith

    2014-01-01

    CONTEXT: Laparoscopic cholecystectomy (LC) is the gold standard cholecystectomy. LC is the most common difficult laparoscopic surgery performed by surgeons today. The factors leading to difficult laparoscopic cholecystectomy can be predicted. AIMS: To develop a scoring method that predicts difficult laparoscopic cholecystectomy. SETTINGS AND DESIGN: Bidirectional prospective study in a medical college setup. MATERIALS AND METHODS: Following approval from the institutional ethical committee, cases from the three associated hospitals in a medical college setup, were collected using a detailed proforma stating the parameters of difficulty in laparoscopic cholecystectomy. Study period was between May 10 and June 12. Preoperative, sonographic and intraoperative criteria were considered. STATISTICAL ANALYSIS USED: Chi Square test and Receiver Operater Curve (ROC) analysis. RESULTS: Total 323 patients were included. On analysis, elderly patients, males, recurrent cholecystitis, obese patients, previous surgery, patients who needed preoperative Endoscopic retrograde cholangiopancreatography (ERCP), abnormal serum hepatic and pancreatic enzyme profiles, distended or contracted gall bladder, intra-peritoneal adhesions, structural anomalies or distortions and the presence of a cirrhotic liver on ultrasonography (USG) were identified as predictors of difficult LC. A scoring system tested against the same sample proved to be effective. A ROC analysis was done with area under receiver operator curve of 0.956. A score above 9 was considered difficult with sensitivity of 85% and specificity of 97.8%. CONCLUSIONS: This study demonstrates that a scoring system predicting the difficulty in LC is feasible. There is scope for further refinement to make the same less cumbersome and easier to handle. Further studies are warranted in this direction. PMID:24761077

  11. The outcomes of SILS cholecystectomy in comparison with classic four-trocar laparoscopic cholecystectomy

    PubMed Central

    Pesta, Wies?aw; Kowalczyk, Marek; G?owacki, Leszek; Ju?kiewicz, Wit; Szynkarczuk, Rafa?; Snarska, Jadwiga; Stanowski, Edward

    2012-01-01

    Introduction General approval of laparoscopy as well as persistent urge to minimize operative trauma with still existing difficulties in putting natural orifice transluminal endoscopic surgery (NOTES) into practice have contributed to the introduction of laparoscopic operations through one incision in the umbilicus named single incision laparoscopic surgery (SILS). Aim The main aim of this study was to assess the benefits to patients of applying SILS cholecystectomy as a method of gallbladder removal based on the comparison with classic four-port laparoscopic cholecystectomy. Material and methods Between 18.03.2009 and 09.12.2009, 100 patients were included in the study and they underwent elective gallbladder removal by applying the laparoscopic technique. All patients were divided into two equal groups: qualified for SILS cholecystectomy (group I) and qualified for classic four-trocar laparoscopic cholecystectomy (group II), whose ASA physical status was I and II. BMI was limited to 35 kg/m2. Outcome measures included operative time, intensity of postoperative pain and consumption of painkillers, hospital stay, need for conversion, complications, and cosmetic effects. Results Mean operating time in group I was 66 min and in group II 47.2 min. Intensity of pain evaluated by using the visual analogue scale (VAS) 6 h after the operation in group I was 3.49 and in group II 4.53, whereas 24 h after the operation in group I it was 1.18 and in group II 1.55. The painkiller requirement in group I was smaller than in group II. Mean hospital stay after the operation in group I was 1.33 days and in group II 1.96 days. There were 4 conversions in group I and one conversion in group II. Among the complications in group I there were noted 2 cases of right pneumothorax, 1 case of choleperitonitis and 4 complications connected with wound healing. There was one injury of the duodenum and one wound infection in group II. Conclusions Single-incision laparoscopic surgery cholecystectomy can be an alternative to classic laparoscopic cholecystectomy, especially with reference to young people with body mass index less than 35 kg/m2, without serious systemic diseases, operated on electively due to benign gallbladder diseases. PMID:23362429

  12. Seeding from early stage gallbladder carcinoma after laparoscopic cholecystectomy.

    PubMed

    Napolitano, L; Artese, L; Innocenti, P

    2001-01-01

    In the last years laparoscopic cholecystectomy has become the "gold standard therapy" in the treatment of symptomatic cholelitiasis, but it is necessary to keep into account some problems and risks that can arise from laparoscopic technique. One of these risks is represented surely by the disregarding of a gallbladder carcinoma. The authors report a case of peritoneal seeding of an unsuspected gallbladder carcinoma following laparoscopic cholecystectomy. The first histologic diagnosis was chronic ulcerous cholecystitis with adenomiosis but 2 months later the metastasis developed at the umbilical port site, at another port site and to the right lobe of the liver. Another histological sampling of the gallbladder specimen was performed and this time a little intra mucous gallbladder adenocarcinoma was found (T1 stage). While the most part of literature data concern advanced stage of the disease at the time of operation (T2, T3) only few reports regard early stage neoplasm. Therefore this risk is present not only in advanced stages of gallbladder carcinoma but even in cases of early stage cancers. After a laparoscopic cholecystectomy all specimen should be opened and inspected. If there is a gallbladder wall irregularity and if there was a bile spillage it is advisable to perform a preoperative histologic examination. PMID:12061225

  13. [Gasless laparoscopic cholecystectomy using retractor of the abdominal wall].

    PubMed

    D'Urbano, C; Fuertes Guiro, F; Sampietro, R

    1996-03-01

    The Authors present a new gasless laparoscopic cholecystectomy method using an abdominal wall elevator with subcutaneous traction ("laparotenser"). Fifty patients between May 1994 and March 1995 were operated by videolaparoscopy using this new gasless method. Twenty of them were operated with Nagai's method while the laparotenser was used in the remaining thirty. The results obtained are similar to those using pneumoperitoneum. It has been observed a global reduction of costs, less postoperative pain, no influence in cardiovascular and metabolic indexes. No complications were reported during the postoperative period but two cases of conversion to laparotomy not related to the method used were needed. Laparoscopic cholecystectomy without pneumoperitoneum using the subcutaneous elevator of the abdominal wall ("laparotenser") has demonstrated that it's possible to operate in a working space similar to that created by the pneumoperitoneum. After an initial period of distrust towards the laparoscopic methods without pneumoperitoneum it has been accepted that gasless methods multiply the indications to minimally invasive surgery in patients with cardiorespiratory problems considered no ideal candidates to laparoscopic cholecystectomy with pneumoperitoneum. PMID:8679422

  14. Use of CO2 laser flexible waveguides during laparoscopic cholecystectomy

    NASA Astrophysics Data System (ADS)

    Lanzafame, Raymond J.

    1992-06-01

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

  15. Laparoscopic cholecystectomy for a left-sided gallbladder.

    PubMed

    Iskandar, Mazen E; Radzio, Agnes; Krikhely, Merab; Leitman, I Michael

    2013-09-21

    Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe. PMID:24124340

  16. Laparoscopic cholecystectomy for a left-sided gallbladder

    PubMed Central

    Iskandar, Mazen E; Radzio, Agnes; Krikhely, Merab; Leitman, I Michael

    2013-01-01

    Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe. PMID:24124340

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

    PubMed

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

    1998-01-01

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

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

    PubMed Central

    Baik, Seung Min; Hong, Kyung Sook

    2013-01-01

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

  19. Utility of fluorescent cholangiography during laparoscopic cholecystectomy: A systematic review

    PubMed Central

    Pesce, Antonio; Piccolo, Gaetano; La Greca, Gaetano; Puleo, Stefano

    2015-01-01

    AIM: To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system. METHODS: MEDLINE and PubMed searches were performed using the key words “fluorescent cholangiography”, “fluorescent angiography”, “intraoperative fluorescent imaging”, and “laparoscopic cholecystectomy” in order to identify relevant articles published in English, French, German, and Italian during the years of 2009 to 2014. Reference lists from the articles were reviewed to identify additional pertinent articles. For studies published in languages other than those mentioned above, all available information was collected from their English abstracts. Retrieved manuscripts (case reports, reviews, and abstracts) concerning the application of fluorescent cholangiography were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. In contrast to classic meta-analyses, statistical analysis was performed where the outcome was calculated as the percentages of an event (without comparison) in pseudo-cohorts of observed patients. RESULTS: A total of 16 studies were found that involved fluorescent cholangiography during standard laparoscopic cholecystectomies (n = 11), single-incision robotic cholecystectomies (n = 3), multiport robotic cholecystectomy (n = 1), and single-incision laparoscopic cholecystectomy (n = 1). Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of important biliary anatomy and could facilitate the prevention of bile duct injuries. The structures effectively identified before dissection of Calot’s triangle included the cystic duct (CD), the common hepatic duct (CHD), the common bile duct (CBD), and the CD-CHD junction. A review of the literature revealed that the frequencies of detection of the extrahepatic biliary system ranged from 71.4% to 100% for the CD, 33.3% to 100% for the CHD, 50% to 100% for the CBD, and 25% to 100% for the CD-CHD junction. However, the frequency of visualization of the CD and the CBD were reduced in patients with a body mass index > 35 kg/m2 relative to those with a body mass index < 35 kg/m2 (91.0% and 64.0% vs 92.3% and 71.8%, respectively). CONCLUSION: Fluorescent cholangiography is a safe procedure enabling real-time visualization of bile duct anatomy and may become standard practice to prevent bile duct injury during laparoscopic cholecystectomy. PMID:26167088

  20. Imaging of the common bile duct in patients undergoing laparoscopic cholecystectomy

    Microsoft Academic Search

    P J Hainsworth; M Rhodes; R H Gompertz; C P Armstrong; T W Lennard

    1994-01-01

    Options for managing the common bile duct during laparoscopic cholecystectomy include routine peroperative cholangiography and selected preoperative endoscopic retrograde cholangiopancreatography (ERCP). The use of these methods was reviewed in 350 patients with symptomatic gall stones referred for laparoscopic cholecystectomy. Unit A (n = 114) performed routine cystic duct cholangiography but undertook preoperative ERCP in patients at very high risk of

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  3. Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis.

    PubMed Central

    Shea, J A; Healey, M J; Berlin, J A; Clarke, J R; Malet, P F; Staroscik, R N; Schwartz, J S; Williams, S V

    1996-01-01

    OBJECTIVE: The purpose of this study was to perform a meta-analysis of large laparoscopic cholecystectomy case-series and compare results concerning complications, particularly bile duct injury, to those reported in open cholecystectomy case-series. SUMMARY BACKGROUND DATA: Since the introduction of laparoscopic cholecystectomy in the United States, hundreds of reports about the technique have been published, many including statements about the advantages of laparoscopic cholecystectomy compared with those of open cholecystectomy. There is an unevenness in scope and quality of the studies. Nevertheless, enough data have accumulated from large series to permit analyses of data regarding some of the most important issues. METHODS: Articles identified via a MEDLINE (the National Library of Medicine's computerized database) search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes of cholecystectomy were abstracted and summarized across studies. RESULTS: Outcomes of laparoscopic cholecystectomy are examined for 78,747 patients reported on in 98 studies and compared with outcomes of open cholecystectomy for 12,973 patients reported on in 28 studies. Laparoscopic cholecystectomy appears to have a higher common bile duct injury rate and a lower mortality rate. Estimated rates of other types of complications after laparoscopic cholecystectomy generally were low. Most conversions followed operative discoveries (e.g., dense adhesions) and were not the result of injury. CONCLUSIONS: There is wide variability in the amount and type of data reported within any single study, and patient populations may not be comparable across studies. Except for a higher common bile duct injury rate, laparoscopic cholecystectomy appears to be at least as safe a procedure as that of open cholecystectomy. PMID:8916876

  4. Long-term pain: less common after laparoscopic than open cholecystectomy.

    PubMed

    Stiff, G; Rhodes, M; Kelly, A; Telford, K; Armstrong, C P; Rees, B I

    1994-09-01

    Persistent symptoms after cholecystectomy are common, occurring in up to 40 per cent of patients. Severe pain persists in 10 per cent of cases. A total of 450 patients were studied, 200 after open cholecystectomy and 250 after the laparoscopic operation. Patient notes were reviewed and a postal questionnaire was circulated. Responses were obtained from 155 patients (77.5 per cent) undergoing open cholecystectomy and 205 (82.0 per cent) having the laparoscopic operation. Mean (s.d.) follow-up was 32(23) months after open cholecystectomy and 15(7) months after the laparoscopic procedure. Right upper quadrant pain was more common after open cholecystectomy (9.7 versus 3.4 per cent, P < 0.05). Indigestion and heartburn were equally prevalent in the two groups. Some 59.4 per cent of patients were free from symptoms after open cholecystectomy compared with 63.4 per cent following the laparoscopic operation; there was symptomatic improvement in 30.3 and 31.7 per cent respectively. Symptoms were the same or worse in 10.3 per cent of patients after open cholecystectomy compared with 4.9 per cent after the laparoscopic operation (P < 0.05). Patients report significantly less right upper quadrant pain after laparoscopic than after open cholecystectomy. PMID:7953418

  5. Laparoscopic cholecystectomy for left sided gallbladder in situs inversus totalis.

    PubMed

    Butt, Muhammad Qasim; Chatha, Sohail Saqib; Ghumman, Adeel Qamar; Rasheed, Asif; Farooq, Mahwish; Ahmed, Javed

    2015-04-01

    Situs inversus totalisis a rare condition affecting intra abdominal and intra thoracic organs. Situs inversususually remains asymptomatic. Life expectancy is normal in the absence of rare cardiac abnormalities. Left sided gallbladder can occur even without situs inversus totalis.Cholelithiasis is not more common in patients with situs inversusthan the general population. However, these patients may pose a diagnostic difficulty. An ultrasound scan can confirm the presence of gallstones and the left-sided gallbladder. Here we present the case of a 40-year female with this diagnosis who was diagnosed on abdominal scanning and underwent laparoscopic cholecystectomy for left sided cholelithiasis. PMID:25933453

  6. Antibiotic Prophylaxis in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

    PubMed Central

    Matsui, Yoichi; Satoi, Sohei; Kaibori, Masaki; Toyokawa, Hideyoshi; Yanagimoto, Hiroaki; Matsui, Kosuke; Ishizaki, Morihiko; Kwon, A-Hon

    2014-01-01

    Background Recent meta-analyses concluded that antibiotic prophylaxis is not warranted in low-risk laparoscopic cholecystectomy. However, most trials in the meta-analyses had a relatively small sample size and were statistically underpowered. In addition, many of the trials mentioned potential cost savings owing to the elimination of prophylactic antibiotics. However, no trial has statistically estimated the cost effectiveness. To evaluate the results of meta-analyses, we conducted a randomized controlled trial on the role of prophylactic antibiotics in low-risk laparoscopic cholecystectomy with an adequate sample size. Methods From March 2007 to May 2013, at the Department of Surgery, Kansai Medical University, patients who were scheduled for elective laparoscopic cholecystectomy were randomly assigned to one of two arms: those who were and were not administered prophylactic antibiotics. The primary endpoint was the occurrence of postoperative infections and secondary endpoints were postoperative hospital stay and medical costs. Findings During the study period, 518 patients were assigned to the Antibiotics group and 519 to the No antibiotics group. Occurrences of surgical site infections, distant infections and overall infections were significantly lower in the Antibiotics group than in the No antibiotics group (0.8 vs. 3.7%, p?=?0.001, OR: 0.205 (95%CI: 0.069 to 0.606); 0.4 vs. 3.1%, p?=?0.0004, OR: 0.122 (95%CI: 0.028 to 0.533); 1.2 vs. 6.7%; p<0.0001, OR: 0.162 (95%CI: 0.068 to 0.389), respectively). The postoperative hospital stay was significantly shorter in the Antibiotics group (mean, SD: 3.69±1.56 vs. 4.07±3.00; p?=?0.01) and the postoperative medical costs were significantly lower in the Antibiotics group (mean, SD: $766±341 vs. 832±670; p?=?0.047). Multivariable analysis showed that independent risk factors for postoperative infectious complications were no prophylactic antibiotics (p<0.0001) and age 65 or older (p?=?0.006). Conclusions Perioperative administration of prophylactic antibiotics should be recommended in laparoscopic cholecystectomy to prevent postoperative infectious complications and to reduce medical costs. Trial Registration UMIN Clinical Trials Registry UMIN000003749. PMID:25192389

  7. Laparoscopic Cholecystectomy and Appendectomy in Situs Inversus Totalis

    PubMed Central

    Djohan, Risal S.; Rodriguez, Heron E.; Wiesman, Irvin M.; Unti, James A.

    2000-01-01

    Situs inversus totalis is an uncommon anatomic anomaly that complicates diagnosis and management of acute abdominal pain. Expedient diagnosis of common intraperitoneal disease processes such as biliary colic, acute appendicitis and diverticulitis is often delayed as a result of seemingly incongruous physical findings. We present the case of a young woman with prior emergency room visits for complaints of a vague left upper quadrant abdominal pain. An ultrasound performed on her third presentation revealed visceral situs inversus with cholelithiasis and dilated intra- and extrahepatic biliary ducts. Standard laparoscopic cholecystectomy and cholangiography with a mirror-image surgical approach was performed successfully and without complication. PMID:10987405

  8. Fluorescent imaging of the biliary tract during laparoscopic cholecystectomy

    PubMed Central

    2014-01-01

    The introduction of laparoscopic cholecystectomy was associated with increased incidences of bile duct injury. The primary cause appears to be misidentification of the biliary anatomy. Routine intra-operative cholangiography has been recommended to reduce accidental duct injury, although in practice it is more often reserved for selected cases. There has been interest in the use of fluorescent agents excreted via the biliary system to enable real-time intra-operative imaging, to aid the laparoscopic surgeon in correctly interpreting the anatomy. The primary aim of this review is to evaluate the ability of fluorescent cholangiography to identify important biliary anatomy intra-operatively. Secondary aims are to investigate its ability to detect important intra-operative pathology such as bile leaks, identify potential alternative fluorophores, and evaluate the evidence regarding patient outcomes. PMID:25317203

  9. Outpatient laparoscopic cholecystectomy: clinical pathway implementation is efficient and cost effective and increases hospital bed capacity

    Microsoft Academic Search

    B. Topal; G. Peeters; A. Verbert; F. Penninckx

    2007-01-01

    Background  Outpatient laparoscopic cholecystectomy (OLC) may decrease the use of hospital resources and save costs. In the current study,\\u000a the effect of implementing a clinical pathway has been assessed in terms of outcome for patients scheduled to undergo laparoscopic\\u000a cholecystectomy, hospital costs, and available bed capacity.\\u000a \\u000a \\u000a \\u000a Methods  Clinical outcome and hospital stay were analyzed for consecutive patients scheduled to undergo laparoscopic cholecystectomy

  10. Elective Cholecystectomy During Laparoscopic Roux-En-Y Gastric Bypass: Is it Worth the Wait?

    Microsoft Academic Search

    Giselle G. Hamad; Sayeed Ikramuddin; William F. Gourash; Philip R. Schauer

    2003-01-01

    Background: Combined gastric bypass and cholecystectomy have been advocated for open bariatric procedures. Our goal was to\\u000a evaluate the safety of this technique in laparoscopic bariatric surgery patients with gallstones diagnosed preoperatively.\\u000a Methods: 94 out of 556 consecutive morbidly obese patients (16.9%) underwent laparoscopic gastric bypass with simultaneous\\u000a cholecystectomy (LGBP\\/LC) for cholelithiasis. Results: 328 patients (59%) had a concomitant secondary

  11. Outcome of 49 repairs of bile duct injuries after laparoscopic cholecystectomy

    Microsoft Academic Search

    Francois P. G. Schol; Peter M. N. Y. H. Go; Dirk J. Gouma

    1995-01-01

    Treatment of bile duct injuries after laparoscopic cholecystectomy is still under discussion. The aim of this study was to evaluate the results of end-to-end or biliodigestive anastomosis for various types of bile duct injury. Patient charts of 49 (0.81%) classified bile duct injuries from a national survey of 6076 laparoscopic cholecystectomies in The Netherlands were analyzed. The median follow-up after

  12. Primary Amyloidosis Manifesting as Cholestatic Jaundice after Laparoscopic Cholecystectomy

    PubMed Central

    Misiakos, Evangelos P.; Bagias, George; Tiniakos, Dina; Roditis, Konstantinos; Zavras, Nick; Papanikolaou, Ioannis; Tsirigotis, Panagiotis; Liakakos, Theodore; Machairas, Anastasios

    2015-01-01

    A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ~6?mg/dL) three months later. An ERCP was performed, in which a gallstone was found, followed by a sphincterotomy and cleansing of the bile duct. Due to deterioration of jaundice (>25?mg/dL), a new, unsuccessful ERCP and stent placement was carried out. Because of ongoing cardiac failure, she underwent an echocardiogram which revealed restrictive cardiomyopathy possibly due to amyloidosis. A liver biopsy was performed, which was positive for amyloid deposits in the liver, and the diagnosis was confirmed by the detection of monoclonal ? IgG protein in urine. The patient's jaundice gradually deteriorated and she died one week later from hepatic insufficiency. PMID:26137342

  13. Effects of laparoscopic cholecystectomy on lung function: A systematic review

    PubMed Central

    Bablekos, George D; Michaelides, Stylianos A; Analitis, Antonis; Charalabopoulos, Konstantinos A

    2014-01-01

    AIM: To present and integrate findings of studies investigating the effects of laparoscopic cholecystectomy on various aspects of lung function. METHODS: We extensively reviewed literature of the past 24 years concerning the effects of laparoscopic cholecystectomy in comparison to the open procedure on many aspects of lung function including spirometric values, arterial blood gases, respiratory muscle performance and aspects of breathing control, by critically analyzing physiopathologic interpretations and clinically important conclusions. A total of thirty-four articles were used to extract information for the meta-analysis concerning the impact of the laparoscopic procedure on lung function and respiratory physiopathology. The quality of the literature reviewed was evaluated by the number of their citations and the total impact factor of the corresponding journals. A fixed and random effect meta-analysis was used to estimate the pooled standardized mean difference of studied parameters for laparoscopic (LC) and open (OC) procedures. A crude comparison of the two methods using all available information was performed testing the postoperative values expressed as percentages of the preoperative ones using the Mann-Whitney two-sample test. RESULTS: Most of the relevant studies have investigated and compared changes in spirometric parameters.The median percentage and interquartile range (IQR) of preoperative values in forced vital capacity (FVC), forced expiratory volume in 1 s and forced expiratory flow (FEF) at 25%-75% of FVC (FEF25%-75%) expressed as percentage of their preoperative values 24 h after LC and OC were respectively as follows: [77.6 (73.0, 80.0) L vs 55.4 (50.0, 64.0) L, P < 0.001; 76.0 (72.3, 81.0) L vs 52.5 (50.0, 56.7) L, P < 0.001; and 78.8 (68.8, 80.9) L/s vs 60.0 (36.1, 66.1) L/s, P = 0.005]. Concerning arterial blood gases, partial pressure of oxygen [PaO2 (kPa)] at 24 or 48 h after surgical treatment showed reductions that were significantly greater in OC compared with LC [LC median 1.0, IQR (0.6, 1.3); OC median 2.4, IQR (1.2, 2.6), P = 0.019]. Fewer studies have investigated the effect of LC on respiratory muscle performance showing less impact of this surgical method on maximal respiratory pressures (P < 0.01); and changes in the control of breathing after LC evidenced by increase in mean inspiratory impedance (P < 0.001) and minimal reduction of duty cycle (P = 0.01) compared with preoperative data. CONCLUSION: Laparoscopic cholecystectomy seems to be associated with less postoperative derangement of lung function compared to the open procedure. PMID:25516676

  14. Acute Cholangitis following Intraductal Migration of Surgical Clips 10 Years after Laparoscopic Cholecystectomy.

    PubMed

    Cookson, Natalie E; Mirnezami, Reza; Ziprin, Paul

    2015-01-01

    Background. Laparoscopic cholecystectomy represents the gold standard approach for treatment of symptomatic gallstones. Surgery-associated complications include bleeding, bile duct injury, and retained stones. Migration of surgical clips after cholecystectomy is a rare complication and may result in gallstone formation "clip cholelithiasis". Case Report. We report a case of a 55-year-old female patient who presented with right upper quadrant pain and severe sepsis having undergone an uncomplicated laparoscopic cholecystectomy 10 years earlier. Computed tomography (CT) imaging revealed hyperdense material in the common bile duct (CBD) compatible with retained calculus. Endoscopic retrograde cholangiopancreatography (ERCP) revealed appearances in keeping with a migrated surgical clip within the CBD. Balloon trawl successfully extracted this, alleviating the patient's jaundice and sepsis. Conclusion. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy which may lead to choledocholithiasis. Appropriate management requires timely identification and ERCP. PMID:25874138

  15. Laparoscopic drainage of abdominal wall abscess from spilled stones post-cholecystectomy

    PubMed Central

    Chong, Vincent; Ram, Rishi

    2015-01-01

    We present a case on abdominal wall abscess from spilled stones post-cholecystectomy and describe laparoscopic drainage as our choice of management. Mr M is a 75-year-old male who presented on multiple occasions to the hospital with right upper quadrant pain and fever post-laparoscopic cholecystectomy. He also required multiple courses of antibiotics. Subsequent computed tomography and magnetic resonance imaging scan confirmed a number of retained stone with signs of chronic inflammation. Hence, 6 months after his initial laparoscopic cholecystectomy, he proceeded to an exploratory laparoscopy. We found an abscess cavity measuring 3 × 4 cm over the anterior abdominal wall. The cavity was de-roofed, drained and washed out. The tissue culture grew Klebsiella pneumoniae. Laparoscopic approach is optimal as the abscess cavity can be clearly identified, stones visualized and removed under direct vision. Patient does not require a laparotomy. PMID:26183574

  16. Acetic Acid Sclerotherapy for Treatment of a Bile Leak from an Isolated Bile Duct After Laparoscopic Cholecystectomy

    SciTech Connect

    Choi, Gibok, E-mail: choigibok@yahoo.co.kr; Eun, Choong Ki, E-mail: ilovegod@chollian.net [Inje University, Department of Radiology, Haeundae Paik Hospital, College of Medicine (Korea, Republic of); Choi, HyunWook, E-mail: gdkid92@daum.net [Maryknoll Medical Center, Department of Radiology (Korea, Republic of)

    2011-02-15

    Bile leak after laparoscopic cholecystectomy is not uncommon, and it mainly occurs from the cystic duct stump and can be easily treated by endoscopic techniques. However, treatment for leakage from an isolated bile duct can be troublesome. We report a successful case of acetic acid sclerotherapy for bile leak from an isolated bile duct after laparoscopic cholecystectomy.

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

    PubMed Central

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

    2015-01-01

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

  18. Laparoscopic nephroureterectomy with transvesical single-port distal ureter and bladder cuff dissection: points of technique and initial surgical outcomes with five patients

    PubMed Central

    Markuszewski, Marcin; K??cz, Jakub; Sieczkowski, Marcin; Po?om, Wojciech; Piaskowski, Wojciech; Krajka, Kazimierz; Matuszewski, Marcin

    2014-01-01

    Although a variety of techniques have been used to manage the distal ureter during laparoscopic radical nephroureterectomy (LNU), a consensus has not yet been established. Recently, some authors have used a single-port transvesical approach to excise the distal ureter and bladder cuff following LNU. The aim of the study was to present our initial experience in „en bloc” dissection of the distal ureter and bladder cuff during LNU, using a transvesical single-port approach (T-LESS) and standard laparoscopic instruments. From April to October 2012, 5 patients aged 45 to 73 years with upper urinary tract urothelial tumors were subjected to LNU/T-LESS. After a standard LNU was performed, a TriPort+® device was introduced into the bladder and the pneumovesicum was established. A bladder cuff with a distal ureter was dissected and put in the paravesical tissue. The bladder wall defect was closed with the V-loc® 3/0 suture. The LNU was then completed in the flank position. All procedures were completed successfully. No significant blood loss or complications were observed. The mean operative time was 250 min (range: 200–370) for a total procedure and 59 min (range: 42–80) for the T-LESS stage. The postoperative hospital stay was 5.2 days (range: 4–9). Pathologic examination revealed no positive margin in any of the cases. The LNU/T-LESS approach is an efficient and safe procedure. A well-visualized dissection of the distal ureter, closing the defect of the bladder, the use of standard laparoscopic instruments and a good cosmesis are advantages of the method. PMID:25097698

  19. Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia

    PubMed Central

    Sumer, Fatih; Kayaalp, Cuneyt; Yagci, Mehmet Ali; Otan, Emrah; Kocaaslan, Huseyin

    2014-01-01

    This study reports a 69-year-old, obese, female patient presenting with a biliary leakage after laparoscopic cholecystectomy for cholelithiasis. Closure of the umbilical trocar site had been neglected during the laparoscopic cholecystectomy. Early, on postoperative day five, endoscopic retrograde cholangiopancreatography (ERCP) requirement after laparoscopic cholecystectomy resolved the biliary leakage problem but resulted with a more complicated clinical picture with an intestinal obstruction and severe abdominal pain. Computed tomography revealed a strangulated hernia from the umbilical trocar site. Increased abdominal pressure during ERCP had strained the weak umbilical trocar site. Emergency surgical intervention through the umbilicus revealed an ischemic small bowel segment which was treated with resection and anastomosis. This report demonstrates that negligence of trocar site closure can result in very early herniation, particularly if an endoscopic intervention is required in the early postoperative period. PMID:25400872

  20. Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia.

    PubMed

    Sumer, Fatih; Kayaalp, Cuneyt; Yagci, Mehmet Ali; Otan, Emrah; Kocaaslan, Huseyin

    2014-11-16

    This study reports a 69-year-old, obese, female patient presenting with a biliary leakage after laparoscopic cholecystectomy for cholelithiasis. Closure of the umbilical trocar site had been neglected during the laparoscopic cholecystectomy. Early, on postoperative day five, endoscopic retrograde cholangiopancreatography (ERCP) requirement after laparoscopic cholecystectomy resolved the biliary leakage problem but resulted with a more complicated clinical picture with an intestinal obstruction and severe abdominal pain. Computed tomography revealed a strangulated hernia from the umbilical trocar site. Increased abdominal pressure during ERCP had strained the weak umbilical trocar site. Emergency surgical intervention through the umbilicus revealed an ischemic small bowel segment which was treated with resection and anastomosis. This report demonstrates that negligence of trocar site closure can result in very early herniation, particularly if an endoscopic intervention is required in the early postoperative period. PMID:25400872

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

    PubMed Central

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

    2014-01-01

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

  2. Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

    PubMed Central

    Agrawal, Rati; Sood, K. C.; Agarwal, Bhupender

    2015-01-01

    Background. The role of early laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis is not yet established. The aim of our prospective randomized study was to evaluate the safety and feasibility of early LC for acute cholecystitis and to compare the results with delayed LC. Methods. Between March 2007 to December 2008, 50 patients with diagnosis of acute cholecystitis were assigned randomly to early group, n = 25 (LC within 24?hrs of admission), and delayed group, n = 25 (initial conservative treatment followed by delayed LC, 6–8 weeks later). Results. We found in our study that the conversion rate in early LC and delayed LC was 16% and 8%, respectively, Operation time for early LC was 69.4?min versus 66.4?min for delayed LC, postoperative complications for early LC were 24% versus 8% for delayed LC, and blood loss was 159.6?mL early group versus 146.8?mL for delayed group. However early LC had significantly shorter hospital stay (4.1 days versus 8.6 days). Conclusions. Early LC for acute cholecystitis with cholelithiasis is safe and feasible, offering the additional benefit of shorter hospital stay. It should be offered to the patients with acute cholecystitis, provided that the surgery is performed within 96?hrs of acute symptoms by an experienced surgeon. PMID:25729775

  3. Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients

    PubMed Central

    Lee, Sang-Ill; Na, Byung-Gon; Yoo, Young-Sun; Mun, Seong-Pyo

    2015-01-01

    Purpose Extremely elderly patients who present with complicated gallstone disease are less likely to undergo definitive treatment. The use of laparoscopic cholecystectomy (LC) in older patients is complicated by comorbid conditions that are concomitant with advanced age and may increase postoperative complications and the frequency of conversion to open surgery. We aimed to evaluate the results of LC in patients (older than 80 years). Methods We retrospectively analyzed 302 patients who underwent LC for acute cholecystitis between January 2011 and December 2013. Total patients were divided into three groups: group 1 patients were younger than 65 years, group 2 patients were between 65 and 79 years, and group 3 patients were older than 80 years. Patient characteristics were compared between the different groups. Results The conversion rate was significantly higher in group 3 compared to that in the other groups. Hematoma in gallbladder fossa and intraoperative bleeding were higher in group 3, the difference was not significant. Wound infection was not different between the three groups. Operating time and postoperative hospital stay were significantly higher in group 3 compared to those in the other groups. There was no reported bile leakage and operative mortality. Preoperative percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography were performed more frequently in group 3 than in the other groups. Conclusion LC is safe and feasible. It should be the gold-standard approach for extremely elderly patients with acute cholecystitis. PMID:25741494

  4. Laparoscopic Cholecystectomy Under Epidural Anesthesia: A Feasibility Study

    PubMed Central

    Hajong, Ranendra; Khariong, Peter Daniel S.; Baruah, Arup J.; Anand, Madhur; Khongwar, Donkupar

    2014-01-01

    Background: Laparoscopic cholecystectomy (LC) is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia. Aims: The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated. Materials and Methods: In all, 20 patients with the American Society of Anesthesiologist's class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study. Results: The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia. Conclusions: The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer. PMID:25535604

  5. Single-incision multiport laparoscopic cholecystectomy for a patient with situs inversus totalis: Report of a case

    Microsoft Academic Search

    Hyung Joon Han; Sae Byeol Choi; Chung Yun Kim; Wan Bae Kim; Tae Jin Song; Sang Yong Choi

    2011-01-01

    Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis in patients with situs inversus\\u000a totalis (SIT). Nowadays, singleincision multiport laparoscopic surgery is safe and feasible for treating benign gallbladder\\u000a disease. We report a case of successful single-incision multiport laparoscopic cholecystectomy for a patient with SIT, and\\u000a describe its technical advantages.

