Splenectomy

MedlinePlus

... a tiny video camera and special surgical tools (laparoscopic splenectomy). With this type of surgery, you may ... begins the surgery using either a minimally invasive (laparoscopic) or open (traditional) procedure. The method used often ...

A rare case of post-splenectomy gastric volvulus managed by laparoscopic anterior gastropexy

PubMed Central

Gupta, Rahul Amreesh; Das, Rinki; Verma, Ganga Ram

2017-01-01

We report an extremely rare case of recurrent gastric volvulus after open splenectomy for hereditary spherocytosis. The initial episode was managed by endoscopic derotation. Later, for recurrent symptoms, she was successfully managed by laparoscopic anterior gastropexy. PMID:28281486

First experience with single incision laparoscopic surgery in Slovakia: concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis.

PubMed

Cingel, Vladimir; Zabojnikova, Lenka; Kurucova, Patricia; Varga, Ivan

2014-09-01

Hereditary spherocytosis is an autosomal dominant inheritance disorder of the red blood cell membrane characterized by the presence of spherical-shaped erythrocytes (spherocytes) in the peripheral blood. The main clinical features include haemolytic anemia, variable jaundice, splenomegaly and cholelithiasis caused by hyperbilirubinemia from erythrocyte hemolysis. Splenectomy does not solve the congenital genetic defect but it stops pathological hemolysis in the enlarged spleen. If gallstones are present, it is appropriate to perform cholecystectomy at the time of splenectomy, although the patient has symptoms of gall bladder disease. We present the case of single incision laparoscopic surgical (SILS) concomitant splenectomy and cholecystectomy performed with conventional laparoscopic instruments in an 11-year-old girl with the diagnosis of hereditary spherocytosis. A 2-3 cm umbilical incision was used for the placement of two 5 mm trocars and one 10 mm flexible videoscope. Conventional laparoscopic dissector, grasper, Ligasure, Harmonic Ace and hemoclips were the main tools during surgical procedure. We prefer Single Incision Laparoscopic Surgery Foam Port (Covidien) as the single umbilical device for introduction into the abdominal cavity. First, we performed cholecystectomy, then the gallbladder was put aside over the liver and after that we peformed splenectomy. To remove the detached spleen and gallbladder, a nylon extraction bag is introduced through one of the port sites. The spleen is than morcellated in the bag with forceps and removed in fragments. After that we removed them and the umbilical fascial incision was closed. Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Our experience shows that SILS splenectomy and cholecystectomy is feasible even in young children and

Hand-Assisted Laparoscopic Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma

PubMed Central

Palese, Michael A.; Ng, Casey K.; Boorjian, Stephen A.; Scherr, Douglas S.; Del Pizzo, Joseph J.; Sosa, R. Ernest

2006-01-01

Objective: We report our experience with hand-assisted laparoscopic nephroureterectomy (HALN) for upper urinary tract transitional cell carcinoma and compare our results with a contemporary series of open nephroureterectomy (ON) performed at our institution. Methods: Between August 1996 and May 2003, 90 patients underwent nephroureterectomy for upper-tract transitional cell carcinoma (TCC). Thirty-eight patients underwent HALN, while 52 had an ON. End-points of comparison included operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of hospital stay, pathologic grade and stage of tumor, and tumor recurrence. Results: The mean patient age was 72.3 and 70.6 years in the ON and HALN groups, respectively. Mean operative duration was 243 minutes (ON) and 244 minutes (HALN), with an EBL of 478mL in the open group versus 191mL in the hand-assisted group (P<0.001). No intraoperative complications occurred, but postoperative complications occurred in 4% and 11% of the ON and HALN groups, respectively (P=0.21). The mean hospital duration was 7.1 days (ON) versus 4.6 days (HALN) (P<0.01). No difference existed in the pathologic grade or stage distribution of urothelial tumors between the 2 groups. The mean follow-up was 51.0 months in the ON group and 31.7 months in the HALN group. Recurrence of urothelial carcinoma occurred in 50% of patients who underwent ON and 40% treated by HALN (P=0.38) at a median interval of 9.1 and 7.7 months, respectively, after surgery. Conclusion: Hand-assisted laparoscopic nephroureterectomy is an effective modality for the treatment of upper urinary tract urothelial carcinoma. Patients benefited from less intraoperative blood loss and a shorter hospitalization with an equivalent intermediate-term oncologic outcome compared with that of the open approach. PMID:17575752

Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes.

PubMed

Nakata, Kohei; Nagai, Eishi; Ohuchida, Kenoki; Shimizu, Shuji; Tanaka, Masao

2015-07-01

Since its widespread acceptance for the treatment of early gastric cancer, laparoscopic gastrectomy has been gaining popularity as a treatment option for advanced gastric cancer. However, laparoscopic total gastrectomy (LTG) with splenectomy is seldom performed, because of its difficulty of removal of station 10 lymph nodes; splenectomy is technically essential for complete removal of these lymph nodes. The purpose of this study was to describe the details of the LTG procedure and to evaluate the short- and long-term outcomes of LTG with splenectomy. Of 725 consecutive patients with gastric cancer who underwent laparoscopic gastrectomy with lymph node dissection in our institution from January 1996 to December 2012, 18 consecutive patients who underwent LTG with splenectomy were enrolled in this study. No operative mortality occurred, and the pathological margins were free from cancer cells in all patients. The mean operation time was 388 min (range 324-566 min). The mean volume of blood loss was 45 ml (range 5-347 ml), and the mean number of dissected lymph nodes was 51 (range 40-105). Postoperative morbidity occurred in six patients (33.3%) (each with grade B postoperative pancreatic fistula, postoperative bleeding, chylous ascites, atelectasis, ileus, and intra-abdominal infection). Five patients (27.8%) developed recurrence (four in the peritoneum and one in the liver), and the overall 3- and 5-year survival rates were 83.0 and 72.6%, respectively. Considering the 0% mortality rate and low rates of postoperative morbidity and locoregional recurrence, LTG with splenectomy is technically and oncologically acceptable. This procedure can be expanded to include advanced gastric cancer, which generally requires splenectomy for lymph node dissection.

Hand-assisted laparoscopic versus robot-assisted laparoscopic partial nephrectomy: comparison of short-term outcomes and cost.

PubMed

Elsamra, Sammy E; Leone, Andrew R; Lasser, Michael S; Thavaseelan, Simone; Golijanin, Dragan; Haleblian, George E; Pareek, Gyan

2013-02-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) have become standard for the surgical management of small renal masses (SRMs). However, no studies have evaluated the short-term outcomes or cost of RALPN as compared with hand-assisted laparoscopic partial nephrectomy (HALPN) in a standardized fashion. A retrospective review of all patients who underwent HALPN or RALPN from 2006 to 2010 were assessed for patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, radiographic tumor size, nephrometry (radius, endo/exophytic, nearness to collecting system, anterior/posterior, lines of polarity [RENAL]) scores, operative and room times, hospital length of stay (LOS), estimated blood loss (EBL), requirement of hilar vessel clamping, warm ischemia time (WIT), pre- and postprocedural creatinine and hemoglobin levels, and complications. Total costs of the procedures were estimated based on operating room component (operative staff time, anesthesia, and supply) and hospital stay cost (room and board, pharmacy). A robotic premium cost, estimated based on the yearly overall cost of the da Vinci S surgical system divided by the annual number of cases, was included in the RALPN cost. Cost figures were obtained from hospital administration and applied to the mean HALPN and RALPN patient. Forty-seven patients underwent HALPN since 2006 and 21 patients underwent RALPN since 2008. ASA, BMI, EBL, tumor size, nephrometry score, positive margin rate, change in creatinine, change in hemoglobin, morphine equivalents used, and complication rate were all similar in both groups (p>0.05). Room time and operative time were significantly shorter for the HALPN cohort (p=0.001) whereas LOS was significantly shorter in the RALPN cohort (p=0.019). Despite the shorter LOS, RALPN was associated with a $1165 increased cost, mainly due to increased operating room time and premium cost of the robot. While early in our

Renal artery aneurysm in hand-assisted laparoscopic donor nephrectomy: case report.

PubMed

Maciel, R F; Branco, A J; Branco, A W; Guterres, J C; Silva, A E; Ramos, L B; Rost, C; Vieira, C A; Cicogna, P E S; Daudt, C A; Deboni, L M; Vieira, M A; Luz, H A; Vieira, J A

2003-12-01

We report a living donor who underwent laparoscopic nephrectomy using a hand-assisted device (HALD). At preoperative arteriography the donor showed a renal artery aneurysm. The patient was a 37-year-old female, 166 cm height, white, weighing 87 kg, HLA identical to the recipient. HALD was indicated due to the better visualization of renal pedicle and greater security in an obese patient. Renal artery aneurysm is a rare condition, with many possible complications. The method proved to be adequate and safe for donor nephrectomy, despite a renal artery aneurysm.

Laparoscopic splenectomy in pediatric age: long-term follow-up.

PubMed

Ates, Ufuk; Tastekin, Nil Y; Gollu, Gulnur; Ergun, Ergun; Yagmurlu, Aydin

2017-12-01

In the last century, with the advancement of the diagnostic procedures, hematologic disorders in pediatric age group have been increased dramatically. In parallel with this increase, splenectomy procedures have also been popularized with different techniques and surgical outcomes. Laparoscopic splenectomy (LS) in the pediatric age group is generally accepted as a technically demanding procedure, which needs experience. The purpose of this study is to present the long-term follow-up results of a case series of children who underwent LS for a variety of hematologic disorders, evaluate possible complications and outcomes. All patients who were admitted to the clinic and who were scheduled for LS from 2005 to 2016 were considered for this study. The study parameters were grouped in four categories including socio-demographic data, preoperative evaluation, clinical follow-up and complications. There were 24 male (48.9%) and 25 (51.1%) female patients. The median age and body weight for the study group was 12 years and 35 kg. Most common indications for LS were thalassemia (13; 26.5%) and hereditary spherocytosis (12; 24.4%). As a technical standpoint, 2 patients (4%) underwent singleport LS surgery. The mean time for LS surgeries was found as 80 minutes. The total intraoperative complication rate was 4% (2/57). The mean time for hospital stay was 5 days. Mean follow-up period was 6.4 years (range: 6 months-16 years). There was no long-term complication. Bilirubin levels and need for blood transfusion significantly decreased in the long term follow-up period (p <0.05). LS is a powerful tool in the hands of an experienced surgeon. It's a safe and effective procedure in children with hematologic disorders resulting in shorter length of stay and lower complication rates. Sociedad Argentina de Pediatría

Hand-Assisted Laparoscopic (HAL) Multiple Segmental Colorectal Resections: Are They Feasible and Safe?

PubMed

Taggarshe, Deepa; Attuwaybi, Bashir O; Matier, Brian; Visco, Jeffrey J; Butler, Bryan N

2015-04-01

The objective of this study was to evaluate the short-term outcomes of synchronous hand-assisted laparoscopic (HAL) segmental colorectal resections. The surgical options for synchronous colonic pathology include extensive colonic resection with single anastomosis, multiple synchronous segmental resections with multiple anastomoses, or staged resections. Traditionally, multiple open, synchronous, segmental resections have been performed. There is a lack of data on HAL multiple segmental colorectal resections. A retrospective chart review was compiled on all patients who underwent HAL synchronous segmental colorectal resections by all the colorectal surgeons from our Group during the period of 1999 to 2014. Demographics, operative details, and short-term outcomes are reported. During the period, 9 patients underwent HAL synchronous multiple segmental colorectal resections. There were 5 women and 4 men, with median age of 54 (24-83) years and median BMI of 24 (19.8-38.7) kg/m(2). Two patients were on long-term corticosteroid therapy. The median operative time was 210 (120-330) minutes and median operative blood loss was 200 (75-300) mLs. The median duration for return of bowel function was 2 days and the median length of stay was 3.5 days. We had 2 minor wound infections. There were no deaths. Synchronous segmental colorectal resections with anastomoses using the hand-assisted laparoscopic technique are safe. Early conversion to open and use of stomas are advisable in challenging cases.

A novel hand-assisted laparoscopic versus conventional laparoscopic right hemicolectomy for right colon cancer: study protocol for a randomized controlled trial.

PubMed

Yang, Xuyang; Wu, Qingbin; Jin, Chengwu; He, Wanbin; Wang, Meng; Yang, Tinghan; Wei, Mingtian; Deng, Xiangbing; Meng, Wenjian; Wang, Ziqiang

2017-07-26

Although conventional laparoscopic and hand-assisted laparoscopic surgery for colorectal cancer is widely used today, there remain many technical challenges especially for right colon cancer in obese patients. Herein, we develop a novel hand-assisted laparoscopic surgery (HALS) with complete mesocolic excision (CME), D3 lymphadenectomy, and a total "no-touch" isolation technique (HALS-CME) in right hemicolectomy to overcome these issues. According to previous clinic practice, this novel procedure is not only feasible and safe but has several technical merits. However, the feasibility, short-term minimally invasive virtues, long-term oncological superiority, and potential total "no-touch" isolation technique benefits of HALS-CME should be confirmed by a prospective randomized controlled trial. This is a single-center, open-label, noninferiority, randomized controlled trial. Eligible participants will be randomly assigned to the HALS-CME group or to the laparoscopic surgery with CME, D3 lymphadenectomy, and total "no-touch" isolation technique (LAP-CME) group, or to conventional laparoscopic surgery with CME and D3 lymphadenectomy (cLAP) group at a 1:1:1 ratio using a centralized randomization list. Primary endpoints include safety, efficacy, and being oncologically clear, and 3-year disease-free, progression-free, and overall survival. Second endpoints include operative outcomes (operation time, blood loss, and incision length), pathologic evaluation (grading the plane of surgery, length of proximal and distal resection margins, distance between the tumor and the central arterial high tie, distance between the nearest bowel wall and the same high tie, area of mesentery resected, width of the chain of lymph-adipose tissue, length of the central lymph-adipose chain, number of harvested lymph nodes), and postoperative outcomes (pain intensity, postoperative inflammatory and immune responses, postoperative recovery). This trial will provide valuable clinical evidence

Single-site multiport combined splenectomy and cholecystectomy with conventional laparoscopic instruments: Case series and review of literature

PubMed Central

Ozemir, Ibrahim Ali; Bayraktar, Baris; Bayraktar, Onur; Tosun, Salih; Bilgic, Cagri; Demiral, Gokhan; Ozturk, Erman; Yigitbasi, Rafet; Alimoglu, Orhan

2015-01-01

Introduction Conventional laparoscopic procedures have been used for splenic diseases and concomitant gallbladder stones, frequently in patients with hereditary spherocytosis since 1990’s. The aim of this study is to evaluate the feasibility of single-site surgery with conventional instruments in combined procedures. Presentation of case series Six consecutive patients who scheduled for combined cholecystectomy and splenectomy because of hereditary spherocytosis or autoimmune hemolytic anemia were included this study. Both procedures were performed via trans-umbilical single-site multiport approach using conventional instruments. All procedures completed successfully without conversion to open surgery or conventional laparoscopic surgery. An additional trocar was required for only one patient. The mean operation time was 190 min (150–275 min). The mean blood loss was 185 ml (70–300 ml). Median postoperative hospital stay was two days. No perioperative mortality or major complications occurred in our series. Recurrent anemia, hernia formation or wound infection was not observed during the follow-up period. Discussion Nowadays, publications are arising about laparoscopic or single site surgery for combined diseases. Surgery for combined diseases has some difficulties owing to the placement of organs and position of the patient during laparoscopic surgery. Single site laparoscopic surgery has been proposed to have better cosmetic outcome, less postoperative pain, greater patient satisfaction and faster recovery compared to standard laparoscopy. Conclusion We consider that single-site multiport laparoscopic approach for combined splenectomy and cholecystectomy is a safe and feasible technique, after gaining enough experience on single site surgery. PMID:26708949

Hand-assisted laparoscopic repair of a grade IV rectal tear in a postparturient mare.

PubMed

Stewart, Suzanne G; Johnston, Janet K; Parente, Eric J

2014-10-01

An 8-year-old multiparous Thoroughbred broodmare was admitted for evaluation of a rectal tear sustained during parturition. On initial evaluation, the mare had mild signs of abdominal discomfort. A full-thickness rectal tear located 30 cm cranial to the anus and extending approximately 15 cm longitudinally along the surface of the small colon between the 4 and 6 o'clock positions, when viewed from behind, was diagnosed on examination per rectum. Laparoscopic evaluation of the abdomen was performed to assess the tear and extent of peritoneal contamination. A hand-assisted repair via a flank incision was performed. The tear was closed in a single-layer, simple continuous pattern with size-0 polydioxanone with a handheld needle holder. Subsequently, a ventral midline celiotomy was performed, and intestinal contents were evacuated via a pelvic flexure enterotomy and a typhlotomy. Following surgery, the mare was managed with IV fluid therapy, partial parenteral nutrition, antimicrobials, and NSAIDs for 5 to 7 days before being gradually reintroduced to a complete pelleted feed and alfalfa hay. Prior to discharge, examination per rectum revealed no stricture formation associated with repair. The mare was discharged from the hospital and performed successfully as a broodmare, with the delivery of a live foal 1 year after surgery. Successful repair with an excellent outcome was achieved in this mare. Hand-assisted laparoscopic repair should be considered as a possible treatment option in horses with grade IV rectal tears.

[Robotic splenectomy--a personal view].

PubMed

Vasilescu, C

2010-01-01

Until now 40 robotic splenectomies were performed in our department, the first case being done on February 25, 2008. Our data show that robotic splenectomy with the DaVinci surgical system is technically feasible and safe, with good results and without complications. The main advantages are a better tridimensional view and an increased versatility of the surgical instruments. The DaVinci system allows an accurate dissection around the splenic hilum and preservation of the splenic remnant vessels in partial splenectomy. Robotic splenectomy will probably not replace the laparoscopic splenectomy for the most common indications like ITP, hemolytic anemia. It may be a very useful surgical tool in difficult splenectomy: partial splenectomy, splenectomy in liver cirrhosis, splenic tumors or malignant hemopathies. In these cases the robotic approach may shorten the operative time, decrease the blood loss and the risk of remorrhagic complications during surgery and even make possible a minimally invasive splenectomy very difficult to be performed by classical laparoscopy.

Hand-assisted versus straight laparoscopic sigmoid colectomy on a training simulator: what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator.

PubMed

Leblanc, Fabien; Delaney, Conor P; Ellis, Clyde N; Neary, Paul C; Champagne, Bradley J; Senagore, Anthony J

2010-12-01

We hypothesized that simulator-generated metrics and intraoperative errors may be able to differentiate the technical differences between hand-assisted laparoscopic (HAL) and straight laparoscopic (SL) approaches. Thirty-eight trainees performed two laparoscopic sigmoid colectomies on an augmented reality simulator, randomly starting by a SL (n = 19) or HAL (n = 19) approach. Both approaches were compared according to simulator-generated metrics, and intraoperative errors were collected by faculty. Sixty-four percent of surgeons were experienced (>50 procedures) with open colon surgery. Fifty-five percent and 69% of surgeons were inexperienced (<10 procedures) with SL and HAL colon surgery, respectively. Time (P < 0.001), path length (P < 0.001), and smoothness (P < 0.001) were lower with the HAL approach. Operative times for sigmoid and splenic flexure mobilization and for the colorectal anastomosis were significantly shorter with the HAL approach. Time to control the vascular pedicle was similar between both approaches. Error rates were similar between both approaches. Operative time, path length, and smoothness correlated directly with the error rate for the HAL approach. In contrast, error rate inversely correlated with the operative time for the SL approach. A HAL approach for sigmoid colectomy accelerated colonic mobilization and anastomosis. The difference in correlation between both laparoscopic approaches and error rates suggests the need for different skills to perform the HAL and the SL sigmoid colectomy. These findings may explain the preference of some surgeons for a HAL approach early in the learning of laparoscopic colorectal surgery.

Robot-assisted general surgery.

PubMed

Hazey, Jeffrey W; Melvin, W Scott

2004-06-01

With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

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

PubMed

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

2013-06-01

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

Robot-assisted laparoscopic ultrasonography for hepatic surgery.

PubMed

Schneider, Caitlin M; Peng, Peter D; Taylor, Russell H; Dachs, Gregory W; Hasser, Christopher J; DiMaio, Simon P; Choti, Michael A

2012-05-01

This study describes and evaluates a novel, robot-assisted laparoscopic ultrasonographic device for hepatic surgery. Laparoscopic liver surgery is being performed with increasing frequency. One major drawback of this approach is the limited capability of intraoperative ultrasonography (IOUS) using standard laparoscopic devices. Robotic surgery systems offer the opportunity to develop new tools to improve techniques in minimally invasive surgery. This study evaluates a new integrated ultrasonography (US) device with the da Vinci Surgical System for laparoscopic visualization, comparing it with conventional handheld laparoscopic IOUS for performing key tasks in hepatic surgery. A prototype laparoscopic IOUS instrument was developed for the da Vinci Surgical System and compared with a conventional laparoscopic US device in simulation tasks: (1) In vivo porcine hepatic visualization and probe manipulation, (2) lesion detection accuracy, and (3) biopsy precision. Usability was queried by poststudy questionnaire. The robotic US proved better than conventional laparoscopic US in liver surface exploration (85% success vs 73%; P = .030) and tool manipulation (79% vs 57%; P = .028), whereas no difference was detected in lesion identification (63 vs 58; P = .41) and needle biopsy tasks (57 vs 48; P = .11). Subjects found the robotic US to facilitate better probe positioning (80%), decrease fatigue (90%), and be more useful overall (90%) on the post-task questionnaire. We found this robot-assisted IOUS system to be practical and useful in the performance of important tasks required for hepatic surgery, outperforming free-hand laparoscopic IOUS for certain tasks, and was more subjectively usable to the surgeon. Systems such as this may expand the use of robotic surgery for complex operative procedures requiring IOUS. Copyright © 2012 Mosby, Inc. All rights reserved.

Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level II vena cava thrombus.

PubMed

Kovac, Jason R; Luke, Patrick P

2010-01-01

Excision of renal cell carcinoma (RCC) with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.

Results after laparoscopic partial splenectomy for children with hereditary spherocytosis: Are outcomes influenced by genetic mutation?

PubMed

Pugi, Jakob; Carcao, Manuel; Drury, Luke J; Langer, Jacob C

2018-05-01

Laparoscopic partial splenectomy (LPS) theoretically maintains long-term splenic immune function for children with hereditary spherocytosis (HS). Our goal was to review our results after LPS and to determine if specific genetic mutations influence outcome. All children with HS undergoing LPS between 2005 and 2016 were reviewed. Thirty-one children underwent LPS (16 male) at a median age of 9 (range 2-18) years. All experienced an increase in hemoglobin and decrease in reticulocyte count early after LPS and at last follow-up. Twenty-two were sent for genetic analysis. Mutations in α-spectrin, β-spectrin, and Ankyrin were identified in 6, 5, and 11 patients, respectively. Gene mutation was not correlated with complications, perioperative transfusion, length of hospital stay, or median hemoglobin, platelet, or reticulocyte counts. Three children required completion splenectomy at 10.9, 6.9, and 3.2years post-LPS, each with a different gene mutation. LPS is effective in reversing anemia and reducing reticulocytosis. So far less than 10% have required completion splenectomy, and those children did benefit from delaying the risks of asplenia. In this preliminary analysis, genetic mutation did not influence outcome after LPS. A larger multicenter study is necessary to further investigate potential correlations with specific genetic mutations. Prognosis Study. IV. Copyright © 2018. Published by Elsevier Inc.

Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report.

PubMed

Taniguchi, Yoshiki; Takahashi, Tsuyoshi; Nakajima, Kiyokazu; Higashi, Shigeyoshi; Tanaka, Koji; Miyazaki, Yasuhiro; Makino, Tomoki; Kurokawa, Yukinori; Yamasaki, Makoto; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

2017-12-01

Epiphrenic esophageal diverticulum is a rare condition that is often associated with a concomitant esophageal motor disorder. Some patients have the chief complaints of swallowing difficulty and gastroesophageal reflux; traditionally, such diverticula have been resected via right thoracotomy. Here, we describe a case with huge multiple epiphrenic diverticula with motility disorder, which were successfully resected using a video-assisted thoracic and laparoscopic procedure. A 63-year-old man was admitted due to dysphagia, heartburn, and vomiting. An esophagogram demonstrated an S-shaped lower esophagus with multiple epiphrenic diverticula (75 × 55 mm and 30 × 30 mm) and obstruction by the lower esophageal sphincter (LES). Esophageal manometry showed normal peristaltic contractions in the esophageal body, whereas the LES pressure was high (98.6 mmHg). The pressure vector volume of LES was 23,972 mmHg 2  cm. Based on these findings, we diagnosed huge multiple epiphrenic diverticula with a hypertensive lower esophageal sphincter and judged that resection might be required. We performed lower esophagectomy with gastric conduit reconstruction using a video-assisted thoracic and hand-assisted laparoscopic procedure. The postoperative course was uneventful, and the esophagogram demonstrated good passage, with no leakage, stenosis, or diverticula. The most common causes of mid-esophageal and epiphrenic diverticula are motility disorders of the esophageal body; appropriate treatment should be considered based on the morphological and motility findings.

Karolinska prostatectomy: a robot-assisted laparoscopic radical prostatectomy technique.

