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Sample records for single-port laparoscopic cholecystectomy

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

    PubMed Central

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

    2015-01-01

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

  2. Single-Port Laparoscopic Cholecystectomy for Gall Bladder Polyps

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  5. Hemobilia post laparoscopic cholecystectomy

    PubMed Central

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

    2015-01-01

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

  6. Laparoscopic triple cholecystectomy.

    PubMed

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

    2004-06-01

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

  7. Appraisal of laparoscopic cholecystectomy.

    PubMed Central

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

    1991-01-01

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

  8. Transumbilical pure single-port laparoscopic donor nephrectomy

    PubMed Central

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

    2015-01-01

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

  9. Single-port laparoscopic fecal diversion: more than cosmetic benefits?

    PubMed

    Aytac, Erman; Stocchi, Luca; Williams, Ryan; Remzi, Feza H; Costedio, Meagan M

    2014-08-01

    Single-port laparoscopic surgery is usually performed on patients with minor comorbidities. The aim of the study was to evaluate feasibility and efficacy of single-port fecal diversion in patients who had previous abdominal operations or comorbidities. Between October 2010 and March 2012, 14 patients with a median age of 57 years were diverted. The reasons for diversion were perianal infection/abscess (n=5), anal incontinence (n=3), radiation proctitis (n=2), colovesical fistula causing sepsis (n=1), outlet obstruction of ileal S pouch (n=1), perforation during pouchoscopy (n=1), and peritoneal carcinomatosis with enterocutaneus fistula (n=1). Median estimated blood loss was 20 mL, operative time was 52 minutes, and length of hospital stay was 4 days. Two patients had ileus postoperatively. One patient had a parastomal hernia 4 months after diversion. Single-port laparoscopic fecal diversion is a safe and feasible operation for patients with significant comorbidities and a history of multiple abdominal operations. PMID:24710240

  10. [Diagnostic measures before laparoscopic cholecystectomy].

    PubMed

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

    1995-05-01

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

  11. Gallstone ileus after laparoscopic cholecystectomy

    PubMed Central

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

    2012-01-01

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

  12. 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

  13. 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

  14. Delayed intrahepatic subcapsular hematoma after laparoscopic cholecystectomy.

    PubMed

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

    2012-01-01

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

  15. Single Incision Laparoscopic Cholecystectomy for Gallbladder Duplication

    PubMed Central

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

    2015-01-01

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

  16. 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

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

    PubMed Central

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

    2015-01-01

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

  18. Laparoscopic cholecystectomy using 2-mm instruments.

    PubMed

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

    1998-10-01

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

  19. One, Two, or Three Ports in Laparoscopic Cholecystectomy?

    PubMed Central

    Justo-Janeiro, Jaime Manuel; Vincent, Gustavo Theurel; Vázquez de Lara, Fernando; de la Rosa Paredes, René; Orozco, Eduardo Prado; Vázquez de Lara, Luis G.

    2014-01-01

    Single-port laparoscopic cholecystectomy (LC) has been compared with 3- or 4-port LC. To our knowledge, there are no studies comparing the 3-, 2-, and 1-port techniques. Patients were randomized into 3 groups: LC 1-port using SILS, LC 2-port using a laparoscope with a working channel, and LC 3-port using the standard ports. Pain was evaluated at recovery, 4 hours, 24 hours, day 5, and day 8, using an analog visual scale. Homogenous groups in their demographic characteristics; all confirmed gallbladder lithiasis. At recovery, there was less pain in group 1 (P = 0.002); at 4 hours pain was similar in all groups (P = 0.899); at 24 hours there was less pain in groups 2 and 3 (P = 0.031); and at days 5 and 8 there was marginal (P = 0.053) and significant (P = 0.003) relevance. In terms of pain perception, LC performed through 1 port does not offer advantages when compared with 2 or 3 ports. More clinical trials are needed to confirm these data. PMID:25437581

  20. 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. PMID:26046038

  1. Preliminary application of a single-port access technique for laparoscopic ovariohysterectomy in dogs

    PubMed Central

    Sánchez-Margallo, F. M.; Tapia-Araya, A.; Díaz-Güemes, I.

    2015-01-01

    Laparoscopic ovariohysterectomy using single-portal access was performed in nine selected owned dogs admitted for elective ovariohysterectomy and the surgical technique and outcomes were detailed. A multiport device (SILS Port, Covidien, USA) was placed at the umbilical area through a single 3?cm incision. Three cannulae were introduced in the multiport device through the access channels and laparoscopic ovariohysterectomy was performed using a 5-mm sealing device, a 5-mm articulating grasper and a 5-mm 30° laparoscope. The mean total operative time was 52.66±15.20?minutes and the mean skin incision during surgery was 3.09±0.20?cm. Of the nine cases examined, in the one with an ovarian tumour, the technique was converted to multiport laparoscopy introducing an additional 5-mm trocar. No surgical complications were encountered and intraoperative blood loss was minimum in all animals. Clashing of the instruments and reduced triangulation were the main limitations of this technique. The combination of articulated and straight instruments facilitated triangulation towards the surgical field and dissection capability. One month after surgery a complete wound healing was observed in all animals. The present data showed that ovariohysterectomy performed with a single-port access is technically feasible in dogs. The unique abdominal incision minimises the abdominal trauma with good cosmetic results. PMID:26568831

  2. Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy.

    PubMed

    Jing, Kong; Shuo-Dong, Wu

    2014-01-01

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

  3. Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy

    PubMed Central

    Jing, Kong; Shuo-Dong, Wu

    2014-01-01

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

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

    PubMed

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

    1991-06-15

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

  5. 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

  6. Laparoscopic cholecystectomy in situs inversus totalis.

    PubMed

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

    2014-07-01

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

  7. The transrectal single port laparoscopic radical prostatectomy in a cadaver model

    PubMed Central

    Akça, Oktay; Zargar, Homayoun; Autorino, Riccardo; Brandao, Luis Felipe; Gürler, Ahmet Selçuk; Av?ar, Abdullah; Horuz, Rahim; Albayrak, Selami

    2015-01-01

    Objective: To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. Materials and methods: After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers’ fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT®Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT®Path, at 3, 6, and 9 o’clock positions. A 5 mm, 0° degree lens was introduced at 6 o’clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. Results: Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. Conclusion: Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route. PMID:26328206

  8. Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    White, J V

    1993-04-01

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

  10. Efficacy investigation of transpostceliac single-port 3-channel laparoscope in the treatment of complex renal cyst

    PubMed Central

    Mai, Haixing; Liu, Junle; Zhao, Li; Qu, Nan; Wang, Yalin; Huang, Cheng; Chen, Biao; Li, Yanshuai; Chen, Lijun; Zhang, Xu

    2015-01-01

    This study aims to investigate the surgical method and long-term efficacy of transpostceliac single-port 3-channel laparoscope in the treatment of complex renal cyst. A retrospective analysis was performed towards the 37 patients who underwent renal cyst unroofing decompression with single-port laparoscope from Jun. 2012 to Jul. 2013. The surgery was performed through the postceliac approach, a 2.5 cm incision was made 4-5 cm away from the iliac spine of midaxillary line, the Olympus single-port TriPort was then implanted, with the laparoscopic channel and the other two operation channels all as 5 mm. The operation was completed with the forceps and scissors which had flexible fronts. The cysts of the 37 patients were performed the appropriate surgical treatments according to their subtype grouping, on case was transferred to the open surgery, and there was no blood transfusion case. The operation time was 11-42 min, with the mean time as 23 min; the bleeding volume was 10-50 ml, with the mean volume as 26 ml; the postoperative follow-up was 1-6 months, and the ultrasound review did not find the recurrence of cyst; the postoperative lumbar scar was approximately 2.5 cm, and the patients could leave the bed and perform some acts on the exact day of the surgery; the hospitalization time was 1-2 d, with the average time as 1.2 d. The efficacy of the transpostceliac single-port 3-channel laparoscope in the treatment of complex renal cyst was positive, with low recurrence rate, and worthy of further promotion. PMID:26309695

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

    PubMed Central

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

    2015-01-01

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

  12. 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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Metzger, J; Berbig, R; Muller, C

    1993-03-01

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

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

    PubMed

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

    2009-02-01

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

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

    PubMed Central

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

    2011-01-01

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

  18. 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.

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

    PubMed

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

    1990-12-18

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

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

    PubMed

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

    2015-01-01

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

  1. 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

  2. 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

  3. 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.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

    Objective The aim of this study was to compare the surgical outcomes of single-port access (SPA) and conventional multi-port access total laparoscopic hysterectomies (TLH) among patients with very large uteri (500 g or more). Methods Fifty consecutive patients who received TLH for large uterine myomas and/or adenomyoses weighing 500 g or more between February 2009 and December 2012 were retrospectively reviewed. SPA and conventional TLH were each performed in 25 patients. Surgical outcomes, including operation time, estimated blood loss, postoperative hemoglobin change, postoperative hospital stay, postoperative pain, and perioperative complications, were compared between the two groups. Results There were no significant demographic differences between the two groups. All operations were completed laparoscopically with no conversion to laparotomy. Total operation time, uterus weight, estimated blood loss, and postoperative hemoglobin change did not significantly differ between the two groups. Postoperative hospital stay was significantly shorter for the SPA-TLH group compared to that of the conventional TLH group (median [range], 3 [2.0-6.0] vs. 4 [3-7] days; P=0.004]. There were no inter-group differences in postoperative pain at 6, 24, and 72 hours after surgery. There was only one complicated case in each group. Conclusion SPA-TLH in patients with large uteri weighing 500 g or more is as feasible as conventional TLH. SPA-TLH is associated with shorter hospital stays compared to that of conventional TLH. PMID:26023674

  6. Single port laparoscopic surgery: concept and controversies of a new technique.

    PubMed

    Springborg, Henrik; Istre, Olav

    2012-10-01

    LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique; however, its large-scale adoption awaits results of prospective randomized controlled studies confirming potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark in which 40 women were treated for benign gynecologic conditions. Although the operations described are the first of their kind reported in Denmark, favorable operating times and very low complication rates are seen. It is the authors' opinion that in addition to being feasible for hysterectomy, single port laparoscopy may become the preferred method for many simple gynecological procedures. PMID:22582946

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

    PubMed

    Brown, Victoria; Martin, Jennifer; Magee, Damian

    2015-01-01

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

  8. Role of sonography in assessing complications after laparoscopic cholecystectomy

    PubMed Central

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

    2014-01-01

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

  9. The chain of postoperative complications after laparoscopic cholecystectomy.

    PubMed

    Karabulut, Mehmet; Gönenç, Murat; Al??, Halil

    2014-01-01

    Bile duct injuries are among the most dreadful complications of cholecystectomy. As laparoscopic cholecystectomy has become increasingly popular, the incidence of this complication increased and has remained unchanged in spite the learning curve being completed. A 50-year-old female underwent elective laparoscopic cholecystectomy for gallstone disease. A complicated bile duct injury occurred during the procedure. As the injury was immediately recognized, it was treated with concomitant hepaticojejunostomy. In the postoperative period, biliary fistula, which was assumed to be the result of an anastomotic leak, was encountered. Diagnostic and therapeutic percutaneous transhepatic biliary drainage was considered. It revealed that the anastomosis was intact and the source of biliary leak was an aberrant right posterior sectorial branch. A severe bleeding through the biliary catheter occurred due to transmigration of the catheter into the portal vein. Bleeding was controlled with embolization by the interventional radiologist. The patient thereafter was re-operated, and the leakage was sealed by ligation of the aberrant right posterior sectorial branch. The postoperative period was uneventful. As long as cholecystectomy is performed, bile duct injuries will always exist. Therefore, every abdominal surgeon should be aware of possible consequences of complications related to this procedure. PMID:25931907

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

    PubMed Central

    Blanco, Felix C.; Kane, Timothy D.

    2012-01-01

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

  11. 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

  12. Role of laryngeal mask airway in laparoscopic cholecystectomy

    PubMed Central

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

    2015-01-01

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

  13. Role of laryngeal mask airway in laparoscopic cholecystectomy.

    PubMed

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

    2015-11-27

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

  14. The analysis of 146 patients with difficult laparoscopic cholecystectomy

    PubMed Central

    Bat, Orhan

    2015-01-01

    Introduction: Laparoscopic cholecystectomy (LC) is very commonly performed surgical intervention. Acute or chronic cholecystitis, adhesions due to previous upper abdomen surgeries, Mirrizi’s syndrome and obesity are common clinical conditions that can be associated with difficult cholecystectomy. In this study, we evaluated and scored the patients with difficult surgical exploration during laparoscopic cholecystectomy. Material and Method: All patients who underwent LC from 2010 to 2015 were retrospectively rewieved. According to intraoperative findings DLC cases were described and classified. Class I difficulty: Adhesion of omentum majus, transverse colon, duodenum to the fundus of the gallbladder. Class II difficulty: Adhesions in Calot’s triangle and difficulty in dissection of cystic artery and cystic duct Class III difficulty: Difficulty in dissection of gallbladder bed (scleroathrophic gallbladder, hemorrhage from liver during dissection of gallbladder, chirotic liver). Class IV difficulty: Difficulty in exploration of gallbladder due to intraabdominal adhesions including technical problems. Results: A total of 146 patients were operated with DLC. The most common difficulty type was Class I difficulty (88 patients/60.2%). Laparoscopic cholecystectomy was converted to laparotomy in 98 patients. Operation time was found to be related with conversion to open surgery (P<0.05). Wound infection rate was also statistically higher in conversion group (P<0.05). The opertion time was found to be longest with Class II difficulty. Conversion rate to open surgery was also highest with Class II difficulty group. Conclusion: Class II difficulty characterized by severe adhesions in calot’s triangle is most serious problem among all DLC cases. They have longer operation time and higher conversion rate. PMID:26629124

  15. Intravenous Paracetamol for Postoperative Analgesia in Laparoscopic Cholecystectomy

    PubMed Central

    Gousheh, Sayed Mohamadreza; Nesioonpour, Sholeh; Javaher foroosh, Fatemeh; Akhondzadeh, Reza; Sahafi, Sayed Ali; Alizadeh, Zeinab

    2013-01-01

    Background Although opioids are the main choice for acute postoperative pain control, many side effects have been reported for them. NSAIDs and paracetamol have been used extensively as alternatives, and it seems that they are more effective for minor to moderate pain control postoperatively when have been used alone or in combination with opioids. As laparoscopic cholecystectomy poses moderate pain postoperatively, this study was planned to assess whether paracetamol is able to provide effective analgesia as a sole analgesic at least in the first few hours post operatively. Objectives We evaluated the effect of intravenous Paracetamol on postoperative pain in patients undergoing laparoscopic cholecystectomy. Patients and Methods This is a randomized double- blind clinical trial study. 30 patients ASA class I, aged 18 to 50 years, candidate for laparoscopic cholecystectomy were recruited, and randomly divided into two equal groups. Group A (paracetamol group) received 1 gr paracetamol and group B received placebo ten minutes after the induction of anesthesia. 0.1 mg/Kg Morphine was administered intravenously based on patients compliant and pain score >3. Pain score and the opioids consumption were recorded in the first six hours postoperative. Patient's pain was measured by the VAS (Visual Analog Scale). Results The pain score was lower in group A (P= 0.01), but the morphine consumption showed no significant difference between the groups (P= 0.24) during the first 6 hours postoperatively. Conclusions Although paracetamol (1gr) has caused a better pain relief quality but it is not a suitable analgesic for moderate pain control in acute phase after surgery alone. PMID:24223365

  16. Two rare cases of intrahepatic subcapsular hematoma after laparoscopic cholecystectomy.

    PubMed

    Minaya Bravo, Ana María; González González, Enrique; Ortíz Aguilar, Manuel; Larrañaga Barrera, Eduardo

    2010-12-01

    The appearance of subcapsular liver hematoma after a laparoscopic cholecystectomy (LC) is an infrequent complication and seldom studied. Some cases have been connected to ketorolac given during surgery and after surgery. Other described causes are : hemangiomas or small iatrogenic lesions that could be aggravated by administration of ketorolac. Coagulation dysfunction like circulating heparin as seen in hemathological diseases is cause of bleeding after aggressive procedures. We describe two cases of subcapsular liver hematoma after LC, both of them have been given intravenous ketorolac and one of them had multiple myeloma. We discuss the causes and treatment of it. PMID:22131659

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

    PubMed

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

    2014-12-01

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

  18. Subcapsular liver haematoma as a complication of laparoscopic cholecystectomy.

    PubMed

    G?uszek, Stanis?aw; Kot, Marta; Nawacki, ?ukasz; Krawczyk, Marek

    2015-07-01

    Cholecystectomy is a common procedure for the treatment of symptomatic cholecystitis. A rare complication is the occurrence of subcapsular haematoma of the liver. In the literature, there are only a few case reports of this type. A 25-year-old woman was admitted to the Surgical Department for surgical treatment of cholecystitis. No complications were observed intra-operatively. On the first day after surgery, the patient manifested symptoms of hypovolaemic shock. The patient was qualified for surgical treatment in the mode of emergency surgery - a giant subcapsular haematoma was found. She was referred to the Clinic of General, Transplant and Liver Surgery of the Medical University of Warsaw for further treatment. This case shows the importance of monitoring the life parameters of patients who have undergone laparoscopic surgery due to symptomatic cholecystitis during the first day after surgery. PMID:26240636

  19. Subcapsular liver haematoma as a complication of laparoscopic cholecystectomy

    PubMed Central

    G?uszek, Stanis?aw; Kot, Marta; Krawczyk, Marek

    2015-01-01

    Cholecystectomy is a common procedure for the treatment of symptomatic cholecystitis. A rare complication is the occurrence of subcapsular haematoma of the liver. In the literature, there are only a few case reports of this type. A 25-year-old woman was admitted to the Surgical Department for surgical treatment of cholecystitis. No complications were observed intra-operatively. On the first day after surgery, the patient manifested symptoms of hypovolaemic shock. The patient was qualified for surgical treatment in the mode of emergency surgery – a giant subcapsular haematoma was found. She was referred to the Clinic of General, Transplant and Liver Surgery of the Medical University of Warsaw for further treatment. This case shows the importance of monitoring the life parameters of patients who have undergone laparoscopic surgery due to symptomatic cholecystitis during the first day after surgery. PMID:26240636

  20. Primary Amyloidosis Manifesting as Cholestatic Jaundice after Laparoscopic Cholecystectomy

    PubMed Central

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

    2015-01-01

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

  1. Preemptive analgesia in laparoscopic cholecystectomy: a randomized controlled study.

    PubMed

    Karaaslan, Dilek; Sivaci, Remziye Gül; Akbulut, Gökhan; Dilek, Osman Nuri

    2006-12-01

    In pain control after laparoscopic cholecystectomy, subhepatic administration of bupivacaine immediately after the creation of pneumoperitoneum has been shown to be more effective than administration before the withdrawal of the trocars. We aimed to investigate the effect of intraperitoneal bupivacaine administration to the subhepatic area before the creation of the pneumoperitoneum. Eighty patients undergoing elective laparoscopic cholecystectomy under general anesthesia were included in a prospective, randomized study. Patients received 20 mL of 0.5% bupivacaine in the subhepatic area just after intubation, before pneumoperitoneum (group 1), immediately after the creation of the pneumoperitoneum (group 2), just before the removal of the trocars (group 3), or received no local anesthetic (group 4). The degree of the postoperative pain was assessed at 0, 4, 8, 12, and 24 hours after the surgery. The consumption of analgesics (diclofenac sodium) was also recorded. The pain scores and analgesic consumption did not differ among groups 1, 3, and 4. The pain scores of group 2 were lower at each time point compared to the other groups (P < 0.001). Postoperative analgesic consumption in group 2 was reduced compared to the other groups (23.4 +/- 35.9 mg vs. 80.0 +/- 66.3 mg, P = 0.005 [group 1], 69.6 +/- 62.2 mg, P = 0.026 [group 3], and 70.0 +/- 59.9 mg, P = 0.022 [group 4]). The subhepatic infiltration of 20 mL of 0.5% bupivacaine offers good postoperative analgesia when applied just after the creation of the pneumoperitoneum, not before the pneumoperitoneum or after the termination of the pneumoperitoneum. PMID:17129304

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

    NASA Astrophysics Data System (ADS)

    Lanzafame, Raymond J.

    1991-07-01

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

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

    PubMed Central

    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

  4. 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

  5. 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

  6. Virtual Reality Training Versus Blended Learning of Laparoscopic Cholecystectomy

    PubMed Central

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

    2015-01-01

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

  7. Clinical experience with a multifunctional, flexible surgery system for endolumenal, single-port, and NOTES procedures

    PubMed Central

    Thompson, Kari; Talamini, Mark; Ferreres, Alberto; Jacobsen, Garth; Spaun, Georg; Cullen, John; Swanstrom, Lee

    2010-01-01

    Background Single-port and incisionless surgical approaches hold the promise of fewer complications, reduced pain, faster recovery, and improved cosmesis compared with traditional open or laparoscopic approaches. The ability to select an access approach (i.e., endolumenal, single-port, transvaginal, or transgastric) with one platform may be important to optimization of individual patient results. The authors report their results using these four separate surgical approaches tailored to three different therapeutic procedures, all with the use of a single flexible platform, the Incisionless Operating Platform (IOP). Methods After institutional review board approval, the IOP was used to perform nine cholecystectomies via transvaginal (TV) (n = 4), transgastric (TG) (n = 4), and single-port transumbilical (TU) (n = 1) access. Two appendectomies were performed via TG access. Endolumenal access was used for 18 gastric pouch and stoma reductions after Roux-en-Y gastric bypass. The TG and TV procedures involved the use of one to three trocars. The recorded data included safety, procedural success, operative time, patient pain assessment (on a 0–10 scale) at discharge, and length of hospital stay. Results Procedural success was achieved for 16 of 18 endolumenal procedures, 1 of 1 single-port procedure, and 10 of 10 NOTES procedures. For 5 of 10 NOTES procedures, only one small trocar was required. The mean operative times were 79 min for pouch with stoma reduction, 171 min for cholecystectomy, and 274 min for appendectomy. Of 29 patients, 27 were discharged in 24 h or less. The average pain scores were 0.44 for pouch with stoma reduction, 1.3 for cholecystectomy, and 2.5 for appendectomy. No significant complications occurred. The ergonomics of IOP allowed the surgeon to interface with the system using an endoscopic or laparoscopic orientation. Conclusion Availability of a multifunctional, flexible surgery platform provides a choice of a single-port or incisionless surgical approach with the potential to reduce complications, pain, and recovery time while improving cosmesis. PMID:20734085

  8. The role of prophylactic antibiotics on surgical site infection in elective laparoscopic cholecystectomy

    PubMed Central

    Chong, Jae Uk; Lim, Jin Hong; Kim, Jee Ye; Kim, Sung Hoon

    2015-01-01

    Backgrounds/Aims Although laparoscopic cholecystectomy is a common and widely accepted technique, the use of prophylactic antibiotics in elective laparoscopic cholecystectomy still remains controversial. The aim of this study is to determine whether prophylactic antibiotics could prevent surgical site infection after elective laparoscopic cholecystectomy and to identify any risk factors for surgical site infection. Methods This study included 471 patients undergoing laparoscopic cholecystectomy between January 2009 and May 2012. Period 1 patients (279) received second generation cephalosporin 1 g intravenously after induction of anesthesia, and Period 2 patients (192) were not given prophylactic antibiotics. The characteristics and surgical site infections of the patients were compared and analyzed. Results The overall rate of surgical site infection was 1.69% for the total of 471 patients. The incidence of surgical site infection was similar for the two Periods: 5 of 279 patients (1.79%) in Period 1, 3 of 192 patients (1.56%) in Period 2 (p=0.973). All of the patients with surgical site infections were well treated under conservative treatments without any sequelae. The preoperative albumin level (p=0.023) contributed to surgical site infection. Conclusions Prophylactic antibiotics are not necessary for elective laparoscopic cholecystectomy but patients in poor nutritional state with low albumin level should consider prophylactic antibiotics. PMID:26693239

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

    PubMed Central

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

    2015-01-01

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

  10. Endoscopic retrograde cholangiopancreatography in conjunction with laparoscopic cholecystectomy.

    PubMed

    Surick, B; Washington, M; Ghazi, A

    1993-01-01

    Laparoscopic cholecystectomy (LC) has become the primary surgical treatment for symptomatic cholelithiasis. In conjunction with the dramatic rise in LC there has been an increase in the number of endoscopic retrograde cholangiopancreatographies (ERCPs) performed. For this study, the records of patients referred to the surgical endoscopy department between January 1991 and February 1992 were reviewed. Seventy-seven ERCPs were performed in conjunction with LC. The indications for ERCP included jaundice or a history of jaundice, gallstone pancreatitis, a suspicious filling defect on either ultrasound or intraoperative cholangiogram, abnormal liver function tests, cholangitis, or postoperative bile leak. Sixty-two procedures were performed prior to LC and 15 procedures after LC. Forty-two patients were female (54.5%) and the patients ages ranged from 14 to 92 years (mean 54.1 years). Of the 62 patients having ERCP preoperatively 35 patients (56.5%) had no evidence of common bile duct (CBD) stones and underwent LC as planned. Twenty-three patients were found to have CBD stones, of which six were referred for an open cholecystectomy and CBD exploration, because of large multiple CBD stones or the presence of a large duodenal diverticulum. Seventeen patients had their CBD cleared endoscopically, and four patients were not successfully cannulated. Fifteen patients had ERCP after LC. There were two patients with CBD injuries who were referred for surgical correction. Two patients had leakage from the cystic duct stump, and four patients had CBD stones, all of whom were successfully treated with endoscopic sphincterotomy. There were four patients who had a normal postoperative ERCP and two patients who could not have their CBD cannulated.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8211613

  11. Comparative Changes in Tissue Oxygenation Between Laparoscopic and Open Cholecystectomy

    PubMed Central

    Bablekos, George D.; Michaelides, Stylianos A.; Analitis, Antonis; Lymperi, Maria H.; Charalabopoulos, Konstantinos A.

    2015-01-01

    Background Previous studies examined the effect of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) on physiological variables of the respiratory system. In this study we compared changes in arterial blood gases-related parameters between LC and OC to assess their comparative influence on gas exchange. Methods We studied 28 patients, operated under identical anesthetic protocol (LC: 18 patients, OC: 10 patients). Measurements were made on the morning before surgery (BS), the second (AS2) and the eighth (AS8) postoperative day. Studied parameters, including alveolar-arterial difference in PO2 ((A-a)DO2) and oxygen content (Oct in vol%), were statistically compared. Results On AS2 a greater increase was found in ((A-a)DO2) for the OC compared to LC (4.673 ± 0.966 kPa versus 3.773 ± 1.357 kPa, respectively). Between BS and AS2, Oct in vol% decreased from 17.55 ± 1.90 to 15.69 ± 1.88 in the LC and from 16.99 ± 2.37 to 14.62 ± 2.23 in the OC, whilst a reduction (P = 0.093) between AS2 and AS8 was also found for the open method. Besides, on AS2, SaO2% decrease was greater in OC compared to LC (P = 0.096). Conclusions On AS2, the greater increase in OC-((A-a)DO2) associated with Oct in vol% and SaO2% findings also in OC group suggest that LC might be associated with lower risk for impaired tissue oxygenation. PMID:25699119

  12. Effect of intravenous esmolol on analgesic requirements in laparoscopic cholecystectomy

    PubMed Central

    Dhir, Ritima; Singh, Mirley Rupinder; Kaul, Tej Kishan; Tewari, Anurag; Oberoi, Ripul

    2015-01-01

    Background and Aims: Perioperative beta blockers are also being advocated for modulation of acute pain and reduction of intraoperative anesthetic requirements. This study evaluated the effect of perioperative use of esmolol, an ultra short acting beta blocker, on anesthesia and modulation of post operative pain in patients of laproscopic cholecystectomy. Material and Methods: Sixty adult ASA I & II grade patients of either sex, scheduled for laparoscopic cholecystectomy under general anesthesia, were enrolled in the study. The patients were randomly allocated to one of the two groups E or C according to computer generated numbers. Group E- Patients who received loading dose of injection esmolol 0.5 mg/kg in 30 ml isotonic saline, before induction of anesthesia, followed by an IV infusion of esmolol 0.05 ?g/kg/min till the completion of surgery and Group C- Patients who received 30 ml of isotonic saline as loading dose and continuous infusion of isotonic saline at the same rate as the esmolol group till the completion of surgery. Results: The baseline MAP at 0 minute was almost similar in both the groups. At 8th minute (time of intubation), MAP increased significantly in group C as compared to group E and remained higher than group E till the end of procedure. Intraoperatively, 16.67% of patients in group C showed somatic signs as compared to none in group E. The difference was statistically significant. 73.33% of patients in group C required additional doses of Inj. Fentanyl as compared to 6.67% in group E. Conclusions: We conclude that intravenous esmolol influences the analgesic requirements both intraoperatively as well as postoperatively by modulation of the sympathetic component of the pain i.e. heart rate and blood pressure. PMID:26330719

  13. Meta-analysis of the clinical application on gasless laparoscopic cholecystectomy in China

    PubMed Central

    Liu, Qian; Zhang, Guangyong; Zhong, Yong; Duan, Chongyang; Hu, Sanyuan

    2015-01-01

    Objective: We aim to perform systematic reviews of the clinical effects of the abdominal wall suspension technique in laparoscopic cholecystectomy in China. Methods: We retrieved databases of literature on randomized controlled trials involving abdominal wall suspension laparoscopic cholecystectomy. Then, we conducted screenings, extracted data, and performed quality assessment and meta-analysis. Results: We analyzed 611 patients. Our analysis showed that the abdominal wall suspension group compared to the traditional group had reduced length of hospital stay (SMD = -0.91, 95% CI = -1.76~-0.06, P = 0.04), had shortened postoperative first exhaust time (SMD = -0.65, 95% CI = -1.11~-0.20, P = 0.005), and had diminished incidence of postoperative complications (P < 0.001), which decreased the cost of hospitalization. Conclusions: Application of abdominal wall suspension endoscopic technique can significantly speed up the rehabilitation of laparoscopic cholecystectomy patients; therefore, it is worthy of further research and clinical application. PMID:25932097

  14. 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

  15. Preoperative Ultrasonography as a Predictor of Difficult Laparoscopic Cholecystectomy that Requires Conversion to Open Procedure