  6. Major bile duct injuries during cholecystectomy in children: conservative laparoscopic approach is possible.

    PubMed

    Farinetti, Anne; Le Hors, Hèlene; Haddad, Mirna; Desvignes, Catherine; Laugier, René; de Lagausie, Pascal

    2012-04-01

    Major bile duct injury is an inherent complication in cases of both open and laparoscopic cholecystectomies. In case of choledochal lesion, conservative treatment or internal derivation by a Roux-en-Y can be proposed. We report the case of a 5-year-old boy referred to our center for an iatrogenic choledochal ligation after open cholecystectomy (performed 20 d before) for asymptomatic gallbladder stone. We performed a laparoscopic conservative treatment with a consistent good result 5 years after the procedure. PMID:22487648

  7. Incidence, Risk Factors, and Prevention of Biliary Tract Injuries during Laparoscopic Cholecystectomy in Switzerland

    Microsoft Academic Search

    Lukas Krähenbühl; Guido Sclabas; Moritz N. Wente; Markus Schäfer; Rolf Schlumpf; Markus W. Büchler

    2001-01-01

    .   Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) which may result in patient disability or death are reported\\u000a to occur more frequently when compared to open surgery. The aim of this nationwide prospective study beyond the laparoscopic\\u000a learning curve was to analyze the incidence, risk factors, and management of major BDI. During a 3-year period (1995–1997)\\u000a 130 items of

  8. Is intraoperative cholangiography necessary during laparoscopic cholecystectomy for cholelithiasis?

    PubMed Central

    Ding, Guo-Qian; Cai, Wang; Qin, Ming-Fang

    2015-01-01

    AIM: To determine the efficacy and safety benefits of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) to treat symptomatic cholelithiasis. METHODS: Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January 2012 and January 2014 for management of symptomatic cholelithiasis were recruited for this prospective randomized trial. Study enrollment was offered to patients with clinical presentation of biliary colic symptoms, radiological findings suggestive of gallstones, and normal serum biochemistry results. Study participants were randomized to receive either routine LC treatment or LC + IOC treatment. The routine LC procedure was carried out using the standard four-port technique; the LC + IOC procedure was carried out with the addition of meglumine diatrizoate (1:1 dilution with normal saline) injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors. Operative data and postoperative outcomes, including operative time, retained common bile duct (CBD) stones, CBD injury, other complications and length of hospital stay, were recorded for comparative analysis. Inter-group differences were statistically assessed by the ?2 test (categorical variables) and Fisher’s exact test (binary variables), with the threshold for statistical significance set at P < 0.05. RESULTS: A total of 371 patients were enrolled in the trial (late-adolescent to adult, age range: 16-70 years), with 185 assigned to the routine LC group and 186 to the LC + IOC group. The two treatment groups were similar in age, sex, body mass index, duration of symptomology, number and size of gallstones, and clinical symptoms. The two treatment groups also showed no significant differences in the rates of successful LC (98.38% vs 97.85%), CBD stone retainment (0.54% vs 0.00%), CBD injury (0.54% vs 0.53%) and other complications (2.16% vs 2.15%), as well as in duration of hospital stay (5.10 ± 1.41 d vs 4.99 ± 1.53 d). However, the LC + IOC treatment group showed significantly longer mean operative time (routine LC group: 43.00 ± 4.15 min vs 52.86 ± 4.47 min, P < 0.01). There were no cases of fatal complications in either group. At the one-year follow-up assessment, one patient in the routine LC group reported experiencing diarrhea for three months after the LC and one patient in the LC + IOC group reported on-going intermittent epigastric discomfort, but radiological examination provided no abnormal findings. CONCLUSION: IOC addition to the routine LC treatment of symptomatic cholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time. PMID:25717250

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

    PubMed Central

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

    1995-01-01

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

  10. Impact of Fellowship During Single-Incision Laparoscopic Cholecystectomy

    PubMed Central

    Romero, Rey Jesús; Arad, Jonathan Kirsch; Kosanovic, Radomir; Lamoureux, Julie

    2014-01-01

    Background and Objectives: Minimally invasive surgery fellowship programs have been created in response to advancements in technology and patient's demands. Single-incision laparoscopic cholecystectomy (SILC) is a technique that has been shown to be safe and feasible, but this appears to be the case only for experienced surgeons. The purpose of this study is to evaluate the impact of minimally invasive surgery fellow participation during SILC. Methods: We reviewed data from our experience with SILC during 3 years. The cases were divided in two groups: group 1 comprised procedures performed by the main attending without the presence of the fellow, and group 2 comprised procedures performed with the fellow present during the operation. Demographic characteristics, comorbidities, indication for surgery, total surgical time, hospital length of stay, and complications were evaluated. Results: The cohort included 229 patients: 142 (62%) were included in group 1 and 87 (38%) in group 2. No differences were found in demographic characteristics, comorbidities, and indication for surgery between groups. The total surgical time was 34.4 ± 11.4 minutes for group 1 and 46.8 ± 16.0 minutes for group 2 (P < .001). The hospital length of stay was 0.89 ± 0.32 days for group 1 and 1.01 ± 0.40 days for group 2 (P = .027). No intraoperative complications were seen in either group. There were 3 postoperative complications (2.1%) in group 1 and none in group 2 (P = .172). Conclusion: Adoption of SILC during an established fellowship program is safe and feasible. A longer surgical time is expected during the teaching process. PMID:24809141

  11. Laparoscopic Cholecystectomy in Two Patients with Symptomatic Cholelithiasis and Situs inversus totalis

    Microsoft Academic Search

    H. Demetriades; D. Botsios; C. Dervenis; J. Evagelou; S. Agelopoulos; J. Dadoukis

    1999-01-01

    Background: Situs inversus viscerum is a rare condition with a genetic predisposition. We report 2 patients with situs inversus totalis and symptomatic cholelithiasis successfully treated via laparoscopic cholecystectomy. Patients and Methods: The first patient was a 61-year-old female presenting with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and

  12. Successful Intraarterial Thrombolysis of an Ischemic Limb Four Days After Laparoscopic Cholecystectomy

    SciTech Connect

    Sandison, Andrew J. P.; Edmondson, Robert A.; Panayiotopoulos, Yiannis [Department of Surgery, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals, Guy's Hospital, St. Thomas Street, London SE1 9RT (United Kingdom); Reidy, John F. [Department of Radiology, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals, Guy's Hospital, St. Thomas Street, London SE1 9RT (United Kingdom); McColl, Ian; Taylor, Peter R. [Department of Surgery, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals, Guy's Hospital, St. Thomas Street, London SE1 9RT (United Kingdom)

    1998-03-15

    Intraarterial thrombolysis is usually contraindicated after abdominal surgery because of the risk of bleeding. However, it is a highly effective treatment for embolic acute limb ischemia, particularly for clearing the distal vessels. We report a case in which intraarterial thrombolysis was safely used 4 days after laparoscopic cholecystectomy in a patient with an acutely ischemic leg due to embolus.

  13. [Laparoscopic cholecystectomy for acute cholecystitis in pregnancy: a case report in woman with situs viscerum inversus].

    PubMed

    Pezzolla, Angela; Lattarulo, Serafina; Disabato, Maria; Barile, Graziana; Primiceri, Giuliana; Paradies, Daniele

    2012-12-01

    We report a case of a three month young pregnant woman (In Vitro Fertilization and Embryo Transfer - IVF-ET - twin pregnancy) with situs viscerum inversus totalis affected by acute cholecystitis. As already happened in other pregnant women, we use laparoscopic approach and cholecystectomy is performed successfully without any morbidity for mother and fetuses. PMID:23258242

  14. Imaging in laparoscopic cholecystectomy--what a radiologist needs to know.

    PubMed

    Desai, Naman S; Khandelwal, Ashish; Virmani, Vivek; Kwatra, Neha S; Ricci, Joseph A; Saboo, Sachin S

    2014-06-01

    Laparoscopic cholecystectomy is the gold standard treatment option for cholelithiasis. In order to properly assess for the complications related to the procedure, an understanding of the normal biliary anatomy, its variants and the normal postoperative imaging is essential. Radiologist must be aware of benefits and limitations of multiple imaging modalities in characterizing the complications of this procedure as each of these modalities have a critical role in evaluating a symptomatic post-cholecystectomy patient. The purpose of this article is describe the multi-modality imaging of normal biliary anatomy and its variants, as well as to illustrate the imaging features of biliary, vascular, cystic duct, infectious as well as miscellaneous complications of laparoscopic cholecystectomy. We focus on the information that the radiologist needs to know about the radiographic manifestations of potential complications of this procedure. PMID:24657107

  15. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices.

    PubMed

    Nickel, Felix; Brzoska, Julia A; Gondan, Matthias; Rangnick, Henriette M; Chu, Jackson; Kenngott, Hannes G; Linke, Georg R; Kadmon, Martina; Fischer, Lars; Müller-Stich, Beat P

    2015-05-01

    This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n?=?42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n?=?42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3?×?4?hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80?min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80?min than BL (45% v 21%, P?=?.02). The BL group scored higher than the VR group in the knowledge test (13.3?±?1.3 vs 11.0?±?1.7, P?laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches. PMID:25997044

  16. Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

    PubMed Central

    Hokkam, Emad N.

    2014-01-01

    Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies. Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A) and delayed (B) cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient's satisfaction. Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient's satisfaction was 92.66 ± 6.8 in group A compared with 75.34 ± 12.85 in group B. Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques. PMID:25197568

  17. Laparoscopic cholecystectomy in situs inversus totalis: Feasibility and review of literature

    PubMed Central

    Salama, Ibrahim Abdelkader; Abdullah, Mohammed Hussein; Houseni, Mohammed

    2013-01-01

    INTRODUCTION Situs inversus totalis is a rare anomaly characterized by transposition of organs to the opposite site of the body. Laparoscopic cholecystectomy in those patients is technically more demanding and needs reorientation of visual-motor skills to left upper quadrant. PRESENTATION OF CASE Herein, we report a 10 year old boy presented with left hypochondrium and epigastric pain 2 months duration. The patient had not been diagnosed as situs inversus totalis before. The patient exhibit a left sided “Murphy's sign”. Diagnosis of situs inversus totalis was confirmed with ultrasound, computerized tomography (CT) and magnetic resonant image (MRI) with presence of multiple gall bladder stones with no intra or extrabiliary duct dilatation. The patient underwent laparoscopic cholecystectomy for cholelithiasis. DISCUSSION Feasibility and technical difficulty in diagnosis and treatment of such case pose challenge problem due to the contra lateral disposition of the viscera. Difficulty is encountered in skelatonizing the structures in Calot's triangle, which consume extra time than normally located gall bladder. A summary of additional 50 similar cases reported up to date in the medical literature is also presented. CONCLUSION Laparoscopic cholecystectomy is feasible and should be done in situs inversus totalis by experienced laparoscopic surgeon, as changes in anatomical disposition of organ not only influence the localization of symptoms and signs arising from a diseased organ but also imposes special demands on the diagnosis and surgical skills of the surgeon. PMID:23810920

  18. Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients

    PubMed Central

    Antoniou, Stavros A; Antoniou, George A; Koch, Oliver O; Pointner, Rudolph; Granderath, Frank A

    2014-01-01

    AIM: To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients. METHODS: Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease. Nevertheless, surgeons have been reluctant to implement the concepts of minimally invasive surgery in older patients. A systematic review of Medline was embarked on, up to June 2013. Studies which provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open cholecystectomy were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was appraised using valid assessment tools. ?he random-effects model was applied to synthesize outcome data. RESULTS: Out of a total of 337 records, thirteen articles (2 randomized and 11 observational studies) reporting on the outcome of 101559 patients (48195 in the laparoscopic and 53364 in the open treatment group, respectively) were identified. Odds ratios (OR) were constantly in favor of laparoscopic surgery, in terms of mortality (1.0% vs 4.4%, OR = 0.24, 95%CI: 0.17-0.35, P < 0.00001), morbidity (11.5% vs 21.3%, OR = 0.44, 95%CI: 0.33-0.59, P < 0.00001), cardiac (0.6% vs 1.2%, OR = 0.55, 95%CI: 0.38-0.80, P = 0.002) and respiratory complications (2.8% vs 5.0%, OR = 0.55, 95%CI: 0.51-0.60, P < 0.00001). Critical analysis of solid study data, demonstrated a trend towards improved outcomes for the laparoscopic concept, when adjusted for age and co-morbid diseases. CONCLUSION: Further high-quality evidence is necessary to draw definite conclusions, although best-available evidence supports the selective use of laparoscopy in this patient population. PMID:25516678

  19. Laparoscopic cholecystectomy in a patient with situs inversus totalis: case report with review of literature.

    PubMed

    Ali, Mohammed Sulaiman; Attash, Saad Muwafaq

    2013-01-01

    Situs inversus totalis is a rare autosomal recessive disorder which can cause diagnostic confusion in a lot of clinical conditions including calculous cholecystitis due to the reversed anatomical positions of abdominal viscera. Laparoscopic cholecystectomy is much more challenging in the presence of this disorder due to loss of usual orientation. We present a case of a 43-year-old woman who was diagnosed at our centre to have calculous cholecystitis in the presence of situs inversus totalis. Laparoscopic cholecystectomy was performed safely after adjustment of the positions of the team inside the operative theatre and of the port sites. The patient tolerated the operation very well and was discharged home after 24h. On follow-up visit the patient was doing very well and completely free of symptoms. PMID:24105014

  20. [Value of absorbable clips in laparoscopic cholecystectomy. A randomized prospective study].

    PubMed

    Rohr, S; De Manzini, N; Vix, J; Tiberio, G; Wantz, C; Meyer, C

    1997-09-01

    Most surgeons use metal clips in laparoscopic cholecystectomy. The aim of this prospective randomized controlled study was to evaluate the efficacy of absorbable clips in elective laparoscopic cholecystectomy. One hundred consecutive patients with symptomatic gallstones without complications were randomized into groups; group T had two metal clips (titan clip ETHICONR), group R (laproclipR Davis and Geck) had one absorbable clip applied on the cystic duct and cystic artery. The patients were followed for one year. There was no difference between the two groups concerning operative time, hospital stay and postoperative complications. The absorbable clips seem to be as effective as metal clips in providing hemostasis in cystic artery and in cystic duct ligation. PMID:9499947

  1. Long-term follow-up after laparoscopic cholecystectomy without routine intraoperative cholangiography.

    PubMed

    Braghetto, I; Debandi, A; Korn, O; Bastias, J

    1998-10-01

    The indications for routine intraoperative cholangiography remain controversial. We present here our recent results concerning the frequency of unknown retained common bile duct stones in 253 consecutive patients who underwent laparoscopic cholecystectomy without intraoperative cholangiography in whom the presence of preoperative choledocholithiasis had been excluded by clinical, biochemical, and ultrasonographic evaluation. These patients were followed up for at least 4 years after surgery with evaluations similar to those made preoperatively. Freedom from symptoms and normal test results were found in 96.8% of patients. Jaundice and abnormal liver function test results were demonstrated in 3.2% of patients, but retained common bile duct stones were found in only 2.3% of patients. We conclude that laparoscopic cholecystectomy without routine intraoperative cholangiography can be performed safely without the discovery of a high percentage of retained common bile duct stones at later follow-up. PMID:9799142

  2. Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation

    Microsoft Academic Search

    J. Roger Maltby; Michael T. Beriault; Neil. C. Watson; Gordon H. Fick

    2000-01-01

    Purpose: The standard laryngeal mask airway LMA-Classic was designed as an alternative to the endotracheal tube (ETT) or the face\\u000a mask for use with either spontaneous or positive pressure ventilation. Positive pressure ventilation may exploit leaks around\\u000a the LMA cuff, leading to gastric distension and\\/or inadequate ventilation. We compared gastric distension and ventilation\\u000a parameters with LMAvs ETT during laparoscopic cholecystectomy.

  3. Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy

    Microsoft Academic Search

    A. W Majeed; G Troy; A Smythe; M. W. R Reed; C. J Stoddard; J Peacock; A. G Johnson; Jp Nicholl

    1996-01-01

    SummaryBackground We report a prospective randomised comparison between laparoscopic and small-incision cholecystectomy in 200 patients which was designed to eliminate bias for or against either technique.Methods Patients were randomised in the operating theatre and anaesthetic technique and pain-control methods were standardised. Four experienced surgeons did both types of procedure. Identical wound dressings were applied in both groups so that carers

  4. Management of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

    Microsoft Academic Search

    Yoshitaka Fujii

    2011-01-01

    The common and distressing complications of postoperative nausea and vomiting (PONV) are the main concern of 40–70% of patients\\u000a undergoing laparoscopic cholecystectomy (LC). The first step in preventing PONV after LC is to reduce the risk factors involving\\u000a patient characteristics, surgical procedure, anesthetic technique, and postoperative care. Particularly, the use of propofol-based\\u000a anesthesia can reduce the incidence of PONV after

  5. Laparoscopic cholecystectomy in situs inversus totalis: The importance of being left-handed

    Microsoft Academic Search

    L. M. Oms; J. M. Badia

    2003-01-01

    Since laparoscopic cholecystectomy has become the standard procedure for the treatment of gallstone disease, several cases have been reported in patients with situs inversus. These cases require more technically demanding procedures due to the symmetrical disposition of the anatomy. Thus, handedness could influence the performance of these operations. The two of us (L.M.O.) and (J.M.B.), a right-handed and a left-handed

  6. Spilled gall stones during laparoscopic cholecystectomy: a review of the literature

    PubMed Central

    Sathesh-Kumar, T; Saklani, A; Vinayagam, R; Blackett, R

    2004-01-01

    Laparoscopic cholecystectomy is associated with spillage of gall stones in 5%–40% of procedures, but complications occur very rarely. There are, however, isolated case reports describing a range of complications occurring both at a distance from and near to the subhepatic area. This review looks into the various modes of presentation, ways to minimise spillage, treating the complications, and the legal implications. PMID:14970293

  7. Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy

    Microsoft Academic Search

    Hiroshi Aono; Akio Takeda; Stephen D. Tarver; Hiroshi Goto

    1998-01-01

    Study Objective: To evaluate and compare the stress hormone responses during laparoscopic cholecystectomy during general anesthesia, general anesthesia supplemented by fentanyl, and general anesthesia combined with epidural anesthesia.Design: Prospective, randomized clinical study.Setting: Operating rooms at a municipal hospital.Patients: 52 ASA physical status I and II patients.Interventions: Anesthesia was induced slowly with sevoflurane and nitrous oxide (N2O) in oxygen (O2) by

  8. Preoperative Multimodal Analgesia Facilitates Recovery After Ambulatory Laparoscopic Cholecystectomy

    Microsoft Academic Search

    Christina Michaloliakou; Frances Chung; Sharad Sharma

    1996-01-01

    Laparoscopy approach to cholecystectomy has short- ened the recovery period, reducing discharge times from 1 to 3 days to same-day discharge. We hypoth- esize that the use of more than one modality to pre- vent postoperative pain may be more efficacious than single modality. Patients were randomized to a treat- ment (n = 24) or control (n = 25) group

  9. Laparoscopic Cholecystectomy in View of Medical Technology Assessment

    Microsoft Academic Search

    Hans Troidl; Ernst Eypasch; Ahmed Al-Jaziri; Wolfgang Spangenberger; Achim Dietrich

    1991-01-01

    When any new procedure or technique is inaugurated and practiced, it is essential to assess its worth. New technologies have a characteristic life cycle which is characterized by a sequence: promising reports, professional adoption, public acceptance as a standard procedure, professional denunciation, and finally discreditation. Endoscopic surgery, especially laparascopic cholecystectomy, is an extremely promising innovation. In order to avoid the

  10. Clinical comparison of propofol-remifentanil TCI with sevoflurane induction/maintenance anesthesia in laparoscopic cholecystectomy

    PubMed Central

    Deng, Xiaoqian; Zhu, Tao

    2014-01-01

    Objective : We aimed to compare the anesthetic characteristics between total intravenous anesthesia (TIVA) using propofol-remifentanil with target control infusion (TCI) and volatile induction and maintenance anesthesia (VIMA) using sevoflurane and sufentanyl for patients undergoing laparoscopic cholecystectomy. Methods: A total of 120 patients undergoing laparoscopic cholecystectomy were randomly assigned to two groups. Patients in group T received TCI of propofol-remifentanil for induction and maintenance. Patients in group S received sevoflurane-sufentanyl for induction and maintenance. Results: Patients in group S had a significantly faster induction time than patients in group T (109s vs.44s). The emergence time in terms of time to extubation was comparable between the two groups, while the time to eyes opening (419s vs.483s, p=0.006) and duration in PACU were longer in group S (44 min vs.53 min, p=0.017). Ten (17.2%) patients in group S were administered an antihypertensive drug when gallbladder issues were present, while only 1(1.7%) patient needed this drug in group T (p=0.004).More patients in group T than in group S received fentanyl for analgesia in PACU (88%vs.70%, p=0.013). The incidence of postoperative nausea and vomiting (PONV) in PACU was higher in group S than in group T (20% vs.38%, p=0.027). Conclusion: Both techniques had advantages and disadvantages in laparoscopic cholecystectomy; none of the techniques studied was superior. PMID:25225518

  11. Comparison of the short-term efficacy of sequential treatment with intravesical single-port laparoscopic partial cystectomy with bladder preservation or open partial cystectomy in combination with cisplatin plus gemcitabine chemotherapy

    PubMed Central

    MAI, HAI-XING; LIU, JUN-LE; PEI, SHU-JUN; ZHAO, LI; QU, NAN; DONG, JIN-KAI; CHEN, BIAO; WANG, YA-LIN; HUANG, CHENG; CHEN, LI-JUN

    2015-01-01

    This study aimed to assess the short-term efficacy of sequential therapy for T2/T3a bladder cancer with intravesical single-port laparoscopic partial cystectomy or open partial cystectomy combined with cisplatin plus gemcitabine (GC) chemotherapy in a prospective randomized controlled study. Thirty patients with bladder cancer who underwent open partial cystectomy (group A) or single-port laparoscopic partial cystectomy (group B) and received standard GC chemotherapy were analyzed. Perioperative functional indicators and tumor recurrence during a 1-year postoperative follow-up were compared between the two groups. The baseline characteristics were comparable between the two groups. The mean operative time, amount of blood loss and duration of hospital stay were 90.3 min, 182.0 ml and 7.3 days, respectively, for group A, and 105.3 min, 49.3 ml and 5.8 days, respectively, for group B. No secondary postoperative bleeding, urine leakage, wound infection or other complications were observed in the two groups. Postoperative scarring was not evident in group B. The overall incidence of surgical complications, tumor recurrence rate and complications during chemotherapy in the postoperative follow-up period of 12 months were similar between the two groups. Single-port laparoscopic partial cystectomy surgery is an idea surgical method for the treatment of invasive bladder cancer, with good surgical effect, minimal invasiveness, rapid recovery and short hospital stay. The data from 1-year postoperative follow-up showed that laparoscopic surgery was superior with regard to perioperative bleeding, postoperative recovery and duration of indwelling urinary catheter use. However, regarding the tumor recurrence rate, long-term comparative details are required to determine the effect of laparoscopic surgery.

  12. Clinical Outcomes of Single Incision Laparoscopic Cholecystectomy in the Anglophone Caribbean: A Multi Centre Audit of Regional Hospitals

    PubMed Central

    Cawich, Shamir O.; Albert, Matthew; Singh, Yardesh; Dan, Dilip; Mohanty, Sanjib; Walrond, Maurice; Francis, Wesley; Simpson, Lindberg K.; Bonadie, Kimon O.; Dapri, Giovanni

    2014-01-01

    Introduction: There has been no report on Single-Incision Laparoscopic Surgery (SILS) cholecystectomy outcomes since it was first performed in the Anglophone Caribbean in 2009. Methods: A retrospective audit evaluated the clinical outcomes of SILS cholecystectomies at regional hospitals in the 17 Anglophone Caribbean countries. Any cholecystectomy using a laparoscopic approach in which all instruments were passed through one access incision was considered a SILS cholecystectomy. The following data were collected: patient demographics, indications for operation, intraoperative details, surgeon details, surgical techniques, specialized equipment, conversions, morbidity and mortality. Descriptive statistics were generated using SPSS 12.0. Results: There were 85 SILS cholecystectomies in women at a mean age of 37.4 ± 8.5 years with a mean BMI of 30.9 ± 2.8. There were 59 elective and 26 emergent cases. Specialized access platforms were used in the first 35 cases and reusable instruments were passed directly across fascia in the latter 50 cases. The mean operative time was 62.9 ± 17.9 minutes. There was no mortality, 2 conversions to multi-trocar laparoscopy and 5 minor complications. Ambulatory procedures were performed in 43/71 (60.6%) patients scheduled for elective operations. Conclusion: In the Caribbean setting, SILS cholecystectomy is a feasible and safe alternative to conventional multi-trocar laparoscopic cholecystectomy for gallbladder disease. PMID:25324700

  13. Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings

    Microsoft Academic Search

    Frederik Keus; Trudy de Jonge; Hein G Gooszen; Erik Buskens; Cornelis JHM van Laarhoven

    2009-01-01

    BACKGROUND: After its introduction, laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus. However, analysis of evidence shows no difference regarding primary outcome measures between laparoscopic and small-incision cholecystectomy. In absence of clear clinical benefit it may be interesting to focus on the resource use associated with the available techniques, a secondary outcome

  14. Laparoscopic cholecystectomy in a patient with situs inversus totalis and previous abdominal surgery.

    PubMed

    Polychronidis, A; Karayiannakis, A; Botaitis, S; Perente, S; Simopoulos, C

    2002-07-01

    Situs inversus totalis is a rare congenital defect that can present difficulties during laparoscopic surgery due to the mirror-image anatomy. We report a patient with symptomatic cholelithiasis and previous abdominal surgery in whom a chest X-ray revealed a right-sided heart, whereas abdominal ultrasound revealed that his gallbladder was located in the left hypochondrium. At surgery, the surgeon and the camera assistant were standing on the right-hand side of the patient, and the first assistant was standing on the left. The camera was introduced through an umbilical incision, and laparoscopy confirmed the situs inversus. The other 10-mm trocar was placed in the midline left of the falciform ligament and two 5-mm trocars were placed in the left subcostal midclavicular line and anterior axillary line, respectively. After dissection of multiple adhesions caused by previous abdominal surgery, a standard laparoscopic cholecystectomy was performed successfully. This report suggests that situs inversus is not a contraindication for laparoscopic surgery. However, the procedure is more difficult and potentially hazardous due to the mirror-image anatomy (particularly the transposition of biliary ducts) causing difficulties in orientation, so that extreme care is required to avoid iatrogenic injuries. Despite these factors, laparoscopic cholecystectomy can be performed safely in patients with situs inversus totalis. PMID:12165836

  15. Is early laparoscopic cholecystectomy for acute cholecystitis preferable to delayed surgery?: Best evidence topic (BET).

    PubMed

    Skouras, Christos; Jarral, Omar; Deshpande, Rahul; Zografos, George; Habib, Nagy; Zacharakis, Emmanouil

    2012-01-01

    A best evidence topic was written according to a structured protocol. The question addressed was whether early laparoscopic cholecystectomy (ELC) in patients presenting with a short history of acute cholecystitis provides better post-operative outcomes than a delayed laparoscopic cholecystectomy (DLC). A total of 92 papers were found using the reported searches of which 10 represented the best evidence; 3 meta-analyses, 4 randomized control trials, 1 prospective controlled study and 2 retrospective cohort studies were included. The authors, date, journal, study type, population, main outcome measures and results were tabulated. No significant difference in complication or conversion rates were shown between the ELC and the DLC group, in the meta-analyses of Gurusamy et al, Lau et al and Siddiqui et al. The ELC group had a decreased hospital stay whereas the DLC group presented a considerable risk for subsequent emergency surgery during the interval period, with a high rate of conversion to open cholecystectomy. All three meta-analyses were based on the randomized control trials of Lo et al, Lai et al, Kolla et al and Johansson et al; the results of each study are summarized. We conclude that there is strong evidence that early laparoscopic cholecystectomy for acute cholecystitis offers an advantage in the length of hospital stay without increasing the morbidity or mortality. The operating time in ELC can be longer, however the incidence of serious complications (i.e. common bile duct injury), is comparable to the DLC group. Larger randomized studies are required before solid conclusions are reached. PMID:22525382

  16. Intraperitoneal Bupivacaine Effect on Postoperative Nausea and Vomiting Following Laparoscopic Cholecystectomy

    PubMed Central

    Yari, Mitra; Rooshani, Bahman; Golfam, Parisa; Nazari, Nahid

    2014-01-01

    Background: Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) has multifactorial etiology. Pain and use of opioids are among the important factors. Objectives: The present study aimed to evaluate the efficacy of intrapritoneal (IP) injection of bupivacaine on PONV. Patients and Methods: This was a double-blind randomized clinical trial, conducted on 66 patients aged 20-60, ASA I or II, candidates for LC. Patients were randomly assigned to two groups. Bupivacaine group received 20 mL bupivacaine 0.25% in the gallbladder bed, before and after cholecystectomy and the control group did not. The incidence of nausea and postoperative pain intensity was measured with Visual analogue scale (VAS) at 1, 2, 3 and 4 hours after operation, at rest and when coughing and changing positions. Nausea and vomiting occurrence were assessed at the same times. Results: There were no demographic data differences between groups. No differences were found between the two groups, in terms of incidence of nausea and vomiting. Furthermore, both groups were similar with respect to opioid consumption, during four hours post-operation. Conclusions: Intraperitoneal bupivacaine administration at the beginning and end of laparoscopic cholecystectomy reduced only visceral and shoulder pains at the 4th postoperative hour, but had no effect on reducing neither PONV, nor opioid demand, during the first four postoperative hours. PMID:25237635

  17. Design, Development, and Evaluation of a Novel Retraction Device for Gallbladder Extraction During Laparoscopic Cholecystectomy

    PubMed Central

    Judge, Joshua M.; Stukenborg, George J.; Johnston, William F.; Guilford, William H.; Slingluff, Craig L.; Hallowell, Peter T.

    2015-01-01

    Background A source of frustration during laparoscopic cholecystectomy involves extraction of the gallbladder through port sites smaller than the gallbladder itself. We describe the development and testing of a novel device for the safe, minimal enlargement of laparoscopic port sites to extract large, stone-filled gallbladders from the abdomen. Methods The study device consists of a handle with a retraction tongue to shield the specimen and a guide for a scalpel to incise the fascia within the incision. Patients enrolled underwent laparoscopic cholecystectomy. Gallbladder extraction was attempted. If standard measures failed, the device was implemented. Extraction time and device utility scores were recorded for each patient. Patients returned 3 - 4 weeks post-operatively for assessment of pain level, cosmetic effect, and presence of infectious complications. Results Twenty (51%) of 39 patients required the device. Average extraction time for the first 8 patients was 120 seconds. After interim analysis, an improved device was used in twelve patients, and average extraction time was 24 seconds. There were no adverse events. Post-operative pain ratings and incision cosmesis were comparable between patients with and without use of the device. Conclusion The study device enables safe and rapid extraction of impacted gallbladders through the abdominal wall. PMID:23897085

  18. The LMA-ProSeal™ is an effective alternative to tracheal intubation for laparoscopic cholecystectomy

    Microsoft Academic Search

    J. Roger Maltby; Michael T. Beriault; Neil C. Watson; David Liepert; Gordon H. Fick

    2002-01-01

    Purpose  To compare LMA-ProSeal™ (LMA-PS) with endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension\\u000a during laparoscopic cholecystectomy.\\u000a \\u000a \\u000a \\u000a Methods  We randomized 109 ASA I–III adults to LMA-PS or ETT after stratifying them as non-obese or obese (body mass index > 30 kg·m?2). After preoxygenation, anesthesia was induced with propofol, fentanyl and rocuronium. An LMA-PS (women #4, men #5) or ETT

  19. Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy.

    PubMed

    Memon, Jan Muhammad; Memon, Muhammad Rafique; Arija, Dharmoon; Bozdar, Ali Gohar; Talpur, Mir Muhammad Ali

    2014-11-01

    This comparative prospective study was conducted at the Ghulam Muhammad Mahar Medical College Hospital and Red Crescent General Hospital, Sukkur, Pakistan, for a period of two years from July 2012 to June 2014. The study included 1800 patients who underwent laparoscopic cholecystectomy for symptomatic cholethiasis. These patients were divided in to two groups. Group I included 900 patients, who underwent conventional laparoscopic cholecystectomy with the four port technique. In these patients, the gall-bladder was retrieved through umbilical port by a sterile surgical hand glove (size 6 ½ or 7 inches) endobag. The fascial defect of 10 mm umbilical port was closed by vicryl "0" with J-shaped needle, while three 5 mm ports closed by applying steri strips. Group-II also included 900 patients. In these patients laparoscopic cholecystectomy was done by using three ports, 10 mm epigastric working port, 5 mm umbilical port for 5 mm telescope and lateral 5 mm port for assistant. The gall-bladder was retrieved through epigastric port without endobag. The results of both these techniques were collected and analyzed on SPSS version 14. The mean age of patients was 45 years. The male to female ratio was 1:3. In group-I, after laparoscopic cholecystectomy, gall-bladder was retrieved safely through 10 mm umbilical port in surgical glove endobag. In acutely inflamed cases, the gall-bladder was opened at the umbilical port site inside the endobag and decompressed before retrieval. In this group, wound infection of umbilical port occurred in 5.11% patients, port-site hernia in 3.66%, port-site bleeding in 1.33% while difficulty in retrieval of gall-bladder in acutely inflamed cases in 1.88% patients. In group-II, wound infection in epigastric port was found in 1.55% patients, port-site hernia in 0.11%, port-site bleeding in 4%, difficulty in retrieval of gall-bladder in 5.33% while leakage /perforation of gall-bladder in 4.11% patients. The serious complications like wound infection and port-site hernia are more frequently found in group-I patients as compared to group-II. PMID:26045380

  20. Small bowel obstruction due to phytobezoar and adhesions following laparoscopic cholecystectomy

    PubMed Central

    Abu jkeim, Nidal; Al hazmi, Ahmad; Alawad, Awad Ali M.; Ibrahim, Rashid; Abu damis, Ahmad; Tawfik, Samir; Mansour, Mohammed

    2015-01-01

    We report a case of 51 –year-old female with history of laparoscopic cholecystectomy presented with abdominal pain and diagnosed as small bowel obstruction caused by adhesions. The initial presentation was periumbilical pain with nausea and vomiting. Plain abdominal radiograph showed dilated small bowel loops and multiple air fluid levels. Due to failure of conservative treatment, laparotomy was performed. An open metallic clip was adhering the bowel to the gallbladder fossa causing sharp angulation. A phytobezoar proximal to this angulation was exteriorized through enterotomy. The patient was recovered smoothly and discharged from our hospital.

  1. Laparoscopic cholecystectomy in the treatment of acalculus cholecystitis in patients after thermal injury.

    PubMed

    McClain, T; Gilmore, B T; Peetz, M

    1997-01-01

    Acalculus cholecystitis accounts for 2% to 14% of all cases of acute cholecystitis and is seen with increasing frequency in patients after major trauma and burns. In these already compromised patients, acute acalculus cholecystitis can be difficult to diagnose and more difficult to treat. We present our experience with laparoscopic cholecystectomy in seven patients with this often lethal combination treated over the last 5 years. All the patients who underwent surgery survived and had minimal morbidity from their operations. We discuss the etiology and diagnosis and review the literature of the treatment of acalculus cholecystitis in patients after thermal injury. PMID:9095424

  2. Laparoscopic cholecystectomy with a three-trocar 5-mm instrument approach.

    PubMed

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

    2007-01-01

    The natural evolution of laparoscopy seems to be the use of miniature instruments and, where possible, a reduction of the number of trocars used. We report the results of our experience with all 5-mm instrument three-trocar cholecystectomy vs. the conventional laparoscopy approach. From July 2002 to July 2005 a total of 518 patients underwent laparoscopic cholecystectomy: 268 of them (51.7%) were operated on with a 5-mm three-trocar approach. The primary end point was the feasibility rate of the technique. Secondary end points were safety and the impact of the technique on the duration of laparoscopy. There were two conversions to laparotomy--one in each group--while a conversion to the classical approach for the three-trocar group was registered in 9.3% of the cases. Occurrence of minor complications was 3.6% (9 cases) with the conventional approach as against 3.7% (10 cases) with the three-trocar approach. The present experience shows that 5-mm three-trocar cholecystectomy is a safe, easy, effective and reproducible approach for gallbladder disease. Such features make the technique a challenging alternative to conventional laparoscopy in the treatment of cholecystopathy, in both the acute and elective setting. PMID:17663379

  3. Techniques of Fluorescence Cholangiography During Laparoscopic Cholecystectomy for Better Delineation of the Bile Duct Anatomy.