PubMed

Nilsson, Andreas E; Carlsson, Stefan; Laven, Brett A; Wiklund, N Peter

2006-01-01

The last decade has witnessed an increasing trend towards minimally invasive management of prostate cancer, including laparoscopic and, more recently, robot-assisted laparoscopic prostatectomy. Several different laparoscopic approaches have been continuously developed during the last 5 years and it is still unclear which technique yields the best outcome. We present our current technique of robot-assisted laparoscopic radical prostatectomy. The technique described has evolved during the course of >400 robotic prostatectomies performed by the robotic team since the robot-assisted laparoscopic radical prostatectomy program was introduced at Karolinska University Hospital in January 2002. Our procedure comprises several modifications of previously reported ones, and we utilize fewer robotic instruments to reduce costs. An extended posterior dissection is performed to aid in the bladder neck-sparing dissection. In nerve-sparing procedures the vesicles are divided to avoid damage to the erectile nerves. In order to preserve the apical anatomy the dorsal venous complex is incised sharply and is first over-sewn after the apical dissection is completed. Our technique enables a more fluent dissection than previously described robotic techniques. Minimizing changes of instruments and the camera not only cuts costs but also reduces inefficient operating maneuvers, such as switching between 30 degrees and 0 degrees lenses during the procedure. We present a technique which in our hands has achieved excellent functional and oncological results.

Extraperitoneal colostomy in laparoscopic abdominoperineal resection using a hand inserted from the perineal side.

PubMed

Shiraishi, Takuya; Tomizawa, Naoki; Ando, Tatsumasa; Arakawa, Kazuhisa; Kobayashi, Katsumi; Muroya, Ken; Kurosaki, Ryo; Sato, Hiroaki; Suto, Yuji; Kato, Ryuji; Ozawa, Naoya; Sunose, Yutaka; Takeyoshi, Izumi

2014-01-01

Extraperitoneal colostomy is considered to be more effective at preventing post-colostomy complications than intraperitoneal colostomy. However, this operation is difficult via laparoscopic surgery alone. We present an extraperitoneal colostomy technique using a hand inserted from the perineal side. Extraperitoneal colostomy was performed in five patients. After the rectum was resected, a hand was inserted into the abdominal cavity from the perineal side, and pneumoperitoneum was created. The peritoneum was dissected to make the extraperitoneal route, and the proximal colon was passed along this route with fingers and laparoscopic manipulation. All procedures were completed without tissue damage or hemorrhage. No patient developed a hernia or ileus postoperatively. Laparoscopic abdominoperineal resection for an extraperitoneal colostomy is difficult via laparoscopic ports only. It can be simplified by operating with manual assistance via the perineal wound. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Laparosopic hand-assisted living donor nephrectomy: the Niguarda experience.

PubMed

Maione, G; Sansalone, C V; Aseni, P; De Roberto, A; Soldano, S; Mangoni, I; Perrino, L; Minetti, E; Civati, G

2005-01-01

Perioperative donor morbidity, a barrier to living organ donation, may be mitigated by the laparoscopic approach. From September 2002 to September 2004, 15 living donors, of ages ranging from 36 to 59 years, underwent laparoscopic nephrectomy. We used a hand-assisted device to increase the safety of the procedure. The average operating time was 200 minutes. The average blood loss was about 100 mL. The patients resumed oral intake and started walking within 1 day. The average postoperative hospital stay was 6 days. Although laparoscopic operating times were longer than those for traditional surgery, we showed benefits to the laparoscopic donor to be less postoperative pain, better cosmesis, shorter recovery time, and faster return to normal activities. We therefore consider laparoscopic nephrectomy a good alternative to traditional surgery for selected patients. Despite a lack of strong evidence, such as large prospective randomized studies, laparoscopic donor nephrectomy is likely to become the gold standard for donor nephrectomy in the near future.

Hand-to-hand coupling and strategies to minimize unintentional energy transfer during laparoscopic surgery.

PubMed

Overbey, Douglas M; Hilton, Sarah A; Chapman, Brandon C; Townsend, Nicole T; Barnett, Carlton C; Robinson, Thomas N; Jones, Edward L

2017-11-01

Energy-based devices are used in nearly every laparoscopic operation. Radiofrequency energy can transfer to nearby instruments via antenna and capacitive coupling without direct contact. Previous studies have described inadvertent energy transfer through bundled cords and nonelectrically active wires. The purpose of this study was to describe a new mechanism of stray energy transfer from the monopolar instrument through the operating surgeon to the laparoscopic telescope and propose practical measures to decrease the risk of injury. Radiofrequency energy was delivered to a laparoscopic L-hook (monopolar "bovie"), an advanced bipolar device, and an ultrasonic device in a laparoscopic simulator. The tip of a 10-mm telescope was placed adjacent but not touching bovine liver in a standard four-port laparoscopic cholecystectomy setup. Temperature increase was measured as tissue temperature from baseline nearest the tip of the telescope which was never in contact with the energy-based device after a 5-s open-air activation. The monopolar L-hook increased tissue temperature adjacent to the camera/telescope tip by 47 ± 8°C from baseline (P < 0.001). By having an assistant surgeon hold the camera/telescope (rather than one surgeon holding both the active electrode and the camera/telescope), temperature change was reduced to 26 ± 7°C (P < 0.001). Alternative energy devices significantly reduced temperature change in comparison to the monopolar instrument (47 ± 8°C) for both the advanced bipolar (1.2 ± 0.5°C; P < 0.001) and ultrasonic (0.6 ± 0.3°C; P < 0.001) devices. Stray energy transfers from the monopolar "bovie" instrument through the operating surgeon to standard electrically inactive laparoscopic instruments. Hand-to-hand coupling describes a new form of capacitive coupling where the surgeon's body acts as an electrical conductor to transmit energy. Strategies to reduce stray energy transfer include avoiding the same surgeon holding the

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

PubMed Central

Rivier, Pablo; Furneaux, Rob; Viguier, Eric

2011-01-01

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

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

PubMed

Rivier, Pablo; Furneaux, Rob; Viguier, Eric

2011-01-01

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

Robotic-Assisted Versus Laparoscopic Colectomy: Cost and Clinical Outcomes

PubMed Central

Davis, Bradley R.; Yoo, Andrew C.; Moore, Matt

2014-01-01

Background and Objectives: Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Methods: Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Results: Of 25 758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17 445 vs $15 448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Conclusion: Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies. PMID:24960484

Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes.

PubMed

Davis, Bradley R; Yoo, Andrew C; Moore, Matt; Gunnarsson, Candace

2014-01-01

Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Of 25,758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17,445 vs $15,448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies.

Splenectomy for people with thalassaemia major or intermedia.

PubMed

Easow Mathew, Manu; Sharma, Akshay; Aravindakshan, Rajeev

2016-06-14

Thalassaemia is a genetic disease of the haemoglobin protein in red blood cells. It is classified into thalassaemia minor, intermedia and major, depending on the severity of the disease and the genetic defect. Thalassaemia major and intermedia require frequent blood transfusions to compensate for the lack of well-functioning red blood cells, although this need is significantly less in thalassaemia intermedia.Damaged or defective red blood cells are normally eliminated in the spleen. In people with thalassaemia there is a large quantity of defective red blood cells which results in an enlarged hyperfunctioning spleen (splenomegaly). Removal of the spleen may thus prolong red blood cell survival by reducing the amount of red blood cells removed from circulation and may ultimately result in the reduced need for blood transfusions. To assess the efficacy and safety of splenectomy in people with beta-thalassaemia major or intermedia. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Review Group's Haemoglobinopathies Trials Register, compiled from searches of electronic databases and the handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of the most recent search: 25 April 2016. We included randomised controlled studies and quasi-randomised controlled studies of people of any age with thalassaemia major or intermedia, evaluating splenectomy in comparison to conservative treatment (transfusion therapy and iron chelation) or other forms of splenectomy compared to each other (laparoscopic, open, radio-frequency). Two authors independently selected and extracted data from the single included study using a customised data extraction form and assessed the risk of bias. One study, including 28 participants was included in the review; the results were described, primarily, in a narrative manner. The study assessed the feasibility of splenectomy using laparoscopy in comparison to open

Splenectomy reduces packed red cell transfusion requirement in children with sickle cell disease.

PubMed

Haricharan, Ramanath N; Roberts, Jared M; Morgan, Traci L; Aprahamian, Charles J; Hardin, William D; Hilliard, Lee M; Georgeson, Keith E; Barnhart, Douglas C

2008-06-01

The purpose of the study was to measure the effect of splenectomy on packed-cell transfusion requirement in children with sickle cell disease. Thirty-seven sickle cell children who underwent splenectomies between January 2000 and May 2006 at a children's hospital were reviewed. Data were collected 6 months preoperatively to 12 months postsplenectomy. Paired t test, analysis of variance, and multivariable regression analyses were performed. Of 37 children with median age 11 years (range, 2-18 years), 34 (21 males) had data that allowed analyses. Twenty-six had Hgb-SS, 5 had Hgb-SC, and 3 had Hgb S-Thal. Laparoscopic splenectomy was attempted in 36 and completed successfully in 34 (94% success). The number of units transfused decreased by 38% for 0 to 6 months and by 45% for 6 to 12 months postsplenectomy. Postoperatively, hematocrit levels increased and reticulocytes concurrently decreased with a reduction in transfusion clinic visits. The decrease in transfusion was not influenced by spleen weight, age, or hemoglobin type. Two children had acute chest syndrome (6%), and 1 had severe pneumonia (3%). Laparoscopic splenectomy can be successfully completed in sickle cell children. Splenectomy significantly reduces the packed red cell transfusion requirement and frequency of clinic visits, in sickle cell children for at least 12 months postoperatively.

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

PubMed Central

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

2016-01-01

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

Use of Pediatric Open, Laparoscopic and Robot-Assisted Laparoscopic Ureteral Reimplantation in the United States: 2000 to 2012.

PubMed

Bowen, Diana K; Faasse, Mark A; Liu, Dennis B; Gong, Edward M; Lindgren, Bruce W; Johnson, Emilie K

2016-07-01

We characterize the use of pediatric open, laparoscopic and robot-assisted laparoscopic ureteral reimplantation in the United States from 2000 to 2012. We used the Kids' Inpatient Database to identify patients who underwent ureteral reimplantation for primary vesicoureteral reflux. Before 2009 laparoscopic ureteral reimplantion and robot-assisted laparoscopic ureteral reimplantation were referred to together as minimally invasive ureteral reimplantation. A detailed analysis of open vs robot-assisted laparoscopic ureteral reimplantation was performed for 2009 and 2012. A total of 14,581 ureteral reimplantations were performed. The number of ureteral reimplantations yearly decreased by 14.3%. However, the proportion of minimally invasive ureteral reimplantations increased from 0.3% to 6.3%. A total of 125 robot-assisted laparoscopic ureteral reimplantations were performed in 2012 (81.2% of minimally invasive ureteral reimplantations), representing 5.1% of all ureteral reimplantations, compared to 3.8% in 2009. In 2009 and 2012 mean ± SD patient age was 5.7 ± 3.6 years for robot-assisted laparoscopic ureteral reimplantation and 4.3 ± 3.3 years for open reimplantation (p <0.0001). Mean ± SD length of hospitalization was 1.6 ± 1.3 days for robot-assisted laparoscopic ureteral reimplantation and 2.4 ± 2.6 for open reimplantation (p <0.0001). Median charges were $22,703 for open and $32,409 for robot-assisted laparoscopic ureteral reimplantation (p <0.0001). These relationships maintained significance on multivariate analyses. On multivariate analysis robot-assisted laparoscopic ureteral reimplantation use was associated with public insurance status (p = 0.04) and geographic region outside of the southern United States (p = 0.02). Only 50 of 456 hospitals used both approaches (open and robotic), and only 6 hospitals reported 5 or more robot-assisted laparoscopic ureteral reimplantations during 2012. Treatment of primary vesicoureteral reflux with ureteral

Assessment of electrosurgical hand controls integrated into a laparoscopic grasper.

PubMed

Brown-Clerk, Bernadette; Rousek, Justin B; Lowndes, Bethany R; Eikhout, Sandra M; Balogh, Bradley J; Hallbeck, M Susan

2011-12-01

The aim of this study was to quantitatively and qualitatively determine the optimal ergonomic placement of novel electrosurgical hand controls integrated into a standard laparoscopic grasper to optimize functionality. This device will allow laparoscopic surgeons to hand-operate standard electrosurgical equipment, eliminating the use of electrosurgical foot pedals, which are prone to activation errors and cause uncomfortable body positions for the physician. Three hand control designs were evaluated by 26 participants during the performance of four basic inanimate laparoscopic electrosurgical tasks. Task completion time, actuation force, forearm electromyography (EMG) and user preference were evaluated for each hand control design. Task speed was controlled using a metronome to minimize subject variability, and resulted in no significant completion time differences between task types (P > 0.05). Hand control design 1 (CD 1) resulted in the ability to generate significantly greater actuation force for three of the four tasks (P < 0.05) with minimal forearm muscle activation. Additionally, CD 1 was rated significantly better for comfort and ease-of-use compared to the other two hand control designs (P < 0.05). As a result, CD 1 was determined to be an advantageous ergonomic design for the novel electrosurgical hand controls.

Construct validity for eye-hand coordination skill on a virtual reality laparoscopic surgical simulator.

PubMed

Yamaguchi, Shohei; Konishi, Kozo; Yasunaga, Takefumi; Yoshida, Daisuke; Kinjo, Nao; Kobayashi, Kiichiro; Ieiri, Satoshi; Okazaki, Ken; Nakashima, Hideaki; Tanoue, Kazuo; Maehara, Yoshihiko; Hashizume, Makoto

2007-12-01

This study was carried out to investigate whether eye-hand coordination skill on a virtual reality laparoscopic surgical simulator (the LAP Mentor) was able to differentiate among subjects with different laparoscopic experience and thus confirm its construct validity. A total of 31 surgeons, who were all right-handed, were divided into the following two groups according to their experience as an operator in laparoscopic surgery: experienced surgeons (more than 50 laparoscopic procedures) and novice surgeons (fewer than 10 laparoscopic procedures). The subjects were tested using the eye-hand coordination task of the LAP Mentor, and performance was compared between the two groups. Assessment of the laparoscopic skills was based on parameters measured by the simulator. The experienced surgeons completed the task significantly faster than the novice surgeons. The experienced surgeons also achieved a lower number of movements (NOM), better economy of movement (EOM) and faster average speed of the left instrument than the novice surgeons, whereas there were no significant differences between the two groups for the NOM, EOM and average speed of the right instrument. Eye-hand coordination skill of the nondominant hand, but not the dominant hand, measured using the LAP Mentor was able to differentiate between subjects with different laparoscopic experience. This study also provides evidence of construct validity for eye-hand coordination skill on the LAP Mentor.

Multipurpose surgical robot as a laparoscope assistant.

PubMed

Nelson, Carl A; Zhang, Xiaoli; Shah, Bhavin C; Goede, Matthew R; Oleynikov, Dmitry

2010-07-01

This study demonstrates the effectiveness of a new, compact surgical robot at improving laparoscope guidance. Currently, the assistant guiding the laparoscope camera tends to be less experienced and requires physical and verbal direction from the surgeon. Human guidance has disadvantages of fatigue and shakiness leading to inconsistency in the field of view. This study investigates whether replacing the assistant with a compact robot can improve the stability of the surgeon's field of view and also reduce crowding at the operating table. A compact robot based on a bevel-geared "spherical mechanism" with 4 degrees of freedom and capable of full dexterity through a 15-mm port was designed and built. The robot was mounted on the standard railing of the operating table and used to manipulate a laparoscope through a supraumbilical port in a porcine model via a joystick controlled externally by a surgeon. The process was videotaped externally via digital video recorder and internally via laparoscope. Robot position data were also recorded within the robot's motion control software. The robot effectively manipulated the laparoscope in all directions to provide a clear and consistent view of liver, small intestine, and spleen. Its range of motion was commensurate with typical motions executed by a human assistant and was well controlled with the joystick. Qualitative analysis of the video suggested that this method of laparoscope guidance provides highly stable imaging during laparoscopic surgery, which was confirmed by robot position data. Because the robot was table-mounted and compact in design, it increased standing room around the operation table and did not interfere with the workspace of other surgical instruments. The study results also suggest that this robotic method may be combined with flexible endoscopes for highly dexterous visualization with more degrees of freedom.

Robot assistant versus human or another robot assistant in patients undergoing laparoscopic cholecystectomy.

PubMed

Gurusamy, Kurinchi Selvan; Samraj, Kumarakrishnan; Fusai, Giuseppe; Davidson, Brian R

2012-09-12

The role of a robotic assistant in laparoscopic cholecystectomy is controversial. While some trials have shown distinct advantages of a robotic assistant over a human assistant others have not, and it is unclear which robotic assistant is best. The aims of this review are to assess the benefits and harms of a robot assistant versus human assistant or versus another robot assistant in laparoscopic cholecystectomy, and to assess whether the robot can substitute the human assistant. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded (until February 2012) for identifying the randomised clinical trials. Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing robot assistants versus human assistants in laparoscopic cholecystectomy were considered for the review. Randomised clinical trials comparing different types of robot assistants were also considered for the review. Two authors independently identified the trials for inclusion and independently extracted the data. We calculated the risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) using the fixed-effect and the random-effects models based on intention-to-treat analysis, when possible, using Review Manager 5. We included six trials with 560 patients. One trial involving 129 patients did not state the number of patients randomised to the two groups. In the remaining five trials 431 patients were randomised, 212 to the robot assistant group and 219 to the human assistant group. All the trials were at high risk of bias. Mortality and morbidity were reported in only one trial with 40 patients. There was no mortality or morbidity in either group. Mortality and morbidity were not reported in the remaining trials. Quality of life or the proportion of patients who were discharged as day-patient laparoscopic cholecystectomy patients were not reported in any

Robot-assisted laparoscopic gastrectomy for gastric cancer

PubMed Central

Caruso, Stefano; Franceschini, Franco; Patriti, Alberto; Roviello, Franco; Annecchiarico, Mario; Ceccarelli, Graziano; Coratti, Andrea

2017-01-01

Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer. PMID:28101302

Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse.

PubMed

Witte, Thomas H; Wilke, Markus; Stahl, Christina; Jandová, Vendula; Haralambus, Rhea; Straub, Reto

2013-10-15

A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain. Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain. Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was corrected. Progressive signs of abdominal pain after surgery prompted repeat ventral midline celiotomy, and small intestinal incarceration in a large, radial mesojejunal rent was detected. The incarceration was reduced, but the defect was not fully accessible for repair via the celiotomy. Repair of the mesenteric defect was not attempted, and conservative management was planned after surgery; however, signs of colic returned. A standard laparoscopic approach was attempted from both flanks in the standing patient, but the small intestine could not be adequately mobilized for full evaluation of the rent. Hand-assisted laparoscopic surgery (HALS) allowed identification and reduction of jejunal incarceration and repair of the mesenteric rent. Although minor ventral midline incisional complications were encountered, the horse recovered fully. HALS techniques should be considered for repair of mesenteric rents in horses. In the horse of this report, HALS facilitated identification, evaluation, and repair of a large radial mesenteric rent that was not accessible from a ventral median celiotomy.

Robotic-assisted laparoscopic management of a caliceal diverticular calculus.

PubMed

Torricelli, Fabio Cesar Miranda; Batista, Lucas T; Colombo, Jose Roberto; Coelho, Rafael Ferreira

2014-08-21

To report the first case of robotic-assisted laparoscopic management of a symptomatic caliceal diverticular calculus and review the literature on laparoscopic treatment for this condition. A 33-year-old obese woman with a 2×1 cm calculus within an anterior caliceal diverticulum located in the middle pole of the left kidney was referred to our service. She had already undergone two flexible ureterorenoscopies without success. We considered that a percutaneous approach would be very challenging due to stone location, thus we elected to perform a robotic-assisted laparoscopic procedure for stone removal and diverticulum fulguration. The procedure was uneventfully performed with no intraoperative or postoperative complications. The patient was discharged from the hospital on the second postoperative day and after 1.5 years of follow-up she is asymptomatic with no recurrence. The robotic-assisted laparoscopic approach to caliceal diverticular calculi is feasible and safe, providing one more option for treatment of stones in challenging locations. 2014 BMJ Publishing Group Ltd.

Robotic-assisted laparoscopic management of a caliceal diverticular calculus

PubMed Central

Torricelli, Fabio Cesar Miranda; Batista, Lucas T; Colombo, Jose Roberto; Coelho, Rafael Ferreira

2014-01-01

Purpose To report the first case of robotic-assisted laparoscopic management of a symptomatic caliceal diverticular calculus and review the literature on laparoscopic treatment for this condition. Case report A 33-year-old obese woman with a 2×1 cm calculus within an anterior caliceal diverticulum located in the middle pole of the left kidney was referred to our service. She had already undergone two flexible ureterorenoscopies without success. We considered that a percutaneous approach would be very challenging due to stone location, thus we elected to perform a robotic-assisted laparoscopic procedure for stone removal and diverticulum fulguration. The procedure was uneventfully performed with no intraoperative or postoperative complications. The patient was discharged from the hospital on the second postoperative day and after 1.5 years of follow-up she is asymptomatic with no recurrence. Conclusions The robotic-assisted laparoscopic approach to caliceal diverticular calculi is feasible and safe, providing one more option for treatment of stones in challenging locations. PMID:25188925

Robot-assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: A propensity score-matched comparative analysis of surgical outcomes and preserved renal parenchymal volume.

PubMed

Tachibana, Hidekazu; Takagi, Toshio; Kondo, Tsunenori; Ishida, Hideki; Tanabe, Kazunari

2018-04-01

To compare surgical outcomes, including renal function and the preserved renal parenchymal volume, between robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy using propensity score-matched analyses. In total, 253 patients, with a normal contralateral kidney, who underwent laparoscopic partial nephrectomy (n = 131) or robot-assisted laparoscopic partial nephrectomy (n = 122) with renal arterial clamping between 2010 and 2015, were included. Patients' background and tumor factors were adjusted by propensity score matching. Surgical outcomes, including postoperative renal function, complications, warm ischemia time and preserved renal parenchymal volume, evaluated by volumetric analysis, were compared between the surgical procedures. After matching, 64 patients were assigned to each group. The mean age was 56-57 years, and the mean tumor size was 22 mm. Approximately 50% of patients had low complexity tumors (RENAL nephrometry score 4-7). The incidence rate of acute kidney failure was significantly lower in the robot-assisted laparoscopic partial nephrectomy (11%) than laparoscopic partial nephrectomy (23%) group (P = 0.049), and warm ischemia time shorter in the robot-assisted laparoscopic partial nephrectomy (17 min) than laparoscopic partial nephrectomy (25 min) group (P < 0.0001). The preservation rate of renal function, measured by the estimated glomerular filtration rate, at 6 months post-surgery was 96% for robot-assisted laparoscopic partial nephrectomy and 90% for laparoscopic partial nephrectomy (P < 0.0001). The preserved renal parenchymal volume was higher for robot-assisted laparoscopic partial nephrectomy (89%) than laparoscopic partial nephrectomy (77%; P < 0.0001). The rate of perioperative complications, surgical margin status and length of hospital stay were equivalent for both techniques. Robot-assisted laparoscopic partial nephrectomy allows to achieve better preservation of renal function and parenchymal volume

Perioperative pain after robot-assisted versus laparoscopic rectal resection.

PubMed

Tolstrup, Rikke; Funder, Jonas Amstrup; Lundbech, Liselotte; Thomassen, Niels; Iversen, Lene Hjerrild

2018-03-01

In order to improve the surgical treatment of rectal cancer, robot-assisted laparoscopy has been introduced. The robot has gained widespread use; however, the scientific basis for treatment of rectal cancer is still unclear. The aim of this study was to investigate whether robot-assisted laparoscopic rectal resection cause less perioperative pain than standard laparoscopic resection measured by the numerical rating scale (NRS score) as well as morphine consumption. Fifty-one patients were randomized to either laparoscopic or robot-assisted rectal resection at the Department of Surgery at Aarhus University Hospital in Denmark. The intra-operative analgetic consumption was recorded prospectively and registered in patient records. Likewise all postoperative medicine administration including analgesia was recorded prospectively at the hospital medical charts. All morphine analogues were converted into equivalent oral morphine by a converter. Postoperative pain where measured by numeric rating scale (NRS) every hour at the postoperative care unit and three times a day at the ward. Opioid consumption during operation was significantly lower during robotic-assisted surgery than during laparoscopic surgery (p=0.0001). However, there were no differences in opioid consumption or NRS in the period of recovery. We found no differences in length of surgery between the two groups; however, ten patients from the laparoscopic group underwent conversion to open surgery compared to one from the robotic group (p=0.005). No significant difference between groups with respect to complications where found. In the present study, we found that patients who underwent rectal cancer resection by robotic technique needed less analgetics during surgery than patients operated laparoscopically. We did, however, not find any difference in postoperative pain score or morphine consumption postoperatively between the robotic and laparoscopic group.

Laparoscopic inguinal hernioplasty after robot-assisted laparoscopic radical prostatectomy.

PubMed

Sakon, M; Sekino, Y; Okada, M; Seki, H; Munakata, Y

2017-10-01

To evaluate the efficacy and safety of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in patients who have undergone robot-assisted laparoscopic radical prostatectomy (RALP). From July 2014 to December 2016, TAPP inguinal hernia repair was conducted in 40 consecutive patients who had previously undergone RALP. Their data were retrospectively analyzed as an uncontrolled case series. The mean operation time in patients who had previously undergone RALP was 99.5 ± 38.0 min. The intraoperative blood loss volume was small, and the duration of hospitalization was 2.0 ± 0.5 days. No intraoperative complications or major postoperative complications occurred. During the average 11.2-month follow-up period, no patients who had previously undergone prostatectomy developed recurrence. Laparoscopic TAPP inguinal hernia repair after RALP was safe and effective. TAPP inguinal hernia repair may be a valuable alternative to open hernioplasty.

Endoscope-assisted laparoscopic repair of perforated peptic ulcers.