    PubMed Central

    Chand, Prem; Singh, Rommel; Singh, Bimaljot; Singla, Rachan Lal; Yadav, Manish

    2015-01-01

    Aim: The present study was conducted to see whether preoperative ultrasonography can be used as a predictor of difficult lapariscopic cholecystectomy or not. Methods: 50 patients of cholelithiasis, selected from surgical OPD of Rajindra Hospital Patiala, who fulfilled all inclusion and exclusion criteria for the study underwent elective cholecystectomy. Ultrasonography was done pre-operatively on all cases in the same setup and with same probe and patients underwent laparoscopic cholecystectomy in same setup. Results: A significant prediction was found between ultrasonographic parameters and conversion of the procedure to open cholecystectomy which proved that pre-operative ultrasonography is a good predictor of difficulty in laparoscopic cholecystectomy in majority of the cases and should be used as a screening procedure. Conclusion: Preoperative ultrasonography should be used as a screening procedure as it is a good predictor of difficulty in laparoscopic cholecystectomy in majority of the cases. It can help surgeon to get an idea of potential difficulty that he can face in the particular patient. PMID:26425061

  16. Immediate Postoperative Pain: An Atypical Presentation of Dropped Gallstones after Laparoscopic Cholecystectomy

    PubMed Central

    Awad, Michael

    2015-01-01

    Cholecystectomy is one of the most commonly performed surgical procedures in the United States. A common complication is dropped gallstones, and the diversity of their presentation poses a substantial diagnostic challenge. We report the case of a 58-year-old man presenting with chronic right upper quadrant hours status post cholecystectomy. Imaging demonstrated retained gallstones in the perihepatic space and symptoms remitted following their removal via laparoscopic operation. Gallstones are lost in roughly 1 in 40 cholecystectomies and are usually asymptomatic. The most common presentations are months or years status post cholecystectomy due to fistula, abscess, or sinus tract formation. We report this case hoping to bring light to a rare presentation for dropped gallstones and provide advice on the management of this common complication of cholecystectomy. PMID:25649178

  17. Ambulatory laparoscopic cholecystectomy: Is it safe and cost effective?

    PubMed Central

    Ali, Athar; Chawla, Tabish; Jamal, Abid

    2009-01-01

    BACKGROUND: Laparoscopic cholecystectomy (LC) is the most commonly performed minimal invasive surgery. However, practice of its use as an ambulatory surgery in our hospital settings is uncommon. OBJECTIVE: To evaluate safety and cost effectiveness of LC as an ambulatory day care surgery. STUDY DESIGN: Quasiexperimental. SETTING: Department of surgery, Aga Khan University Hospital, Karachi, Pakistan. MATERIALS AND METHODS: Patients with uncomplicated symptomatic gallstones were selected for Ambulatory LC. They were admitted electively on the same day and operated on in the morning hours and discharged after a check by the surgeon 6–8 hrs later. RESULTS: Of fifty (n = 50) patients selected for ambulatory LC, 92% were discharged successfully after 6–8 hrs observation. No significant perioperative complications were noted. Unplanned admission and readmission rate was 8 and 2%, respectively. Cost saving for the daycare surgery was Rs. 6,200, Rs. 13,300, and Rs.22,800 per patient as compared to in patient general, semiprivate, and private ward package, respectively. CONCLUSION: Practice ambulatory LC is safe and cost-effective in selected patients with uncomplicated symptomatic gallstones. PMID:19547682

  18. 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

  19. 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

  20. Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method

    PubMed Central

    Agrawal, Nikhil; Singh, Sumitoj; Khichy, Sudhir

    2015-01-01

    Background: Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. At times, it is difficult and takes longer time or has to be converted to an open procedure. This study is undertaken to determine the predictive factors for difficult LC. Aim: The aim was to evaluate a scoring method to predict difficult LC preoperatively. Materials and Methods: There were 30 cases operated by a single experienced surgeon. There are total 15 score from history, clinical and sonological findings. Score up to 5 predicted easy, 6–10 difficult and >10 are very difficult. Results: Prediction came true in 76.4% for easy and 100% difficult cases; there were no cases with a score above 10. The factors like previous history of hospitalization (P - 0.004), clinically palpable gallbladder (GB) (P - 0.009), impacted GB stone (P - 0.001), pericholecystic collection (P - 0.04), and abdominal scar due to previous abdominal surgery (P - 0.009) were found statistically significant in predicting difficult LC. Conclusion: The proposed scoring system is reliable with a sensitivity of 76.47% and specificity of 100%. PMID:26425067

  1. The effect of laparoscopic cholecystectomy on insulin sensitivity.

    PubMed

    Hawthorne, G C; Ashworth, L; Alberti, K G

    1994-10-01

    It is well known that there is impaired glucose tolerance after open abdominal surgery. We have investigated the effect on insulin sensitivity of laparoscopic cholecystectomy. Eight non-diabetic patients aged 51 +/- 3.5 years were studied pre and postoperatively. Insulin sensitivity measured by the short insulin tolerance test (ITT) was expressed as % disappearance of glucose per minute (KITT). Preoperative fasting blood glucose was 4.7 +/- 0.15 mmol/l compared with postoperative fasting blood glucose of 5.7 +/- 0.31 mmol/l (p = 0.02). Fasting insulin levels were 8.4 +/- 1.6 mU/l preoperatively compared to 30.0 +/- 9.3 mU/l postoperatively (p = 0.1 NS). KITT was 2.29 +/- 0.2% min-1 (range 1.0-3.03) preoperatively with 1.11 +/- 0.25% min-1 (range 0.13-1.97) postoperatively (p = 0.02). Hence marked insulin resistance is a consequence of major abdominal surgery irrespective of surgical technique. PMID:7851871

  2. Single Incision Laparoscopic Cholecystectomy Performed Via the "Marionette" Technique Shows Equivalence in Outcome and Cost to Standard Four Port Laparoscopic Cholecystectomy in a Selected Patient Population.

    PubMed

    Saidy, Maryam N; Patel, Sunal S; Choi, Mark W; Al-Temimi, Mohammed; Tessier, Deron J

    2015-10-01

    The aim of our study is to compare single incision laparoscopic cholecystectomy (SILC) performed using the "marionette" technique (m-SILC), to the standard four-port technique [four-port laparoscopic cholecystectomy (4PLC)]. Patient information was extracted from a prospectively maintained database (n = 188). Our primary endpoint was operative costs (determined by operating time and instruments used). Secondary endpoints were length of stay, operative time, blood loss, and postoperative complication rates. Univariate and adjusted multivariate analysis was used to compare the outcomes. There were a total of 188 patients for this study. Gender, body mass index, American Society of Anesthesiologists class, and resident participation were similar. Patients undergoing m-SILC were younger (43.8 vs 49.8 years old), less likely to have cholangiogram (32% vs 54%), and were more likely to undergo cholecystectomy for chronic cholecystitis (73.3% vs 52%). In univariate analysis, cholecystectomy performed by the "marionette method" as compared with the 4PLC was associated with shorter operative time (67 vs 59 minutes respectively) and shorter hospital stay (1.2 vs 2.08 days respectively). In multivariate analysis, SILC was associated with shorter hospital stay and comparable operative time, blood loss, and postoperative complications. Instrumentation cost was less in SILC (by $94). SILC done by an experienced surgeon with the "marionette" technique on a carefully selected population shows a statistically significant cost benefit while maintaining clinically comparable outcomes to the standard 4PLC. PMID:26463300

  3. 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

  4. Comparing the Impact of Intraperitoneal Hydrocortisone With Bupivacaine on Postoperative Pain After Laparoscopic Cholecystectomy

    PubMed Central

    Amini, Shahram; Sabzi Sarvestani, Amene

    2014-01-01

    Background: Postoperative pain is a major complaint following laparoscopic cholecystectomy. Objectives: The aim of this study was to compare the impact of intraperitoneal hydrocortisone with intraperitoneal bupivacaine on pain relief after laparoscopic cholecystectomy Patients and Methods: In a double blind clinical trial, 63 candidates for laparoscopic cholecystectomy were randomly allocated to receive intraperitoneal instillation of either 100 mg bupivacaine in 250 mL normal saline (n = 32) or 100 mg hydrocortisone in 250 mL normal saline (n = 31) before insufflation of CO2 into the peritoneum for postoperative pain relief. Patients were investigated regarding abdominal and shoulder pain using (visual analog scale) VAS in recovery room and at 6, 12 and 24 hours postoperatively. Patients were also followed regarding postoperative analgesic requirements, nausea and vomiting, and return of bowel function. Results: Sixty patients completed the study. Patients in the hydrocortisone group had no statistically significant abdominal and shoulder pain scores compared to the bupivacaine group. The patients were similar regarding postoperative analgesic requirements, return of bowel function, nausea and vomiting. No adverse effect was detected in either group. Conclusions: Intraperitoneal administration of hydrocortisone is as effective as bupivacaine to reduce pain and analgesic requirements after laparoscopic cholecystectomy. PMID:25337471

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

    SciTech Connect

    Sandison, Andrew J. P.; Edmondson, Robert A.; Panayiotopoulos, Yiannis; Reidy, John F.; McColl, Ian; Taylor, Peter R.

    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.

  6. Relative efficiency of two warming devices during laparoscopic cholecystectomy.

    PubMed

    Kadam, V Rao; Moyes, D; Moran, J L

    2009-05-01

    Intraoperative hypothermia is a known consequence of general anaesthesia. Forced air warming devices are commonly used to prevent hypothermia in anaesthesia, but there are limited data on the use of radiant warming devices. Previous trials comparing the efficacy of forced air and radiant warming devices have reported discordant results. The current study evaluated the efficacy of these devices during elective laparoscopic cholecystectomy, where surgery was expected to last > 60 minutes. Twenty-nine patients were randomised to either a forced air warming device (Warm-touch; group 1, n = 15) or a radiant warming device applied to the face (Sun-touch; group 2, n = 14). All fluids were given via a standardised fluid warmer set at 41 degrees C. Oesophageal temperature was measured every 15 minutes until the end of the procedure. Between-group, over-time temperatures and interaction were analysed using a linear mixed model. Statistical significance was ascribed at P < or = 0.05. The median (range) time of surgery was 90 (60 to 180) minutes. Mean (SD) oesophageal temperatures in the Warm-touch and Sun-touch groups were at 15 minutes 36.2 (0.30) degrees C and 36.2 (0.57) degrees C, and at 90 minutes 36.2 (0.44) degrees C and 35.9 (0.29) degrees C respectively. There was no statistically significant temperature difference between groups (P = 0.69) or over time (P = 0.61), and no interaction between time and treatment group (P = 0.97). Postoperative headache was recorded in four Sun-touch and no Warm-touch patients (P = 0.04). No difference in the efficacy of the Sun-touch warming device compared with the Warm-touch was demonstrated. Operational-mode side-effects may limit the use of the Sun-touch device. PMID:19499869

  7. Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis

    PubMed Central

    Ikumoto, Taro; Yamagishi, Hidetsugu; Iwatate, Mineo; Sano, Yasushi; Kotaka, Masahito; Imai, Yasuo

    2015-01-01

    AIM: To assess the safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis. METHODS: All patients who underwent SILC at Sano Hospital (Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy. RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients (41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines (TG13) for the severity of cholecystitis, 86 and 14 patients had grade?I?and grade II acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients (89%). Conversion laparotomy was performed in 12 patients (12%). Postoperative complications of Clavien-Dindo grade III or greater were observed in 4 patients (4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset. CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion. PMID:26722614

  8. Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy

    SciTech Connect

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

    2005-04-15

    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-up after treatment by a multidisciplinary approach. Methods. Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months). Results. Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed. Conclusion. Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures.

  9. Protocol for extended antibiotic therapy after laparoscopic cholecystectomy for acute calculous cholecystitis (Cholecystectomy Antibiotic Randomised Trial, CHART)

    PubMed Central

    Pellegrini, Pablo; Campana, Juan Pablo; Dietrich, Agustín; Goransky, Jeremías; Glinka, Juan; Giunta, Diego; Barcan, Laura; Alvarez, Fernando; Mazza, Oscar; Sánchez Claria, Rodrigo; Palavecino, Martin; Arbues, Guillermo; Ardiles, Victoria; de Santibañes, Eduardo; Pekolj, Juan; de Santibañes, Martin

    2015-01-01

    Introduction Acute calculous cholecystitis represents one of the most common complications of cholelithiasis. While laparoscopic cholecystectomy is the standard treatment in mild and moderate forms, the need for antibiotic therapy after surgery remains undefined. The aim of the randomised controlled Cholecystectomy Antibiotic Randomised Trial (CHART) is therefore to assess if there are benefits in the use of postoperative antibiotics in patients with mild or moderate acute cholecystitis in whom a laparoscopic cholecystectomy is performed. Methods and analysis A single-centre, double-blind, randomised trial. After screening for eligibility and informed consent, 300 patients admitted for acute calculus cholecystitis will be randomised into two groups of treatment, either receiving amoxicillin/clavulanic acid or placebo for 5 consecutive days. Postoperative evaluation will take place during the first 30?days. Postoperative infectious complications are the primary end point. Secondary end points are length of hospital stay, readmissions, need of reintervention (percutaneous or surgical reinterventions) and overall mortality. The results of this trial will provide strong evidence to either support or abandon the use of antibiotics after surgery, impacting directly in the incidence of adverse events associated with the use of antibiotics, the emergence of bacterial resistance and treatment costs. Ethics and dissemination This study and informed consent sheets have been approved by the Research Projects Evaluating Committee (CEPI) of Hospital Italiano de Buenos Aires (protocol N° 2111). Results The results of the trial will be reported in a peer-reviewed publication. Trial registration number NCT02057679. PMID:26582405

  10. 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

  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. PMID:26170915

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

    PubMed

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

    2010-12-01

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

  13. Falciform ligament hernia after laparoscopic cholecystectomy: a rare case and review of the literature.

    PubMed

    Charles, Anthony; Shaikh, Almaas A; Domingo, Shirley; Kreske, Edward

    2005-04-01

    The occurrence of an internal hernia through a congenital or iatrogenic defect in the falciform ligament is extremely rare. In the era of minimally invasive surgery, we present an unusual case of small bowel obstruction after laparoscopic cholecystectomy. An 85-year-old white male presented to the emergency room 2 weeks after an uneventful cholecystectomy and complaining of a colicky, nonradiating right upper quadrant abdominal pain. Hydroxyiminodiacetic acid (HIDA) scan and endoscopic retrograde cholangiopancreatography (ERCP) performed revealed an open ductal system. Abdominal computed tomography (CT) scan was suggestive of a high-grade small bowel obstruction. Exploratory laparotomy revealed a herniated loop of distal ileum, passing from right to left through a defect in the falciform ligament created by the subxyphoid trochar. The surgeon should consider dividing the inferior leaf of the free edge of the falciform ligament, including the round ligament, should an aperture be created during laparoscopic port placement. PMID:15943414

  14. Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy

    PubMed Central

    Jain, Nikhar; Neogi, Sushanto; Bali, Rajandeep Singh; Harsh, Niket

    2015-01-01

    Aim. To assess the occurrence of SSIs in patients with spillage of gallbladder contents and bacteriobilia during laparoscopic cholecystectomy. Methods. We evaluated 113 patients who underwent laparoscopic cholecystectomy between September 2013 and April 2015. The SSIs and their relationship with gallbladder rupture and bacteriobilia were assessed. Results. The mean age of patients developing SSIs was 45.57 ± 8.89 years. 18 patients (16%) had spillage of bile from the gallbladder. Percentage of SSIs overall was 6%, while percentage of SSIs in gallbladder content spillage was 5.5%. Organism profile of the culture from surgical site showed monomicrobial infection: 58% Staphylococcus aureus, 14% Pseudomonas, and 14% E. coli. The occurrence of SSIs in patients with bacteriobilia was 16% as compared to 2% in patients without bacteriobilia. Conclusions. Gallbladder content spillage is not a significant risk factor leading to increase in SSIs. The occurrence of SSIs is significantly higher in patients with bacteriobilia. PMID:26605081

  15. The effect of positive end-expiratory pressure on inflammatory cytokines during laparoscopic cholecystectomy

    PubMed Central

    Y?lmazlar, Firdevs; Karabay?rl?, Safinaz; Gözdemir, Muhammet; Usta, Burhanettin; Peker, Murat; Namuslu, Mehmet; Erdamar, Hüsamettin

    2015-01-01

    Objectives: To investigate effects of the positive end-expiratory pressure (PEEP) application of 10 cm H2O on the plasma levels of cytokines during laparoscopic cholecystectomy. Methods: A prospective study was conducted on 40 patients who presented to the Department of General Surgery, Medical Faculty, Turgut Özal University, Ankara, Turkey scheduled for laparoscopic cholecystectomy operation during a 10 month period from September 2012 to June 2013. Forty patients scheduled for laparoscopic cholecystectomy operation were randomly divided into 2 groups; ventilation through zero end-expiratory pressure (ZEEP) (0 cm H2O PEEP) (n=20), and PEEP (10 cm H2O PEEP) (n=20). All patients were ventilated with 8 ml/kg TV. Levels of interleukin (IL)-6, tumor necrosis factor (TNF)-?, IL 10, and transforming growth factor (TGF)-?1 were measured in the pre- and post-operatively collected samples. Results: Blood samples of 30 patients’ were analyzed for plasma cytokine levels, and 10 were excluded from the study due to hemolysis. Post-operative plasma IL-6 levels were observed to be significantly higher than the pre-operative patients (p=0.035). Post-operative plasma TGF-?1 levels in the PEEP group was found significantly higher compared with the pre-operative group levels (p=0.033). However, there were no significant differences in the pre- and post-operative plasma cytokine levels between the 2 groups. Conclusion: The application of PEEP of 10 cm H2O, which has known beneficial effect on respiratory mechanics, does not have any effect on systemic inflammatory response undergoing pneumoperitoneum during laparoscopic cholecystectomy surgery. PMID:26593173

  16. Laparoscopic Cholecystectomy: Incidental Carcinoma of the Gallbladder with Abdominal Wall and Axillary Node Metastasis

    PubMed Central

    Fligelstone, Louis J.; Wheeler, Malcolm H.; Horgan, Kieran; Maughan, Timothy S.

    1997-01-01

    A case report is presented of intra-mural gallbladder carcinoma discovered incidentally after laparoscopic cholecystectomy who subsequently developed abdominal wall recurrence at the epigastric exit port, and axillary lymph node metastases. Possible preventative steps for tumour dissemination and a management plan if incidental carcinoma is diagnosed is discussed. The use of a non-porous retrieval bag, early recognition of the carcinoma and excision of the exit wound are advocated. PMID:9174863

  17. Effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy

    PubMed Central

    Choi, Geun Joo; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Kim, Dong Rim

    2015-01-01

    AIM: To systematically evaluate the effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy (LC). METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials in English that compared the effect of intraperitoneal administration of local anesthetics on pain with that of placebo or nothing after elective LC under general anesthesia were included. The primary outcome variables analyzed were the combined scores of abdominal, visceral, parietal, and shoulder pain after LC at multiple time points. We also extracted pain scores at resting and dynamic states. RESULTS: We included 39 studies of 3045 patients in total. The administration of intraperitoneal local anesthetic reduced pain intensity in a resting state after laparoscopic cholecystectomy: abdominal [standardized mean difference (SMD) = -0.741; 95%CI: -1.001 to -0.48, P < 0.001]; visceral (SMD = -0.249; 95%CI: -0.493 to -0.006, P = 0.774); and shoulder (SMD = -0.273; 95%CI: -0.464 to -0.082, P = 0.097). Application of intraperitoneal local anesthetic significantly reduced the incidence of shoulder pain (RR = 0.437; 95%CI: 0.299 to 0.639, P < 0.001). There was no favorable effect on resting parietal or dynamic abdominal pain. CONCLUSION: Intraperitoneal local anesthetic as an analgesic adjuvant in patients undergoing laparoscopic cholecystectomy exhibited beneficial effects on postoperative abdominal, visceral, and shoulder pain in a resting state. PMID:26715824

  18. Effect of Pain Medication Choice on Emergency Room Visits for Pain after Ambulatory Laparoscopic Cholecystectomy.

    PubMed

    Reddy, Vemuru Sunil K; Brown, Joshua D; Ku, Benson; Gilchrist, Brian F; Farkas, Daniel T

    2015-08-01

    Inadequate pain control after ambulatory surgery can lead to unexpected return visits to the hospital. The purpose of this study was to compare patients based on which medications they were prescribed and to see whether this affected the rate of return to the hospital. A retrospective chart review of patients who underwent ambulatory laparoscopic cholecystectomy between January 2009 and December 2013 was performed. Patients were divided into two groups based on the pain medication prescribed after surgery: Opioids and nonopioids. Patients returning to the Emergency room (ER) within seven days were evaluated. If no complication or other diagnosis was identified, the patient was considered to have returned for inadequate pain control. The two groups were statistically compared with each other using Fisher's exact chi-squared test. A total of 749 patients underwent laparoscopic cholecystectomy during the study period: 180 (25.2%) were prescribed opioids, whereas, 560 (74.8%) were prescribed nonopioids. In the nonopioid group, 14 (1.9%) returned to the ER for pain, whereas no patient in the opioid group returned for pain. This difference was statistically significant (P = 0.027). In conclusion, patients who were given opioid pain medications after ambulatory laparoscopic cholecystectomy were less likely to return to the ER for pain. This implied that opioids were better at pain control and helped avoid the costs of unnecessary ER visits. Future research should be aimed at more direct measures of pain control, as well as the role of opioids after inpatient surgery. PMID:26215248

  19. Does endoscopic retrograde cholangiopancreatography have a negative effect on laparoscopic cholecystectomy?

    PubMed Central

    Çak?r, Murat; Küçükkartallar, Tevfik; Tekin, Ahmet; Y?ld?r?m, Mehmet Aykut; Kartal, Adil

    2015-01-01

    Objective: We have observed that patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) had some difficulties with laparoscopic cholecystectomy procedures. Through a retrospective study, we planned to compare the surgical procedures between patients who had undergone ERCP and those who had not in order to clarify this. Material and Methods: The results of 122 patients who had undergone ERCP because of choledocholithiasis before undergoing laparoscopic cholecystectomy procedures between 2008 and 2011 were compared to the values of 2140 patients operated because of cholelithiasis only within the same period. Results: Among the patients who underwent surgical procedures following ERCP, 80 (65%) were female and 42 (35%) were male. The average age of the patients was 51.9 years (range: 20–83 years). The operation period after the procedure was 30.14 days (range: 1–93 days). Although the hospitalization period was 4.67 days (range: 1–22 days), the postoperative hospitalization period was 2.68 days (range: 1–15 days). Regarding the difficulty of operation, adhesion in 58 (47.5%) patients, bleeding in two (1.6%) patients, and conversion to open procedure in 12 (9.8) patients were observed. In two (1.6%) patients, bleeding and biliary fistula were the reasons for re-operation. Conclusion: Laparoscopic cholecystectomy is more complicated in patients who underwent ERCP. PMID:26504415

  20. Preoperative mannitol infusion improves perioperative cerebral oxygen saturation and enhances postoperative recovery after laparoscopic cholecystectomy

    PubMed Central

    Mousa, Wesam F.; Mowafi, Hany A.; Al-Metwalli, Roshdi R.; Al-Ghamdi, Abdulmohsin A.; Al-Gameel, Haytham Z.

    2015-01-01

    Objectives: To test the effect of preoperative mannitol infusion on perioperative decreased cerebral oxygen saturation (rSO2) during laparoscopic cholecystectomy. Methods: Forty patients scheduled for laparoscopic cholecystectomy were enrolled in this study conducted at Dammam Hospital of the University, Dammam, Kingdom of Saudi Arabia from December 2013 to June 2014. Patients received either 0.5 g/kg of 20% intravenous mannitol infusion over 10 minutes before induction of anesthesia (group M), or an equal volume of normal saline instead (group C). Primary outcome variable was rSO2. Other variables included extubation time, clinical assessment of consciousness recovery using the Modified Observer’s Assessment of Alertness/Sedation Scale (OAA/S), and the mini-mental state examination (MMSE) for cognitive evaluation. Results: Anesthesia induction increased rSO2 in both groups. Pneumoperitoneum decreased rSO2 in group C, but not in group M. This drop in rSO2 in the group C reached its maximum 30 minutes after extubation, and was significantly less than the preinduction value. Time to extubation in group M was significantly shorter compared to group C (p=0.007). The OAAS in group M at 10 min after extubation was significantly higher compared to group C. No differences were found between the 2 groups in cognitive function as measured by MMSE score. Conclusion: Preoperative mannitol infusion maintains perioperative rSO2 during laparoscopic cholecystectomy and shortens extubation time with earlier resurgence of OAAS. PMID:26446331

  1. Gallbladder removal - laparoscopic

    MedlinePLUS

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

  2. Feasibility and safety of day-surgery laparoscopic cholecystectomy: a single-institution 5-year experience of 1140 cases

    PubMed Central

    Almodhaiberi, Helayel; Ali, Bander; Alballa, Abdulrahman; Alsowaina, Khalid; Alhasan, Ibrahim; Algarni, Abdullah; Alharbi, Haifa; Degna; Alarma, Maria-Rosene

    2015-01-01

    Backgrounds/Aims We report our experience with day-surgery laparoscopic cholecystectomy and assess its feasibility and safety. Methods Data was collected on all the patients who underwent day-surgery laparoscopic cholecystectomy between February 2009 and February 2014 at Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. All patients had symptomatic cholelithiasis that was proven on imaging studies with clearance of the common bile duct. The patient biographical data (age, gender, American Society of Anaesthesiology status, medical comorbidities) and surgical outcomes were then obtained. There was an evaluation of the success rate of day-surgery laparoscopic cholecystectomy, reasons for unexpected admission, and the re-admission rate. Results A total of 1,140 patients were included in this study. The success rate for day-surgery laparoscopic cholecystectomy was 96%. The reasons for unexpected hospital admission for 46 patients (4%) included persistent abdominal pain and postoperative emesis. The postoperative re-admission rate was 0.4% (5 patients). There were no major complications, and the conversion rate was 0.5% (6 patients). Conclusions We suggest that day-surgery laparoscopic cholecystectomy is both safe and feasible in a local setting. Careful patient selection is essential in ensuring a high success rate. PMID:26379732

  3. Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

    PubMed Central

    Rashid, Arshad; Mushtaque, Majid; Bali, Rajandeep Singh; Nazir, Saima; Khuroo, Suhail; Ishaq, Sheikh

    2015-01-01

    Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot's triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries. PMID:26240761

  4. Comparative Evaluation of Dexmedetomidine and Esmolol on Hemodynamic Responses During Laparoscopic Cholecystectomy

    PubMed Central

    Nagle, Vaishali; Agrawal, Sanjay; Kumar, Diwakar; Verma, Amit; Kedia, Sunil

    2015-01-01

    Background: The advent of laparoscopic surgery has benefited the patient and surgeon; however creation of pneumoperitoneum for same has bearings during the perioperative period. These effects of pneumoperitoneum are associated with significant haemodynamic changes, increasing the morbidity of the patient. Aim: The present study compared the efficacy of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy Materials and Methods: A total of 90 patients aged 20-60 y, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for laparoscopic cholecystectomy were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine loading dose 1 mcg/kg over a period of 15 min and maintenance 0.5 mcg/kg/h throughout the pneumoperitoneum. Group E received esmolol loading dose 1 mg/kg over a period of 5 min and maintenance 0.5 mg/kg/h throughout the pneumoperitoneum. Group C received same volume of normal saline. Measurements: Heart rate (HR), systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP) were recorded preoperative, after study drug, after induction, after intubation, after pneumoperitoneum at 15 min intervals, post pneumoperitoneum and postoperative period after 15 min. Propofol induction dose, intraoperative fentanyl requirement and sedation score were also recorded. Results: In group D, there was no statistically significant increase in HR and blood pressure after pneumoperitoneum at any time intervals, whereas in Group E, there was a statistical significant increase in MAP after pneumoperitoneum at 15, 45, and 60 min only and HR during the whole pneumoperitoneum period. There was a significant decrease in induction dose of propofol and intraoperative fentanyl requirement in Group D and E, compared to Group C (p<0.0001). Conclusion: Dexmedetomidine is more effective than esmolol for attenuating the hemodynamic response to pneumoperitoneum in elective laparoscopic cholecystectomy. Dexmedetomidine and esmolol also reduced requirements of anaesthetic agents. PMID:25954683

  5. 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

  6. Comparison of i-gel® and LMA Supreme® during laparoscopic cholecystectomy

    PubMed Central

    Park, Sang Yoong; Rim, Jong Cheol; Kim, Hyuk; Lee, Ji Hyeon

    2015-01-01

    Background In laparoscopic surgical procedures, many clinicians recommend supraglottic airway devices as good alternatives to intubation. We compared the i-gel® (i-gel) and LMA Supreme® (Supreme Laryngeal Mask Airway, SLMA) airway devices during laparoscopic cholecystectomy regarding sealing pressure and respiratory parameters before, during, and after pneumoperitoneum. Methods Following Institutional Review Board approval and written informed consent, 93 patients were randomly allocated into the i-gel (n = 47) or SLMA group (n = 46). Insertion time, number of insertion attempts, and fiberoptic view of glottis were recorded. Oropharyngeal leak pressure (OLP), the use of airway manipulation, peak inspiratory pressure, lung compliance, and hemodynamic parameters were measured before, during, and after pneumoperitoneum. Results There were no significant differences between the two groups regarding demographic data, insertion time, fiberoptic view of glottis, and the use of airway manipulation. The gastric tube insertion time was longer in the i-gel group (20.4 ± 3.9 s) than in the SLMA group (16.7 ± 1.6 s) (P < 0.001). All devices were inserted on the first attempt, excluding one case in each group. Peak inspiratory pressure, lung compliance, and OLP changed following carbon dioxide pneumoperitoneum in each group, but there were no significant differences between the groups. Conclusions Both the i-gel and SLMA airway devices can be comparably used in patients who undergo laparoscopic cholecystectomy, and they offer similar performance including OLP. PMID:26495055

  7. Abdominal actinomycosis after laparoscopic cholecystectomy: an uncommon presentation of an uncommon problem

    PubMed Central

    Tankel, James A.; Gurjar, Shashank V.; Holford, Nicholas C.; Williams, Sian

    2015-01-01

    Actinomycosis is a rare bacterial infection with a broad clinical presentation that is seldom reported after elective cholecystectomy. We present an as-of-yet unreported case of actinomycosis in an 81-year-old gentleman who was found to have right-sided peritonitis and small bowel obstruction 11 months after elective laparoscopic cholecystectomy. A complex loculated lesion was found on laparotomy with a protracted course of antibiotics being needed for treatment. The rarity of this condition will mean it remains a surprise diagnosis to many clinicians. However, it is important that clinicians maintain some index of suspicion to prevent unnecessary surgery and are aware of the protracted course of antibiotics that is needed for successful treatment. PMID:25988074

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

    PubMed

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

    2015-10-01

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

  9. Obstructive jaundice secondary to endoclip migration into common bile duct after laparoscopic cholecystectomy.

    PubMed

    Sormaz, I C; Keskin, M; Sönmez, R E; Soyta?, Y; Tekant, Y; Avtan, L

    2015-10-01

    Obstructive jaundice is a rare condition due to foreign body in common bile. In this article we report a 69 year-old man who was diagnosed obstructive jaundice secondary to the endoscopic clip migration. The patient had been performed laparoscopic cholecystectomy 5 years ago and had recovered without any complications. He presented with abdominal pain and jaundice. The magnetic resonance cholangiopancreatography (MRCP) revealed filling defect in choledoch consistent with a bile duct stone. The endoscopic retrograde cholangiopancreatography (ERCP) exhibited an endoclip migration into the common bile duct which caused bile duct stone. Endoclips can migrate into bile duct and cause obstructive jaundice. ERCP is the first option for its treatment. PMID:26488761

  10. Importance of the node of Calot in gallbladder neck dissection: an important landmark in the standardized approach to the laparoscopic cholecystectomy.