    PubMed

    Kono, Yoshiharu; Ishizawa, Takeaki; Tani, Keigo; Harada, Nobuhiro; Kaneko, Junichi; Saiura, Akio; Bandai, Yasutsugu; Kokudo, Norihiro

    2015-06-01

    To evaluate the clinical and technical factors affecting the ability of fluorescence cholangiography (FC) using indocyanine green (ICG) to delineate the bile duct anatomy during laparoscopic cholecystectomy (LC).Application of FC during LC began after laparoscopic fluorescence imaging systems became commercially available.In 108 patients undergoing LC, FC was performed by preoperative intravenous injection of ICG (2.5?mg) during dissection of Calot's triangle, and clinical factors affecting the ability of FC to delineate the extrahepatic bile ducts were evaluated. Equipment-related factors associated with bile duct detectability were also assessed among 5 laparoscopic systems and 1 open fluorescence imaging system in ex vivo studies.FC delineated the confluence between the cystic duct and common hepatic duct (CyD-CHD) before and after dissection of Calot's triangle in 80 patients (74%) and 99 patients (92%), respectively. The interval between ICG injection and FC before dissection of Calot's triangle was significantly longer in the 80 patients in whom the CyD-CHD confluence was detected by fluorescence imaging before dissection (median, 90?min; range, 15-165?min) than in the remaining 28 patients in whom the confluence was undetectable (median, 47?min; range, 21-205?min; P?laparoscopic imaging systems and tended to decrease more steeply than those of the open imaging system as the target-laparoscope distance increased and porcine tissues covering the samples became thicker.FC is a simple navigation tool for obtaining a biliary roadmap to reach the "critical view of safety" during LC. Key factors for better bile duct identification by FC are administration of ICG as far in advance as possible before surgery, sufficient extension of connective tissues around the bile ducts, and placement of the tip of laparoscope close and vertically to Calot's triangle. PMID:26107666

  4. Evaluation of perioperative cholangiography in one thousand laparoscopic cholecystectomies.

    PubMed

    Ledniczky, G; Fiore, N; Bognár, G; Ondrejka, P; Grosfeld, J L

    2006-01-01

    We analyzed a teaching institution's experience with intra-operative cholangiography (IOCG) and endoscopic retrograde cholangiopancreatography (ERCP) and established an algorithm for their timing and use. The records of all patients undergoing LC during a five year period were reviewed. Patients with a history of jaundice or pancreatitis, abnormal bilirubin, alkaline phosphatase, serum glutamic-oxaloacetic transaminase, or radiographic evidence suggestive of choledocholithiasis were considered "at risk" for common bile duct stones (CBDS). The remaining patients were considered to be at low "risk." LC was attempted on 1002 patients during the study period and successfully completed on 941 (94% of the time). The major complication rate was 3.1% and the common bile duct injury rate 0.1%. Eighty eight (9.5%) patients underwent ERCP, 67 in the preoperative period and 19 in the postoperative period. IOCG was attempted in 272 (24%) patients and completed in 234 for a success rate of 86%. Intraoperative cholangiography (IOCG) and preoperative endoscopic retrograde cholangiopancreatography (ERCP) were equivalent in the detection of CBDSs Twelve of the 21 patients (57%) with IOCG positive for stones underwent successful laparoscopic clearance of the common duct, and did not require postop. ERCP. No patients were converted to an open procedure for common bile duct exploration. Because postoperative ERCP was 100% successful in clearing the common duct, reoperation for retained common bile duct stones was not necessary. IOCG is an alternative procedure to ERCP for patients at risk with biochemical, radiological, or clinical evidence of choledocholithiasis. The incidence of CBDS in low-risk patients is 1.7%, a risk that does not warrant routine cholangiography. Preoperative ERCP is recommended in cases of cholangitis unresponsive to antibiotics, suspicion of carcinoma, and biliary pancreatitis unresponsive to supportive care. Although IOCG leads to a similar percentage of nontherapeutic studies as preoperative ERCP, it often allows for one procedure therapy. PMID:16927915

  5. Delayed laparoscopic cholecystectomy after more than 6 weeks on easily controlled cholecystitis patients

    PubMed Central

    Kwon, Jungnam

    2013-01-01

    Backgrounds/Aims There is debate on the timing of cholecystectomy in acute cholecystitis. Although there is a recent trend toward early laparoscopic cholecystectomy (eLC), that is, within 72 hours of symptom onset, some surgeons still prefer delayed operations, or operations after several weeks, expecting subsidence of the inflammation and therefore a higher chance of avoiding open conversion and minimizing complications. Our experience of LC for 10 years was reviewed retrospectively for the timing of the operation and perioperative outcomes, focusing on evaluating the feasibility of delayed LC (dLC). Methods The severity of the acute cholecystitis was classified into three grades: easily responding to antibiotics and mostly symptom-free (mild, grade I), symptoms persisting during the treatment (moderate, grade II), and worsening into a septic state (severe, grade III). Results Among 353 cholecystectomy patients, grade I (N=224) patients had eLC in 152 cases and dLC in 72 cases. Grade II (N=117) patients had eLC in 103 cases and 12 had dLC. All grade III patients (N=12) underwent open cholecystectomy. In Grade I patients, when the operation was delayed, there were fewer open conversion cases compared to eLC patients (20.45% vs 7.69%) (p<0.05), and complications also were decreased (p>0.05). Grade II patients' rate of open conversions (58.3% vs 44.2%) and complications (25.0% vs 19.5%) increased when the operations were delayed compared with eLC patients (p<0.05). In grade I and II patients, the most common reason for open conversion was bleeding, and the most common complication was also bleeding. Conclusions For patients with cholecystits that easily responds to antibiotics (grade I), dLC showed a higher laparoscopic success rate than eLC at the expense of prolonged treatment time and examinations, With moderate to severe cholecystitis (grade II, III), however, there was no room for delayed operations.

  6. Don’t cry over spilled stones? Complications of gallstones spilled during laparoscopic cholecystectomy: case report and literature review

    PubMed Central

    Patterson, Emma J.; Nagy, Alexander G.

    1997-01-01

    The gallbladder is perforated and stones are spilled more frequently during laparoscopic cholecystectomy than during open cholecystectomy. Recent reports have implicated spilled gallstones as a source of infrequent but serious complications of laparoscopic cholecystectomy. They can cause serious morbidity, and in most cases the patient will require open surgery for management of these complications. The authors report the case of a patient who was ill for 14 months after laparoscopic cholecystectomy when spilled stones formed a nidus for intra-abdominal abscess and colocutaneous fistula. Every effort must be made to prevent gallbladder perforation. When it does occur, all stones should be retrieved. Attempts at repairing gallbladder perforations are often unsatisfactory. A simple solution to this potential problem is to retrieve all stones immediately, place them in an intraperitoneal specimen bag, and “park” the bag on the liver. As soon as the gallbladder is dissected off the liver it should be placed in the specimen bag with the stones and removed through the umbilical port opening. PMID:9267300

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

    PubMed Central

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

    2015-01-01

    Bilateral salpingo-oophorectomy (BSO) in carriers of BRCA1 and BRCA2 mutations is widely recommended as part of a risk-reduction strategy for ovarian or breast cancer due to an underlying genetic predisposition. BSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. BSO may be performed via a minimally invasive approach with the use of three to four 5 mm and/or 12 mm ports inserted through a skin incision. To further reduce the morbidity associated with the placement of multiple port sites and to improve cosmetic outcomes, single-port laparoscopy has been developed with a single access point from the umbilicus. The purpose of this study was to evaluate the surgical outcomes associated with reducing the risks of salpingo-oophorectomy performed in a single port, while comparing multiport laparoscopy in women with a high risk for ovarian cancer. Single-port laparoscopy–BSO is feasible and safe, with favorable surgical and cosmetic outcomes when compared to conventional laparoscopy. PMID:26170692

  8. Accidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy: a case report

    PubMed Central

    2011-01-01

    Introduction Unintentional ingestion of a toothpick is not an uncommon event. Often the ingested toothpicks spontaneously pass through the gut without sequelae. However, serious complications can happen when these sharp objects migrate through the gastrointestinal wall. Case presentation In the current report, we describe the case of a 37-year-old Caucasian woman with an incidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy for symptomatic gall stones. Conclusion Toothpick ingestion is not an uncommon event and can predispose patients to serious complications. In this particular case, the toothpick was only discovered at the time of unrelated surgery. Therefore, it was important during surgery to exclude any related or missed injury to the adjacent structures by this sharp object. PMID:21878119

  9. Laparoscopic cholecystectomy for acalculous cholecystitis in a neutropenic patient after chemotherapy for acute lymphoblastic leukemia

    PubMed Central

    Ejduk, Anna; Wróblewski, Tadeusz; Szczepanik, Andrzej B.

    2014-01-01

    Acute acalculous cholecystitis (ACC) is most frequently reported in critically ill patients following sepsis, extensive injury or surgery. It is rather uncommon as a chemotherapy-induced complication, which is usually life-threatening in neutropenic patients subjected to myelosuppressive therapy. A 23-year-old patient with acute lymphoblastic leukemia was subjected to myelosuppressive chemotherapy (cyclophosphamide, cytarabine, pegaspargase). After the first chemotherapy cycle the patient was neutropenic and feverish; she presented with vomiting and pain in the right epigastrium. Ultrasound demonstrated an acalculous gallbladder with wall thickening up to 14 mm. The ACC was diagnosed. Medical therapy included a broad spectrum antibiotic regimen and granulocyte-colony stimulating factors. On the second day after ACC diagnosis the patient's general condition worsened. Laparoscopic cholecystectomy was performed. The resected gallbladder showed no signs of bacterial or leukemic infiltrates. The postoperative course was uneventful. In the management of neutropenic patients with ACC surgical treatment is as important as pharmacological therapy. PMID:25337176

  10. Outpatient Laparoscopic Cholecystectomy: Patient Outcomes After Implementation of a Clinical Pathway

    PubMed Central

    Calland, J. Forrest; Tanaka, Koji; Foley, Eugene; Bovbjerg, Viktor E.; Markey, Donna W.; Blome, Sonia; Minasi, John S.; Hanks, John B.; Moore, Marcia M.; Young, Jeffery S.; Jones, R. Scott; Schirmer, Bruce D.; Adams, Reid B.

    2001-01-01

    Objective To determine the success of a clinical pathway for outpatient laparoscopic cholecystectomy (LC) in an academic health center, and to assess the impact of pathway implementation on same-day discharge rates, safety, patient satisfaction, and resource utilization. Summary Background Data Laparoscopic cholecystectomy is reported to be safe for patients and acceptable as an outpatient procedure. Whether this experience can be translated to an academic health center or larger hospital is uncertain. Clinical pathways guide the care of specific patient populations with the goal of enhancing patient care while optimizing resource utilization. The effectiveness of these pathways in achieving their goals is not well studied. Methods During a 12-month period beginning April 1, 1999, all patients eligible for an elective LC (n = 177) participated in a clinical pathway developed to transition LC to an outpatient procedure. These were compared with all patients undergoing elective LC (n = 208) in the 15 months immediately before pathway implementation. Successful same-day discharges, reasons for postoperative admission, readmission rates, complications, deaths, and patient satisfaction were compared. Average length of stay and total hospital costs were calculated and compared. Results After pathway implementation, the proportion of same-day discharges increased significantly, from 21% to 72%. Unplanned postoperative admissions decreased as experience with the pathway increased. Patient characteristics, need for readmission, complications, and deaths were not different between the groups. Patients surveyed were highly satisfied with their care. Resource utilization declined, resulting in more available inpatient beds and substantial cost savings. Conclusions Implementation of a clinical pathway for outpatient LC was successful, safe, and satisfying for patients. Converting LC to an outpatient procedure resulted in a significant reduction in medical resource use, including a decreased length of stay and total cost of care. PMID:11323509

  11. Effect of Transversus Abdominis Plane Block on Cost of Laparoscopic Cholecystectomy Anesthesia

    PubMed Central

    Kokulu, Serdar; Bak?, Elif Do?an; Kaçar, Emre; Bal, Ahmet; ?enay, Hasan; Üstün, Kübra Demir; Y?lmaz, Sezgin; Ela, Yüksel; S?vac?, Remziye Gül

    2014-01-01

    Background Use of transversus abdominis plane (TAP) block for postoperative analgesia is continuously increasing. However, few studies have investigated intraoperative effects of TAP block. We aimed to study the effects of TAP block in terms of cost-effectiveness and consumption of inhalation agents. Material/Methods Forty patients undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomly divided into 2 groups: Group 1 (n=20) patients received TAP block and Group 2 (n=20) patients did not receive TAP block. Standard anesthesia induction was used in all patients. For the maintenance of anesthesia, fractional inspired oxygen (FIO2) of 50% in air with desflurane was used with a fresh gas flow of 4 L/min. All patients were monitored with electrocardiography and for peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ET), heart rate (HR), noninvasive mean blood pressure (MBP), and bispectral index (BIS). Bilateral TAP blocks were performed under ultrasound guidance to Group 1 patients. The BIS value was maintained at between 40 and 50 during the surgery. The Dion formula was used to calculate consumption of desflurane for each patient. Results There was no difference between the groups with respect to demographic characteristics of the patients. Duration of anesthesia, surgery time, and dosage of fentanyl were similar in the 2 groups. However, the cost and consumption of desflurane was significantly lower in Group 1. Conclusions Total anesthesia consumption was lower and the cost-effectiveness of anesthesia was better in TAP block patients with general anesthesia than in non-TAP block patients undergoing laparoscopic cholecystectomy. PMID:25534331

  12. Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholithiasis

    Microsoft Academic Search

    Maurice E. Arregui; Chad J. Davis; Alan M. Arkush; Robert F. Nagan

    1992-01-01

    Six hundred twenty-two laparoscopic cholecystectomies were performed at St. Vincent Hospital over a 14-month period. We reviewed the records of 366 of these patients who were referred to the authors. Thirty-six patients had suspected choledocholithiasis. The primary author (M.E.A.) performed 38 endoscopic retrograde cholangiopancreatography (ERCPs) on these patients for diagnosis and management. Seventeen of the 36 patients had common bile

  13. Endoscopic Sphincterotomy Using the Rendezvous Technique for Choledocholithiasis during Laparoscopic Cholecystectomy: A Case Report.

    PubMed

    Tanaka, Takayuki; Haraguchi, Masashi; Tokai, Hirotaka; Ito, Shinichiro; Kitajima, Masachika; Ohno, Tsuyoshi; Onizuka, Shinya; Inoue, Keiji; Motoyoshi, Yasuhide; Kuroki, Tamotsu; Kanemastu, Takashi; Eguchi, Susumu

    2014-05-01

    A 50-year-old male was examined at another hospital for fever, general fatigue and slight abdominal pain. He was treated with antibiotics and observed. However, his symptoms did not lessen, and laboratory tests revealed liver dysfunction, jaundice and an increased inflammatory response. He was then admitted to our hospital and underwent an abdominal computed tomography scan and magnetic resonance cholangiopancreatography (MRCP), which revealed common bile duct (CBD) stones. He was diagnosed with mild acute cholangitis. As the same time, he was admitted to our hospital and an emergency endoscopic retrograde cholangiopancreatography was performed. Vater papilla opening in the third portion of the duodenum and presence of a peripapillary duodenal diverticulum made it difficult to perform cannulation of the CBD. In addition, MRCP revealed that the CBD was extremely narrow (diameter 5 mm). We therefore performed laparoscopic cholecystectomy and endoscopic sphincterotomy using the rendezvous technique for choledocholithiasis simultaneously rather than laparoscopic CBD exploration. After the operation, the patient was discharged with no complications. Although the rendezvous technique has not been very commonly used because several experts in the technique and a large operating room are required, this technique is a very attractive and effective approach for treating choledocholithiasis, for which endoscopic treatment is difficult. PMID:25298761

  14. The Eindhoven laparoscopic cholecystectomy training course—improving operating room performance using virtual reality training: results from the first E.A.E.S. accredited virtual reality trainings curriculum

    Microsoft Academic Search

    M. P. Schijven; J. J. Jakimowicz; I. A. M. J. Broeders; L. N. L. Tseng

    2005-01-01

    Background: This study was undertaken to investigate operating room performance of surgical residents, after participating in the Eindhoven virtual reality laparoscopic cholecystectomy training course. This course is the first formal surgical resident trainings course, using a variety of complementary virtual reality (VR) skills training simulation in order to prepare surgical residents for their first laparoscopic cholecystectomy. The course was granted

  15. Suprapubic transvesical single-port technique for control of lower end of ureter during laparoscopic nephroureterectomy for upper tract transitional cell carcinoma

    PubMed Central

    Ahlawat, Rajesh K.; Gautam, Gagan

    2011-01-01

    Context: Various minimally invasive techniques – laparoscopic, endoscopic or combinations of both - have been described to handle the lower ureter during laparoscopic nephroureterectomy but none has received wide acceptance. Aims: We describe an endoscopic technique for the management of lower end of ureter during laparoscopic nephroureterectomy using a single suprapubic laparoscopic port. Materials and Methods: Transurethral resectoscope is used to make a full thickness incision in the bladder cuff around the ureteric orifice from 1 o’clock to 11 o’clock. A grasper inserted through the transvesical suprapubic port is used to retract the ureter to complete the incision in the bladder cuff overlying the anterior aspect of the ureteric orifice. The lower end of ureter is subsequently sealed with a clip applied through the port. This is followed by a laparoscopic nephrectomy and the specimen is removed by extending the suprapubic port incision. Our technique enables dissection and control of lower end of ureter under direct vision. Moreover, surgical occlusion of the lower end of the ureter prior to dissection of the kidney may decrease cell spillage. The clip also serves as a marker for complete removal of the specimen. Results: Three patients have undergone this procedure with an average follow up of 19 months. Operative time for the management of lower ureter has been 35, 55 and 40 minutes respectively. A single recurrence was detected on the opposite bladder wall after 9 months via a surveillance cystoscopy. There has been no residual disease or any other locoregional recurrence. Conclusions: The described technique for management of lower end of ureter during laparoscopic nephroureterectomy adheres to strict oncologic principles while providing the benefit of a minimally invasive approach. PMID:21814308

  16. Laparoscopic ultrasonography as a good alternative to intraoperative cholangiography (IOC) during laparoscopic cholecystectomy: results of prospective study.

    PubMed

    Hublet, A; Dili, A; Lemaire, J; Mansvelt, B; Molle, G; Bertrand, C

    2009-01-01

    Intraoperative cholangiography (IOC), used routinely or selectively, is the standard method for bile duct imaging during cholecystectomy. Laparoscopic ultrasonography (LUS) has emerged as a possible, safe and quick alternative. This study examined the evolving use and the performance of these two methods as primary technique for routine bile duct imaging, so as to detect common bile duct stones (CBDS) and to prevent common bile duct injury (CBDI). A prospective database permitted to evaluate the results of the two methods in 968 consecutive cholecystectomies. Nine hundered and twenty five were performed by laparoscopy, 18 (1.9%) by laparotomy and 25 (2.6) necessitated a conversion. The systematic use of the IOC was gradually replaced by a systematic use of the LUS. The success to delineate and evaluate the CBD, the detection of a CBDS, any type of bile duct complication, especially of CBDI, were registered. All the CBDS suspected by LUS were controlled by IOC. The patients were followed during 1 and 6 months. Six hundred and eighty five IOC and 269 LUS were performed. The procedure was technically unsuccessful in 35 IOC (5.1%) (mainly due to difficulty in catheterising the cystic duct) and in 2 LUS (1%) (due to steatosis). Concerning the detection of CBDS, 31 were detected by IOC (4.5%) and 16 by LUS (6%). Five IOC were considered as false positive, 1 as false negative (sensitivity and specificity of 96,9 and 99,2%) and 1 LUS as false positive (sensitivity and specificity of 100 and 99,6%). Five CBDI were detected in the complete seria: 2 during the dissection before the IOC, 1 thermic injury, 1 late stenosis, 1 lateral stenosis by the cystic clip detected by LUS. However none of these CBDI could have been prevented by IOC. In our experience, in this prospective study, LUS has been certainly as effective as IOC as a primary imaging technique for bile duct. It permitted to detect CBDS with a high specificity and sensitivity, and CBDS and was not followed by an increase in CBDI. PMID:19943585

  17. A risk score to predict the difficulty of elective laparoscopic cholecystectomy

    PubMed Central

    Rado?ak, Jozef

    2014-01-01

    Introduction Several preoperative scoring systems have been proposed to predict the difficulty of laparoscopic cholecystectomy in order to optimize the results of surgical treatment by either selection of patients for the procedure or providing an adequately experienced surgical team for a given patient. Nevertheless, none of them has achieved significant penetration into everyday practice. Aim To propose and validate a novel risk score based on the patient's history, physical examination and abdominal ultrasonography parameters. Material and methods The risk score was defined by the presence of the following risk factors: male sex, biliary colic within the last 3 weeks prior to surgery, history of acute cholecystitis treated conservatively, previous upper abdominal surgery, right upper quadrant pain, rigidity in right upper abdomen and ultrasonographic parameters – thickening of the gallbladder wall ? 4 mm, hydropic gallbladder (diameter exceeding 4.5 cm) and shrunken gallbladder. One point was allocated for each risk factor, except for previous upper abdominal surgery, which scored two. Difficulty of the surgery was assessed by operating time (OT) and the postoperative subjective evaluation score (PSES). Results Five hundred and eighty-six consecutive patients were enrolled in the prospective observational study. A significant linear correlation was observed between the risk score and measures of difficulty employed. Five levels of difficulty were defined (score 0, 1, 2, 3, ? 4) with significant differences in OT, PSES and conversion rates (p < 0.001). Conclusions The suggested risk score is designed as a simple and reliable predictive model, possibly effective to overcome the negative effect of the individual proficiency gain curve and/or to select ‘easy’ cases for day surgery, single incision laparoscopic surgery or natural orifice translumenal endoscopic surgery procedures. PMID:25562000

  18. Early Laparoscopic Cholecystectomy with Continuous Pressurized Irrigation and Dissection in Acute Cholecystitis

    PubMed Central

    Ozsan, I.; Yoldas, O.; Karabuga, T.; Y?ld?r?m, U. M.; Cetin, H. Y.; Alpdo?an, O.; Aydin, U.

    2015-01-01

    Background. The aim of this study was to evaluate the preliminary results of a new dissection technique in acute cholecystitis. Material and Method. One hundred and forty-nine consecutive patients with acute cholecystitis were operated on with continuous pressurized irrigation and dissection technique. The diagnosis of acute cholecystitis was based on clinical, laboratory, and radiological evidences. Age, gender, time from symptom onset to hospital admission, operative risk according to the American Society of Anesthesiologists (ASA) score, white blood cell count, C-reactive protein test levels, positive findings of radiologic evaluation of the patients, operation time, perioperative complications, mortality, and conversion to open surgery were prospectively recorded. Results. Of the 149 patients, 87 (58,4%) were female and 62 (41,6%) were male. The mean age was 46.3 ± 6.7 years. The median time from symptom onset to hospital admission 3.2 days (range, 1–6). There were no major complications such as bile leak, common bile duct injury or bleeding. Subhepatic liquid collection occurred in 3 of the patients which was managed by percutaneous drainage. Conversion to open surgery was required in four (2,69%) patients. There was no mortality in the study group. Conclusion. Laparoscopic cholecystectomy with continuous pressurized irrigation and dissection technique in acute cholecystitis seems to be an effective and reliable procedure with low complication and conversion rates. PMID:25810716

  19. Usefullness of the ultrasonically activated scalpel in laparoscopic cholecystectomy: our experience and review of literature.

    PubMed

    Minutolo, V; Gagliano, G; Rinzivillo, C; Li Destri, G; Carnazza, M; Minutolo, O

    2008-05-01

    Laparoscopic cholecystectomy (LC) actually represents the most used and proper treatment for gallbladder lithiasis, because its many and known advantages in comparison with 'open' abdominal surgery. But there are some problems during and after LC due to the use of the electric scalpel and these have brought to the search of an alternative system of dissection and coagulation. The ultrasonically activated scalpel (Harmonic Scalpel, HS) allows to perform dissection and coagulation with a minimal thermal side effect for surrounding tissues, unlike the electrocoagulation. Furthermore, the use of the HS brings a series of advantages in comparison to the other electromagnetic forms of energy (electro-scalpel, laser). HS cuts and coagulates with the same effectiveness of the electro-scalpel but, unlike this, it doesn't introduce risks of wandering currents. Moreover, HS contributes to have a more clean and clear (smokes-free) field of operation and it reduces the operative time, the bleeding and the costs of the operation without an increase of the complications and of the percentages of 'open' conversion, and perhaps leads to a less negative influence on the postoperative systemic immune response. The Authors report their experience that confirm these observations, according also with results reported in a brief review of the recent scientific literature, and support wider diffusion and technical development of this ultrasonically-operating surgical team. PMID:18507962

  20. Epidural anesthesia for laparoscopic cholecystectomy in a patient with sickle cell anemia, beta thalassemia, and Crohn's disease -A case report-

    PubMed Central

    Özlü, Onur

    2012-01-01

    A 37-year-old woman diagnosed with sickle cell anemia (SCA), beta (+) thalassemia, Crohn's disease, and liver dysfunction was scheduled for laparoscopic cholecystectomy (LC) due to acute cholecystitis with gall bladder. Regional anesthesia was performed. An epidural catheter was inserted into the 9-10 thoracal epidural space and then 15 ml of 0.5% bupivacaine was injected through the catheter. The level of sensorial analgesia tested with pinprick test reached up to T4. Here we describe the first case of the combination of sickle cell anemia (SCA), beta (+) thalassemia, and Crohn's disease successful anesthetic management with attention to hemodynamics, particularly with regards to liver dysfunction. PMID:23115690

  1. Primary access-related complications in laparoscopic cholecystectomy via the closed technique: experience of a single surgical team over more than 15 years

    Microsoft Academic Search

    Prakash Kumar Sasmal; Om Tantia; Mayank Jain; Shashi Khanna; Bimalendu Sen

    2009-01-01

    Background  Laparoscopic cholecystectomy (LC), a common laparoscopic procedure, is a relatively safe invasive procedure, but complications\\u000a can occur at every step, starting from creation of the pneumoperitoneum. Several studies have investigated procedure-related\\u000a complications, but the primary access- or trocar-related complications generally are underreported, and their true incidence\\u000a may be higher than studies show. Major vascular or visceral injury resulting from blind

  2. A rare condition: Ectopic liver tissue with its unique blood supply encountered during laparoscopic cholecystectomy

    PubMed Central

    Bal, Ahmet; Yilmaz, Sezgin; Yavas, Betul Demirciler; Ozdemir, Cigdem; Ozsoy, Mustafa; Akici, Murat; Kalkan, Mustafa; Ersen, Ogun; Saripinar, Baris; Arikan, Yuksel

    2015-01-01

    Introduction Developmental abnormalities of liver including ectopic liver tissue (ELT) are rare conditions. Few cases presenting ELT have been reported in literature till now. Even though the most common area seen is gallbladder, it is detected both abdominal and thoracic sites. There is a relationship between HCC and ectopic liver that necessitates the removal. Presentation of case A 51-year-old female was hospitalized because of abdominal pain. Gallstone and bile duct dilatation were determined during ultrasonographic (USG) evaluation. The patient was operated for cholecystectomy following a successful endoscopic retrograde cholangiopancreatography (ERCP). During operation, a mass located on gallbladder with its unique vascular support was identified and resected together with gallbladder. The mass had a separate vascular stalk arising from liver parenchyma substance and it was clipped with laparoscopic staples. The histopathological examination revealed that the mass adherent to gallbladder was ectopic liver confirming the intraoperative observation. The postoperative course of patient was uneventfull and she was discharged at the second day after the operation. Discussion Ectopic liver tissue is incidentally found both in abdominal and thoracic cavity. ELT can rarely be diagnosed before surgical procedures or autopsies. It can be overlooked easily by radiological techniques. Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. ELT also has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. Conclusion Although ELT is rarely seen, it should be removed when recognized in order to prevent the complications and malignant transformation. PMID:25723748

  3. Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

    PubMed Central

    Ismail, Eman A.; Ibrahim, Ahmed

    2015-01-01

    Background Postoperative nausea and vomiting (PONV) are common following laparoscopic cholecystectomy (LC). Dexamethasone has been reported to reduce PONV. However, there is insufficient evidence regarding the effect of dexmedetomidine in decreasing PONV. This study was designed to compare the effects of a single dose of dexmedetomidine to dexamethasone for reducing PONV after LC. Methods Eighty-six adult patients scheduled for LC were randomized to receive either single dose 1 µg/kg of dexmedetomidine (Dexmed group, N = 43) or 8 mg dexamethasone (Dexa group, N = 43) before skin incision. During the first 24 h postoperatively, the incidence and severity of PONV were assessed. Pain and sedation scores were assessed on arrival in the recovery room and early postoperatively. Analgesic and antiemetic consumption during the 24 h after surgery were calculated. Intra-operative and postoperative hemodynamics were recorded. Results Twenty-one percent of the patients in the Dexmed group developed PONV compared to 28% in the Dexa group (P = 0.6). Severity of PONV was similar between the two groups (P = 0.07). Early postoperatively, pain severity was significantly lower in the Dexmed group, but sedation scores were significantly higher. The first analgesic request was significantly delayed in the Dexmed group (P = 0.02). The total amounts of intraoperative fentanyl and postoperative tramadol administered were significantly lower in the Dexmed group. No difference in ondansetron was noted between the two groups. Mean arterial pressure and heart rate were significantly lower in the Dexmed group after administration of dexmedetomidine. No major side effects were reported. Conclusions Dexmedetomidine reduces the incidence and severity of PONV, similar to dexamethasone. It is superior to dexamethasone in reducing postoperative pain and total analgesic consumption during the first 24 h after LC.

  4. A Rare Case of Biliary Leakage After Laparoscopic Cholecystectomy–Diagnostic Evaluation and Nonsurgical Treatment: a Case Report

    PubMed Central

    Mehmedovic, Zlatan; Mehmedovic, Majda; Hasanovic, Jasmin

    2015-01-01

    Although laparoscopic cholecystectomy has become a gold standard in treatment of symptomatic cholelithiasis, it is associated with higher risk of intraoperative lesions and primarily lesions of biliary ducts. In small percentage of cases biliary fistulas occur, most commonly after leakage from cystic duct stump or accessory bile ducts – Luschka’s duct. We report of a patient who had episodes of abdominal pain following routine laparoscopic cholecystectomy for acute calculous gallbladder. Results of conducted diagnostics verify the presence of biliary fistula caused by obstruction of bile pathways by stagnant pus and microcalculi of common bile duct, with development of biloma presumably caused by pressure injection of contrast material during ERCP procedure. Endoscopic sphincterectomy via ERCP enabled healing of formed biliary fistula, whilst continuous percutaneous ultrasound guided drainage of biloma was method of choice in later treatment of our patient. It is important to note that diagnostic evaluation of biliary fistula is very challenging and that timely nonsurgical treatment is of great benefit for patient. PMID:26005280

  5. A rare case of biliary leakage after laparoscopic cholecystectomy-diagnostic evaluation and nonsurgical treatment: a case report.

    PubMed

    Mehmedovic, Zlatan; Mehmedovic, Majda; Hasanovic, Jasmin

    2015-04-01

    Although laparoscopic cholecystectomy has become a gold standard in treatment of symptomatic cholelithiasis, it is associated with higher risk of intraoperative lesions and primarily lesions of biliary ducts. In small percentage of cases biliary fistulas occur, most commonly after leakage from cystic duct stump or accessory bile ducts - Luschka's duct. We report of a patient who had episodes of abdominal pain following routine laparoscopic cholecystectomy for acute calculous gallbladder. Results of conducted diagnostics verify the presence of biliary fistula caused by obstruction of bile pathways by stagnant pus and microcalculi of common bile duct, with development of biloma presumably caused by pressure injection of contrast material during ERCP procedure. Endoscopic sphincterectomy via ERCP enabled healing of formed biliary fistula, whilst continuous percutaneous ultrasound guided drainage of biloma was method of choice in later treatment of our patient. It is important to note that diagnostic evaluation of biliary fistula is very challenging and that timely nonsurgical treatment is of great benefit for patient. PMID:26005280

  6. The Effect of Single-Dose Administration of Dexamethasone on Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy

    PubMed Central

    Mohtadi, Ahmadreza; Nesioonpour, Sholeh; Salari, Amir; Akhondzadeh, Reza; Masood Rad, Babak; Aslani, Seyed Mohammad Mehdi

    2014-01-01

    Background: Postoperative pain is considered as a reason of patient’s delay in discharge and disability aggravation. Therefore, multimodal approaches have been suggested in order to mitigate pain and decrease postoperative side effects. Objectives: The aim of this study was to evaluate analgesic effect of a single dose injection of dexamethasone on reducing postoperative pain in laparoscopic cholecystectomy. Patients and Methods: In this double-blind, prospective study, 122 patients aged 18-60 years old, whom were selected for laparoscopic cholecystectomy, were classified into two case and control groups, and 61 patients were included in each group. The case (D) group underwent general anesthesia and a single- dose intravenous injection of dexamethasone. The Control (C) group received general anesthesia and intravenous injection of normal saline. Total dose of consumed meperidine and pain intensity during first 24 hours were evaluated in both groups. Results: No significant difference existed between two groups regarding age, sex, weight and operation time. Pain intensity in group D was significantly less than group C (P < 0.01) after two, six and 12 hoursof surgery. No significant difference existed in pain intensity between two groups at the beginning of and 24 hours after the surgery (P > 0.05). Meperidine consumption in group D was significantly less than group C (P < 0.05). Conclusions: Findings of present study showed that single dose of intravenous dexamethasone, led to less pain intensity and amounts of meperidine consumption, in comparison with placebo. PMID:25237639

  7. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis

    Microsoft Academic Search

    Ram M Spira; Aviran Nissan; Oded Zamir; Tzeela Cohen; Scott I Fields; Herbert R Freund

    2002-01-01

    Background: The ultimate therapy for acute cholecystitis is cholecystectomy. However, in critically ill elderly patients the mortality of emergency cholecystectomy may reach up to 30%. Open cholecystostomy performed under local anesthesia was considered to be the procedure of choice for treatment of acute cholecystitis in high-risk patients. In recent years, ultrasound- or computed tomography (CT)-guided percutaneous transhepatic cholecystostomy (PTHC) replaced

  8. Modified technique of laparoendoscopic rendezvous ERCP during laparoscopic cholecystectomy for concomitant gallstone and common bile ductal stone.