PubMed

Lee, Kun-Hua; Chang, Hung-Chi; Lo, Chong-Jeh

2004-04-01

Laparoscopic repairs for perforated peptic ulcer (PPU) are likely to fail in patients with shock, gastric outlet obstruction, or large perforations. This prospective study was performed to evaluate a revised approach of laparoscopic repair with endoscopic assistance to treat these patients. Between April 2001 and February 2002, 30 consecutive patients with PPU were enrolled in this study. The mean age was 43.1 +/- 12.2 years. Male to female ratio was 27:2. One patient was excluded from laparoscopic repair due to a gastric outlet obstruction. The other 29 patients were managed according to a protocol of preoperative upper endoscopy and laparoscopic intracorporeal suture repair with an omental patch. The average operative time was 58.1 +/- 13.5 minutes (range, 36-96 min). The average diameter of perforation was 4.2 +/- 2.0 mm (range, 1-12 mm). The average time to resume oral fluids was 3.2 +/- 0.8 days (range, 2-8 days). The average hospital stay was 4.7 +/- 1.1 days (range, 3-10 days). There was no leakage or mortality. Most patients did not receive parenteral analgesics postoperatively. We conclude that endoscope-assisted laparoscopic repair for PPU is safe and effective. This revised technique allows surgeons to exclude patients who are likely to fail the laparoscopic repair.

Does robotic assistance confer an economic benefit during laparoscopic radical nephrectomy?

PubMed

Yang, David Y; Monn, M Francesca; Bahler, Clinton D; Sundaram, Chandru P

2014-09-01

While robotic assisted radical nephrectomy is safe with outcomes and complication rates comparable to those of the pure laparoscopic approach, there is little evidence of an economic or clinical benefit. From the 2009 to 2011 Nationwide Inpatient Sample database we identified patients 18 years old or older who underwent radical nephrectomy for primary renal malignancy. Robotic assisted and laparoscopic techniques were noted. Patients treated with the open technique and those with evidence of metastatic disease were excluded from analysis. Descriptive statistics were performed using the chi-square and Mann-Whitney tests, and the Student t-test. Multiple linear regression was done to examine factors associated with increased hospital costs and charges. We identified 24,312 radical nephrectomy cases for study inclusion, of which 7,787 (32%) were performed robotically. There was no demographic difference between robotic assisted and pure laparoscopic radical nephrectomy cases. Median total charges were $47,036 vs $38,068 for robotic assisted vs laparoscopic surgery (p <0.001). Median total hospital costs for robotic assisted surgery were $15,149 compared to $11,735 for laparoscopic surgery (p <0.001). There was no difference in perioperative complications or the incidence of death. Compared to the laparoscopic approach robotic assistance conferred an estimated $4,565 and $11,267 increase in hospital costs and charges, respectively, when adjusted for adapted Charlson comorbidity index score, perioperative complications and length of stay (p <0.001). Robotic assisted radical nephrectomy results in increased medical expense without improving patient morbidity. Assuming surgeon proficiency with pure laparoscopy, robotic technology should be reserved primarily for complex surgeries requiring reconstruction. Traditional laparoscopic techniques should continue to be used for routine radical nephrectomy. Copyright © 2014 American Urological Association Education and Research

Completely staple-free hand-sewn laparoscopic anastomosis in colorectal surgery.

PubMed

Lipski, David; Dapri, Giovanni; Himpens, Jacques

2008-04-01

Colonic continuity following a laparoscopic left hemicolectomy is usually performed by using a circular stapler to achieve end-to-end colorectal anastomosis. However, not much consideration is given to the costs of this technique and the long-term risk of stenosis. In this paper, we report the first case of a completely staple-free hand-sewn laparoscopic colonic anastomosis (CSHLCA) following a laparoscopic left hemicolectomy for cancer. Total operative time was 170 minutes, and the time to perform the anastomosis was 38 minutes. The postoperative stay was uneventful, with a total hospital stay of 6 days. CSHLCA is feasible and can lower the cost of the laparoscopic procedure. It may be considered in countries with limited access to mechanical staplers.

Robotic-Assisted Laparoscopic Cervicovaginal Myomectomy.

PubMed

Javadian, Pouya; Juusela, Alexander; Nezhat, Farr

2018-03-28

To illustrate a robotic-assisted laparoscopic resection for cervicovaginal myomectomy. Step-wise instruction using video and case report (Canadian Task Force classification III). A tertiary referral center. A 39-year-old woman. Robotic-assisted laparoscopy resection of leiomyoma. A 39-year-old woman, gravida 0, body mass index of 23.0 kg/m 2 , with a known cervicovaginal myoma that in the past underwent uterine artery embolization, presented with recurrence of her severe abnormal vaginal bleeding. She was referred for surgical resection of the mass. Magnetic resonance imaging revealed a 5-cm posterior cervicovaginal leiomyoma. The patient wanted to preserve her reproductive organs. A total robotic procedure lasted 123 minutes, with an estimated blood loss of 100 mL. She was discharged uneventfully on the day 0 postoperatively. Pathology results showed a 37-g leiomyoma of the uterus. The patient presented at her 2-weeks postoperative visit with no more complaint of vaginal bleeding. Robot-assisted laparoscopic surgery is a feasible approach for cervicovaginal myoma with minimal complications. Copyright © 2018 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy.

PubMed

Shiroki, Ryoichi; Fukami, Naohiko; Fukaya, Kosuke; Kusaka, Mamoru; Natsume, Takahiro; Ichihara, Takashi; Toyama, Hiroshi

2016-02-01

Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot-assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm(2) , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy

Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation.

PubMed

Rawlings, Clarence A; Mahaffey, Mary B; Bement, Shannon; Canalis, Chanda

2002-12-01

To determine long-term outcome associated with laparoscopic-assisted gastropexy in prevention of gastric dilatation-volvulus (GDV) in susceptible dogs and to evaluate use of laparoscopy to correct GDV. Prospective study. 25 client-owned large-breed dogs. 23 dogs susceptible to GDV were referred as candidates for elective gastropexy. These dogs had a history of treatment for gastric dilatation, clinical signs of gastric dilatation, or family members with gastric dilatation. Laparoscopic-assisted gastropexy was performed. One year after surgery, abdominal ultrasonography was performed to evaluate the attachment of the stomach to the abdominal wall. Two dogs with GDV were also treated with laparoscopic-assisted derotation of the stomach and gastropexy. None of the dogs developed GDV during the year after gastropexy, and all 20 dogs examined ultrasonographically had an intact attachment. Another dog was euthanatized at 11.5 months for unrelated problems. Two dogs with GDV successfully underwent laparoscopic-assisted gastropexy after the stomach was repositioned. Laparoscopic-assisted gastropexy resulted in a persisting attachment between the stomach and abdominal wall, an absence of GDV development, and few complications. Dogs with a high probability for development of GDV should be considered candidates for minimally invasive gastropexy. Carefully selected dogs with GDV can be treated laparoscopically.

[Prostatectomy-pros and cons on open surgery/laparoscopic surgery/robot-assisted surgery].

PubMed

Abe, Mitsuhiro; Kawano, Yoshiyuki; Kameyama, Shuji

2011-12-01

We have 3 options when perfoming prostatectomy for the treatment of localized prostate cancer. Those are retropubic radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy. We compared the characteristics and results of these techniques. Robot-assisted laparoscopic radical prostatectomy could be superior to the others in many ways. However, it would be very difficult to adopt it in Japan because it would pose economical difficulties. The administrative assistance in the insurance systems requireds much more than we have.

The Role of Laparoscopic-Assisted Myomectomy (LAM)

PubMed Central

Nezhat, Ceana H.; Nezhat, Farr.; Nezhat, Camran

2001-01-01

Laparoscopic myomectomy has recently gained wide acceptance. However, this procedure remains technically highly demanding and concerns have been raised regarding the prolonged time of anesthesia, increased blood loss, and possibly a higher risk of postoperative adhesion formation. Laparoscopic-assisted myomectomy (LAM) is advocated as a technique that may lessen these concerns regarding laparoscopic myomectomy while retaining the benefits of laparoscopic surgery, namely, short hospital stay, lower costs, and rapid recovery. By decreasing the technical demands, and thereby the operative time, LAM may be more widely offered to patients. In carefully selected cases, LAM is a safe and efficient alternative to both laparoscopic myomectomy and myomectomy by laparotomy. These cases include patients with numerous large or deep intramural myomas. LAM allows easier repair of the uterus and rapid morcellation of the myomas. In women who desire a future pregnancy, LAM may be a better approach because it allows meticulous suturing of the uterine defect in layers and thereby eliminates excessive electrocoagulation. PMID:11719974

Solo surgery--early results of robot-assisted three-dimensional laparoscopic hysterectomy.

PubMed

Tuschy, Benjamin; Berlit, Sebastian; Brade, Joachim; Sütterlin, Marc; Hornemann, Amadeus

2014-08-01

Report of our initial experience in laparoscopic hysterectomy by a solo surgeon using a robotic camera system with three-dimensional visualisation. This novel device (Einstein Vision®, B. Braun, Aesculap AG, Tuttlingen, Germany) (EV) was used for laparoscopic supracervical hysterectomy (LASH) performed by one surgeon. Demographic data, clinical and surgical parameters were evaluated. Our first 22 cases, performed between June and November 2012, were compared with a cohort of 22 age-matched controls who underwent two-dimensional LASH performed by the same surgeon with a second surgeon assisting. Compared to standard two-dimensional laparoscopic hysterectomy, there were no significant differences regarding duration of surgery, hospital stay, blood loss or incidence of complications. The number of trocars used was significantly higher in the control group (p <.0001). All hysterectomies in the treatment group were performed without assistance of a second physician. Robot-assisted solo surgery laparoscopic hysterectomy is a feasible and safe procedure. Duration of surgery, hospital stay, blood loss, and complication rates are comparable to a conventional laparoscopic hysterectomy.

Safety and cost-effectiveness analysis of laparoscopic splenectomy by secondary pedicle division using monopolar electrocautery.

PubMed

Zhou, Jianyin; Liu, Pingguo; Yin, Zhenyu; Zhao, Yilin; Wang, Xiaomin

2013-09-01

The expense of laparoscopic splenectomy (LS) has limited its use in developing countries, while medical costs are increasing worldwide. In this study, we performed LS by secondary pedicle division using monopolar electrocautery to achieve cost savings. Over seven years, we performed 45 consecutive LSs by secondary pedicle division using monopolar electrocautery (n=17) or ultrasonic shears (n=28) at a single center. These were reviewed to assess outcome and cost. Mean operating time was 179.7min, 7 conversions to open operation (15.6%) were necessary. There were four postoperative complications (8.9%) and no deaths. Twenty-three of 28 (82.1%) patients with idiopathic thrombocytopenic purpura developed a long-term positive response; and mean operative cost was RMB6,577 (US$1,034), which was much lower than that of Endo-GIATM in published reports. Between the monopolar electrocautery and ultrasonic shears groups, there were no significant differences in demographic characteristics or intraoperative and postoperative details, but operative cost was significantly lower in the former (RMB4,416, US$696 vs. RMB7,889, US$1,243; p<0.01). LS by secondary pedicle division using monopolar electrocautery is safe, efficacious and economical.

Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias.

PubMed

Chen, Y Julia; Huynh, Desmond; Nguyen, Scott; Chin, Edward; Divino, Celia; Zhang, Linda

2017-03-01

The aim of the study is to investigate the outcomes of the da Vinci robot-assisted laparoscopic hernia repair of small-sized ventral hernias with circumferential suturing of the mesh compared to the traditional laparoscopic repair with trans-fascial suturing. A retrospective review was conducted of all robot-assisted umbilical, epigastric and incisional hernia repairs performed at our institution between 2013 and 2015 compared to laparoscopic umbilical or epigastric hernia repairs. Patient characteristics, operative details and postoperative complications were collected and analyzed using univariate analysis. Three primary minimally invasive fellowship trained surgeons performed all of the procedures included in the analysis. 72 patients were identified during the study period. 39 patients underwent robot- assisted repair (21 umbilical, 14 epigastric, 4 incisional), and 33 patients laparoscopic repair (27 umbilical, 6 epigastric). Seven had recurrent hernias (robot: 4, laparoscopic: 3). There were no significant differences in preoperative characteristics between the two groups. Average operative time was 156 min for robot-assisted repair and 65 min for laparoscopic repair (p < 0.0001). The average defect size was significantly larger for the robot group [3.07 cm (1-9 cm)] than that for the laparoscopic group [2.02 cm (0.5-5 cm)] (p < 0.0001), although there was no significant difference in the average size of mesh used (13 vs. 13 cm). There was no difference in patients requiring postoperative admission or length of stay between the two groups. The mean duration of follow-up was 47 days. There was no difference in complication rate during this time, and no recurrences were reported. There are no significant differences in terms of safety and early efficacy when comparing small-sized ventral hernias repaired using the robot-assisted technique versus the standard laparoscopic repair.

Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

PubMed Central

Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

2016-01-01

Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

Laparoscopic assistance by operating room nurses: Results of a virtual-reality study.

PubMed

Paschold, M; Huber, T; Maedge, S; Zeissig, S R; Lang, H; Kneist, W

2017-04-01

Laparoscopic assistance is often entrusted to a less experienced resident, medical student, or operating room nurse. Data regarding laparoscopic training for operating room nurses are not available. The aim of the study was to analyse the initial performance level and learning curves of operating room nurses in basic laparoscopic surgery compared with medical students and surgical residents to determine their ability to assist with this type of procedure. The study was designed to compare the initial virtual reality performance level and learning curves of user groups to analyse competence in laparoscopic assistance. The study subjects were operating room nurses, medical students, and first year residents. Participants performed three validated tasks (camera navigation, peg transfer, fine dissection) on a virtual reality laparoscopic simulator three times in 3 consecutive days. Laparoscopic experts were enrolled as a control group. Participants filled out questionnaires before and after the course. Nurses and students were comparable in their initial performance (p>0.05). Residents performed better in camera navigation than students and nurses and reached the expert level for this task. Residents, students, and nurses had comparable bimanual skills throughout the study; while, experts performed significantly better in bimanual manoeuvres at all times (p<0.05). The included user groups had comparable skills for bimanual tasks. Residents with limited experience reached the expert level in camera navigation. With training, nurses, students, and first year residents are equally capable of assisting in basic laparoscopic procedures. Copyright © 2017 Elsevier Ltd. All rights reserved.

A systematic review on radiofrequency assisted laparoscopic liver resection: Challenges and window to excel.

PubMed

Reccia, Isabella; Kumar, Jayant; Kusano, Tomokazu; Zanellato, Artur; Draz, Ahmed; Spalding, Duncan; Habib, Nagy; Pai, Madhava

2017-09-01

Laparoscopic liver resection has progressively gained acceptance as a safe and effective procedure in the treatment of benign and malignant liver neoplasms. However, blood loss remains the major challenge in liver surgery. Several techniques and devices have been introduced in liver surgery in order to minimize intraoperative haemorrhage during parenchymal transection. Radiofrequency (RF)-assisted liver resection has been shown to be an effective method to minimize bleeding in open and laparoscopic liver resection. A number of RF devices for parenchymal transection have been designed to assist laparoscopic liver resections. Here we have reviewed the results of various RF devices in laparoscopic liver resection. A total 15 article were considered relevant for the evaluation of technical aspects and outcomes of RF-assisted liver resections in laparoscopic procedures. In these studies, 176 patients had laparoscopic liver resection using RF-assisted parenchymal coagulation. Two monopolar and three bipolar devices were employed. Blood loss was limited in most of the studies. The need of blood transfusions was limited to two cases in all the series. Conversion was necessary due to bleeding in 3 cases. Operative and transection times varied between studies. However, RF-assisted resection with bipolar devices appeared to have taken less time in comparison to other RF devices. RF-related complications were minimum, and only one case of in-hospital death due to hepatic failure was reported. Although RF has been used in a small minority of laparoscopic liver resections, laparoscopic RF-assisted liver resection for benign and malignant disease is a safe and feasible procedure associated with reduction in blood loss, low morbidity, and lower hospital mortality rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

An actuated force feedback-enabled laparoscopic instrument for robotic-assisted surgery.

PubMed

Moradi Dalvand, Mohsen; Shirinzadeh, Bijan; Shamdani, Amir Hossein; Smith, Julian; Zhong, Yongmin

2014-03-01

Robotic-assisted minimally invasive surgery systems not only have the advantages of traditional laparoscopic instruments but also have other important advantages, including restoring the surgeon's hand-eye coordination and improving the surgeon's precision by filtering hand tremors. Unfortunately, these benefits have come at the expense of the surgeon's ability to feel. Various solutions for restoring this feature have been proposed. An actuated modular force feedback-enabled laparoscopic instrument was proposed that is able to measure tip-tissue lateral interaction forces as well as normal grasping forces. The instrument has also the capability to adjust the grasping direction inside the patient body. In order to measure the interaction forces, strain gauges were employed. A series of finite element analyses were performed to gain an understanding of the actual magnitude of surface strains where gauges are applied. The strain gauge bridge configurations were calibrated. A series of experiments was conducted and the results were analysed. The modularity feature of the proposed instrument makes it interchangeable between various tip types of different functionalities (e.g. cutter, grasper, dissector). Calibration results of the strain gauges incorporated into the tube and at the base of the instrument presented the monotonic responses for these strain gauge configurations. Experimental results from tissue probing and tissue characterization experiments verified the capability of the proposed instrument in measuring lateral probing forces and characterizing artificial tissue samples of varying stiffness. The proposed instrument can improve the quality of palpation and characterization of soft tissues of varying stiffness by restoring sense of touch in robotic assisted minimally invasive surgery operations. Copyright © 2013 John Wiley & Sons, Ltd.

Daikenchuto stimulates colonic motility after laparoscopic-assisted colectomy.

PubMed

Yaegashi, Mizunori; Otsuka, Koki; Itabashi, Tetsuya; Kimura, Toshimoto; Kato, Kuniyuki; Fujii, Hitoshi; Koeda, Keisuke; Sasaki, Akira; Wakabayashi, Go

2014-01-01

Paralytic ileus after laparoscopic-assisted surgery often occurs. We investigated whether daikenchuto (DKT), a traditional Japanese herbal medicine, improves intestinal motility in patients undergoing laparoscopic-assisted colectomy for colon cancer. Fifty-four patients who underwent colectomy at Iwate Medical University Hospital between October 2010 and March 2012 were randomized to either the DKT group (7.5 g/day, p.o.) or the control group (lactobacillus preparation, 3g/day, p.o.). Primary endpoints included time to first flatus, bowel movement, and tolerance of diet after extubation. Secondary endpoints were WBC count, C-reactive protein (CRP) level, length of hospital stay, and postoperative ileus. Colonic transit time was measured using radiopaque markers and abdominal radiographs. Fifty-one patients (DKT, 26 vs. control, 25) were included in the per-protocol analysis. The DKT group had significantly faster time until first flatus (67.5 +/- 13.6h vs. 77.9 +/- 11.8h, P < 0.01) and bowel movement (82.9 +/- 17.8h vs. 99.5 +/- 18.9h, P < 0.01) and colonic transit time (91.9 +/- 19.8h vs. 115.2 +/- 12.8 h, P < 0.05). There were no significant intergroup differences in secondary endpoints and adverse events. DKT accelerates colonic motility in patients undergoing laparoscopic-assisted colectomy for colon cancer.

Laparoscopic splenectomy for patients with liver cirrhosis: Improvement of liver function in patients with Child-Pugh class B.

PubMed

Yamamoto, Naoki; Okano, Keiichi; Oshima, Minoru; Akamoto, Shitaro; Fujiwara, Masao; Tani, Joji; Miyoshi, Hisaaki; Yoneyama, Hirohito; Masaki, Tsutomu; Suzuki, Yasuyuki

2015-12-01

We aimed to assess the short-term outcomes of laparoscopic splenectomy (LS) and liver function at 1 year after splenectomy in the patients with liver cirrhosis. Forty-five patients with liver cirrhosis and hypersplenism underwent LS. We reviewed electronic medical records regarding the liver functional reserve, the etiology of liver cirrhosis, and the presence of hepatocellular carcinoma and esophago-gastric varices. Prospectively collected data of perioperative variables, postoperative complications, and long-term liver function were analyzed. Forty-five patients had a chronic liver disease classified into Child-Pugh classes (A/B/C: 23/20/2). The etiologies of disease were hepatitis C virus infection in 34 patients, hepatitis B virus infection in 4, and others in 7. Fourteen patients underwent procedures in addition to LS, including hepatectomy (n = 7) and devascularization for esophagogastric varices (n = 8). Postoperative complications occurred in 11 patients (24%). Neither postoperative liver failure nor in-hospital mortality occurred. White blood cell and platelet counts determined 7 days, 1 month, and 1 year after LS doubled or increased more than twice compared with the preoperative values (P < .001). One year after LS, patients who had been classified preoperatively into Child-Pugh class B had decreased total serum bilirubin levels (P = .03), and increased prothrombin activity (P = 003) and decreased Child-Pugh scores (P = .001). The Child-Pugh classifications improved in 14 of 18 patients (78%) who had Child-Pugh class B preoperatively. LS is a safe and feasible procedure for hypersplenism in patients with liver cirrhosis. In addition, LS most likely ameliorates liver function at 1 year after LS in patients with Child-Pugh class B liver cirrhosis. Copyright © 2015 Elsevier Inc. All rights reserved.

Advances in Laparoscopic Colorectal Surgery.

PubMed

Parker, James Michael; Feldmann, Timothy F; Cologne, Kyle G

2017-06-01

Laparoscopic colorectal surgery has now become widely adopted for the treatment of colorectal neoplasia, with steady increases in utilization over the past 15 years. Common minimally invasive techniques include multiport laparoscopy, single-incision laparoscopy, and hand-assisted laparoscopy, with the choice of technique depending on several patient and surgeon factors. Laparoscopic colorectal surgery involves a robust learning curve, and fellowship training often lays the foundation for a high-volume laparoscopic practice. This article provides a summary of the various techniques for laparoscopic colorectal surgery, including operative steps, the approach to difficult patients, and the learning curve for proficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparing Zero Ischemia Laparoscopic Radio Frequency Ablation Assisted Tumor Enucleation and Laparoscopic Partial Nephrectomy for Clinical T1a Renal Tumor: A Randomized Clinical Trial.

PubMed

Huang, Jiwei; Zhang, Jin; Wang, Yanqing; Kong, Wen; Xue, Wei; Liu, Dongming; Chen, YongHui; Huang, Yiran

2016-06-01

We evaluated the functional outcome, safety and efficacy of zero ischemia laparoscopic radio frequency ablation assisted tumor enucleation compared with conventional laparoscopic partial nephrectomy. A prospective randomized controlled trial was conducted from April 2013 to March 2015 in patients with cT1a renal tumor scheduled for laparoscopic nephron sparing surgery. All patients were followed for at least 12 months. Patients in the laparoscopic radio frequency ablation assisted tumor enucleation group underwent tumor enucleation after radio frequency ablation without hilar clamping. The primary outcome was the change in glomerular filtration rate of the affected kidney by renal scintigraphy at 12 months. Secondary outcomes included changes in estimated glomerular filtration rate, estimated blood loss, operative time, hospital stay, postoperative complications and oncologic outcomes. The Pearson chi-square or Fisher exact, Student t-test and Wilcoxon rank sum tests were used. The trial ultimately enrolled 89 patients, of whom 44 were randomized to the laparoscopic radio frequency ablation assisted tumor enucleation group and 45 to the laparoscopic partial nephrectomy group. In the laparoscopic partial nephrectomy group 1 case was converted to radical nephrectomy. Compared with the laparoscopic partial nephrectomy group, patients in the laparoscopic radio frequency ablation assisted tumor enucleation group had a smaller decrease in glomerular filtration rate of the affected kidney at 3 months (10.2% vs 20.5%, p=0.001) and 12 months (7.6% vs 16.2%, p=0.002). Patients in the laparoscopic radio frequency ablation assisted tumor enucleation group had a shorter operative time (p=0.002), lower estimated blood loss (p <0.001) and a shorter hospital stay (p=0.029) but similar postoperative complications (p=1.000). There were no positive margins or local recurrence in this study. Zero ischemia laparoscopic radio frequency ablation assisted tumor enucleation enables tumor

[Applied anatomy of laparoscopic-assisted right hemicolectomy for colon cancer].

PubMed

Lin, Guole; Xiao, Yi; Qiu, Huizhong

2015-06-01

Laparoscopic-assisted colon surgery is an alternative to open surgery. Furthermore, complete mesocolic excision (CME) as a new concept in colon cancer surgery was first proposed by Hohenberger from Germany, which follows the oncological principle of the tumor and is based on the embryology and anatomy. Some researches about CME showed that this procedure could improve the prognosis, decrease the local recurrence of the tumor without increased complications. Although a laparoscopic approach for right colon cancer is performed frequently, identifying an adequate dissection plane is not always easy. The surgeons need to know well about local anatomy of laparoscopic-assisted radical right hemicolectomy, and to master the right surgical plane in operation process, then to reduce the incidence of conversion to laparotomy and side injury. The superior mesenteric vein (SMV) is the key landmark. The fusion fascia space is the right surgical plane, as well as a series of peripheral peritoneal attachments are important fixations in laparoscopic right hemicolectomy by medial access. Identifying the anatomical location of the SMV and performing meticulous dissection along the SMV is an essential procedure to dissect all potential lymphatic drainage during laparoscopic CME for right colon cancer.