    PubMed

    Ferzli, George; Timoney, Michael; Nazir, Sharique; Swedler, David; Fingerhut, Abe

    2015-01-01

    The current rate of bile duct injury (BDI) after laparoscopic cholecystectomy is 0.4%, which is an unacceptable outcome. Several surgical approaches have been suggested to mitigate the occurrence of this dreaded complication. We propose a standardized approach, using Calot's node as a critical anatomical landmark to guide gallbladder dissection and avoid BDI. We retrospectively analyzed a prospectively gathered database of 907 laparoscopic cholecystectomies using this standardized approach in our practice over a 5-year period. To date we have had no BDI and no cystic duct leak. Therefore, we suggest identification of Calot's node as an additional method to avoid BDI during laparoscopic cholecystectomy. PMID:25559890

  11. Automatic PSO-Based Deformable Structures Markerless Tracking in Laparoscopic Cholecystectomy

    NASA Astrophysics Data System (ADS)

    Djaghloul, Haroun; Batouche, Mohammed; Jessel, Jean-Pierre

    An automatic and markerless tracking method of deformable structures (digestive organs) during laparoscopic cholecystectomy intervention that uses the (PSO) behavour and the preoperative a priori knowledge is presented. The associated shape to the global best particles of the population determines a coarse representation of the targeted organ (the gallbladder) in monocular laparoscopic colored images. The swarm behavour is directed by a new fitness function to be optimized to improve the detection and tracking performance. The function is defined by a linear combination of two terms, namely, the human a priori knowledge term (H) and the particle's density term (D). Under the limits of standard (PSO) characteristics, experimental results on both synthetic and real data show the effectiveness and robustness of our method. Indeed, it outperforms existing methods without need of explicit initialization (such as active contours, deformable models and Gradient Vector Flow) on accuracy and convergence rate.

  12. Evaluation and comparison of postoperative levels of serum bilirubin, serum transaminases and alkaline phosphatase in laparoscopic cholecystectomy versus open cholecystectomy

    PubMed Central

    Singal, Rajinder Pal; Sandhu, Karamjot; Singh, Bir; Bhatia, Gaurav; Khatri, Abhishek; Sharma, Bhanu Pratap

    2015-01-01

    Background Laparoscopic cholecystectomy (LC) requires the creation of a pneumoperitoneum via insufflations of carbon dioxide; resulting in increased partial pressure of carbon dioxide (CO2) and intraperitoneal pressure which leads to the changes in pulmonary function and hemodynamic measurements. Hypercarbia leads to visceral organ ischemia including liver and venous stasis/thromboembolism or both due to impaired flow. The present study has been undertaken to see the changes in liver function tests (LFTs) after laparoscopic/open cholecystectomy (OC), the incidences of such change, their relation to age, sex, duration of surgery and to know the clinical significances of such disturbances. Aims and objectives To compare and correlate the serum level of bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) in patients who underwent LC to those who underwent OC. Materials and methods The present study was conducted in the Department of Surgery at MMIMSR, MM University, Mullana, Ambala. A total number of 200 patients diagnosed as cholelithiasis were included in the study from May 2012 to May 2014. These cases were randomly divided into two groups (A and B) consisting of 100 cases each. LC was performed in group A patients and OC was done in group B patients. Three blood samples were taken: (I) pre-operatively; (II) after 24 hours of surgery; and (III) after 72 hours of surgery for comparison of the enzyme level alterations. Results In LC patients, there were rise in the levels of serum bilirubin, AST and ALT after 24 hrs of surgery from the preoperative value and then again fall was noted (near to normal value) after 72 hrs of surgery except in that of ALP. ALP levels showed slight fall after 24 hrs of surgery and then slight rise after 72 hrs which was within the normal limit. Whereas in OC patients, there were slight variations in the liver enzymes (which were within the normal range). Conclusions Transient elevation of serum bilirubin, AST and ALT occurs after LC or after OC. The alteration in the liver enzymes can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy, patient position, and arterial injury may also other factors. These changes return to normal in 3-4 days after procedure and they have no clinical consequences in patients with normal hepatic function but they may still cause worry to the surgeon regarding the integrity of biliary tree. PMID:26487940

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

    PubMed Central

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

    2015-01-01

    Abstract 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

  14. Comparative study between paracetamol and two different doses of pregabalin on postoperative pain in laparoscopic cholecystectomy

    PubMed Central

    Esmat, Ibrahim M.; Farag, Hanan M.

    2015-01-01

    Background: Postoperative pain is the primary reason for prolonged hospital stay after laparoscopic cholecystectomy. This study compared the effect of a single oral preoperative administration of paracetamol (1 g) with 2 different doses of pregabalin (150 or 300 mg) for attenuating postoperative pain and analgesic consumption. Materials and Methods: Seventy-five patients, aged 18-60 years, American Society of Anesthesiologists’ physical status I and II undergoing elective laparoscopic cholecystectomy were included in this randomized controlled study. Patients were divided into three groups, 25 each to receive either oral paracetamol 1 g (group I, control group) or pregabalin 150 (group II) or 300 mg (group III), 2 h before surgery. Postoperative pain was evaluated based on visual analog scale over a period of 6 h and 1st time for rescue analgesia. Postoperative sedation, hemodynamic changes, serum cortisol level, and side effects were also evaluated. Results: There was a significant decrease in mean heart rate, mean systolic blood pressure, sedation score, pain score, and delayed the first request for analgesics postoperatively in group (II) and group (III) compared to group (I) 2 h postoperatively. There was no significant difference in group (III) compared to group (II) postoperatively. The incidence of postoperative side effects was more in group (III). Conclusion: The single oral preoperative dose administration of pregabalin had significant opioid-sparing effect in the first 6 h after surgery, whereas side effects were more common with administration of pregabalin 300 mg. PMID:26543452

  15. Occult gallbladder carcinoma after laparoscopic cholecystectomy: a report of four cases.

    PubMed

    Yokomuro, Shigeki; Arima, Yasuo; Mizuguchi, Yoshiaki; Shimizu, Tetsuya; Kawahigashi, Yutaka; Kannda, Tomohiro; Arai, Masao; Tajiri, Takashi

    2007-08-01

    Eighty-four patients underwent laparoscopic cholecystectomy (LC) from January through August 2006. Of these patients, 4 (4.7%) were found to have occult gallbladder carcinoma (GC) either during or after the procedure. Two of the patients were women and 2 were men. The mean age was 75.0 years. One patient had mucosal tumors, 2 had subserosal tumors, and 1 had a serosal lesion. One of the 2 patients with subserosal tumors underwent radical surgery. In a previous study, 0.83% (10 of 1,195) of patients who had undergone LC were found to have occult GC, either during of after the procedure. The prevalence of gallbladder carcinoma has recently been increasing. GC has been reported in 0.3% to 1.5% of patients who have undergone cholecystectomy. Since the introduction of laparoscopic surgery, the number of cholecystectomies being performed has increased, which may explain why occult GC seems to be occurring more frequently. The prognosis for GC is poor, and surgical resection is the only potentially curative treatment. However, GC is difficult to diagnose at an early stage and difficult to recognize even in the advanced stages. Fifteen percent to 30% of patients show no preoperative or intraoperative evidence of malignancy. Occult GC is also increasing. Because flat infiltrating GC and GC with cholecystitis and numerous stones are difficult to diagnose preoperatively, we recommend taking frozen sections from patients who are of advanced age (older than 70 years), have a long history of stones, or have a thickened gallbladder wall. PMID:17878700

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

    PubMed Central

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

    2015-01-01

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

  17. Laparoscopic versus small-incision cholecystectomy: Health status in a blind randomised trial

    PubMed Central

    de Vries, Jolanda; Gooszen, Hein G.; van Laarhoven, Cornelis J. H. M.

    2007-01-01

    Background Gallstones are a major cause of morbidity, and cholecystectomy is a commonly performed procedure. Minimal invasive procedures, laparoscopic cholecystectomy (LC) and small-incision cholecystectomy (SIC), have replaced the classical open cholecystectomy. No differences have been found in primary outcome measures between LC and SIC, therefore secondary outcome measures have to be considered to determine preferences. The aim of our study was to examine health status applying evidence-based guidelines in LC and SIC in a randomised trial. Methods Patients with symptomatic cholecystolithiasis were included in a blind randomised trial. Operative procedures, anaesthesia, analgesics and postoperative care were standardised in order to limit bias. Questionnaires were filled in preoperatively, the first day postoperatively, and at outpatients follow-up at 2, 6 and 12 weeks. In accordance with evidence-based guidelines, the generic short form (SF-36) and the disease-specific gastrointestinal quality-of-life index (GIQLI) questionnaires were used in addition to the body image questionnaire (BIQ). Results A total of 257 patients were randomised between LC (120) and SIC (137). Analyses were performed according to intention-to-treat (converted procedures included) and also distinguishing converted from minimal invasive (nonconverted) procedures. Questionnaires were obtained with a response rate varying from 87.5% preoperatively to 77.4% three months postoperatively. Except for two time-specific measurements in one SF-36 subscale, there were no differences between LC and SIC. There were significant differences in several subscales in all three questionnaires comparing minimal invasive versus converted procedures. Conclusions Applying adequate methodological quality and evidence-based guidelines (by using SF-36 and GIQLI), there are no significant differences in health status between LC and SIC. PMID:18071815

  18. Premedication With Single Dose of Acetazolamide for the Control of Referral Shoulder Pain After Laparoscopic Cholecystectomy

    PubMed Central

    Movassaghi, Reza; Peirovifar, Ali; Aghamohammadi, Davood; Mohammadipour Anvari, Hassan; EJ Golzari, Samad; Kourehpaz, Zohreh

    2015-01-01

    Background: The use of laparoscopic surgeries is escalating thanks to their advantages over the open surgeries. However, several complications can be observed following laparoscopy operation. Postoperative pain is a major concern in cholecystectomy surgeries. Pain can be both experienced in operated areas and radiated to the right shoulder. Acetazolamide is used for glaucoma, acute mountain sickness prophylaxis, and epilepsy in few patients with recurrent epilepsy. It seems that patients’ pain can be reduced by preventing carbonic acid production in abdomen after operation. Objectives: We aimed at evaluating if administration of acetazolamide preoperatively could affect early or late postoperative pain following laparoscopic surgery. Patients and Methods: In a randomized-controlled clinical trial study, 70 subjects (30 - 60 years) scheduled for laparoscopic cholecystectomy were included after obtaining a written informed consent. Patients were divided into two groups randomly (intervention and control). The intervention group received 5 mg/kg oral acetazolamide one hour before the operation. The control group did not receive any further medication. Results: Administration of a single dose of acetazolamide did not have any statistically significant impact on sleep quality (P = 1.000). Moreover, there was no statistically significant difference between groups regarding nausea and vomiting on single dose administration of acetazolamide (P = 1.000). Single dose of acetazolamide was associated with statistically significant decrease in shoulder pain immediately after laparoscopy (P = 0.017). However, there was no statistically significant difference regarding shoulder pain between the studied groups 2, 4, 6, 8, 10, 12, and 24 hours after laparoscopy. Single dose of acetazolamide did not significantly affect analgesic administration in 2, 4, 6, 8, 10, 12, and 24 hours after laparoscopy. Conclusions: Single dose of acetazolamide was associated with statistically significant decrease in shoulder pain immediately after laparoscopy. However, this effect was limited to the first postoperative hours and it failed to reduce postoperative pain of right shoulder during 24 hours after the operation. PMID:26705522

  19. 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

  20. Incidental detection of carcinoma gall bladder in laparoscopic cholecystectomy specimens: a thirteen year study of 23 cases and literature review.

    PubMed

    Gulwani, Hanni V; Gupta, Suneeta; Kaur, Sukhpreet

    2015-03-01

    Carcinoma of gall bladder is the most common malignancy of the biliary tract worldwide and is usually associated with poor prognosis. In this era of laparoscopic cholecystectomy, there has been increase in detection of early stage incidental gall bladder carcinoma in cholecystectomy specimens. A retrospective study was carried out in tertiary care hospital in central India. A total of 2990 patients underwent laparoscopic cholecystectomy during the year 2001-2013. Hospital records and histopathology reports of these patients were studied in detail. Twenty three cases of gall bladder carcinoma were detected incidentally accounting for an incidence of 0.76 %. It was more common in females with an M: F ratio of 1:1.9. Mean age of presentation was 57.8 years. Gall stones were present in 22 cases and one patient presented with features of acute cholecystitis. Three patients had associated xanthogranulomatous inflammation and 10 had associated intestinal metaplasia. It is not uncommon to encounter incidental malignancies of gall bladder in laparoscopic cholecystectomy specimens sent to histopathology for presumably benign disease. Histopathology reports must include comments on extent of infiltration, perineural invasion, tumor differentiation and nodal involvement for oncologist information and subsequent management of patients. PMID:25937761

  1. Major bile duct injuries during laparoscopic cholecystectomy. Follow-up after combined surgical and radiologic management.

    PubMed Central

    Lillemoe, K D; Martin, S A; Cameron, J L; Yeo, C J; Talamini, M A; Kaushal, S; Coleman, J; Venbrux, A C; Savader, S J; Osterman, F A; Pitt, H A

    1997-01-01

    OBJECTIVE: The authors provide the results of follow-up evaluation after combined surgical and radiologic management of 89 patients with major bile duct injuries during laparoscopic cholecystectomy. SUMMARY BACKGROUND DATA: The incidence and mechanism of injury of major bile duct injuries during laparoscopic cholecystectomy has been clearly defined. Furthermore, a number of series have described the management of these injuries by surgical, endoscopic, and radiologic techniques with excellent short-term results. Long-term follow-up data, however, are lacking in the management of these injuries. METHODS: Data were collected prospectively on 89 patients treated at a single institution with major bile duct injuries after laparoscopic cholecystectomy managed between July 1, 1990, and July 1, 1996. Patients referred with injuries underwent early percutaneous transhepatic cholangiography and biliary drainage. Based on the cholangiographic appearance and clinical situation, patients were managed by either percutaneous balloon dilatation or surgical reconstruction with a Roux-en-Y hepaticojejunostomy with transanastomotic stenting. Follow-up was obtained by personal interview during October 1996. RESULTS: Two patients died without an attempt at definitive therapy. Both deaths were caused by sepsis and multisystem organ failure present at the time of transfer to the authors' institution. The remaining 87 patients were managed initially by either balloon dilatation (N = 28) or surgical reconstruction (N = 59). Ten patients have not completed treatment and still have biliary stents in place. Evaluation of 25 patients completing treatment after balloon dilatation (mean follow-up, 27.8 months) showed a success rate of 64%. Evaluation of 52 patients completing treatment after surgical reconstruction (mean follow-up, 33.4 months) showed a success rate of 92%. All failures were managed successfully by either surgical reconstruction or balloon dilatation. CONCLUSIONS: Major bile duct injuries can be managed successfully by combined surgical and radiologic techniques. This series provides, for the first time, significant follow-up on a large number of patients with overall success rates of 64% after balloon dilatation and 92% after surgical reconstruction. The combination of surgery and balloon dilatation resulted in a successful outcome in 100% of patients treated. PMID:9193174

  2. YouTube as a potential training method for laparoscopic cholecystectomy

    PubMed Central

    Lee, Jun Suh; Seo, Ho Seok

    2015-01-01

    Purpose The purpose of this study was to analyze the educational quality of laparoscopic cholecystectomy (LC) videos accessible on YouTube, one of the most important sources of internet-based medical information. Methods The keyword 'laparoscopic cholecystectomy' was used to search on YouTube and the first 100 videos were analyzed. Among them, 27 videos were excluded and 73 videos were included in the study. An arbitrary score system for video quality, devised from existing LC guidelines, were used to evaluate the quality of the videos. Video demographics were analyzed by the quality and source of the video. Correlation analysis was performed. Results When analyzed by video quality, 11 (15.1%) were evaluated as 'good', 40 (54.8%) were 'moderate', and 22 (30.1%) were 'poor', and there were no differences in length, views per day, or number of likes, dislikes, and comments. When analyzed by source, 27 (37.0%) were uploaded by primary centers, 20 (27.4%) by secondary centers, 15 (20.5%) by tertiary centers, 5 (6.8%) by academic institutions, and 6 (8.2%) by commercial institutions. The mean score of the tertiary center group (6.0 ± 2.0) was significantly higher than the secondary center group (3.9 ± 1.4, P = 0.001). The video score had no correlation with views per day or number of likes. Conclusion Many LC videos are accessible on YouTube with varying quality. Videos uploaded by tertiary centers showed the highest educational value. This discrepancy in video quality was not recognized by viewers. More videos with higher quality need to be uploaded, and an active filtering process is necessary. PMID:26236699

  3. 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

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

    PubMed Central

    Cheon, Seong Uk; Choi, In Seok

    2015-01-01

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

  5. 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

  6. Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist

    PubMed Central

    Connor, Saxon J; Perry, William; Nathanson, Leslie; Hugh, Thomas B; Hugh, Thomas J

    2014-01-01

    Objectives Prevalences of bile duct injury (BDI) following laparoscopic cholecystectomy (LC) remain unacceptably high. There is no standardized method for performing an LC. This study aims to describe a standardized technique for LC that will allow for the development of a concept LC checklist, the use of which, it is hoped, will decrease the prevalence of BDI. Methods A standardized method for LC was developed based on previously published expert analysis supplemented by video error analysis of operations in which BDI occurred. Established checklist methodology was then used to construct an LC-specific concept checklist. Results A five-step technique for the safe establishment of the critical view was created to guide the development of the checklist. The five steps are: (i) confirm the gallbladder lies in the hepatic principal plane and is retracted to the 10?o'clock position; (ii) confirm Hartmann's pouch is lifted up and toward the segment IV pedicle; (iii) identify Rouvière's sulcus; (iv) confirm the release of the posterior leaf of the peritoneum covering the hepatobiliary triangle, and (v) confirm the critical view with or without intraoperative cholangiography. Conclusions A standardized approach to LC would allow for the creation of an LC-specific checklist that has the potential to lower the prevalence of BDI. PMID:23961737

  7. Comparison of a radiant patient warming device with forced air warming during laparoscopic cholecystectomy.

    PubMed

    Wong, A; Walker, S; Bradley, M

    2004-02-01

    The importance of maintaining a patient's core body temperature during anaesthesia to reduce the incidence of postoperative complications has been well documented. The standard practice of this institution is the use of a forced air device for intraoperative warming. The purpose of this study was to compare this standard with an alternative warming device using a radiant heat source which only heated the face. This prospective, randomized controlled trial compared the efficacy of two methods of intraoperative warming: the BairHugger (Augustine Medical, U.S.A.) forced air device and the SunTouch (Fisher & Paykel Healthcare, N.Z.) radiant warmer during laparoscopic cholecystectomy in 42 female patients. Oesophageal core temperatures were recorded automatically on to computer during operations using standardised anaesthesia, intravenous infusions and draping. The study failed to show any statistical or clinical difference between the two patient groups in terms of mean core temperature both intraoperatively (P = 0.42) and in the recovery period (P = 0.54). Mean start to end core temperature differences were marginally lower in the radiant group (0.08 degree C) but not statistically or clinically significantly different. Given some of the drawbacks with forced air systems, such as the expense of the single use blanket, this new radiant warming device offers an alternative method of active warming with advantages in terms of cost and possible application to a wide variety of surgical procedures. PMID:15058128

  8. Perforin Expression in Peripheral Blood Lymphatic Cells of Patients Subjected to Laparoscopic or Open Cholecystectomy

    PubMed Central

    Grbas, Harry; Mrakov?i?-Šuti?, Ines; Depolo, Arsen; Radoševi?-Staši?, Biserka

    2009-01-01

    Perforin-(P-) related characteristics of cytotoxic T lymphocytes and natural killer cells were investigated in peripheral blood of patients subjected to open (OC; n = 23) or laparoscopic cholecystectomy (LC; n = 21) and healthy controls (n = 20). Blood samples were obtained preoperatively and 24 hours after the surgeries, and the data were correlated with the intensity of cholestasis and concomitant inflammation, determined by functional hepatic tests. Postoperative differences were found to be minimal: OC decreased only the percentage of CD56+ cells, while LC decreased the fraction of CD8+P+ cells and augmented the mean fluorescence intensity of P in CD56 cells. Patients elected for OC had, however, higher preoperative numbers of total P+, CD3+P+, and CD4+P+ cells than patients elected for LC and healthy controls, while both groups of patients, preoperatively, had lower fraction of CD16+P+ and CD56+P+ cells. These changes were in high correlation with blood concentrations of CRP, AP, and ALT, emphasizing the link between the preoperative cholestasis and inflammation and P-dependent cytotoxic mechanisms. PMID:19436761

  9. Intrathecal dextmedetomidine to reduce shoulder tip pain in laparoscopic cholecystectomies under spinal anesthesia

    PubMed Central

    Bhatia, Tarundeep; Bhatia, Jaideep; Attri, Joginder Pal; Singh, Sukhpreet; Khetarpal, Ranjana

    2015-01-01

    Background: General anesthesia as a technique for laparoscopic cholecystectomies has disadvantage in terms of the stress response, lack of postoperative analgesia and emesis. Regional anesthesia offers advantages over general anesthesia in terms of cost, postoperative analgesia, intact respiratory control mechanism and early ambulation. Shoulder tip pain remains the main concerns that can be alleviated by adding various adjuvants to local anesthetics. Aims and Objectives: To study the effect of adding intrathecal dexmedetomidine to bupivacaine to decrease shoulder tip pain, onset and duration of sensory and motor block, hemodynamic changes and side effects if any. Materials and Methods: Totally, 60 patients were divided into two groups of 30 each. Group A received 3 ml of bupivacaine heavy and group B received 5 µg of dexmedetomidine along with 3 ml of bupivacaine diluted to total volume of 3.5 ml in each group. Statistical Analysis: It was done using Chi-square and Student's t-test. Results and Conclusions: Intrathecal dexmedetomidine provides stable hemodynamics, excellent sedation and analgesia and abolishes shoulder tip pain. PMID:26712967

  10. Comparative evaluation of cost effectiveness and recovery profile between propofol and sevoflurane in laparoscopic cholecystectomy

    PubMed Central

    Singh, Yashpal; Singh, Anil P.; Jain, Gaurav; Yadav, Ghanshyam; Singh, Dinesh Kumar

    2015-01-01

    Background: Anesthetic agents should be chosen not only on the basis of safety-efficacy profile, but also on the economic aspect. Propofol and sevoflurane are commonly utilized anesthetic agent for general anesthesia. Aim: The present study was designated to compare cost-effectiveness and recovery profile between propofol and sevoflurane for induction, maintenance or both. Settings and Design: Randomized controlled, participant and data operator blinded trial. Materials and Methods: Ninety patients undergoing laparoscopic cholecystectomy were randomized into three equal groups to receive: Group P to receive injection propofol for both induction and maintenance; Group PS to receive injection propofol for induction and sevoflurane for maintenance; and Group S to receive sevoflurane for both induction and maintenance of general anesthesia, respectively. Cost analysis, hemodynamic parameter, and recovery profile were compared between these groups. Statistical Analysis: One-way analysis of variance test or Fisher's exact test/Chi-square test whichever appropriate. Results: Total cost of anesthesia was highest in Group P and lowest in Group S. Mean time to extubation and time to follow verbal commands was lowest in Group S than Group P or Group P/S. Hemodynamic parameter was more stable in Group S. Conclusion: We conclude that sevoflurane appears to be better anesthetic agents in terms of cost-effectiveness and recovery profile. PMID:26417120

  11. 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

  12. Comparison of bupivacaine and parecoxib for postoperative pain relief after laparoscopic cholecystectomy: a randomized controlled trial

    PubMed Central

    Lin, Shengping; Hua, Jie; Xu, Bin; Yang, Tingsong; He, Zhigang; Xu, Chenglei; Meng, Hongbo; Zhou, Bo; Song, Zhenshun

    2015-01-01

    Background: Pain is the most common complaint of patients on the first day after laparoscopic cholecystectomy (LC). The aim of this study was to compare the efficacy of local anesthesia with bupivacaine and intravenous parecoxib on postoperative abdominal pain relief up to 24 h after surgery. Methods: One hundred and eighty patients who underwent LC were randomized to one of three groups with sixty patients each: Group A received 50 mg 0.5% bupivacaine subcutaneously at trocar sites before incision closure; Group B received intravenous parecoxib (40 mg) after entering the recovery room; Group C did not receive postoperative analgesia unless needed and was served as control. The postoperative pain at 1, 2, 4, 8, 12, and 24 h after the operation was assessed using a visual analog scale (VAS). Secondary outcomes, including intraoperative and postoperative complications, the incidence of shoulder pain, pethidine requirements, postoperative nausea and vomiting, and hospital stay were also recorded. Results: At 1, 2, and 4 hours after surgery, VAS pain scores were significantly lower in group A and B compared with group C (P < 0.05 for all). There was no significant difference among the three groups at 8, 12, and 24 hours after the procedure (P > 0.05 for all). A repeated-measures ANOVA analysis revealed that VAS pain scores over the first 24 hours after LC were significantly lower in group A and B compared with group C (P = 0.014 and P = 0.029 for between-group comparison, respectively). Furthermore, the percentage of patients requiring postoperative rescue analgesics was significantly higher in group C as compared with group A and group B (P = 0.018). Conclusion: Local anesthesia with bupivacaine and intravenous parecoxib are both effective at decreasing postoperative pain and pethidine requirements after LC. PMID:26550332

  13. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session: Feasibility and safety

    PubMed Central

    Zang, Jin-Feng; Zhang, Chi; Gao, Jun-Ye

    2013-01-01

    AIM: To explore the feasibility and safety of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy (LC) performed during the same session. METHODS: Between July 2010 and May 2013, 156 patients with gallstones and common bile duct (CBD) stones were enrolled in this retrospective study. According to the sequence of endoscopic procedures and LC, patients were classified into two groups: in group 1, patients underwent endoscopic stone extraction and LC during the same session, and in group 2, patients underwent LC at least 3 d after endoscopic stone extraction. Outcomes of the endoscopic procedures and LC were compared between the two groups, respectively. RESULTS: There were 91 patients in group 1 and 65 patients in group 2. The characteristics of the two groups were similar. The mean duration of the endoscopic procedures was 34.9 min in group 1 and 35.3 min in group 2. There were no significant differences in the success rate of the endoscopic procedures (97.8% for group 1 vs 98.5% for group 2), the total rate of endoscopic complications (4.40% for group 1 vs 4.62% for group 2) and CBD stone clearance rate (96.7% for group 1 vs 96.9% for group 2). Duration of LC was 53.6 min in group 1 and 52.8 min in group 2. There were no significant differences in the overall LC-related morbidity and postoperative hospital stay. CONCLUSION: Endoscopic stone extraction and LC performed during the same session was feasible and safe in patients with gallstones and concomitant CBD stones. PMID:24106411

  14. 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

  15. 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. PMID:26045928

  16. Influence of preemptive analgesia on pulmonary function and complications for laparoscopic cholecystectomy.

    PubMed

    ?en, Meral; Özol, Duygu; Bozer, Mikdat

    2009-12-01

    Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of preemptive analgesia on pulmonary functions and complications. Seventy patients scheduled for elective LC were included in our double-blind, randomized, placebo-controlled, prospective study. Randomly, 35 patients received 1 g etofenamate (group 1) and 35 patients 0.9% saline (group 2) intramuscularly 1 h before surgery. All patients underwent physical examination, chest radiography, lung function tests, and pulse oxygen saturation measurements 2 h before surgery and postoperatively on day 2. Atelectasis was graded as micro, focal, segmental, or lobar. With preemptive analgesia, the need for postoperative analgesia decreased significantly in group 1. In both groups mean spirometric values were reduced significantly after the operation, but the difference and proportional change according to preoperative recordings were found to be similar [29.5 vs. 31.3% reduction in forced vital capacity (FVC) and 32.9 vs. 33.5% reduction in forced expiratory volume in 1 s (FEV(1)) for groups 1 and 2, respectively]. There was an insignificant drop in oxygen saturation rates for both groups. The overall incidence of atelectasia was similar for group 1 and 2 (30.2 vs. 29.2%). Although the degree of atelectesia was found to be more severe in the placebo group, the difference was not statistically significant. We concluded that although preemptive analgesia decreased the need for postoperative analgesia, this had no effect on pulmonary functions and pulmonary complications. PMID:19117121

  17. 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

  18. Results of treatment of patients with gallstone disease and ductal calculi by single-stage laparoscopic cholecystectomy and bile duct exploration

    PubMed Central

    Bia?ecki, Jacek; Ko?omecki, Krzysztof

    2014-01-01

    Introduction Choledocholithiasis is the most common cause of obstructive jaundice. Common bile duct stones are observed in 10–14% of patients diagnosed with gall bladder stones. In the case of gall bladder and common bile duct stones the procedure involves not only performing cholecystectomy but also removing the stones from bile ducts. Aim To compare the results of the treatment of patients with gallstone disease and ductal calculi by one-stage laparoscopic cholecystectomy and common bile duct exploration with two other methods: one-stage open cholecystectomy and common bile duct exploration, and a two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Material and methods Between 2004 and 2011 three groups of 100 patients were treated for obstructive jaundice caused by choledocholithiasis. The first group of 42 patients underwent ERCP followed by laparoscopic cholecystectomy. The second group of 23 patients underwent open cholecystectomy and common bile duct exploration, whereas the third group of 35 patients underwent laparoscopic cholecystectomy with common bile duct exploration. The data were analysed prospectively. The methods were compared according to complete execution, bile duct clearance and complication rate. Complications were analysed according to Clavien’s Classification of Surgical Complications. The results were compared using the ANOVA statistical test and Student’s t-test in Statistica. Value of p was calculated statistically. A p-value less than 0.05 (p < 0.05) signified that groups differed statistically, whereas a p-value more than 0.05 (p > 0.05) suggested no statistically significant differences between the groups. Results The procedure could not be performed in 11.9% of patients in the first group and in 14.3% of patients in the third group. Residual stones were found in 13.5% of the patients in the first group, in 4.3% of the patients in the second group and in 6.7% of the patients in the third group. According to Clavien’s classification of complications grade II and III, we can assign the range in the first group at 21.6% for grade II and 0% for grade III, in the second group at 21.4% and 3.6% and in the third group at 6.7% and 3.3% respectively. Conclusions The use of all three methods of treatment gives similar results. One-stage laparoscopic cholecystectomy with common bile duct exploration is after all the least invasive, safer and more effective procedure. PMID:25097684