    PubMed

    Liu, Wei; Wang, Qunwei; Huang, Jiangsheng; Liu, Luyao; Li, Pengfei; Xiao, Jing; Zhao, Liying

    2014-09-01

    Laparoendoscopic rendezvous ERCP and laparoscopic cholecystectomy (LC+ERCP/LERV) is considered an optimal approach for concomitant gallstone and common bile duct stone, but this procedure could be failed due to some technical challenges. We describe a modified technique which was adopted in 32 consecutive cases and yielded good results. A Dormia basket is inserted through cystic duct to enter duodenum and grasp the guide wire which is introduced with sphincterotome through endoscope. After pulling the basket catheter and guide wire into bile duct, the selective bile duct cannulation could be achieved by advancing sphinterotome over guide wire. An atraumatic clamp is also used to temporarily occlude proximal jejunum preventing diffuse bowel distention by air insufflation. The procedure was successfully performed in 31 cases(96.8%) , the mean operative time and endoscopic time were 82.6±19.6 min and 26.5±5.99min, respectively. This modified technique is safe, feasible and associated with short operative time. PMID:25436338

  9. ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure

    PubMed Central

    Jones, Maris; Johnson, Matthew; Samourjian, Edward; Slauch, Karen; Ozobia, Nathan

    2014-01-01

    Background Current treatment of complicated calculous biliary disease typically involves a two-step procedure consisting of preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Alternatively, laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) and intraoperative common bile duct exploration or ERCP at a later date may be performed. This study compared the benefits of the traditional two-step procedure to the novel one-step procedure for the management of calculous biliary disease. Methods A retrospective review of 20 patients was conducted comparing one-step to two-step procedures for the management of choledocholithiasis. We define the one-step procedure to be a laparoscopic cholecystectomy with IOC to confirm the presence or absence of stones. Intraoperative ERCP with stone extraction was conducted if necessary as part of the one-step procedure. Results A statistically significant difference existed between hospital charges for one-step ($58,145.30, SD $17,963.09) and two-step ($78,895.53, SD $21,954.78) procedures (p = 0.033). Other parameters (length of stay, preoperative days) trended toward significance; however, statistical significance was not achieved. Conclusions There appears to be a significant cost reduction with implementation of the one-step treatment of calculous biliary disease. Further research with a larger study population is necessary to determine the additional benefits of this procedure and to help augment the surgical endoscopists’ armamentarium. PMID:23239300

  10. Migration of clips after laparoscopic cholecystectomy; a case report and literature review.

    PubMed

    Ghavidel, Ali

    2015-01-01

    Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. Most of such incidents have been reported as case reports. This study reviews a case of postcholecystectomy clip migration. It can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most cases can be managed successfully with ERCP. PMID:25628854

  11. Migration of Clips after Laparoscopic Cholecystectomy; A Case Report and Literature Review

    PubMed Central

    Ghavidel, Ali

    2015-01-01

    Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. Most of such incidents have been reported as case reports. This study reviews a case of postcholecystectomy clip migration. It can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most cases can be managed successfully with ERCP. PMID:25628854

  12. Ovarian cystectomy for a dermoid cyst with the new single-port robotic system.

    PubMed

    Gungor, Mete; Kahraman, Korhan; Ozbasli, Esra; Genim, Canan

    2015-04-01

    We report a 27 year-old patient with a dermoid cyst who underwent robotic single port transumbilical ovarian cystectomy. She was operated through a 2 cm long single midline umbilical incision using a new platform from Intuitive Surgical. The operative time was 45 minutes and the docking time was 15 minutes. Ovarian cystectomy using the da Vinci single-port system is feasible and effective. This new semi-rigid robotic surgery platform may increase access to the potential advantages of single-site surgery. Robotic systems designed specifically for single port approach have the potential of alleviating several of the limitations associated with traditional laparoscopic single-site surgery. PMID:25175356

  13. Laparoscopic Cholecystectomy in Patients With Situs Inversus Totalis: Literature Review of Two Patients

    PubMed Central

    Demiryilmaz, Ismail; Yilmaz, Ismayil; Albayrak, Yavuz; Peker, Kemal; Sahin, Atalay; Sekban, Nurdan

    2012-01-01

    Situs inversus totalis is a rare condition, which presents difficulties in diagnosis and treatment of gallstones due to the reversal location of abdominal organs. In this article we present 2 cases of women in age of 51 and 55 years with situs inversus totalis and gallstones. There are described the clinical and imaging features, also the laparoscopic surgery with the difficulties encountered by right handed surgeon. In patients with situs inversus totalis, laparoscopic surgery may be performed safely by a surgeon with experience. PMID:23482252

  14. Intraoperative management of a carbon dioxide embolus in the setting of laparoscopic cholecystectomy for a patient with primary biliary cirrhosis: A case report

    PubMed Central

    Cadis, Amy Susan; Velasquez, Chelsea Diane; Brauer, Mark; Hoak, Bruce

    2014-01-01

    INTRODUCTION Carbon dioxide (CO2) embolism is a rare complication of laparoscopic cholecystectomy of which both surgeons and anesthesiologists must be aware. This paper presents a case of a CO2 embolus that occurred in a patient with primary biliary cirrhosis (PBC) and discusses the possible correlation between these two events. PRESENTATION OF CASE Our patient with PBC presented with symptomatic biliary dyskinesia and was determined to be a good candidate for laparoscopic cholecystectomy. During this routine surgery a CO2 embolus entered through the altered hepatic parenchyma and progressed to the heart leading to acute hemodynamic collapse. Rapid detection and management aided in the subsequent dissolution of the embolus and recovery of the patient. DISCUSSION In patients with PBC, pathological changes that have taken place in the liver may increase the risk of CO2 embolism. Hepatic alterations that have been previously described include increased angiogenesis and vasodilation. Prior to the operation, the most appropriate method of monitoring should be determined for patients with known liver disease. CONCLUSION Both the surgical and anesthesia team must keep in mind the potential for CO2 embolism during laparoscopic surgery. It is imperative that the medical staff be aware of the risks, signs, and subsequent management so this rare, but potentially fatal event can be managed appropriately. PMID:25462045

  15. Intraoperative ERCP: What role does it have in the era of laparoscopic cholecystectomy?

    PubMed Central

    Rábago, Luis R; Ortega, Alejandro; Chico, Inmaculada; Collado, David; Olivares, Ana; Castro, Jose Luis; Quintanilla, Elvira

    2011-01-01

    In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC), or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation, or if they are available and yield contradictory radiological and clinical results, patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS. The choice of treatment depends on the level of experience and availability of each option at each hospital. Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate, an easy learning curve, low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP). Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails. PMID:22195234

  16. Comparison of effects of intraoperative esmolol and ketamine infusion on acute postoperative pain after remifentanil-based anesthesia in patients undergoing laparoscopic cholecystectomy

    PubMed Central

    Lee, Mi Hyeon; Chung, Mi Hwa; Han, Cheol Sig; Lee, Jeong Hyun; Choi, Young Ryong; Lim, Hyun Kyung; Cha, Young Duk

    2014-01-01

    Background Remifentanil is a short-acting drug with a rapid onset that is useful in general anesthesia. Recently, however, it has been suggested that the use of opioids during surgery may cause opioid-induced hyperalgesia (OIH). Researchers have recently reported that esmolol, an ultra-short-acing ?1 receptor antagonist, reduces the postoperative requirement for morphine and provides more effective analgesia than the administration of remifentanil and ketamine. Hence, this study was conducted to determine whether esmolol reduces early postoperative pain in patients who are continuously infused with remifentanil for anesthesia during laparoscopic cholecystectomy. Methods Sixty patients scheduled to undergo laparoscopic cholecystectomy were randomly divided into three groups. Anesthesia was maintained with sevoflurane and 4 ng/ml (target-controlled infusion) of remifentanil in all patients. Esmolol (0.5 mg/kg) was injected and followed with a continuous dosage of 10 µg/kg/min in the esmolol group (n = 20). Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µg/kg/min in the ketamine group (n = 20), while the control group was injected and infused with an equal amount of normal saline. Postoperative pain score (visual analog scale [VAS]) and analgesic requirements were compared for the first 6 hours of the postoperative period. Results The pain score (VAS) and fentanyl requirement for 15 minutes after surgery were lower in the esmolol and ketamine groups compared with the control group (P < 0.05). There were no differences between the esmolol and ketamine groups. Conclusions Intraoperative esmolol infusion during laparoscopic cholecystectomy reduced opioid requirement and pain score (VAS) during the early postoperative period after remifentanil-based anesthesia. PMID:24729845

  17. Non-randomised patients in a cholecystectomy trial: characteristics, procedures, and outcomes

    Microsoft Academic Search

    Axel Ros; Per Carlsson; Mikael Rahmqvist; Karin Bäckman; Erik Nilsson

    2006-01-01

    BACKGROUND: Laparoscopic cholecystectomy is now considered the first option for gallbladder surgery. However, 20% to 30% of cholecystectomies are completed as open operations often on elderly and fragile patients. The external validity of randomised trials comparing mini-laparotomy cholecystectomy and laparoscopic cholecystectomy has not been studied. The aim of this study is to analyse characteristics, procedures, and outcomes for all patients

  18. Integration and Preliminary Evaluation of an Insertable Robotic Effectors Platform for Single Port Access Surgery

    E-print Network

    Simaan, Nabil

    Access Surgery Andrea Bajo, Roger E. Goldman, Long Wang, Dennis Fowler, and Nabil Simaan Abstract Platform (IREP) for Single Port Access Surgery (SPAS). The unique design of the IREP includes planar that the IREP meets the minimal workspace and dexterity requirements specified for laparoscopic surgery

  19. Transvaginal single-port natural orifice transluminal endoscopic surgery for benign uterine adnexal pathologies.

    PubMed

    Ahn, Ki Hoon; Song, Jae Yun; Kim, Sun Haeng; Lee, Kyu Wan; Kim, Tak

    2012-01-01

    Transvaginal natural orifice transluminal endoscopic surgery (NOTES) with pneumoperitoneum has been used in cholecystectomies, appendectomies, and nephrectomies, but transvaginal NOTES using a single port in gynecologic procedures has not been described despite gynecologist familiarity with the vaginal approach. We performed transvaginal single-port NOTES in 10 women with benign uterine adnexal disease: oophorectomy in 3 patients, salpingostomy and salpingectomy in 2 each, and ovarian cystectomy, paratubal cystectomy, and ovarian wedge resection in 1 each. The patients were discharged at 1 or 2 days postoperatively, and were satisfied, with minimal pain, no abdominal scar, and no complications at 2-month follow-up. We conclude that transvaginal single-port NOTES to treat benign uterine adnexal disease is a feasible and attractive option. PMID:22763314

  20. Anesthetic management of patient with systemic lupus erythematosus and antiphospholipid antibodies syndrome for laparoscopic nephrectomy and cholecystectomy

    PubMed Central

    Khokhar, Rashid Saeed; Baaj, Jumana; Al-Saeed, Abdulhamid; Sheraz, Motasim

    2015-01-01

    We report a case of a female having systemic lupus erythematosus and antiphospholipid antibodies syndrome, who was on immunosuppressant therapy. We discussed the preoperative evaluation and perioperative management who underwent nephrectomy and cholecystectomy. PMID:25558207

  1. True single-port appendectomy: first experience with the “puppeteer technique”

    Microsoft Academic Search

    Kurt Eric Roberts

    2009-01-01

    Background  Laparoscopic appendectomy is one of the most commonly performed minimally invasive surgeries worldwide. In recent years, successful\\u000a attempts to reduce the number of the traditionally used three ports have been reported. Specifically, two-port techniques,\\u000a hybrid approaches, and single-port assisted techniques have been described.\\u000a \\u000a \\u000a \\u000a Methods  In this case series, the author describes for the first time a successful and uncomplicated true single-port

  2. Experiences of Single Incision Cholecystectomy

    PubMed Central

    Yilmaz, Huseyin; Alptekin, Husnu; Acar, Fahrettin; Ciftci, Ilhan; Tekin, Ahmet; Sahin, Mustafa

    2013-01-01

    Purpose: Single incision laparoscopic surgery in suitable cases is preferred today because it results in less postoperative pain, a more rapid recovery period, more comfort, and a better cosmetic appearance from smaller incisions. This study aims to present our experiences with single incision laparoscopic cholecystectomy to evaluate the safety and feasibility of this procedure. Methods: A total of 150 patients who underwent single incision laparoscopic cholecystectomy between January 2009 and December 2011 were evaluated retrospectively. In this serial, two different access techniques were used for single incision laparoscopy. Results: Single incision laparoscopic cholecystectomy was performed successfully on 150 patients. Median operative time was 29 (minimum-maximum=5-66) minutes. Median duration of hospital stay was found to be 1.33 (minimum-maximum=1-8) days. Patients were controlled on the seventh postoperative day. Bilier complication was not seen in the early period. Five patients showed port site hernia complications. Other major complications were not seen in the 36-month follow-up period. Conclusion: Operation time of single incision laparoscopic cholecystectomy is significantly shortened with the learning curve. Single incision laparoscopic cholecystectomy seems a safe method. PMID:23289008

  3. Analgesia and Respiratory Function after Laparoscopic Cholecystectomy in Patients receiving Ultrasound-Guided Bilateral Oblique Subcostal Transversus Abdominis Plane Block: A Randomized Double-Blind Study

    PubMed Central

    Basaran, Betul; Basaran, Ahmet; Kozanhan, Betul; Kasdogan, Ela; Eryilmaz, Mehmet Ali; Ozmen, Sadik

    2015-01-01

    Background Transversus abdominis plane (TAP) block has been shown to ameliorate postoperative pain after abdominal surgery. Postoperative pain-associated respiratory compromise has been the subject of several studies. Herein, we evaluate the effect of oblique subcostal TAP (OSTAP) block on postoperative pain and respiratory functions during the first 24 postoperative hours. Material/Methods In this double-blind, randomized study, 76 patients undergoing laparoscopic cholecystectomy were assigned to either the OSTAP group (n=38) or control group (n=38). Bilateral ultrasound-guided OSTAP blocks were performed with 20 ml 0.25% bupivacaine after induction of general anesthesia. Both the OSTAP and control groups were treated with paracetamol, tenoxicam, and tramadol as required for postoperative analgesia. Visual Analog Scale (VAS) pain scores (while moving and at rest), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), arterial blood gas variables, and opioid consumption were assessed during first 24 h. Results VAS pain scores at rest and while moving were significantly lower in the OSTAP group on arrival to PACU and at 2 h postoperatively. The total postoperative tramadol requirement was significantly reduced at 0–2 h and 2–24 h in the OSTAP group. Postoperative deterioration in FEV1 and FVC was significantly less in the OSTAP group when compared to the control group (P<0.01 and P<0.05, respectively). There were no between-group differences in arterial blood gas variables. Conclusions After laparoscopic cholecystectomy, OSTAP block can provide significant improvement in respiratory function and better pain relief with lower opioid requirement. PMID:25948166

  4. Laparoscopic cholecystectomy and common bile duct stones. The utility of planned perioperative endoscopic retrograde cholangiography and sphincterotomy: experience with 63 patients.

    PubMed Central

    Graham, S M; Flowers, J L; Scott, T R; Bailey, R W; Scovill, W A; Zucker, K A; Imbembo, A L

    1993-01-01

    OBJECTIVE: Planned perioperative endoscopic retrograde cholangiography (ERC) and sphincterotomy (ES) for suspected or proven common bile duct stones (CBDS) has been attempted in 63 of 540 consecutive patients undergoing laparoscopic cholecystectomy (LC). Experience with this intervention has been studied with respect to accuracy, efficacy, and safety. SUMMARY BACKGROUND DATA: The optimal management of CBDSs in the era of LC is not defined. Methods exist for the laparoscopic manipulation of the common bile duct; however, experience is limited. Until surgeons become comfortable with this more demanding technique, ERC and ES will have a prominent role in the perioperative management of CBDSs. METHODS: A preoperative group (n = 41) included all candidates for LC with historical, biochemical, or radiologic evidence of CBDSs. A postoperative LC group (n = 22) included patients with stones diagnosed by intraoperative cholangiogram (IOC) (n = 6) or with signs or symptoms of retained, but unproven, CBDSs (n = 16). RESULTS: Thirty-six (88%) of the preoperative attempts were successful. Stones were identified in 18 cases and ES and duct clearance were achieved in all 18. In the postoperative group, ERC was successful in 21 (95%) cases. Calculi were demonstrated in 5 of 6 patients with a positive IOC and 6 of 16 with clinically suspected retained stones. ES and duct clearance were achieved in all 11 patients with documented CBDSs. Overall, ERC was accomplished in 90% of cases. Stones were identified in 51% of cases and all stones were cleared by ES. Morbidity was confined to four cases of self-limited pancreatitis (6%). There were no deaths. CONCLUSIONS: The perioperative management of CBDSs is an appealing approach for patients anticipating the benefits of LC, at least until the laparoscopic manipulation of the common bile duct becomes a more widely accepted technique. PMID:8328830

  5. Concomitant Laparoscopic Adjustable Gastric Banding and Laparoscopic Cholecystectomy in a Super-Obese Patient with Situs Inversus Totalis Who Previously Underwent Intragastric Balloon Placement

    Microsoft Academic Search

    Mustafa Taskin; Kagan Zengin; Volkan Ozben

    2009-01-01

    Laparoscopic adjustable gastric banding has been increasingly performed since its introduction in 1990. Situs inversus totalis\\u000a is a rare anomaly in which transposition of organs to the opposite side of the body occurs. Laparoscopic gastric banding in\\u000a such few patients has been reported in the literature. We discuss a super-obese patient with situs inversus totalis and asymptomatic\\u000a cholelithiasis who previously

  6. Single incision cholecystectomy using a clipless technique with LigaSure in a resource limited environment: The Bahamas experience

    PubMed Central

    Downes, Ross O.; McFarlane, Michael; Diggiss, Charles; Iferenta, James

    2015-01-01

    Background Scarless/single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It affords a superior cosmetic outcome when compared to conventional laparoscopic cholecystectomy. We examine the application of this technique using LigaSure via a clipless method. The present study looks at the experience of a single surgeon using this method with initial evaluation of the safety, feasibility, affordability, and benefits of this procedure. Methods Twenty-eight patients underwent transumbilical SILC at Doctors Hospital from January to December, 2014. The cohort included both emergency and elective patients. There was no difference in the preoperative work-up as indicated. To perform the operation, a 2–2.5-cm linear incision was made through the umbilicus and the single port platform utilized. A 10 mm 30-degree laparoscope, a 5 mm LigaSure and straight instruments were used to perform the laparoscopic cholecystectomy procedure. Results All patients except two were operated on successfully. Conversion was considered the placement of an additional epigastric/Right upper quadrant (RUQ) port. The conversion rate to standard LC was 7%. No patient was converted to open cholecystectomy. In the 28 successfully completed patients, the median duration of the operation was 38.5 min and estimated operative blood loss was 24 ml. Patients were commenced on liquid diet immediately on being fully conscious and after return to the ward with an estimated time of 6 h. The mean postoperative hospital stay was 1.4 days. Follow-up visits were conducted for all patients at 2-weeks intervals and continued for 6 weeks after surgery where possible. Two patients developed wound infections. All patients were satisfied with the good cosmetic effect of the surgery. The total satisfaction rate was 100%. Conclusions SILC is a safe and feasible technique for operating with scarless outcomes and reducing perioperative discomfort at the same time. The GelPOINTTM is a safe and feasible platform to be used. The procedure can be accomplished using regular instruments and laparoscope. Curved instruments and a bariatric length laparoscope may make the procedure easier and result in greater time saving. The addition of LigaSure™ decreases the complexity of the operation, decreases operative time and blood loss. The technique is economical in a resource-limited environment. PMID:25958050

  7. Imaging of gallbladder and biliary tract before laparoscopic cholecystectomy: comparison of intravenous cholangiography and the combined use of HASTE and single-shot RARE MR imaging.

    PubMed

    Vanbeckevoort, D; Van Hoe, L; Ponette, E; Marchal, G; Bosmans, H; De Clercq, B; Aerts, R; Baert, A L

    1997-02-01

    To compare intravenous cholangiography (i.v.c.) and magnetic resonance imaging (MRI) as preoperative imaging techniques in patients scheduled for laparoscopic cholecystectomy. Twenty patients underwent i.v.c. and MRI, 40 axial 'localizer' images were first obtained with a half-Fourier single-shot turbo spin echo (HASTE) sequence. Next, an extremely high T2-weighted rapid acquisition relaxation enhancement (RARE) acquisition (TE = 1100 msec) was used for MR cholangiography. All images obtained with i.v.c. and MRI were independently analyzed by two observers. The relative visibility of the (normal or abnormal) gallbladder (GB), cystic duct (CD), and bile ducts (BD) on both types of images was scored as follows: 1 = MRI better than i.v.c.; 2 = no difference; 3 = i.v.c. better than MRI. We observed 3 anatomic variants: 1 of the cystic duct and 2 of the intrahepatic bile ducts; 15 patients had gallstones; one had cholecystitis. Magnetic resonance images were considered more informative than i.v.c.-images for visualization of GB in 11 patients (55%), for CD in 9 patients (45%), and in 8 patients (40%) for visualization of the CBD. Intravenous cholangiography outperformed MRI in the evaluation of the CBD and CD in one patient (5%). The combined use of half-Fourier single-shot RARE and high T2-weighted RARE MR imaging is a valuable alternative to i.v.c. in the preoperative evaluation of gallbladder and biliary tract. PMID:9103705

  8. A Modified Technique Reduced Operative Time of Laparoendoscopic Rendezvous Endoscopic Retrograde Cholangiopancreatography Combined with Laparoscopic Cholecystectomy for Concomitant Gallstone and Common Bile Ductal Stone

    PubMed Central

    Liu, Wei; Wang, Qunwei; Xiao, Jing; Zhao, Liying; Huang, Jiangsheng; Tan, Zhaohui; Li, Pengfei

    2014-01-01

    Laparoendoscopic rendezvous (LERV) endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC+ERCP/LERV) are considered an optimal approach for concomitant gallstones and common bile duct stones. The rendezvous technique is essential for the success of procedure. We applied two different LERV techniques, traditional technique and modified technique, in 60 consecutive cases from January 2011 to November 2012. 32 cases who underwent modified technique (group 1) from February 2012 to November 2012 were retrospectively compared to 28 cases (group 2) who underwent traditional technique from January 2011 to January 2012. There was no significant difference between two groups with respect to preoperative demographic features. Although the difference was not statistically significant, the procedure was successfully performed in 31 cases (96.9%) in group 1 and 24 cases (86.2%) in group 2. The mean operative time and time of endoscopic part were 82.6?±?19.6?min and 26.5?±?5.99?min in group 1 which were significantly shorter than those in group 2 (118.0?±?23.1?min and 58.7?±?13.3?min, resp.). There was no postoperative pancreatitis and mortality in both groups. The mean hospital stay, blood loss, incidence of complications, and residual stone were of no difference in both groups. This study proved that this modified technique can effectively reduce the operative time and time of endoscopic part of LC+ERCP/LERV compared with traditional technique. PMID:25024701

  9. Single Port ElectroThermal Propulsion-Performance Factors

    Microsoft Academic Search

    Donald G. Johansen

    2008-01-01

    Performance models for single port ETP (Electro-Thermal Propulsion) devices are presented considering all significant efficiency factors. Single-port ETP devices, which use the nozzle exit as entrance port for beamed power, are capable of high efficiency and high thrust with low mass penalty for both propellant and structure. Previously considered parabolic nozzle shapes have operated in pulse mode to exchange energy

  10. Single Port ElectroThermal Propulsion—Performance Factors

    Microsoft Academic Search

    Donald G. Johansen

    2008-01-01

    Performance models for single port ETP (Electro-Thermal Propulsion) devices are presented considering all significant efficiency factors. Single-port ETP devices, which use the nozzle exit as entrance port for beamed power, are capable of high efficiency and high thrust with low mass penalty for both propellant and structure. Previously considered parabolic nozzle shapes have operated in pulse mode to exchange energy

  11. Single-incision laparoscopic liver resection

    Microsoft Academic Search

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

    2011-01-01

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

  12. Evaluation of the Efficacy of Methylprednisolone, Etoricoxib and a Combination of the Two Substances to Attenuate Postoperative Pain and PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Placebo-controlled Trial

    PubMed Central

    Agarwal, Amita; Das, Pravin Kumar; Agarwal, Anil; Kumar, Sanjay; Khuba, Sandeep

    2014-01-01

    Background Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. Methods One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher's exact test. P values of less than 0.05 were considered to be significant. Results Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P<0.05). The methylprednisolone + etoricoxib combination caused a significant reduction in postoperative pain and fentanyl consumption as compared to methylprednisolone or etoricoxib alone (P<0.05); however, there was no significant difference between the methylprednisolone and etoricoxib groups (P>0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P<0.05). Conclusions A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo. PMID:25031815

  13. Gallstones and cholecystectomy in modern Britain

    PubMed Central

    Bateson, M

    2000-01-01

    BACKGROUND—It has been suggested that gallstone disease is now commoner, and that this might explain an increase in cholecystectomy rates, though conclusive evidence has been lacking.?METHODS—All the non-forensic necropsy results for Dundee 1953-98 were examined to assess the prevalence of gallstone disease. The NHS Scotland annual cholecystectomy figures were extracted from their earliest availability in 1961 up to the present. The subgroup of patients from Dundee was analysed separately, as were laparoscopic procedures, which were recorded from 1991.?RESULTS—Gallstone disease was much commoner in 1974-98 than in 1953-73. Increasing age was the main determinant of gallstone disease. Though gallstone disease was commoner in women than men aged 40-89, there was no sex difference under 40 or over 90 years. Cholecystectomy became much commoner in the 1960s when frequency of gallstone disease did not change. It increased further in the 1970s, peaking in 1977-8. There was a gradual fall in rates in the 1980s when gallstone prevalence remained high. There was a further moderate rise in the 1990s after the wide introduction of laparoscopic cholecystectomy. Cholecystectomy is now much commoner in young women and this change started in the 1960s. By contrast, cholecystectomy in men has become more prevalent in the older age group.?CONCLUSIONS—Gallstones were definitely more common in both sexes at all ages over 40 in the last 25 years. Changes in the cholecystectomy rates are only partly explained by changes in gallstone prevalence, and are more determined by surgical practice.???Keywords: cholecystectomy; gallstones PMID:11060144

  14. The laparoscopic management of appendicitis and cholelithiasis during pregnancy

    Microsoft Academic Search

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

    1999-01-01

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

  15. Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: A randomized controlled study

    PubMed Central

    Akkurt, B. Cagla Ozbakis; Temiz, Muhyittin; Inanoglu, Kerem; Aslan, Ahmet; Turhanoglu, Selim; Asfuroglu, Zeynel; Canbolant, Elif

    2009-01-01

    Background:Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy. Objective: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility. Methods: Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2–2.5 mg/kg) and alfentanil (20 ?g/kg) or desflurane (4%–6%) and alfentanil (20 ?g/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale. Results: Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter in the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements in a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03). Conclusion: Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study. PMID:24683221

  16. Single Port Electro-Thermal Propulsion—Performance Factors

    NASA Astrophysics Data System (ADS)

    Johansen, Donald G.

    2008-04-01

    Performance models for single port ETP (Electro-Thermal Propulsion) devices are presented considering all significant efficiency factors. Single-port ETP devices, which use the nozzle exit as entrance port for beamed power, are capable of high efficiency and high thrust with low mass penalty for both propellant and structure. Previously considered parabolic nozzle shapes have operated in pulse mode to exchange energy at a concentrated focal region, resulting in low efficiency. The proposed cone/bell shape diffuses the focal region prior to chamber entry to allow continuous combustion inside the chamber with high efficiency. Mechanical and thermal limits are evaluated. For vacuum operation, low chamber pressure operation is possible. Thin wall thruster construction results in low chamber and nozzle mass. Further, at low pressure, regenerative cooling is needed only for the chamber and throat region with radiation cooling for the nozzle exit region. These factors permit high expansion ratio and thrust-to-weight ratio needed for performance.

  17. Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP) procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy) for the management of cholelithiasis with choledocholithiasis

    PubMed Central

    Sahoo, Manash Ranjan; Kumar, Anil T; Patnaik, Aashish

    2014-01-01

    INTRODUCTION: The ‘Rendezvous’ technique consists of laparoscopic cholecystectomy (LC) standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial. MATERIALS AND METHODS: From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In ‘group-A’,41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct (CBD) clearance and second by LC. In ‘group-B’, 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique. RESULTS: In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5%) and in arm-B in 39 cases (93%). In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22%) and severe pancreatitis in five patients (12%) versus none of the patients (0%) in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively. CONCLUSION: One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient's compliance and prevents unnecessary intervention to CBD. PMID:25013330

  18. Effectiveness of a Surgical Glove Port for Single Port Surgery

    Microsoft Academic Search

    Michihiro Hayashi; Mitsuhiro Asakuma; Koji Komeda; Yoshiharu Miyamoto; Fumitoshi Hirokawa; Nobuhiko Tanigawa

    2010-01-01

    Background  A new surgical concept, such as single port surgery (SPS), usually raises many questions regarding safety, usefulness, appropriateness,\\u000a applicability, and cost. Because many new port devices have been developed, choosing the type of port device for SPS is the\\u000a most important factor. We herein briefly report our newly developed SPS port made using a standard surgical glove.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  SPS starts with

  19. Single-Incision Cholecystectomy for Left-Sided Gallbladder

    PubMed Central

    Veenstra, Benjamin R.; Komar, Thomas M.; Richter, Harry M.

    2014-01-01

    True left-sided gallbladder (sinistroposition) is a rare anatomic anomaly in which the gallbladder is found to the left of the falciform ligament, under the left lobe of the liver. Though uncommon, it is important for the surgeon to recognize this finding because the ductal anatomy is unique and the mechanics of the operation provide a technical challenge. Multiple case reports have documented safe management of sinistroposition encountered during conventional laparoscopic cholecystectomy. We present a case of sinistroposition encountered during a single-incision laparoscopic cholecystectomy. We believe that the single-site laparoscopic technique is not only a safe option but may actually provide certain benefits in approaching this difficult anatomy in the properly selected patient and the experienced single-site surgeon's hands. PMID:24960503

  20. Management of post-cholecystectomy biliary fistula according to type of cholecystectomy

    PubMed Central

    Sultan, Ahmad M.; Elnakeeb, Ayman M.; Elshobary, Mohamed M.; El-Geidi, Ahmed A.; Salah, Tarek; El-hanafy, Ehab A.; Atif, Ehab; Hamdy, Emad; Elebiedy, Gamal K.

    2015-01-01

    Background and study aims: A study was undertaken to describe the management of post-cholecystectomy biliary fistula according to the type of cholecystectomy. Patients and methods: A retrospective analysis of 111 patients was undertaken. They were divided into open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) groups. Results: Of the 111 patients, 38 (34.2?%) underwent LC and 73 (65.8?%) underwent OC. Endoscopic retrograde cholangiopancreatography (ERCP) diagnosed major bile duct injury (BDI) in 27 patients (38.6?%) in the OC group and in 3 patients (7.9?%) in the LC group (P?=?0.001). Endoscopic management was not feasible in 15 patients (13.5?%) because of failed cannulation (n?=?3) or complete ligation of the common bile duct (n?=?12). Endoscopic therapy stopped leakage in 35 patients (92.1?%) and 58 patients (82.9?%) following LC and OC, respectively, after the exclusion of 3 patients in whom cannulation failed (P?=?0 0.150). Major BDI was more commonly detected after OC (P?

  1. Novel "glove" access port for single port surgery in right hemicolectomy: a pilot study.

    PubMed

    Day, Weida; Lau, Patrick

    2011-06-01

    The trend of single port surgery is increasing recently, and it is technically feasible for right hemicolectomy. However, the operation requires special and expensive access port for the insertion of the instruments. Day et al reported the use of a novel "glove" access port for right hemicolectomy in this pilot study. Four single port right hemicolectomies were performed by using this access port. The access port was found to be user-friendly and durable. No adverse outcome was associated with this access port. This "glove" access port is a suitable device for single port right hemicolectomy. PMID:21654290

  2. Laparoscopic cholecystectomy in situs inversus totalis with \\

    Microsoft Academic Search

    Sumihiro Kamitani; Yosihiro Tsutamoto; Kazuyoshi Hanasawa; Tohru Tani

    Abstract Abstract Abstract Abstract A 76-year-old man with known situs inversus totalis presented with left-sided discomfort. Abdominal ultrasonography and CT scan confirmed the diagnosis of a gallstone, as well as, situs inversus; the liver and gallbladder on the left side and the spleen on the right. The biliary system was thought to be left-right reversal, mirror image in the view

  3. Pediatric Cholecystectomy: Clinical Significance of Cases Unrelated to Hematologic Disorders

    PubMed Central

    Kim, Hae-Young; Kim, Soo-Hong

    2015-01-01

    Purpose Cholecystectomy is rarely performed in the child and adolescent. However, it is associated with several conditions. This study was conducted to describe the characteristics of pediatric patient who underwent cholecystectomy unrelated to hematologic disorders, and then to suggest its clinical significance in management by comparing a simple and complicated gallbladder disease. Methods We reviewed cases of cholecystectomy in pediatric patients (under 18 years old) at a single institution between January 2003 and October 2014. There were 143 cases during the study period and 24 were selected as the subject group. Results There were 7 male (29.2%) and 17 female (70.8%) patients. The mean age was 13.1 years old, and 66.6% of patients were older than 12 years. Mean body weight was 52.7 kg, and body mass index was 21.7 kg/m2, with 41.7% of patients being overweight or obese. We could identify a female predominance and high proportion of overweight or obesity in a complicated disease. There were also significantly increased levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and bilirubin in this group. Most patients (87.5%) underwent laparoscopic cholecystectomy. Conclusion Cholecystectomy for diseases unrelated to hematologic disorders is rarely performed in the child and adolescent. In general, female patients who are overweight or obese, and those older than 12 years old, require laparoscopic cholecystectomy owing to multiple gallstones. This condition has a tendency to show a complicated gallbladder disease and significantly increased levels of AST, ALT, ALP, and bilirubin.

  4. Experience with partial cholecystectomy in severe cholecystitis

    PubMed Central

    2013-01-01

    Backgrounds/Aims Partial cholecystectomy (PC) is often an inevitable operative procedure when Calot triangle is severely inflamed and fibrosed with conglomerated structures. We reviewed our clinical outcomes of PC to compare its feasibility with conventional total cholecystectomy (TC), especially for its possible application to laparoscopic procedure. Methods From Aug. 2000 to July 2008, 20 cases of PC by laparotomy were performed, including converted cases during laparoscopic cholecystectomy. Sixty-eight cases of TC by open method during the same period were compared in a mean follow-up period of 108 months. Results Bile fistula was observed in 3 cases of PC; one case needed endoscopic biliary stent for management and a second case showed fistula that closed by supportive care in 2 months. The last patient died from peritonitis. No bile fistula was observed in PC. Morbidities were found in 9 cases of PC (45%) and in 11 cases of TC (16.2%). Bile fistula (n=3) and wound infection (n=3) were prominent in the PC group, and wound infection (n=7) in the TC group. Reoperations were necessary for 5 (25.0%) and 4 (5.9%) patients from PC and TC, respectively. Mortality occurred in 2 (2/10 10%) and 4 cases (4/68 5.9%) of PC and TC, respectively. Two mortalities in each group resulted from direct extension of cholecystitis. Conclusions Considering the higher risks of complications and mortality, PC should be avoided as long as possible, and patients should always be informed of its clinical outcomes postoperatively. Further elaboration of a safer operative plan should be sought.

  5. Single-step treatment of gallbladder and bile duct stones: A combined endoscopic-laparoscopic technique

    Microsoft Academic Search

    Giuseppe Iodice; Cristiano Giardiello; Giampiero Francica; Gennaro Sarrantonio; Giovanni Angelone; Stefano Cristiano; Raffaele Finelli; Giampaolo Tramontano

    2001-01-01

    Background: The introduction of laparoscopic cholecystectomy has given rise to a debate as to whether endoscopic retrograde cholangiopancreatography (ERCP) should be performed before or after cholecystectomy in patients with bile duct stones. Methods: This study evaluated the efficacy of treatment of cholecystocholedocholithiasis in a single step by performing ERCP during surgery in 52 patients (35 women, 17 men; mean age

  6. Is single port incisionless-intracorporeal conventional equipment-endoscopic surgery feasible in patients with retrocecal acute appendicitis?

    PubMed Central

    Karakus, Suleyman Cuneyt; Koku, Naim; Ertaskin, Idris

    2013-01-01

    Purpose Since laparoscopic appendectomy was first described, various modifications, such as single port incisionless-intracorporeal conventional equipment-endoscopic surgery (SPICES), have been described for reducing pain and improving cosmetic results. In the retrocecal and retrocolic positions, attachments to the lateral peritoneum and cecum may lead to difficulties during SPICES, which is performed with only one port. Here, we present the effects of variations in the position of the vermiform appendix in treating acute appendicitis with SPICES. Methods We retrospectively reviewed 52 children who underwent SPICES for acute appendicitis between March 2010 and November 2011 in our institution. One group (group A) consisted of 30 patients (mean age, 10.5 ± 2.5 years) with retrocecal appendix, while the other group (group B) included 22 patients (mean age, 10.9 ± 2.3 years) with the appendix lying free in the peritoneal cavity. Results There were no significant differences between groups in terms of patient age, gender, success rate of SPICES, mean operating time, mean follow-up period, overall complication rates or mean postoperative hospitalization period. Conclusion These results suggest that SPICES is a safe and feasible approach even in patients with retrocecal acute appendicitis. PMID:23908965

  7. History of laparoscopic surgery.

    PubMed

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

    1992-06-01

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

  8. Anesthetic implications of laparoscopic surgery.

    PubMed Central

    Cunningham, A. J.