Single Incision Laparoscopic Assisted Appendectomy: Experience of 82 Cases

PubMed Central

Sinha, Anant Narayan; Deepak, Desh; Pandey, NK; Nandani

2016-01-01

Introduction Single Incision Laparoscopic Surgery (SILS) is one of the most recent developments which have been made in the field of minimal assesses surgery. It has potential advantages of less postoperative pain and better cosmesis, but at the same time, this procedure is time consuming and it increases the cost of surgery. Aim In this study, we evaluated the feasibility, safety and potential advantages of single incision laparoscopic assisted appendectomy. Materials and Methods Single incision laparoscopic assisted appendectomy was done in 82 patients who were diagnosed with acute or chronic appendicitis. A single 10mm incision made over right lower quadrant was used for placing two 5mm trocars and appendisectomy was done as in open surgery, after delivering out the appendix from the incision. Results Mean operative time was 32.56 ± 15.5 minutes. Mean post-operative pain scores as per visual analogue scalewere 6.5, 4.2 and 1.2 on 12 hours day 1 and day 2 after surgery respectively. Mean length of hospital stay was 1.4 ± 1.2 days. Conclusion Single incision laparoscopic appendectomy is safe and feasible. PMID:27437295

Robot-assisted laparoscopic pyeloplasty: minimum 1-year follow-up

NASA Astrophysics Data System (ADS)

Patel, Vipul; Thaly, Rahul; Shah, Ketul

2007-02-01

Objectives: To evaluate the feasibility and efficacy of robotic-assisted laparoscopic pyeloplasty. Laparoscopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. However, the steep learning curve has hindered its acceptance into mainstream urologic practice. The introduction of robotic assistance provides advantages that have the potential to facilitate precise dissection and intracorporeal suturing. Methods: A total of 50 patients underwent robotic-assisted laparoscopic dismembered pyeloplasty. A four-trocar technique was used. Most patients were discharged home on day 1, with stent removal at 3 weeks. Patency of the ureteropelvic junction was assessed in all patients with mercaptotriglycylglycine Lasix renograms at 1, 3, 6, 9, and 12 months, then every 6 months for 1 year, and then yearly. Results: Each patient underwent a successful procedure without open conversion or transfusion. The average estimated blood loss was 40 ml. The operative time averaged 122 minutes (range 60 to 330) overall. Crossing vessels were present in 30% of the patients and were preserved in all cases. The time for the anastomosis averaged 20 minutes (range 10 to 100). Intraoperatively, no complications occurred. Postoperatively, the average hospital stay was 1.1 days. The stents were removed at an average of 20 days (range 14 to 28) postoperatively. The average follow-up was 11.7 months; at the last follow-up visit, each patient was doing well. Of the 50 patients, 48 underwent one or more renograms, demonstrating stable renal function, improved drainage, and no evidence of recurrent obstruction. Conclusions: Robotic-assisted laparoscopic pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. The procedure provides a minimally invasive alternative with good short-term results.

Laparoscopic-Assisted Resection of Colorectal Malignancies

PubMed Central

Chapman, Andrew E.; Levitt, Michael D.; Hewett, Peter; Woods, Rodney; Sheiner, Harry; Maddern, Guy J.

2001-01-01

Objective To compare the safety and efficacy of laparoscopic-assisted resection of colorectal malignancies with open colectomy. Methods Two search strategies were devised to retrieve literature from the Medline, Current Contents, Embase, and Cochrane Library databases until July 1999. Inclusion of papers was determined using a predetermined protocol, independent assessments by two reviewers, and a final consensus decision. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series, or case reports. Fifty-two papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding, and chance. Results Little high-level evidence was available. Laparoscopic resection of colorectal malignancy was more expensive and time-consuming, but little evidence suggests high rates of port site recurrence. The new procedure’s advantages revolve around early recovery from surgery and reduced pain. Conclusions The evidence base for laparoscopic-assisted resection of colorectal malignancies is inadequate to determine the procedure’s safety and efficacy. Because of inadequate evidence detailing circumferential marginal clearance of tumors and the necessity of determining a precise incidence of cardiac and other major complications, along with wound and port site recurrence, it is recommended that a controlled clinical trial, ideally with random allocation to an intervention and control group, be conducted. Long-term survival rates need to be a primary aim of such a trial. PMID:11685021

[Clinical observation on laparoscopic radiofrequency ablation assisted enucleation for the renal epithelial angimyolipoma].

PubMed

Yang, Yang; Yang, Rong; Guo, Hongqian

2014-08-13

To explore the clinicopathological characteristics of epithelial angiomyolipoma (EAML) and examine the clinical efficacy and prognosis of laparoscopic radio frequency ablation assisted enucleation. The clinicopathological data of 7 patients with renal EAML undergoing laparoscopic radio frequency ablation assisted enucleation were reviewed from April 2009 to June 2012. And the clinical efficacy and prognosis of laparoscopic radio frequency ablation assisted enucleation were analyzed. Laparoscopic radio frequency ablation assisted enucleation was successfully performed in all cases without postoperative bleeding, ureteral obstruction, chronic renal insufficiency or urinary leakage. The mean operative duration was 110 min. Renal pedicles were blocked in 4 patients with a mean blockage time of 9 min. The mean intraoperative bleeding was 90 ml. No blood transfusion was required. The absolute bedrest time was 1-3 days and the drainage tube implanted for 3.8 days. Postoperative pathology showed that all cases were EAML. Immunohistochemistry showed HMB-45⁺ and small muscle action⁺ and creatine kinase⁻ in epithelioid cells. During a mean follow-up period of 1.8 years, none of them had local tumor recurrence, chronic renal insufficiency or other complications. Renal EAML is a rare subtype of angiomyolipoma without specific clinical and imaging features. And its definite confirmation depends on pathology. Laparoscopic radio frequency ablation assisted enucleation is both safe and effective in the treatment of renal EAML with pseudocapsule.

Revolutionizing (robot-assisted) laparoscopic gamma tracing using a drop-in gamma probe technology

PubMed Central

van Oosterom, Matthias N; Simon, Hervé; Mengus, Laurent; Welling, Mick M; van der Poel, Henk G; van den Berg, Nynke S; van Leeuwen, Fijs WB

2016-01-01

In complex (robot-assisted) laparoscopic radioguided surgery procedures, or when low activity lesions are located nearby a high activity background, the limited maneuverability of a laparoscopic gamma probe (LGP; 4 degrees of freedom (DOF)) may hinder lesion identification. We investigated a drop-in gamma probe (DIGP) technology to be inserted via a trocar, after which the laparoscopic surgical tool at hand can pick it up and maneuver it. Phantom experiments showed that distinguishing a low objective from a high background source (1:100 ratio) was only possible with the detector faced >90° from the high background source. Signal-low-objective-to-background ratios of 3.77, 2.01 and 1.84 were found for detector angles of 90°, 135° and 180°, respectively, whereas detector angles of 0° and 45° were unable to distinguish the sources. This underlines the critical role probe positioning plays. We then focused on engineering of the gripping part for optimal DIGP pick-up with a conventional laparoscopic forceps (4 DOF) or a robotic forceps (6 DOF). DIGPs with 0°, 45°, 90°, and 135° -grip orientations were designed, and their maneuverability- and scanning direction were evaluated and compared to a conventional LGP. The maneuverability- and scanning direction of the DIGP was found highest when using the robotic forceps, with the largest effective scanning direction range obtained with the 90° -grip design (0-180° versus 0-111°, 0-140°, and 37-180° for 0°, 45° and 135° -grip designs, respectively). For the laparoscopic forceps, the scan direction directly translated from the angle of the grip design with the advantage that the 135° -gripped DIGP could be faced backwards (not possible with the conventional LGP). In the ex vivo clinical setup, the surgeon rated DIGP pick-up most convenient for the 45°-grip design. Concluding, the DIGP technology was successfully introduced. Optimization of the grip design and grasping angle of the DIGP increased its utility

Determinants of splenectomy in splenic injuries following blunt abdominal trauma.

PubMed

Akinkuolie, A A; Lawal, O O; Arowolo, O A; Agbakwuru, E A; Adesunkanmi, A R K

2010-02-01

The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic preservation. Files of 55 patients managed for isolated splenic injuries from blunt abdominal trauma between 1998 and 2007 were retrospectively analysed using a pro forma. Management options were classified into nonoperative, operative salvage and splenectomy. The majority of patients suffered splenic injury as a result of motor vehicle accident (MVA) trauma or falls. Splenectomy was undertaken in 33 (60%) patients, 12 (22%) had non-operative management, and operative salvage was achieved in 10 (18%) patients. Significant determinants of splenectomy were grade of splenic injury, hierarchy of the surgeon, and hierarchy of the assistant. MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of technology that enables splenic salvage surgery, and the experience of the surgeon and assistant appear to determine the surgical management. Legislation on vehicle safety and good parental control may reduce the severity of splenic injury in blunt abdominal trauma. When surgery is indicated, salvage surgery should be considered in intermediate isolated splenic injury to reduce the incidence of OPSI.

Surgeons' perceptions and injuries during and after urologic laparoscopic surgery.

PubMed

Gofrit, Ofer N; Mikahail, Albert A; Zorn, Kevin C; Zagaja, Gregory P; Steinberg, Gary D; Shalhav, Arieh L

2008-03-01

The biomechanical and mental strains placed on the surgeon while performing laparoscopic procedures are significantly higher compared with open surgical techniques. We undertook this study to assess the prevalence of surgeons' deleterious perceptions or injuries related to laparoscopic urologic surgery. Members of endourological society were mailed a questionnaire evaluating their laparoscopic experience, total number of standard laparoscopic surgeries (SLS), hand-assisted laparoscopic surgeries (HALS), and robotic-assisted laparoscopic surgeries (RALS) they performed. The subjects reported any neuromuscular or arthritic injuries sustained during laparoscopic surgery, and graded the degree of pain, numbness, and fatigue they experienced. A total of 73 urologists completed the questionnaires. The average responder was 44 years old, had completed a median of 117 procedures, and was performing 3 laparoscopic surgeries per week. Neuromuscular or arthritic symptoms during surgery were reported by 22 responders (30%), the most common was finger paresthesia (18%). At the conclusion of HALS, 45% of the surgeons suffered from hand and wrist numbness and 37% reported pain in these areas. A significant association was observed between the risk of sustaining injury during surgery and the total number of laparoscopic procedures performed by the responder (P = 0.016). RALS was the procedure least associated with injuries, and HALS the most. The laparoscopic operating theater is a hostile ergonomic environment. Surgeons' awareness of the common injuries associated with laparoscopic surgery and careful equipment adjustments before surgery are mandatory to minimize injury. Future improvements in instrument design according to ergonomic principles are highly warranted.

Robot-assisted laparoscopic staging surgery for endometrial cancer--a preliminary report.

PubMed

Lee, Chyi-Long; Han, Chien-Min; Su, Hsuan; Wu, Kai-Yun; Wang, Chin-Jung; Yen, Chih-Feng

2010-12-01

The robotic surgical system is reported to overcome some technical difficulties in traditional laparoscopic hysterectomy. This study aimed to evaluate the feasibility and surgical outcomes of a robotic surgery program for endometrial cancer. Patients with endometrial cancer with the intention to receive treatment using robot-assisted laparoscopic staging surgery were recruited in a university hospital from July 2007 to August 2008. All of these surgeries were performed with the da Vinci system. Six patients (mean age, 47.5 ±1.4 years; mean body mass index, 26.2 ±3.5 kg/m(2)) were enrolled and completed robot-assisted laparoscopic staging surgery. The robot docking time was 45.0 ±13.6 minutes and the robot-assisted operation time was 200.3 ±30.0 minutes. The mean estimated blood loss was 180.0 ±147.6 mL. The mean number of lymph nodes retrieved was 23.2 ±7.4. No laparoconversion and no intraoperative or postoperative complications occurred. All patients were alive and free of disease up to the date of this report, at a median follow-up of 6.5 months (range, 5-17 months). Robot-assisted laparoscopic staging surgery is a feasible treatment and helps overcome the technical limitations in conventional laparoscopy for endometrial cancer. Copyright © 2010 Taiwan Association of Obstetric & Gynecology. Published by Elsevier B.V. All rights reserved.

Long-term outcomes of robot-assisted laparoscopic rectopexy for rectal prolapse.

PubMed

Perrenot, Cyril; Germain, Adeline; Scherrer, Marie-Lorraine; Ayav, Ahmet; Brunaud, Laurent; Bresler, Laurent

2013-07-01

Robot-assisted laparoscopic rectopexy for total rectal prolapse is safe and feasible. Small series proved clinical and functional short-term results comparable with conventional laparoscopy. No long-term results have been reported yet. The primary objective of the study was to evaluate long-term functional and anatomic results of robot-assisted laparoscopic rectopexy. The secondary objective was to evaluate the learning curve of this procedure. Monocentric study data, both preoperative and perioperative, were collected prospectively, and follow-up data were assessed by a telephone questionnaire. The study was performed in an academic center by 3 different surgeons. We evaluated all of the consecutive patients who underwent a robot-assisted laparoscopic rectopexy between June 2002 and August 2010. Rectopexy was performed with 2 anterolateral meshes or with 1 ventral mesh, and in 9 patients a sigmoidectomy was associated with rectopexy. The actuarial recurrence rate was evaluated using the Kaplan-Meier method. During the study period, 77 patients underwent a robot-assisted laparoscopic rectopexy, and the mean age was 59.9 years (range, 23-90 y). Average operating time was 223 minutes (range, 100-390 min); the learning curve was completed after 18 patients were seen. Two patients died of causes unrelated to surgery at 5 and 24 months. There were 5 conversions (6%) to open procedure. Overall morbidity was low and concerned only 8 patients (10.4%). Mean follow-up time was 52.5 months (range, 12-115 mo). Recurrences have been observed in 9 patients (12.8%). Preoperatively, 24 (34%) of the patients had constipation. Postoperatively, constipation disappeared for 12 (50%) of 24 and constipation appeared for 11 (24%) of 46 patients. Fecal incontinence decreased after surgery from Wexner score 10.5 to 5.1 of 20. There was a lack of standardization of the surgical procedure. The study was monocentric. Seven patients (9%) were lost to follow-up. Long-term results of robot-assisted

Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii.

PubMed

Middleton, Kellie K; Hamilton, Travis; Tsai, Pei-Chien; Middleton, Dana B; Falcone, John L; Hamad, Giselle

2013-11-01

Video games have been shown to improve eye-hand coordination, spatial visualization, manual dexterity, and rapid mental processing, which are important in the acquisition of laparoscopic skills. This study investigated the relationship between playing Nintendo(®) Wii™ and virtual reality (VR) laparoscopic surgery simulator performance. We hypothesized that playing the Wii would improve surgical skills performance on a VR laparoscopic simulator and hoped to elucidate which tasks, in particular, would be most beneficial for nondominant hand training. This was a single-blinded, randomized, prospective study conducted with 23 student volunteers. VR laparoscopic skills were assessed at baseline on a Simbionix LapMentor™ Surgical Simulator (Simbionix Ltd., Israel) and after the gaming period of 2 weeks. Simulator performance metrics were compared between groups using nonparametric statistics and an alpha of 0.05. Compared with the control group, the Wii-playing group demonstrated greater improvement of six measures, including accuracy on the eye-hand coordination task (p = 0.04), faster completion time (p = 0.04), decreased number of left-handed movements (p = 0.03), decreased left handed total path length (p = 0.03), decreased total number of grasping attempts (p = 0.04), and improved left-handed economy of movement (p = 0.05) for the bimanual clipping and grasping task. When comparing the number of measures improved upon by the Wii-playing group and the control group for all three tasks, the Wii-playing group consistently outperformed the control group in 18 measures compared with the control group's improvement in 6. This study further characterizes the association between video game playing and surgical performance. Improvements following the intervention were made in the most basic of surgical skills, most notably with the nondominant hand, suggesting that short-term playing of the Wii could improve bimanual dexterity and expedite the acquisition of basic

The First Korean Experience of Telemanipulative Robot-Assisted Laparoscopic Cholecystectomy Using the da Vinci System

PubMed Central

Kang, Chang Moo; Chi, Hoon Sang; Hyeung, Woo Jin; Kim, Kyung Sik; Choi, Jin Sub; Kim, Byong Ro

2007-01-01

With the advancement of laparoscopic instruments and computer sciences, complex surgical procedures are expected to be safely performed by robot assisted telemanipulative laparoscopic surgery. The da Vinci system (Intuitive Surgical, Mountain View, CA, USA) became available at the many surgical fields. The wrist like movements of the instrument's tip, as well as 3-dimensional vision, could be expected to facilitate more complex laparoscopic procedure. Here, we present the first Korean experience of da Vinci robotic assisted laparoscopic cholecystectomy and discuss the introduction and perspectives of this robotic system. PMID:17594166

Laparoscopic unroofing of splenic cysts results in a high rate of recurrences.

PubMed

Schier, Felix; Waag, Karl-Ludwig; Ure, Benno

2007-11-01

Laparoscopic unroofing is described as an appropriate treatment modality of nonparasitic splenic cysts. However, we repeatedly encountered recurrences with this technique. Because splenic cysts are rare, we analyzed the combined experience of 3 German pediatric surgical departments. Between 1995 and 2005, primary and secondary nonparasitic splenic cysts were unroofed laparoscopically in 14 children (aged 5-12 years; median, 8.5 years). In 3 patients, the inner surface was coagulated with the argon beamer. In most children, the cavity was surfaced with omentum. In addition, in 4 patients the omentum was sutured to the splenic parenchyma. No intraoperative complications occurred, and no inadvertent splenectomy or blood transfusions were necessary. However, in 9 children (64%) the cysts recurred at intervals ranging from 6 to 12 months (median, 12 months). Also, argon laser treatment of the surface resulted in recurrence. Laparoscopic unroofing of true splenic cysts alone proved inadequate in this series. Either removal of the inner layer or partial splenectomy appears to be necessary to prevent recurrences.

Robotic single-access splenectomy using the Da Vinci Single-Site® platform: a case report.

PubMed

Corcione, Francesco; Bracale, Umberto; Pirozzi, Felice; Cuccurullo, Diego; Angelini, Pier Luigi

2014-03-01

Single-access laparoscopic splenectomy can offer patients some advantages. It has many difficulties, such as instrument clashing, lack of triangulation, odd angles and lack of space. The Da Vinci Single-Site® robotic surgery platform could decrease these difficulties. We present a case of single-access robotic splenectomy using this device. A 37 year-old female with idiopathic thrombocytopenic purpura was operated on with a single-site approach, using the Da Vinci Single-Site robotic surgery device. The procedure was successfully completed in 140 min. No intraoperative and postoperative complications occurred. The patient was discharged from hospital on day 3. Single-access robotic splenectomy seems to be feasible and safe using the new robotic single-access platform, which seems to overcome certain limits of previous robotic or conventional single-access laparoscopy. We think that additional studies should also be performed to explore the real cost-effectiveness of the platform. Copyright © 2013 John Wiley & Sons, Ltd.

Exploration of assistive technology for uniform laparoscopic surgery.

PubMed

Sato, Masakazu; Koizumi, Minako; Hino, Takahiro; Takahashi, Yu; Nagashima, Natsuki; Itaoka, Nao; Ueshima, Chiharu; Nakata, Maki; Hasumi, Yoko

2018-02-19

Laparoscopic surgery is less invasive than open surgery and is now common in various medical fields. However, laparoscopic surgery is more difficult than open surgery and often requires additional time for the operator to achieve mastery. Therefore, we investigated the use of assistive technology for uniform laparoscopic surgery. We used the OpenCV2 library for augmented reality with an ArUco marker to detect and estimate forceps positioning. We used Sense HAT as the gyro sensor. The development platforms used were Mac OS X 10.11.3 and Raspberry Pi 3, model B. By attaching the ArUco marker to the needle holder, we could draw a line vertically to the marker. When the needle was held, a cube could be imagined, and both the needle and lines could be used to determine the appropriate position. By attaching the gyro sensor to the camera, we could detect its angle of rotation. We obtained stabilized images by rotating the image by the detected degrees; this was possible for any camera position. Assistive technology allowed us to obtain consecutive converted images in real time and may be readily applicable to clinical practice. © 2018 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center.

PubMed

Liu, Rong; Zhang, Tao; Zhao, Zhi-Ming; Tan, Xiang-Long; Zhao, Guo-Dong; Zhang, Xuan; Xu, Yong

2017-06-01

Pancreaticoduodenectomy (PD) is a difficult and complex operation. The introduction of robotics has opened up new angles in pancreatic surgery. This study aims to assess the surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy relative to its laparoscopic counterpart. A retrospective study was designed to compare the surgical outcomes of 27 robot-assisted laparoscopic pancreaticoduodenectomy (RPD) and 25 laparoscopic pancreaticoduodenectomy (LPD). Perioperative data, including operating time, complication, morbidity and mortality, estimated blood loss, and postoperative length of stay, were analyzed. The robotic group exhibited significantly shorter operative time (mean 387 vs. 442 min), shorter hospital stay (mean 17 vs. 24 days), and less blood loss (mean 219 vs. 334 ml) than those in the LPD group. No statistical difference was observed between the two groups in terms of complication rate, mortality rate, R0 resection rate, and number of harvested lymph node. RPD is more efficient and secure process than LPD among properly selected patients. RPD is therefore a feasible alternative to the laparoscopic procedure. Further studies are needed to evaluate the cost effectiveness of the robotic approach for PD.

Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer.

PubMed

Hosogi, Hisahiro; Okabe, Hiroshi; Shinohara, Hisashi; Tsunoda, Shigeru; Hisamori, Shigeo; Sakai, Yoshiharu

2016-01-01

Laparoscopic distal gastrectomy has recently become accepted as a surgical option for early gastric cancer in the distal stomach, but laparoscopic total gastrectomy (LTG) has not become widespread because of technical difficulties of esophagojejunal anastomosis and splenic hilar lymphadenectomy. Splenic hilar lymphadenectomy should be employed in the treatment of advanced proximal gastric cancer to complete D2 dissection, but laparoscopically it is technically difficult even for skilled surgeons. Based on the evidence that prophylactic combined resection of spleen in total gastrectomy increased the risk of postoperative morbidity with no survival impact, surgeons have preferred laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) for advanced tumors without metastasis to splenic hilar nodes or invasion to the greater curvature of the stomach, and reports with LSPL have been increasing rather than LTG with splenectomy. In this paper, recent reports with laparoscopic splenic hilar lymphadenectomy were reviewed.

Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

PubMed

van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J

2017-01-01

To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

The Role of Hand-Assisted Laparoscopic Technique in the Age of Single-Incision Laparoscopy: An Effective Alternative to Avoid Open Conversion in Colorectal Surgery.

PubMed

Jung, Kyung Uk; Yun, Seong Hyeon; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

2018-04-01

Continuous efforts to reduce the numbers and size of incisions led to the emergence of a new technique, single-incision laparoscopic surgery (SILS). It has been rapidly accepted as the preferred surgical approach in the colorectal area. In the age of SILS, what is the role of hand-assisted laparoscopic surgery (HALS)? We introduce the way to take advantage of it, as an effective alternative to avoid open conversion. This is a retrospective review of prospectively collected data of SILS colectomies performed by a single surgeon in Samsung Medical Center between August 2009 and December 2012. Out of 631 cases of SILS colectomy, 47 cases needed some changes from the initial approach. Among these, five cases were converted to HALS. Four of them were completed successfully without the need for open conversion. One patient with rectosigmoid colon cancer invading bladder was finally opened to avoid vesical trigone injury. The mean operation time of the 4 patients was 265.0 minutes. The mean estimated blood loss was 587.5 mL. The postoperative complication rate associated with the operation was 25%. Conversion from SILS to HALS in colorectal surgery was feasible and effective. It seemed to add minimal morbidity while preserving advantages of minimally invasive surgery. It could be considered an alternative to open conversion in cases of SILS, especially when the conversion to conventional laparoscopy does not seem to be helpful.

Robot-assisted Versus Laparoscopic Surgery for Rectal Cancer: A Phase II Open Label Prospective Randomized Controlled Trial.

PubMed

Kim, Min Jung; Park, Sung Chan; Park, Ji Won; Chang, Hee Jin; Kim, Dae Yong; Nam, Byung-Ho; Sohn, Dae Kyung; Oh, Jae Hwan

2018-02-01

The phase II randomized controlled trial aimed to compare the outcomes of robot-assisted surgery with those of laparoscopic surgery in the patients with rectal cancer. The feasibility of robot-assisted surgery over laparoscopic surgery for rectal cancer has not been established yet. Between February 21, 2012 and March 11, 2015, patients with rectal cancer (cT1-3NxM0) were enrolled. Patients were randomized 1:1 to either robot-assisted or laparoscopic surgery, and stratified per sex and administration of preoperative chemoradiotherapy. The primary outcome was the quality of total mesorectal excision (TME) specimen. Secondary outcomes were the circumferential and distal resection margins, the number of harvested lymph nodes, morbidity, bowel function recovery, and quality of life. A total of 163 patients were randomly assigned to the robot-assisted (n = 81) and laparoscopic (n = 82) surgery groups, and 139 patients were eligible for the analyses (73 vs 66, respectively). One patient (1.2%) in the robot-assisted group was converted to open surgery. The TME quality did not differ between the robot-assisted and laparoscopic groups (80.3% vs 78.1% complete TME, respectively; 18.2% vs 21.9% nearly complete TME, respectively; P = 0.599). The resection margins, number of harvested lymph nodes, morbidity, and bowel function recovery also were not significantly different. On analyzing quality of life, scores of the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ C30) and EORTC QLQ CR38 were similar in the 2 groups, but in the EORTC QLQ CR 38 questionnaire, sexual function 12 months postoperatively was better in the robot-assisted group than in the laparoscopic group (P = 0.03). Robot-assisted surgery in rectal cancer showed TME quality comparable with that of laparoscopic surgery, and it demonstrated similar postoperative morbidity, bowel function recovery, and quality of life.

Laparoscopic surgery for trauma: the realm of therapeutic management.

PubMed

Zafar, Syed N; Onwugbufor, Michael T; Hughes, Kakra; Greene, Wendy R; Cornwell, Edward E; Fullum, Terrence M; Tran, Daniel D

2015-04-01

The use of laparoscopy in trauma is, in general, limited for diagnostic purposes. We aim to evaluate the therapeutic role of laparoscopic surgery in trauma patients. We analyzed the National Trauma Data Bank (2007 to 2010) for all patients undergoing diagnostic laparoscopy. Patients undergoing a therapeutic laparoscopic surgical procedure were identified and tabulated. Mortality and hospital length of stay for patients with isolated abdominal injuries were compared between the open and laparoscopic groups. Of a total of 2,539,818 trauma visits in the National Trauma Data Bank, 4,755 patients underwent a diagnostic laparoscopy at 467 trauma centers. Of these, 916 (19.3%) patients underwent a therapeutic laparoscopic intervention. Common laparoscopic operations included diaphragm repair, bowel repair or resection, and splenectomy. Patients undergoing laparoscopic surgery had a significantly shorter length of stay than the open group (5 vs 6 days; P < .001). Therapeutic laparoscopic surgery for trauma is feasible and may provide better outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Medical complications following splenectomy.