  19. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

    PubMed Central

    Mehta, Nandita; Gupta, Sunana; Sharma, Atul; Dar, Mohd Reidwan

    2015-01-01

    Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. PMID:26664202

  20. Comparison of palanosetron with ondansetron for postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anesthesia

    PubMed Central

    Bhalla, Jyoti; Baduni, Neha; Bansal, Pooja

    2015-01-01

    BACKGROUND: Post-operative nausea and vomiting (PONV) is a ‘big little’ problem especially after laparoscopic surgeries. Palanosetron is a new potent 5 hydroxy tryptamine 3 antagonists. In this randomized double blind clinical study we compared the effects of i.v. ondansetron and palanosetron administered at the end of surgery in preventing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anesthesia. MATERIALS AND METHODS: A total of 100 subjects between 18–60 years with Apfel score ?2, were randomly assigned into one of the two groups, containing 50 patients each. Group A received ondansetron 4 mg i.v. and Group B received palanosetron 0.07 5mg i.v. both as bolus before induction. The incidence of nausea, retching and vomiting, incidence of total PONV, requirement of rescue antiemetics and adverse effects were evaluated during the first 24 h following end of surgery. RESULTS: The incidence of nausea was significantly lower in patients who had received palanosetron (16%) as compared to ondansetron (24%). Need of rescue antiemetics was significantly higher in patients receiving ondansetron (32%) as compared to palanosetron (16%). The incidence of total PONV was also significantly lower in group receiving palanosetron (20%) as compared to ondansetron (50%). Among the side effects, headache was noted significantly higher with ondansetron (20%) as compared to palanosetron (6%). CONCLUSION: Palanosetron has got better anti-nausea effect, less need of rescue antiemetics, favourable side effect profile and a decrease in the incidence of total PONV as compared to ondansetron in 24 h post operative period in patients undergoing laproscopic cholecystectomy under general anesthesia. PMID:26195878

  1. Paravertebral block using bupivacaine with/without fentanyl on postoperative pain after laparoscopic cholecystectomy: A double-blind, randomized, control trial

    PubMed Central

    Hashemi, Seyed Jalal; Heydari, Seyed Morteza; Hashemi, Seyed Taghi

    2014-01-01

    Background: Postoperative pain is one of the most common complaints after elective laparoscopic cholecystectomy. The present study was aimed to evaluate the effect of paravertebral block using bupivacaine with/without fentanyl on postoperative pain and complications after laparoscopic cholecystectomy. Materials and Methods: This study was done on 90 patients scheduled to undergo elective laparoscopic cholecystectomy. Patients were assessed in two groups: The case group received bupivacaine and fentanyl, and the control group received bupivacaine and normal saline. Primary outcomes were severity of postoperative pain at rest and during coughing. Secondary outcomes were postoperative cumulative morphine consumption and the incidence of side-effects. Results: Pain score at rest before surgery, after recovery, hour-1 and hour-6 was not significantly different between the groups. But in hour-24 cases, the pain score during coughing was significantly higher than controls. Severity of pain at rest in time points was not different between groups. The frequencies (%) of moderate pain at mentioned times in case and control groups were 64, 31, 16, 9, 0 versus 67, 16, 7, 4, and 0, respectively. Pain score during coughing was lower in controls at hour-24 in comparison with cases, but in other time points was not significant. The control group significantly received more total dose of morphine in comparison with cases group. Nausea, vomiting and hypotension were similar in groups, but pruritus was significantly different between the groups. Conclusion: Adding fentanyl to bupivacaine in paravertebral block did not significantly improve the postoperative pain and complications after laparoscopic cholecystectomy. However, further studies are needed to be done. PMID:25250301

  2. Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease

    PubMed Central

    2012-01-01

    Background Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. The high prevalence of gallstones in the population and the consequent widespread use of surgical removal of the gallbladder require an assessment of the relationship between cholecystectomy and gastric mucosal disorders. Morphological evaluations performed on serial pre and post – surgical biopsies have provided new acquisitions about gastric damage induced by bile in the organ. Methods 62 elderly patients with gallstone related disease were recruited in a 30 months period. All patients were subjected to the most appropriate treatment (Laparoscopic cholecystectomy). The subjects had a pre-surgical evaluation with: • dyspeptic symptoms questionnaire, • gastric endoscopy with body, antrum, and fundus random biopsies, • histo-pathological analysis of samples and elaboration of bile reflux index (BRI). The same evaluation was repeated at a 6 months follow-up. Results In our series the duodeno-gastric reflux and the consensual biliary gastritis, assessed histologically with the BRI, was found in 58% of the patients after 6 months from cholecystectomy. The demonstrated bile reflux had no effect on H. pylori’s gastric colonization nor on the induction of gastric precancerous lesions. Conclusions Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period. PMID:23173777

  3. Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation

    PubMed Central

    Shukla, Usha; Prabhakar, T; Malhotra, Kiran; Srivastava, Dheeraj; Malhotra, Kriti

    2015-01-01

    Background and Aims: Intraperitoneal instillation of local anaesthetics has been shown to minimise post-operative pain after laparoscopic surgeries. We compared the antinociceptive effects of intraperitoneal dexmedetomidine or tramadol combined with bupivacaine to intraperitoneal bupivacaine alone in patients undergoing laparoscopic cholecystectomy. Methods: A total of 120 patients were included in this prospective, double-blind, randomised study. Patients were randomly divided into three equal sized (n = 40) study groups. Patients received intraperitoneal bupivacaine 50 ml 0.25% +5 ml normal saline (NS) in Group B, bupivacaine 50 ml 0.25% + tramadol 1 mg/kg (diluted in 5 ml NS) in Group BT and bupivacaine 50 ml 0.25% + dexmedetomidine 1 ?g/kg, (diluted in 5 ml NS) in Group BD before removal of trocar at the end of surgery. The quality of analgesia was assessed by visual analogue scale score (VAS). Time to the first request of analgesia, total dose of analgesic in the first 24 h and adverse effects were noted. Statistical analysis was performed using Microsoft (MS) Office Excel Software with the Student's t-test and Chi-square test (level of significance P = 0.05). Results: VAS at different time intervals, overall VAS in 24 h was significantly lower (1.80 ± 0.36, 3.01 ± 0.48, 4.5 ± 0.92), time to first request of analgesia (min) was longest (128 ± 20, 118 ± 22, 55 ± 18) and total analgesic consumption (mg) was lowest (45 ± 15, 85 ± 35, 175 ± 75) in Group BD than Group BT and Group B. Conclusion: Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine is superior to bupivacaine alone and may be better than bupivacaine with tramadol. PMID:25937650

  4. Visibility enhancement of common bile duct for laparoscopic cholecystectomy by vivid fiber-optic indication: a porcine experiment trial.

    PubMed

    Lin, Hsing-Ying; Huang, Chen-Han; Shy, Shannon; Chang, Yu-Chung; Chui, Hsiang-Chen; Yu, Tsung-Chih; Chang, Chih-Han

    2012-09-01

    Bile duct injury (BDI) is the most serious iatrogenic complication during laparoscopic cholecystectomy (LC) and occurs easily in inexperienced surgeons since the position of common bile duct (CBD) and its related ductal junctions are hard to precisely identify in the hepatic anatomy during surgery. BDI can be devastating, leading to chronic morbidity, high mortality, and prolonged hospitalization. In addition, it is the most frequent injury resulting in litigation and the most likely injury associated with a successful medical malpractice claim against surgeons. This study introduces a novel method for conveniently and rapidly indicating the anatomical location of CBD during LC by the direct fiber-optic illumination of 532-nm diode-pumped solid state laser through a microstructured plastic optical fiber to avoid the wrong identification of CBD and the injury from mistakenly cutting the CBD that can lead to permanent and even life threatening consequences. Six porcine were used for preliminary intra-CBD illumination experiments via laparotomy and direct duodenal incision to insert the invented CBD illumination laser catheter with nonharmful but satisfactory visual optical density. PMID:23024892

  5. "Hook and roll technique" using an articulating hook cautery to provide a critical view during single-incision laparoscopic cholecystectomy.

    PubMed

    Idani, Hitoshi; Nakano, Kanyu; Asami, Shinya; Kubota, Tetsushi; Komoto, Satoshi; Kurose, Yohei; Kubo, Shinichiro; Nojima, Hiroki; Hioki, Katsuyoshi; Kin, Hitoshi; Takakura, Norihisa

    2013-01-01

    We describe a new simple and easy technique called the "Hook and roll technique" (HRT) that uses an articulating hook cautery to provide a critical view during single incision laparoscopic cholecystectomy (SILC). A 2-cm incision is made at the umbilicus to insert three 5-mm trocars or a multichannel port. After dissection of the serosa of the dorsal and ventral sides of the gall bladder, including Calot's triangle, the angled tip of the hook cautery is inserted between the cystic artery and duct with its tip placed dorsally. The tip is then rotated in a clockwise manner to avoid bile duct injury, allowing the connective tissue between them to be hooked, coagulated and cut. This procedure is repeated several times, followed by dissection between the cystic artery and the liver bed to achieve a critical view. From December 2008 to May 2011, 121 patients underwent SILC using HRT in our hospital without any serious complications. This technique is suitable for SILC, as it is consists of simple procedures that can be performed safely and easily, even by left hand in a cross-over approach, and it allows complete dissection of Calot's triangle to achieve a critical view without using any dissector under dangerous in-line viewing. PMID:23970325

  6. The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal, oral and intramuscular, in early postoperative period in laparoscopic cholecystectomy operations

    PubMed Central

    Gulcin Ural, Sedef; Yener, Ozlem; Sahin, Hasan; Simsek, Tuncer; Aydinli, Bahar; Ozgok, Aysegul

    2014-01-01

    Objective: The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption. Methods: Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia (iv PCA). Ramsey Sedation Score (RSS), Modified Aldrete’s Score System(MASS) and Visual Analog Scale Pain Score (VAS) was used for postoperative evaluation. Postoperative opioid consumption was recorded. Results: Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported. Conclusion: In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment. PMID:24639839

  7. The safety and efficacy of percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy

    PubMed Central

    Na, Byung-Gon; Yoo, Young-Sun; Mun, Seong-Pyo; Kim, Seong-Hwan; Lee, Hyun-Young

    2015-01-01

    Purpose Laparoscopic cholecystectomy (LC) is the standard management for acute cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) may be an alternative interim strategy before surgery in elderly patients with comorbidities. This study was designed to evaluate the safety and efficacy of PTGBD for elderly patients (>60 years) with acute cholecystitis. Methods We reviewed consecutive patients diagnosed with acute cholecystitis between January 2009 and December 2013. Group I included patients who underwent PTGBD, and patients of group II did not undergo PTGBD before LC. Results All 116 patients (72.7 ± 7.1 years) were analyzed. The preoperative details of group I (n = 39) and group II (n = 77) were not significantly different. There was no significant difference in operative time (P = 0.057) and intraoperative estimated blood loss (P = 0.291). The rate of conversion to open operation of group I was significantly lower than that of group II (12.8% vs. 32.5%, P < 0.050). No significant difference of postoperative morbidity was found between the two groups (25.6% vs. 26.0%, P = 0.969). In addition, perioperative mortality was not significantly different. Preoperative hospital stay of group I was significantly longer than that of group II (10.3 ± 5.7 days vs. 4.4 ± 2.8 days, P < 0.050). However, two groups were not significantly different in total hospital stay (16.3 ± 9.0 days vs. 13.4 ± 6.5 days, P = 0.074). Conclusion PTGBD is a proper preoperative management before LC for elderly patients with acute cholecystitis. PMID:26236695

  8. Comparative evaluation of the effects of propofol and sevoflurane on cognitive function and memory in patients undergoing laparoscopic cholecystectomy: A randomised prospective study

    PubMed Central

    Goswami, Upasana; Babbar, Savita; Tiwari, Saurabh

    2015-01-01

    Background and Aims: General anaesthesia (GA) may cause post-operative impairment of cognition and memory. This is of importance where time to discharge after anaesthesia is short as after laparoscopic cholecystectomy. This study was conducted to compare the effects of propofol and sevoflurane on cognitive function in the post-operative period. Methods: After approval of the Ethical Committee, 80 female patients posted for laparoscopic cholecystectomy to be performed under GA were randomly divided into two groups. Propofol was used in Group P and sevoflurane in Group S. Data analysis was done with California verbal learning test (CVLT), digit span test (DST), Rivermead behavioural memory test (RBMT), mini mental state examination (MMSE) score, and semantic memory tests. Aldrete recovery scoring system and visual analogue scale for pain were assessed post-operatively. The level of statistical significance was set at P < 0.05. Results: There was no significant difference in demographic and haemodynamic data. Cognition and explicit memory were affected more in the propofol group in the immediate post-operative period. With majority of tests, such as semantic memory test, MMSE score, DST and RBMT, the difference was insignificant at 2 and 4 h post-operatively. But CVLT values were found to be statistically significant between groups even at 4 h. Conclusion: Propofol was associated with significant impact on cognitive functions in comparison to sevoflurane in the immediate post-operative period. Sevoflurane anaesthesia might be a better option in day care surgeries. PMID:25838586

  9. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy

    PubMed Central

    LI, YUHONG; HE, RUI; CHEN, SHUNFU; QU, YULIAN

    2015-01-01

    The use of intravenous dexmedetomidine during surgery has been shown to suppress inflammatory cytokines peri-operatively. It has also been demonstrated that dexmedetomidine may benefit cognitive function in elderly patients following surgery; however, it is not clear whether dexmedetomidine reduces postoperative cognitive dysfunction (POCD) via the suppression of inflammatory cytokines. The aim of the present study was to investigate the effects of dexmedetomidine on early POCD and inflammatory cytokines in elderly patients undergoing laparoscopic cholecystectomy (LC). The study comprised 120 elderly patients undergoing selective LC, who were randomly allocated to receive either dexmedetomidine intravenously (DEX group, n=60) or the same volume of normal saline (control group, n=60). Cognitive function was assessed by Mini-Mental State Examination (MMSE) scores 1 day prior to surgery, 6 h following surgery and postoperatively on days 1 and 2. Interleukin (IL)-1?, IL-6 and C-reactive protein (CRP) levels were also measured at these time-points. On the basis of whether the patients had POCD on the first day after surgery, patients were divided into a POCD group and a non-POCD group. Blood cytokine levels were compared between the patients with and without POCD. A total of 100 patients completed both pre- and postoperative MMSE tests. At 1 day following surgery, POCD occurred in 10/50 (20%) patients in the DEX group and in 21/50 (42%) patients in the control group (P=0.017). At 6 h following surgery, IL-1?, IL-6 and CRP levels showed significant increases (P<0.01) compared with the baseline levels in the two groups. Furthermore, in the control group, CRP levels showed a significant increase on day 1 (P<0.001) and day 2 (P=0.017) postoperatively. In the DEX group compared with the control group, IL-1?, IL-6 and CRP levels were markedly decreased at 6 h and 1 day after surgery (P<0.01). Concentrations of IL-1?, IL-6 and CRP were significantly higher in patients who developed POCD on day 1 following surgery than in the patients who did not develop POCD (P<0.05). The findings of the current study support the hypothesis that dexmedetomidine administration during anesthesia decreases the incidence of early POCD, most likely by the mechanism of reduction of the inflammatory response level. PMID:26640530

  10. [Prophylaxis of injuries of biliary ducts in laparoscopic cholecystectomy: clinical recommendations of Ukrainian association of specialists for miniinvasive, endoscopic and laser technologies].

    PubMed

    Nichita?lo, M E; Grubnik, V V; Skums, A V; Ogorodnik, P V; Tkachenko, A I; Malinovski', A V

    2013-06-01

    Wide introduction of laparoscopic cholecystectomy (LCHE) caused during last 20 years a significant enhancement of rate of the biliary ducts injuries (BDI). Taking into account the experience gained in performing of more than 40,000 operations of LCHE in a leading clinics, including such in a technically complex situations, as well as experience of more than 500 operations performance for BDI, clinical recommendations, based on principles of a substantiality medicine were elaborated. More than 100 sources of foreign and domestic literature were analyzed, summarizing the results of more than 150,000 operations of LCHE, special attention was drawn to the sources I (meta-analysis and prospective randomized investigations) and II (systematic reviews, thoroughly planned prospective comparative investigations) levels of substantiality. Every paragraph is accompanied by a certain level of a recommendation strength (RS, A-C). It is necessary to follow these recommendations strictly today. PMID:23987021

  11. 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

  12. Single Incision Laparoscopic Myomectomy

    PubMed Central

    Ramesh, B; Vidyashankar, Madhuri; Bharathi, BV

    2011-01-01

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

  13. Does routine intra-operative cholangiography reduce the risk of biliary injury during laparoscopic cholecystectomy? An evidence-based approach.

    PubMed

    Slim, K; Martin, G

    2013-11-01

    The role of routine intra-operative cholangiography (IOC) during cholecystectomy remains controversial. The purpose of this evidence-based review was to analyze the role of IOC in the prevention and detection of biliary ductal injury during cholecystectomy. The relative rarity of biliary complications means that the randomized trials and meta-analyses that include fewer than 12,000 patients cannot answer the question. Therefore, only six comparative studies were included in this review. The conclusions of these studies were conflicting, half showing a protective effect of routine IOC and the other half showing no effect. Nevertheless, the U.S. and Swedish studies that included the largest number of patients suggested that, while not a panacea, routine IOC could prevent major biliary injuries (one ductal injury per 500 cholecystectomies). Finally, in the context of risk management, we must also emphasize the educational value of teaching young (and not so young) surgeons how to correctly interpret the operative cholangiogram. PMID:23911201

  14. The evolving application of single-port robotic surgery in general surgery.

    PubMed

    Qadan, Motaz; Curet, Myriam J; Wren, Sherry M

    2014-01-01

    Advances in the field of minimally invasive surgery have grown since the original advent of conventional multiport laparoscopic surgery. The recent development of single incision laparoscopic surgery remains a relatively novel technique, and has had mixed reviews as to whether it has been associated with lower pain scores, shorter hospital stays, and higher satisfaction levels among patients undergoing procedures through cosmetically-appeasing single incisions. However, due to technical difficulties that arise from the clustering of laparoscopic instruments through a confined working space, such as loss of instrument triangulation, poor surgical exposure, and instrument clashing, uptake by surgeons without a specific interest and expertise in cutting-edge minimally invasive approaches has been limited. The parallel use of robotic surgery with single-port platforms, however, appears to counteract technical issues associated with single incision laparoscopic surgery through significant ergonomic improvements, including enhanced instrument triangulation, organ retraction, and camera localization within the surgical field. By combining the use of the robot with the single incision platform, the recognized challenges of single incision laparoscopic surgery are simplified, while maintaining potential advantages of the single-incision minimally invasive approach. This review provides a comprehensive report of the evolving application single-port robotic surgery in the field of general surgery today. PMID:24124130

  15. New minimally invasive approaches for cholecystectomy: Review of literature

    PubMed Central

    Gaillard, Martin; Tranchart, Hadrien; Lainas, Panagiotis; Dagher, Ibrahim

    2015-01-01

    Laparoscopic cholecystectomy is the most commonly performed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy (SILC), minilaparoscopic cholecystectomy (MLC) and natural orifice transluminal endoscopic surgery (NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment. PMID:26523212

  16. New minimally invasive approaches for cholecystectomy: Review of literature.

    PubMed

    Gaillard, Martin; Tranchart, Hadrien; Lainas, Panagiotis; Dagher, Ibrahim

    2015-10-27

    Laparoscopic cholecystectomy is the most commonly performed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy (SILC), minilaparoscopic cholecystectomy (MLC) and natural orifice transluminal endoscopic surgery (NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment. PMID:26523212

  17. Gallbladder removal - laparoscopic - discharge

    MedlinePLUS

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

  18. 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

  19. Is Infusion of Subhypnotic Propofol as Effective as Dexamethasone in Prevention of Postoperative Nausea and Vomiting Related to Laparoscopic Cholecystectomy? A Randomized Controlled Trial

    PubMed Central

    Celik, Mine; Dostbil, Aysenur; Aksoy, Mehmet; Ince, Ilker; Comez, Mehmet; Erdem, Ali Fuat

    2015-01-01

    Background. Postoperative nausea and vomiting (PONV) is one of common complications in patients undergoing laparoscopic cholecystectomy (LC). Aim of this study was to compare the efficacy of subhypnotic (1?mg/kg/h) infusion of propofol with dexamethasone on PONV in patients undergoing LC. Methods. A total of 120 patients were included in this randomized, double-blind, placebo-controlled study. Patients were randomly assigned to 3 groups; patients of group dexamethasone (group D) were administrated 8?mg dexamethasone before induction of anesthesia, patients of group propofol (group P) were infused to subhypnotic (1?mg/kg/h) propofol during operation and patients of group control (group C) were applied infusion of 10% intralipid. The incidence of PONV and needs for rescue analgesic and antiemetic were recorded in the first 24?h postoperatively. Results. In the 0–24?h, the incidence of PONV was significantly lower in the group D and group P compared with the group C (37.5%, 40%, and 72.5%, resp.). There was no significant difference in the incidence of PONV and use of antiemetics and analgesic between group D and group P. Conclusion. We concluded that infusion of propofol 1?mg/kg/h is as effective as dexamethasone for the prevention of PONV during the first 24 hours after anesthesia in patients undergoing LC. PMID:25695061

  20. Effects of dexmedetomidine and clonidine as propofol adjuvants on intra-operative hemodynamics and recovery profiles in patients undergoing laparoscopic cholecystectomy: A prospective randomized comparative study

    PubMed Central

    Anjum, Naz; Tabish, Hussain; Debdas, Saha; Bani, Hembrom P; Rajat, Choudhuri; Anjana Basu, Ghosh Dastidar

    2015-01-01

    Context: Alpha-2 (?2) adrenergic receptor agonists, clonidine and dexmedetomidine, are widely used as adjuvants during anesthesia for analgesic, sedative, sympatholytic, and cardiovascular stabilizing effects. Aims: We compared effects of clonidine and dexmedetomidine (as propofol adjuvants) on intra-operative hemodynamics, recovery time, and postoperative cognitive function impairment. Subjects and Methods: Forty-five American Society of Anesthesiologists I and II patients, scheduled for laparoscopic cholecystectomy were divided into three groups (n = 15). Group C patients received bolus of clonidine 3 ?g/kg followed by a continuous infusion; Group D patients received dexemedetomidine 1 ?g/kg and a continuous infusion; and Group P patients received a bolus of normal saline followed by an infusion. Intra-operative mean arterial pressure (MAP) and pulse rate (PR) were measured throughout the surgery. Bispectral index was maintained at 55 ± 5 by titrating propofol infusion rate. The time between the interruption of anesthesia and eye opening (recovery time) was measured. Cognitive function was assessed using short mental status questionnaire at 15, 30, 45, and 60 min postoperatively. Results: The sympathetic response to laryngoscopy and extubation on MAP and PR were significantly reduced with the use of clonidine and dexmedetomidine (P < 0.05). The recovery was delayed (P < 0.05) with both the drug combinations and it was more pronounced with dexmedetomidine (P < 0.05). Dexmedetomidine group showed cognitive impairment in a postoperative period lasting up to an hour. Conclusions: When co-administered with propofol, both clonidine, and dexmedetomidine attenuate sympathetic response to laryngoscopy and extubation but cause delay in the recovery from anesthesia. Dexmedetomidine causes impairment of postoperative cognitive functions. PMID:26229757

  1. Single-Site Robotic Cholecystectomy

    PubMed Central

    Jung, Myung Jae; Lee, So young; Lee, Sung Hwan; Kang, Chang Moo; Lee, Woo Jung

    2015-01-01

    Abstract This study aims to introduce an alternative technique for effective single-site robotic cholecystectomy (SSRC) using a reverse port. Proper exposure of Calot's triangle is critical for safe laparoscopic cholecystectomy. Current robotic surgical systems are useful for single-site cholecystectomy. However, in exposing Calot's triangle, the gallbladder is usually retracted in a medial and upward direction, resulting in a narrow triangle. This intraoperative view is a major obstacle to safe laparoscopic cholecystectomy. From October 2013 to October 2014, 55 consecutive patients underwent SSRC by a single surgeon at Yonsei University Severance Hospital. Initially, 5 patients underwent the original robotic single site cholecystectomy technique, and the remaining 50 patients underwent robotic single site cholecystectomy using our reverse port technique. There were no differences between the SSRC-O (original port) group and the SSRC-R (reverse port) group in terms of patient age (P?=?0.244), body mass index (P?=?0.503), and pathologic conditions of the gallbladder (P?=?0.841). Total operation time (132.6 vs 99.12 min; P?=?0.009), actual dissection time (51.6 vs 30.28 min; P?=?0.001), and console time (84.4 vs 50.46 min; P?=?0.001) were all significantly shorter in the SSRC-R group. Mean intraoperative blood loss was minimal in both groups (20 vs 12.4 mL, P?=?0.467), and bile spillage occurred in 2 patients of the SSRC-R group. There was one case of laparoscopic conversion in the SSRC-R group. The reverse port technique described in this study successfully widened Calot's triangle and improved the safety of the current robotic surgical system for single-site robotic cholecystectomy. PMID:26496344

  2. Pediatric single port transumbilical nephrectomy and nephroureterectomy

    PubMed Central

    Sulis?awski, Janusz; Wolnicki, Micha?

    2011-01-01

    Objective To present seven cases of single incision laparoscopic nephrectomy and nephroureterectomy in children as a recent videoscopic innovation. Patients and methods Seven children with nonfunctioning kidneys, three with multicystic dysplastic kidneys, two with end-stage renal nephropathy due to vesicoureteral reflux, and two with giant hydronephrosis were qualified to nephrectomy or nephroureterectomy. The surgery was performed transperitoneally using single incision access laparoscopy. The operative time was in the range of 50-90 min. Results There were no intraoperative or postoperative complications. The patients were discharged on the third postoperative day. The incision scars were hidden inside the umbilicus. Conclusions Nephrectomy or nephroureterectomy using a single transumbilical port in children is a feasible and efficacious technique. The advantages are shortened convalescence, excellent cosmetic results, and reduction of potential wounds complications. However, clear indication of single site laparoscopic procedures in children remains to be clarified. PMID:24578903

  3. Improving the Advantages of Single Port in Right Hemicolectomy: Analysis of the Results of Pure Transumbilical Approach with Intracorporeal Anastomosis

    PubMed Central

    Morales-Conde, Salvador; Barranco, Antonio; Socas, María; Méndez, Cristina; Alarcón, Isaias; Cañete, Jesús; Padillo, Francisco J.

    2012-01-01

    Background. Single-port laparoscopic surgery has recently emerged as a method to improve patient recovery and cosmetic benefits of laparoscopic surgery. The evolution of our technique has led us to move from a periumbilical incision to a transumbilical one, avoiding the use of drain and maintaining a pure single-port approach with intracorporeal anastomosis in order to maintain the incision as smaller as possible. Method. We report a prospective clinical analysis of our first 38 patients. Oncological surgical steps were followed as during the standard laparoscopic approach, performing the anastomosis intracorporeally in all cases. Results. Mean age of 68,39 years old and an average BMI of 27,88%. (range 19,81–41,5). Most lesions were adenocarcinoma (65,8%), while the remaining were polyps (31,5%) and one a mucocele of the appendix. We moved from a periumbilical incision, initial 14 cases, into a transumbilical one, (medium size of the incision 3,25?cm). Average surgical time was 117,42 minutes. Drains was only used in our first 3 cases. Mean hospital stay was 5,2 days, (86,5% stayed less than 5 days). Total morbidity was 13%. Histological exams of the specimens showed that the oncological criteria were preserved. Conclusions. Single-port right hemicolectomy with intracorporeal anastomosis is feasible and safe. The advantages of a total intracorporeal anastomosis include that there is no need to enlarge the umbilical incision and avoid traction of the pedicle of the mesenterium of the transverse colon during the extracorporeal anastomosis. A transumbilical incision offers better cosmetic results, and the use of drains can be avoided, which increase, patient's satisfaction. PMID:22567227

  4. Single-Port Thoracic Surgery: A New Direction

    PubMed Central

    Ng, Calvin S. H.