    1998-01-01

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

  9. Changes in T cell subsets, interleukin-6 and C-reactive protein after laparoscopic and open colorectal resection for malignancy

    Microsoft Academic Search

    B. J. Mehigan; J. E. Hartley; P. J. Drew; A. Saleh; P. C. Dore; P. W. Lee; J. R. T. Monson

    2001-01-01

      Background: Attenuation of the immune response to surgery, as demonstrated with the laparoscopic approach to cholecystectomy,\\u000a has potential benefits in patients undergoing laparoscopic colonic resection for malignancy. We aimed to study the perioperative\\u000a immune response in patients undergoing laparoscopically assisted and open surgery for colorectal cancer. Methods: This study\\u000a involved 23 patients undergoing laparoscopically assisted (n = 13) and open

  10. A Tree Based Router Search Engine Architecture With Single Port Memories

    E-print Network

    A Tree Based Router Search Engine Architecture With Single Port Memories Florin Baboescu , Dean M routers to meet speed demands. Tree-based searches are pipelined across a number of stages to achieve high is the need to provide high packet forwarding rates through the router. This paper presents a novel

  11. Complicated Gallstones after Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Sioka, Eleni; Zacharoulis, Dimitris; Zachari, Eleni; Katsogridaki, Georgia; Tzovaras, George

    2014-01-01

    Background. The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established. Methods. A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed. Results. Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3–8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwent cholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect. Conclusion. A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy. PMID:25105023

  12. Prophylactic cholecystectomy during abdominal surgery.

    PubMed

    Cabarrou, P; Portier, G; Chalret Du Rieu, M

    2013-09-01

    The presence of asymptomatic gallstones is no longer an indication for elective prophylactic cholecystectomy (PC) according to the recommendations of the 1991 French Consensus Conference on cholelithiasis. However, there may be potential benefits of performing prophylactic cholecystectomy during certain abdominal procedures for non-biliary disease; this remains a subject of debate. This debate has become livelier with the recent increase in bariatric surgery. Gastrectomy for cancer, small bowel resection, colonic resection, and splenectomy for hereditary spherocytosis as well as all bariatric surgical interventions can all alter the physiology of gallstone disease raising the question of the value of PC, but the specific morbidity of cholecystectomy must be kept in mind. The purpose of this study was to report epidemiological and pathophysiological data and the results from literature reports in order to assess the value of concomitant prophylactic cholecystectomy during various common surgical situations. PMID:23916848

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

    PubMed Central

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

    2009-01-01

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

  14. In vivo experiments of a surgical robot with vision field control for Single Port Endoscopic Surgery.

    PubMed

    Sekiguchi, Yuta; Kobayashi, Yo; Watanabe, Hiroki; Tomono, Yu; Noguchi, Takehiko; Takahashi, Yu; Toyoda, Kazutaka; Uemura, Munenori; Ieiri, Satoshi; Ohdaira, Takeshi; Tomikawa, Morimasa; Hashizume, Makoto; Fujie, Masakatsu G

    2011-01-01

    Recently, robotics systems are focused to assist in Single Port Endoscopic Surgery (SPS). However, the existing system required a manual operation of vision and viewpoint, hindering the surgical task. We proposed a surgical endoscopic robot for SPS with dynamic vision control, the endoscopic view being manipulated by a master controller. The prototype robot consists of a manipulator for vision control, and dual tool tissue manipulators (gripping: 5DOFs, cautery: 3DOFs) can be attached at the tip of sheath manipulator. In particular, this paper focuses on an in vivo experiment. We showed that vision control in the stomach and a cautery task by a cautery tool could be effectively achieved. PMID:22255961

  15. Hybrid DynaCT scan-guided localization single-port lobectomy.

    PubMed

    Ng, Calvin S H; Man Chu, Cheuk; Kwok, Micky W T; Yim, Anthony P C; Wong, Randolph H L

    2015-03-01

    Small pulmonary lesions can be difficult to locate intraoperatively. Preoperative CT scan-guided localization, for example with hookwire, is a popular method to help localize such lesions. However, the delay between CT scan localization with hookwire and surgery can lead to risks of pneumothorax and wire dislodgement. We describe a 56-year-old woman who underwent DynaCT-guided hookwire localization of a ground-glass opacity in the hybrid operating room followed immediately by single-port video-assisted thoracic surgery lobectomy. The advantages, disadvantages, and special considerations in adopting this approach are discussed. PMID:25732474

  16. Management of giant hepatic cysts in the laparoscopic era

    PubMed Central

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

    2013-01-01

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

  17. Design of a surgical robot with dynamic vision field control for Single Port Endoscopic Surgery.

    PubMed

    Kobayashi, Yo; Sekiguchi, Yuta; Tomono, Yu; Watanabe, Hiroki; Toyoda, Kazutaka; Konishi, Kozo; Tomikawa, Morimasa; Ieiri, Satoshi; Tanoue, Kazuo; Hashizume, Makoto; Fujie, Masaktsu G

    2010-01-01

    Recently, a robotic system was developed to assist Single Port Endoscopic Surgery (SPS). However, the existing system required a manual change of vision field, hindering the surgical task and increasing the degrees of freedom (DOFs) of the manipulator. We proposed a surgical robot for SPS with dynamic vision field control, the endoscope view being manipulated by a master controller. The prototype robot consisted of a positioning and sheath manipulator (6 DOF) for vision field control, and dual tool tissue manipulators (gripping: 5DOF, cautery: 3DOF). Feasibility of the robot was demonstrated in vitro. The "cut and vision field control" (using tool manipulators) is suitable for precise cutting tasks in risky areas while a "cut by vision field control" (using a vision field control manipulator) is effective for rapid macro cutting of tissues. A resection task was accomplished using a combination of both methods. PMID:21096985

  18. Stress analysis of single port (ISB) jumper connectors for 2-, 3-, and 4-in. sizes

    SciTech Connect

    Islam, M.A.; Julyk, J.L.; Weiner, E.O. [ICF Kaiser Hanford Co., Richland, WA (United States)

    1995-05-26

    Jumper connectors are used in the Hanford site for remotely connecting jumper pipe lines in the radioactive zones. The jumper pipes are used for transporting radioactive fluids and hazardous chemicals. This report evaluates the adequacy and the integrity of the 2-, 3-, and 4-in. single-port integral seal block (ISB) jumper connector assemblies, as well as the three-way 2-in. configuration. The evaluation considers limiting forces from the piping to the nozzle. A stress evaluation of the jumper components (hook, hook pin, operating screw, nozzle and nozzle flange, and block) under operational (pressure, thermal, dead weight, and axial torquing of the jumper) and seismic loading is addressed in the report.

  19. Laparoscopic adrenalectomy

    Microsoft Academic Search

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

    1994-01-01

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

  20. Gasless single-port access endoscopic surgery in urology: minimum incision endoscopic surgery, MIES.

    PubMed

    Kihara, Kazunori; Kawakami, Satoru; Fujii, Yasuhisa; Masuda, Hitoshi; Koga, Fumitaka

    2009-10-01

    Abstract Minimum incision endoscopic surgery (MIES) is a gasless, single-port access, cost-effective, and minimally invasive surgery that has been in development since the late 1990s. Use of MIES has steadily increased in Japan and Asia and has been introduced into Europe and the USA. In 2006, MIES was certified by the Japanese government as an advanced surgery and since 2008 it has been covered by the Japanese universal health insurance system as a new surgical technique. Briefly, MIES involves an initial minimum incision (a single port) that permits extraction of the target specimen. A wide working space through the port is then made by separating the anatomical plane extraperitoneally. This is maintained with special retractors instead of gas insufflation. All instruments including an endoscope are inserted through the port and the operation is completed. The size of the port can be tailored to the situation if necessary, which contributes to preclusion of patient selection. The procedure uses only two disposable devices that are inexpensive, resulting in low equipment costs. Surgeons have the benefits of magnified vision through endoscopy as well as stereovision and panoramic vision of naked eyes through the port, which reduces the technical demands of the procedure. Techniques for two basic MIES procedures allow MIES to be performed for most urological organs and in extraordinary cases by their modifications. Thus, the MIES system permits minimally invasive surgery without use of CO(2) gas, which is ideal from medical, environmental and economic perspectives, is cost-effective and minimizes patient selection. PMID:19694839

  1. Review. Laparoscopic appendicectomy: current status.

    PubMed Central

    Memon, M. A.

    1997-01-01

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

  2. Laparoscopic antegrade sphincterotomy. A new technique for the management of complex choledocholithiasis.

    PubMed Central

    Curet, M J; Pitcher, D E; Martin, D T; Zucker, K A

    1995-01-01

    OBJECTIVE: Laparoscopic antegrade sphincterotomy represents a new technique that expands the ability of the surgeon to manage complex choledocholithiasis at the time of laparoscopic cholecystectomy. The authors describe their experience with six patients with cholelithiasis and complex common bile duct stone disease who underwent successful laparoscopic cholecystectomy and antegrade sphincterotomies. SUMMARY BACKGROUND DATA: Patients with complex choledocholithiasis have represented a technical challenge to the minimally invasive surgeon. Recently, a laparoscopic technique of antegrade biliary sphincterotomy has been reported by DePaulo in Brazil. This technique has been successful at clearing the common bile duct at the time of laparoscopic cholecystectomy. METHODS: Laparoscopic antegrade sphincterotomy was performed in six patients with multiple common bile duct stones. A standard endoscopic sphincterotome was introduced antegrade via the cystic duct or common bile duct and guided through the ampulla. A side-viewing duodenoscope was used to confirm proper positioning of the sphincterotome. Then a blended current was applied until the sphincterotomy was complete. RESULTS: There was no mortality or morbidity associated with laparoscopic antegrade sphincterotomy. The mean additional operative time to complete laparoscopic antegrade sphincterotomy was 19 minutes. Three of the six patients were noted to have transient, asymptomatic elevation in serum amylase levels immediately after surgery (average 252 international units/L; normal < 115), which normalized within 72 hours. The mean postoperative hospital stay was 2.9 days. At a mean follow-up of 5 months (range 1 to 10 months), five patients remain asymptomatic. One individual with acquired immune deficiency syndrome had persistent symptoms, and a diagnosis of cytomegalovirus pancreatitis was eventually made. CONCLUSIONS: Laparoscopic antegrade sphincterotomy appears to be a safe and effective technique for the management of complex biliary tract disease. Images Figure 1. Figure 2. Figure 4.,Figure 5.,Figure 6. PMID:7857142

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

    PubMed

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

    2013-01-01

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

  4. Quick Cooling and Filling Through a Single Port for Cryogenic Transfer Operations

    NASA Technical Reports Server (NTRS)

    Jones, J. R.; Fesmire, James E.; MacDowell, L. G. (Technical Monitor)

    2001-01-01

    Improved technology for the efficient transfer of cryogens is needed for future on-orbit fueling and remote Lunar/Mars operations. The cooling and filling of a liquid nitrogen (LN2) test vessel through a single port were investigated in a series of experiments. A new 'in-space' transfer tube design concept was used to demonstrate the ability to quickly cool and load cryogens through a single feed-through connection. Three different fill tube configurations with three different diameters were tested. The tubes providing the quickest cooldown time and the quickest fill time for the test article tank were determined. The results demonstrated a clear trade-off between cooling time and filling time for the optimum tube design. This experimental study is intended to improve technology for future flight tank designs by reducing fill system size, complexity, heat leak rate, and operations time. These results may be applied to Space Shuttle Power Reactant Storage and Distribution (PRSD) System upgrades and other future applications. Further study and experimental analysis for optimization of the fill tube design are in progress.

  5. Design and Coordination Kinematics of an Insertable Robotic Effectors Platform for Single-Port Access Surgery.

    PubMed

    Ding, Jienan; Goldman, Roger E; Xu, Kai; Allen, Peter K; Fowler, Dennis L; Simaan, Nabil

    2013-10-01

    Single port access surgery (SPAS) presents surgeons with added challenges that require new surgical tools and surgical assistance systems with unique capabilities. To address these challenges, we designed and constructed a new insertable robotic end-effectors platform (IREP) for SPAS. The IREP can be inserted through a Ø15 mm trocar into the abdomen and it uses 21 actuated joints for controlling two dexterous arms and a stereo-vision module. Each dexterous arm has a hybrid mechanical architecture comprised of a two-segment continuum robot, a parallelogram mechanism for improved dual-arm triangulation, and a distal wrist for improved dexterity during suturing. The IREP is unique because of the combination of continuum arms with active and passive segments with rigid parallel kinematics mechanisms. This paper presents the clinical motivation, design considerations, kinematics, statics, and mechanical design of the IREP. The kinematics of coordination between the parallelogram mechanisms and the continuum arms is presented using the pseudo-rigid-body model of the beam representing the passive segment of each snake arm. Kinematic and static simulations and preliminary experiment results are presented in support of our design choices. PMID:23963105

  6. The First Experiences of Robotic Single-Site Cholecystectomy in Asia: A Potential Way to Expand Minimally-Invasive Single-Site Surgery?

    PubMed Central

    Lee, Sung Hwan; Jung, Myung Jae; Hwang, Ho Kyoung; Lee, Woo Jung

    2015-01-01

    Purpose Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy. Materials and Methods From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC). Results Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group. Conclusion RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease. PMID:25510764

  7. Case report: laparoscopic cholecystectomy in situs viscerum inversus.

    PubMed

    Docimo, G; Manzi, F; Maione, L; Canero, A; Veneto, F; Lo Schiavo, F; Sparavigna, L; Amoroso, V; De Rosa, M; Docimo, L

    2004-01-01

    Situs viscerum inversus is a rare condition, in which the organs are transposed from their normal location in the opposite side of the body. The inversion of L-R asymmetry may be complete (SVI totalis) or partial (SVI partialis), whereby transposition is confined to either the abdominal or thoracic viscera. The authors report a case of videolaparocholecystectomy for cholelithiasis successfully performed on a 41-year-old Caucasian woman with situs viscerum inversus totalis. The patient was discharged on the 2nd postoperative day. The symptomatology disappeared right after the intervention, and still now, after a follow-up of six months, is absent. The procedure was safely performed on the patient with no particular difficulties, except for the reverse position of the angle between the operating and exposing trocars, which led to a difficult approach to the Calot triangle when using the right hand of the surgeon. PMID:15239223

  8. Laparoscopic ultrasound for the diagnosis of choledocholithiasis: quick, safe, and effective.

    PubMed

    Shaaban, Hossam; Welch, Andrew; Rao, Sudhindra

    2014-06-01

    Visualization of the common bile duct during laparoscopic cholecystectomy is frequently required to confirm or exclude choledocholithiasis. Although on-table cholangiogram (OTC) is the traditional imaging technique, laparoscopic ultrasound (LUS) is increasingly deployed for this purpose. We are reporting a 31-month experience with an LUS, starting from the initial set up of the equipment. We retrospectively studied 70 patients who underwent LUS during their laparoscopic cholecystectomy operation over a period of 31 months. Data about preoperative investigation, intraoperative findings, and postoperative outcome were retrospectively collected and analyzed. LUS was found to be quick, safe, and effective in the intraoperative diagnosis of the common bile duct stones. It does not add significantly to the operative time and is inherently safer than intraoperative cholangiogram owing to the fact that it does not involve ionizing radiation. It is also more convenient, as there is no need to wear protective lead to avoid the side effects of ionizing radiation. PMID:24710230

  9. Non-intubated single port thoracoscopic procedure under local anesthesia with sedation for a 5-year-old girl.

    PubMed

    Hwang, Jinwook; Min, Too Jae; Kim, Dong Jun; Shin, Jae Seung

    2014-07-01

    Medical thoracoscopy is a feasible procedure for the diagnosis or treatment of thoracic diseases, and it can be performed under local anesthesia without tracheal intubation in cooperative adult patients. However, for younger than school aged patients, even simple procedures require general anesthesia with tracheal intubation. In this case report, we demonstrated the safe performance of a single port thoracoscopic procedure without tracheal intubation in a 5-year-old girl under local anesthesia and sedation. Local anesthesia around the site of a previous chest tube and sedation with intravenous (IV) dexmedetomidine and ketamine were applied. In the aspect of not only minimal injection of local anesthetics but also enhanced visualization of the thoracic structures, the non-intubated single port thoracoscopic surgery under local anesthesia with sedation was a good option for performing a simple thoracoscopic procedure in this 5-year-old patient. PMID:25093102

  10. Laparoscopic resection for rectal cancer: what is the evidence?

    PubMed

    Chan, Dedrick Kok-Hong; Chong, Choon-Seng; Lieske, Bettina; Tan, Ker-Kan

    2014-01-01

    Laparoscopic colectomy for colon cancer is a well-established procedure supported by several well-conducted large-scale randomised controlled trials. Patients could now be conferred the benefits of the minimally invasive approach while retaining comparable oncologic outcomes to the open approach. However, the benefits of laparoscopic proctectomy for rectal cancer remained controversial. While the laparoscopic approach is more technically demanding, results from randomised controlled trials regarding long term oncologic outcomes are only beginning to be reported. The impacts of bladder and sexual functions following proctectomy are considerable and are important contributing factors to the patients' quality of life in the long-term. These issues present a delicate dilemma to the surgeon in his choice of operative approach in tackling rectal cancer. This is compounded further by the rapid proliferation of various laparoscopic techniques including the hand assisted, robotic assisted, and single port laparoscopy. This review article aims to draw on the significant studies which have been conducted to highlight the short- and long-term outcomes and evidence for laparoscopic resection for rectal cancer. PMID:24822196

  11. New trends in colorectal surgery: Single port and natural orifice techniques

    PubMed Central

    Daher, Ronald; Chouillard, Elie; Panis, Yves

    2014-01-01

    Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans. PMID:25561780

  12. PARAMIS parallel robot for laparoscopic surgery.

    PubMed

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

    2010-01-01

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

  13. National survey on cholecystectomy related bile duct injury--public health and financial aspects in Belgian hospitals--1997.

    PubMed

    Van de Sande, St; Bossens, M; Parmentier, Y; Gigot, J F

    2003-04-01

    Public health and financial aspects of cholecystectomy related bile duct injury (BDI) are highlighted in a National Cholecystectomy Survey carried out through 'datamining' the Federal State Medical Records Summaries and Financial Summaries of all Belgian hospitals in 1997. All cancer diagnoses, children < or = 10 years, cholecystectomies performed as an abdominal co-procedure or patients having undergone other non-related surgery were excluded from the study. 10.595 laparoscopic (LC) and 1.033 open cholecystectomies (OC) as well as 137 secondary BDI treatments (LC/OC) were included in the survey (total 11.765). Both LC and OC groups turned out to be significantly different as to distribution of patient's age and APR-DRG severity classes. Composite criteria in terms of ICD-9-CM and billing codes were elaborated to classify: 1) primary, intra-operatively detected and treated BDI (N = 30), 2) primary delayed BDI treatments (N = 38), 3) secondary BDI treatments (N = 137), 4) non-BDI abdomino-surgical complications (N = 119), 4) uneventful laparoscopic (N = 7.476) and 5) uneventful open cholecystectomy (N = 681). Complication rates, community costs of LC and OC groups, incidence of preoperative ERCP and/or intra-operative cholangiography as well as interventions for complications were studied. Incidence of cholecystectomy related BDI was 0.37% in LC, 2.81% in OC and 0.58% overall. Average costs amounted to [symbol: see text] 1.721 for uneventful LC, [symbol: see text] 2.924 for uneventful OC, [symbol: see text] 7.250 for primary, intra-operatively detected and immediately treated BDI [symbol: see text] 9.258 for primary delayed BDI treatments, [symbol: see text] 6.076 for secondary BDI treatments and [symbol: see text] 10.363 for non-BDI abdomino-surgical complications. In conclusion BDI with cholecystectomy reveals to be a serious complication increasing the overall average cost factor ninefold if not detected intra-operatively, in which case the raise is only fourfold. As a consequence BDI should be avoided by all means. In this respect 4 crucial surgical guidelines are emphasised. PMID:12768860

  14. A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy

    PubMed Central

    2009-01-01

    Background Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it was performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage. Methods We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage. Conclusion The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated. PMID:19903347

  15. Development of explicit criteria for cholecystectomy

    Microsoft Academic Search

    J M Quintana; J Cabriada; I Lo?pez de Tejada; M Varona; V Oribe; B Barrios; I Aro?stegui; A Bilbao

    2002-01-01

    Objective: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cholecystectomy. New diagnostic and treatment techniques have been developed in the last decade, so an updated appropriateness of indications tool was developed for cholecystectomy in patients with non-malignant diseases. The validity and reliability of panel results using this tool were tested.Methods: Criteria

  16. Laparoscopic Radical Prostatectomy

    Microsoft Academic Search

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

    2001-01-01

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

  17. Laparoscopic Common Bile Duct Exploration in Pregnancy With Acute Gallstone Pancreatitis

    PubMed Central

    Kim, Young W.; Chung, Mathew H.

    2006-01-01

    Background: We present a case in which a laparoscopic common bile duct exploration was performed safely in a pregnant patient with acute gallstone pancreatitis. Case Report: A 25-year-old female, gravida 4 para 3, at 14-weeks gestation presented to her obstetrician with complaints of epigastric pain radiating to the back. She was otherwise healthy with no past medical or surgical history. A physical examination revealed a healthy young female with no evidence of jaundice and in no acute distress. An abdominal examination was remarkable for a gravid abdomen with mild tenderness to palpation in her epigastrium and negative Murphy's sign. The patient safely underwent a laparoscopic common bile duct exploration after a laparoscopic cholecystectomy was performed. Conclusion: This case illustrates the role of laparoscopic common bile duct exploration in the diagnosis and treatment of possible choledocholithiasis in a pregnant patient. PMID:16709365

  18. Robotic assisted Roux-en-Y hepaticojejunostomy in a post-cholecystectomy type E2 bile duct injury.

    PubMed

    Prasad, Arun; De, Sudipto; Mishra, Purak; Tiwari, Abhishek

    2015-02-14

    Roux-en-Y hepaticojejunostomy anastomosis is the treatment of choice for common hepatic duct injury type E2. It has been performed laparoscopically with the advancement of laparoscopic skill. Recently, a telemanipulative robotic surgical system was introduced, providing laparoscopic instruments with wrist-arm technology and 3-dimensional visualization of the operative field. We present a case of 36-year-old female patient who had undergone elective cholecystectomy 2 mo ago for gall stones and had a common bile duct injury during surgery. As the stricture was old and complete it could not be tackled endoscopically. We did a laparoscopic assisted adhesiolysis followed by robotic Roux-en-Y hepaticojejunostomy. No intraoperative complications or technical problems were encountered. Postoperative period was uneventful and she was discharged on the 4th postoperative day. At follow-up, she is doing well without evidence of jaundice or cholangitis. This is the first reported case of robotic hepaticojejunostomy following common bile duct injury. The hybrid technique gives the patient benefit of laparoscopic adhesiolysis and robotic suturing. PMID:25684934

  19. Wound sepsis after cholecystectomy: effect of incidental appendicectomy.

    PubMed Central

    Pollock, A V; Evans, M

    1977-01-01

    The records of a consecutive series of 224 patients were analysed to discover the effect of incidental appendicectomy on the wound sepsis rate after cholecystectomy. One hundred and five patients had had a cholecystectomy alone and 119 cholecystectomy with incidental appendicectomy. The incidence of wound sepsis in patients not given adequate antibiotic prophylaxis was significantly lower (16-1%) when cholecystectomy alone was carried out than when the appendix was removed as well (41-1%). PMID:831968

  20. Laparoscopic applications of laser-activated tissue glues

    NASA Astrophysics Data System (ADS)

    Bass, Lawrence S.; Oz, Mehmet C.; Auteri, Joseph S.; Williams, Matthew R.; Rosen, Jeffrey; Libutti, Steven K.; Eaton, Alexander M.; Lontz, John F.; Nowygrod, Roman; Treat, Michael R.

    1991-07-01

    The rapid growth of laparoscopic cholecystectomy and other laparoscopic procedures has created the need for simple, secure techniques for laparoscopic closure without sutures. While laser tissue welding offers one solution to this problem, concerns about adequacy of weld strength and watertightness remain. Tissue solders are proteinaceous materials which are placed on coapted tissue edges of the tissue to be closed or sealed. Laser energy is then applied to fix the glue in place completing the closure. Closure of the choledochotomy following a laparoscopic common duct exploration is one potential application of this technique. Canine longitudinal choledochotomies 5 mm in length were sealed using several laser glues and using the 808 nm diode laser. Saline was then infused until rupture of the closure and peak bursting strength recorded. Fibrinogen glue provided moderately good adhesion but poor burst strength. Handling characteristics were variable. A viscosity adjusted fibrinogen preparation produced good adherence with mean weld strength 264 +/- 7 mm Hg. The clinical endpoint for welding was a whitening and drying of the tissue. New laser solders can provide a watertight choledochotomy closure of adequate immediate strength. This would allow reliable, technically feasible common bile duct exploration via a laparoscopic approach.

  1. Integrated image monitoring system using head-mounted display for gasless single-port clampless partial nephrectomy.

    PubMed

    Kihara, Kazunori; Saito, Kazutaka; Komai, Yoshinobu; Fujii, Yasuhisa

    2014-12-01

    A novel head-mounted display (HMD) offers a higher quality of endoscopic imagery in front of the eyes regardless of head position. We present an application of the HMD system as a personal integrated multi-image monitoring system in gasless single-port clampless partial nephrectomy (PN). Our HMD system displayed multiple forms of information as integrated, sharp, high-contrast images both seamlessly and synchronously using a four-split screen. The surgeon wearing an HMD display could continuously and simultaneously monitor the endoscopic, three-dimensional (3D) video and intraoperative ultrasound images. In addition, the operator can rotate the 3D video image using fingertip movements on the finger tracking system. All two clampless partial nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The integrated image HMD system might facilitate maneuverability and safety in minimally invasive clampless PN. PMID:25562006

  2. Integrated image monitoring system using head-mounted display for gasless single-port clampless partial nephrectomy

    PubMed Central

    Saito, Kazutaka; Komai, Yoshinobu; Fujii, Yasuhisa

    2014-01-01

    A novel head-mounted display (HMD) offers a higher quality of endoscopic imagery in front of the eyes regardless of head position. We present an application of the HMD system as a personal integrated multi-image monitoring system in gasless single-port clampless partial nephrectomy (PN). Our HMD system displayed multiple forms of information as integrated, sharp, high-contrast images both seamlessly and synchronously using a four-split screen. The surgeon wearing an HMD display could continuously and simultaneously monitor the endoscopic, three-dimensional (3D) video and intraoperative ultrasound images. In addition, the operator can rotate the 3D video image using fingertip movements on the finger tracking system. All two clampless partial nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The integrated image HMD system might facilitate maneuverability and safety in minimally invasive clampless PN. PMID:25562006

  3. Proving the Value of Simulation in Laparoscopic Surgery

    PubMed Central

    Fried, Gerald M.; Feldman, Liane S.; Vassiliou, Melina C.; Fraser, Shannon A.; Stanbridge, Donna; Ghitulescu, Gabriela; Andrew, Christopher G.

    2004-01-01

    Objective: To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) physical laparoscopic simulator for construct and predictive validity and for its educational utility. Summary Background Data: MISTELS is the physical simulator incorporated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in their Fundamentals of Laparoscopic Surgery (FLS) program. MISTELS’ metrics have been shown to have high interrater and test-retest reliability and to correlate with skill in animal surgery. Methods: Over 200 surgeons and trainees from 5 countries were assessed using MISTELS in a series of experiments to assess the validity of the system and to evaluate whether practicing MISTELS basic skills (transferring) would result in skill acquisition transferable to complex laparoscopic tasks (suturing). Results: Face validity was confirmed through questioning 44 experienced laparoscopic surgeons using global rating scales. MISTELS scores increased progressively with increasing laparoscopic experience (n = 215, P < 0.0001), and residents followed over time improved their scores (n = 24, P < 0.0001), evidence of construct validity. Results in the host institution did not differ from 5 beta sites (n = 215, external validity). MISTELS scores correlated with a highly reliable validated intraoperative rating of technical skill during laparoscopic cholecystectomy (n = 19, r = 0.81, P < 0.0004; concurrent validity). Novice laparoscopists were randomized to practice/no practice of the transfer drill for 4 weeks. Improvement in intracorporeal suturing skill was significantly related to practice but not to baseline ability, career goals, or gender (P < 0.001). Conclusion: MISTELS is a practical and inexpensive inanimate system developed to teach and measure technical skills in laparoscopy. This system is reliable, valid, and a useful educational tool. PMID:15319723

  4. Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy.

    PubMed

    Morse, Bryan C; Smith, J Brandon; Lawdahl, Richard B; Roettger, Richard H

    2010-07-01

    The diagnosis of acute cholecystitis in critically ill patients carries a high mortality rate. Although decompression and drainage of the gallbladder through a cholecystostomy tube may be used as a temporary treatment of acute cholecystitis in this population, there is still some debate about the management of the tube and the subsequent need for a cholecystectomy. This series evaluates the clinical course and outcomes of critically ill patients who underwent the insertion of cholecystostomy tubes for the initial treatment of acute cholecystitis. This is a retrospective review of critically ill patients admitted to the hospital intensive care unit who were diagnosed with acute cholecystitis and underwent a cholecystostomy tube as a temporary treatment for the disease. Patients were identified through the Greenville Hospital System electronic medical records coding database. Medical records were reviewed for demographic data, diagnoses, imaging, complications, and outcomes. From January 2002 through June 2008, 50 patients were identified for the study. The mean age was 72 +/- 11 years, and the majority (66%) were men. The following comorbidities were found: severe cardiovascular disease (40 patients), respiratory failure (30 patients), and multisystem organ dysfunction (30 patients). The mean intensive care unit length of stay (LOS) was 16 +/- 9 days, and the mean hospital LOS was 28 +/- 27 days. At 30 days, the morbidity associated with the cholecystostomy tube itself was 4 per cent, but overall in-hospital morbidity and mortality rates were 62 and 50 per cent, respectively. Of the 25 patients who survived longer than 30 days, 12 retained their cholecystostomy tubes until they underwent cholecystectomy (four open, seven laparoscopic). All of the remaining 13 patients had their cholecystostomy tubes removed, and eight developed recurrent cholecystitis. Of these patients with recurrent of cholecystitis, five had cholecystectomy or repeat cholecystostomy, but the remaining three patients died. Although this is a small patient population, these data suggest that, in critically ill patients, cholecystostomy tubes should remain in place until the patient is deemed medically suitable to undergo cholecystectomy. Removal of the cholecystostomy tube without subsequent cholecystectomy is associated with a high incidence of recurrent cholecystitis and devastating consequences. PMID:20698375

  5. 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

  6. Laparoscopic surgery for benign and malign diseases of the digestive system: indications, limitations, and evidence.

    PubMed

    Küper, Markus Alexander; Eisner, Friederike; Königsrainer, Alfred; Glatzle, Jörg

    2014-05-01

    The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s. Since then, the development of this technique has been extraordinary. Triggered by technical innovations (stapling devices or coagulation/dissecting devices), nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient's condition. This summary gives an overview over 30 years of laparoscopic surgery with focus on today's indications and evidence. Main indications remain the more common procedures, e.g., appendectomy, cholecystectomy, bariatric procedures or colorectal resections. For all these indications, the laparoscopic approach has become the gold standard with less perioperative morbidity. Regarding oncological outcome there have been several high-quality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections. Less common procedures like esophagectomy, oncological gastrectomy, liver and pancreatic resections can be performed successfully as well by an experienced surgeon. However, the evidence for these special indications is poor and a general recommendation cannot be given. In conclusion, laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery. PMID:24803799

  7. Laparoscopic restorative proctocolectomy

    Microsoft Academic Search

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

    2000-01-01

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

  8. An in vitro comparison of the electrical conducting properties of multiport versus single-port epidural catheters for the epidural stimulation test.

    PubMed

    Tsui, Ban C H; Sze, Corey K C

    2005-11-01

    Effective conduction of electricity through a catheter is essential for the success of the epidural stimulation test. In this in vitro study we examined the electrical conductivity of single and multiport epidural catheters (with and without embedded metal elements) after being primed with normal saline. Seven different types of 19-gauge catheters (n = 5), either single-port or multiport catheters, with or without embedded metal elements, were studied. The proximal end of each epidural catheter was connected to the cathode of a nerve stimulator via an electrode adapter. The catheter, primed with normal saline, was placed at the bottom of a syringe filled with 5 different volumes of saline (1, 2, 3, 4 and 5 mL) and attached to an electrode adapter. The voltage of the peripheral nerve stimulator was measured using an oscilloscope. The electrical resistance between the proximal and distal end of the catheter was calculated using Ohm's Law. In catheters without metal elements the electrical resistances were too high to be measured. In catheters that had metal elements, the mean electrical resistances of the same catheter design (single-port or multiport) were similar. However, the electrical resistances of the multiport metal reinforced epidural catheters were significantly lower (P < 0.05) than the single-port metal coil reinforced epidural catheters. The volume of saline in the syringe had no impact on the measured electrical resistances. This study suggests that multiport metal reinforced epidural catheters have low electrical resistances and, thus, are a reasonable alternative to single-port catheters for transmitting sufficient current for performing the epidural stimulation test. On the other hand, epidural catheters without metal elements (single-port or multiport) are not suitable for performing the stimulation test. PMID:16244025

  9. Abdominal symptoms: do they disappear after cholecystectomy?

    Microsoft Academic Search

    M. Y. Berger; T. C. olde Hartman; A. M. Bohnen

    2003-01-01

    Objective: To evaluate the effect of cholecystectomy in patients with gallstones on preoperative abdominal symptoms. Methods: A systematic search was made of the Medline database in combination with reference checking. Articles were excluded if patients aged Results: The pooled relief rate for “biliary pain” was high 92% (95% confidence interval 86 to 96%). Symptom relief rates were consistently higher in

  10. Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases.