PubMed

Buzelé, R; Barbier, L; Sauvanet, A; Fantin, B

2016-08-01

Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever. Thromboembolic complications can involve both the caval system (deep-vein thrombophlebitis, pulmonary embolism) and the portal system. Portal vein thrombosis occurs more commonly in patients with myeloproliferative disease and cirrhosis. No thromboembolic prophylaxis is recommended apart from perioperative low molecular weight heparin. However, some authors choose to prescribe a short course of anti-platelet medication if the post-splenectomy patient develops significant thrombocytosis. Thrombosis of the portal or caval venous system requires prolonged warfarin anticoagulation for 3 to 6 months. Finally, some studies have suggested an increase in the long-term incidence of cancer in splenectomized patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Laparoscopic hysterectomy assisted with robot. Report of first case in Mexico ].

PubMed

Gallardo-Valencia, Luis Ernesto; Gallardo-Fuentes, J J; Ruz-Barros, R E

2014-10-01

Some 15 years ago since the DaVinci system is launched in the market and since then has been gaining ground in the field of surgery. There have been published case series and large casuisticals comparing the benefits from robotic surgery versus laparoscopic. In 2005 the Food & Drug Administration (FDA) approves its use for gynecological surgery. In Mexico, we have no experience in the use of this technology in this field of medicine. To describe the first laparoscopic hysterectomy case assisted with a robot (LHAR) intervened in Mexico, the results and review of the literature reported at the global level. this is a 47 year-old patient with clinical and ultrasonographic diagnosis of uterine fibroids of large items, who is scheduled for laparoscopic hysterectomy assisted with robot at Hospital Angeles del Pedregal in May of 2014. It examines the parameters of surgical time, transoperative bleeding, surgical complications, postoperative pain and hospital stay. It is also a review of the literature and compared the results obtained with what is reported in the literature world. The surgery had a duration of 2 hours 35 minutes. Blood loss was less than 50 mL. There were no complications and the patient had an EVA test of 2 at 24 hours after surgery. Hospital stay was 2 days. Laparoscopic hysterectomy assisted with a robot is a reliable procedure according to what is reported at the global level, offering benefits to both the surgeon and the patient.

Comparison of precision and speed in laparoscopic and robot-assisted surgical task performance.

PubMed

Zihni, Ahmed; Gerull, William D; Cavallo, Jaime A; Ge, Tianjia; Ray, Shuddhadeb; Chiu, Jason; Brunt, L Michael; Awad, Michael M

2018-03-01

Robotic platforms have the potential advantage of providing additional dexterity and precision to surgeons while performing complex laparoscopic tasks, especially for those in training. Few quantitative evaluations of surgical task performance comparing laparoscopic and robotic platforms among surgeons of varying experience levels have been done. We compared measures of quality and efficiency of Fundamentals of Laparoscopic Surgery task performance on these platforms in novices and experienced laparoscopic and robotic surgeons. Fourteen novices, 12 expert laparoscopic surgeons (>100 laparoscopic procedures performed, no robotics experience), and five expert robotic surgeons (>25 robotic procedures performed) performed three Fundamentals of Laparoscopic Surgery tasks on both laparoscopic and robotic platforms: peg transfer (PT), pattern cutting (PC), and intracorporeal suturing. All tasks were repeated three times by each subject on each platform in a randomized order. Mean completion times and mean errors per trial (EPT) were calculated for each task on both platforms. Results were compared using Student's t-test (P < 0.05 considered statistically significant). Among novices, greater errors were noted during laparoscopic PC (Lap 2.21 versus Robot 0.88 EPT, P < 0.001). Among expert laparoscopists, greater errors were noted during laparoscopic PT compared with robotic (PT: Lap 0.14 versus Robot 0.00 EPT, P = 0.04). Among expert robotic surgeons, greater errors were noted during laparoscopic PC compared with robotic (Lap 0.80 versus Robot 0.13 EPT, P = 0.02). Among expert laparoscopists, task performance was slower on the robotic platform compared with laparoscopy. In comparisons of expert laparoscopists performing tasks on the laparoscopic platform and expert robotic surgeons performing tasks on the robotic platform, expert robotic surgeons demonstrated fewer errors during the PC task (P = 0.009). Robotic assistance provided a reduction in errors at all

[Laparoscopic-assisted vaginal hysterectomy after multiple abdominal surgeries--case study].

PubMed

Malinowski, Andrzej; Wiecka-Płusa, Monika; Mołas, Justyna

2009-11-01

At present the laparoscopic-assisted vaginal hysterectomy (LAVH) is the most widespread and most frequently executed variation of hysterectomy. It is an effective and safe operating alternative for the traditional way--abdominal hysterectomy. Good cosmetic effects, short post-operative stay at hospital and, first of all, a small risk of intra- and postoperative complications are the major driving factors justifying the choice of this method of surgery. In the following article we describe a case of a 43-year-old woman who underwent many interventions in the peritoneal cavity (abdominal surgery) and was shortlisted for the laparoscopic-assisted vaginal hysterectomy. The cause of the operation was recurrent bilateral ovary cystis that could not be treated neither conservatively nor surgically, as well as the uterus myoma leading to abnormal uterus bleeding and hypermenorrhoea. Surgery in patients who have previously undergone abdominal operations is always difficult and the risk of complications is high indeed. In this case, while selecting the method of the next surgical procedure, surgeons must not exclude the vaginal and laparoscopic methods, or use them simultaneously. Experiences of other surgeons, as well as the unique case of a treated patient, show that previous abdominal surgical procedures are not a contraindication for either vaginal or laparoscopic procedures, and in some cases they might be safer than yet another laparotomy.

Use of near infrared fluorescence during robot-assisted laparoscopic partial nephrectomy.

PubMed

Cornejo-Dávila, V; Nazmy, M; Kella, N; Palmeros-Rodríguez, M A; Morales-Montor, J G; Pacheco-Gahbler, C

2016-04-01

Partial nephrectomy is the treatment of choice for T1a tumours. The open approach is still the standard method. Robot-assisted laparoscopic surgery offers advantages that are applicable to partial nephrectomy, such as the use of the Firefly® system with near-infrared fluorescence. To demonstrate the implementation of fluorescence in nephron-sparing surgery. This case concerned a 37-year-old female smoker, with obesity. The patient had a right kidney tumour measuring 31 mm, which was found using tomography. She therefore underwent robot-assisted laparoscopic partial nephrectomy, with a warm ischaemia time of 22 minutes and the use of fluorescence with the Firefly® system to guide the resection. There were no complications. The tumour was a pT1aN0M0 renal cell carcinoma, with negative margins. Robot-assisted renal laparoscopic surgery is employed for nephron-sparing surgery, with good oncological and functional results. The combination of the Firefly® technology and intraoperative ultrasound can more accurately delimit the extent of the lesion, increase the negative margins and decrease the ischaemia time. Near-infrared fluorescence in robot-assisted partial nephrectomy is useful for guiding the tumour resection and can potentially improve the oncological and functional results. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Strategies to optimize the performance of Robotic-assisted ­laparoscopic hysterectomy

PubMed Central

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

2014-01-01

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

System for robot-assisted real-time laparoscopic ultrasound elastography

NASA Astrophysics Data System (ADS)

Billings, Seth; Deshmukh, Nishikant; Kang, Hyun Jae; Taylor, Russell; Boctor, Emad M.

2012-02-01

Surgical robots provide many advantages for surgery, including minimal invasiveness, precise motion, high dexterity, and crisp stereovision. One limitation of current robotic procedures, compared to open surgery, is the loss of haptic information for such purposes as palpation, which can be very important in minimally invasive tumor resection. Numerous studies have reported the use of real-time ultrasound elastography, in conjunction with conventional B-mode ultrasound, to differentiate malignant from benign lesions. Several groups (including our own) have reported integration of ultrasound with the da Vinci robot, and ultrasound elastography is a very promising image guidance method for robotassisted procedures that will further enable the role of robots in interventions where precise knowledge of sub-surface anatomical features is crucial. We present a novel robot-assisted real-time ultrasound elastography system for minimally invasive robot-assisted interventions. Our system combines a da Vinci surgical robot with a non-clinical experimental software interface, a robotically articulated laparoscopic ultrasound probe, and our GPU-based elastography system. Elasticity and B-mode ultrasound images are displayed as picture-in-picture overlays in the da Vinci console. Our system minimizes dependence on human performance factors by incorporating computer-assisted motion control that automatically generates the tissue palpation required for elastography imaging, while leaving high-level control in the hands of the user. In addition to ensuring consistent strain imaging, the elastography assistance mode avoids the cognitive burden of tedious manual palpation. Preliminary tests of the system with an elasticity phantom demonstrate the ability to differentiate simulated lesions of varied stiffness and to clearly delineate lesion boundaries.

Robotic Camera Assistance and Its Benefit in 1033 Traditional Laparoscopic Procedures: Prospective Clinical Trial Using a Joystick-guided Camera Holder.

PubMed

Holländer, Sebastian W; Klingen, Hans Joachim; Fritz, Marliese; Djalali, Peter; Birk, Dieter

2014-11-01

Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, Aktormed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Eight of nine surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable, but it cannot fully replace a human assistant.

Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer.

PubMed

Xingmao, Zhang; Haitao, Zhou; Jianwei, Liang; Huirong, Hou; Junjie, Hu; Zhixiang, Zhou

2014-09-01

The purposes of this study were to compare the short-term outcomes of natural orifice specimen extraction (NOSE) and laparoscopic-assisted resection for sigmoid colon cancer or rectal cancer and to appraise whether totally laparoscopic resection with NOSE had more advantages compared with conventional laparoscopic-assisted resection. Sixty-five patients who underwent totally laparoscopic resection with NOSE were assigned to NOSE group, and 132 patients who underwent laparoscopic-assisted resection were assigned to laparoscopic-assisted (LA) group. Data of all 197 cases were reviewed. Short-term outcomes (including operative outcomes, gastrointestinal recovery, hospital stay, and complication) of the two groups were compared. Mean numbers of lymph nodes harvested were 17.0 ± 8.3 and 18.9 ± 11.6 in NOSE group and LA group, respectively, (P = 0.248); mean operative times were 111.6 ± 25.4 min and 115.3 ± 23.0 min in the two groups (P = 0.384); and the mean blood losses in these two groups were 70.2 ± 66.1 ml and 126.3 ± 58.6 ml, respectively, (P < 0.001). Times to first flatus were 2.7 ± 0.8 and 3.4 ± 0.9 days (P < 0.001), and times to first defecation were 3.3 ± 0.6 and 3.9 ± 1.1 days (P = 0.002) in NOSE group and LA group, respectively. Hospital stay in NOSE group were 9.0 ± 1.9 and 9.9 ± 2.0 days in LA group. Incidences of peri-operative complications were 6.2 and 17.2% in the two groups, respectively (P = 0.031). Without compromising oncologic outcome, totally laparoscopic resection with NOSE had more advantages including less blood loss, less pain, faster recovery of intestinal function and shorter hospital stay compared with laparoscopic-assisted resection for selected patients with sigmoid colon cancer or rectal cancer.

A case of robot-assisted laparoscopic radical prostatectomy in primary small cell prostate cancer.

PubMed

Kim, Ki Hong; Park, Sang Un; Jang, Jee Young; Park, Won Kyu; Oh, Chul Kyu; Rha, Koon Ho

2010-12-01

Primary small cell carcinoma of the prostate is a rare and very aggressive disease with a poor prognosis, even in its localized form. We managed a case of primary small cell carcinoma of the prostate. The patient was treated with robot-assisted laparoscopic radical prostatectomy and adjuvant chemotherapy. Herein we report this first case of robot-assisted laparoscopic radical prostatectomy performed in a patient with primary small cell carcinoma of the prostate.

Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy.

PubMed

Kawanaka, Hirofumi; Akahoshi, Tomohiko; Nagao, Yoshihiro; Kinjo, Nao; Yoshida, Daisuke; Matsumoto, Yoshihiro; Harimoto, Norifumi; Itoh, Shinji; Yoshizumi, Tomoharu; Maehara, Yoshihiko

2018-01-01

Laparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy. We analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging. Thirty-four patients with efferent drainage veins suitable for balloon-occluded retrograde transvenous obliteration (B-RTO) underwent B-RTO instead of surgical GDS, with subsequent Lap SPL. Among 27 patients with gastric varices unsuitable for B-RTO, 15 patients with PGV/SGV underwent Lap GDS of the greater curvature and SPL, and 12 patients with LGV or LGV/PGV/SGV underwent Lap GDS of the greater and lesser curvature and SPL. The mean operation time was 294 min and mean blood loss was 198 g. There was no mortality or severe morbidity. Gastric varices were eradicated in all 61 patients, with no bleeding or recurrence during a mean follow-up of 55.9 months. The cumulative 3-, 5-, and 7-year survival rates were 92, 82, and 64%, respectively. Lap GDS and SPL customized based on CT vascular anatomy is a safe and effective procedure for treating gastric varices.

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

PubMed

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

2011-11-01

The objective of this meta-analysis was to assess whether laparoscopic-assisted vaginal hysterectomy achieves better clinical results compared with abdominal hysterectomy. Medline (PubMed), EMBASE, Web of Science, ProQuest, Cochrane Library and China Biological Medicine Database were searched to identify randomized controlled trials that compared laparoscopic-assisted vaginal hysterectomy with abdominal hysterectomy. Twenty-three trials were studied and the analysis was performed using Review Manager Version 5 and R Version 2.11.1. The results showed that laparoscopic-assisted vaginal hysterectomy was associated with a longer operation time, less blood loss, shorter hospital stay, smaller haemoglobin drop, less postoperative pain, quicker return to normal activities and fewer peri-operative complications. Quality of life is likely to be the key outcome to evaluate the approach for hysterectomy, but further research is needed. For suitable patients and surgeons, laparoscopic-assisted vaginal hysterectomy is a better choice than abdominal hysterectomy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy: comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis.

PubMed

Ikeda, Tetsuo; Kawano, Hiroyuki; Hisamatsu, Yuichi; Ando, Koji; Saeki, Hiroshi; Oki, Eiji; Ohga, Takefumi; Kakeji, Yoshihiro; Tsujitani, Shunichi; Kohnoe, Shunji; Maehara, Yoshihiko

2013-01-01

Billroth I (B-I) gastroduodenostomy is an anastomotic procedure that is widely performed after gastric resection for distal gastric cancer. A circular stapler often is used for B-I gastroduodenostomy in open and laparoscopic-assisted distal gastrectomy. Recently, totally laparoscopic distal gastrectomy (TLDG) has been considered less invasive than laparoscopic-assisted gastrectomy, and many institutions performing laparoscopic-assisted distal gastrectomy are trying to progress to TLDG without markedly changing the anastomosis method. The purpose of this report is to introduce the technical details of new methods of intracorporeal gastroduodenostomy using either a circular or linear stapler and to evaluate their technical feasibility and safety. Seventeen patients who underwent TLDG with the intracorporeal double-stapling technique using a circular stapler (n = 7) or the book-binding technique (BBT) using a linear stapler (n = 10) between February 2010 and April 2011 were enrolled in the study. Clinicopathological data, surgical data, and postoperative outcomes were analyzed. There were no intraoperative complications or conversions to open surgery in any of the 17 patients. The usual postoperative complications following gastroduodenostomy, such as anastomotic leakage and stenosis, were not observed. Anastomosis took significantly longer to complete with DST (64 ± 24 min) than with BBT (34 ± 7 min), but more stapler cartridges were needed with BBT than with DST. TLDG using a circular or linear stapler is feasible and safe to perform. DST will enable institutions performing laparoscopic-assisted distal gastrectomy with circular staplers to progress to TLDG without problems, and this progression may be more economical because fewer stapler cartridges are used during surgery. However, if an institution has already been performing δ anastomosis in TLDG but has been experiencing certain issues with δ anastomosis, converting from δ anastomosis to BBT should be

Hand-eye calibration for rigid laparoscopes using an invariant point.

PubMed

Thompson, Stephen; Stoyanov, Danail; Schneider, Crispin; Gurusamy, Kurinchi; Ourselin, Sébastien; Davidson, Brian; Hawkes, David; Clarkson, Matthew J

2016-06-01

Laparoscopic liver resection has significant advantages over open surgery due to less patient trauma and faster recovery times, yet it can be difficult due to the restricted field of view and lack of haptic feedback. Image guidance provides a potential solution but one current challenge is in accurate "hand-eye" calibration, which determines the position and orientation of the laparoscope camera relative to the tracking markers. In this paper, we propose a simple and clinically feasible calibration method based on a single invariant point. The method requires no additional hardware, can be constructed by theatre staff during surgical setup, requires minimal image processing and can be visualised in real time. Real-time visualisation allows the surgical team to assess the calibration accuracy before use in surgery. In addition, in the laboratory, we have developed a laparoscope with an electromagnetic tracking sensor attached to the camera end and an optical tracking marker attached to the distal end. This enables a comparison of tracking performance. We have evaluated our method in the laboratory and compared it to two widely used methods, "Tsai's method" and "direct" calibration. The new method is of comparable accuracy to existing methods, and we show RMS projected error due to calibration of 1.95 mm for optical tracking and 0.85 mm for EM tracking, versus 4.13 and 1.00 mm respectively, using existing methods. The new method has also been shown to be workable under sterile conditions in the operating room. We have proposed a new method of hand-eye calibration, based on a single invariant point. Initial experience has shown that the method provides visual feedback, satisfactory accuracy and can be performed during surgery. We also show that an EM sensor placed near the camera would provide significantly improved image overlay accuracy.

Robot-Assisted Laparoscopic Repair of Spontaneous Appendicovesical Fistula

PubMed Central

Kibar, Yusuf; Yalcin, Serdar; Kopru, Burak; Topuz, Bahadir; Ebiloglu, Turgay

2016-01-01

Abstract Background: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. Case Presentation: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. Conclusion: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option. PMID:27579435

Laparoscopic robot-assisted pancreas transplantation: first world experience.

PubMed

Boggi, Ugo; Signori, Stefano; Vistoli, Fabio; D'Imporzano, Simone; Amorese, Gabriella; Consani, Giovanni; Guarracino, Fabio; Marchetti, Piero; Focosi, Daniele; Mosca, Franco

2012-01-27

Surgical complications are a major disincentive to pancreas transplantation, despite the undisputed benefits of restored insulin independence. The da Vinci surgical system, a computer-assisted electromechanical device, provides the unique opportunity to test whether laparoscopy can reduce the morbidity of pancreas transplantation. Pancreas transplantation was performed by robot-assisted laparoscopy in three patients. The first patient received a pancreas after kidney transplant, the second a simultaneous pancreas kidney transplantation, and the third a pancreas transplant alone. Operations were carried out through an 11-mm optic port, two 8-mm operative ports, and a 7-cm midline incision. The latter was used to introduce the grafts, enable vascular cross-clamping, and create exocrine drainage into the jejunum. The two solitary pancreas transplants required an operating time of 3 and 5 hr, respectively; the simultaneous pancreas kidney transplantation took 8 hr. Mean warm ischemia time of the pancreas graft was 34 min. All pancreatic transplants functioned immediately, and all recipients became insulin independent. The kidney graft, revascularized after 35 min of warm ischemia, also functioned immediately. No patient had complications during or after surgery. At the longer follow-up of 10, 8, and 6 months, respectively, all recipients are alive with normal graft function. We have shown the feasibility of laparoscopic robot-assisted solitary pancreas and simultaneous pancreas and kidney transplantation. If the safety and feasibility of this procedure can be confirmed by larger series, laparoscopic robot-assisted pancreas transplantation could become a new option for diabetic patients needing beta-cell replacement.

Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy.

PubMed

Park, J S; Choi, G-S; Park, S Y; Kim, H J; Ryuk, J P

2012-09-01

Robotic surgery was invented to overcome the demerits of laparoscopic technique. However, it is unclear whether robot-assisted colectomy (RAC) has significant clinical advantages over laparoscopically assisted colectomy (LAC) in treating colonic cancer. The aim of this study was to compare the surgical outcomes of RAC versus LAC for right-sided colonic cancer. Patients with right-sided colonic cancer were randomized to receive RAC or LAC. The primary outcome measure was length of hospital stay. Secondary outcomes were duration of operation, morbidity, postoperative pain, hospital costs and pathological quality of the specimen. Of 71 patients randomized, 70 (35 in each group) were included in the analysis. Hospital stay, surgical complications, postoperative pain score, resection margin clearance and number of lymph nodes harvested were similar in both groups. The duration of surgery was longer in the RAC group (195 versus 130 min; P < 0·001). No conversion to open surgery was needed in either group. Overall hospital costs were significantly higher for RAC (US $ 12,235 versus $ 10,320; P = 0·013); the higher costs were attributed primarily to the costs of surgery, including consumables. Robotic-assisted laparoscopic right colectomy was feasible but provided no benefit to justify the greater cost. NCT01042743 (http://www.clinicaltrials.gov). Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Outcome of laparoscopic ovariectomy and laparoscopic-assisted ovariohysterectomy in dogs: 278 cases (2003-2013).

PubMed

Corriveau, Kayla M; Giuffrida, Michelle A; Mayhew, Philipp D; Runge, Jeffrey J

2017-08-15

OBJECTIVE To compare outcomes for laparoscopic ovariectomy (LapOVE) and laparoscopic-assisted ovariohysterectomy (LapOVH) in dogs. DESIGN Retrospective case series. ANIMALS 278 female dogs. PROCEDURES Medical records of female dogs that underwent laparoscopic sterilization between 2003 and 2013 were reviewed. History, signalment, results of physical examination, results of preoperative diagnostic testing, details of the surgical procedure, durations of anesthesia and surgery, intraoperative and immediate postoperative (ie, during hospitalization) complications, and short- (≤ 14 days after surgery) and long-term (> 14 days after surgery) outcomes were recorded. Data for patients undergoing LapOVE versus LapOVH were compared. RESULTS Intraoperative and immediate postoperative complications were infrequent, and incidence did not differ between groups. Duration of surgery for LapOVE was significantly less than that for LapOVH; however, potential confounders were not assessed. Surgical site infection was identified in 3 of 224 (1.3%) dogs. At the time of long-term follow-up, postoperative urinary incontinence was reported in 7 of 125 (5.6%) dogs that underwent LapOVE and 12 of 82 (14.6%) dogs that underwent LapOVH. None of the dogs had reportedly developed estrus or pyometra by the time of final follow-up. Overall, 205 of 207 (99%) owners were satisfied with the surgery, and 196 of 207 (95%) would consider laparoscopic sterilization for their dogs in the future. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that short- and long-term outcomes were similar for female dogs undergoing sterilization by means of LapOVE or LapOVH; however, surgery time may have been shorter for dogs that underwent LapOVE. Most owners were satisfied with the outcome of laparoscopic sterilization.

Laparoscopic liver resection for malignancy: a review of the literature.

PubMed

Alkhalili, Eyas; Berber, Eren

2014-10-07

To review the published literature about laparoscopic liver resection for malignancy. A PubMed search was performed for original published studies until June 2013 and original series containing at least 30 patients were reviewed. 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. 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.

Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women.

PubMed

Rebeles, Sonia A; Muntz, Howard G; Wieneke-Broghammer, Carrie; Vason, Emily S; McGonigle, Kathryn F

2009-10-01

Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach. One-hundred consecutive robot-assisted TLHs were performed over a 17-month period. Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function to tolerate Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Data were prospectively collected on patient characteristics, total operative time, hysterectomy time, estimated blood loss, length of stay, and complications. Outcomes with non-obese and obese women were compared. The median age, weight, and BMI of the 100 patients who underwent robot-assisted TLH was 57.6 years (30.0-90.6), 82.1 kg (51.9-159.6), and 30.2 kg/m(2) (19.3-60.2), respectively. Fifty (50%) patients were obese (BMI ≥ 30); 22 patients were morbidly obese (BMI ≥ 40). There was no increase in complications (p = 0.56) or blood loss (p = 0.44) with increasing BMI. While increased BMI was associated with longer operative times (p = 0.05), median time increased by only 36 min when comparing non-obese and morbidly obese patients. Median length of stay was one day for all weight categories (p = 0.42). Robot-assisted TLH is feasible and can be safely performed in obese patients. More data are needed to compare robot-assisted TLH with other hysterectomy techniques in obese patients. Nonetheless, our results are encouraging. Robot-assisted total laparoscopic hysterectomy may be the preferred technique for appropriately selected obese patients.

Cost-effectiveness of open versus laparoscopic versus robotic-assisted laparoscopic cystectomy and urinary diversion.

PubMed

Zehnder, Pascal; Gill, Inderbir S

2011-09-01

To provide insight into the recently published cost comparisons in the context of open, laparoscopic, and robotic-assisted laparoscopic radical cystectomy and to demonstrate the complexity of such economic analyses. Most economic evaluations are from a hospital perspective and summarize short-term perioperative therapeutic costs. However, the contributing factors (e.g. study design, included variables, robotic amortization plan, supply contract, surgical volume, surgeons' experience, etc.) vary substantially between the institutions. In addition, a real cost-effective analysis considering cost per quality-adjusted life-year gained is not feasible because of the lack of long-term oncologic and functional outcome data with the robotic procedure. On the basis of a modeled cost analysis using results from published series, robotic-assisted cystectomy was - with few exceptions - found to be more expensive when compared with the open approach. Immediate costs are affected most by operative time, followed by length of hospital stay, robotic supply, case volume, robotic cost, and transfusion rate. Any complication substantially impacts overall costs. Economic cost evaluations are complex analyses influenced by numerous factors that hardly allow an interinstitutional comparison. Robotic-assisted cystectomy is constantly refined with many institutions being somewhere on their learning curve. Transparent reports of oncologic and functional outcome data from centers of expertise applying standardized methods will help to properly analyze the real long-term benefits of robotic surgery and successor technologies and prevent us from becoming slaves of successful marketing strategies.

Thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism.

PubMed

Duan, Ya-Qi; Liang, Ping

2013-05-01

Many studies have been conducted on splenic thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In this article, we review the evolution and current status of radiofrequency and microwave ablation in the treatment of spleen diseases. All publications from 1990 to 2011 on radiofrequency and microwave ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism were retrieved by searching PubMed. Thermal ablation in the spleen for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism can preserve part of the spleen and maintain splenic immunologic function. Thermal ablation for assisting hemostasis in partial splenectomy minimizes blood loss during operation. Thermal ablation for spleen trauma reduces the number of splenectomy and the amount of blood transfusion. Thermal ablation for splenic metastasis is minimally invasive and can be done under the guidance of an ultrasound, which helps shorten the recovery time. Thermal ablation for hypersplenism increases platelet (PLT) and white blood cell (WBC) counts and improves liver function. It also helps to maintain splenic immunologic function and even improves splenic immunologic function in the short-term. In conclusion, thermal ablative approaches are promising for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In order to improve therapeutic effects, directions for future studies may include standardized therapeutic indications, prolonged observation periods and enlarged sample sizes.

Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes.

PubMed

Takagi, Toshio; Kondo, Tsunenori; Tachibana, Hidekazu; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Yoshida, Kazuhiko; Tanabe, Kazunari

2017-07-01

To compare surgical outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with chronic kidney disease. Of 550 patients who underwent partial nephrectomy between 2012 and 2015, 163 patients with T1-2 renal tumors who had an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m 2 , and underwent robot-assisted laparoscopic partial nephrectomy or open partial nephrectomy were retrospectively analyzed. To minimize selection bias between the two surgical methods, patient variables were adjusted by 1:1 propensity score matching. The present study included 75 patients undergoing robot-assisted laparoscopic partial nephrectomy and 88 undergoing open partial nephrectomy. After propensity score matching, 40 patients were included in each operative group. The mean preoperative estimated glomerular filtration rate was 49 mL/min/1.73 m 2 . The mean ischemia time was 21 min in robot-assisted laparoscopic partial nephrectomy (warm ischemia) and 35 min in open partial nephrectomy (cold ischemia). Preservation of the estimated glomerular filtration rate 3-6 months postoperatively was not significantly different between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy (92% vs 91%, P = 0.9348). Estimated blood loss was significantly lower in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (104 vs 185 mL, P = 0.0025). The postoperative length of hospital stay was shorter in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (P < 0.0001). The prevalence of Clavien-Dindo grade 3 complications and a negative surgical margin status were not significantly different between the two groups. In our experience, robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy provide similar outcomes in terms of functional preservation and perioperative complications among patients with

The weight is over: RN first assisting techniques for laparoscopic sleeve gastrectomy.

PubMed

Wentzell, Joanne; Neff, Marc

2015-08-01

Obesity-related laparoscopic sleeve gastrectomy is a common yet technically challenging bariatric procedure that requires specialized surgical knowledge and training for OR personnel. Critical components of care include an effective preoperative assessment, positioning of the patient, and operation and maintenance of laparoscopic equipment and instrumentation. The purpose of this article is to explain the steps of laparoscopic sleeve gastrectomy and illustrate principles and surgical techniques for the RN who is first assisting during the procedure. Also provided is a perioperative nursing care plan for the patient undergoing bariatric surgery, to aid perioperative nurses in understanding the sequence of events and special considerations for this patient population. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas.

PubMed

Sebajang, H; Trudeau, P; Dougall, A; Hegge, S; McKinley, C; Anvari, M

2006-09-01

The aim of this study was to assess whether telementoring and telerobotic assistance would improve the range and quality of laparoscopic colorectal surgery being performed by community surgeons. We present a series of 18 patients who underwent telementored or telerobotically assisted laparoscopic colorectal surgery in two community hospitals between December 2002 and December 2003. Four community surgeons with no formal advanced laparoscopic fellowship were remotely mentored and assisted by an expert surgeon from a tertiary care center. Telementoring was achieved with real-time two-way audio-video communications over bandwidths of 384 kbps-1.2 mbps and included one redo ileocolic resection, two right hemicolectomies, two sigmoid resections, three low anterior resections, one subtotal colectomy, one reversal of a Hartmann operation, and one abdominoperineal resection. A Zeus TS microjoint system (Computer Motion Inc, Santa Barbara CA) was used to provide telepresence for the telerobotically assisted laparoscopic procedures, which included three right hemicolectomies, three sigmoid resections, and one low anterior resection. There were no major intraoperative complications. There were two minor intraoperative complications involving serosal tears of the colon from the robotic graspers. In the telementored cases, there were two postoperative complications requiring reoperation (intra-abdominal bleeding and small bowel obstruction). Two telementored procedures were converted because of the mentee's inability to find the appropriate planes of dissection. One telerobotically assisted procedure was completed laparoscopically by the local surgeon with aid of telementoring because of inadequate robotic arm position. The median length of hospital stay for this series was 4 days. The surgeons considered telementoring useful in all cases (median score 4 out of 5). The use of remote telerobotic assistance was also considered a significant enabling tool. Telementoring and remote

A matched comparison of perioperative outcomes of a single laparoscopic surgeon versus a multisurgeon robot-assisted cohort for partial nephrectomy.

PubMed

Ellison, Jonathan S; Montgomery, Jeffrey S; Wolf, J Stuart; Hafez, Khaled S; Miller, David C; Weizer, Alon Z

2012-07-01

Minimally invasive nephron sparing surgery is gaining popularity for small renal masses. Few groups have evaluated robot-assisted partial nephrectomy compared to other approaches using comparable patient populations. We present a matched pair analysis of a heterogeneous group of surgeons who performed robot-assisted partial nephrectomy and a single experienced laparoscopic surgeon who performed conventional laparoscopic partial nephrectomy. Perioperative outcomes and complications were compared. All 249 conventional laparoscopic and robot-assisted partial nephrectomy cases from January 2007 to June 2010 were reviewed from our prospectively maintained institutional database. Groups were matched 1:1 (108 matched pairs) by R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines) nephrometry score, transperitoneal vs retroperitoneal approach, patient age and hilar nature of the tumor. Statistical analysis was done to compare operative outcomes and complications. Matched analysis revealed that nephrometry score, age, gender, tumor side and American Society of Anesthesia physical status classification were similar. Operative time favored conventional laparoscopic partial nephrectomy. During the study period robot-assisted partial nephrectomy showed significant improvements in estimated blood loss and warm ischemia time compared to those of the experienced conventional laparoscopic group. Postoperative complication rates, and complication distributions by Clavien classification and type were similar for conventional laparoscopic and robot-assisted partial nephrectomy (41.7% and 35.0%, respectively). Robot-assisted partial nephrectomy has a noticeable but rapid learning curve. After it is overcome the robotic procedure results in perioperative outcomes similar to those achieved with conventional laparoscopic partial nephrectomy done by an experienced surgeon. Robot-assisted

Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia.

PubMed

Herling, Suzanne F; Palle, Connie; Møller, Ann M; Thomsen, Thordis; Sørensen, Jan

2016-03-01

The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference in Danish kroner between total abdominal hysterectomy and robotic-assisted laparoscopic hysterectomy. The average cost of consumables was 12,642 Danish kroner more expensive per patient for robotic-assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7.50 Danish kroner). When including all cost-drivers, the analysis showed that the robotic-assisted laparoscopic hysterectomy procedure was 9386 Danish kroner (17%) cheaper than the total abdominal hysterectomy (p = 0.003). When the robot investment was included, the cost difference reduced to 4053 Danish kroner (robotic-assisted laparoscopic hysterectomy was 7% cheaper than total abdominal hysterectomy) (p = 0.20). Increasing age and Type 2 diabetes appeared to influence the overall costs. For women with endometrial cancer or atypical complex hyperplasia, robotic-assisted laparoscopic hysterectomy was cheaper than total abdominal hysterectomy, mostly due to fewer complications and shorter length of hospital stay. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Flexible Carbon Dioxide Laser Fiber Versus Ultrasonic Scalpel in Robot-Assisted Laparoscopic Myomectomy.

PubMed

Choussein, Souzana; Srouji, Serene S; Farland, Leslie V; Gargiulo, Antonio R

2015-01-01

To compare the effectiveness and safety of a flexible carbon dioxide (CO2) laser fiber to the ultrasonic scalpel when employed through a robotic surgical system. Retrospective cohort study. Level II-2 evidence. Reproductive surgery practice at an academic hospital. Two hundred thirty-six women who had undergone robot-assisted laparoscopic myomectomy with either CO2 laser (n = 85) or the ultrasonic scalpel (n = 151). Robot-assisted laparoscopic myomectomy employing either a flexible CO2 laser fiber or a robotic ultrasonic scalpel as the primary energy tool. Perioperative outcomes (estimated blood loss, operative time, length of hospital stay) of patients undergoing robot-assisted myomectomy with a flexible laser fiber or ultrasonic scalpel. Estimated blood loss and operative time were comparable (p = .95 and p = .55, respectively) between the 2 groups after adjusting for all confounders, whereas length of hospital stay remained significantly different (p = .004). Odds ratio for complications was 0.35 (95% confidence interval 0.08-1.56; p = .17), which denotes no difference in the risk for complications between the 2 groups. Robot-assisted laparoscopic myomectomy with a flexible CO2 laser fiber is safe and has comparable operative outcomes to the ultrasonic scalpel. The small size and flexibility of this device allows robotic surgeons to employ safe focal energy without sacrificing operative ergonomics. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Introduction of hand-assisted retroperitoneoscopic living donor nephrectomy at Karolinska University Hospital Huddinge.

PubMed

Gjertsen, H; Sandberg, A-K A; Wadström, J; Tydén, G; Ericzon, B-G

2006-10-01

Living donor kidney transplantation accounts for about 50% of the total number of renal transplantations at our center. From 1999 through 2005, 75 out of 220 living donor nephrectomies were performed with a laparoscopic technique (LLDN). In June 2005, we introduced the technique of hand-assisted retroperitoneoscopic nephrectomy (HARS) for living donors. Since the introduction until the end of 2005, 11 out of 18 living donor nephrectomies (LDN) were performed with HARS. Reduced operation time was observed for the HARS group (mean, 166 minutes) compared with the LLDN (mean, 244 minutes). Two grafts showed delayed function, one in the LLND group and one in the HARS group. No major perioperative or postoperative complications were observed in the HARS group, whereas one patient who underwent LLDN developed severe pancreatitis. So far in our hands HARS is a fast and safe procedure with results comparable with open LDN. Compared to LLDN, we experienced reduced operation time together with the advantage of retroperitoneal access.

Continence outcomes in patients undergoing robotic assisted laparoscopic mitrofanoff appendicovesicostomy.

PubMed

Wille, Mark A; Zagaja, Gregory P; Shalhav, Arieh L; Gundeti, Mohan S

2011-04-01

Continent catheterizable channels for emptying the bladder are typically performed via an open surgical approach. We present our surgical approach and initial outcomes with specific attention to continence for robotic assisted laparoscopic Mitrofanoff appendicovesicostomy formation. Between February 2008 and April 2010, 13 patients were considered for robotic assisted laparoscopic Mitrofanoff appendicovesicostomy and 11 underwent the procedure (2 open conversions). Five patients underwent enterocystoplasty with appendicovesicostomy and 6 underwent isolated appendicovesicostomy. The appendicovesicostomy anastomosis was performed on the anterior (without augmentation) or posterior (with augmentation) bladder wall and the stoma was brought to the umbilical site or right lower quadrant. Detrusor backing (4 cm) was ensured except in 1 patient (number 5). Mean patient age at surgery was 10.4 years (range 5 to 14). Mean estimated blood loss was 61.8 cc. Mean operative time for isolated appendicovesicostomy was 347 minutes and there were no intraoperative complications. Incontinence through the stoma developed in 1 patient with inadequate detrusor backing (less than 4 cm), which resolved with dextranomer/hyaluronic acid injection into the appendicovesicostomy anastomosis. This patient had resolution of incontinence with an increase in bladder capacity to 300 cc. Three patients required skin flap revision for cutaneous scarring. To date all patients are catheterizing without difficulty and are continent. Median followup was 20 months (range 3 to 29). We are encouraged by our preliminary experience with the robotic assisted laparoscopic Mitrofanoff appendicovesicostomy continent urinary diversion with or without ileocystoplasty. Early in the experience we emphasize the importance of 4 cm of detrusor backing to maintain stomal continence. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results.

PubMed

Tomulescu, V; Stănciulea, O; Bălescu, I; Vasile, S; Tudor, St; Gheorghe, C; Vasilescu, C; Popescu, I

2009-01-01

Robotic surgery was developed in response to the limitations and drawbacks of laparoscopic surgery. Since 1997 when the first robotic procedure was performed various papers pointed the advantages of robotic-assisted laparoscopic surgery, this technique is now a reality and it will probably become the surgery of the future. The aim of this paper is to present our preliminary experience with the three-arms "da Vinci S surgical system", to assess the feasibility of this technique in various abdominal and thoracic procedures and to point out the advantages of the robotic approach for each type of procedure. Between 18 January 2008 and 18 January 2009 153 patients (66 men and 87 women; mean age 48,02 years, range 6 to 84 years) underwent robotic-assisted surgical procedures in our institution; we performed 129 abdominal and 24 thoracic procedures, as follows: one cholecystectomy, 14 myotomies with Dor fundoplication, one gastroenteroanastomosis for unresectable antral gastric cancer, one transthoracic esophagectomy, 14 gastrectomies, one polypectomy through gastrotomy, 22 splenectomies,7 partial spleen resections, 22 thymectomy, 6 Nissen fundoplications, one Toupet fundoplication, one choledocho-duodeno-anastomosis, one drainage for pancreatic abscess, one distal pancreatectomy, one hepatic cyst fenestration, 7 hepatic resections, 29 colonic and rectal resections, 5 adrenalectomies, 12 total radical hysterectomies and pelvic lymphadenectomy, 3 hysterectomies with bilateral adnexectomy for uterine fibroma, one unilateral adnexectomy, and 2 cases of cervico-mediastinal goitre resection. 147 procedures were robotics completed , whereas 6 procedures were converted to open surgery due to the extent of the lesion. Average operating room time was 171 minutes (range 60 to 600 minutes, Median length of stay was 8,6 days (range 2 to 48 days). One system malfunctions was registered. Post-operatory complications occurred in 14 cases. There were no deaths. Our preliminary experience

Pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy: complete intracorporeal--initial case report.

PubMed

Gundeti, Mohan S; Eng, Michael K; Reynolds, W Stuart; Zagaja, Gregory P

2008-11-01

To the best of our knowledge, we report the first case of complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in a pediatric patient, outlining the surgical technique and short-term results. The operative steps of the open procedure were replicated laparoscopically using robotic-assistance. In brief, 5 transperitoneal laparoscopic ports were placed before docking the da Vinci S robotic system. A 20-cm ileal segment was isolated, and the gastrointestinal anastomosis was performed in an end-to-end fashion using intracorporeal suturing. The appendix was anastomosed to the right posterior wall of the bladder over an 8F feeding tube in an extravesical fashion. The bladder was incised in a coronal plane, and the simple ileal on-lay patch was anastomosed to the posterior and anterior walls of the bladder. A suprapubic catheter and pelvic drain were placed, and the Mitrofanoff stoma was then fashioned. Cystography was performed at 4 weeks postoperatively. This preliminary first successful report suggests that robotic-assisted ileocystoplasty and appendicovesicostomy is feasible. A reasonable outcome with early recovery, resumption of normal activities, and excellent cosmesis can be achieved in selected patients. However, whether a robotic-assisted approach provides any significant advantages over conventional open procedures is yet to be determined with a large case series.

Active and Passive Haptic Training Approaches in VR Laparoscopic Surgery Training.

PubMed

Marutani, Takafumi; Kato, Toma; Tagawa, Kazuyoshi; Tanaka, Hiromi T; Komori, Masaru; Kurumi, Yoshimasa; Morikawa, Shigehiro

2016-01-01

Laparoscopic surgery has become a widely performed surgery as it is one of the most common minimally invasive surgeries. Doctors perform the surgery by manipulating thin and long surgical instruments precisely with the assistance of laparoscopic video with limited field of view. The power control of the instruments' tip is especially very important, because excessive power may damage internal organs. The training of this surgical technique is mainly supervised by an expert in hands-on coaching program. However, it is difficult for the experts to spend sufficient time for coaching. Therefore, we aim to teach the expert's hand movements in laparoscopic surgery to trainees using VR-based simulator, which is equipped with a guidance force display device. To realize the system, we propose two haptic training approaches for transferring the expert's hand movements to the trainee. One is active training, and the other is passive training. The former approach shows the expert's movements only when the trainee makes large errors while the latter shows the expert's movements continuously. In this study, we validate the applicability of these approaches through tasks in VR laparoscopic surgery training simulator, and identify the differences between these approaches.

Laparoscopic-assisted extirpation of falciform ligament hemangiosarcoma in a dog.

PubMed

Hoddinott, Katie; Singh, Ameet; Crawford, Evan C; Guieu, Elizabeth V; Richardson, Danielle

2015-04-01

An 8-year-old, spayed female, bichon frisé dog had incidental nodules within its falciform ligament identified on routine abdominal ultrasonography. A laparoscopic-assisted technique provided both a diagnostic and a therapeutic treatment option. A histopathological diagnosis of hemangiosarcoma was made. This is the second case reporting hemangiosarcoma of the falciform fat.

Laparoscopic versus open abdominal surgery in children with sickle cell disease is associated with a shorter hospital stay.

PubMed

Goers, Trudie; Panepinto, Julie; Debaun, Michael; Blinder, Morey; Foglia, Robert; Oldham, Keith T; Field, Joshua J

2008-03-01

Limited information exists comparing the post-operative complication rate of laparoscopic or open abdominal surgeries in children with sickle cell disease (SCD). The primary objective of this study was to compare the outcomes in children with SCD who required laparoscopic or open abdominal surgery for a cholecystectomy or splenectomy. We conducted a retrospective analysis of laparoscopic and open abdominal surgeries performed in children with SCD (ages 0-20 years) at two medical centers from 1984 to 2004. The primary outcome measures were the rates of post-operative pain and acute chest syndrome (ACS) episodes following laparoscopic or open abdominal surgery. The secondary outcome was length of hospital stay following surgery. We also examined the potential contribution of pre-operative (transfusion) and intra-operative factors (operating time, estimated blood loss, and end-operative temperature) to post-operative SCD-related complications. A total of 140 cases were identified, 98 laparoscopic and 42 open. Episodes of post-operative pain and ACS episodes were comparable between laparoscopic and open procedures (pain: 4% vs. 3%, P = 0.619; ACS: 5% vs. 5%, P = 0.933). Additionally, laparoscopic surgeries were associated with a significantly shorter hospital stay (2.9 vs. 5.4 days, 95% CI -3.7 to -1.4, P < 0.001). There was no difference in the number of hospital readmissions within 1 month of the surgery. For children with SCD who need a cholecystectomy or splenectomy, laparoscopy is the preferred strategy because of a shorter hospital stay with a similar complication rate compared to open surgeries. (c) 2007 Wiley-Liss, Inc.

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

Laparoscopic mesh fixation using laser-assisted tissue soldering in a porcine model.

PubMed

Lanzafame, Raymond J; Soltz, Barbara A; Stadler, Istvan; Soltz, Robert

2009-01-01

Animal studies using open surgical models indicate that collagen solder is capable of fixation of surgical meshes without interfering with tissue integration, increasing adhesions, or increasing inflammation intraperitoneally. This study describes development of instrumentation and techniques for laparoscopic herniorrhaphy using laser-assisted soldering technology. Anesthetized 20 kg to 25 kg female Yorkshire pigs underwent laparoscopy with a 3-trocar technique. Parietex TET, Parietex TEC, and Prolene mesh segments (5 x 5 cm) were embedded in 55% collagen solder. Segments were inserted by using a specially designed introducer and affixed to the peritoneum by using prototype laser devices (1.45 micro, 4.5 W continuous wave, 5-mm spot, 55 degrees C set temperature) and a custom laparoscopic handpiece (IPOM). Parietex PCO mesh was inserted and affixed using the Endo-hernia stapler (Control). Animals were recovered and underwent second-look laparoscopy at 6 weeks. Mesh sites were harvested after animals were euthanized. The mesh-solder constructs were easily inserted and affixed in an IPOM approach. Prolene mesh tended to curl at its edges as the solder was melted. Postoperative healing was similar to that in Control segments in all cases. Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce the use of staples or other foreign bodies for laparoscopic mesh fixation, prevent tissue ischemia and possibly nerve entrapment, which result in severe postoperative pain and morbidity. Laser-assisted mesh fixation is a promising alternative for laparoscopic herniorrhaphy. Further development of this strategy is warranted.

Robot-assisted laparoscopic (RAL) procedures in general surgery.

PubMed

Alimoglu, Orhan; Sagiroglu, Julide; Atak, Ibrahim; Kilic, Ali; Eren, Tunc; Caliskan, Mujgan; Bas, Gurhan

2016-09-01

Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot-assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures. Ninety seven patients underwent RALS from 2009 to 2012. Indications for RALS were cholelithiasis, gastric carcinoma, splenic tumors, colorectal carcinoma, benign colorectal diseases, non-toxic nodular goiter and incisional hernia. Records of patients were analyzed for demographic features, intraoperative and postoperative complications and conversion to open surgery. Forty six female and 51 male patients were operated and mean age was 58,4 (range: 25-88). Ninety three out of 97 procedures (96%) were completed robotically, 4 were converted to open surgery and there were 15 postoperative complications. There was no mortality. Wide variety of procedures of general surgery can be managed safely and effectively by RALS. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Technical proficiency in hand-assisted laparoscopic colon and rectal surgery: determining how many cases are required to achieve mastery.

PubMed

Pendlimari, Rajesh; Holubar, Stefan D; Dozois, Eric J; Larson, David W; Pemberton, John H; Cima, Robert R

2012-04-01

To determine how many cases are required to achieve technical proficiency for hand-assisted laparoscopic surgery (HALS). Retrospective study. Tertiary care hospital. Using a prospective database, all HALS colorectal resections from 2003 to 2009 by 2 surgeons (A and B) were reviewed. Over 6 years, surgeons A and B performed 397 and 322 cases. Change-Point Analysis (CUSUM) was used to define the number of cases required to effect improvement in operative time. Cases before and after the change point were considered as being in the "learning period" and "skilled period." Operative time; short-term outcomes. The change point occurred after 108 and 105 cases for surgeons A and B, respectively. The learning period and skilled period were similar with respect to age, sex, body mass index, prior abdominal surgery, medical comorbidities, and American Society of Anesthesiologists class. Mean overall operative time decreased from 263 to 185 minutes (P < .001). The decrease in mean operative duration for specific resections were as follows: right colectomy, 35 minutes (P = .003); left colectomy, 63 minutes (P = .006); sigmoid colectomy, 63 minutes (P < .001); anterior resection, 70 minutes (P < .001); coloanal anastomosis, 52 minutes (P = .003); subtotal colectomy, 75 minutes (P < .001); and total proctocolectomy with ileal reservoir, 80 minutes (P < .001). Intraoperative complications and conversion rate were similar, but overall morbidity, infectious complications, readmissions, and length of stay were all significantly (P < .05) lower during the skilled period. For HALS colorectal resection, technical proficiency occurred after approximately 105 cases, and increased surgeon experience resulted in improved short-term outcomes. These data suggest that the learning curve for HALS colorectal resection will extend beyond fellowship training for many colorectal surgeons.

Partial splenectomy: A case series and systematic review of the literature

PubMed Central

Esposito, Francesco; Noviello, Adele; Moles, Nicola; Cantore, Nicola; Baiamonte, Mario; Coppola Bottazzi, Enrico; Miro, Antonio

2018-01-01

Backgrounds/Aims Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches. Methods Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients. Results Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5–50%) and in 3% of cases (range, 7–10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5–25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%). Conclusions The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery. PMID:29896572

Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults.

PubMed

Minnillo, Brian J; Cruz, Jose A S; Sayao, Rogerio H; Passerotti, Carlo C; Houck, Constance S; Meier, Petra M; Borer, Joseph G; Diamond, David A; Retik, Alan B; Nguyen, Hiep T

2011-04-01

Laparoscopic pyeloplasty is one of the more common robotic assisted procedures performed in children. However, data regarding long-term experience and clinical outcomes for this procedure are limited. We evaluated the long-term outcomes in a large series of patients undergoing robotic assisted laparoscopic pyeloplasty at a teaching institution, and the effect of a collaborative program between the robotic surgeons, surgical nurses and anesthesiologists on overall operative time. We retrospectively reviewed 155 patients who underwent robotic assisted laparoscopic pyeloplasty between 2002 and 2009. Operative data, including surgical approach, type of procedure, total and specific operative times and placement of ureteral stents, were determined. Postoperative outcome measurements, including duration of hospital stay, duration of Foley catheter drainage, radiological findings and any subsequent complications, were assessed. Mean operative time and length of hospitalization decreased significantly by the end of the study. At a mean followup of 31.7 months the primary success rate was 96% (hydronephrosis was improved in 85% of patients and stable in 11%). The complication rate was 11%, and recurrent obstruction requiring redo robotic assisted laparoscopic pyeloplasty or open pyeloplasty developed in 3% of patients. Success rate and complication rate were unchanged during the study period. This study confirms that even within the confines of a pediatric urology training program successful collaboration between robotic surgeons, surgical nurses and anesthesiologists can lead to shorter operative times and hospital stays. Long-term surgical success and complication rates were comparable to open surgery. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Anastomotic leakage after laparoscopic-assisted radical right hemicolectomy: reason analysis and management].