    2014-01-01

    Single-port video-assisted thoracic surgery (VATS) has slowly established itself as an alternate surgical approach for the treatment of an increasingly wide range of thoracic conditions. The potential benefits of fewer surgical incisions, better cosmesis, and less postoperative pain and paraesthesia have led to the technique’s popularity worldwide. The limited single small incision through which the surgeon has to operate poses challenges that are slowly being addressed by improvements in instrument design. Of note, instruments and video-camera systems that are narrower and angulated have made single-port VATS major lung resection easier to perform and learn. In the future, we may see the development of subcostal or embryonic natural orifice translumenal endoscopic surgery access, evolution in anaesthesia strategies, and cross-discipline imaging-assisted lesion localization for single-port VATS procedures. PMID:25207240

  5. 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

  6. A Technique for Simultaneous Cholecystectomy During Bariatric Surgery

    PubMed Central

    Lee, Ju-Hee; Han, Guru; Kim, Yong Jin; Jung, Min-Sung

    2015-01-01

    Background and Objectives: Cholecystectomy performed during bariatric surgery is technically demanding. Herein is described a technique we term the Glissonian approach along with an evaluation of its effectiveness and safety. Methods: From April 1, 2009, through February 28, 2014, laparoscopic cholecystectomy was performed during laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in 38 patients with proven cholecystopathy on diagnostic imaging. Perioperative outcomes were compared between the patients operated on with the Glissonian approach and those who underwent conventional laparoscopic cholecystectomy. Results: The Glissonian approach was adopted in 13 patients—11 during LRYGB and 2 during LSG—and the conventional operation was performed on 16 patients during LRYGB and 9 during LSG. Mean body mass indexes were 40.1 kg/m2 in the Glissonian-approach group and 37.6 kg/m2 in the conventional group. Laparoscopic cholecystectomy by the Glissonian approach saved a mean operative time of 7 minutes compared with the operative time of the conventional operation. No surgical complications related to cholecystectomy were noted in either group. Conclusion: This simple technique can be performed safely in morbidly obese patients, with low resultant morbidity and acceptable operation times. PMID:26648677

  7. Laparoendoscopic Single-Site Surgery for Benign Urologic Disease with a Homemade Single Port Device: Design and Tips for Beginners

    PubMed Central

    Lee, Joo Yong; Kang, Dong Hyuk; Chung, Jae Hoon; Jo, Jung Ki

    2012-01-01

    Purpose A single surgeon skilled in conventional laparoscopic surgery used laparoendoscopic single-site surgery (LESS) to treat benign urological diseases. This study reports our surgical results and introduces a simple technique with tips based on our experience. Materials and Methods LESS surgery was performed on 116 patients by use of a homemade single-port device composed of an Alexis wound retractor and a powder-free surgical glove. Cases were 44 varicocelectomies (including 8 bilateral cases), 38 renal cyst marsupializations (including 3 bilateral cases), 26 ureterolithotomies (with 1 concomitant ureterolithotomy and contralateral renal cyst marsupialization), 4 prostatic enucleations, and 4 bladder rupture repairs. The mean patient age was 44.43±16.46 years (range, 11 to 76 years), and the male-to-female ratio was 87:29. Results In one ureterolithotomy case, LESS was converted to conventional laparoscopic surgery. The mean operative time was 87.03±45.03 minutes, the estimated blood loss was 61.90 ml (range, 0 to 2,000 ml), and the mean hospital stay was 3.03±2.12 days. Two patients underwent single-port transvesical enucleation of the prostate (STEP) requiring patient-controlled anesthesia. No patients developed major complications, and all patients were satisfied, with 75.86% expressing a high degree of satisfaction. Conclusions We report successful treatment outcomes for LESS in 116 cases of benign urological disease. Our findings suggest that LESS can replace conventional laparoscopy. PMID:22468211

  8. Laparoendoscopic single-site cholecystectomy in a pregnant patient

    PubMed Central

    Behera, Ramya Ranjan; Salgaonkar, Hrishikesh P; Bhandarkar, Deepraj S; Gupta, Tarun; Desai, Shyam

    2013-01-01

    Feasibility and safety of laparoscopic cholecystectomy during pregnancy for patients with symptomatic or complicated gallstone disease is well established. Laparoendoscopic single-site cholecystectomy (LESS-chole) is a new modality in which the entire surgery is undertaken via a transumbilical incision. We describe a 33-year-old patient who underwent a LESS-chole in the 20th week of pregnancy for gallstone disease complicated by episodes of obstructive jaundice and acute pancreatitis. This is the first reported case of LESS-chole performed using conventional laparoscopic instruments. The technical aspects as well as the various perioperative measures utilized to undertake this procedure safely are outlined. PMID:24250067

  9. Recent advances in laparoscopic surgery.

    PubMed

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

    2013-02-01

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

  10. Residual gallbladder stones after cholecystectomy: A literature review

    PubMed Central

    Chowbey, Pradeep; Sharma, Anil; Goswami, Amit; Afaque, Yusuf; Najma, Khoobsurat; Baijal, Manish; Soni, Vandana; Khullar, Rajesh

    2015-01-01

    BACKGROUND: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. MATERIALS AND METHODS: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. RESULTS: Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. CONCLUSION: Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones. PMID:26622110

  11. Single-incision multiport laparoscopy versus multichannel-tipped single port laparoscopy in gynecologic surgery: outcomes and benefits

    PubMed Central

    Zhao, Mingzhi; Zhao, Jing; Hua, Keqin; Zhu, Zhiling; Hu, Changdong

    2015-01-01

    Objective: To estimate the feasibility and safety of single-incision multiport laparoscopy (SIMPL) used in patients who underwent laparoendoscopic single-site surgery (LESS) for gynecologic disease, and the cosmetic outcome and economic benefit compared with multichannel-tipped single port laparoscopy (MSPL). Intervention: We underwent LESS via a single 2.5- to 3.0-cm umbilical incision with the Single-Incision Multiport Laparoscopic Surgery Trocar available on the market, briefly named MSPL. Since January 2014, we improved the procedure and named SIMPL. In SIMPL group, two traditional laparoscopic trocar (diameter=5 mm) and one mini-laparoscopic trocar (diameter =3 mm) were inserted into the peritoneum separately through a single 1.5- to 1.8-cm umbilical transcutaneous incision. Subject demographics and clinical variables were collected and perioperative outcomes analyzed. In addition, the size of umbilicus was measured in all patients prior to the operation and the levels of cosmetic satisfaction were evaluated at 4 weeks after surgery. Measurements and main results: From January 2014 to December 2014, there were 32 patients who underwent SIMPL for ovarian cystectomy. Hospital cost was significantly lower in SIMPL group compared with MSPL group (RMB 10207.0 vs 17973.7 yuan), P<0.001. Compared with MSPL group, the SIMPL group reported significantly higher cosmetic satisfaction at 4 weeks afer surgery (P<0.1). Besides, the SIMPL procedures performed in benign gynecologic surgery were myomectomy (n=8), salpingpoophorectomy (n=2), salpingectomy (n=5), adhesiolysis and fimbrioplasty (n=32), ovarian drilling (n=3), salpingotomy for ectopic pregnancy (n=3). All surgeries were completed successfully without conversion to the traditional laparoscopic approach. Two postoperative complications occurred were delay healing of umbilicus incision after myomectomy. The cosmetic satisfactory rate was 100%. Conclusion: According to our experience, SIMPL is safe and efficient for simple gynecologic operation, with lower cost and better cosmetic results than MSPL. Beyond cosmetic and economic results, further randomized studies are needed to identify a possible benefit.

  12. Single-Site Robotic Cholecystectomy: Reverse-Port Technique.

    PubMed

    Jung, Myung Jae; Lee, So Young; Lee, Sung Hwan; Kang, Chang Moo; Lee, Woo Jung

    2015-10-01

    This study aims to introduce an alternative technique for effective single-site robotic cholecystectomy (SSRC) using a reverse port.Proper exposure of Calot's triangle is critical for safe laparoscopic cholecystectomy. Current robotic surgical systems are useful for single-site cholecystectomy. However, in exposing Calot's triangle, the gallbladder is usually retracted in a medial and upward direction, resulting in a narrow triangle. This intraoperative view is a major obstacle to safe laparoscopic cholecystectomy.From October 2013 to October 2014, 55 consecutive patients underwent SSRC by a single surgeon at Yonsei University Severance Hospital. Initially, 5 patients underwent the original robotic single site cholecystectomy technique, and the remaining 50 patients underwent robotic single site cholecystectomy using our reverse port technique.There were no differences between the SSRC-O (original port) group and the SSRC-R (reverse port) group in terms of patient age (P?=?0.244), body mass index (P?=?0.503), and pathologic conditions of the gallbladder (P?=?0.841). Total operation time (132.6 vs 99.12 min; P?=?0.009), actual dissection time (51.6 vs 30.28 min; P?=?0.001), and console time (84.4 vs 50.46 min; P?=?0.001) were all significantly shorter in the SSRC-R group. Mean intraoperative blood loss was minimal in both groups (20 vs 12.4 mL, P?=?0.467), and bile spillage occurred in 2 patients of the SSRC-R group. There was one case of laparoscopic conversion in the SSRC-R group.The reverse port technique described in this study successfully widened Calot's triangle and improved the safety of the current robotic surgical system for single-site robotic cholecystectomy. PMID:26496344

  13. Laparoscopic Surgery

    MedlinePLUS

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

  14. Training for single port video assisted thoracoscopic surgery lung resections

    PubMed Central

    McElnay, Philip J.

    2015-01-01

    With many surgical training programmes providing less time for training it can be challenging for trainees to acquire the necessary surgical skills to perform complex video assisted thoracoscopic surgery (VATS) lung resections. Indeed as the utilization of single port operations increases the need to approach the operating theatre with already-existing excellent hand-eye coordination skills increases. We suggest that there are a number of ways that trainees can begin to develop these necessary skills. Firstly, using computer games that involve changing horizons and orientations. Secondly, utilizing box-trainers to practice using the thoracoscopic instruments. Thirdly, learning how essential tools such as the stapler work. Trainees will then be able to progress to meaningfully assisting in theatre and indeed learning how to perform the operation themselves. At this stage is useful to observe expert surgeons whilst they operate—to watch both their technical and non-technical skills. Ultimately, surgery is a learned skill and requires implementation of these techniques over a sustained period of time. PMID:26697479

  15. Portable single port 23-gauge vitrectomy in postoperative endophthalmitis

    PubMed Central

    Höhn, Fabian; Kretz, Florian TA; Sheth, Saumil; Natarajan, S; Singh, Pankaj; Koch, Frank H; Koss, Michael J

    2015-01-01

    Aim To evaluate the safety and effectiveness of the Intrector® for treating postoperative endophthalmitis. Materials and methods In a retrospective multicenter study, patients who received a single port 23-gauge core pars plana vitrectomy and isovolumetric injection of vancomycin, ceftazidime, and dexamethasone/amphotericin B using the Intrector® for postoperative endophthalmitis of intermediate severity (grade II or III vitreous inflammation and best-corrected visual acuity between hand movements and 0.3 logMAR [logarithm of the minimum angle of resolution]) were evaluated. Improvement in visual acuity, resolution of intraocular inflammation, the need for additional surgical procedures, and the development of complications were evaluated at a 1-month follow-up examination. Results Fifteen patients (mean age 55.6±7.2 years) underwent treatment with the Intrector®. The mean vitreous volume aspirated was 0.78±0.22 mL. The vitreous samples indicated positive microorganism culture results in six of the 15 cases, but the samples were positive when analyzed by real-time polymerase chain reaction in all cases (15/15). The mean best-corrected visual acuity improved significantly (P=0.01) from 0.88±0.29 (logMAR) to 0.32±0.28. Each patient demonstrated at least three lines of visual improvement. No additional medical or surgical interventions were required, and the complete resolution of intraocular inflammation was noted in all patients at the 1-month follow-up examination. No procedure-related complications were observed. Conclusion The Intrector® may be a safe and effective treatment option for infectious postoperative endophthalmitis. Larger studies comparing the outcomes of the Intrector® to the traditional treatments for postoperative endophthalmitis need to be conducted before its role in the treatment of postoperative endophthalmitis can be properly defined. PMID:26316685

  16. [Celioscopic cholecystectomy. 2 cases of infectious complications].

    PubMed

    Caron, F; Fayeulle, V; Peillon, C; Roullée, N; Koning, E; Bénozio, M; Testart, J; Humbert, G

    1994-06-11

    Despite the low morbidity and mortality of laparoscopic cholecystectomy, trauma and infection have been reported. Such complications can produce a misleading clinical picture, as in two cases we observed. Case 1. A symptomatic 56-year-old female patient underwent laparoscopic cholecystectomy. During the operation, the gall bladder ruptured and the contents had to be aspirated from the abdominal cavity. The patient complained of hepatalgia 2 weeks after the operation, then was not seen again for more than 1 year when fever and hepatalgia did not respond to symptomatic treatment. An inter-hepato-renal collection (6 cm in diameter) was punctured under echography. Aspirate culture yielded Pseudomonas aeruginosa. Adapted antibiotic therapy was unsuccessful and surgery was required to empty the abscess then remove a fibrous conjunctive tissue formation. Case 2. A 55-year-old female patient with a history of complete remission after mammectomy for breast cancer underwent laparoscopic cholecystectomy in 1991. Two days after the operation, fever (39 degrees C) was accompanied by abdominal defence. Biliary peritonitis due to imperfect suture of the bile duct was repaired followed by peritoneal lavage-drainage. Per-operative blood samples revealed type 6 Pseudomonas aeruginosa. Despite adapted parenteral antibiotics, fever persisted at 39 degrees C and intense jaundice was observed. A second laparoscopy 14 days later showed inflammatory narrowing of the main bile duct which was drained into a small bowel loop. Eight days later computed tomography revealed multiple abscess in the liver. Transparietal cholangiography was performed and showed that the contrast medium entered the abscesses via the biliary canals. The state of sepsis persisted, jaundice worsened and hepatic encephalopathy developed with obnubilation and flapping tremor. After 1 month of general antibiotherapy, no improvement was seen on computed tomography images and needle biopsy of an abscess led to the identification of resistant type 6 P. aeruginosa. Antibiotics were adapted and administered iv with no clinical improvement. Selective catheterism of the hepatic artery via the femoral access was performed to allow intra-hepatic antibiotic delivery. Three weeks later clinical situation remained unchanged when acute respiratory distress highly suggestive of pulmonary embolism led to death. Autopsy was not performed. In both of these rare cases of infectious complications due to P. aeruginosa after laparoscopic cholecystectomy, the source of contamination remained unknown. Nosocomial infection was suspected. PMID:7971806

  17. Single-Port Video-Assisted Thoracic Surgery for Secondary Spontaneous Pneumothorax: Preliminary Results

    PubMed Central

    Kim, Min-Seok; Yang, Hee Chul; Bae, Mi-Kyung; Cho, Sukki; Kim, Kwhanmien; Jheon, Sanghoon

    2015-01-01

    Background The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). Methods Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.1±19.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. Results Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). Conclusion Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax. PMID:26665104

  18. Laparoscopic use of laser and monopolar electrocautery

    NASA Astrophysics Data System (ADS)

    Hunter, John G.

    1991-07-01

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

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

    PubMed Central

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

    2015-01-01

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

  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. 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. PMID:26157697

  2. 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

  3. Single-port thoracoscopic right main bronchial tumor sleeve resection and secondary carinal reconstruction

    PubMed Central

    Liang, Mingqiang; Zheng, Wei; Chen, Hao; Wu, Weidong; Zhang, Shuliang

    2015-01-01

    We describe herein a case of single-port thoracoscopic right main bronchial tumor sleeve resection and secondary carinal reconstruction. A 66-year-old male patient had a right main bronchial tumor longer than 12 months, who had been received endobronchial cryosurgery twice before. However, the tumor relapsed quickly. Then the patient transferred to our department. He was underwent a single-port complete thoracoscopic right main bronchial tumor sleeve resection and secondary carinal reconstruction. He recovered smoothly, without any perioperative complications. On the 5th postoperative day (POD), he was discharged in good condition. PMID:26623110

  4. Single-port video-assisted thoracoscopic surgery for lung cancer

    PubMed Central

    Liu, Chao-Yu; Lin, Chen-Sung; Shih, Chih-Hsun

    2014-01-01

    In 2004, novel results using pulmonary wedge resection executed through single-port video-assisted thoracoscopic surgery (VATS) was first described. Since that time, single-port VATS has been advocated for the treatment of a spectrum of thoracic diseases, especially lung cancer. Lung cancer remains one of the top three cancer-related deaths in Taiwan, and surgical resection remains the “gold standard” for early-stage lung cancer. Anatomical resections (including pneumonectomy, lobectomy, and segmentectomy) remain the primary types of lung cancer surgery, regardless of whether conventional open thoracotomy, or 4/3/2-ports VATS are used. In the past three years, several pioneers have reported their early experiences with single-port VATS lobectomy, segmentectomy, and pneumonectomy for lung cancer. Our goal was to appraise their findings and review the role of single-port VATS in the treatment of lung cancer. In addition, the current concept of mini-invasive surgery involves not only smaller resections (requiring only a few incisions), but also sub-lobar resection as segmentectomy. Therefore, our review will also address these issues. PMID:24455171

  5. Single-port video-assisted thoracoscopic right upper lobectomy using a flexible videoscope.

    PubMed

    Yang, Yunhai; Bao, Feichao; He, Zhehao; Hu, Jian

    2014-09-01

    Single-port video-assisted thoracoscopic surgery (VATS) has recently been proposed as an innovative minimally invasive alternative to the standard three-port VATS for lobectomies, most of which are performed using a conventional rigid thoracoscope. Here, we report a single-port VATS approach for right upper lobectomy and systematic lymph node dissection using a flexible endoscope. A 61-year-old male smoker presented with a pulmonary nodule. A single-port VATS procedure was performed through a 4-cm intercostal incision using a flexible laparo-thoraco videoscope. Right upper lobectomy and systematic lymph node dissection were performed. The total operating time was 106 in. The procedure was successful and the recovery uneventful. The patient's chest tube was removed on the third day, and he was discharged home on the fourth. The use of a flexible videoscope facilitated the single-port VATS procedure by avoiding interference between the videoscope and other operating instruments and providing ample space for the surgeon. PMID:24659314

  6. [Cholecystectomy and duodenogastric reflux].

    PubMed

    Lorusso, D; Pezzolla, F; Messa, C; Cavallini, A; Berloco, P; Misciagna, G; Guerra, V

    1992-12-01

    With the aim of evaluating whether cholecystectomy causes an increase in duodenogastric reflux (DGR) 34 patient (12 males and 22 females, mean age 50 years) were examined before and 6 months after cholecystectomy. DGR was evaluated by assaying total and individual biliary acids in gastric juice and was expressed as fasting bile reflux (FBR) in mumol/h. The histology of gastric mucosa in endoscopic biopsies taken from the antrum and body was also analysed. FBR of total biliary acids rose from 2.4 mumol/h before surgery to 41.33 mumol/h after cholecystectomy (p = 0.000). A significant increase was observed for all the individual biliary acids. Histological tests of gastric mucosa revealed an increased percentage of chronic atrophic gastritis of the antrum following cholecystectomy. Histological conditions in the body were unaltered. The results of this study show that there is a significant increase in DGR (months after cholecystectomy together with increased histological damage to the mucosa of the antrum. Further studies are necessary in order to evaluate whether the two phenomena are related. PMID:1289748

  7. Clinical privileges for laparoscopic surgery.

    PubMed

    Albrink, M H; Rosemurgy, A S

    1993-06-01

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

  8. Risk Assessment in Cholelithiasis: Is Cholecystectomy Always to be Preferred?

    PubMed Central

    Mertens, Marlies C.; Roukema, Jan A.; Scholtes, Vincent P. W.

    2010-01-01

    Background As many patients with gallstone disease do not benefit from cholecystectomy, preoperative recognition of such high-risk patients is important. The aim of the study is to identify predictors of persisting symptoms at 6 months after cholecystectomy for patients with different preoperative symptomatology. Method Participants in this prospective study were consecutive patients (n?=?172), age 18–65 years, with symptomatic cholelithiasis, undergoing a laparoscopic cholecystectomy. Predictors were identified using uni- and multivariate regression analyses. Results At 6 months postcholecystectomy, patients with only preoperative biliary symptoms were most often free of symptoms (62.5%). Patients with only dyspeptic symptoms most often reported persistence of preexisting symptoms (63.2%). Preoperative non-specific symptoms predicted the report of postoperative biliary and/or dyspeptic symptoms (OR?=?4.5–6.1). Persistence of preexisting pattern of symptoms was predicted by the use of psychotropic medication (OR?=?5.3) and dyspeptic symptoms (OR?=?4.5). Postoperative biliary symptoms were predicted by High Trait Anxiety (HTA) (OR?=?10.6). Conclusion Surgeons should take account of individual risks of patients in the management of cholelithiasis. Instead of cholecystectomy, expectative management should be the first choice in patients with non-specific symptoms, with dyspeptic symptoms only, with HTA and in patients using psychotropic medication. PMID:20502977

  9. Minireview on laparoscopic hepatobiliary and pancreatic surgery

    PubMed Central

    Tan-Tam, Clara; Chung, Stephen W

    2014-01-01

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

  10. Single-port video-assisted thoracoscopic surgery lung resection: experiences in Fujian Medical University Union Hospital

    PubMed Central

    Zhu, Yong; Xu, Guobing; Zheng, Bin; Liang, Mingqiang; Wu, Weidong; Zheng, Wei

    2015-01-01

    Video-assisted thoracoscopic surgery (VATS) is currently a better choice than thoracotomy for lung resection, and then single-port VATS has been increasingly applied in clinical settings with the improvements in both endoscopic instruments and surgical skills. Our center began to perform single-port VATS lobectomy in May 2014 and had performed all sort of lung resection in 168 patients till December 2014, including wedge resection, routine lobectomy, sleeve lobectomy, segmentectomy and pneumonectomy. All these procedures were successfully performed without any severe complication. We believe the single-port VATS lung resection is a safe and feasible procedure after surgery practice. PMID:26380741

  11. Single-Port Surgery: Laboratory Experience with the daVinci Single-Site Platform

    PubMed Central

    Haber, Georges-Pascal; Kaouk, Jihad; Kroh, Matthew; Chalikonda, Sricharan; Falcone, Tommaso

    2011-01-01

    Background and Objectives: The purpose of this study was to evaluate the feasibility and validity of a dedicated da Vinci single-port platform in the porcine model in the performance of gynecologic surgery. Methods: This pilot study was conducted in 4 female pigs. All pigs had a general anesthetic and were placed in the supine and flank position. A 2-cm umbilical incision was made, through which a robotic single-port device was placed and pneumoperitoneum obtained. A data set was collected for each procedure and included port placement time, docking time, operative time, blood loss, and complications. Operative times were compared between cases and procedures by use of the Student t test. Results: A total of 28 surgical procedures (8 oophorectomies, 4 hysterectomies, 8 pelvic lymph node dissections, 4 aorto-caval nodal dissections, 2 bladder repairs, 1 uterine horn anastomosis, and 1 radical cystectomy) were performed. There was no statistically significant difference in operating times for symmetrical procedures among animals (P=0.3215). Conclusions: This animal study demonstrates that single-port robotic surgery using a dedicated single-site platform allows performing technically challenging procedures within acceptable operative times and without complications or insertion of additional trocars. PMID:21902962

  12. The economic considerations in laparoscopic surgery.

    PubMed

    MacFadyen, B V; Lenz, S

    1994-07-01

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

  13. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience

    PubMed Central

    Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.

    2009-01-01

    Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our experience, however, demonstrates that robotic cholecystectomy is one means by which general surgeons may gain confidence in performing advanced robotic procedures. PMID:19865571

  14. Two-Trocar Cholecystectomy by Strategic Laparoscopy for Improved Cosmesis (SLIC)

    PubMed Central

    Mirhaidari, Shayda; Pozsgay, Mark; Standerwick, Andrew; Bohon, Ashley; Zografakis, John G.

    2013-01-01

    Background and Objectives: Until the advent of single-incision laparoscopic surgery, few advances were aimed at improving cosmesis with laparoscopic cholecystectomy. Criticisms of the single-incision laparoscopic surgery technique include a larger incision and increased incidence of wound-related complications. We present our initial experience with a novel technique aimed at performing strategic laparoscopy for improved cosmesis (SLIC) for cholecystectomy. Methods: Twenty-five patients with biliary symptoms were selected for SLIC cholecystectomy. Access to the abdomen was obtained with a 5-mm optical trocar in the left upper quadrant and a 5-mm trocar in the umbilicus. Retraction was performed by a transabdominal suture in the dome of the gallbladder and a needlescopic grasper. Age, American Society of Anesthesiologists score, body mass index, operative time, length of stay, pathology results, and short-term complications at follow-up were prospectively recorded. Results: The 25 female patients had a mean age of 34.3 years and mean body mass index of 24 kg/m2. American Society of Anesthesiologists scores ranged from 1 to 3. The mean operative time was 51.3 minutes. Pathology revealed chronic cholecystitis in all patients. All procedures were performed on an outpatient basis. The only complication was one ultrasonography-documented deep vein thrombosis. All 25 planned SLIC cholecystectomies were successfully completed. Conclusions: SLIC cholecystectomy is feasible and safe. This technique decreases the cumulative incision length, as well as the number of incisions, leading to very desirable cosmetic results in patients with a favorable body habitus and surgical history. PMID:24398200

  15. Laparoscopic herniorrhaphy.

    PubMed

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

    1992-10-01

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

  16. Laparoscopic management of a cystic artery pseudoaneurysm in a patient with calculus cholecystitis

    PubMed Central

    Loizides, Sofronis; Ali, Asad; Newton, Richard; Singh, Krishna Kumar

    2015-01-01

    INTRODUCTION Pseudoaneurysm of the cystic artery is very rare. In the majority of cases it has been reported as a post-operative complication of laparoscopic cholecystectomy, however it has also been associated with the presence of acute cholecystitis or pancreatitis. When these pseudoaneurysms rupture they can lead to intraperitoneal bleeding, haemobilia and upper gastrointestinal haemorrhage. Radiological as well as open surgical approaches have been described for control of this rare pathology. PRESENTATION OF CASE We report the laparoscopic surgical management of an incidental, unruptured cystic artery pseudoaneurysm in a patient presenting with acute cholecystitis. DISCUSSION Cystic artery pseudoaneurysm is a rare entity and as such there is no consensus on the clinical management of this condition. A variety of treatment strategies have been reported in the literature including radiological selective embolisation and coiling, open cholecystectomy with ligation of the aneurysm, or a two-step approach involving radiological management of the pseudoaneurysm followed by an elective cholecystectomy. CONCLUSION In this report we have demonstrated that laparoscopic management of a cystic artery pseudoaneurysm with simultaneous laparoscopic cholecystectomy is feasible and safe. This avoids multiple invasive procedures and decreases morbidity associated with open surgery. PMID:26291047

  17. 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.

    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.

  18. Minimally invasive colon resection (laparoscopic colectomy).

    PubMed

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

    1991-09-01

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

  19. Gallbladder Removal: Laparoscopic Method

    MedlinePLUS

    ... surgery to remove the gallbladder is called a cholecystectomy (say "co-lee-sist-eck-toe-mee"). During ... below your waist. This is called an open cholecystectomy. A newer way to remove the gallbladder is ...

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Périssat, J

    1999-08-01

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

  2. Acute cholecystitis – early laparoskopic surgery versus antibiotic therapy and delayed elective cholecystectomy: ACDC-study

    PubMed Central

    Weigand, Kilian; Köninger, Jörg; Encke, Jens; Büchler, Markus W; Stremmel, Wolfgang; Gutt, Carsten N

    2007-01-01

    Background Acute cholecystitis occurs frequently in the elderly and in patients with gall stones. Most cases of severe or recurrent cholecystitis eventually require surgery, usually laparoscopic cholecystectomy in the Western World. It is unclear whether an initial, conservative approach with antibiotic and symptomatic therapy followed by delayed elective surgery would result in better morbidity and outcome than immediate surgery. At present, treatment is generally determined by whether the patient first sees a surgeon or a gastroenterologist. We wish to investigate whether both approaches are equivalent. The primary endpoint is the morbidity until day 75 after inclusion into the study. Design A multicenter, prospective, randomized non-blinded study to compare treatment outcome, complications and 75-day morbidity in patients with acute cholecystitis randomized to laparoscopic cholecystectomy within 24 hours of symptom onset or antibiotic treatment with moxifloxacin and subsequent elective cholecystectomy. For consistency in both arms moxifloxacin, a fluorquinolone with broad spectrum of activity and high bile concentration is used as antibiotic. Duration: October 2006 – November 2008 Organisation/Responsibility The trial was planned and is being conducted and analysed by the Departments of Gastroenterology and General Surgery at the University Hospital of Heidelberg according to the ethical, regulatory and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989) and the Good Clinical Practice guideline (GCP). Trial Registration ClinicalTrials.gov NCT00447304 PMID:17916243

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

    PubMed

    Senagore, Anthony J

    2015-09-01

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

  4. Laparoscopic surgery: A qualified systematic review

    PubMed Central

    Buia, Alexander; Stockhausen, Florian; Hanisch, Ernst

    2015-01-01

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

  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. 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.

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

    PubMed Central

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

    2012-01-01

    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

  8. Minilaparoscopic cholecystectomy – the new non-visible scars technique. Preliminary report of first series

    PubMed Central

    Kobry?, Konrad; Nazarewski, ?ukasz; Dec, Marta; Ziarkiewicz-Wróblewska, Bogna; Krawczyk, Marek

    2015-01-01

    Introduction Surgery without scars is the dream of many patients and surgeons as well. It includes many new laparoscopic techniques (LESS, SILS, hybrid NOTES), but data concerning common bile duct (CBD) lesions are unavailable. Aim To establish the new technique of minilaparoscopic cholecystectomy (MCh): non-visible scar intervention without increasing the risk of CBD lesions. Material and methods Forty consecutive patients with symptomatic gallbladder lithiasis were qualified for elective laparoscopic cholecystectomy (LCh) using one 10/11 mm umbilical port, one 5 mm right suprapubic port and two minilaparoscopic, disposable, no-port graspers. There were 26 women and 14 men, with the mean age 56 (17–72) years and with the average body mass index 28 (18–33) kg/m2. CO2 Veress 15 mm Hg pneumoperitoneum was performed after transumbilical incision, and the first 10/11 mm port was inserted at the beginning for the 5 mm laparoscope and finally for typical instruments. Next under camera control, a 5 mm trocar was inserted in the right ‘bikini line’. To this port the laparoscope was relocated from the umbilicus, and under its control two minilaparoscopic, disposable, non-port graspers were introduced after small, 2 mm skin incisions in the right anterior axillary line and in the right mesogastrium to catch the gallbladder. Next through the umbilical port, using typical instruments, the cystic duct and artery were dissected, clipped and cut. The gallbladder was removed through the umbilical port whole. Results There was no conversion to open cholecystectomy. In 5 cases drainage of the gallbladder lodge was necessary through a 5 mm port in the right bikini line. The time of the intervention ranged from 90 min during the introduction of the new method to 50 min for the last procedures. No postoperative complications were observed, and all patients were discharged at the same time as after conventional LCh. Conclusions Two-port laparoscopic cholecystectomy performed with two minilaparoscopic no-port graspers does not increase the risk of CBD lesions. It provides an excellent cosmetic effect and is very convenient for the surgeon like typical LCh. PMID:26240613

  9. 2002 IEEE Systems and Information Design SymposiumUniversity of Virginia VIDEO-BASED TRAINING FOR LAPAROSCOPIC SURGERY

    E-print Network

    Virginia, University of

    of Surgery, University of Virginia Health System KEYWORDS: Cholecystectomy, computer- based training-Based Training For Laparoscopic Surgery 104 surmount using traditional training techniques. The adjustment2002 IEEE Systems and Information Design Symposium·University of Virginia 103 VIDEO-BASED TRAINING

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

    PubMed

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

    2015-12-01

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

  11. Isolated right posterior bile duct injury following cholecystectomy: report of two cases.

    PubMed

    Wojcicki, Maciej; Patkowski, Waldemar; Chmurowicz, Tomasz; Bialek, Andrzej; Wiechowska-Kozlowska, Anna; Stankiewicz, Rafa?; Milkiewicz, Piotr; Krawczyk, Marek

    2013-09-28

    Anatomic variations of the right biliary system are one of the most common risk factors for sectoral bile duct injury (BDI) during cholecystectomy. Isolated right posterior BDI may in particular be a challenge for both diagnosis and management. Herein we describe two cases of isolated right posterior sectoral BDI that took place during laparoscopic cholecystectomy. Despite effective external biliary drainage from the liver hilum in both cases, there was a persistent biliary leak observed which was not visible on endoscopic retrograde cholangiogram. Careful evaluation of images from both endoscopic and magnetic resonance cholangiograms revealed the diagnosis of an isolated right posterior sectoral BDI. These were treated with a delayed bisegmental (segments 6 and 7) liver resection and a Roux-en-Y hepaticojejunostomy respectively with good outcomes at 24 and 4 mo of follow-up. This paper discusses strategies for prevention of such injuries along with the diagnostic and therapeutic challenges it offers. PMID:24106416

  12. The Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics may not correlate with operative performance in a novice cohort

    PubMed Central

    Steigerwald, Sarah N.; Park, Jason; Hardy, Krista M.; Gillman, Lawrence; Vergis, Ashley S.