    PubMed

    Navez, B; Mutter, D; Russier, Y; Vix, M; Jamali, F; Lipski, D; Cambier, E; Guiot, P; Leroy, J; Marescaux, J

    2001-10-01

    Laparoscopic cholecystectomy (LC) is now widely accepted as the modality of choice for the treatment of symptomatic uncomplicated cholelithiasis. The application of the laparoscopic technique in the setting of acute cholecystitis (AC) is more controversial. The precise role as well as the potential benefits of LC in the treatment of the acutely inflamed gallbladder have not been clearly established through large clinical series. The aim of our study was to assess the feasibility, safety, benefits, and specific complications of the laparoscopic approach in patients with AC. A retrospective chart analysis involving the patients admitted to two busy emergency digestive surgical units between October 1990 and December 1997 was carried out. Six hundred and nine patients meeting our criteria for AC were identified and evaluated. Overall complication rate was 15% with 12 postoperative bile leakages (1.97%) and 4 biliary tract injuries (BTI) (0.66%). The overall mortality rate was 0.66%. Local and overall complication rates were significantly correlated with the delay between the onset of acute symptoms and the operation but not the rate of general complications nor deaths. Our results demonstrate the safety and feasibility of LC in the setting of AC. Early cholecystectomy within 4 days is strongly recommended to minimize complications and increase the chances of a successful laparoscopic approach. PMID:11596902

  11. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    PubMed Central

    Ho?ten, Tülay; Y?ld?z, Tülay ?ahin; Ku?, Alparslan; Solak, Mine; Toker, Kamil

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH2O; P-LMA, 27.0±4.7 cmH2O; p=0.42) and did not change during the induction of and throughout pneumoperitoneum. The first attempt success rates were 93% with both S-LMA and P-LMA. Mean airway device insertion time was significantly shorter with S-LMA than with P-LMA (12.5±4.1 seconds versus 15.6±6.0 seconds; p=0.02). The first attempt success rates for the drainage tube insertion were similar (P-LMA, 93%; S-LMA 100%); however, drainage tubes were inserted more quickly with S-LMA than with P-LMA (9.0±3.2 seconds versus 14.7±6.6 seconds; p=0.001). In the PACU, vomiting was observed in five patients (three females and two males) in the S-LMA group and in one female patient in the P-LMA group (p=0.10). Conclusion: Both airway devices can be used safely in laparoscopic cholecystectomies with suitable patients and experienced users. However, further studies are required not only for comparing both airway devices in terms of postoperative nausea and vomiting but also for yielding definitive results. PMID:25207022

  12. Current Limitations and Perspectives in Single Port Surgery: Pros and Cons Laparo-Endoscopic Single-Site Surgery (LESS) for Renal Surgery

    PubMed Central

    Weibl, Peter; Klingler, Hans-Christoph; Klatte, Tobias; Remzi, Mesut

    2010-01-01

    Laparo-Endoscopic Single-Site surgery (LESS) for kidney diseases is quickly evolving and has a tendency to expand the urological armory of surgical techniques. However, we should not be overwhelmed by the surgical skills only and weight it against the basic clinical and oncological principles when compared to standard laparoscopy. The initial goal is to define the ideal candidates and ideal centers for LESS in the future. Modification of basic instruments in laparoscopy presumably cannot result in better functional and oncological outcomes, especially when the optimal working space is limited with the same arm movements. Single port surgery is considered minimally invasive laparoscopy; on the other hand, when using additional ports, it is no more single port, but hybrid traditional laparoscopy. Whether LESS is a superior or equally technique compared to traditional laparoscopy has to be proven by future prospective randomized trials. PMID:20169054

  13. Cholecystectomy. The impact of socioeconomic change.

    PubMed Central

    Saunders-Kirkwood, K D; Aizen, B; Thompson, J E; Zinner, M J; Cates, J A; Bennion, R; Gill, J; Boudi, F; Roslyn, J J

    1992-01-01

    The impact of our evolving health care system on a commonly performed surgical procedure, cholecystectomy, was assessed in a county-subsidized and private university hospital setting. Although condition on admission, use of resources, and outcome were unchanged in the private setting between 1980 and 1988, significant differences were noted among the largely uninsured patients at the county facility during this same time interval. There was a significant increase in the acuity of illness among patients undergoing cholecystectomy at the county hospital in 1988 as compared with 1980. These data suggest that alterations in reimbursement strategies and allocation of resources are significantly impacting on patient care, particularly in nonprivate health care facilities. PMID:1558411

  14. Abdominal Drainage Following Appendectomy and Cholecystectomy

    PubMed Central

    Stone, H. Harlan; Hooper, C. Ann; Millikan, William J.

    1978-01-01

    Consecutive patients undergoing emergency appendectomy (283) or urgent cholecystectomy (51) were prospectively studied for the development of post-operative incisional or peritoneal sepsis. Severity of the original peritoneal infection was carefully recorded, while use of a Penrose dam to drain the peritoneum was randomized according to pre-assigned hospital number. Both aerobic and anaerobic cultures were taken from the abdomen at the time of operation as well as from all postoperative infectious foci. Results demonstrated no essential differences in incidence of wound and peritoneal infection following appendectomy for simple or suppurative appendicitis (187) or following cholecystectomy for acute cholecystitis (51). However, with gangrenous or perforative appendicitis (94), incisional and intra-abdominal infection rates were 43% and 45%, respectively, when a drain was used; yet only 29 and 13%, respectively, without a drain. These latter differences were significant (p < 0.001). In addition, intra-abdominal abscesses were three times as likely to drain through the incision than along any tract provided by the rubber conduit. Cultures revealed that hospital pathogens accounted for a greater proportion of wound and peritoneal sepsis after cholecystectomy and appendectomy for simple or suppurative appendicitis if a drain had been inserted than if managed otherwise. By contrast, a mixed bacterial flora was responsible for most infections following appendectomy for gangrenous or perforated appendicitis, irrespective as to use of a drain. PMID:646499

  15. Lateral transperitoneal laparoscopic adrenalectomy

    Microsoft Academic Search

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

    1999-01-01

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

  16. Laparoscopic herniorrhaphy in children

    Microsoft Academic Search

    C. M. Gorsler; F. Schier

    2003-01-01

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

  17. Laparoscopic reconstructive urology

    PubMed Central

    Murphy, Declan; Challacombe, Ben; Rane, Abhay

    2005-01-01

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

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

    PubMed Central

    Dursun, Polat; Tezcaner, Tugan; Zeyneloglu, Hulusi B.; Alyaz?c?, Irem; Haberal, Ali; Ayhan, Ali

    2013-01-01

    Objective. To report our experience treating adnexal masses using a combination of the SILS port and straight nonroticulating laparoscopic instruments. Study Design. This prospective feasibility study included 14 women with symptomatic and persistent adnexal masses. Removal of adnexal masses via single-incision laparoscopic surgery using a combination of the SILS port and straight nonroticulating laparoscopic instruments was performed. Results. All of the patients had symptomatic complex adnexal masses. Mean age of the patients was 38.4 years (range: 21–61 years) and mean duration of surgery was 71?min (range: 45–130?min). All surgeries were performed using nonroticulating straight laparoscopic instruments. Mean tumor diameter was 6?cm (range: 5–12?cm). All patient pathology reports were benign. None of the patients converted to laparotomy. All the patients were discharged on postoperative d1. Postoperatively, all the patients were satisfied with their incision and cosmetic results. Conclusion. All 14 patients were successfully treated using standard, straight nonroticulating laparoscopic instruments via the SILS port. This procedure can reduce the cost of treatment, which may eventually lead to more widespread use of the SILS port approach. Furthermore, concomitant surgical procedures are possible using this approach. However, properly designed comparative studies with single port and classic laparoscopic surgery are urgently needed. PMID:24307944

  19. Single-Incision Laparoscopic Repair of Spigelian Hernia

    PubMed Central

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

    2015-01-01

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

  20. Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones

    PubMed Central

    Chen, Chao-Hung; Lin, Herng-Ching; Lee, Cha-Ze

    2015-01-01

    Background Prior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD) after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database. Methods Using ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER) were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy. Results Of 6755 patients with gallstones, 173 (2.56%) were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient’s sex, age and geographic location, the hazard ratio (HR) of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02–2.04) for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08–2.41) for patients who underwent cholecystectomy compared to those who did not. Conclusions There is an association between cholecystectomy and subsequent risk of DD among females, but not in males. PMID:26053886

  1. Laparoscopic partial adrenalectomy

    Microsoft Academic Search

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

    1999-01-01

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

  2. Initial Cholecystectomy with Cholangiography Decreases Length of Stay Compared to Preoperative MRCP or ERCP in the Management of Choledocholithiasis.

    PubMed

    Lin, Christine; Collins, Jay N; Britt, Rebecca C; Britt, Lunzy D

    2015-07-01

    There are several treatments available for choledocholithiasis, but the optimal treatment is highly debated. Some advocate preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) with cholangiography (IOC). Others advocate initial LC + IOC followed by common bile duct exploration or ERCP. The purpose of this study was to determine whether initial LC + IOC had a shorter length of stay (LOS) compared with preoperative magnetic resonance cholangiopancreatography (MRCP) or ERCP. Patients who underwent cholecystectomy between 2012 and 2013 at two institutions were reviewed. Patients were selected if they had suspected choledocholithiasis, indicated by dilated CBD and/or elevated bilirubin, or confirmed choledocholithiasis. They were excluded if they had pancreatitis or cholangitis. There were 126 patients with suspected choledocholithiasis in this study. Of these, 97 patients underwent initial LC ± IOC with an average LOS of 3.9 days. IOC was negative in 47.4 per cent patients, and they had a shorter LOS compared with positive IOC patients (2.93 vs 4.82, P < 0.001). Laparoscopic common bile duct exploration was successful in 64.7 per cent and had a shorter LOS compared with postoperative ERCP patients (P = 0.01). Preoperative MRCP was performed in 21 patients with an average LOS of 6.48 days. Preoperative ERCP was performed in eight patients with an average LOS of seven days. Initial LC+IOC is associated with a shorter LOS compared to preoperative MRCP or ERCP. It is recommended as the optimal treatment choice for suspected choledocholithiasis. PMID:26140895

  3. Laparoscopic splenectomy in patients with hereditary spherocytosis: report on 12 consecutive cases.

    PubMed

    Vecchio, R; Intagliata, Eva; Ferla, F; Marchese, S; Cacciola, R R; Cacciola, E

    2013-12-01

    Hereditary spherocytosis is an inherited hemolytic anemia caused by a deficiency in erythrocyte membrane proteins. Removal of the spleen may reduce the intra-splenic hemolytic process of the disease and, therefore, may correct the anemia. Furthermore, it seems to decrease the levels of serum bilirubin, thus reducing the formation of gallbladder stones. Indications and timing of splenectomy, however, are still debated. Twelve patients with severe hereditary spherocytosis operated on with laparoscopic splenectomy were retrospectively reviewed. Median age at diagnosis was 13.8 years (range 8-25 years). Male to female ratio was 5/7. Indications for laparoscopic removal of the spleen included anemia unresponsive to iron supplementation in eight patients (66.6 %) with increase need for red cells transfusions, and jaundice with symptoms related to cholelitiasis in four patients (33.3 %). Laparoscopic splenectomy was associated in four cases to laparoscopic cholecystectomy. Mean operative time was 50 min (range 40-75 min) with no conversion to open surgery. Mean hospital stay ranged from 3 to 7 days. In a 16-month follow-up, no complications were recorded and a persistent correction of anemia was observed. With the advent of laparoscopic surgery, splenectomy has been performed by this mini-invasive approach in referral centers. Laparoscopic splenectomy is an effective technique, when performed in patients with hereditary spherocytosis. Low complication rate and persistent correction of the hematologic disorders can be expected after the laparoscopic splenectomy, provided that a proper technique is performed and an experienced surgical team is available. PMID:24129854

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

    PubMed Central

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

    2014-01-01

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

  5. New three-dimensional head-mounted display system, TMDU-S-3D system, for minimally invasive surgery application: procedures for gasless single-port radical nephrectomy.

    PubMed

    Kihara, Kazunori; Fujii, Yasuhisa; Masuda, Hitoshi; Saito, Kazutaka; Koga, Fumitaka; Matsuoka, Yoh; Numao, Noboru; Kojima, Kazuyuki

    2012-09-01

    We present an application of a new three-dimensional head-mounted display system that combines a high-definition three-dimensional organic electroluminescent head-mounted display with a high-definition three-dimensional endoscope to minimally invasive surgery, using gasless single-port radical nephrectomy procedures as a model. This system presents the surgeon with a higher quality of magnified three-dimensional imagery in front of the eyes regardless of head position, and simultaneously allows direct vision by moving the angle of sight downward. It is also significantly less expensive than the current robotic surgery system. While carrying out gasless single-port radical nephrectomy, the system provided the surgeon with excellent three-dimensional imagery of the operative field, direct vision of the outside and inside of the patient, and depth perception and tactile feedback through the devices. All four nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The display was light enough to comfortably be worn for a long operative time. Our experiences show that the three-dimensional head-mounted display system might facilitate maneuverability and safety in minimally invasive procedures, without prohibitive cost, and thus might mitigate the drawbacks of other three-dimensional vision systems. Because of the potential benefits that this system offers, it deserves further refinements of its role in various minimally invasive surgeries. PMID:22587397

  6. Cholecystectomy and NAFLD: does gallbladder removal have metabolic consequences?

    PubMed

    Nervi, Flavio; Arrese, Marco

    2013-06-01

    Pathogenesis of nonalcoholic fatty liver (NAFLD) disease and gallbladder (GB) disease secondary to cholesterol gallstones is complex, yet both conditions share similar associated risk factors, most of them related to the metabolic syndrome. Cholecystectomy, the best treatment for GB disease, is one of the most performed abdominal surgeries worldwide. In this issue of the American Journal of Gastroenterology, Ruhl and Everhart, using data from the Third United States National Health and Nutrition Examination Survey (1988-1994), show that NAFLD is associated with cholecystectomy (odds ratio (OR)=2.4; 1.8-3.3), but not with gallstones (OR=1.1; 0.84-1.4). This finding suggests that cholecystectomy may itself represent a risk factor for NAFLD, which is in line with the recently undisclosed role of the GB and bile acids in systemic metabolic regulation. Thus, cholecystectomy may not be innocuous and may have a major impact on public health by contributing to NAFLD development. PMID:23735917

  7. Laparoscopic transabdominal lateral adrenalectomy.

    PubMed

    Bickenbach, Kai A; Strong, Vivian E

    2012-10-01

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

  8. Laparoscopic Partial Nephrectomy

    Microsoft Academic Search

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

  9. [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

  10. Extraction of a foreign body in the liver using single incision laparoscopic surgery: a new application for minimally invasive surgical procedures.

    PubMed

    Belgrano, Valerio; Bagge, Roger Olofsson; Scordamaglia, Chiara; Scordamaglia, Renato

    2015-04-01

    Ingestion of foreign bodies is a common medical problem frequently observed in children, psychiatric patients and prisoners. Various cases have been found in the medical literature, with different diagnostic and therapeutic approaches. We report a case of a 41-year-old male inmate, hospitalized for right upper quadrant pain of the abdomen due to the ingestion of two syringe needles two weeks previously. We describe the diagnostic procedure and the removal of one of the two needles that had migrated into the liver parenchyma, using a single-incision laparoscopic surgical technique. The operation was carried out safely through a 2.5 cm transverse incision below the umbilicus. The dissection and the removal of the foreign body were easily conducted under direct visualization using a minimally invasive surgical technique. Our case report demonstrates the efficacy and the security of the laparoscopic treatment in such a challenging area, employing a single port access only. PMID:25960804

  11. 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.

  12. Correcting reflux laparoscopically.

    PubMed

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

    1998-01-01

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

  13. Laparoscopic treatment of intussusception

    PubMed Central

    Vilallonga, Ramon; Himpens, Jacques; Vandercruysse, Femke

    2014-01-01

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

  14. Complications in laparoscopic surgery.

    PubMed

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

    1995-01-01

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

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

    PubMed

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

    2011-02-01

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

  16. Laparoscopic Reconstructive Urology

    Microsoft Academic Search

    JIHAD H. KAOUK; INDERBIR S. GILL

    2003-01-01

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

  17. Laparoscopic Paraesophageal Hernia Repair

    PubMed Central

    Medina, Laura; Peetz, Michael; Ratzer, Erick

    1998-01-01

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

  18. Pediatric Laparoscopic Dismembered Pyeloplasty

    Microsoft Academic Search

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

    1995-01-01

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

  19. Gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy

    Microsoft Academic Search

    B. Bülent Mentes; M. Akin; O. Irkörücü; A. Yildinm; I. Maral

    2001-01-01

      Background: There is an ongoing need, from both the medical and the economic perspective, for a more accurate definition of\\u000a the influence of symptomatic or asymptomatic gallstone disease on gastrointestinal symptomatology, as well as on the health\\u000a of the individual in general. Methods: Using the Gastrointestinal Quality of Life Index (GIQLI), 37 symptomatic and 30 asymptomatic\\u000a gallstone patients were evaluated

  20. A case of negative pressure pulmonary edema in an asthmatic patient after laparoscopic cholecystectomy

    PubMed Central

    Rasheed, Asim; Palaria, Urmila; Rani, Dolly; Sharma, Shatrunjay

    2014-01-01

    Negative pressure pulmonary edema is often misdiagnosed or can go clinically unrecognized by anesthesiologists. It is characterized by a markedly low intrapleural pressure which leads to exudation of fluid and red blood cells in the interstitium. Recognition of patients with predisposing factors for upper airway obstruction is important in the diagnosis which is often confused with pulmonary aspiration of gastric contents. Signs and symptoms are subtle and edema is usually self-limited. Our patient was management conservatively with maintenance of a patent airway and administration of supplemental oxygen and had a successful outcome. PMID:25886111

  1. Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach

    Microsoft Academic Search

    Mauro Neiva Fernandes; Ivan Nazareno Campos Neiva; Francisco de Assis Camacho; Lucas Crociati Meguins; Marcelo Neiva Fernandes; Emília Maíra Crociati Meguins

    2008-01-01

    Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT

  2. Laparoscopic Management of Large Myomas

    PubMed Central

    Sinha, Rakesh; Sundaram, Meenakshi

    2009-01-01

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

  3. Laparoscopic en bloc kidney transplantation

    PubMed Central

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

    2012-01-01

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

  4. ICG-loaded microbubbles for multimodal billiary imaging in cholecystectomy

    NASA Astrophysics Data System (ADS)

    Qin, Ruogu; Melvin, Scott; Xu, Ronald X.

    2012-12-01

    A dual-mode imaging technique has been developed for intraoperative imaging of bile ducts and real-time identification of iatrogenic injuries in cholecystectomy. The technique is based on ultrasound (US) and fluorescence (FL) imaging of a dual-mode microbubble (MB) agent comprising a poly (lactic-co-glycolic acid) (PLGA) shell and a core of Indocyanine Green. During cholecystectomy, a clinical US probe is used to localize the bile duct structure after bolus injection of dual-mode MBs. As the surrounding adipose tissue is removed and the Calot's triangle is exposed, FL imaging is used to identify the MB distribution and to determine the potential bile duct injury. The contrast-enhanced bile duct imaging technique has been demonstrated in both a surgical simulation model and an ex vivo porcine tissue model under two surgical scenarios. The first scenario simulates the correct procedure where the cystic duct is clipped. The second scenario simulates the incorrect procedure where the common bile duct is clipped, leading to consequent bile duct injury. Benchtop experiments in both the phantom and the ex vivo models show that the dual-mode imaging technique is able to identify the potential bile duct injury during cholecystectomy. A phantom system has also been established for future device calibration and surgical training in image-guided cholecystectomy. Further in vivo animal validation tests are necessary before the technique can be implemented in a clinical setting.

  5. A three-dimensional head-mounted display system (RoboSurgeon system) for gasless laparoendoscopic single-port partial cystectomy.

    PubMed

    Fujii, Yasuhisa; Kihara, Kazunori; Yoshida, Soichiro; Ishioka, Junichiro; Matsuoka, Yoh; Numao, Noboru; Saito, Kazutaka

    2014-12-01

    We developed a new three-dimensional (3D) head-mounted display (HMD) system (RoboSurgeon system) that combines a high-definition 3D organic electroluminescent HMD with a high-definition 3D endoscope and applies it to minimally invasive surgery. This system presents the surgeon with a higher quality of magnified 3D imagery in front of the eyes, regardless of head position. We report 5 cases of RoboSurgeon gasless laparoendoscopic single-port partial cystectomy, which is carried out as part of our selective bladder-sparing protocol, with a technique utilizing both an intravesical and extravesical approach. While carrying out the surgery, the system provides the surgeon with both excellent 3D imagery of the operative field and clear imagery of the cystoscopy. All procedures were safely completed and there were no complications except for a case of postoperative lymphorrhea. Our experience shows that the 3D HMD system might facilitate maneuverability and safety in various minimally invasive procedures. PMID:25562007

  6. A three-dimensional head-mounted display system (RoboSurgeon system) for gasless laparoendoscopic single-port partial cystectomy

    PubMed Central

    Fujii, Yasuhisa; Yoshida, Soichiro; Ishioka, Junichiro; Matsuoka, Yoh; Numao, Noboru; Saito, Kazutaka

    2014-01-01

    We developed a new three-dimensional (3D) head-mounted display (HMD) system (RoboSurgeon system) that combines a high-definition 3D organic electroluminescent HMD with a high-definition 3D endoscope and applies it to minimally invasive surgery. This system presents the surgeon with a higher quality of magnified 3D imagery in front of the eyes, regardless of head position. We report 5 cases of RoboSurgeon gasless laparoendoscopic single-port partial cystectomy, which is carried out as part of our selective bladder-sparing protocol, with a technique utilizing both an intravesical and extravesical approach. While carrying out the surgery, the system provides the surgeon with both excellent 3D imagery of the operative field and clear imagery of the cystoscopy. All procedures were safely completed and there were no complications except for a case of postoperative lymphorrhea. Our experience shows that the 3D HMD system might facilitate maneuverability and safety in various minimally invasive procedures. PMID:25562007

  7. Initial single-port thoracoscopy to reduce surgical trauma during open en bloc chest wall and pulmonary resection for locally invasive cancer

    PubMed Central

    Bayarri, Clara I.; de Guevara, Antonio Cueto Ladron; Martin-Ucar, Antonio E.

    2013-01-01

    OBJECTIVES En bloc pulmonary and chest wall resection is the preferred method of treatment for locally invasive lung carcinoma. However, it carries major trauma to the chest wall, especially in cases with chest wall involvement distant to the potential location of ‘traditional’ thoracotomies. We describe an alternative method of estimating the boundaries of chest wall resection employing video assisted thoracoscopic surgery (VATS) and hypodermic needles. METHODS VATS delineation of boundaries of chest wall involvement by lung cancer has been performed in six patients who gave written consent. In one case the single–port thoracoscopic examination revealed unexpected distant pleural metastases thus preventing from resection. The other 5 patients, three males and two females [median age of 60.5 (range 39 to 75) years] underwent en bloc anatomical lung resection in addition to chest wall excision and reconstruction for T3N0 lung cancer. RESULTS In these five cases the chest wall opening was restricted to the extent of the rib excision, and the pulmonary resection was performed via the existing chest wall opening without requiring extension of the thoracotomy or any rib spreading. DISCUSSION Minimally invasive techniques aid to delineate the boundaries of chest wall involvement of lung cancer and intraoperative staging. This helped tailoring the surgical approach and location of the thoracotomy, and prevented rib-spreading or additional thoracotomies in our cases. PMID:23592724

  8. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding

    Microsoft Academic Search

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

    2003-01-01

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

  9. Total Laparoscopic Pancreaticoduodenectomy

    PubMed Central

    Kamyab, Armin

    2013-01-01

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

  10. Peritonitis: laparoscopic approach

    PubMed Central

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

    2006-01-01

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

  11. Laparoscopic herniorrhaphy in girls

    Microsoft Academic Search

    F Schier

    1998-01-01

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

  12. Laparoscopic renal surgery.

    PubMed

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

    2009-08-01

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

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

    PubMed

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

    1996-01-01

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

  14. NERVE INJURY AFTER LAPAROSCOPIC VARICOCELECTOMY

    Microsoft Academic Search

    KRISTIN CHROUSER; DAVID VANDERSTEEN; JULIE CROCKER; YURI REINBERG

    2004-01-01

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

  15. Laparoscopic Treatment of Splenic Cysts

    PubMed Central

    2001-01-01

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

  16. Laparoscopic radical prostatectomy: preliminary results

    Microsoft Academic Search

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

    2000-01-01

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

  17. Laparoscopic splenectomy for ITP

    Microsoft Academic Search

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

    1996-01-01

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

  18. LAPAROSCOPIC HEMINEPHROURETERECTOMY IN PEDIATRIC PATIENTS

    Microsoft Academic Search

    Gunter Janetschek; Jorg Seibold; Christian Radmayr; Georg Bartsch

    1997-01-01

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

  19. Laparoscopic treatment of perforated appendicitis

    PubMed Central

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

    2014-01-01

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

  20. Cystic duct patency in malignant obstructive jaundice. An ERCP-based study relevant to the role of laparoscopic cholecystojejunostomy.

    PubMed Central

    Tarnasky, P R; England, R E; Lail, L M; Pappas, T N; Cotton, P B

    1995-01-01

    OBJECTIVE: This endoscopic retrograde cholangiopancreatography-(ERCP)based study estimates the potential role of laparoscopic cholecystojejunostomy for palliation of patients with malignant obstructive jaundice. SUMMARY BACKGROUND DATA: Traditional treatment of malignant obstructive jaundice has used a standard bilioenteric anastomosis. Laparoscopic biliary bypass via a gallbladder conduit currently is an established technique; it provides a low initial morbidity alternative to open procedures, similar to endoscopic stenting. No study has specifically addressed anatomic factors relevant to cholecystojejunostomy, such as prior cholecystectomy, stricture location in reference to the hepatocystic junction, and cystic duct patency in patients with malignant obstructive jaundice. METHODS: Retrograde cholangiograms were reviewed from consecutive patients with malignant obstructive jaundice and a control group without biliary disease who underwent ERCP during a 2-year period. Patients with either prior biliary surgery or hilar tumors were excluded. The presence of gallbladder or cystic duct filling was assessed. In patients with patent cystic ducts, the distance from obstruction to the cystic duct takeoff was classified as either greater or less than 1 cm. RESULTS: Nearly half the patients with malignant obstructive jaundice were ineligible for cholecystojejunostomies because of prior biliary surgery (29%) or hilar tumors (17%). Half (50 of 101) of the remaining potential candidates had patent hepatocystic junctions. Patients with ampullary carcinoma and patent hepatocystic junctions (5 of 9) were all ideal candidates for cholecystojejunostomies, having biliary obstruction more than 1 cm from the cystic duct takeoff. Two thirds of the remaining eligible patients (28 of 45) had obstructions less than 1 cm from patent hepatocystic junctions. CONCLUSIONS: Palliation of malignant obstructive jaundice by laparoscopic cholecystojejunostomy should only be attempted after direct cholangiography demonstrates a patent hepatocystic junction that is well separated from the malignant stricture. The majority of patients with malignant obstructive jaundice are ineligible for cholecystojejunostomies because of prior cholecystectomies, hilar obstructions, or tumor involvement of the hepatocystic junction. Nonoperative treatments will continue to be indicated for the majority of patients with malignant obstructive jaundice. Images Figure 2. Figure 3. PMID:7536405

  1. Laparoscopic Gastric Banding: preliminary series

    Microsoft Academic Search

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

    1993-01-01

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

  2. Laparoscopic Surgery for Ulcerative Colitis

    PubMed Central

    Stocchi, Luca

    2010-01-01

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

  3. Rhabdomyolysis after Laparoscopic Bariatric Surgery

    Microsoft Academic Search

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

    2004-01-01

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

  4. Laparoscopic repair of Morgagni hernia

    Microsoft Academic Search

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

    2007-01-01

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

  5. Laparoscopic Placement of Cervical Cerclage

    PubMed Central

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

    2012-01-01

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

  6. Laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis

    Microsoft Academic Search

    H. L. Tan; A. Najmaldin

    1993-01-01

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

  7. Application of Augmented Reality to Laparoscopic Surgery

    E-print Network

    Whitton, Mary C.

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

  8. Laparoscopic adrenalectomy—indications and technique

    Microsoft Academic Search

    Geeta Lal; Quan-Yang Duh

    2003-01-01

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

  9. Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments

    Microsoft Academic Search

    Daniel J. Scott; Shou-jiang Tang; Raul Fernandez; Richard Bergs; Mouza T. Goova; Ilia Zeltser; Farid J. Kehdy; Jeffrey A. Cadeddu

    2007-01-01

    Introduction  Natural orifice translumenal endoscopic surgery (NOTES) is an evolving field and suitable instruments are lacking. The purpose\\u000a of this study was to perform transvaginal cholecystectomies using instruments incorporated into a magnetic anchoring and guidance\\u000a system (MAGS).\\u000a \\u000a \\u000a \\u000a Methods  Non-survival procedures were conducted in pigs (n = 4). Through a vaginotomy created under direct vision, a rigid access port was inserted into the peritoneal cavity

  10. Gossypiboma presented as abdominal lump seven years after open cholecystectomy

    PubMed Central

    Ray, S; Das, K

    2011-01-01

    Gossypiboma is very rare in clinical practice. Despite its clinical importance, it carries some medico legal implications. We report a case of gossypiboma in a 54 years old female who presented with pain and a slowly growing lump in the abdomen 7 years after open cholecystectomy. Computed tomography (CT) scan of the abdomen showed a mass with enhanced internal septae and a radio-opaque marker within it, raising the suspicion of a foreign body. She underwent excision of the mass along with a segment of densely adherent transverse colon. Post-operative recovery was uneventful and the patient was well at 19-month follow up. PMID:24950393

  11. 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.

  12. Post Cholecystectomy Gossypiboma Mimicking a Liver Hydatid Cyst: Comprehensive Literature Review

    PubMed Central

    Yagmur, Yusuf; Akbulut, Sami; Gumus, Serdar

    2015-01-01

    Background: Gossypiboma is the term for forgotten textile products such as a surgical sponge and compress in the body cavity after a surgical procedure. Objectives: The aim of this study was to evaluate previously published articles related to post cholecystectomy gossypiboma. Materials and Methods: We conducted a systematic search using PubMed, Medline, Google and Google Scholar on post cholecystectomy gossypiboma. The keywords used were: gossypiboma and cholecystectomy, textiloma and cholecystectomy and post cholecystectomy gossypiboma. Furthermore, we also present a new case of post cholecystectomy gossypiboma. Results: A total of 32 articles concerning 38 patients with post cholecystectomy gossypiboma that met the aforementioned criteria were included. Detailed intraoperative findings and surgical management were provided. The patients were aged from 26 to 79 years (Mean ± SD: 47 ± 13.6 years); 32 were female and six were male. The time from the causative operation to presentation with a retained surgical sponge ranged from one to 480 months (Mean ± SD: 56.5 ± 93.5 months). Conclusions: Gossypiboma may not be symptomatic for many years or could be symptomatic for a short duration of time. Besides being a rare surgical complication, gossypiboma can lead to serious morbidity and mortality that may cause medico-legal problems. Diagnosis with imaging methods is difficult. PMID:26023336

  13. Pediatric cholelithiasis and laparoscopic management: A review of twenty two cases

    PubMed Central

    Deepak, J; Agarwal, Prakash; Bagdi, R K; Balagopal, S; Madhu, R; Balamourougane, P

    2009-01-01

    AIM: To evaluate the role of laparoscopic cholecystectomy (LC) in the management of cholelithiasis in children. MATERIALS AND METHODS: A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and March 2009 was done. Data points reviewed included patient demographics, clinical history, haematological investigations, imaging studies, operative techniques, postoperative complications, postoperative recovery and final histopathological diagnosis. RESULTS: During the study period of 36 months, 22 children (10 males and 12 females) with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3 to 18 years). Twenty-one children had symptoms of biliary tract disease and one child was incidentally detected with cholelithiasis during an ultrasonogram of the abdomen for an unrelated cause. Only five (22.7%) children had definitive etiological risk factors for cholelithiasis and the remaining 13(77.3%) cases were idiopathic. Twenty cases had pigmented gallstones and two had cholesterol gallstones. All the 22 patients underwent LC, 21 elective and one emergency LC. The mean operative duration was 74.2 minutes (range 50-180 minutes). Postoperative complications occurred in two (9.1%) patients. The average duration of hospital stay was 4.1 days (range 3-6 days). CONCLUSION: Laparoscopic chloecystectomy is confirmed to be a safe and efficacious treatment for pediatric cholelithiasis. The cause for an increased incidence of pediatric gallstones and their natural history need to be further evaluated. PMID:20407567

  14. 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

  15. Laparoscopic cryptorchidectomy in standing bulls.

    PubMed

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

    2015-06-01

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

  16. Laparoscopic cryptorchidectomy in standing bulls

    PubMed Central

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

    2015-01-01

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

  17. Laparoscopic live-donor nephrectomy.

    PubMed

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

    1994-04-01

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

  18. Laparoscopic management of colorectal endometriosis

    Microsoft Academic Search

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

    1999-01-01

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

  19. Laparoscopic colposuspension using mesh reinforcement

    Microsoft Academic Search

    R. A. Birken; P. L. Leggett

    1997-01-01

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

  20. Laparoscopic Splenectomy in Blunt Trauma

    PubMed Central

    Dissanaike, Sharmila

    2006-01-01

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

  1. [Peritoneum and laparoscopic environment].

    PubMed

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

    2007-12-01

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

  2. Laparoscopic telesurgical workstation

    NASA Astrophysics Data System (ADS)

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

    1998-06-01

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

  3. Entrapment neuropathy in laparoscopic herniorrhaphy

    Microsoft Academic Search

    A. S. Seid; E. Amos

    1994-01-01

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

  4. Robotic-assisted laparoscopic adrenalectomy.

    PubMed

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

    2005-10-01

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

  5. Spleen removal - laparoscopic - adults - discharge

    MedlinePLUS

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

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

    PubMed Central

    Gadiyaram, Srikanth; Shetty, Neel

    2012-01-01

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

  7. Laparoscopic Adjustable Esophagogastric Banding: a Preliminary Experience

    Microsoft Academic Search

    Erik Niville; Joost Vankeirsbilck; Anné Dams; Thierry Anne

    1998-01-01

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

  8. Hand-assisted laparoscopic low anterior resection

    Microsoft Academic Search

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

    2002-01-01

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

  9. Augmented Reality Visualization for Laparoscopic Surgery

    Microsoft Academic Search

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

    1998-01-01

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

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

    PubMed

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

    2010-02-01

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

  11. Laparoscopic pouch surgery in ulcerative colitis

    PubMed Central

    Hemandas, Anil K.; Jenkins, John T.

    2012-01-01

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

  12. Laparoscopic artificial insemination in sheep.

    PubMed

    Gourley, D D; Riese, R L

    1990-11-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  16. [The laparoscopic treatment of varicocele].