PubMed

Wu, Xin; Lin, Guole; Qiu, Huizhong; Xiao, Yi; Wu, Bin

2017-06-25

To analyze the clinical features, possible reasons and management of anastomotic leakage after laparoscopic-assisted radical right hemicolectomy. Clinical data of 546 patients undergoing laparoscopic-assisted radical right hemicolectomy in Peking Union Medical College Hospital from October 2010 to September 2016 were retrospectively analyzed. The occurrence of anastomotic leakage and its countermeasures were evaluated. Among 546 patients, 8(1.5%) cases developed anastomotic leakage, including 7 males and 1 female with mean age of (54.3±10.3) years. Six cases of ascending colon cancer, 1 case of phlegmon and 1 case of arterior-venous malformation were confirmed after operation. The incidence of anastomotic leakage after D3 and D2 lymphadenectomy was 2.1%(6/290) and 0.8%(2/256). The time from operation to the diagnosis of anastomotic leakage was (6.6±3.6) days. The clinical manifestation of anastomotic leakage were stool-like drainage in 7 patients, fever in 4 and abdominal pain in 3. Amylase and bilirubin in drainage of 4 patients increased obviously. All the 8 patients underwent secondary ileostomy, including 4 with laparoscopy and 4 with laparotomy. One patient suffered from respiratory failure after re-operation because of severe abdominal infection and was cured by ventilator support treatment. Another one had pelvic encapsulated effusion and was treated by puncture drainage. All the patients discharged from hospital smoothly. Anastomotic leakage after laparoscopic-assisted right hemicolectomy is a quite rare but serious complication, which may be associated with over-cleaning of lymph fatty tissues. Ileostomy should be the first choice of anastomotic leakage after laparoscopy-assisted right hemicolectomy and its efficacy is satisfactory.

Comparing renal function preservation after laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for clinical T1a renal tumor: using a 3D parenchyma measurement system.

PubMed

Zhu, Liangsong; Wu, Guangyu; Huang, Jiwei; Wang, Jianfeng; Zhang, Ruiyun; Kong, Wen; Xue, Wei; Huang, Yiran; Chen, Yonghui; Zhang, Jin

2017-05-01

To compare the renal function preservation between laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy. Data were analyzed from 246 patients who underwent laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for solitary cT1a renal cell carcinoma from January 2013 to July 2015. To reduce the intergroup difference, we used a 1:1 propensity matching analysis. The functional renal parenchyma volume preservation were measured preoperative and 12 months after surgery. The total renal function recovery and spilt GFR was compared. Multivariable logistic analysis was used for predictive factors for renal function decline. After 1:1 propensity matching, each group including 100 patients. Patients in the laparoscopic radio frequency ablation assisted tumor enucleation had a smaller decrease in estimate glomerular filtration rate at 1 day (-7.88 vs -20.01%, p < 0.001), 3 months (-2.31 vs -10.39%, p < 0.001), 6 months (-2.16 vs -7.99%, p = 0.015), 12 months (-3.26 vs -8.03%, p = 0.012) and latest test (-3.24 vs -8.02%, p = 0.040), also had better functional renal parenchyma volume preservation (89.19 vs 84.27%, p < 0.001), lower decrease of the spilt glomerular filtration rate (-9.41 vs -17.13%, p < 0.001) at 12 months. The functional renal parenchyma volume preservation, warm ischemia time and baseline renal function were the important independent factors in determining long-term functional recovery. The laparoscopic radio frequency ablation assisted tumor enucleation technology has unique advantage and potential in preserving renal parenchyma without ischemia damage compared to conventional laparoscopic partial nephrectomy, and had a better outcome, thus we recommend this technique in selected T1a patients.

Bloody otorrhea after robotically assisted laparoscopic prostatectomy.

PubMed

Cohen, Andrew; Ledezma-Rojas, Rodrigo; Mhoon, Ernest; Zagaja, Gregory

2015-06-01

Bilateral bloody otorrhea is a rare complication of surgery and to our knowledge a previously unpublished event. We review the case of a 50-year-old male who underwent robotic-assisted laparoscopic radical prostatectomy (RALP) with bilateral lymphadenectomy for Gleason's Score 4 + 4 = 8 prostate cancer. Bloody discharge from bilateral auditory canals was noted upon removal of the surgical drapes. Otolaryngologic examination revealed bilateral anterior auditory canal hematomas without any loss of hearing. Steep Trendelenburg position in combination with perioperative anticoagulants may have contributed to this complication. Given the rarity of this event no specific risk factors are identified.

Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature.

PubMed

Passerotti, Carlo Camargo; Pessoa, Rodrigo; da Cruz, Jose Arnaldo Shiomi; Okano, Marcelo Takeo; Antunes, Alberto Azoubel; Nesrallah, Adriano Joao; Dall'oglio, Marcos Francisco; Andrade, Enrico; Srougi, Miguel

2012-01-01

Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients ' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL) ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT) ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses. Further prospective studies are needed to compare open partial nephrectomy with its minimally invasive counterparts.

Prospective evaluation of short-term impact and recovery of health related quality of life in men undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy.

PubMed

Miller, Javier; Smith, Angela; Kouba, Erik; Wallen, Eric; Pruthi, Raj S

2007-09-01

In the last few years there have been increasing claims that robotic assisted laparoscopic radical prostatectomy decreases short-term morbidity in patients undergoing surgical treatment for prostate cancer. However, there is surprisingly little objective evidence to support this point, which is often used to market the procedure to patients. To address this issue we prospectively evaluated patients undergoing open and robotic assisted laparoscopic radical prostatectomy at baseline and weekly through the postoperative period using a validated questionnaire. A total of 162 men undergoing radical prostatectomy, including open radical prostatectomy in 120 and robotic assisted laparoscopic radical prostatectomy in 42, for clinically localized prostate cancer completed the SF-12, version 2 Physical and Mental Health Survey Acute Form preoperatively and each week postoperatively for 6 weeks. Physical and Mental Component Scores were calculated from the questionnaires at each time point. Comparisons between the 2 surgical approaches were made at each time point. No significant differences were seen between the open and robotic assisted laparoscopic radical prostatectomy groups with regard to patient age, clinical stage or preoperative prostate specific antigen. Mean surgical blood loss was significantly higher in the open group compared to that in the robotic assisted laparoscopic group. Physical Component Scores in the robotic assisted laparoscopic group were significantly higher than those in the open cohort beginning postoperative week 1 and extending through week 6. On statistical extrapolation Physical Component Scores returned to baseline between weeks 5 and 6 postoperatively in the robotic assisted laparoscopic group and between weeks 6 and 7 in the open group. Mental Component Score scores were not statistically different between the groups except preoperatively. This study helps prospectively define short-term health related quality of life in patients undergoing

[A Case of Laparoscopic Repair of Internal Hernia after Laparoscope-Assisted Distal Gastrectomy with Antecolic Roux-en-Y Reconstruction].

PubMed

Maezawa, Yukio; Cho, Haruhiko; Kano, Kazuki; Nakajima, Tetsushi; Ikeda, Kousuke; Yamada, Takanobu; Sato, Tsutomu; Ohshima, Takashi; Rino, Yasushi; Masuda, Munetaka; Ogata, Takashi; Yoshikawa, Takaki

2017-10-01

A 72-year-old woman had undergone laparoscope-assisted distal gastrectomy with D1 plus lymph node dissection and antecolic Roux-en-Y reconstruction for early gastric cancer. She visited our department outpatient clinic with left upper abdominal pain 1 year and 9 months after the surgery. CT revealed a spiral sign of the superior mesenteric arteriovenous branch. An internal hernia was suspected on hospitalization. Although abdominal symptoms were relieved by conservative treatment, the hernia persisted. Laparoscopic surgery was performed and revealed that almost entire small intestine had been affected due to Petersen's defect. Since no ischemic changes were observed, the defect was repaired laparoscopically with suture closure. There has been no recurrence of internal hernia after the laparoscopic surgery. Internal hernia after distal gastrectomy is relatively rare. However, the risk of internal hernia is high due to the gap between the elevated jejunum and transverse colon mesentery in Roux-en-Y reconstruction and can lead to intestinal necrosis. Since an internal hernia can occur in patients who have undergone gastric resection with Roux-en-Y reconstruction, suture closure of Petersen's defect should be performed to prevent this occurrence.

[Sacrocolpopexy - pro laparoscopic].

PubMed

Hatzinger, M; Sohn, M

2012-05-01

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

Laparoscopic Mesh Fixation Using Laser-Assisted Tissue Soldering in a Porcine Model

PubMed Central

Soltz, Barbara A.; Stadler, Istvan; Soltz, Robert

2009-01-01

Background and Objective: Animal studies using open surgical models indicate that collagen solder is capable of fixation of surgical meshes without interfering with tissue integration, increasing adhesions, or increasing inflammation intraperitoneally. This study describes development of instrumentation and techniques for laparoscopic herniorrhaphy using laser-assisted soldering technology. Study Design and Methods: Anesthetized 20 kg to 25 kg female Yorkshire pigs underwent laparoscopy with a 3-trocar technique. Parietex TET, Parietex TEC, and Prolene mesh segments (5 × 5 cm) were embedded in 55% collagen solder. Segments were inserted by using a specially designed introducer and affixed to the peritoneum by using prototype laser devices (1.45 µ, 4.5 W continuous wave, 5-mm spot, 55° C set temperature) and a custom laparoscopic handpiece (IPOM). Parietex PCO mesh was inserted and affixed using the Endo-hernia stapler (Control). Animals were recovered and underwent second-look laparoscopy at 6 weeks. Mesh sites were harvested after animals were euthanized. Results: The mesh-solder constructs were easily inserted and affixed in an IPOM approach. Prolene mesh tended to curl at its edges as the solder was melted. Postoperative healing was similar to that in Control segments in all cases. Discussion and Conclusion: Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce the use of staples or other foreign bodies for laparoscopic mesh fixation, prevent tissue ischemia and possibly nerve entrapment, which result in severe postoperative pain and morbidity. Laser-assisted mesh fixation is a promising alternative for laparoscopic herniorrhaphy. Further development of this strategy is warranted. PMID:19793465

Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection.

PubMed

Joselyn, Anita; Bhalla, Tarun; McKee, Christopher; Pepper, Victoria; Diefenbach, Karen; Michalsky, Marc; Tobias, Joseph D

2015-01-01

One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection. With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure. This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024). Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS). No difference was noted in the postoperative pain scores. Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

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.

Laparoscopic liver resection: Experience based guidelines

PubMed Central

Coelho, Fabricio Ferreira; Kruger, Jaime Arthur Pirola; Fonseca, Gilton Marques; Araújo, Raphael Leonardo Cunha; Jeismann, Vagner Birk; Perini, Marcos Vinícius; Lupinacci, Renato Micelli; Cecconello, Ivan; Herman, Paulo

2016-01-01

Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers’ practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation. PMID:26843910

Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon.

PubMed

Zorn, Kevin C; Orvieto, Marcelo A; Gong, Edward M; Mikhail, Albert A; Gofrit, Ofer N; Zagaja, Gregory P; Shalhav, Arieh L

2007-04-01

Several experienced practitioners of open surgery with limited or no laparoscopic background have adopted robot-assisted laparoscopic radical prostatectomy (RLRP) as an alternative to open radical prostatectomy (RRP), demonstrating outcomes comparable to those in large RRP and laparoscopic prostatectomy series. Thus, the significance of prior laparoscopic skills seems unclear. The learning curve, with respect to operative time and complications, in the hands of a devoted laparoscopic surgeon has not been critically assessed. We evaluated the learning curve of a highly experienced laparoscopic surgeon in achieving expertise with RLRP. We prospectively evaluated 150 consecutive patients undergoing RLRP by a single surgeon between March 2003 and September 2005. The first 25 cases were performed with the assistance of a surgeon experienced in open RRP. Data were compared for the first, second, and third groups of 50 cases. Demographic data were similar for the three groups. Urinary and sexual function data were evaluated subjectively and objectively using the RAND-36v2 Survey and the UCLA PCI preoperatively and at 3, 6, and 12 months postoperatively. The mean operative time, blood loss, and conversion rate decreased significantly with increasing experience. All open conversions occurred during the first 25 cases. Intraoperative and postoperative complication rates were similar among groups. Although the differences were not significant, urinary and sexual function recovery improved with experience. The RLRP learning curve for a fellowship-trained laparoscopic surgeon seems to be similar to that of laparoscopically naive yet experienced practitioners of open RRP. The RLRP is safe and reproducible and even during the learning curve can produce results similar to those reported in large RRP series. The importance of assistance by an experienced open RRP surgeon during the learning curve cannot be overemphasized.

Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position.

PubMed

Youssef, Yassar; Lee, Gyusung; Godinez, Carlos; Sutton, Erica; Klein, Rosemary V; George, Ivan M; Seagull, F Jacob; Park, Adrian

2011-07-01

This study compares surgical techniques and surgeon's standing position during laparoscopic cholecystectomy (LC), investigating each with respect to surgeons' learning, performance, and ergonomics. Little homogeneity exists in LC performance and training. Variations in standing position (side-standing technique vs. between-standing technique) and hand technique (one-handed vs. two-handed) exist. Thirty-two LC procedures performed on a virtual reality simulator were video-recorded and analyzed. Each subject performed four different procedures: one-handed/side-standing, one-handed/between-standing, two-handed/side-standing, and two-handed/between-standing. Physical ergonomics were evaluated using Rapid Upper Limb Assessment (RULA). Mental workload assessment was acquired with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Virtual reality (VR) simulator-generated performance evaluation and a subjective survey were analyzed. RULA scores were consistently lower (indicating better ergonomics) for the between-standing technique and higher (indicating worse ergonomics) for the side-standing technique, regardless of whether one- or two-handed. Anatomical scores overall showed side-standing to have a detrimental effect on the upper arms and trunk. The NASA-TLX showed significant association between the side-standing position and high physical demand, effort, and frustration (p<0.05). The two-handed technique in the side-standing position required more effort than the one-handed (p<0.05). No difference in operative time or complication rate was demonstrated among the four procedures. The two-handed/between-standing method was chosen as the best procedure to teach and standardize. Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for

The University of Chicago technique of complete intracorporeal pediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy.

PubMed

Gundeti, Mohan S; Acharya, Sujeet S; Zagaja, Gregory P

2009-06-01

We present the University of Chicago technique for complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy. The operative steps of the open procedure were replicated laparoscopically using robotic assistance. Initially, five transperitoneal laparoscopic ports are placed prior to docking the da Vinci S robotic system. A 20 cm ileal segment is isolated, and the gastrointestinal anastomosis is performed in an end-to-end fashion using intracorporeal suturing. The appendix is anastomosed to the right posterior wall of the bladder over an 8F feeding tube in an extravesical fashion. Then, the bladder is incised in a coronal plane, and the simple detubularized ileal on-lay patch is anastomosed to the posterior and anterior walls of the bladder. A suprapubic catheter and pelvic drain are placed. Finally, the Mitrofanoff stoma is then fashioned. Cystography is done at 4 weeks postoperatively. This report suggests that robotic-assisted ileocystoplasty and appendicovesicostomy is feasible. A reasonable outcome with early recovery, resumption of normal activities, and excellent cosmesis can be achieved in select patients. A large case series, however, is necessary to determine whether a robotic-assisted approach provides any significant advantages over conventional open procedures.

Laparoscopic assisted vaginal hysterectomy, setting up a service at a peripheral teaching hospital.

PubMed

Tsaltas, J; Kovacs, G; Dennis, J; Pratt, A

1996-01-01

The establishment of a laparoscopically assisted hysterectomy program at Box Hill Hospital is described. The first eight cases have been reviewed and recommendations are made to other gynaecology units who wish to establish a minimally invasive gynaecological surgery unit.

Recommendations regarding splenectomy in hereditary hemolytic anemias

PubMed Central

Iolascon, Achille; Andolfo, Immacolata; Barcellini, Wilma; Corcione, Francesco; Garçon, Loïc; De Franceschi, Lucia; Pignata, Claudio; Graziadei, Giovanna; Pospisilova, Dagmar; Rees, David C.; de Montalembert, Mariane; Rivella, Stefano; Gambale, Antonella; Russo, Roberta; Ribeiro, Leticia; Vives-Corrons, Jules; Martinez, Patricia Aguilar; Kattamis, Antonis; Gulbis, Beatrice; Cappellini, Maria Domenica; Roberts, Irene; Tamary, Hannah

2017-01-01

Hereditary hemolytic anemias are a group of disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anemias, thalassemia syndromes and hemoglobinopathies. As damaged red blood cells passing through the red pulp of the spleen are removed by splenic macrophages, splenectomy is one possible therapeutic approach to the management of severely affected patients. However, except for hereditary spherocytosis for which the effectiveness of splenectomy has been well documented, the efficacy of splenectomy in other anemias within this group has yet to be determined and there are concerns regarding short- and long-term infectious and thrombotic complications. In light of the priorities identified by the European Hematology Association Roadmap we generated specific recommendations for each disorder, except thalassemia syndromes for which there are other, recent guidelines. Our recommendations are intended to enable clinicians to achieve better informed decisions on disease management by splenectomy, on the type of splenectomy and the possible consequences. As no randomized clinical trials, case control or cohort studies regarding splenectomy in these disorders were found in the literature, recommendations for each disease were based on expert opinion and were subsequently critically revised and modified by the Splenectomy in Rare Anemias Study Group, which includes hematologists caring for both adults and children. PMID:28550188

Laparoscopic Assisted Vaginal Hysterectomy, Setting Up a Service at a Peripheral Teaching Hospital

PubMed Central

Kovacs, Gab; Dennis, Jenny; Pratt, Amanda

1996-01-01

The establishment of a laparoscopically assisted hysterectomy program at Box Hill Hospital is described. The first eight cases have been reviewed and recommendations are made to other gynaecology units who wish to establish a minimally invasive gynaecological surgery unit. PMID:18493427

A new operation technique for uterine prolapse: Vaginally-assisted laparoscopic sacrohysteropexy

PubMed Central

Sanverdi, İlhan; Kılıççı, Çetin; Polat, Mesut; Özkaya, Enis; Kılıç, Sami Gökhan; Dizdar, Merve; Karateke, Ateş

2017-01-01

Objective: To describe the new surgical technique and report the safety and feasibility of vaginally-assisted laparoscopic sacrohysteropexy (VALSH). Materials and Methods: Thirty-three women with stage 3 or more uterine prolapse underwent VALSH operation. Patients were followed up for 12 months for mesh-related complications and improvements of symptoms. The operation had three sections; 1st laparoscopic, 2nd vaginal, 3rd laparoscopic. Results: The mean age, gravidity, and parity of the study population were 46.5 years (range, 25-68 years), 4.3 (1-9), and 2.9 (1-6), respectively. The mean duration of operation was 59.5 min (range, 20-120 min). There were significant differences between the pre- and post-operative values of pelvic organ prolapse quantification parameters, which were favorable in the latter evaluation (p<0.001); total vaginal length was preserved after surgery (p>0.05). Conclusion: VALSH is a safe and minimally-invasive procedure in uterovaginal prolapse, with favorable anatomic and functional outcomes at 12 months post-operatively. PMID:29085709

Laparoscopically assisted biomaterial graft for reconstruction in congenital atresia of vagina and cervix.

PubMed

Li, MengHui; Zhang, ZhenYu

2013-12-01

To report successful treatment by laparoscopically assisted biomaterial graft for reconstruction in patients with congenital atresia of the uterine cervix and vagina. Technique and instrumentations. University-based tertiary care hospital. An 18-year-old woman with vaginal agenesis and cervical dysgenesis and a 13-year-old woman with vaginal agenesis and cervical agenesis, both patients with a functional uterus. Creation of a neovagina by vaginal procedure and laparoscopically assisted biomaterial graft for uterovaginal anastomosis was performed in all patients. All surgical findings were carefully reviewed to determine the anatomic characteristics of the malformed cervix. Subsequent follow-up was done by referring physicians. Uterovaginal continuity was established successfully in both patients, and all of the women were menstruating normally. Granulomatous polyps occurred in one patient, and this condition was successfully managed. At 6-month follow-up, mean vaginal length was 12 cm and ≥ 80% of neovaginal epithelium was iodine positive in both patients. Unimpeded menstrual flow continued after 4 years of follow-up in one patient and 5 years of follow-up in the other patient. A combined laparoscopic and vaginal procedure with biomaterial graft could be an effective alternative in selected women with atresia of cervix and vagina. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Diagnosis and treatment of portal vein thrombosis following splenectomy.

PubMed

van't Riet, M; Burger, J W; van Muiswinkel, J M; Kazemier, G; Schipperus, M R; Bonjer, H J

2000-09-01

Portal vein thrombosis is a rare but potentially fatal complication of splenectomy. The aim of this study was to assess the incidence, risk factors, treatment and outcome of portal vein thrombosis after splenectomy in a large series of patients. All patients who had undergone a splenectomy in the University Hospital, Rotterdam, between 1984 and 1997 were reviewed retrospectively. Splenectomy that was followed by symptomatic portal vein thrombosis was selected for analysis. Risk factors for portal vein thrombosis were sought. Of 563 splenectomies, nine (2 per cent) were complicated by symptomatic portal vein thrombosis. All these patients had either fever or abdominal pain. Two of 16 patients with a myeloproliferative disorder developed portal vein thrombosis after splenectomy (P = 0.03), and four of 49 patients with haemolytic anaemia (P = 0.005). Treatment within 10 days after splenectomy was successful in all patients, while delayed treatment was ineffective. Portal vein thrombosis should be suspected in a patient with fever or abdominal pain after splenectomy. Patients with a myeloproliferative disorder or haemolytic anaemia are at higher risk; they might benefit from early detection and could have routine Doppler ultrasonography after splenectomy.

Incidence and location of positive surgical margin among open, laparoscopic and robot-assisted radical prostatectomy in prostate cancer patients: a single institutional analysis.

PubMed

Koizumi, Atsushi; Narita, Shintaro; Nara, Taketoshi; Takayama, Koichiro; Kanda, Sohei; Numakura, Kazuyuki; Tsuruta, Hiroshi; Maeno, Atsushi; Huang, Mingguo; Saito, Mitsuru; Inoue, Takamitsu; Tsuchiya, Norihiko; Satoh, Shigeru; Nanjo, Hiroshi; Habuchi, Tomonori

2018-06-19

To evaluate the positive surgical margin rates and locations in radical prostatectomy among three surgical approaches, including open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy. We retrospectively reviewed clinical outcomes at our institution of 450 patients who received radical prostatectomy. Multiple surgeons were involved in the three approaches, and a single pathologist conducted the histopathological diagnoses. Positive surgical margin rates and locations among the three approaches were statistically assessed, and the risk factors of positive surgical margin were analyzed. This study included 127, 136 and 187 patients in the open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy groups, respectively. The positive surgical margin rates were 27.6% (open radical prostatectomy), 18.4% (laparoscopic radical prostatectomy) and 13.4% (robot-assisted radical prostatectomy). In propensity score-matched analyses, the positive surgical margin rate in the robot-assisted radical prostatectomy was significantly lower than that in the open radical prostatectomy, whereas there was no significant difference in the positive surgical margin rates between robot-assisted radical prostatectomy and laparoscopic radical prostatectomy. In the multivariable analysis, PSA level at diagnosis and surgical approach (open radical prostatectomy vs robot-assisted radical prostatectomy) were independent risk factors for positive surgical margin. The apex was the most common location of positive surgical margin in the open radical prostatectomy and laparoscopic radical prostatectomy groups, whereas the bladder neck was the most common location in the robot-assisted radical prostatectomy group. The significant difference of positive surgical margin locations continued after the propensity score adjustment. Robot-assisted radical prostatectomy may potentially achieve the lowest positive

Robotic-assisted laparoscopic prostatectomy in umbilical hernia patients: University of California, Irvine, technique for port placement and repair.

PubMed

Kim, William; Abdelshehid, Corollos; Lee, Hak J; Ahlering, Thomas

2012-06-01

To discuss a technique currently used at our institution for the management of umbilical hernias during robot-assisted laparoscopic prostatectomy. As more patients undergo robot-assisted radical prostatectomy, there will be an increase in patients who qualify for robotic surgery with comorbidities. This technique has been utilized in clinically localized prostate cancer patients with umbilical hernias using the da Vinci Surgical System and standard laparoscopic instrumentation. Port placements and closures were performed by a resident assistant and a nurse at the operating table. The prostatectomy was performed by a single experienced surgeon at the console. Currently, no data are available regarding patients with umbilical hernias undergoing robotic prostatectomy. We reviewed our technique of port placement for patients with a pre-existing umbilical hernia undergoing robot-assisted laparoscopic prostatectomy. This technique allows for a reduction of the umbilical hernia, the use of the fascial defect as a robotic port, and the removal of the prostate by way of transverse incision and transverse repair. In our experience, this technique is feasible and reproducible for any small or large umbilical hernia. Copyright © 2012 Elsevier Inc. All rights reserved.

A comparative direct cost analysis of pediatric urologic robot-assisted laparoscopic surgery versus open surgery: could robot-assisted surgery be less expensive?

PubMed

Rowe, Courtney K; Pierce, Michael W; Tecci, Katherine C; Houck, Constance S; Mandell, James; Retik, Alan B; Nguyen, Hiep T

2012-07-01

Cost in healthcare is an increasing and justifiable concern that impacts decisions about the introduction of new devices such as the da Vinci(®) surgical robot. Because equipment expenses represent only a portion of overall medical costs, we set out to make more specific cost comparisons between open and robot-assisted laparoscopic surgery. We performed a retrospective, observational, matched cohort study of 146 pediatric patients undergoing either open or robot-assisted laparoscopic urologic surgery from October 2004 to September 2009 at a single institution. Patients were matched based on surgery type, age, and fiscal year. Direct internal costs from the institution were used to compare the two surgery types across several procedures. Robot-assisted surgery direct costs were 11.9% (P=0.03) lower than open surgery. This cost difference was primarily because of the difference in hospital length of stay between patients undergoing open vs robot-assisted surgery (3.8 vs 1.6 days, P<0.001). Maintenance fees and equipment expenses were the primary contributors to robotic surgery costs, while open surgery costs were affected most by room and board expenses. When estimates of the indirect costs of robot purchase and maintenance were included, open surgery had a lower total cost. There were no differences in follow-up times or complication rates. Direct costs for robot-assisted surgery were significantly lower than equivalent open surgery. Factors reducing robot-assisted surgery costs included: A consistent and trained robotic surgery team, an extensive history of performing urologic robotic surgery, selection of patients for robotic surgery who otherwise would have had longer hospital stays after open surgery, and selection of procedures without a laparoscopic alternative. The high indirect costs of robot purchase and maintenance remain major factors, but could be overcome by high surgical volume and reduced prices as competitors enter the market.