    2015-01-01

    Background Considerable resources have been invested in both low- and high-fidelity simulators in surgical training. The purpose of this study was to investigate if the Fundamentals of Laparoscopic Surgery (FLS, low-fidelity box trainer) and LapVR (high-fidelity virtual reality) training systems correlate with operative performance on the Global Operative Assessment of Laparoscopic Skills (GOALS) global rating scale using a porcine cholecystectomy model in a novice surgical group with minimal laparoscopic experience. Methods Fourteen postgraduate year 1 surgical residents with minimal laparoscopic experience performed tasks from the FLS program and the LapVR simulator as well as a live porcine laparoscopic cholecystectomy. Performance was evaluated using standardized FLS metrics, automatic computer evaluations, and a validated global rating scale. Results Overall, FLS score did not show an association with GOALS global rating scale score on the porcine cholecystectomy. None of the five LapVR task scores were significantly associated with GOALS score on the porcine cholecystectomy. Conclusions Neither the low-fidelity box trainer or the high-fidelity virtual simulator demonstrated significant correlation with GOALS operative scores. These findings offer caution against the use of these modalities for brief assessments of novice surgical trainees, especially for predictive or selection purposes. PMID:26641071

  13. 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

  14. Laparoscopic splenectomy.

    PubMed

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

    1996-09-01

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

  15. Development of a Virtual Reality Simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) Cholecystectomy Procedure.

    PubMed

    Ahn, Woojin; Dargar, Saurabh; Halic, Tansel; Lee, Jason; Li, Baichun; Pan, Junjun; Sankaranarayanan, Ganesh; Roberts, Kurt; De, Suvranu

    2014-01-01

    The first virtual-reality-based simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is developed called the Virtual Translumenal Endoscopic Surgery Trainer (VTESTTM). VTESTTM aims to simulate hybrid NOTES cholecystectomy procedure using a rigid scope inserted through the vaginal port. The hardware interface is designed for accurate motion tracking of the scope and laparoscopic instruments to reproduce the unique hand-eye coordination. The haptic-enabled multimodal interactive simulation includes exposing the Calot's triangle and detaching the gall bladder while performing electrosurgery. The developed VTESTTM was demonstrated and validated at NOSCAR 2013. PMID:24732469

  16. Use of Stapling Devices for Safe Cholecystectomy in Acute Cholecystitis

    PubMed Central

    Odabasi, Mehmet; Muftuoglu, M. A. Tolga; Ozkan, Erkan; Eris, Cengiz; Yildiz, Mehmet Kamil; Gunay, Emre; Abuoglu, Haci Hasan; Tekesin, Kemal; Akbulut, Sami

    2014-01-01

    Many techniques are described for the ligation of a difficult cystic duct (CD). The aim of this study is to assess the effectiveness and safety of stapling of a difficult CD in acute cholecystitis using Endo-GIA. From January 2008 to June 2012, 1441 patients with cholelithiasis underwent laparoscopic cholecystectomy (LC) at the Department of General Surgery, Haydarpasa Numune Education and Research Hospital. Of these, 19 (0.62%) were identified as having a difficult CD and were ligated using an Endo-GIA stapler. All patients were successfully treated with a laparoscopic approach. The length of hospital stay was 3.4 days. There were umbilical wound infections in 4 patients (21%). The length of follow-up ranged from 1.0 to 50.4 months. In conclusion, Endo-GIA is a safe and easy treatment method for patients with a dilated and difficult CD. The cystic artery should be isolated and ligated if possible before firing the Endo-GIA stapler. If isolation and stapling are not possible, fibrin sealant can be applied to avoid bleeding. The vascular Endo-GIA can be applied in a large CD, but for acute cholecystitis with an edematous CD, the Endo-GIA roticulator 4.8 or 3.5 stapler is preferred. PMID:25216423

  17. Laparoscopy-Assisted Single-Port Appendectomy in Children: Safe Alternative also for Perforated Appendicitis?

    PubMed

    Sesia, Sergio B; Berger, Eliane; Holland-Cunz, Stefan; Mayr, Johannes; Häcker, Frank-Martin

    2015-12-01

    Because of its low complication rate, favorable safety, cost-effectiveness, and technical ease, mono-instrumental, laparoscopy-assisted single-port appendectomy (SPA) has been the standard therapy for appendicitis in our department since its introduction 10 years ago. We report our experience with this technique and compare its outcome to open appendectomy (OA).The records of all children who underwent appendectomy at our institution over a period of 8 years were analyzed retrospectively. Patient baseline data, markers of inflammation, operative time, length of hospital stay, complication rate according to the classification of Clavien-Dindo, and histologic grading were assessed to compare the 2 surgical techniques (SPA and OA). The chi square test, the Student's t test and the Wilcoxon-Mann-Whitney test were used to analyze the data and the comparisons of the mean values. A P value

  18. Core value of laparoscopic colorectal surgery.

    PubMed

    Li, Xin-Xiang; Wang, Ren-Jie

    2015-12-10

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

  19. Core value of laparoscopic colorectal surgery

    PubMed Central

    Li, Xin-Xiang; Wang, Ren-Jie

    2015-01-01

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

  20. Total laparoscopic removal of accessory gallbladder: A case report and review of literature

    PubMed Central

    Cozacov, Yaniv; Subhas, Gokulakkrishna; Jacobs, Michael; Parikh, Janak

    2015-01-01

    Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct (H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications.

  1. Liver resection for the treatment of post-cholecystectomy biliary stricture with vascular injury

    PubMed Central

    Perini, Marcos V; Herman, Paulo; Montagnini, Andre L; Jukemura, Jose; Coelho, Fabricio F; Kruger, Jaime A; Bacchella, Telesforo; Cecconello, Ivan

    2015-01-01

    AIM: To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular injury. METHODS: From a prospective database of patients treated for benign biliary strictures at our hospital, cases that underwent liver resections were reviewed. All cases were referred after one or more attempts to repair bile duct injuries following cholecystectomy (open or laparoscopic). Liver resection was indicated in patients with Strasberg E3/E4 (hilar stricture) bile duct lesions associated with vascular damage (arterial and/or portal), ipsilateral liver atrophy/abscess, recurrent attacks of cholangitis, and failure of previous hepaticojejunostomy. RESULTS: Of 148 patients treated for benign biliary strictures, nine (6.1%) underwent liver resection; eight women and one man with a mean age of 38.6 years. Six patients had previously been submitted to open cholecystectomy and three to laparoscopic surgery. The mean number of surgical procedures before definitive treatment was 2.4. All patients had Strasberg E3/E4 injuries, and vascular injury was present in all cases. Eight patients underwent right hepatectomy and one underwent left lateral sectionectomy without mortality. Mean time of follow up was 69.1 mo and after long-term follow up, eight patients are asymptomatic. CONCLUSION: Liver resection is a good therapeutic option for patients with complex postoperative biliary stricture and vascular injury presenting with liver atrophy/abscess in which previous hepaticojejunostomy has failed. PMID:25717244

  2. Laparoscopic Spine Surgery

    MedlinePLUS

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

  3. Laparoscopic revolution in bariatric surgery

    PubMed Central

    Sundbom, Magnus

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  5. Cholecystectomy and Clinical Presentations of Gastroparesis

    PubMed Central

    2013-01-01

    Background Many patients with gastroparesis have had their gallbladder removed. Aim To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed. Methods Gastroparetic patients were prospectively enrolled into the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including Patient Assessment of GI Symptoms (PAGI-SYM). Results Of 391 subjects with diabetic (DG) or idiopathic gastroparesis (IG), 142 (36%) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46%) of T2DM compared to 19/78 (24%) T1DM and 96/254 IG (38%) (P=0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR=2.06; p=0.01), more comorbidities (OR=1.26; P<0.001), less severe gastric retention (OR(severe)=0.68; overall P=0.03) and more severe symptoms of retching (OR=1.19; P=0.02) and upper abdominal pain (OR=1.21; P=0.02), less severe constipation symptoms (OR=0.84; P=0.02), and not classified as having IBS (OR=0.51; P=0.02). Etiology was not independently associated with a prior cholecystectomy. Conclusions Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis. PMID:23456496

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

    PubMed Central

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

    2015-01-01

    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

  7. Laparoscopic management of a two staged gall bladder torsion

    PubMed Central

    Sunder, Yadav Kamal; Akhilesh, Sali Priyanka; Raman, Garg; Deborshi, Sharma; Shantilal, Mehta Hitesh

    2015-01-01

    Gall bladder torsion (GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel’s lobe (part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful post-operative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot’s triangle. Laparoscopic cholecystectomy has the benefit of early recovery.

  8. Patients' experiences with cholecystitis and a cholecystectomy.

    PubMed

    Lindseth, Glenda N; Denny, Dawn L

    2014-01-01

    Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care. PMID:25461462

  9. Optimization of near-infrared fluorescence cholangiography for open and laparoscopic surgery

    PubMed Central

    Verbeek, Floris P.R.; Schaafsma, Boudewijn E.; Tummers, Quirijn R.J.G.; van der Vorst, Joost R.; van der Made, Wendeline J.; Baeten, Coen I.M.; Bonsing, Bert A.; Frangioni, John V.; van de Velde, Cornelis J.H.; Vahrmeijer, Alexander L.; Swijnenburg, Rutger-Jan

    2013-01-01

    Background During laparoscopic cholecystectomy, common bile duct (CBD) injury is a rare but severe complication. To reduce the risk of injury, near-infrared (NIR) fluorescent cholangiography using indocyanine green (ICG) has recently been introduced as a novel method to visualize the biliary system during surgery. To date, several studies have shown feasibility of this technique. However, liver background fluorescence remains a major problem during fluorescent cholangiography. The aim of the current study was to optimize ICG dose and timing for NIR cholangiography using a quantitative intraoperative camera system during open hepatopancreatobiliary (HPB) surgery. Subsequently, these results were validated during laparoscopic cholecystectomy using a laparoscopic fluorescence imaging system. Methods 27 patients who underwent NIR imaging using the Mini-FLARE image-guided surgery system during open HPB surgery were analyzed to assess optimal dosage and timing of ICG administration. ICG was intravenously injected preoperatively at doses of 5, 10, and 20 mg, and imaged at either 30 min (early) or 24 h (delayed) post-injection. Next, the optimal doses found for early and delayed imaging were applied to 2 groups of 7 patients (n=14) undergoing laparoscopic NIR fluorescent cholangiography during laparoscopic cholecystectomy. Results Median liver-to-background contrast was 23.5 (range: 22.1–35.0), 16.8 (range: 11.3–25.1), 1.3 (range: 0.7–7.8), and 2.5 (range: 1.3–3.6) for the 5 mg/30 min, 10 mg/30 min, 10 mg/24 h and 20 mg/24 h respectively. Fluorescence intensity of the liver was significantly lower in the 10 mg delayed imaging dose group compared to the early imaging 5 mg and 10 mg dose groups (P = 0.001), which resulted in a significant increase in CBD-to-liver contrast ratio compared to the early administration groups (p < 0.002). These findings were qualitatively confirmed during laparoscopic cholecystectomy. Conclusion This study shows that a prolonged interval between ICG administration and surgery permits optimal NIR cholangiography with minimal liver background fluorescence. PMID:24232054

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

    NASA Astrophysics Data System (ADS)

    Demos, Stavros G.; Urayama, Shiro

    2014-03-01

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

  11. Short-term clinical outcome of laparoscopic liver biopsy in dogs: 106 cases (2003-2013).

    PubMed

    McDevitt, Heidi L; Mayhew, Philipp D; Giuffrida, Michelle A; Brown, Dottie C; Culp, William T N; Runge, Jeffrey J

    2016-01-01

    OBJECTIVE To describe the operative technique, complications, and conversion rates for laparoscopic liver biopsy (LLB) in dogs and evaluate short-term clinical outcome for dogs that underwent the procedure. DESIGN Retrospective case series. ANIMALS 106 client-owned dogs. PROCEDURES Medical records were reviewed to identify dogs that underwent an LLB with a single-port or multiport technique at either of 2 veterinary teaching hospitals from August 2003 to September 2013. Demographic and laboratory data, preoperative administration of fresh frozen plasma, procedural and diagnostic information, intraoperative complications, and survival to discharge were recorded. The LLB specimens were obtained with 5-mm laparoscopic biopsy cup forceps and a grasp-and-twist technique. RESULTS Prior to surgery, 25 of 94 (27%) dogs had coagulopathy (prothrombin time or partial thromboplastin time greater than the facility reference ranges, regardless of platelet count). Twenty-one dogs were thrombocytopenic, 14 had ascites, and 14 received fresh frozen plasma transfusion before surgery. In all cases, biopsy samples collected were of sufficient size and quality for histopathologic evaluation. Two dogs required conversion to an open laparotomy because of splenic laceration during initial port placement. One hundred one of 106 dogs survived to discharge; 5 were euthanized during hospitalization owing to progression of liver disease and poor prognosis. CONCLUSIONS AND CLINICAL RELEVANCE Single-port and multiport LLB were found to be effective, minimally invasive diagnostic techniques with a low rate of complications. Results suggested LLB can be safely used in dogs with underlying coagulopathies and advanced liver disease. PMID:26684095

  12. 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

  13. The current status and future perspectives of laparoscopic surgery for gastric cancer

    PubMed Central

    Ahn, Sang-Hoon

    2011-01-01

    Gastric cancer is most common cancer in Korea. Surgery is still the main axis of treatment. Due to early detection of gastric cancer, the innovation of surgical instruments and technological advances, gastric cancer treatment is now shifting to a new era. One of the most astonishing changes is that minimally invasive surgery (MIS) is becoming more dominant treatment for early gastric cancer. These MIS are represented by endoscopic resection, laparoscopic surgery, robotic surgery, single-port surgery and natural orifice transluminal endoscopic surgery. Among them, laparoscopic gastrectomy is most actively performed in the field of surgery. Laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) has already gained popularity in terms of the short-term outcomes including patient's quality of life. We only have to wait for the long-term oncologic results of Korean Laparoscopic Gastrointestinal Surgery Study Group. Upcoming top issues following oncologic safety of LADG are function-preserving surgery for EGC, application of laparoscopy to advanced gastric cancer and sentinel lymph node navigation surgery. In the aspect of technique, laparoscopic surgery at present could reproduce almost the whole open procedures. However, the other fields mentioned above need more evidences and experiences. All these new ideas and attempts provide technical advances, which will minimize surgical insults and maximize the surgical outcomes and the quality of life of patients. PMID:22066116

  14. Timing of cholecystectomy in biliary pancreatitis treatment

    PubMed Central

    Demir, Uygar; Yaz?c?, P?nar; Bostanc?, Özgür; Kaya, Cemal; Köksal, Hakan; I??l, Gürhan; Bozda?, Emre; Mihmanl?, Mehmet

    2014-01-01

    Objective: Gallstone pancreatitis constitutes 40% of all cases with pancreatitis while it constitutes up to 90% of cases with acute pancreatitis. The treatment modality in this patient population is still controversial. In this study, we aimed to compare the results of early and late cholecystectomy for patients with biliary pancreatitis. Material and Methods: Patients treated with a diagnosis of acute biliary pancreatitis in our clinics between January 2000 and December 2011 were retrospectively reviewed. Patients were divided into two groups: Group A, patients who underwent cholecystectomy during the first pancreatitis attack, Group B, patients who underwent an interval cholecystectomy at least 8 weeks after the first pancreatitis episode. The demographic characteristics, clinical symptoms, number of episodes, length of hospital stay, morbidity and mortality data were recorded. All data were evaluated with Statistical Package for the Social Sciences (SPSS) 13.0 for windows and p <0.05 was considered as statistically significant. Results: During the last 12 years, a total of 91 patients with surgical treatment for acute biliary pancreatitis were included into the study. There were 62 female and 29 male patients, with a mean age of 57.9±14.6 years (range: 21–89). A concomitant acute cholecystitis was present in 46.2% of the patients. Group A and B included 48 and 43 patients, respectively. The length of hospital stay was significantly higher in group B (9.4 vs. 6.8 days) (p<0,05). More than half of the patients in Group B were readmitted to the hospital for various reasons. No significant difference was observed between the two groups, one patient died due to heart failure in the postoperative period in group B. Conclusion: In-hospital cholecystectomy after remission of acute pancreatitis is feasible. It will not only result in lower recurrence and complication rates but also shorten length of hospital stay. We recommend performing cholecystectomy during the course of the first episode in patients with acute pancreatitis. PMID:25931883

  15. Laparoscopic Spleen Removal (Splenectomy)

    MedlinePLUS

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

  16. Laparoscopic Inguinal Hernia Repair

    MedlinePLUS

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

  17. Laparoscopic Adrenal Gland Removal

    MedlinePLUS

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

  18. Laparoscopic Ventral Hernia Repair

    MedlinePLUS

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

  19. Laparoscopic Colon Resection

    MedlinePLUS

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  2. Cholecystectomy: Surgical Removal of the Gallbladder

    MedlinePLUS

    ... on the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) outcome initiative. Surgical Endoscopy . 2003;17:365-370 ... 2008;(2): CD006583. 30. Retrieved from http://www.sages.org/publications/patient-information/ patient-information-for-laparoscopic- ...

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

    PubMed Central

    Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  5. 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

  6. Pancreatic insulinomas: Laparoscopic management.

    PubMed

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

    2015-11-10

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

  7. Pancreatic insulinomas: Laparoscopic management

    PubMed Central

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

    2015-01-01

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

  8. Laparoscopic surgery and muscle relaxants: is deep block helpful?

    PubMed

    Kopman, Aaron F; Naguib, Mohamed

    2015-01-01

    It has been hypothesized that providing deep neuromuscular block (a posttetanic count of 1 or more, but a train-of-four [TOF] count of zero) when compared with moderate block (TOF counts of 1-3) for laparoscopic surgery would allow for the use of lower inflation pressures while optimizing surgical space and enhancing patient safety. We conducted a literature search on 6 different medical databases using 3 search strategies in each database in an attempt to find data substantiating this proposition. In addition, we studied the reference lists of the articles retrieved in the search and of other relevant articles known to the authors. There is some evidence that maintaining low inflation pressures during intra-abdominal laparoscopic surgery may reduce postoperative pain. Unfortunately most of the studies that come to these conclusions give few if any details as to the anesthetic protocol or the management of neuromuscular block. Performing laparoscopic surgery under low versus standard pressure pneumoperitoneum is associated with no difference in outcome with respect to surgical morbidity, conversion to open cholecystectomy, hemodynamic effects, length of hospital stay, or patient satisfaction. There is a limit to what deep neuromuscular block can achieve. Attempts to perform laparoscopic cholecystectomy at an inflation pressure of 8 mm Hg are associated with a 40% failure rate even at posttetanic counts of 1 or less. Well-designed studies that ask the question "is deep block superior to moderate block vis-à-vis surgical operating conditions" are essentially nonexistent. Without exception, all the peer-reviewed studies we uncovered which state that they investigated this issue have such serious flaws in their protocols that the authors' conclusions are suspect. However, there is evidence that abdominal compliance was not increased by a significant amount when deep block was established when compared with moderate neuromuscular block. Maintenance of deep block for the duration of the pneumoperitoneum presents a problem for clinicians who do not have access to sugammadex. Reversal of block with neostigmine at a time when no response to TOF stimulation can be elicited is slow and incomplete and increases the potential for postoperative residual neuromuscular block. The obligatory addition of sugammadex to any anesthetic protocol based on the continuous maintenance of deep block is not without associated caveats. First, monitoring of neuromuscular function is still essential and second, antagonism of deep block necessitates doses of sugammadex of ?4.0 mg/kg. Thus, maintenance of deep block has substantial economic repercussions. There are little objective data to support the proposition that deep neuromuscular block (when compared with less intense block; TOF counts of 1-3) contributes to better patient outcome or improves surgical operating conditions. PMID:25625254

  9. [A technic for laparoscopic gastrostomy].

    PubMed

    Kala, Z; Vomela, J; Hanke, I

    1995-08-01

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

  10. Transumbilical laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunal anastomosis.

    PubMed

    Fernández, José Ignacio; Ovalle, Cristian; Farias, Carlos; de la Maza, Jaime; Cabrera, Carolina

    2013-01-01

    Single-port laparoscopic surgery has undergone significant development over the past 5 years. Single port is used in various procedures, including bariatric surgery. The aim of this paper is to describe a surgical technique for gastric bypass with a transumbilical approach (transumbilical gastric bypass-TUGB) with hand-sewn gastrojejunostomy, in selected patients who may be benefited by a better cosmetic result. The procedure begins with a transumbilical vertical incision. We use the GelPOINT single-port device and a 5-mm assistant trocar in the left flank (in the first two cases, a 2-mm subxiphoid liver retractor was used). A gastric pouch is made and calibrated with a 36-Fr bougie. The gastrojejunal anastomosis is performed by hand-sewing in two layers. A Roux-en-Y with a biliary limb of 50 cm and an alimentary limb of 120 cm is performed with a stapler. Three women were subjected to TUGB. The women were aged 28, 31, and 42 years; they had body mass indexes of 40.3, 33, and 38.2; and the operating times were 150, 200, and 150 min, respectively. The first two women underwent a Roux-en-Y gastric bypass (RYGB), and the last woman underwent a RYGB with a resection of the stomach remnant. There were no conversions to open or multitrocar techniques. No complications or deaths occurred. The three patients were satisfied with the cosmetic result. The technique described for TUGB is a feasible procedure for surgeons who have previous experience with the transumbilical approach. PMID:23104389

  11. [Impact of preemptive analgesia on postoperative pain syndrome in laparoscopic surgery].

    PubMed

    Kokhno, V N; Shmerko, P S; Shakhtarin, I Iu

    2009-01-01

    The study included 90 patients who had undergone laparoscopic cholecystectomy. The patients were divided into 3 groups: 1) paracetamol was given for preemptive and postoperative analgesia; 2) ketorolac tromethamine; and 3) promedol (a control group). The visual analogue scale (VAS) and the determination of the time course of changes in the blood levels of tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP), and glucose were used to evaluate the degree of pain syndrome. Preemptive analgesia in laparoscopic surgery using ketorolac and paracetamol could reduce the degree of postoperative pain syndrome by 40.1%, as shown by the VAS. Comparative analysis of the characteristics of the agents showed that paracetamol produced a more powerful antistress defense, as confirmed by the time course of changes in the levels of TNF-alpha and CRP. PMID:20099654

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

    PubMed Central

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

    2015-01-01

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

  13. Laparoscopic surgery in weightlessness

    NASA Technical Reports Server (NTRS)

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

    1996-01-01

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

  14. Pediatric laparoscopic dismembered pyeloplasty.

    PubMed

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

    1995-06-01

    We performed laparoscopic dismembered pyeloplasty in a boy with right ureteropelvic junction obstruction using 4 cannula sites, and a dismembering and reanastomosis technique identical to that used in open pyeloplasty. Interrupted sutures were placed and tied intracorporeally. A nephrostomy tube was placed under direct vision for drainage but no ureteral stent was used. Total operating time was 5 hours. The patient was discharged home 36 hours after the procedure. The nephrostomy tube was removed 10 days postoperatively after radiographic demonstration of patency and 24 hours of clamping without pain. Followup excretory urography at 6 weeks showed much less hydronephrosis and a widely patent anastomosis. Our case illustrates the technical features and feasibility of laparoscopic pyeloplasty in children, and should encourage further development of pediatric urological reconstructive laparoscopic techniques. PMID:7752371

  15. Laparoscopic treatment of an upper gastrointestinal obstruction due to Bouveret’s syndrome

    PubMed Central

    Yang, Dong; Wang, Zhen; Duan, Zhi-Jun; Jin, Shi

    2013-01-01

    Bouveret’s syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations, such as abdominal distension and pain, nausea and vomiting, fever or even gastrointestinal bleeding, which may easily be misdiagnosed. In the present case, a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain, fever, jaundice or melena. At first, gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large, hard stone in the duodenal bulb. A revised diagnosis of Bouveret’s syndrome was made following abdominal computed tomography. Subsequently, the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret’s syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective, with good patient tolerability, rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret’s syndrome is worth exploring. PMID:24187475

  16. 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.

  17. Laparoscopic Removal of Gossypiboma

    PubMed Central

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

    2015-01-01

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

  18. [Progress of the laparoscopic colorectal surgery with special consideration regarding cancer treatment].

    PubMed

    Buchmann, P; Dinçler, S

    2006-04-26

    The development of laparoscopic surgery began with the diagnostic coelioscopy in 1901 and the first appendectomy in 1983. Its worldwide spread started in 1987 with the cholecystectomy. Four years later the right hemicolectomy and sigmoid resection were also described. The initial euphoria however evaporated when the first reports of port-site-metastasis appeared. The controversy whether one should be allowed or not to operate carcinomas laparoscopically, provoked a boom in research with as result that in 2000 it had been confirmed that the incidence of port-site-metastasis was about the same as drain-site-metastasis after open procedures (0.9%). Randomized studies comparing laparoscopic interventions and open surgery showed no difference in the long-term results of colon-carcinoma. For experienced surgeons this is also the case for rectum-carcinoma. Hereby the learning curve is of great importance and has been put at 30 to 70 procedures, taken into account the duration of the operation or other criteria such as conversion to open surgery and complications. With growing experience the amount of material used during an operation goes down, which results in a lower overall cost of the minimal-invasive technique compared with open surgery. In cost calculations one should also take into account the fact that the recovery time and the return to every-day life is generally quicker for patients after laparoscopic surgery while overall they also have a significant better quality of life score (SF-36) in the longer term. Currently, i.e. in 2006 the laparoscopic colorectal surgery has become an established procedure. It is thought that laparoscopic interventions give additional advantages because the immune system is less affected but this must still be confirmed through research. PMID:16686322

  19. Transumbilical Single-Incision Laparoscopic Wedge Resection for Gastric Submucosal Tumors: Technical Challenges Encountered in Initial Experience

    PubMed Central

    Park, Ji Yeon; Eom, Bang Wool; Yoon, Hongman; Ryu, Keun Won; Kim, Young-Woo

    2012-01-01

    Purpose To report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors. Materials and Methods The medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection between July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed. Results The mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas. Conclusions Single-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates. PMID:23094229

  20. 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

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

    PubMed Central

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

    2014-01-01

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

  2. 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

  3. Laparoscopic-Assisted Surgical Procedures.

    PubMed

    Steffey, Michele A

    2016-01-01

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

  4. Virtual reality in laparoscopic surgery.

    PubMed

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

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

  5. Timing of cholecystectomy after acute severe pancreatitis in pregnancy

    PubMed Central

    TALEBI-BAKHSHAYESH, Mousa; MOHAMMADZADEH, Alireza; ZARGAR, Ali

    2015-01-01

    Acute pancreatitis is one of the most common diseases of the gastrointestinal tract and is usually caused by gallstones; its occurrence in pregnancy is rare. Cholecystectomy for biliary pancreatitis during pregnancy is unavoidable, but its timing is controversial. We herein present the case of a patient who underwent termination of pregnancy due to deteriorated acute severe pancreatitis during the 27th week of gestation. Cholecystectomy was performed because of the relapse of acute biliary pancreatitis 10 days after being discharged. The interval from pancreatitis to cholecystectomy varies with its severity; in mild pancreatitis the interval may be one week, but in severe cases it maybe up to three weeks. Because pancreatitis may relapse during this interval, as occurred in the present case, a better solution for the timing of cholecystectomy must be sought. PMID:26715899

  6. Laparoscopic Appendicectomy: Calculating the Cost

    PubMed Central

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

    2009-01-01

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

  7. 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

  8. Laparoscopic Surgery - What Is It?

    MedlinePLUS

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

  9. Laparoscopic resection of hilar cholangiocarcinoma

    PubMed Central

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

    2015-01-01

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

  10. [Morpho-functional characteristics of reflux gastritis in patients after cholecystectomy and without cholecystectomy].