    PubMed

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

    1997-01-01

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

  17. Ultracision in gynaecological laparoscopic surgery.

    PubMed

    Kunde, D; Welch, C

    2003-07-01

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

  18. Laparoscopic appendectomy for perforated appendicitis

    Microsoft Academic Search

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

    2002-01-01

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

  19. Complications of Laparoscopic Donor Nephrectomy

    Microsoft Academic Search

    Alexei Wedmid; Michael A. Palese

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

  20. Severe endometriosis: laparoscopic rectum resection

    Microsoft Academic Search

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

    2010-01-01

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

  1. Laparoscopic pancreatectomy: Indications and outcomes

    PubMed Central

    Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

    2014-01-01

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

  2. Is laparoscopic hysterectomy a waste of time?

    Microsoft Academic Search

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

    1995-01-01

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

  3. Symptomatic internal hernias after laparoscopic bariatric surgery

    Microsoft Academic Search

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

    2005-01-01

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

  4. Laparoscopic Era of Operations for Morbid Obesity

    Microsoft Academic Search

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

    2003-01-01

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

  5. Laparoscopically assisted vaginal resection of rectovaginal endometriosis

    Microsoft Academic Search

    Marc Possover; Herbert Diebolder; Karin Plaul; Achim Schneider

    2000-01-01

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

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

    PubMed

    Colombo, J R; Gill, I S

    2006-05-01

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

  7. Laparoscopic treatment of cornual heterotopic pregnancy.

    PubMed

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

    2002-08-01

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

  8. Laparoscopic excision of splenic hydatid cyst

    PubMed Central

    Gharaibeh, K

    2001-01-01

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

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

    Microsoft Academic Search

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

    2003-01-01

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

  10. Laparoscopic Diagnosis and Treatment in Gynecologic Emergencies

    PubMed Central

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

    2003-01-01

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

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

    PubMed

    Li, Ziyu

    2014-08-01

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

  12. Cholecystectomy and sphincterotomy in patients with mild acute biliary pancreatitis in Sweden 1988 - 2003: a nationwide register study

    Microsoft Academic Search

    Birger Sandzén; Markku M Haapamäki; Erik Nilsson; Hans C Stenlund; Mikael Öman

    2009-01-01

    BACKGROUND: Gallstones represent the most common cause of acute pancreatitis in Sweden. Epidemiological data concerning timing of cholecystectomy and sphincterotomy in patients with first attack of mild acute biliary pancreatitis (MABP) are scarce. Our aim was to analyse readmissions for biliary disease, cholecystectomy within one year, and mortality within 90 days of index admission for MABP. METHODS: Hospital discharge and

  13. Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries

    PubMed Central

    Paat-Ahi, Gerli; Aaviksoo, Ain; ?widerek, Maria

    2014-01-01

    Background: As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods: National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. Results: European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England). The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Conclusion: Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries’ DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement. PMID:25489596

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

    PubMed Central

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

    2015-01-01

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

  15. Laparoscopic repair and groin hernia surgery.

    PubMed

    Crawford, D L; Phillips, E H

    1998-12-01

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

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

    PubMed Central

    Rivier, Pablo; Furneaux, Rob; Viguier, Eric

    2011-01-01

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

  17. Laparoscopic splenectomy: lessons from the learning curve

    PubMed Central

    Poulin, Eric C.; Mamazza, Joseph

    1998-01-01

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

  18. The laparoscopic evaluation of ascites.

    PubMed

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

    2001-01-01

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

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

    PubMed Central

    Tsuda, Shawn

    2014-01-01

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

  20. Laparoscopic gastric resection for gastrointestinal stromal tumors

    Microsoft Academic Search

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

    2008-01-01

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

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

    PubMed

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

    2015-02-01

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

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

    PubMed Central

    Ikoma, Naruhiko; Oshima, Go; Kitagawa, Yuko

    2015-01-01

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

  3. LAPAROSCOPIC BOWEL INJURY: INCIDENCE AND CLINICAL PRESENTATION

    Microsoft Academic Search

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

    1999-01-01

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

  4. Minimizing knot tying during reconstructive laparoscopic urology

    Microsoft Academic Search

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

    2006-01-01

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

  5. LYMPHATIC SPARING LAPAROSCOPIC VARICOCELECTOMY: A MICROSURGICAL REPAIR

    Microsoft Academic Search

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

    2005-01-01

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

  6. Incidence of complications following laparoscopic hernioplasty

    Microsoft Academic Search

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

    1995-01-01

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

  7. Laparoscopic cardiomyotomy and anterior partial fundoplication forachalasia

    Microsoft Academic Search

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

    2001-01-01

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

  8. Laparoscopic Approaches to Pancreatic Endocrine Tumors

    Microsoft Academic Search

    John B. Martinie; Stephen M. Smeaton

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

  9. Laparoscopic nephrectomy for renal cell carcinoma

    Microsoft Academic Search

    Isaac Yi Kim; Peter G. Schulam

    2001-01-01

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

  10. A misdiagnosis of clonorchiasis as gallstone, leading to an unnecessary cholecystectomy: a case report.

    PubMed

    Sun, Qingsong; Liu, Xiaolei; Hao, Yuhua; Li, YuXiang; Bai, Xue; Wang, Feng; Liu, Mingyuan

    2014-11-01

    This case report describes an unusual presentation of Clonorchissinensis infection. In this rare case, a clonorchiasis infection that had been latent for decades was misdiagnosed as acute calculous cholecystitis.Exploratory surgery and a cholecystectomy were performed. Therefore,in the course of diagnosis of hepatic and gall diseases, we cannot neglect parasite infections such as clonorchiasis. PMID:24881515

  11. A Multimodal Approach in Coil Embolization of a Bile Leak Following Cholecystectomy

    SciTech Connect

    Schelhammer, F. [University Hospital, Institute of Diagnostic Radiology (Germany)], E-mail: frank.schellhammer@med.uni-duesseldorf.de; Dahl, S. vom [St. Franziskus Hospital, Department of Internal Medicine (Germany); Heintges, T. [University Hospital, Department of Gastroenterology, Hepatology and Infectiology (Germany); Fuerst, G. [University Hospital, Institute of Diagnostic Radiology (Germany)

    2007-06-15

    Bile leak is a well-known complication of cholecystectomy. Endoscopic drainage and decompression of the biliary system including temporary insertion of a biliary stent is generally considered the treatment of choice. We report the successful obliteration of a bile leak using fibered platinum coils placed under fluoroscopic guidance after stent treatment had failed.

  12. Cholecystectomy is independently associated with nonalcoholic fatty liver disease in an Asian population

    PubMed Central

    Kwak, Min-Sun; Kim, Donghee; Chung, Goh Eun; Kim, Won; Kim, Yoon Jun; Yoon, Jung-Hwan

    2015-01-01

    AIM: To investigate the relationship between gallstone disease and nonalcoholic fatty liver disease (NAFLD) in a large Asian population. METHODS: A cross-sectional study including 17612 subjects recruited from general health check-ups at the Seoul National University Hospital, Healthcare System Gangnam Center between January 2010 and December 2010 was conducted. NAFLD and gallstone disease were diagnosed based on typical ultrasonographic findings. Subjects who were positive for hepatitis B or C, or who had a history of heavy alcohol consumption (> 30 g/d for men and > 20 g/d for women) or another type of hepatitis were excluded. Gallstone disease was defined as either the presence of gallstones or previous cholecystectomy, and these two entities (gallstones and cholecystectomy) were analyzed separately. Clinical parameters including body mass index, waist circumference, hypertension, diabetes, smoking status, and regular physical activity were reviewed. Laboratory parameters, including serum levels of gamma-glutamyl transpeptidase, alanine aminotransferase, aspartate aminotransferase, fasting glucose, fasting insulin, total cholesterol, triglycerides, and high-density lipoprotein, were also reviewed. RESULTS: The mean age of the subjects was 48.5 ± 11.3 years, and 49.3% were male. Approximately 30.3% and 6.1% of the subjects had NAFLD and gallstone disease, respectively. The prevalence of gallstone disease (8.3% vs 5.1%, P < 0.001), including both the presence of gallstones (5.5% vs 3.4%, P < 0.001) and a history of cholecystectomy (2.8% vs 1.7%, P < 0.001), was significantly increased in the NAFLD group. In the same manner, the prevalence of NAFLD increased with the presence of gallstone disease (41.3% vs 29.6%, P < 0.001). Multivariate regression analysis showed that cholecystectomy was associated with NAFLD (OR = 1.35, 95%CI: 1.03-1.77, P = 0.028). However, gallstones were not associated with NAFLD (OR = 1.15, 95%CI: 0.95-1.39, P = 0.153). The independent association between cholecystectomy and NAFLD was still significant after additional adjustment for insulin resistance (OR = 1.45, 95%CI: 1.01-2.08, P = 0.045). CONCLUSION: This study shows that cholecystectomy, but not gallstones, is independently associated with NAFLD after adjustment for metabolic risk factors. These data suggest that cholecystectomy may be an independent risk factor for NAFLD. PMID:26034364

  13. Automated Instrument Tracking in Robotically-Assisted Laparoscopic Surgery

    E-print Network

    Wang, Yuan-Fang

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

  14. Does Cholecystectomy Increase the Esophageal Alkaline Reflux? Evaluation by Impedance-pH Technique

    PubMed Central

    Akyuz, Filiz; Ermis, Fatih; Arici, Serpil; Bas, Gurhan; Cakirca, Mustafa; Baran, Bulent; Mungan, Zeynel

    2012-01-01

    Background/Aims The aim of this study is to investigate the reflux patterns in patients with galbladder stone and the change of reflux patterns after cholecystectomy in such patients. Methods Fourteen patients with cholecystolithiasis and a control group including 10 healthy control subjects were enrolled in this prospective study. Demographical findings, reflux symptom score scale and 24-hour impedance pH values of the 14 cholecystolithiasis cases and the control group were evaluated. The impedance pH study was repeated 3 months after cholecystectomy. Results Age, gender, and BMI were not different between the two groups. Total and supine weakly alkaline reflux time (%) (1.0 vs 22.5, P = 0.028; 201.85 vs 9.65, P = 0.012), the longest episodes of total, upright and supine weakly alkaline reflux mediums (11 vs 2, P = 0.025; 8.5 vs 1.0, P = 0.035; 3 vs 0, P = 0.027), total and supine weakly alkaline reflux time in minutes (287.35 vs 75.10, P = 0.022; 62.5 vs 1.4, P = 0.017), the number of alkaline reflux episodes (162.5 vs 72.5, P = 0.022) were decreased with statistical significance. No statistically significant difference was found in the comparison of symptoms between the subjects in the control group and the patients with cholecystolithiasis, in preoperative, postoperative and postcholecystectomy status. Conclusions Significant reflux symptoms did not occur after cholecystectomy. Post cholecystectomy weakly alkaline reflux was decreased, but it was determined that acid reflux increased after cholecystectomy by impedance pH-metry in the study group. PMID:22523728

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

    Microsoft Academic Search

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

    2009-01-01

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

  16. Laparoscopic splenectomy using conventional instruments

    PubMed Central

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

    2005-01-01

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

  17. Laparoscopic duodenoduodenostomy for duodenal atresia.

    PubMed

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

    2001-02-01

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

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

    Microsoft Academic Search

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

    2004-01-01

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

  19. Cutaneous Metastasis Following Laparoscopic Pelvic Lymphadenectomy for Prostatic Carcinoma

    Microsoft Academic Search

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

    1995-01-01

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

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

    Microsoft Academic Search

    Tom Mala; Bjørn Edwin

    2005-01-01

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

  1. Laparoscopic hemicolectomy in a patient with situs inversus totalis

    Microsoft Academic Search

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

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

  2. A study of 362 consecutive laparoscopic Nissen fundoplications

    Microsoft Academic Search

    Constantine T Frantzides; Christina Richards

    1998-01-01

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

  3. Periodic Extraction of Interstitial Fluid from the Site of Subcutaneous Insulin Infusion for the Measurement of Glucose: A Novel Single-Port Technique for the Treatment of Type 1 Diabetes Patients

    PubMed Central

    Lindpointner, Stefan; Korsatko, Stefan; Tutkur, Dina; Bodenlenz, Manfred; Pieber, Thomas R.

    2013-01-01

    Abstract Background Treatment of type 1 diabetes patients could be simplified if the site of subcutaneous insulin infusion could also be used for the measurement of glucose. This study aimed to assess the agreement between blood glucose concentrations and glucose levels in the interstitial fluid (ISF) that is extracted from the insulin infusion site during periodic short-term interruptions of continuous subcutaneous insulin infusion (CSII). Subjects and Methods A perforated cannula (24 gauge) was inserted into subcutaneous adipose tissue of C-peptide-negative type 1 diabetes subjects (n=13) and used alternately to infuse rapid-acting insulin (100?U/mL) and to extract ISF glucose during a fasting period and after ingestion of a standard oral glucose load (75?g). Results Although periodically interrupted for extracting glucose (every hour for approximately 10?min), insulin infusion with the cannula was adequate to achieve euglycemia during fasting and to restore euglycemia after glucose ingestion. Furthermore, the ISF-derived estimates of plasma glucose levels agreed well with plasma glucose concentrations. Correlation coefficient and median absolute relative difference values were found to be 0.95 and 8.0%, respectively. Error grid analysis showed 99.0% of all ISF glucose values within clinically acceptable Zones A and B (83.5% Zone A, 15.5% Zone B). Conclusions Results show that ISF glucose concentrations measured at the insulin infusion site during periodic short-term interruptions of CSII closely reflect blood glucose levels, thus suggesting that glucose monitoring and insulin delivery may be performed alternately at the same tissue site. A single-port device of this type could be used to simplify and improve glucose management in diabetes. PMID:23126579

  4. Single port access holographic particle image velocimetry

    SciTech Connect

    Woodruff, S.D.; Richards, G.A. [USDOE Morgantown Energy Technology Center, WV (United States); Cha, D.J. [National Research Council, Washington, DC (United States)

    1995-07-01

    An optical system, which requires only a single optical window mounted on a test volume, is proposed for holographic particle image velocimetry (HPIV). The optical system is a derivative of the double-exposure, double-reference-beam, off-axis HPIV system, but the innovative idea behind the system is to use back scattered light from the particles as the object wave. A 45{degree} beam splitter inserted in front of the window serves to admit the illuminating beam and extract the back scattered light. This concept can be of great engineering interest because optical access is often limited to one window in practical devices. The preliminary results of the technique appear quite promising, with current studies aimed at defining the optical resolution capabilities.

  5. Image acquisition in laparoscopic and endoscopic surgery

    NASA Astrophysics Data System (ADS)

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

    1995-04-01

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

  6. Laparoscopic Resection of Retroperitoneal Neural Tumors

    PubMed Central

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

    2013-01-01

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

  7. Laparoscopic Ureteroneocystostomy for Ureteral Injuries After Hysterectomy

    PubMed Central

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

    2013-01-01

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

  8. Current status of laparoscopic distal pancreatectomy.

    PubMed

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

    2012-09-01

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

  9. Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases.

    PubMed

    Weber-Sanchez, A; Weber-Alvarez, P; Garteiz-Martinez, D

    2012-02-01

    We report the case of a 4-year-old girl treated by a laparoscopic transabdominal preperitoneal (TAPP) technique with polypropylene mesh in whom a primary contralateral hernia was found and repaired, closing the orifice with a suture. This 4-year-old female had a medical history of clubfoot treated by surgery during her first year of age, ureteral reimplantation because of stenosis, and laparoscopic cholecystectomy because of hydrocholecystis. She had recurrence 1 year after a conventional inguinal herniorraphy and was treated by the TAPP technique with polypropylene mesh. A primary contralateral hernia was found and repaired, and the orifice was closed with a suture. The child's acceptance of the procedure was good, and the postoperative evolution was uneventful, requiring minimal analgesia in the first 24 h. She was discharged the following day. Two years later, there have been no recurrences, and the girl is developing and carrying out activities in a normal way. The open technique remains the gold standard for hernioplasty in children, but laparoscopy may be an option, and it is possible that in some special cases, the use of mesh to reinforce the inguinal wall using the TAPP technique, although it is controversial, may be justified. PMID:20803043

  10. Circumstance of endoscopic and laparoscopic treatments for gastric cancer in Japan: A review of epidemiological studies using a national administrative database

    PubMed Central

    Murata, Atsuhiko; Matsuda, Shinya

    2015-01-01

    Currently, endoscopic submucosal dissection (ESD) and laparoscopic gastrectomy (LG) have become widely accepted and increasingly play important roles in the treatment of gastric cancer. Data from an administrative database associated with the diagnosis procedure combination (DPC) system have revealed some circumstances of ESD and LG in Japan. Some studies demonstrated that medical costs or length of stay of patients receiving ESD for gastric cancer had become significantly reduced while length of hospitalization and costs were significantly increased in older patients. With respect to LG, some recent reports have shown that this has been a cost-beneficial treatment for patients compared with open gastrectomy while simultaneous LG and cholecystectomy is a safe procedure for patients with both gastric cancer and gallbladder stones. These epidemiological studies using the administrative database in the DPC system closely reflect clinical circumstances of endoscopic and surgical treatment for gastric cancer in Japan. However, DPC database does not contain detailed clinical data such as histological types and lesion size of gastric cancer. The link between the DPC database and another detailed clinical database may be vital for future research into endoscopic and laparoscopic treatments for gastric cancer. PMID:25685268

  11. Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept

    PubMed Central

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

    2014-01-01

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

  12. Laparoscopic subtotal hysterectomy: evidence and techniques.

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2004-09-01

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

  14. Diagnostic laparoscopic biopsy for intraabdominal tumors.

    PubMed

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

    2015-03-01

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

  15. [Robotics-assisted laparoscopic colorectal resection].

    PubMed

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

    2013-08-01

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

  16. Ureteral Injury After Laparoscopic Versus Open Colectomy

    PubMed Central

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

    2014-01-01

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

  17. Secondary Hemorrhage After Total Laparoscopic Hysterectomy

    PubMed Central

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

    2014-01-01

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

  18. Pseudogallbladder appearance in partial afferent loop obstruction in a patient with cholecystectomy

    SciTech Connect

    Morse, J.M.; Lakshman, S.; Thomas, E.

    1986-08-01

    We have described a patient who was admitted to the hospital for evaluation of RUQ abdominal pain 40 years after a Billroth II gastrectomy, as well as a cholecystectomy of which the patient was unaware. Gray-scale abdominal ultrasonography and Tc 99m-IDA hepatobiliary imaging were interpreted as revealing an enlarged gallbladder and cholelithiasis. An obstructed afferent loop of the Billroth II anastomosis had mimicked a gallbladder on ultrasonography and hepatobiliary imaging.

  19. +Gz-induced post-cholecystectomy syndrome in rabbit model by using a telemetric method.

    PubMed

    Kong, Yalin; Zhao, Gang; Li, Yifeng; Wen, Dongqing; Zhang, Hui; He, Xiaojun; Zhen, Yuying; Zhang, Hongyi

    2015-01-01

    Aviation-related mechanism may exist in the post-cholecystectomy syndrome (PCS) of aircrew patients. The aim of this study was to test this hypothesis on vivo rabbit model and to explore the mechanism by using a novel telemetric method. We constructed a bile duct-to-intestinal bridge bypass on 30 rabbits, with a telemetry implant attached to the Oddi's sphincter. Then a telemetric recording system was used to record the biliary pressure fluctuation through the subcutaneous bridge and the changes of electromyography of the Oddi's sphincter under different +Gz acceleration. Self-control comparison was made before and after cholecystectomy. The fully implantable device was very well accepted by rabbits and the data could reflect the real experimental environment simultaneously. Biliary pressure in common bile duct increased accordingly with +Gz acceleration increased, but bile secretion didn't change. Although +Gz acceleration could increase the frequency of burst of spike potentials in the Oddi's sphincter, the frequency didn't change with the +Gz acceleration increased, and the spike activity didn't change obviously before cholecystectomy. After cholecystectomy, the biliary pressure in common bile duct remained high in 12 rabbits (40%) under +Gz exposure, and the pressure value didn't change as the +Gz acceleration increased. The long-time changes in electromyography of the Oddi's sphincter were observed in the same 12 rabbits, with symptoms of PCS developed in 9 of them. +Gz exposure is an important external factor leading to the biliary physiology disorder, and it may induce PCS in some aircrew patients with individual susceptibility, which means gallbladder maybe a dominant factor in regulating the biliary physiology in theses aircrew patients. PMID:26064268

  20. One-stop cholecystectomy clinic: an application of lean thinking--can it improve the outcomes?

    PubMed

    Siddique, Khurram; Elsayed, Sameh Effat Abd; Cheema, Raza; Mirza, Shirin; Basu, Sanjoy

    2012-11-01

    Lean thinking principles were utilised to set up 'One-stop cholecystectomy clinics' at which patients underwent the surgical and the preoperative assessment during the same visit. The main aims were to reduce the number of patient hospital visits, preoperative admissions and the waiting time to surgery. The results showed a significant reduction in the number of patient visits as well as the waiting time to surgery thus highlighting that patientcare can be improved by good team working and lean management. PMID:23311022

  1. +Gz-induced post-cholecystectomy syndrome in rabbit model by using a telemetric method

    PubMed Central

    Kong, Yalin; Zhao, Gang; Li, Yifeng; Wen, Dongqing; Zhang, Hui; He, Xiaojun; Zhen, Yuying; Zhang, Hongyi

    2015-01-01

    Aviation-related mechanism may exist in the post-cholecystectomy syndrome (PCS) of aircrew patients. The aim of this study was to test this hypothesis on vivo rabbit model and to explore the mechanism by using a novel telemetric method. We constructed a bile duct-to-intestinal bridge bypass on 30 rabbits, with a telemetry implant attached to the Oddi’s sphincter. Then a telemetric recording system was used to record the biliary pressure fluctuation through the subcutaneous bridge and the changes of electromyography of the Oddi’s sphincter under different +Gz acceleration. Self-control comparison was made before and after cholecystectomy. The fully implantable device was very well accepted by rabbits and the data could reflect the real experimental environment simultaneously. Biliary pressure in common bile duct increased accordingly with +Gz acceleration increased, but bile secretion didn’t change. Although +Gz acceleration could increase the frequency of burst of spike potentials in the Oddi’s sphincter, the frequency didn’t change with the +Gz acceleration increased, and the spike activity didn’t change obviously before cholecystectomy. After cholecystectomy, the biliary pressure in common bile duct remained high in 12 rabbits (40%) under +Gz exposure, and the pressure value didn’t change as the +Gz acceleration increased. The long-time changes in electromyography of the Oddi’s sphincter were observed in the same 12 rabbits, with symptoms of PCS developed in 9 of them. +Gz exposure is an important external factor leading to the biliary physiology disorder, and it may induce PCS in some aircrew patients with individual susceptibility, which means gallbladder maybe a dominant factor in regulating the biliary physiology in theses aircrew patients.

  2. Incidence, Pattern and Management of Bile Duct Injuries during Cholecystectomy: Experience from a Single Center

    Microsoft Academic Search

    Biju Pottakkat; Ranjith Vijayahari; Anand Prakash; Rajneesh Kumar Singh; Anu Behari; Ashok Kumar; Vinay Kumar Kapoor; Rajan Saxena

    2010-01-01

    Background: The incidence and pattern of bile duct injury (BDI) may be underreported because of the heterogeneous referral from multiple institutions. Methods: Retrospective analysis of data from 5,782 cholecystectomies performed between 1989 and 2007 was done. BDI were categorized into Strasberg types. Results: Fifty-seven (1%) patients sustained BDI. Ten of 57 (18%) patients had minor BDI (type A-10), 25\\/57 (44%)

  3. Laparoscopic rectocele repair using polyglactin mesh.

    PubMed

    Lyons, T L; Winer, W K

    1997-05-01

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

  4. Ergonomic problems associated with laparoscopic surgery

    Microsoft Academic Search

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

    1999-01-01

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

  5. Laparoscopic ventral hernia repair: a systematic review

    Microsoft Academic Search

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

    2009-01-01

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

  6. Opioid Requirements after Laparoscopic Bariatric Surgery

    Microsoft Academic Search

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

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

  7. Laparoscopic resection of pancreatic neuroendocrine tumors

    PubMed Central

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

    2014-01-01

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

  8. Laparoscopic Resection of Unruptured Rudimentary Horn Pregnancy

    PubMed Central

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

    2011-01-01

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

  9. Laparoscopic Radiofrequency Ablation of Neuroendocrine Liver Metastases

    Microsoft Academic Search

    Eren Berber; Nora Flesher; Allan E. Siperstein

    2002-01-01

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

  10. Retroperitoneal laparoscopic bilateral lumbar sympathectomy.

    PubMed

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

    2007-06-01

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

  11. Rabeprazole combined with hydrotalcite is effective for patients with bile reflux gastritis after cholecystectomy

    PubMed Central

    Chen, Huimin; Li, Xiaobo; Ge, Zhizheng; Gao, Yunjie; Chen, Xiaoyu; Cui, Yun

    2010-01-01

    BACKGROUND: Regardless of surgical technique, patients who have undergone cholecystectomy appear to be predisposed to the development of bile reflux gastritis. OBJECTIVE: To assess the efficacy of rabeprazole and hydrotalcite in patients with bile reflux gastritis after cholecystectomy. METHODS: Postcholecystectomy patients with bile reflux gastritis confirmed by endoscopy and 24 h gastric bilirubin monitoring were randomly assigned to one of four eight-week treatments: observation (group A), rabeprazole alone (group B), hydrotalcite alone (group C) and rabeprazole in combination with hydrotalcite (group D). Endoscopy and 24 h gastric bilirubin monitoring were repeated in all patients after treatment. Dyspeptic symptoms of abdominal pain, bloating, heartburn, bitter taste, endoscopic and histological finding, and biliary reflux were evaluated before and after treatment. RESULTS: After administering medication, patient symptoms in groups B, C and D were relieved – most significantly in group D (P<0.05). There were no significant differences in endoscopic hyperemia and histological inflammation among the groups (P>0.05). However, histological activity, the number of reflux episodes and the number of reflux episodes lasting longer than 5 min were significantly decreased only in group D (P<0.05). The total per cent of bilirubin absorption (value of 0.14 units or greater) time was decreased in groups B, C and D, and most significantly in group D (P<0.05). CONCLUSION: Rabeprazole combined with hydrotalcite is an effective therapeutic option in the treatment of patients with bile reflux gastritis after cholecystectomy. PMID:20352149

  12. Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

    PubMed Central

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

    2009-01-01

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

  13. Management of mechanical ventilation during laparoscopic surgery.

    PubMed

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

    2010-06-01

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

  14. Laparoscopic repair of adult Bochdalek's hernia

    PubMed Central

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

    2013-01-01

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

  15. Reasons for early recurrence following laparoscopic hernioplasty

    Microsoft Academic Search

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

    1995-01-01

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

  16. Laparoscopic surgery and the systemic immune response.

    PubMed Central

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

    1998-01-01

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

  17. Preoperative Surgical Planning Using Virtual Laparoscopic Camera

    E-print Network

    Zhukov, Leonid

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

  18. Laparoscopic urology: Past, present, and future

    Microsoft Academic Search

    Ralph V. Clayman; Louis R. Kavoussi

    1993-01-01

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

  19. Laparoscopic splenectomy for atraumatic splenic rupture.

    PubMed

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

    2011-01-01

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

  20. Laparoscopic versus open splenectomy in children

    Microsoft Academic Search

    Robert K Minkes; Mara Lagzdins; Jacob C Langer

    2000-01-01

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

  1. Major Vascular Injury in Laparoscopic Urology

    PubMed Central

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

    2014-01-01

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

  2. Laparoscopic assisted adenomyomectomy using double flap method

    PubMed Central

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

    2014-01-01

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

  3. 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

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

    PubMed Central

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

    2014-01-01

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

  5. Hand-assisted laparoscopic splenectomy for ruptured spleen.

    PubMed

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

    2001-03-01

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

  6. The role of hand motion connectivity in the performance of laparoscopic procedures on a virtual reality simulator.

    PubMed

    Loukas, Constantinos; Rouseas, Constantinos; Georgiou, Evangelos

    2013-08-01

    Assessment of surgical skills based on virtual reality (VR) technology has received major attention in recent years, with special focus placed on experience discrimination via hand motion analysis. Although successful, this approach is restricted from extracting additional important information about the trainee's hand kinematics. In this study, we investigate the role of hand motion connectivity in the performance of a laparoscopic cholecystectomy on a VR simulator. Two groups were considered: experienced residents and beginners. The connectivity pattern of each subject was evaluated by analyzing their hand motion signals with multivariate autoregressive (MAR) models. Our analysis included the entire as well as key phases of the operation. The results revealed that experienced residents outperformed beginners in terms of the number, magnitude and covariation of the MAR weights. The magnitude of the coherence spectra between different combinations of hand signals was in favor of the experienced group. Yet, the more challenging (in terms of hand movement activity) an operational phase was, the more connections were generated, with experienced subjects performing more coordinated gestures per phase. The proposed approach provides a suitable basis for hand motion analysis of surgical trainees and could be utilized in future VR simulators for skill assessment. PMID:23543278

  7. 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 equation that can be solved efficiently, in real-time, with finite difference techniques. The solution describes the flow of blood over the polyhedral surfaces representing the anatomical structures and is displayed as a continuous polyhedral surface drawn over the anatomy. PMID:10538392

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

    Microsoft Academic Search

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

    1999-01-01

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

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

    Microsoft Academic Search

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

    2000-01-01

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

  10. Laparoscopic classification and treatment of the impalpable testis

    Microsoft Academic Search

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

    1999-01-01

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

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

    Microsoft Academic Search

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

    1998-01-01

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

  12. Laparoscopic Italian Experience with the Lap-Band ®

    Microsoft Academic Search

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

    2001-01-01

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

  13. Hand-assisted laparoscopic splenectomy for ruptured spleen

    Microsoft Academic Search

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

    2001-01-01

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

  14. The clinical suitability of laparoscopic instrumentation. A prospective clinical study of function and hygiene.

    PubMed

    Fengler, T W; Pahlke, H; Bisson, S; Kraas, E

    2000-04-01

    On the basis of experience gained from 6,000 laparoscopies (73% cholecystectomies) at the Moabit Hospital in Berlin, we carried out a cohort study to analyze the failure rate and decontamination of labeled "tracer" instruments processed in three test trays that were each subjected to 100 cycles. The majority of repairs focused on the functional parts of separable scissors and damaged or lost components. At 4%, the repair index after laparascopic use was less than that of a previously documented investigation period covering 1990 to 1996. A comparison of the costs of disposable and reusable instruments showed that reusable instruments were more cost-effective by a factor of > or =10, indicating that the price gap reported in our previous calculation for 1992 and 1994 has closed only slightly. After 100 cycles, we found traces of proteinaceous material in the eluate on every fourth instrument inspected (eight of 32); half of them (four) gave a positive reading when tested with a hemoglobin pseudoperoxidase test stick. It must be said, however, that similar residual contamination has been found on instruments used in conventional open surgery, with no indication of clinical relevance. This study was designed to examine the clinical suitability of laparoscopic instruments in terms of function and hygiene. Improvements in instrument design and cleanability must focus in particular on the reproducibility of cleaning results, because cleaning is the most important step in processing sterile supplies. As the number of minimally invasive operations has risen considerably, a mere visual check no longer meets the requirements prescribed by modern quality assurance. A multicenter study of residual proteins found on tracer instruments in all surgical fields is now in progress. PMID:10790561

  15. The outcome of early laparoscopic surgery to treat acute cholecystitis: a single-center experience

    PubMed Central

    Ciftci, Fatih; Abdurrahman, Ibrahim; Girgin, Sadullah

    2015-01-01

    Aim: The aim of this study was to prospectively assess the outcome of early laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. Materials and methods: Between July 2005 and December 2012, of 623 patients who had symptoms of acute cholecystitis during the first 72 h of hospital admission and who did not respond to non-operative treatment, 302 underwent surgical treatment. After initial treatment, all patients were followed up for 21 months on average (range: 5-27 months). The clinical, biochemical, radiological, and operative data of the 302 consecutive patients with acute cholecystitis were recorded and analyzed prospectively. Results: Of the 302 patients who underwent LC for acute cholecystitis, 169 were females and 133 males. Their mean ages were 47.8 years (range: 17-79 years) and 53.3 years (range: 27-90 years) respectively. Conversion to open surgery was required in 32 patients (10.5%). The mean postoperative length of hospital stay was 2 days (range: 1-3 days) in the LC group and 3 days (range: 2-6 days) in the conversion group. Significant differences between the successful LC group and the conversion group were evident terms of the length of postoperative hospitalization and gallbladder wall thickness (P=0.023). Factors associated with conversion were male gender, pericholecystic collection observed via ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. We experienced two minor bile duct injury complications that were treated via T tube placement. No mortality occurred. Ten patients suffered infections at the incisional locations, and eight patients developed lung infections. Conclusion: Early LC is safe in patients with acute cholecystitis. Male gender, pericholecystic collection determined via ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.

  16. Outcomes analysis of laparoscopic resection of pancreatic neoplasms

    Microsoft Academic Search

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

    2007-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Zheng, Minhua; Ma, Junjun

    2015-06-25

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

  19. Superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy.

    PubMed

    Pineda, Lucas; Sarhan, Mohammad; Ahmed, Leaque

    2013-08-01

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

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

    Microsoft Academic Search

    Philippe Mognol; Denis Chosidow; Jean-Pierre Marmuse

    2004-01-01

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

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

    Microsoft Academic Search

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

    2006-01-01

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

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

    Microsoft Academic Search

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

    2000-01-01

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

  3. Comparison of open and laparoscopic live donor nephrectomy.

    PubMed Central

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

    1997-01-01

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

  4. 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

  5. Laparoscopic fascial suture repair of parastomal hernia

    PubMed Central

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

    2013-01-01

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

  6. Laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma.

    PubMed

    Kuroki, Tamotsu; Eguchi, Susumu

    2014-08-26

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

  7. Unexpected pathology during laparoscopic bariatric surgery

    Microsoft Academic Search

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

    2007-01-01

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

  8. Laparoscopic repair of a Morgagni hernia

    Microsoft Academic Search

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

    1994-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  10. The Development of Laparoscopic Surgery in Spain

    Microsoft Academic Search

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

    2004-01-01

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

  11. Laparoscopic versus Open Appendectomy: Time to Decide

    Microsoft Academic Search

    Abe Fingerhut; Bertrand Millat; Fredéric Borrie

    1999-01-01

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

  12. Revisional surgery after laparoscopic sleeve gastrectomy.

    PubMed

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

    2015-02-01

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

  13. Laparoscopic Treatment of Pancreatic Pseudocysts in Children

    PubMed Central

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

    2009-01-01

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

  14. Learning kinematic mappings in laparoscopic surgery

    Microsoft Academic Search

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

    2010-01-01

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

  15. Laparoscopic Anderson-Hynes pyeloplasty in children

    Microsoft Academic Search

    F. Schier

    1998-01-01

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

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

    Microsoft Academic Search

    Peter Ojo; Elmer Valin

    2009-01-01

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

  17. Laparoscopic fundoplication for gastroesophageal reflux disease

    PubMed Central

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

    2014-01-01

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

  18. [A novel technique of laparoscopic hepatectomy].

    PubMed

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

    2014-11-01

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

  19. Laparoscopic Kasai portoenterostomy for biliary atresia.

    PubMed

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

    2002-12-01

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

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

    Microsoft Academic Search

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

    1996-01-01

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

  1. Laparoscopic preservation of ovarian function: An underused procedure

    Microsoft Academic Search

    Mazen Bisharah; Togas Tulandi

    2003-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  3. Comparison of laparoscopic versus open repair of paraesophageal hernia

    Microsoft Academic Search

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

    1998-01-01

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

  4. Laparoscopic Total Mesorectal Excision—The Turin Experience

    Microsoft Academic Search

    M. Morino; G. Giraudo

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

  5. Smaller Ports Result in Shorter Convalescence After Laparoscopic Varicocelectomy

    Microsoft Academic Search

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

    1995-01-01

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

  6. Learning laparoscopic surgery by imitation using robot trainer

    Microsoft Academic Search

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

    2011-01-01

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

  7. A 3 TROCAR TECHNIQUE FOR TRANSPERITONEAL LAPAROSCOPIC NEPHRECTOMY

    Microsoft Academic Search

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

    1999-01-01

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

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

    Microsoft Academic Search

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

    2005-01-01

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

  9. Open and Laparoscopic Treatment of Nonparasitic Splenic Cysts

    Microsoft Academic Search

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

    2003-01-01

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

  10. Force Propagation Models in Laparoscopic Tools and Shahram Payandeh

    E-print Network

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

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

    PubMed

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

    2012-01-01

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

  12. Laparoscopic Liver Resection for Malignant Liver Tumors

    PubMed Central

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

    2002-01-01

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

  13. Robotic laparoscopic surgery: cost and training.

    PubMed

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

    2009-06-01

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

  14. The use of laser lithotripsy status post cholecystostomy tube placement without interval cholecystectomy for calculous cholecystitis in a patient unfit for general anesthesia.

    PubMed

    Polite, Nathan M; Brown, Roy; Braveman, Joshua

    2013-12-01

    Acute cholecystitis in patients unfit for general anesthesia often initially requires cholecystectomy tube placement without cholecystectomy. The best way to definitively manage those patients with irreversible medical conditions, leaving them unable to undergo cholecystectomy, has yet to be defined. Laser lithotripsy is currently used in the management of stones of the genitourinary system. Extracorporeal shock wave cholelithotripsy has been extensively evaluated in Munich, Germany and since then, has been abandoned as an alternative treatment of cholelithiasis. This report discusses a novel approach using established cholecystocutaneous fistula tracts and laser lithotripsy to definitively treat this group of patients. PMID:24300938

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

    PubMed

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

    2003-01-01

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

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

    PubMed Central

    Lim, Sang Woo; Kim, Hyeong Rok

    2014-01-01

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

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

    PubMed

    Shekherdimian, Shant; DeUgarte, Daniel

    2011-05-01

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

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

    PubMed

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

    2006-03-01

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

  19. Stentless laparoscopic pyeloplasty: A single center experience

    PubMed Central

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

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  1. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound.

    PubMed Central

    John, T G; Greig, J D; Crosbie, J L; Miles, W F; Garden, O J

    1994-01-01

    OBJECTIVE. The authors describe the technique of staging laparoscopy with laparoscopic contact ultrasonography in the preoperative assessment of patients with liver tumors, and assess its impact on the selection of patients for hepatic resection with curative intent. SUMMARY BACKGROUND DATA. Laparoscopy may be useful in the selection of patients with a variety of intra-abdominal malignancies for operative intervention. Laparoscopic ultrasonography is a new technique that combines the principles of high resolution intraoperative contact ultrasound with those of the laparoscopic examination, and thus, allows the laparoscopist to perform detailed assessment of the liver. METHODS. This study analyzes a cohort of 50 consecutive patients who were diagnosed as having potentially resectable liver tumors, and in whom staging laparoscopy was successfully undertaken. Laparoscopic ultrasonography was performed in 43 patients, and the impact of the ensuing findings on the decision to proceed to operative assessment of resectability is examined. The resectability rate in those patients assessed laparoscopically and subsequently submitted to laparotomy is compared with a preceding group of patients in whom no laparoscopic assessment was performed. RESULTS. Laparoscopy demonstrated factors precluding curative resection in 23 patients (46%). Laparoscopic ultrasonography identified liver tumors not visible during laparoscopy in 14 patients (33%), and provided staging information in addition to that derived from laparoscopy alone in 18/43 patients (42%). The resectability rate was significantly higher among those patients undergoing laparoscopic staging (93%) compared with those in whom operative assessment was undertaken without laparoscopy (58%). CONCLUSIONS. Staging laparoscopy with laparoscopic ultrasonography optimizes patient selection for liver resection with curative intent. Images Figure 1. Figure 2. PMID:7986136

  2. Laparoscopic management of benign liver diseases: where are we?

    PubMed Central

    Hubert, Catherine; Banice, Radu; Kendrick, Michael L

    2004-01-01

    Background The role of laparoscopic surgery in the management of benign cystic and solid liver tumours appears to differ according to each tumour type. As regards congenital liver cysts, laparoscopic treatment is now the gold standard for treating selected, huge, accessible, highly symptomatic or complicated cysts. In contrast, the laparoscopic approach is not useful for patients suffering from adult polycystic liver disease (PLD), except for type I PLD with large multiple hepatic cysts. For benign hepatocellular tumours, the surgical management has recently benefited from a better knowledge of the natural history of each type of tumour and from the improvement of imaging techniques in assuring a precise diagnosis of tumour nature. Thus the general tendency has led to a progressive restriction and tailoring of indications for resection in benign liver tumours, selecting only patients with huge, specifically symptomatic or compressive benign tumours or patients suffering from liver cell adenoma. Despite the enthusiastic use of the laparoscopic approach, selective indications for resection of benign liver tumours should indeed remain unchanged. For all types of benign liver tumours, the best indication remains small, superficial lesions, located in the anterior or the lateral segments of the liver. Deep, centrally located lesions or tumours in contact with major vascular or biliary trunks are not ideal candidates for laparoscopic liver resections. When performed by expert liver and laparoscopic surgeons using an adequate surgical technique, the laparoscopic approach is safe for performing minor liver resections and is accompanied by the usual postoperative benefits of laparoscopic surgery. When applied in selected patients and tumours, laparoscopic management of benign liver diseases appears to be a promising technique for hepatobiliary surgeons. PMID:18333077

  3. Bladder perforation during laparoscopic donor nephrectomy.

    PubMed

    Metcalfe, P D; Hickey, L; Lawen, J G

    2004-12-01

    We present two cases of bladder perforation during laparoscopic donor nephrectomy at our institution. Neither of the surgeries was otherwise complicated, and the diagnoses were made post-operatively. The kidneys were extracted through a Pfannenstiel incision and used blunt dissection to penetrate the peritoneum. Both patients had previous tubal ligations, adhesions from which may have increased the chance of injury. We believe that this is a previously unreported complication that merits attention. Care should be taken with the peritoneal incision and dissection as the bladder may be susceptible to injury. PMID:15636672

  4. Laparoscopic resection for gastric carcinoma: Western experience.

    PubMed

    Strong, Vivian E

    2012-01-01

    There has been much speculation regarding differences in outcome for patients who have gastric cancer in the Eastern versus Western world. Among other factors, these differences have contributed to a unique cohort of patients and experience in the Western staging/evaluation of gastric cancer and in the application of minimally invasive approaches for treatment. This review summarizes the current state of laparoscopic approaches for the staging and treatment of gastric adenocarcinoma for patients presenting in Western countries, with their associated unique presentation, comorbidities, and outcomes. PMID:22098837

  5. Laparoscopic diagnosis of ascites in Lesotho.

    PubMed Central

    Menzies, R I; Fitzgerald, J M; Mulpeter, K

    1985-01-01

    In a prospective study of 98 consecutive patients with undiagnosed ascites examined by laparoscopy a correct immediate diagnosis was made in 76 (78%) and a final diagnosis in 92 (94%) of those who underwent laparoscopy. Visual diagnosis was highly accurate in patients with tuberculous peritonitis but only moderately accurate in those with carcinomatosis and liver disease. When the laparoscopic findings were compared with histological and microbiological results visual diagnosis was found to be the most accurate diagnostic method. Laparoscopy may readily be used in rural hospitals for diagnosing ascites. PMID:3160432

  6. Perforated marginal ulcers after laparoscopic gastric bypass

    Microsoft Academic Search

    Edward L. Felix; John Kettelle; Elijah Mobley; Daniel Swartz

    2008-01-01

    Background  Perforated marginal ulcer (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a serious complication, but its incidence\\u000a and etiology have rarely been investigated. Therefore, a retrospective review of all patients undergoing LRYGB at the authors’\\u000a center was conducted to determine the incidence of PMU and whether any causative factors were present.\\u000a \\u000a \\u000a \\u000a Methods  A prospectively kept database of all patients at the

  7. Completely Intracorporeal Robotic-Assisted Laparoscopic Ileovesicostomy

    PubMed Central

    Dolat, MaryEllen T.; Wade, Greg; Grob, B. Mayer; Hampton, Lance J.; Klausner, Adam P.

    2014-01-01

    We present a report of a completely intracorporeal robotic-assisted laparoscopic ileovesicostomy with long term follow-up. The patient was a 55-year-old man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction. The procedure was performed using a da Vinci Surgical system (Intuitive Surgical, Sunnyvale, CA) and took 330 minutes with an estimated blood loss of 100?mL. The patient recovered without perioperative complications. He continues to have low pressure drainage without urethral incontinence over two years postoperatively. PMID:24600527

  8. Robotic-assisted laparoscopic mesh sacrocolpopexy

    PubMed Central

    Gilleran, Jason P.; Johnson, Matthew; Hundley, Andrew

    2010-01-01

    The current ‘gold standard’ surgical repair for apical prolapse is the abdominal mesh sacrocolpopexy. Use of a robotic-assisted laparoscopic surgical approach has been demonstrated to be feasible as a minimally invasive approach and is gaining popularity amongst pelvic floor reconstructive surgeons. Although outcome data for robotic-assisted sacrocolpopexy (RASC) is only just emerging, several small series have demonstrated anatomic and functional outcomes, as well as complication rates, comparable to those reported for open surgery. The primary advantages thus far for RASC over open surgery include decreased blood loss and shorter hospital stay. PMID:21789075

  9. Laparoscopic myomectomy and pregnancy outcome in infertile patients

    Microsoft Academic Search

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

    1999-01-01

    Objective: To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients.Design: Retrospective analysis.Setting: Tertiary care advanced laparoscopic center.Patient(s): Twenty-eight infertile patients with at least one uterine leiomyoma of >5 cm in diameter.Intervention(s): Laparoscopic myomectomy.Main Outcome Measure(s): Occurrence of pregnancy, delivery rate, and pregnancy-related complications.Result(s): The average size of the myomas removed was 6 cm (range, 4–13.3 cm). None

  10. Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications

    Microsoft Academic Search

    Rajesh Varma; Janesh K. Gupta

    2008-01-01

    Background  This study aimed to establish criteria for safe laparoscopic entry through a systematic literature search and evidence-based\\u000a medicine appraisal, to determine surgeon preferences for laparoscopic entry in the United Kingdom, and to appraise the medicolegal\\u000a ramifications of complications arising from laparoscopic entry.\\u000a \\u000a \\u000a \\u000a Methods  A systematic literature search of MEDLINE and EMBASE (1996–2007) was performed as well as a national surgeon survey

  11. Natural orifice transluminal endoscopic surgery: The transvaginal route moving forward from cholecystectomy

    PubMed Central

    Targarona, Eduardo M; Maldonado, Edgar Mauricio; Marzol, Jose Antonio; Marinello, Franco

    2010-01-01

    The advent of minimally invasive surgery and the advances in endoluminal flexible endoscopy have converged to generate a new concept in digestive surgery, whose acronym natural orifice transluminal endoscopic surgery (NOTES), has become a familiar term in the surgical community. NOTES has been performed through the mouth, the bladder, the rectum and the vagina. Of these four approaches, the vagina has gained most popularity for several reasons. It is not only readily accessible and easy to decontaminate but it also provides safe entry and simple closure. The transvaginal approach has been described in the experimental and the clinical setting as an option for cholecystectomy, nephrectomy, splenectomy, segmental gastrectomy, retroperitoneal exploration and bariatric surgery. However, larger series are needed to delineate the exact risks of this approach, and to transcend cultural barriers that impede its wider introduction. Prospective randomized trials will shed light on the definitive role of the vaginal approach in minimal invasive surgery of the future. PMID:21160871

  12. Prior cholecystectomy predisposes to acute pancreatitis in codeine-prescribed patients

    PubMed Central

    Turkmen, Serdar; Buyukhatipoglu, Hakan; Suner, Ali; Apucu, Haci Gokhan; Ulas, Turgay

    2015-01-01

    In this paper, we report a case of drug-induced pancreatitis just after taking a pain pill including a low-dose combination of acetaminophen and codeine. Codeine-induced pancreatitis has been rarely reported, however, well-established. The proposed mechanism for codeine-induced pancreatitis is by increasing Oddi sphincter pressure. However, the clinically important point is that the codeine-induced pancreatitis is seen almost only in the cholecystectomized patients due to lacking of its reservoir capacity. Codeine is commonly used alone or in combination in pain medicine. Therefore, it is fairly important to question whether a patient underwent cholecystectomy when a physician decides to prescribe codeine-included preparations.

  13. Laparoscopic Gastric Bypass versus Laparoscopic Adjustable Gastric Banding in the Super-obese: A Comparative Study of 290 Patients

    Microsoft Academic Search

    Philippe Mognol; Denis Chosidow; Jean-Pierre Marmuse

    2005-01-01

    Background: Controversy exists regarding the best surgical treatment for super-obesity (BMI >50 kg\\/m 2 ). The two most common\\u000a bariatric procedures performed worldwide are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric\\u000a bypass (LRYGBP). We undertook a retrospective single-center study to compare the safety and efficacy of these two operations\\u000a in super-obese patients. Methods: 290 super-obese patients underwent laparoscopic

  14. What is the risk of diagnostic endoscopic retrograde cholangiopancreatography before cholecystectomy?

    PubMed

    Jones, Wesley B; Blackwell, Joseph; McKinley, Brian; Trocha, Steven

    2014-08-01

    Many surgeons prefer to perform endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy, specifically in patients at significant risk of having biliary pathology. However, a preoperative diagnostic ERCP, without the use of an endoscopic ultrasound or magnetic retrograde cholangiopancreatoscopy, remains controversial. This is the result of the risk of either performing an unnecessary procedure and/or the development of post-ERCP pancreatitis (PEP). We performed a retrospective review of all surgeon-performed ERCPs at our institution between July 2011 and May 2013. This was done to examine patients who had pericholecystectomy ERCP. We had 550 ERCPs performed at our institution during this time period, 169 of which were pericholecystectomy procedures. We divided the 169 patients who had a diagnostic procedure (Diagnostic group) from those who had known biliary pathology before intervention (Therapeutic group). As a result, 34 patients (20.1%) were placed in the Diagnostic group and 135 patients (79.9%) in the Therapeutic group. Of the 34 Diagnostic patients, four (11.8%) developed PEP. Fifteen (44.1%) had unnecessary procedures, two of which had PEP (2.9%). Of the 135 ERCPs in the Therapeutic group, 18 patients (13.4%) developed PEP. Five of the 11 who had unnecessary procedures developed PEP. Based on the low incidence of complications, diagnostic ERCP has an acceptable rate of pancreatitis and/or unnecessary procedures when performed in highly selected patients and before cholecystectomy when compared with patients undergoing therapeutic ERCP. However, more aggressive use of diagnostic imaging before ERCP should be adopted given the number of unnecessary procedures performed. PMID:25105391

  15. Laparoscopic Splenectomy for Isolated Splenic Sarcoidosis

    PubMed Central

    Tempes, Bruna Cogo; Lambert, Bruna Franco; Trindade, Eduardo Neubarth; Trindade, Manoel Roberto Maciel

    2014-01-01

    Introduction: Sarcoidosis is an inflammatory disease with an unknown etiology. The pulmonary interstitium is mainly involved, with noncaseating granulomas and lymphadenopathy. It is a multisystemic disease, and the differential diagnosis should include infectious, neoplastic, and autoimmune diseases to prevent inappropriate treatment and unnecessary surgery. Abdominal disease without evidence of pulmonary abnormalities on chest radiography in sarcoidosis can be found in approximately 25% to 38% of cases. The approach to isolated splenic nodules in a patient with nonspecific abdominal symptoms should be focused on exclusion of malignancies and infections, and may require computed tomography, magnetic resonance imaging, and positron emission tomography–computed tomography imaging; scintigraphy; bone marrow biopsy; breast and genital examinations; and endoscopies. This report documents a rare case of isolated granulomatous disease of the spleen that was diagnosed and treated laparoscopically. Case: A 29-year-old woman presented with nonspecific complaints such as nausea, vomiting, and epigastric discomfort. Further laboratory test results were normal. Abdominal ultrasonography, computed tomography, and magnetic resonance imaging revealed multiple splenic lesions. Additional examination findings were negative for occult neoplasia or infectious disease. Laparoscopic splenectomy was performed as a diagnostic procedure, without complications, and the final diagnosis was sarcoidosis. Conclusion: Isolated splenic sarcoidosis is a rare manifestation of extrapulmonary disease. The final diagnosis may be achieved only by histology, requiring biopsy or splenectomy. Minimally invasive surgery is a safe and efficient method for diseases of the spleen and should be the first option when feasible. The patient did well; however, further monitoring is required to diagnose recurrence. PMID:24680162

  16. Teaching instrument: a laparoscopic training model.

    PubMed

    Tintara, H; Choobun, T

    2001-11-01

    A laparoscopic training model with female surface anatomy has been developed. This training model is made of a plastic boutique-showing model that is equivalent to normal-size female anatomy from the neck to the upper thigh. Four holes were made on the model's abdominal wall as puncture-sites to enter the cavity, the first is 80-mm diameter at the umbilical area, and the other three 38-mm diameter holes are located on both sides of the lower abdomen and suprapubic area. The umbilical hole can be covered with a simulated abdominal wall made from 6.5-mm insulation sheet, fixed to the model using a rubber band. The other three puncture-sites were plugged with a flexible rubber diaphragm as working ports. When used as video-laparoscopy, the auto-focus camcorder is used as a telescope and is connected to a regular television set as a monitor. This model can be used for training of abdominal entry by Veress needle or trocar, laparoscopic tubal ligation (LTL), and video-eye-hand co-ordination. This model has been a training medium in our Department for 1 year and was included in the OSCE for the Board Examination of the Royal Thai College of Obstetricians and Gynecologists in the year 2000 to assess the process of Veress needle insertion. PMID:11853305

  17. Laparoscopic (endoscopic) radical prostatectomy: techniques and results

    NASA Astrophysics Data System (ADS)

    Nelius, Thomas; de Riese, Werner T. W.; Reiher, Frank; Lindenmeir, Tobias; Filleur, Stephanie; Allhoff, Ernst P.

    2005-04-01

    Laparoscopic radical prostatectomy (LRP) is a relatively new technique for treating organ-confined prostate cancer. Recent progress of laparoscopic/endoscopic techniques allow to perform these complex oncological procedure. Since the first description of LRP in the early 1990s the technique has undergone significant technical modifications. Two operation routes were mainly used: the transperitoneal LRP and the extraperitoneal endoscopic radical prostatectomy (EERPE). Here we review the surgical techniques of both operation routes, and highlight results, outcome and complications. The transperitoneal LRP and the EERPE can be used successfully and reproducibly, giving results comparable with those from the open retropubic procedure. Despite many advantages, transperitoneal LRP is associated with potential intraperitoneal complications. The technical improvements of the EERPE completely obviates these complications. The available data are encouraging and promising, but long-term oncological results will define the definitive role of these new techniques. We truly believe that minimally invasive surgery in treating localized prostate cancer has a bright future and that these techniques will continue to be developed.

  18. Laparoscopic spigelian hernia repair: a series of 40 patients.

    PubMed

    Kelly, Michael E; Courtney, Danielle; McDermott, Frank D; Heeney, Anna; Maguire, Donal; Geoghegan, Justin G; Winter, Des C

    2015-06-01

    Spigelian hernias are a rare abdominal wall hernia. The aim of this study was to assess the efficacy and outcomes of patients who underwent a laparoscopic spigelian hernia repair. A retrospective study was performed reviewing all patients who had a laparoscopic spigelian hernia repair. We assessed the success of the procedure including conversion rates, postoperative morbidities, and recurrence rates. Forty patents had a laparoscopic repair. Two thirds (n=25) had an intraperitoneal repair. There was no conversion to open repair. Four patients had postoperative morbidities. At 6-month follow-up all patients were pain free, with 1 recurrence. There is considerable evidence supporting the opinion that laparoscopic repair offers excellent outcomes. This report is the largest series to date, and we advocate that this approach should become the standard of care. PMID:25383942

  19. Laparoscopic transperitoneoscopic nephroureterectomy in a patient with situs inversus totalis.

    PubMed

    Gökçen, Kaan; Çelik, Hüseyin; Kobaner, Murat; Karazindiyano?lu, Sinan

    2015-04-01

    This article discusses the case of a 78-year-old female with painless gross hematuria. Chest X-rays showed dextrocardia with situs inversus, and whole-body computed tomography scanning showed a renal mass in the right renal pelvis, no evidence of metastasis, and mirror-image organs with left-to-right transposition, which resulted in a diagnosis of situs inversus totalis (SIT). A laparoscopic transperitoneoscopic right nephroureterectomy was scheduled. To our knowledge, our case is the second case of laparoscopic nephroureterectomy in renal pelvic urothelial carcinoma with SIT to be presented, but it is the first case of laparoscopic transperitoneoscopic nephroureterectomy. Laparoscopic transperitoneoscopic nephroureterectomy was successfully performed in a renal pelvic urothelial carcinoma patient with SIT with a correct description of renal vascularity and abdominal anatomy. PMID:25972677

  20. The role of laparoscopic surgery in gastric cancer

    PubMed Central

    Pavlidis, Theodoros E; Pavlidis, Efstathios T; Sakantamis, Athanasios K

    2012-01-01

    The laparoscopic surgery in gastric cancer is applied with increasing frequency nowadays; noticeable reports come mainly from Korea and Japan with satisfactory results. This review presents briefly the issue by evaluating its role. A PubMed search of relevant articles published up to 2010 was performed to identify current information. Most data come from Far East, where gastric cancer occurs more often, and the proportion of early gastric cancer is high. Laparoscopic approach includes both the diagnostic laparoscopy and laparoscopic resection. Laparoscopic gastrectomy has currently limited application for gastric cancer in the West; it is not widely accepted and raises important considerations necessitating the planning of multicentre randomised control trials based mainly on the long-term results. PMID:22623823

  1. Laparoscope Self-calibration for Robotic Assisted Minimally Invasive Surgery

    Microsoft Academic Search

    Danail Stoyanov; Ara Darzi; Guang-zhong Yang

    2005-01-01

    For robotic assisted minimal access surgery, recovering 3D soft tis- sue deformation is important for intra-operative surgical guidance, motion compensation, and prescribing active constraints. We propose in this paper a method for determining varying focal lengths of stereo laparoscope cameras during robotic surgery. Laparoscopic images typically feature dynamic scenes of soft-tissue deformation and self-calibration is difficult with existing ap- proaches

  2. The Swedish Adjustable Gastric Band: Laparoscopic Technique and Preliminary Results

    Microsoft Academic Search

    Antonio Catona; Luigi La Manna; Peter Forsell

    2000-01-01

    Background: The laparoscopic technique for the Swedish Adjustable Gastric Band (SAGB) has been developed based on the previously\\u000a established open technique. Methods: From March 1996-June 1997, laparoscopic SAGB was attempted in 85 consecutive obese patients\\u000a (77 women and 8 men). The average preoperative BMI was 44 (34-59). Results: All operations except one were completed by laparoscopy.\\u000a One patient had to

  3. [Peritoneal closure using absorbable knotless device during laparoscopic sacrocolpopexy].

    PubMed

    Deffieux, X; Pachy, F; Donnadieu, A-C; Trichot, C; Faivre, E; Fernandez, H

    2011-02-01

    Laparoscopic sacrocolpopexy is one of the gold standards of pelvic organ surgery. However, this intervention is associated with long operation duration. One of the steps of this intervention (peritoneal closure) can be shortened using several methods of suturing (e.g. staples). Recently, a self-anchoring barbed suture has been described for wound closure. The goal of this initial feasibility study was to describe the use of the barbed suture (V-Loc™) in peritoneal closure during laparoscopic sacrocolpopexy. PMID:20943328

  4. Robotic-Assisted Versus Laparoscopic Colectomy: Cost and Clinical Outcomes

    PubMed Central

    Davis, Bradley R.; Yoo, Andrew C.; Moore, Matt

    2014-01-01

    Background and Objectives: Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Methods: Patients aged ?18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Results: Of 25 758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17 445 vs $15 448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Conclusion: Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies. PMID:24960484

  5. Surgical technology and the ergonomics of laparoscopic instruments

    Microsoft Academic Search

    R. Berguer

    1998-01-01

    .   Laparoscopic surgery provides patients with less painful surgery and a more rapid recovery, while requiring that surgeons\\u000a work harder and in a more remote manner from the operating field. Cost-containment pressures on surgeons demand efficient\\u000a surgery, whereas the increased technological complexity and sometimes poorly adapted equipment have led to increased complaints\\u000a of surgeon fatigue and discomfort during laparoscopic surgery.

  6. Metrics for Laparoscopic Skills Trainers: The Weakest Link

    Microsoft Academic Search

    Stephane Cotin; Nicholas Stylopoulos; Mark P. Ottensmeyer; Paul F. Neumann; David W. Rattner; Steven Dawson

    2002-01-01

    Metrics are widely employed in virtual environments and provide a yardstick for performance measurement. The current method\\u000a of defining metrics for medical simulation remains more an art than a science. Herein, we report a practical scientific approach\\u000a to defining metrics, specifically aimed at computer-assisted laparoscopic skills training. We also propose a standardized\\u000a global scoring system usable across different laparoscopic trainers

  7. Lessons learned from laparoscopic gastric banding for morbid obesity

    Microsoft Academic Search

    Jeff W Allen; Mark G Coleman; George A Fielding

    2001-01-01

    Background: Laparoscopic gastric banding is a minimally invasive bariatric operation that is increasing in popularity at many centers worldwide. Although this procedure is not yet approved in the United States, clinical trials are ongoing.Methods: We report our results of a 3-year follow-up on 60 patients who underwent the laparoscopic gastric band procedure for the treatment of morbid obesity. The procedure

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

    PubMed Central

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

    2014-01-01

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

  9. Laparoscopic Exploration in the Management of Retroperitoneal Masses

    PubMed Central

    Chan, Steve W.H.; Bercowsky, Eduardo; Elbahnassy, Abdelhamid M.; McDougall, Elspeth M.; Clayman, Ralph V.

    1999-01-01

    Background and Objectives: The isolated finding of a retroperitoneal mass (RM) often represents a diagnostic challenge. Image-guided biopsy is frequently inadequate for diagnosis. With increasing experience, the use of laparoscopy for exploration of an indeterminate RM may provide a minimally invasive alternative to open exploration. Herein, we present a retrospective review of our initial four laparoscopic explorations, comparing our experience to four contemporary open explorations for an RM. Patients and Methods: From July 1995 to January 1998, four patients, aged 50 to 62 years old, with an RM of undetermined etiology underwent laparoscopic exploration. Another four patients underwent open exploration at the same hospital. The medical records of these patients were reviewed. Results: The tumors were smaller in the laparoscopic group, averaging 3.7 cm (range 2-6 cm) vs 6.5 cm (range 1-10 cm) in the open group. A definitive diagnosis was obtained for all eight patients. Postoperative complications were observed in one of the laparoscopic explorations, and in three of the open explorations; there was no operative mortality. The blood loss (90 vs 440 ml), fall in hematocrit (5.1 vs 7.8%), time to resumption of a regular diet (3 vs 5 days), amount of morphine sulfate equivalents required for analgesia (128 mg vs 161 mg), time to ambulation (2.3 vs 6 days) and hospital stay (4.8 vs 6 days) were all less among the laparoscopy patients. However, the operative time was longer for the laparoscopic procedure; this time included stent placement and patient repositioning in addition to the time for laparoscopic excision of the mass (7.8 vs 4.3 hours). Conclusion: Laparoscopic exploration appears to be a viable alternative to open exploration in patients presenting with a retroperitoneal mass. It is as effective as an open procedure and provides benefits with regard to patient morbidity and convalescence. However, operative time for this laparoscopic procedure is lengthy. PMID:10527333

  10. Laparoscopic treatment of hydatid cysts of the liver

    Microsoft Academic Search

    G. Khoury; T. Geagea; A. Hajj; S. Jabbour-Khoury; A. Baraka; G. Nabbout

    1994-01-01

    We report for the first time treatment of hydatid cyst of the liver laparoscopically. The patient is a 27-year-old man who presented to our hospital with a 6-week history of recurrent right-upper-quadrant pain with abdominal ultrasound findings compatible with hydatid cyst of the liver. The cyst was approached laparoscopically using the same hydatid asepsis as in open surgery. The cyst

  11. Case report: Three-trocar technique for bilateral laparoscopic nephropexy.

    PubMed

    Chekulaev, Dimitri; Dayma, Thierry; Abecassis, Jean-Paul; Peyromaure, Michaël

    2007-01-01

    Nephroptosis is a rare syndrome, which affects the right kidney in the majority of cases. In the current report, a case of bilateral nephroptosis with an unusual presentation is presented. We performed bilateral laparoscopic nephropexy using a three-trocar approach. The intervention was successful, with a short operative time and minimal blood loss. The clinical presentation of our patient and the surgical technique for bilateral laparoscopic nephropexy are described. PMID:17263609

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

    PubMed Central

    Gill, Diana; Locher, Stephen R.

    2009-01-01

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

  13. Structuralized box-trainer laparoscopic training significantly improves performance in complex virtual reality laparoscopic tasks

    PubMed Central

    Stefaniak, Tomasz J.; Makarewicz, Wojciech; Proczko, Monika; Gruca, Zbigniew; ?ledzi?ski, Zbigniew

    2011-01-01

    Introduction In the era of flowering minimally invasive surgical techniques there is a need for new methods of teaching surgery and supervision of progress in skills and expertise. Virtual and physical box-trainers seem especially fit for this purpose, and allow for improvement of proficiency required in laparoscopic surgery. Material and methods The study included 34 students who completed the authors‘ laparoscopic training on physical train-boxes. Progress was monitored by accomplishment of 3 exercises: moving pellets from one place to another, excising and clipping. Analysed parameters included time needed to complete the exercise and right and left hand movement tracks. Students were asked to do assigned tasks prior to, in the middle and after the training. Results The duration of the course was 28 h in total. Significant shortening of the time to perform each exercise and reduction of the left hand track were achieved. The right hand track was shortened only in exercise number 1. Conclusions Exercises in the laboratory setting should be regarded as an important element of the process of skills acquisition by a young surgeon. Virtual reality laparoscopic training seems to be a new, interesting educational tool, and at the same time allows for reliable control and assessment of progress. PMID:23255997

  14. Single incision laparoscopic surgery in general surgery: a review

    PubMed Central

    Greaves, N; Nicholson, J

    2011-01-01

    Single incision laparoscopic surgery (SILS) is a rapidly developing field that may represent the future of laparoscopic surgery. The major advantage of SILS over standard laparoscopic surgery is in cosmesis, with surgery becoming essentially scarless if the incision is hidden within the umbilicus. Only one incision is required so the risk of potential complications like port site hernias, haematomas and wound infection is reduced. The trade-off for this is a technically more challenging procedure with different underlying principles to that of traditional laparoscopic surgery. A wide variety of new equipment has been developed to support SILS and the range of procedures that are amenable to the technique is increasing. To date most of the published data relating to SILS are in the form of case series, with the first large randomised controlled trials due to be completed by the end of 2012. The existing evidence suggests that SILS is similar to standard laparoscopic surgery in terms of complication rates, completion rates and post-operative pain scores. However, the duration of SILS is longer than equivalent laparoscopic procedures. This article discusses SILS with regard to its applications in general surgery and reviews the evidence currently available. PMID:21929912

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

    PubMed Central

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

    2015-01-01

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

  16. The biliopancreatic diversion. A comparison of laparoscopic and laparotomic techniques.

    PubMed

    Stefanoni, M; Casciola, L; Ceccarelli, G; Spaziani, A; Conti, D; Bartoli, A; Di Zitti, L; Bellocchi, R; Valeri, R

    2006-06-01

    AIM: Morbid obesity has increased its frequency in the last 20 years in association with the increase of a country's richness. Bariatric surgery has developed a role which is becoming more and more important. The aim of this study, after 10 years of experience with the biliopancreatic diversion, is to compare the laparoscopic versus open technique RESULTS: METHODS: From March 1993 to December 2004, 150 patients were operated by biliopancreatic diversion. We divided our experience into 2 groups: laparotomic and laparoscopic techniques. We compared the following variables in the 2 groups: total operating time, intestinal functions, postoperative pain, patient's discharge and recovery time, major postoperative complications, postoperative mortality, late complications, incisional hernia incidence and anastomotic ulceration. RESULTS: We found a significant difference in both the reduction of the postoperative pain and the recanalization time in the laparoscopic group. Equally, we found a reduction in the incidence of abdominal wall complications, especially the reduction of incisional hernia and infections. The mean operative time was longer in the laparoscopic group, in particular due to the hard learning curve. CONCLUSIONS: The laparoscopic biliopancreatic diversion is a feasible and safe operation with good results: less postoperative discomfort, shorter recanalization and ospedalization time, less incidence of abdominal wall morbidity (incisional hernia). However, the procedure may prove difficult and it needs a highly experienced surgeon in laparoscopic technique. PMID:16858302

  17. Laparoscopic liver resection: Toward a truly minimally invasive approach.

    PubMed

    Ogiso, Satoshi; Hatano, Etsuro; Nomi, Takeo; Uemoto, Shinji

    2015-03-16

    In the surgical treatment of hepatocellular carcinoma and colorectal liver metastasis, it is important to preserve sufficient liver volume after resection in order to avoid post-hepatectomy liver sufficiency and to increase the feasibility of repeated hepatectomy in case of intrahepatic recurrence. Parenchyma-sparing approach, which minimizes the extent of resection while obtaining sufficient surgical margins, has been developed in open hepatectomy. Although this approach can possibly have positive impacts on morbidity and mortality, it is not popular in laparoscopic approach because parenchyma-sparing resection is technically demanding especially by laparoscopy due to its intricate curved transection planes. "Small incision, big resection" is the words to caution laparoscopic surgeons against an easygoing trend to seek for a superficial minimal-invasiveness rather than substantial patient-benefits. Minimal parenchyma excision is often more important than minimal incision. Recently, several reports have shown that technical evolution and accumulation of experience allow surgeons to overcome the hurdle in laparoscopic parenchyma-sparing resection of difficult-to-access liver lesions in posterosuperior segments, paracaval portion, and central liver. Laparoscopic surgeons should now seek for the possibility of laparoscopic parenchyma-sparing hepatectomy as open approach can, which we believe is beneficial for patients rather than just a small incision and lead laparoscopic hepatectomy toward a truly minimally-invasive approach. PMID:25789085

  18. Transvaginal/Transumbilical Hybrid—NOTES—Versus 3-Trocar Needlescopic Cholecystectomy: Short-term Results of a Randomized Clinical Trial

    PubMed Central

    Knuth, Jürgen; Cerasani, Nicola; Sauerwald, Axel; Lefering, Rolf; Heiss, Markus Maria

    2015-01-01

    Objective: For cholecystectomy, both the needlescopic cholecystectomy (NC) 3-trocar technique using 2 to 3 mm trocars and the umbilical-assisted transvaginal cholecystectomy (TVC) technique have found their way into clinical routine. This study compares these 2 techniques in female patients who are in need of an elective cholecystectomy. Background: Natural orifice transluminal endoscopic surgery (NOTES) is a surgical concept permitting scarless intra-abdominal operations through natural orifices, such as the vagina. Because of the lack of an adequately powered trial, we designed this first randomized controlled study for the comparison of TVC and NC. Methods: This prospective, randomized, nonblinded, single-center trial evaluates the safety and effectiveness of TVC (intervention), compared with NC (control) in female patients with symptomatic cholecystolithiasis. The primary endpoint was intensity of pain until the morning of postoperative day (POD) 2. Secondary outcomes were among others intra- and postoperative complications, procedural time, amount of analgesics used, pain intensity until POD 10, duration of hospital stay, satisfaction with the aesthetic result, and quality of life on POD 10 as quantified with the Eypasch Gastrointestinal Quality of Life Index (GIQLI). Results: Between February 2010 and June 2012, 40 patients were randomly assigned to the interventional or control group. All patients completed follow-up. Procedural time, length of postoperative hospital stay, and the rate of intra- and postoperative complications were similar in the 2 groups. However, significant advantages were found for the transvaginal access regarding pain until POD 2, but also until POD 10 (P = 0.043 vs P = 0.010) despite significantly less use of peripheral analgesics (P = 0.019). In the TVC group, patients were significantly more satisfied with the aesthetic result (P < 0.001) and had a significantly better GIQLI (P = 0.028). Conclusions: Although comparable in terms of safety, TVC caused less pain, increased satisfaction with the aesthetic result, and improved postoperative quality of life in the short term. PMID:24108196

  19. Laparoscopic Swedish Adjustable Gastric Banding: 6-year Follow-up and Comparison to other Laparoscopic Bariatric Procedures

    Microsoft Academic Search

    Reinhard P. Mittermair; Helmut Weiss; Hermann Nehoda; Werner Kirchmayr; Franz Aigner

    2003-01-01

    Background: The advantages of laparoscopy over open surgery are well known. The aim of this study was to compare our results\\u000a with Swedish adjustable gastric banding (SAGB) with other laparoscopically performed bariatric procedures (gastric bypass,\\u000a LapBand?, vertical banded gastroplasty). Methods: Between January 1996 and December 2001, 454 patients (381 women, 73 men) underwent\\u000a laparoscopic SAGB. All data (demographic and morphologic,

  20. Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: A single-institution comparison study of early results

    Microsoft Academic Search

    Jay C. Jan; Dennis Hong; Natasha Pereira; Emma J. Patterson

    2005-01-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are common surgical procedures\\u000a for morbid obesity, but few studies have compared LRYGB and LAGB. All patients who underwent LRYGB and LAGB by a single surgeon\\u000a at Legacy Health System were identified from a prospectively maintained database. Preoperatively, most patients were allowed\\u000a to choose between LRYGB and LAGB. Age,