    PubMed

    Scalon, P; Di Mario, F; Rugge, M; Meggiato, T; Baffa, R; Mantovani, G; Plebani, M; Cutolo, M; Del Favero, G

    1991-01-01

    The aim of this study was to evaluate some biochemical and histopathological aspects in a group of patients with a view to identifying any differences depending on whether the pathology was associated with previous cholecystectomy or idiopathic. The study involved 23 patients (8 post-cholecystectomy cases and 15 ulcer-free dyspeptic patients) with the diagnosis of duodenogastric reflux gastritis confirmed by endoscopic histopathological evaluation. The following parameters were considered: 1) pH and bile salt concentration in gastric juice; 2) histological classification of antral biopsies (Niemela's criteria); 3) dyspeptic symptoms (dyspepsia, pyrosis and epigastric pain, sense of repletion, foul-tasting mouth) graded on a scale from 0 to 4. All parameters were considered in relation to whether or not Helicobacter Pylori was found in the histological specimens. No significant differences were found between the two groups for pH and bile salt values or for Helicobacter Pylori positivity. No relationship was observed between the Helicobacter Pylori and either the severity of the histological picture, the features of the biochemical parameters or the severity of the clinical symptoms. Such findings confirm the common pathophysiological pattern of reflux gastritis regardless of any permanent biliary tract alterations and the low importance of Helicobacter Pylori infection in determining this syndrome. PMID:1742396

  11. Laparoscopic herniorrhaphy in children.

    PubMed

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

    2015-01-01

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

  12. Design of a pressure sensing laparoscopic grasper

    E-print Network

    Reyda, Caitlin J. (Caitlin Jilaine)

    2011-01-01

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

  13. Biliary leakage after urgent cholecystectomy: Optimization of endoscopic treatment

    PubMed Central

    Ljubi?i?, Neven; Biš?anin, Alen; Pavi?, Tajana; Nikoli?, Marko; Budimir, Ivan; Miji?, August; ?uzel, Ana

    2015-01-01

    AIM: To investigate the results of endoscopic treatment of postoperative biliary leakage occurring after urgent cholecystectomy with a long-term follow-up. METHODS: This is an observational database study conducted in a tertiary care center. All consecutive patients who underwent endoscopic retrograde cholangiography (ERC) for presumed postoperative biliary leakage after urgent cholecystectomy in the period between April 2008 and April 2013 were considered for this study. Patients with bile duct transection and biliary strictures were excluded. Biliary leakage was suspected in the case of bile appearance from either percutaneous drainage of abdominal collection or abdominal drain placed at the time of cholecystectomy. Procedural and main clinical characteristics of all consecutive patients with postoperative biliary leakage after urgent cholecystectomy, such as indication for cholecystectomy, etiology and type of leakage, ERC findings and post-ERC complications, were collected from our electronic database. All patients in whom the leakage was successfully treated endoscopically were followed-up after they were discharged from the hospital and the main clinical characteristics, laboratory data and common bile duct diameter were electronically recorded. RESULTS: During a five-year period, biliary leakage was recognized in 2.2% of patients who underwent urgent cholecystectomy. The median time from cholecystectomy to ERC was 6 d (interquartile range, 4-11 d). Endoscopic interventions to manage biliary leakage included biliary stent insertion with or without biliary sphincterotomy. In 23 (77%) patients after first endoscopic treatment bile flow through existing surgical drain ceased within 11 d following biliary therapeutic endoscopy (median, 4 d; interquartile range, 2-8 d). In those patients repeat ERC was not performed and the biliary stent was removed on gastroscopy. In seven (23%) patients repeat ERC was done within one to fourth week after their first ERC, depending on the extent of the biliary leakage. In two of those patients common bile duct stone was recognized and removed. Three of those seven patients had more complicated clinical course and they were referred to surgery and were excluded from long-term follow-up. The median interval from endoscopic placement of biliary stent to demonstration of resolution of bile leakage for ERC treated patients was 32 d (interquartile range, 28-43 d). Among the patients included in the follow-up (median 30.5 mo, range 7-59 mo), four patients (14.8%) died of severe underlying comorbid illnesses. CONCLUSION: Our results demonstrate the great efficiency of the endoscopic therapy in the treatment of the patients with biliary leakage after urgent cholecystectomy. PMID:25992194

  14. Laparoscopic approach is safe and effective in the management of Mirizzi syndrome

    PubMed Central

    Kamalesh, Naduthottam Palaniswami; Prakash, Kurumboor; Pramil, Kaniyarakal; George, Thaliyachira Deepak; Sylesh, Aikot; Shaji, Ponnambathayil

    2015-01-01

    CONTEXT: Mirizzi syndrome (MS), an unusual complication of gallstone disease is due to mechanical obstruction of the common hepatic duct and is associated with clinical presentation of obstructive jaundice. Pre-operative identification of this entity is difficult and surgical management constitutes a formidable challenge to the operating surgeon. AIM: To analyse the clinical presentation, pre-operative diagnostic strategies, operative management and outcome of patients operated for MS in a tertiary care centre. MATERIALS AND METHODS: This retrospective study identified patients operated for MS between January 2006 and August 2013 and recorded and analysed their pre-operative demographics, pre-operative diagnostic strategies, operative management, and outcome. RESULTS: A total of 20 patients was identified out of 1530 cholecystectomies performed during the study period giving an incidence of 1.4%. There were 11 males and 9 females with a mean age of 55.6 years. Abdomen pain and jaundice were predominant symptoms and alteration of liver function test was seen in 14 patients. Endoscopic retrograde cholangiopancreatography (ERCP) the mainstay of diagnosis was diagnostic of MS in 72% of patients, while the rest were identified intra-operatively. The most common type of MS was Type II with an incidence of 40%. Cholecystectomy was completed by laparoscopy in 14 patients with a conversion rate of 30%. A choledochoplasty was sufficed in most of the patients and none required a hepaticojejunostomy. The laparoscopic cohort had a shorter length of hospital stay when compared to the entire group. CONCLUSION: MS, a rare complication of cholelithiasis is a formidable diagnostic and therapeutic challenge and pre-operative ERCP as a main diagnostic strategy enables the surgeon to identify and minimize bile duct injury. A choledochoplasty might be sufficient in the majority of the types of MS, while a laparoscopic approach is feasible and safe in most cases as well.

  15. Laparoscopic radical prostatectomy.

    PubMed

    Krongrad, A

    2000-05-01

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

  16. 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.

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

    PubMed

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

    2004-10-01

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

  18. 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

  19. Hemostasis in laparoscopic renal surgery

    PubMed Central

    Hassouna, Hussam A.; Manikandan, Ramaswamy

    2012-01-01

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

  20. 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

  1. Laparoscopic management of appendicular mass

    PubMed Central

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

    2011-01-01

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

  2. Laparoscopic lower urinary tract reconstruction.

    PubMed

    Anderson, K R; Clayman, R V

    2000-10-01

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

  3. [Laparoscopic treatment of benign ovarian cysts].

    PubMed

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

    2002-01-01

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

  4. Porcelain Gallbladder: No Longer an Indication for Prophylactic Cholecystectomy.

    PubMed

    Chen, Gao L; Akmal, Yasir; DiFronzo, Andrew L; Vuong, Brooke; O'Connor, Victoria

    2015-10-01

    Porcelain gallbladder (PG) was historically associated with gallbladder cancer (GBC), (range 12-62%, largest series n = 26). Presently, cholecystectomy is still performed in many patients with PG. The objective of this study was to determine the incidence of GBC in patients with radiographic diagnosis of PG. We conducted a retrospective chart review of the Kaiser Permanente southern California electronic medical record database and identified patients with radiographic diagnosis of PG between 2008 and 2013. Extracted were patient demographics, imaging modality, symptoms, surgical and observational outcomes, and pathology results. Out of 192 PG patients, 102 underwent cholecystectomy, and 90 were observed. None of the patients in the surgery group had GBC on pathology review, and none of the observed patients developed GBC during follow-up (mean 3.5 years). In the surgery group, 82 per cent of the patients were asymptomatic with a perioperative complication rate of 10.7 per cent. Among symptomatic patients, the complication rate was 16.7 per cent. Rate of conversion to open surgery was 5 per cent. Complications led to eight endoscopic or percutaneous interventions and five additional operations. PG is not associated with increased risk of GBC but is associated with high risk of postoperative complications. Cholecystectomy should not be recommended in asymptomatic patients with PG. PMID:26463284

  5. Laparoscopic strategies for resection of insulinomas.

    PubMed

    Fernández-Cruz, Laureano; Cesar-Borges, Gleydson

    2006-05-01

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

  6. Small Intestinal Bacterial Overgrowth Diagnosed by Glucose Hydrogen Breath Test in Post-cholecystectomy Patients

    PubMed Central

    Sung, Hea Jung; Paik, Chang-Nyol; Chung, Woo Chul; Lee, Kang-Moon; Yang, Jin-Mo; Choi, Myung-Gyu

    2015-01-01

    Background/Aims Patients undergoing cholecystectomy may have small intestinal bacterial overgrowth (SIBO). We investigated the prevalence and characteristics of SIBO in patients with intestinal symptoms following cholecystectomy. Methods Sixty-two patients following cholecystectomy, 145 with functional gastrointestinal diseases (FGIDs), and 30 healthy controls undergoing hydrogen (H2)-methane (CH4) glucose breath test (GBT) were included in the study. Before performing GBT, all patients were interrogated using bowel symptom questionnaire. The positivity to GBT indicating the presence of SIBO, gas types and bowel symptoms were surveyed. Results Post-cholecystectomy patients more often had SIBO as evidenced by a positive (+) GBT than those with FGID and controls (29/62, 46.8% vs 38/145, 26.2% vs 4/30, 13.3%, respectively; P = 0.010). In the gas types, the GBT (H2) + post-cholecystectomy patients was significantly higher than those in FGIDs patients (P = 0.017). Especially, positivity to fasting GBT (H2) among the GBT (H2)+ post-cholecystectomy patients was high, as diagnosed by elevated fasting H2 level. The GBT+ group had higher symptom scores of significance or tendency in abdominal discomfort, bloating, chest discomfort, early satiety, nausea, and tenesmus than those of the GBT negative group. The status of cholecystectomy was the only significant independent factor for predicting SIBO. Conclusions The SIBO with high levels of baseline H2 might be the important etiologic factor of upper GI symptoms for post-cholecystectomy patients. PMID:26351251

  7. Laparoscopic approach to retrorectal cyst

    PubMed Central

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

    2008-01-01

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

  8. Laparoscopic Excision of Retroperitoneal Schwannoma

    PubMed Central

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

    2015-01-01

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

  9. Laparoscopic colon resection: a case report.

    PubMed

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

    1991-08-01

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

  10. Systematic analysis of the safety and benefits of transvaginal hybrid-NOTES cholecystectomy

    PubMed Central

    Bulian, Dirk R; Knuth, Jurgen; Lehmann, Kai S; Sauerwald, Axel; Heiss, Markus M

    2015-01-01

    AIM: To evaluate transvaginal hybrid-NOTES cholecystectomy (TVC) during its clinical establishment and compare it with the traditional laparoscopic technique (LC). METHODS: The specific problems and benefits of TVC were reviewed using a registry analysis, a comparative cohort study and a randomized clinical trial. At first, feasibility, safety and specific complications of the TVC were analyzed based on the first 488 data sets of the German NOTES Registry (GNR). Hereafter, we compared the early postoperative results of our first 50 TVC-patients with those of 50 female LC-patients matched by age, BMI and ASA classification. The same cohort was contacted an average of two years later to evaluate long-term results concerning pain and satisfaction with the aesthetic results and the overall postoperative results as well as sexual intercourse by means of two domains of the German version of the Female Sexual Function Index (FSFI-d). Consequently, we performed a randomized clinical trial comparing 20 TVC-patients with 20 needlescopic/3-trocar cholecystectomies (NC) also concerning the early postoperative results as well as pain, satisfaction and quality of life by means of the Eypasch Gastrointestinal Quality of Life Index (GIQLI) in the later course. Finally, we discussed the results in accordance with other published studies. RESULTS: The complication (3.5%) and conversion rates (4.1%) for TVC were low in the GNR and comparable to those of the LC. Access related intraoperative complications included injuries to the bladder (n = 4; 0.8%) and bowel (n = 3; 0.6%). The study cohort revealed less postoperative pain after TVC comparing to the LC-patients on the day of surgery (NRS, 1.5/10 vs 3.1/10, P = 0.003), in the morning (NRS, 1.9/10 vs 2.8/10, P = 0.047) and in the evening (NRS, 1.1/10 vs 1.8/10, P = 0.025) of postoperative day (POD) one. The randomized clinical trial consistently found less cumulative pain until POD 2 (NRS, 8/40 vs 14/40, P = 0.043), as well as until POD 10 (NRS, 22/190 vs 41/190, P = 0.010). Furthermore, the TVC-patients had a better quality of life on POD 10 than did the LC-patients (GIQLI, 124/144 vs 107/144, P = 0.028). The complication rates were comparable and no specific problems were detected in the long-term follow-up for sexual intercourse for either group. The TVC-patients were more satisfied with the aesthetic result in the long-term course in the matched cohort analysis (1.00 vs 1.88, P < 0.001) as well as in the randomized clinical trial (1.00 vs 1.70, P < 0.001) when compared with the LC-patients. CONCLUSION: TVC is a feasible procedure with a high safety profile and has advantages in regard to postoperative pain and aesthetic results when compared with LC or NC. PMID:26478683

  11. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

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

    2015-01-01

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

  12. 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

  13. 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

  14. Cholecystectomy does not significantly increase the risk of fatty liver disease

    PubMed Central

    Wang, Hong-Gang; Wang, Li-Zhen; Fu, Hang-Jiang; Shen, Peng; Huang, Xiao-Dan; Zhang, Fa-Ming; Xie, Rui; Yang, Xiao-Zhong; Ji, Guo-Zhong

    2015-01-01

    AIM: To investigate the relationship between cholecystectomy and fatty liver disease (FLD) in a Chinese population. METHODS: A total of 32428 subjects who had voluntarily undergone annual health checkups in the Second Affiliated Hospital of Nanjing Medical University from January 2011 to May 2013 were included in this study. Basic data collection, physical examination, laboratory examination, and abdominal ultrasound examination were performed. RESULTS: Subjects undergoing cholecystectomy were associated with greater age, female sex, higher body mass index, and higher levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, and triglycerides. However, no significant differences were found in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, albumin, and serum uric acid. The overall prevalence of FLD diagnosed by ultrasonography was high at 38.4%. The prevalence of FLD was significantly higher for subjects who had undergone cholecystectomy (46.9%) than those who had not undergone cholecystectomy (38.1%; ?2 test, P < 0.001). Cholecystectomy was positively associated with FLD (OR = 1.433, 95%CI: 1.259-1.631). However, after adjusting for possible factors associated with FLD, multivariate regression analysis showed that the association between cholecystectomy and FLD was not statistically significant (OR = 1.096; 95%CI: 0.939-1.279). CONCLUSION: According to our study results, cholecystectomy may not be a significant risk factor for FLD. PMID:25834328

  15. Gallbladder Fossa Abscess Masquerading as Cholecystitis After Cholecystectomy.

    PubMed

    Rodrigue, Paul; Fakhri, Asif; Baumgartner, Andrew

    2015-12-01

    We present a case of a 59-y-old woman who had undergone cholecystectomy and was subsequently found to have an abscess within the gallbladder fossa. A hepatobiliary scan using (99m)Tc-diisopropyliminodiacetic acid demonstrated the characteristic rim sign, a photopenic defect surrounded by a rim of mildly increased activity immediately adjacent to the gallbladder fossa. The rim sign was thought to be the result of reactive inflammation in the hepatic tissue adjacent to a postoperative abscess within the gallbladder fossa. PMID:26111711

  16. Laparoscopic approach to Meckel's diverticulum

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. Laparoscopic Anti-Reflux (GERD) Surgery

    MedlinePLUS

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

  19. Laparoscopic appendectomy in the elderly: our experience

    PubMed Central

    2013-01-01

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

  20. Laparoscopic Management of a Torted Appendix

    PubMed Central

    Rajendran, N; Ameen, S; Rohatgi, A

    2006-01-01

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

  1. Single-incision bilateral laparoscopic oophorectomy

    PubMed Central

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

    2011-01-01

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

  2. Laparoscopic Management of Renal Hydatid Cyst

    PubMed Central

    Bansal, Ankur

    2014-01-01

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

  3. 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

  4. Early or Delayed Intervention for Bile Duct Injuries following Laparoscopic Cholecystectomy? A Dilemma Looking for an Answer

    PubMed Central

    Petrou, Athanasios; Moris, Demetrios; Dimitrokallis, Nikolaos; Bramis, Konstantinos; Griniatsos, John; Pikoulis, Emmanouil; Diamantis, Theodoros

    2015-01-01

    Background. To evaluate the effect of timing of management and intervention on outcomes of bile duct injury. Materials and Methods. We retrospectively analyzed 92 patients between 1991 and 2011. Data concerned patient's demographic characteristics, type of injury (according to Strasberg classification), time to referral, diagnostic procedures, timing of surgical management, and final outcome. The endpoint was the comparison of postoperative morbidity (stricture, recurrent cholangitis, required interventions/dilations, and redo reconstruction) and mortality between early (less than 2 weeks) and late (over 12 weeks) surgical reconstruction. Results. Three patients were treated conservatively, two patients were treated with percutaneous drainage, and 13 patients underwent PTC or ERCP. In total 74 patients were operated on in our unit. 58 of them underwent surgical reconstruction by end-to-side Roux-en-Y hepaticojejunostomy, 11 underwent primary bile duct repair, and the remaining 5 underwent more complex procedures. Of the 56 patients, 34 patients were submitted to early reconstruction, while 22 patients were submitted to late reconstruction. After a median follow-up of 93 months, there were two deaths associated with BDI after LC. Outcomes after early repairs were equal to outcomes after late repairs when performed by specialists. Conclusions. Early repair after BDI results in equal outcomes compared with late repair. BDI patients should be referred to centers of expertise and experience. PMID:25722718

  5. Variation in the Use of Intraoperative Cholangiography during Cholecystectomy

    PubMed Central

    Sheffield, Kristin M; Han, Yimei; Kuo, Yong-Fang; Townsend, Courtney M; Goodwin, James S; Riall, Taylor S

    2012-01-01

    Background The role of intraoperative cholangiography (IOC) in prevention of common bile duct (CBD) injuries and the management of CBD stones is controversial, and current variation in use of IOC has not been well described. Study Design Multilevel hierarchical models using data from the Texas Hospital Inpatient Discharge Public Use data files (2001–2008) were used to evaluate the percentage of variance in the use of IOC that was attributable to patient, surgeon, and hospital factors. Results A total of 176,981 cholecystectomies were performed in 212 hospitals in Texas. There was wide variation in IOC use, ranging from 2.4% to 98.4% of cases among surgeons and 3.7% to 94.8% of cases among hospitals, even after adjusting for case mix differences. The percentage of variance in IOC use attributable to the surgeon was 20.7% and an additional 25.7% was attributable to the hospital. IOC use was associated with increased age, gallstone pancreatitis or CBD stones, Hispanic race, decreased illness severity, insurance, and later year of cholecystectomy. ERCP (24.0% vs. 14.9%, P<0.0001) and CBD exploration (1.63% vs. 0.42%, P<0.0001) were more commonly performed in patients undergoing IOC. Conclusions Uncertainty regarding the benefit of IOC leads to wide variation in use across surgeons and hospitals. The surgeon and hospital are more important determinants of IOC use than patient characteristics. Our study highlights the need for further evaluation of comparative effectiveness of IOC in the prevention of CBD injuries and retained stones taking into account patient risk factors, surgeon skill, cost, and availability of local expertise. PMID:22366491

  6. Cholecystectomy and the risk of alimentary tract cancers: A systematic review

    PubMed Central

    Coats, Maria; Shimi, Sami M

    2015-01-01

    AIM: To investigate the association between cholecystectomy and gastro-intestinal tract (GIT) cancers. METHODS: We conducted a systematic review according to the PRISMA guidelines. A MEDLINE search was performed with predefined search criteria for English Language articles on the association between cholecystectomy and GIT cancers. Additional articles were retrieved by manual search of references. All relevant articles were accessed in full text. Data on study type; cases; controls; country; effect estimate; adjustments for confounders and quality of publication were extracted. The quality of the publications were scored by adherence to the STROBE checklist. The data for each part of the GIT were presented in separate tables. RESULTS: Seventy-five studies and 5 meta-analyses satisfied the predefined criteria for inclusion and were included in this review. There were inconsistent reports and no strong evidence of an association between cholecystectomy and cancers of the oesophagus (Adenocarcinoma), pancreas, small bowel and right-sided colon cancers. In squamous cancer of the oesophagus, cancers of the stomach, liver, bile ducts, small bowel and left sided colon cancers, good quality studies suggested a lack of association with cholecystectomy. Equally, distal colon and rectal cancers were found not to be associated with cholecystectomy. Several mechanisms for carcinogenesis/promotion of carcinogensis have been proposed. These have focused on a role for bile salts in carcinogenesis with several potential mutagenic molecular events and gut metabolic hormones signaling cell proliferation or initiation of carcinogenesis. CONCLUSION: This is a comprehensive review of the association between GIT cancers and cholecystectomy. This review found no clear association between cholecystectomy and GIT cancers. PMID:25834337

  7. 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.

  8. Laparoscopic Colorectal Resection in Octogenarian Patients

    PubMed Central

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

    2015-01-01

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

  9. Visual search behaviour during laparoscopic cadaveric procedures

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  10. HandPort Laparoscopic Surgery-Review and Current Status.

    PubMed

    Goel, Amit

    2015-06-01

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

  11. 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

  12. Duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty.

    PubMed

    Lorusso, D; Pezzolla, F; Montesani, C; Giorgio, P; Caruso, M L; Cavallini, A; Guerra, V; Misciagna, G

    1990-11-01

    Sixteen patients who had undergone cholecystectomy plus sphincteroplasty, 14 cholecystectomized patients and ten control patients were studied to evaluate whether differences existed in duodenogastric reflux and whether these were related to morphological damage of the gastric mucosa. Duodenogastric bile reflux during fasting was evaluated by measuring the concentration of total bile acids (by an enzymatic method) and single bile acids in the gastric juice by high performance liquid chromatography. The damage was evaluated histologically by systematic endoscopic biopsy of the antrum and body of the stomach. There was a statistically significant difference in fasting bile reflux between the three groups (Kruskal-Wallis test, P less than 0.001), and the group that underwent cholecystectomy plus sphincteroplasty had a significantly higher median value than the cholecystectomized group (P less than 0.05) and the control group (P less than 0.01). The distribution of chronic antral atrophic and superficial gastritis was different in the three groups (chi 2 test, P less than 0.005). Chronic atrophic gastritis was associated with cholecystectomy plus sphincteroplasty (P less than 0.01), while chronic superficial gastritis was more frequent in cholecystectomized patients. These results suggest that there may be more duodenogastric reflux after cholecystectomy plus sphincteroplasty than after cholecystectomy alone, and that there may be a correlation between the amount of duodenogastric reflux and the severity of mucosal damage. PMID:2253017

  13. Laparoscopic ovariectomy in two standing llamas.

    PubMed

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

    1998-08-15

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

  14. [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

  15. Current Trends in Laparoscopic Ventral Hernia Repair

    PubMed Central

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

    2015-01-01

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

  16. Laparoscopic excision of infra-renal PEComa

    PubMed Central

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

    2015-01-01

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

  17. Laparoscopic Robot-Assisted Diaphragm Plication.

    PubMed

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

    2016-01-01

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

  18. 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

  19. Long-term consequences of bile duct injury after cholecystectomy.

    PubMed

    Barbier, L; Souche, R; Slim, K; Ah-Soune, P

    2014-09-01

    Late complications arising after bile duct injury (BDI) include biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis. Secondary biliary cirrhosis resulting in associated hepatic failure or digestive tract bleeding due to portal hypertension is a substantial risk factor for morbidity and mortality after bile duct repair. Parameters that determine the management of late complications of BDI include the type of biliary injury, associated vascular injury, hepatic atrophy, the presence of intra-hepatic strictures or lithiasis, repetitive infectious complications, the quality of underlying parenchyma (fibrosis, secondary biliary cirrhosis) and the presence of portal hypertension. Endoscopic drainage is indicated for patients with uncontrolled acute sepsis, patients at high operative risk, patients with cirrhosis who are not eligible for liver transplantation and patients who have previously undergone several attempts at repair. Roux-en-Y hepaticojejunostomy, whether de novo or as an iterative repair, is the technique of reference for post-cholecystectomy BDI. Hepatic resection is indicated in only rare instances, mainly in case of extended hilar stricture, multiple stone retention in one sector of the liver or in patients for whom the repair is deemed technically difficult. Liver transplantation is indicated only in exceptional circumstances, when secondary biliary cirrhosis is associated with liver failure and portal hypertension. PMID:24954866

  20. [Course and results of the Karlsbad cure after cholecystectomy].

    PubMed

    Solc, P; Nová, R

    1982-01-15

    The course and the result of a cure in Karlovy Vary was pursued in 148 cholecystectomized patients. With the exception of 5 patients who were transferred to the surgeon after a bilious attack and 1 patient with malignoma of the biliary ducts 142 patients spoke of a subjective improvement at the end of the cure. The cure passed systematically in 50 patients with slight biliary complaints. In more considerable complaints, however, in 23 of 98 patients a bilious attack occurred during the cure, which made necessary the surgical intervention in 5 patients. Relapsing fever episodes could be clinically governed in 41 patients. Antibiotics remained without any effect in 41 patients. The values of the alkaline serum phosphatase and gamma-glutamyl-transpeptidase normalised only in 8 of this group, not, however, in 45 patients. The results altogether refer to the fat that the indications to a cure in Karlovy Vary must be made more carefully. After a cholecystectomy they should be recommended only then, when the biliary ducts eventually were cleant up. In these cases the only cholangiitis is no contraindication. The treatment may be supplemented by antibiotics. PMID:6123202

  1. Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy

    PubMed Central

    Mitra, Kinshuk; Melvin, James; Chang, Shufang; Park, Kyoungjin; Yilmaz, Alper; Melvin, Scott; Xu, Ronald X.

    2012-01-01

    Abstract. We encapsulate indocyanine green (ICG) in poly[(D,L-lactide-co-glycolide)-co-PEG] diblock (PLGA-PEG) microballoons for real-time fluorescence and hyperspectral imaging of biliary anatomy. ICG-loaded microballoons show superior fluorescence characteristics and slower degradation in comparison with pure ICG. The use of ICG-loaded microballoons in biliary imaging is demonstrated in both biliary-simulating phantoms and an ex vivo tissue model. The biliary-simulating phantoms are prepared by embedding ICG-loaded microballoons in agar gel and imaged by a fluorescence imaging module in a Da Vinci surgical robot. The ex vivo model consists of liver, gallbladder, common bile duct, and part of the duodenum freshly dissected from a domestic swine. After ICG-loaded microballoons are injected into the gallbladder, the biliary structure is imaged by both hyperspectral and fluorescence imaging modalities. Advanced spectral analysis and image processing algorithms are developed to classify the tissue types and identify the biliary anatomy. While fluorescence imaging provides dynamic information of movement and flow in the surgical region of interest, data from hyperspectral imaging allow for rapid identification of the bile duct and safe exclusion of any contaminant fluorescence from tissue not part of the biliary anatomy. Our experiments demonstrate the technical feasibility of using ICG-loaded microballoons for biliary imaging in cholecystectomy. PMID:23214186

  2. Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy

    NASA Astrophysics Data System (ADS)

    Mitra, Kinshuk; Melvin, James; Chang, Shufang; Park, Kyoungjin; Yilmaz, Alper; Melvin, Scott; Xu, Ronald X.

    2012-11-01

    We encapsulate indocyanine green (ICG) in poly[(D,L-lactide-co-glycolide)-co-PEG] diblock (PLGA-PEG) microballoons for real-time fluorescence and hyperspectral imaging of biliary anatomy. ICG-loaded microballoons show superior fluorescence characteristics and slower degradation in comparison with pure ICG. The use of ICG-loaded microballoons in biliary imaging is demonstrated in both biliary-simulating phantoms and an ex vivo tissue model. The biliary-simulating phantoms are prepared by embedding ICG-loaded microballoons in agar gel and imaged by a fluorescence imaging module in a Da Vinci surgical robot. The ex vivo model consists of liver, gallbladder, common bile duct, and part of the duodenum freshly dissected from a domestic swine. After ICG-loaded microballoons are injected into the gallbladder, the biliary structure is imaged by both hyperspectral and fluorescence imaging modalities. Advanced spectral analysis and image processing algorithms are developed to classify the tissue types and identify the biliary anatomy. While fluorescence imaging provides dynamic information of movement and flow in the surgical region of interest, data from hyperspectral imaging allow for rapid identification of the bile duct and safe exclusion of any contaminant fluorescence from tissue not part of the biliary anatomy. Our experiments demonstrate the technical feasibility of using ICG-loaded microballoons for biliary imaging in cholecystectomy.

  3. Acute surgical unit safely reduces unnecessary after-hours cholecystectomy.

    PubMed

    Suhardja, T S; Bae, L; Seah, E Z; Cashin, P; Croagh, D G

    2015-11-01

    Introduction The acute surgical model has been trialled in several institutions with mixed results. The aim of this study was to determine whether the acute surgical model provides better outcomes for patients with acute biliary presentation, compared with the traditional emergency surgery model of care. Methods A retrospective review was carried out of patients who were admitted for management of acute biliary presentation, before and after the establishment of an acute surgical unit (ASU). Outcomes measured were time to operation, operating time, after-hours operation (6pm - 8am), length of stay and surgical complications. Results A total of 342 patients presented with acute biliary symptoms and were managed operatively. The median time to operation was significantly reduced in the ASU group (32.4 vs 25.4 hours, p=0.047), as were the proportion of operations performed after hours (19.5% vs 2.5%, p<0.001) and the median length of stay (4 vs 3 days, p<0.001). The median operating time, rate of conversion to open cholecystectomy and wound infection rates remained similar. Conclusions Implementation of an ASU can lead to objective differences in outcomes for patients who present with acute cholecystitis. In our study, the ASU significantly reduced time to operation, the number of operations performed after hours and length of stay. PMID:26492901

  4. 257 Incidental Appendectomies During Total Laparoscopic Hysterectomy

    PubMed Central

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

    2007-01-01

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

  5. [Lymphangioma of the retroperitoneum treated laparoscopically].

    PubMed

    Skach, J; Chrenko, M; Hromádka, P

    2014-09-01

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

  6. Augmented Reality Visualization for Laparoscopic Surgery

    E-print Network

    State, Andrei

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

  7. Laparoscopic Pyeloplasty in the Animal Model

    PubMed Central

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

    1997-01-01

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

  8. 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

  9. Intestinal Obstruction After Totally Extraperitoneal Laparoscopic Inguinal Hernia Repair

    PubMed Central

    Rink, Joanne

    2004-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  11. 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

  12. Cholecystectomy after breast reconstruction with a pedicled autologous tram flap. Types of surgical access.

    PubMed

    Graczyk, Magdalena; Kostro, Justyna; Jankau, Jerzy; Bigda, Justyna; Skorek, Andrzej

    2014-09-01

    The number of breast reconstruction procedures has been increasing in recent years. One of the suggested treatment methods is breast reconstruction with a pedicled skin and muscle TRAM flap (transverse rectus abdominis muscle - TRAM). Surgical incisions performed during a cholecystectomy procedure may be located in the areas significant for flap survival. The aim of this paper is to present anatomical changes in abdominal walls secondary to pedicled skin and muscle (TRAM) flap breast reconstruction, which influence the planned access in cholecystectomy procedures. The authors present 2 cases of cholecystectomy performed due to cholelithiasis in female patients with a history of TRAM flap breast reconstruction procedures. The first patient underwent a traditional method of surgery 14 days after the reconstruction due to acute cholecystitis. The second patient underwent a laparoscopy due to cholelithiasis 7 years after the TRAM procedure. In both cases an abdominal ultrasound scan was performed prior to the operation, and surgical access was determined following consultation with a plastic surgeon. The patient who had undergone traditional cholecystectomy developed an infection of the postoperative wound. The wound was treated with antibiotics, vacuum therapy and skin grafting. After 7 weeks complete postoperative wound healing and correct healing of the TRAM flap were achieved. The patient who had undergone laparoscopy was discharged home on the second postoperative day without any complications. In order to plan a safe surgical access, it is necessary to know the changes in the anatomy of abdominal walls following a pedicled TRAM flap breast reconstruction procedure. PMID:25337177

  13. 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

  14. 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

  15. 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

  16. The Association between Cholecystectomy and Gastroesophageal Reflux Symptoms: A Prospective Controlled Study

    PubMed Central

    Lin, Otto S.; Kozarek, Richard A.; Arai, Andrew; Gan, S. Ian; Gluck, Michael; Jiranek, Geoffrey C.; Kowdley, Kris V.; Triadafilopoulos, George

    2013-01-01

    Objective A large controlled prospective observational study to compare pre- and post-surgery changes in reflux symptoms between cholecystectomy and hernia repair surgery patients. Summary Background Data Six studies have suggested that gastroesophageal reflux worsens after cholecystectomy. However, these studies all had design limitations. Methods We recruited 302 patients scheduled to undergo elective cholecystectomy (study group) or hernia repair (controls) at two hospitals. Both groups filled out the validated Reflux Symptom Score (RSS) and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires 1–15 days prior to and 4–12 weeks after the operation. Changes in symptom scores between the pre and post-surgery assessments were measured, and compared between the two groups. Results Baseline RSS and GSRS reflux subscores were higher in the study group than controls (1.44 vs. 1.02 and 1.91 vs. 1.43 respectively; p<0.05). There were no significant differences in any of the symptom score changes between the two groups except for the GSRS pain subscore, which decreased more in the study group than the control group (?0.59 vs. ?0.10; p<0.001). With regard to reflux, the RSS decreased by ?0.34 in the study group and ?0.14 in controls (p=0.27), while the GSRS reflux subscore decreased by ?0.32 in the study group and ?0.05 in controls (p=0.12). GSRS diarrhea and constipation subscores decreased slightly after surgery, to the same extent in both groups. Conclusions This large prospective controlled study, the only one using validated reflux symptom questionnaires, shows that cholecystectomy does not lead to an increase in reflux symptoms. As expected, GSRS pain subscores were decreased in the cholecystectomy group but not the controls. PMID:19858706

  17. Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma.

    PubMed

    Emmett, C D; Barrett, P; Gilliam, A D; Mitchell, A I

    2015-10-01

    Introduction Gallstone disease is treated commonly with cholecystectomy. Malignant disease of the gallbladder may present similarly and has a poor prognosis. It is common for cholecystectomy specimens to be sent for histological examination to exclude malignancy. However, the incidence of incidental gallbladder carcinoma (IGBC) is low and it has therefore been suggested that macroscopic inspection of the gallbladder by the surgeon, followed by selective histological examination of abnormal specimens, may be safe and cost saving. Methods All cholecystectomies performed between 1 May 2003 and 1 September 2009 were identified from clinical coding. Pathology records were used to identify gallbladder malignancies; these were searched manually to identify IGBC. Pathology reports and case notes were cross-referenced to determine whether there were macroscopic abnormalities present. Annual cost savings were estimated by comparing the number of gallbladder specimens over one year (May 2013 - April 2014) with the total number of cholecystectomies performed in that time. Results Of 4,776 cholecystectomies identified, 12 (0.25%) were cases of IGBC. These cases had a higher median age (68 vs 54 years, p<0.001) and a higher proportion were emergency operations (50% vs 12%, p<0.001). All cases had some form of macroscopic abnormality, most commonly wall thickening (n=6, 50%). Only two cases (17%) had a visible tumour present. Conclusions All cases of IGBC in this study had a macroscopically abnormal gallbladder. Our findings suggest it is safe to adopt a selective approach to histological examination. Savings of almost £20,500 per annum have been achieved. PMID:26274738

  18. Cholecystectomy for Prevention of Recurrence after Endoscopic Clearance of Bile Duct Stones in Korea

    PubMed Central

    Song, Myung Eun; Lee, Dong-Jun; Oh, Tak Geun; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Song, Si Young; Chung, Jae Bock

    2016-01-01

    Purpose Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. Materials and Methods A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. Results The mean duration of follow-up after CBD stone extraction was 25.4±22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). Conclusion A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients. PMID:26632393

  19. Laparoscopic Management of a Complex Adrenal Cyst

    PubMed Central

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

    2015-01-01

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

  20. Laparoscopic surgery for left paraduodenal hernia.

    PubMed

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

    2004-04-01

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

  1. Laparoscopic Resection of Symptomatic Gastric Diverticula

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Ntourakis, Dimitrios; Mavrogenis, Georgios

    2015-01-01

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

  3. Advances in Laparoscopic Skills Training and Management.

    PubMed

    Fransson, Boel A

    2016-01-01

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

  4. Laparoscopic and robotic surgical training in urology.

    PubMed

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

    2003-04-01

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

  5. Laparoscopic treatment of congenital choledochal cyst.

    PubMed

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

    1998-10-01

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

  6. Multiresolution foveated laparoscope with high resolvability.

    PubMed

    Qin, Yi; Hua, Hong; Nguyen, Mike

    2013-07-01

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

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

    PubMed

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

    2015-12-01

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

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

    PubMed Central

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

    2003-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  10. EYE MOVEMENTS IN A VIRTUAL LAPAROSCOPIC TRAINING ENVIRONMENT

    E-print Network

    Atkins, M. Stella

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

  11. Visual Tracking of Laparoscopic Instruments in Standard Training

    E-print Network

    Faloutsos, Petros

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

  12. Laparoscopic vs mini-incision open appendectomy

    PubMed Central

    Çiftçi, Fatih

    2015-01-01

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

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

    PubMed

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

    1999-02-01

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

  14. Zoom lens design using liquid lens for laparoscope.

    PubMed

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

    2013-01-28

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

  15. Simulation System for Training in Laparoscopic Surgery

    NASA Technical Reports Server (NTRS)

    Basdogan, Cagatay; Ho, Chih-Hao

    2003-01-01

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

  16. +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. PMID:26064268

  17. Evaluation of Specialized Laparoscopic Suturing and Tying Devices

    PubMed Central

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

    2004-01-01

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

  18. [In vitro development of laparoscopic skills].

    PubMed

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

    2012-08-01

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

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

    PubMed

    Berkes, Eniko; Bokor, Attila; Rigó, János

    2010-07-11

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

  20. 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

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

    PubMed

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

    2015-05-01

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

  2. Robotic-assisted laparoscopic mesh sacrocolpopexy

    PubMed Central

    Gilleran, Jason P.; Johnson, Matthew; Hundley, Andrew

    2010-01-01

    The current ‘gold standard’ surgical repair for apical prolapse is the abdominal mesh sacrocolpopexy. Use of a robotic-assisted laparoscopic surgical approach has been demonstrated to be feasible as a minimally invasive approach and is gaining popularity amongst pelvic floor reconstructive surgeons. Although outcome data for robotic-assisted sacrocolpopexy (RASC) is only just emerging, several small series have demonstrated anatomic and functional outcomes, as well as complication rates, comparable to those reported for open surgery. The primary advantages thus far for RASC over open surgery include decreased blood loss and shorter hospital stay. PMID:21789075

  3. Recurrent mucinous cystadenoma: a laparoscopic approach.

    PubMed

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

    2009-03-01

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

  4. Augmented reality assisted laparoscopic partial nephrectomy.

    PubMed

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

    2014-01-01

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

  5. Breakage of fascial closure device during laparoscopic surgery

    PubMed Central

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

    2005-01-01

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

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

    PubMed Central

    Nguyen, Ninh T.; Schauer, Philip R.

    1998-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-12-01

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

  9. Laparoscopic Radiofrequency Thermal Ablation for Uterine Adenomyosis

    PubMed Central

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

    2015-01-01

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

  10. Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome

    PubMed Central

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

    2009-01-01

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

  11. International experience for laparoscopic major liver resection.

    PubMed

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

    2014-10-01

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

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

    PubMed Central

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

    2015-01-01

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

  13. Robotic-assisted laparoscopic adrenalectomy for an adrenal adenoma

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  15. Laparoscopic approach for inflammatory bowel disease surgical managment.

    PubMed

    Maggiori, Léon; Panis, Yves

    2012-01-01

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

  16. 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

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

    PubMed Central

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

    2006-01-01

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

  18. Laparoscopic Appendectomy Performed by Residents and Experienced Surgeons

    PubMed Central

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

    2009-01-01

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

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

    PubMed

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

    2013-07-01

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

  20. Late complication of laparoscopic sleeve gastrectomy.

    PubMed

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

    2013-01-01

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

  1. Late Complication of Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Assalia, Ahmad; Kluger, Yoram

    2013-01-01

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

  2. Laparoscopic rectopexy in solitary rectal ulcer.

    PubMed

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

    2011-01-01

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

  3. Laparoscopic Salpingo-oophorectomy in Conscious Sedation

    PubMed Central

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

    2015-01-01

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

  4. Is cholecystectomy a reasonable treatment option for simple gallbladder polyps larger than 10 mm?

    PubMed Central

    Park, Hye Yon; Oh, Se Hoon; Lee, Kwang Hyuck; Lee, Jong Kyun; Lee, Kyu Taek

    2015-01-01

    AIM: To determine the relevance of the 10-mm size criterion of the generally accepted surgical indication for gallbladder polyps (GBPs). METHODS: We collected data of patients who were confirmed to have GBPs through cholecystectomy at Samsung Medical Center between January 1997 and December 2012. Among the patients who underwent cholecystectomy for GBP, those with a definite evidence for malignancy such as adjacent organ invasion, metastasis on preoperative imaging studies, polyp larger than 20 mm, absence of preoperative imaging study results, and patients having gallstones were excluded. We retrospectively collected and analyzed information on patient’s clinical characteristics, symptoms, ultrasonographic findings, and blood laboratory tests. RESULTS: A total of 836 patients who had undergone cholecystectomy were retrospectively analyzed. Seven hundred eighty patients (93%) had benign polyps, whereas 56 patients (7%) had malignant polyps. Of the 56 patients with malignancy, 4 patients (7%) had borderline GBP (10-12 mm) and a patient had small GBP (< 10 mm) with T2 stage. We conducted an ROC curve analysis to verify the 10-mm size criteria (AUC = 0.887, SD = 0.21, P < 0.001). In the ROC curve for polyp size and malignancy, sensitivity and specificity of the 10-mm size criterion was 98.2% and 19.6%, respectively. The specificity of the 11-mm and 12-mm size criteria was 44.6% and 56%, respectively, whereas the sensitivity of these two size criteria was similar. We defined the GBPs of 10 to 12 mm as a borderline-sized GBP, which were found in 411 patients (49%). In this group, there was a significant difference in age between patients with benign and malignant GBPs (47 years vs 60 years, P < 0.05). CONCLUSION: GBPs larger than 13 mm need immediate excision whereas for borderline-sized GBPs detected in young patients, careful medical observation can be a rational decision. PMID:25892875

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

    PubMed

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

    2015-12-01

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

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

    E-print Network

    Atallah, Louis

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

  7. One or two trainees per workplace in a structured multimodality training curriculum for laparoscopic surgery? Study protocol for a randomized controlled trial – DRKS00004675

    PubMed Central

    2014-01-01

    Background Laparoscopy training courses have been established in many centers worldwide to ensure adequate skill learning before performing operations on patients. Different training modalities and their combinations have been compared regarding training effects. Multimodality training combines different approaches for optimal training outcome. However, no standards currently exist for the number of trainees assigned per workplace. Methods This is a monocentric, open, three-arm randomized controlled trial. The participants are laparoscopically-naive medical students from Heidelberg University. After a standardized introduction to laparoscopic cholecystectomy (LC) with online learning modules, the participants perform a baseline test for basic skills and LC performance on a virtual reality (VR) trainer. A total of 100 students will be randomized into three study arms, in a 2:2:1 ratio. The intervention groups participate individually (Group 1) or in pairs (Group 2) in a standardized and structured multimodality training curriculum. Basic skills are trained on the box and VR trainers. Procedural skills and LC modules are trained on the VR trainer. The control group (Group C) does not receive training between tests. A post-test is performed to reassess basic skills and LC performance on the VR trainer. The performance of a cadaveric porcine LC is then measured as the primary outcome using standardized and validated ratings by blinded experts with the Objective Structured Assessment of Technical Skills. The Global Operative Assessment of Laparoscopic Surgical skills score and the time taken for completion are used as secondary outcome measures as well as the improvement of skills and VR LC performance between baseline and post-test. Cognitive tests and questionnaires are used to identify individual factors that might exert influence on training outcome. Discussion This study aims to assess whether workplaces in laparoscopy training courses for beginners should be used by one trainee or two trainees simultaneously, by measuring the impact on operative performance and learning curves. Possible factors of influence, such as the role of observing the training partner, exchange of thoughts, active reflection, model learning, motivation, pauses, and sympathy will be explored in the data analysis. This study will help optimize the efficiency of laparoscopy training courses. Trial registration number DRKS00004675 PMID:24754961

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

    PubMed Central

    Hopkins, Mary Ann

    1999-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2015-04-01

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

  11. Laparoscopic repair of iatrogenic vesicovaginal and rectovaginal fistula

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  13. Subcapsular hematoma of the liver due to intercostal anesthesic blockage after cholecystectomy: case report.

    PubMed

    Santos Rodrigues, A L; Silva Santana, A C; Crociati Meguins, L; Felgueiras Rolo, D; Lobato Ferreira, M; Ribeiro Braga, C A

    2009-01-01

    The subcapsular hematoma of the liver (SHL) are the results of injuries such as liver needle biopsy, liver trauma, pregnancy illnesses, parasitic diseases and others. The approach of these lesions depends on the various clinical presentations of subcapsular hematoma of the liver because it may be small with minimal clinical repercussion, managed only by ultrasound observation. In some situations the SHL may present large dimensions with hemodinamic instability. A case of subcapsular hematoma of the liver secondary to anesthetic intercostal blockade to control the postoperative pain after cholecystectomy is reported. A 34-year-old woman was submitted to intercostal anesthetic blockade after cholecystectomy for treatment of cholelithiasis. The blockade evolved with pain in right flank followed of mucocutaneous pallor and fall of the haematocrit and hemoglobin levels. At relaparotomy, subcapsular hematoma of the liver was proven and tamponed with compresses. The patient had good postoperative evolution being discharged from hospital, after removing the compresses. In conclusion, the intercostal anesthesic blockade, as any other medical procedure, is not exempt of complications. Therefore, it must be carried through in well selected cases; Anyway nowadays, there are efficient drugs for the control of postoperative pain. PMID:19735615

  14. Biochemical and histopathological aspects in duodenogastric reflux gastritis patients with or without prior cholecystectomy.

    PubMed

    Scalon, P; Di Mario, F; Del Favero, G; Meggiato, T; Rugge, M; Baffa, R; Basso, D; Battistel, M; Plebani, M; Naccarato, R

    1993-01-01

    The aim of this study was to evaluate some biochemical and histopathological aspects in a group of patients with a view to identifying any differences depending on whether the pathology was associated with previous cholecystectomy or idiopathic. The study involved 23 patients (8 post-cholecystectomy cases and 15 ulcer-free dyspeptic patients) with the diagnosis of duodenogastric reflux gastritis confirmed by endoscopic histopathological evaluation. The following parameters were considered: 1. pH and bile salt concentration in gastric juice; 2. histological classification of antral biopsies (Niemela's criteria); 3. dyspeptic symptoms (dyspepsia, pyrosis and epigastric pain, sense of repletion, foul-tasting mouth) graded on a scale from 0 to 4. All parameters were considered in relation to whether or not Helicobacter Pylori was found in the histological specimens. No significant differences were found between the two groups for pH and bile salt values or for Helicobacter Pylori positivity. No relationship was observed between the Helicobacter Pylori and either the severity of the histological picture, the features of the biochemical parameters or the severity of the clinical symptoms. Such findings confirm the common pathophysiological pattern of reflux gastritis regardless of any permanent biliary tract alterations and the low importance of Helicobacter Pylori infection in determining this syndrome. PMID:8368047

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

    PubMed Central

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

    2015-01-01

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

  16. Need for simulation in laparoscopic colorectal surgery training

    PubMed Central

    Celentano, Valerio

    2015-01-01

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

  17. Laparoscopic Cystogastrostomy for Pancreatic Pseudocyst: A Case Report

    PubMed Central

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

    2000-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. Study on an infrared endoscope for energized laparoscopic method

    NASA Astrophysics Data System (ADS)

    Chen, Minghui; Song, Chengli

    2014-11-01

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

  20. Need for simulation in laparoscopic colorectal surgery training.

    PubMed

    Celentano, Valerio

    2015-09-27

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

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

    PubMed

    Hopp, H; Rummler, S; Reumuth, J

    1983-01-01

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

  2. Development of a standardized laparoscopic caecum resection model to simulate laparoscopic appendectomy in rats

    PubMed Central

    2014-01-01

    Background Laparoscopic appendectomy (LA) has become one of the most common surgical procedures to date. To improve and standardize this technique further, cost-effective and reliable animal models are needed. Methods In a pilot study, 30 Wistar rats underwent laparoscopic caecum resection (as rats do not have an appendix vermiformis), to optimize the instrumental and surgical parameters. A subsequent test study was performed in another 30 rats to compare three different techniques for caecum resection and bowel closure. Results Bipolar coagulation led to an insufficiency of caecal stump closure in all operated rats (Group 1, n?=?10). Endoloop ligation followed by bipolar coagulation and resection (Group 2, n?=?10) or resection with a LigaSure™ device (Group 3, n?=?10) resulted in sufficient caecal stump closure. Conclusions We developed a LA model enabling us to compare three different caecum resection techniques in rats. In conclusion, only endoloop closure followed by bipolar coagulation proved to be a secure and cost-effective surgical approach. PMID:24934381

  3. [Changes in secretion of cholecystokinin after cholecystectomy and the effect of these changes on biliary reflux and the state of the gastric mucosa].

    PubMed

    Muszy?ski, J; Rehfeld, J F; Wierzbicki, Z; Siemi?ska, J; Biernacka, D; Czyzyk, A

    1996-09-01

    Cholecystokinin's role in regulations of gallbladder and gastric function was well documented. After cholecystectomy a secretion of cholecystokinin may be changed and observed symptoms are able to create a new clinical picture including biliary gastric reflux. In the study was noticed that in 12 patients after cholecystectomy the cholecystokinin secretion was increased in comparison to the period before operation. Observed increased levels of the enzyme were not in connection with biliary gastric reflux. PMID:9139786

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

    PubMed

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

    2006-01-01

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

  5. Amyand's hernia: Our experience in the laparoscopic era.

    PubMed

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

  6. Monolimb Paralysis after Laparoscopic Appendectomy Due to Conversion Disorder

    PubMed Central

    Song, Sung Hyuk; Lee, Kyeong Hwan

    2014-01-01

    Limb paralysis can develop for various reasons. We found a 13-year-old patient who became paralyzed in her lower extremities after laparoscopic appendectomy. Some tests, including electrodiagnostic studies and magnetic resonance imaging, were performed to evaluate the cause of lower limb paralysis. None of the tests yielded definite abnormal findings. We subsequently decided to explore the possibility of psychological problems. The patient was treated with simultaneous rehabilitation and psychological counseling. Paralysis of the patient's lower extremity improved gradually and the patient returned to normal life. Our findings indicate that psychological problems can be related to limb paralysis without organ damage in patients who have undergone laparoscopic surgical procedures. PMID:25426280

  7. Amyand's hernia: Our experience in the laparoscopic era

    PubMed Central

    Sahu, Diwakar; Swain, Sudeepta; Wani, Majid; Reddy, Prasanna Kumar

    2015-01-01

    Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment. PMID:25883458

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

    PubMed Central

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

    1991-01-01

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

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

    PubMed

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

    2015-09-01

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

  10. Robot-assisted laparoscopic bladder diverticulectomy.

    PubMed

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

    2013-02-01

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

  11. Laparoscopic complete mesocolic excision: West meets East

    PubMed Central

    Chow, Carina F K; Kim, Seon Hahn

    2014-01-01

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

  12. Laparoscopic-Assisted Percutaneous Endoscopic Transgastrostomy Jejunostomy

    PubMed Central

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

    2014-01-01

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

  13. Laparoscopic and robotic adrenal surgery: transperitoneal approach.

    PubMed

    Okoh, Alexis K; Berber, Eren

    2015-10-01

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

  14. Laparoscopic and robotic adrenal surgery: transperitoneal approach

    PubMed Central

    Okoh, Alexis K.

    2015-01-01

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

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

    PubMed

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

    2014-10-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2009-01-01

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

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

    PubMed

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

    2008-01-01

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

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

    PubMed

    Nichitaylo, M E; Bulik, L M

    2015-06-01

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

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

    PubMed

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

    2015-11-01

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

  1. Laparoscopic first step approach in the two stage hepatectomy

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-10-01

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

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

    PubMed Central

    Manatakis, Dimitrios K.; Georgopoulos, Nikolaos

    2014-01-01

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

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

    PubMed Central

    Makker, Jitin; Conklin, Jeffrey

    2015-01-01

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

  5. Infection Prevention and Evaluation of Fever After Laparoscopic Hysterectomy

    PubMed Central

    Moulton, Laura J.; Jaiyeoba, Oluwatosin

    2015-01-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed Central

    Alkhalili, Eyas; Berber, Eren

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  10. Radio frequency leakage current from unipolar laparoscopic electrocoagulators.

    PubMed

    DiNovo, J A

    1983-09-01

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

  11. SYSTEM FOR LAPAROSCOPIC TISSUE TRACKING Darin Knaus1

    E-print Network

    Miga, Michael I.

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

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

    PubMed Central

    Almulaifi, Abdullah; Mohammad, Waleed M.

    2013-01-01

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

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

    PubMed

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

    2005-11-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Manatakis, Dimitrios K; Georgopoulos, Nikolaos

    2014-01-01

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

  16. Magnetic link design for a robotic laparoscopic camera

    NASA Astrophysics Data System (ADS)

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

    2010-05-01

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

  17. Laparoscopic Transhiatal Esophagectomy at a Low-Volume Center

    PubMed Central

    Price, Phillip

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    E-print Network

    Faloutsos, Petros

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

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

    PubMed Central

    Lin, Chiuhsiang Joe

    2013-01-01

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

  1. Prevalence of Helicobacter pylori in patients with gall stones before and after cholecystectomy: a longitudinal study.

    PubMed Central

    Farsakh, N A; Roweily, E; Steitieh, M; Butchoun, R; Khalil, B

    1995-01-01

    Fifty six patients with gall stones were enrolled in this study to assess the presence of Helicobacter pylori in gastric mucosa before and after cholecystectomy. Samples were taken from gastric juice and antral mucosa through endoscopy performed on these patients before and after the operation. Gastric juice was examined for bile salt concentration as an indicator of duodenogastric reflux. Antral mucosa was studied for the presence of H pylori and inflammatory response. Duodenogastric reflux was significantly increased (p < 0.001) and H pylori significantly decreased (p < 0.01) in the postoperative period. Mucosal inflammation and its activity were less in the postoperative period but the differences did not reach statistically significant values. PMID:7797115

  2. Duodenogastric reflux, histology and cell proliferation of the gastric mucosa before and six months after cholecystectomy.

    PubMed

    Lorusso, D; Pezzolla, F; Linsalata, M; Caruso, M L; Giorgio, P; Guerra, V; Misciagna, G; Piccioli, E; Di Leo, A

    1995-01-01

    In order to evaluate the effects that an increase in duodenogastric reflux (DGR) has on the mucosal cell proliferation of the non-operated stomach, we made a prospective study on 13 patients (9 female and 4 male, mean age 52 years) both before and 6 months after cholecystectomy, an operation which determines a significant increase in DGR with an intact pyloric sphincter. DGR was evaluated by measuring total intragastric bile acids (dosed by an enzymatic method), and single intragastric bile acids (dosed by High Performance Liquid Chromatography) and it was expressed as Fasting Bile Reflux (FBR) in mumol/h. Gastric cell proliferation was evaluated by measuring (by High Performance Liquid Chromatography) polyamine (putrescine, spermidine and spermine) levels in biopsy specimens taken from the antrum and gastric body. The histology of the antrum and gastric body was also evaluated. After cholecystectomy, there was a significant increase in DGR (delta = 39.23 mumol/h, 95% C.L. 11.69-136.22, sign-test for matched pairs p = 0.0003). The tissue concentration of putrescine in the antrum increased significantly (delta = 8.36 mumol/g of tissue, 95% C.L. 0.34-18.01, sign-test for matched pairs p = 0.013) and there was a worsening of histological findings in the antrum (preoperative chronic atrophic gastritis rate 38.5%, postoperative 69%). In the body there were no significant variations either in polyamine levels or in histology. The increase in DGR and in putrescine concentrations in the antrum were associated negatively (Spearman's rank -0.64, 95% C.L. -0.88 to -0.14).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7604668

  3. The Risk of Depression in Patients With Cholelithiasis Before and After Cholecystectomy

    PubMed Central

    Shen, Te-Chun; Lai, Hsueh-Chou; Huang, Yu-Jhen; Lin, Cheng-Li; Sung, Fung-Chang; Kao, Chia-Hung

    2015-01-01

    Abstract The association between cholelithiasis and depression remains unclear. We examined the risk of depression in patients with cholelithiasis. From the National Health Insurance population claims data of Taiwan, we identified 14071 newly diagnosed cholelithiasis patients (4969 symptomatic and 9102 asymptomatic) from 2000 to 2010. For each cholelithiasis patient, 4 persons without cholelithiasis were randomly selected in the control cohort from the general population frequency matched by age, sex, and diagnosis year. Both cohorts were followed up until the end of 2011 to monitor the occurrence of depression. Adjusted hazard ratios (aHRs) of depression were estimated using the Cox proportional hazards model after controlling for age, sex and comorbidities. The overall incidence rates of depression were 1.87- and 1.83-fold greater in the symptomatic and asymptomatic cholelithiasis subcohorts than in the control cohort (incidence, 10.1 and 9.96 vs 5.43 per 1000 person-years, respectively). The multivariable Cox proportional hazards regression analysis revealed higher variable-specific aHRs in women than in men, in younger patients than in older patients, and in those without comorbidities than in those with any comorbidity. Cholecystectomy reduced the hazard of developing depression with aHRs of 0.79 (95% confidence interval [CI] 0.62–0.99) for symptomatic cholelithiasis patients and 0.76 (95% CI 0.60–0.96) for asymptomatic patients. Patients with cholelithiasis are at a higher risk of developing depression than the general population. Patients could be benefited from cholecystectomy and have the hazard of developing depression significantly reduced. PMID:25761193

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

    PubMed

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

    1998-05-01

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

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

    PubMed Central

    Postlewait, Lauren M.

    2015-01-01

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

  6. Laparoscopic Cerclage as a Treatment Option for Cervical Insufficiency

    PubMed Central

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

    2015-01-01

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

  7. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis

    PubMed Central

    Choi, Kui Sun; Choi, Sae Byeol; Park, Pyoungjae; Kim, Wan Bae; Choi, Sang Yong

    2015-01-01

    AIM: To perform a systematic review of incidental or unsuspected gallbladder (GB) cancer diagnosed during or after cholecystectomy. METHODS: Data in PubMed, EMBASE, and Cochrane Library were reviewed and 26 publications were included in the meta-analysis. The inclusion criterion for incidental GB cancer was GB cancer diagnosed during or after cholecystectomy that was not suspected at a preoperative stage. Pooled proportions of the incidence, distribution of T stage, and revisional surgery of incidental GB cancer were analyzed. RESULTS: The final pooled population comprised 2145 patients with incidental GB cancers. Incidental GB cancers were found in 0.7% of cholecystectomies performed for benign gallbladder diseases on preoperative diagnosis (95%CI: 0.004-0.012). Nearly 50% of the incidental GB cancers were stage T2 with a pooled proportion of 47.0% (95%CI: 0.421-0.519). T1 and T3 GB cancers were found at a similar frequency, with pooled proportions of 23.0% (95%CI: 0.178-0.291) and 25.1% (95%CI: 0.195-0.317), respectively. The pooled proportion that completed revisional surgery for curative intent was 40.9% (95%CI: 0.329-0.494). The proportion of patients with unresectable disease upon revisional surgery was 23.0% (95%CI: 0.177-0.294). CONCLUSION: A large proportion of incidental GB cancers were T2 and T3 lesions. Revisional surgery for radical cholecystectomy is warranted in T2 and more advanced cancers. PMID:25632207

  8. 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2012-04-01

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

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

    PubMed

    Reddy, Mallikarjun N; Nerli, Rajendra B

    2015-02-01

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

  12. Immersive training and mentoring for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

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

    2007-04-01

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

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

    PubMed Central

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

    2014-01-01

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

  14. Three Trocars Laparoscopic Resection of Angiomyolipoma of the Liver

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2011-01-01

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

  16. Laparoscopic repair of recurrent lateral enterocele and rectocele.

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  18. Robot-assisted laparoscopic urological surgery in children.

    PubMed

    Sávio, Luís F; Nguyen, Hiep T

    2013-11-01

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

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

    PubMed Central

    Godazandeh, Gholamali; Mortazian, Meysam

    2012-01-01

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

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

    PubMed

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

    2015-05-01

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

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

    PubMed

    Mueller, W

    1993-04-01

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

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

    PubMed Central

    Ha, Gi Won; Lee, Min Ro

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  4. Laparoscopic versus open resection of gastric gastrointestinal stromal tumors

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2015-10-01

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

  6. Towards real-time remote processing of laparoscopic video

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  7. Laparoscopic Gastric Plication in the Morbidly Obese Adolescent Patient

    PubMed Central

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

    2014-01-01

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

  8. Endoscopic Web Localization for Laparoscopic Duodenal Web Excision.

    PubMed

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

    2015-12-01

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

  9. Fertility Considerations in Laparoscopic Treatment of Infiltrative Bowel Endometriosis

    PubMed Central

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

    2005-01-01

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

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

    PubMed

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

    2015-12-01

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

  11. Speech recognition for embedded automatic positioner for laparoscope

    NASA Astrophysics Data System (ADS)

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

    2014-07-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-10-14

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

  14. Barbed Suture for Vaginal Cuff Closure in Laparoscopic Hysterectomy

    PubMed Central

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

    2014-01-01

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

  15. Laparoscopic right hepatectomy for hepatocellular carcinoma in cirrhotic patient

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Shapovalova, Yu A

    2015-08-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    E-print Network

    Alberta, University of

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

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

    PubMed Central

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

    2000-01-01

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

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

    PubMed

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

    2009-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2010-01-01

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

  3. A prospective study on duodenogastric reflux and on histological changes in gastric mucosa after cholecystectomy.

    PubMed

    Lorusso, D; Pezzolla, F; Cavallini, A; Messa, C; Giorgio, P; Caruso, M L; Piccioli, E; Guerra, V; Misciagna, G

    1992-01-01

    The authors carried out a prospective study to evaluate variations with time in postcholecystectomy duodenogastric reflux (expressed as "fasting bile reflux" in mumol/h) and in gastric mucosal damage. Ten patients underwent (before cholecystectomy, 6 months after surgery and after a median period of 4 years from surgery) a gastric drainage to assess total (enzymatic method) and single (high performance liquid chromatography) intragastric bile acids, and a gastroscopy with biopsies of the antrum and gastric body to assess histological damage to the mucosa. The results showed that there was a progressive increase in the fasting bile reflux of total bile acids with time (precholecystectomy median value 0.295 mumol/h; 6 mo