Clinical outcomes of laparoscopic-assisted synchronous bowel anastomoses for synchronous colorectal cancer: initial clinical experience

PubMed Central

Wei, Yunwei; Liu, Peng; Xu, Jun

2017-01-01

The primary aim of this study was to explore the safety and feasibility of laparoscopic-assisted synchronous bowel anastomoses (LSBA) for synchronous colorectal cancer (SCRC). All patients who underwent LSBA for SCRC were retrospectively reviewed and analyzed for clinical and pathological features, technical feasibility and short-term as well as long-term oncological outcomes. Between July 2008 and January 2012, a series of 11 consecutive SCRC patients underwent LSBA. Six patients underwent laparoscopic-assisted right hemicolectomy and anterior resection. Five patients had laparoscopic-assisted right hemicolectomy and sigmoidectomy. There were no intraoperative complications that required open conversions. Mean operation time was 233 (range, 195–285) minutes, and mean estimated blood loss was 224 (range, 100–300) mL. The postoperative course of the patients was uneventful with the mean return to oral intake was 6.9 (range 5–12) days, and mean length of hospital stay was 12.6 (range 9–17) days. All surgical wounds showed good cosmetic outcome, and the mean incision length was 4.1 (range 3.5-5.0) cm. During a median follow-up period of 76 months, no local tumor recurrences were found. LSBA is a potentially feasible and safe procedure for SCRC when performed by an experienced surgeon. Further large clinical controlled trials are warranted to confirm the findings. PMID:27821798

A new laparoscopic-assisted hepatectomy (LAH) utilizing radiofrequency ablation and high-frequency electrocautery.

PubMed

Miyazawa, Mitsuo; Torii, Takahiro; Toshimitsu, Yasuko; Okada, Katsuya; Ogawa, Nobuji; Shinozuka, Nozomi; Koyama, Isamu

2006-01-01

Compared to tumors located at the edge of the liver, tumors located directly on the liver surface are often difficult to resect, especially when the organ is cirrhotic. To remove tumors at this location, our group has developed a round high-frequency electrosurgical knife that allows hemispherical resection of the liver tissue. This study describes a new laparoscopic-assisted hepatectomy utilizing radiofrequency ablation of the tissue surrounding the tumor and high-frequency electrocautery. When compared with the laparoscopic hepatectomy, this new procedure seems to offer a safer, more effective, and less time-consuming means of resecting tumors on the liver surface. (c) 2005 Wiley-Liss, Inc.

Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy.

PubMed

Ehieli, Eric I; Howard, Lauren E; Monk, Terri G; Ferrandino, Michael N; Polascik, Thomas J; Walther, Philip J; Freedland, Stephen J

2016-08-01

To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy. We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using t-tests, rank sum or χ(2) -tests as appropriate. The association between positive end-expiratory pressure and estimated blood loss was tested using linear regression. Patients were classified into high (≥4 cmH2 O) and low (≤1 cmH2 O) positive-end expiratory pressure groups. Estimated blood loss in radical retropubic prostatectomy was higher in the high positive end-expiratory pressure group (1000 mL vs 800 mL, P = 0.042). Estimated blood loss in robot-assisted laparoscopic prostatectomy was lower in the high positive end-expiratory pressure group (150 mL vs 250 mL, P = 0.015). After adjusting for other factors known to influence blood loss, a 5-cmH2 O increase in positive end-expiratory pressure was associated with a 34.9% increase in estimated blood loss (P = 0.030) for radical retropubic prostatectomy, and a 33.0% decrease for robot-assisted laparoscopic prostatectomy (P = 0.038). In radical retropubic prostatectomy, high positive end-expiratory pressure was associated with higher estimated blood loss, and the benefits of positive end-expiratory pressure should be weighed against the risk of increased estimated blood loss. In robot-assisted laparoscopic prostatectomy, high positive end-expiratory pressure was associated with lower estimated blood loss, and might have more than just pulmonary benefits. © 2016 The Japanese Urological Association.

The first experience of robot assisted spleen-preserving laparoscopic distal pancreatectomy in Korea.

PubMed

Kim, Dong Hyun; Kang, Chang Moo; Lee, Woo Jung; Chi, Hoon Sang

2011-05-01

Spleen-preservation has recently been emphasized in benign and borderline malignant pancreatic diseases requiring distal pancreatectomy. Reports to suggest that laparoscopic distal pancreatectomy is feasible and safe have been increasingly published. Robotic surgical system has been introduced and is expected to provide unique advantages in laparoscopic surgery. However, robot-assisted pancreatic surgery has not yet been performed by many surgeons. A 45-year-old female patient with abdominal discomfort was found to have pancreatic cyst in the body of the pancreas. Mucinous cystic tumor of the pancreas was the most favourable preoperative diagnosis. She underwent spleen-preserving laparoscopic distal pancreatectomy by using da Vinci surgical robot system. Splenic artery and vein were so tightly adherent to the pancreatic cyst that segmental resection of splenic vessels was required. Postoperative course was uneventful. She was able to come home in 5 days after surgery. Postoperative follow up color doppler ultrasound scan, taken on 2 weeks after surgery, showed minimal fluid collection around surgical field and no evidence of splenic infarction with good preservation of splenic perfusion. Robot-assisted spleen preserving distal pancreatectomy is thought to be feasible and safe. Several unique advantages of robotic system are expected to enhance safer and more precise surgical performance in near future. More experiences are mandatory to confirm real benefit of robot surgery in pancreatic disease.

Splenectomy Is Modifying the Vascular Remodeling of Thrombosis

PubMed Central

Frey, Maria K.; Alias, Sherin; Winter, Max P.; Redwan, Bassam; Stübiger, Gerald; Panzenboeck, Adelheid; Alimohammadi, Arman; Bonderman, Diana; Jakowitsch, Johannes; Bergmeister, Helga; Bochkov, Valery; Preissner, Klaus T.; Lang, Irene M.

2014-01-01

Background Splenectomy is a clinical risk factor for complicated thrombosis. We hypothesized that the loss of the mechanical filtering function of the spleen may enrich for thrombogenic phospholipids in the circulation, thereby affecting the vascular remodeling of thrombosis. Methods and Results We investigated the effects of splenectomy both in chronic thromboembolic pulmonary hypertension (CTEPH), a human model disease for thrombus nonresolution, and in a mouse model of stagnant flow venous thrombosis mimicking deep vein thrombosis. Surgically excised thrombi from rare cases of CTEPH patients who had undergone previous splenectomy were enriched for anionic phospholipids like phosphatidylserine. Similar to human thrombi, phosphatidylserine accumulated in thrombi after splenectomy in the mouse model. A postsplenectomy state was associated with larger and more persistent thrombi. Higher counts of procoagulant platelet microparticles and increased leukocyte–platelet aggregates were observed in mice after splenectomy. Histological inspection revealed a decreased number of thrombus vessels. Phosphatidylserine‐enriched phospholipids specifically inhibited endothelial proliferation and sprouting. Conclusions After splenectomy, an increase in circulating microparticles and negatively charged phospholipids is enhanced by experimental thrombus induction. The initial increase in thrombus volume after splenectomy is due to platelet activation, and the subsequent delay of thrombus resolution is due to inhibition of thrombus angiogenesis. The data illustrate a potential mechanism of disease in CTEPH. PMID:24584745

The paradoxical effects of splenectomy on tumor growth.

PubMed

Prehn, Richmond T

2006-06-26

There is a vast and contradictory literature concerning the effect of the spleen and particularly of splenectomy on tumor growth. Sometimes splenectomy seems to inhibit tumor growth, but in other cases it seems, paradoxically, to facilitate both oncogenesis and the growth of established tumors. In this essay I have selected from this large literature a few papers that seem particularly instructive, in the hope of extracting some understanding of the rules governing this paradoxical behavior. In general, whether splenectomy enhances or inhibits tumor growth seems to depend primarily upon the ratio of spleen to tumor. Small proportions of spleen cells usually stimulate tumor growth, in which case splenectomy is inhibitory. Larger proportions of the same cells, especially if they are from immunized animals, usually inhibit tumor growth, in which case splenectomy results in tumor stimulation.

Computed tomography-assisted laparoscopic removal of intraabdominally migrated levonorgestrel-releasing intrauterine systems.

PubMed

Mahmoud, Mohamad S; Merhi, Zaher O

2010-04-01

To report three cases of migrated levonorgestrel intrauterine device (LNG-IUS) into the pelvic/abdominal cavity removed laparoscopically with the aid of preoperative computed tomography (CT) scan imaging. Three patients presenting with a missing LNG-IUS on examination and pelvic ultrasound are presented. A preoperative CT scan was performed, what helped in a successful removal of the LNG-IUS. The patients were discharged home the same day of the procedure. Our cases reinforce, besides the diagnosis of a migrated LNG-IUS by ultrasound, the fact that preoperative CT scan imaging assists in the diagnosis of the precise location of a migrated LNG-IUS into the pelvic/abdominal cavity and helps the physician in the prediction of the difficulty of the laparoscopic removal.

Robotic-assisted Laparoscopic Repair of Scrotal Inguinal Hernias.

PubMed

Yheulon, Christopher G; Maxwell, Daniel W; Balla, Fadi M; Patel, Ankit D; Lin, Edward; Stetler, Jamil L; Davis, Steven S

2018-06-01

Scrotal inguinal hernias represent a challenging surgical pathology. Although some advanced laparoscopists can repair these hernias through a minimally invasive approach, open repair is considered the technique of choice for most surgeons. The purpose of this study is to show our results of robotic-assisted laparoscopic repair of scrotal inguinal hernias. We reviewed the charts of 14 patients with inguinoscrotal hernias who underwent robotic-assisted transabdominal preperitoneal (TAPP) hernia repair. Mean follow-up was 7 months. The European Registry for Abdominal Wall Hernia Quality of Life score, a 90-point scale, was utilized to quantify patient reported outcomes. Robotic TAPP repair was successful in all 14 patients. Average case duration was 100 minutes (78 to 140 min) for unilateral hernias and 208 minutes (166 to 238 min) for bilateral hernias. Trainees were involved in 93% (13/14) of cases. There were no recurrences. Three patients developed postoperative seromas. The mean European Registry for Abdominal Wall Hernia Quality of Life score was 3.7 (0 to 10). Scrotal hernias can be safely repaired using robotic-assisted TAPP methods with low morbidity and favorable patient reported outcomes.

The paradoxical effects of splenectomy on tumor growth

PubMed Central

Prehn, Richmond T

2006-01-01

Background There is a vast and contradictory literature concerning the effect of the spleen and particularly of splenectomy on tumor growth. Sometimes splenectomy seems to inhibit tumor growth, but in other cases it seems, paradoxically, to facilitate both oncogenesis and the growth of established tumors. Approach In this essay I have selected from this large literature a few papers that seem particularly instructive, in the hope of extracting some understanding of the rules governing this paradoxical behavior. Conclusion In general, whether splenectomy enhances or inhibits tumor growth seems to depend primarily upon the ratio of spleen to tumor. Small proportions of spleen cells usually stimulate tumor growth, in which case splenectomy is inhibitory. Larger proportions of the same cells, especially if they are from immunized animals, usually inhibit tumor growth, in which case splenectomy results in tumor stimulation. PMID:16800890

Current controversies and challenges in robotic-assisted, laparoscopic, and open partial nephrectomies.

PubMed

Laviana, Aaron A; Hu, Jim C

2014-06-01

Recent studies demonstrate that partial versus radical nephrectomy confers a survival advantage while lowering the risk of severe chronic kidney disease. Open partial nephrectomy remains the gold standard, but the use of minimally invasive approaches is expanding. Using a MEDLINE literature search, we reviewed all relevant literature between 2000 and 2014. Fifty-one articles were left for review after filtering for inclusion of trends, learning curve, perioperative outcomes, warm ischemia time, and costs. Partial nephrectomy use has increased over the past decade accounting for 24.7 % of all surgeries performed for the treatment of organ-confined renal masses in 2008. The introduction of robotic technology has continued to alter the landscape accounting for 47 % of all partial nephrectomies at academic US centers in 2011, though a center bias and publication bias likely exist. A slower adoption rate has been seen at non-academic centers and those in low-income areas. The learning curve for robotic-assisted laparoscopic nephrectomy has been shorter than for laparoscopic partial nephrectomy, explaining, in part, why the rate of partial nephrectomy remained relatively stagnant before the robotic-assisted laparoscopic nephrectomy, despite an increase in the detection of small renal masses. Operative and warm ischemia time remain shortest for open partial nephrectomy, though it is associated with the highest blood loss and longest hospital stay. Finally, open partial nephrectomy remains the least costly modality. Each approach to partial nephrectomy has its advantages and disadvantages, and continued effort must be applied to comparative effectiveness research for nephron-sparing treatments for renal cell carcinoma.

J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results.

PubMed

Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gundogan, Ersin; Gezen, Fazli Cem; Oncel, Mustafa

2017-11-01

To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

TAMIS Assisted Laparoscopic Low Anterior Resection with Total Mesorectal Excision in a Cadaveric Series

PubMed Central

McLemore, Elisabeth C.; Coker, Alisa; Devaraj, Bikash; Chakedis, Jeffrey; Maawy, Ali; Inui, Tazo; Talamini, Mark A.; Horgan, Santiago; Peterson, Mike; Sylla, Patricia; Ramamoorthy, Sonia

2014-01-01

Background The purpose of this study is to demonstrate the feasibility of an innovative technique for the surgical management of rectal cancer: trans anal minimally invasive surgery assisted low anterior resection with total mesorectal excision (TAMIS assisted LAR TME) in a cadaver model. Trans anal endoscopic low anterior resection via natural orifice translumenal endoscopic surgery (NOTES) has been reported in cadaveric series using rigid trans anal endoscopic platforms. This procedure has not been described using a combination of a single incision laparoscopy and TAMIS soft trans anal endoscopic platform. Herein, we describe the first cadaveric series of TAMIS assisted single incision laparoscopic LAR with TME. Methods TAMIS assisted laparoscopic single incision LAR with TME was successfully performed in 5 fresh male human cadavers. The procedure was performed using the mini-Gelpoint single incision platform and the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA). The variables recorded were age, body mass index (BMI in kg/m2), operative time, complications, and specimen length. The grade of the TME was determined by evaluation of the specimen by photo documentation by a gastrointestinal pathologist. Results All cadavers were male with a mean age of 71 +/− 8 years and mean BMI of 28 +/− 3 kg/m2. The mean operative time was 200 +/− 55 minutes (range 128 – 249 min). The quality of the TME was Grade I (complete) with intact mesorectum in all five cases. The mean specimen length was 36.8 +/− 3.4 cm. Intra-operative complications included one bowel injury and one splenic capsular tear. Conclusions TAMIS assisted laparoscopic LAR with TME is feasible in this pre-clinical cadaveric series. We have also demonstrated that a high quality TME can be achieved with this technique. Trans anal endoscopic techniques employed to perform total mesorectal dissection may revolutionize the surgical management of rectal cancer. However, phase II

Assessment of the incidence of GDV following splenectomy in dogs.

PubMed

Goldhammer, M A; Haining, H; Milne, E M; Shaw, D J; Yool, D A

2010-01-01

To establish if splenectomy increases the incidence of gastric dilatation and volvulus (GDV) in dogs. Two case-series studies of cases and controls were performed. Records of dogs that had undergone splenectomy (37 cases) were compared with records of dogs that had undergone other abdominal surgery (43 cases). Records of dogs that presented for non-elective gastropexy (33 cases) were compared with records of dogs presented to the hospital for unrelated reasons (39 cases). Survival following splenectomy and development of GDV in the first 12 months following surgery were retrieved from the clinical records and by questionnaire-based canvassing of the referring clinician. The incidence of GDV following splenectomy was established and the association between a current episode of GDV and previous splenectomy was assessed. There was no evidence that splenectomy was associated with an increased incidence of subsequent GDV (P=0.469). No association between a current episode of GDV and previous splenectomy was found. Splenectomy is not associated with an increase in the incidence of GDV.

[The standardized practice of laparoscopic-assisted radical right hemicolectomy in order to achieve complete mesocolic excision].

PubMed

Li, Bing-gen; Nie, Xiang-yang; He, Yong-zhong; Xie, Hui-hua; Yu, Guo-zhong; Du, Han-peng; Kong, Fan-dong; Gong, Du-hui; Lin, Wei-bin; Wu, Ming-jian

2012-03-01

To explore the feasibility of laparoscopic-assisted radical right hemicolectomy with the outcome being a complete mesocolic excision (CME). Between February 2010 and June 2011, we performed the standardized surgery of laparoscopic-assisted radical right hemicolectomy with an aim of CME on 14 patients. There were 10 males and 4 females, with an average age of 57 years (range 36 to 74 years). All the pathologic results in 14 cases were primary colonic adenocarcinoma. The TNM stages were distributed as follows: 2 in II A, 3 in II B, 3 in III A, 5 in III B and 1 in III C. Surgery was successfully performed for all patients without open conversion. The average operation time was (178 ± 37) minutes (range 127 to 221 minutes), average intraoperative blood loss was (67 ± 23) ml (range 30 to 110 ml), while the average number of lymph node harvest was 21 ± 7 (range 14 to 31), and the postoperative hospital stay was (10.0 ± 2.2) days (range 7 to 15 days). Minor complications occured in 2 patients. Major complications and post-operative mortality were not observed. All the patients were followed up for 3 to 19 months, no tumor recurrence or metastasis was identified. The standardized surgery of laparoscopic-assisted radical right hemicolectomy with the final outcome of CME is safe and feasible.

The clinical application of laparoscope-assisted peritoneal vaginoplasty for the treatment of congenital absence of vagina.

PubMed

Qin, Chenglu; Luo, Guangnan; Du, Min; Liao, Shi; Wang, Chunping; Xu, Keke; Tang, Jie; Li, Baoyan; Zhang, Juanjuan; Pan, Hongxin; Ball, Tyler W; Fang, Yujiang

2016-06-01

To evaluate the outcomes of laparoscope-assisted peritoneal vaginoplasty for the treatment of congenital vaginal atresia. A retrospective study enrolled patients diagnosed with congenital vaginal atresia who were treated with one of two different laparoscope-assisted peritoneal vaginoplasty techniques (named Luohu-one and Luohu-two) between October 31, 2001 and December 31, 2014. Operative time, intraoperative bleeding volume, surgical difficulty, complications, and post-procedure sexual satisfaction were reported. Data were collected for 620 patients. The Luohu-one procedure was used in the treatment of 145 patients, while 475 patients were treated with the Luohu-two procedure. In 5 (0.8%) patients, it was necessary to perform a sigmoid colon vaginoplasty. During surgery, 16 patients experienced a rectal injury, among whom, 9 patients experienced a rectal-vaginal fistula. Follow-up data extending to 7years were available for 285 patients. Of these 285 patients, 231 agreed to report details of their sexual experiences. In total, 222 (96.1%) patients reported being very satisfied with their vaginal conditions and sex life. The Luohu-two procedure demonstrated shorter operative and recovery time, and reduced intraoperative bleeding. However, both procedures demonstrated satisfactory results. Laparoscope-assisted peritoneal vaginoplasty demonstrated good safety and effectiveness in the treatment of patients with congenital vaginal atresia. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Circular Stapler-Assisted Extraperitoneal Colostomy in Laparoscopic Abdominoperineal Resection: a Single Surgeon Experience.

PubMed

Zhang, Peng; Bai, Jie; Shuai, Xiaoming; Chang, Weilong; Gao, Jinbo; Liu, Xinghua; Wang, Guobin; Tao, Kaixiong

2016-03-01

Nowadays, laparoscopic abdominoperineal resection (LAPR) not only has the same oncologic safety of open surgery and but also has the common advantages of laparoscopic surgery. However, given the difficulty in operation and long operative time, laparoscopic extraperitoneal colostomy construction is rarely practiced and reported. In this study, we describe technique of extraperitoneal colostomy using circular stapler following LAPR and demonstrate its efficacy and safety. This is a retrospective analysis of prospectively maintained data of 42 patients who underwent LAPR with circular stapler-assisted extraperitoneal colostomy in our department between July 2011 and June 2014. The mean time for extraperitoneal colostomy construction was 25 min (18-33 min). The mean operative time, estimated blood loss, postoperative gastrointestinal function recovery time, and duration of postoperative hospital stay were 160 min (115-225 min), 45 ml (10-250 ml), 33 h (26-45 h), and 8.6 days (6-13 days), respectively; 4.8 % of the patients had postoperative short-term complications. There were no stenosis, prolapse, and parastomal hernia observed in follow-up period. At 6 months after operation, 26 patients (62 %) claimed to be satisfied with their postoperative stool habits, 29 patients (69 %) had sensation to defecate per stoma, and 11 (26.2 %) patients had the ability to defer defecation for solid or liquid stool per stoma. Circular stapler-assisted extraperitoneal colostomy is an easy, effective, and safe technique following LAPR and appears to minimize the occurrence of stomal complications and improve the quality of life for patients.

Robot-assisted laparoscopic reconstruction of retrocaval ureter: description and video of technique.

PubMed

LeRoy, Timothy J; Thiel, David D; Igel, Todd C

2011-05-01

Ureteral obstruction secondary to retrocaval ureter is rarely reported in the urologic literature. Symptomatic retrocaval ureters usually present in the 3rd and 4th decade of life. Standard treatment involves ureteroureterostomy approximating the ureter anterior to the vena cava. We describe the initial presentation, imaging, port placement, and operative technique including video presentation of a robot-assisted laparoscopic repair of a retrocaval ureter.

Positioning the endoscope in laparoscopic surgery by foot: Influential factors on surgeons' performance in virtual trainer.

PubMed

Abdi, Elahe; Bouri, Mohamed; Burdet, Etienne; Himidan, Sharifa; Bleuler, Hannes

2017-07-01

We have investigated how surgeons can use the foot to position a laparoscopic endoscope, a task that normally requires an extra assistant. Surgeons need to train in order to exploit the possibilities offered by this new technique and safely manipulate the endoscope together with the hands movements. A realistic abdominal cavity has been developed as training simulator to investigate this multi-arm manipulation. In this virtual environment, the surgeon's biological hands are modelled as laparoscopic graspers while the viewpoint is controlled by the dominant foot. 23 surgeons and medical students performed single-handed and bimanual manipulation in this environment. The results show that residents had superior performance compared to both medical students and more experienced surgeons, suggesting that residency is an ideal period for this training. Performing the single-handed task improves the performance in the bimanual task, whereas the converse was not true.

Revision with Totally Hand-Sewn Gastrojejunostomy and Vagotomy for Refractory Marginal Ulcer after Laparoscopic Roux-en-Y Gastric Bypass.

PubMed

Chang, Po-Chih; Huang, Chih-Kun; Rajan, Mahendra; Hsin, Ming-Che

2016-05-01

Marginal ulcer is not infrequent after laparoscopic Roux-en-Y gastric bypass and could result in undesirable complications, such as intractability, bleeding, or perforation. Those patients who failed medical therapy, regarded as refractory marginal ulcers, may be considered as candidates for revisional surgery. Herein, we make a video presentation of a laparoscopic revisional procedure for refractory marginal ulcer. A 29-year-old morbidly obese woman (initial body mass index 37.1 kg/m(2)), a non-smoker, presented with persistent epigastric pain 3 months after initial laparoscopic Roux-en-Y gastric bypass at another institution. After an exhaustive work-up there, only the gastroendoscopy revealed a marginal ulcer and she underwent medical treatment (proton pump inhibitor and sucralfate) for 3 months, but the patient's symptom aggravated and the serial gastroendoscopies still confirmed the marginal ulcer without obvious resolution after a total of 4 months proton pump inhibitor therapy, suggesting failure of medical treatment and intractability. Laparoscopic revisional procedure with totally hand-sewn gastrojejunostomy and vagotomy was performed to relieve her intractable condition. The procedure took 130 min, without any intra-operative complications. Blood loss was 80 mL. The patient had an uneventful postoperative course, and the postoperative hospital stay was 3 days. She was relieved of her symptoms after this revisional surgery, and a subsequent gastroendoscopy 15 months later showed no marginal ulcers. Though long-term follow-up is needed to draw a definite conclusion, totally hand-sewn gastrojejunostomy and vagotomy remains a practicable revisional procedure to relieve refractory marginal ulcers.

A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design

PubMed Central

Kim, Hee Seung; Kim, Jae Weon; Kim, Mi-Kyung; Chung, Hyun Hoon; Lee, Taek Sang; Jeon, Yong-Tark; Kim, Yong Beom; Jeon, Hye Won; Yun, Young Ho; Park, Noh Hyun; Song, Yong Sang; Kang, Soon-Beom

2009-01-01

Background Laparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by uterine fibroids in place of hysterectomy. The current study was designed to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to evaluate the efficacy of laparoscopic uterine artery ligation which can treat symptomatic uterine fibroids with the preservation of uterus. Methods and design Patients enrolled the current study are randomized to laparoscopic uterine artery ligation or laparoscopy-assisted vaginal hysterectomy. The primary outcome is to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer patients version 3.0. Secondary outcomes are to evaluate the volume reduction of uterus, uterine fibroids and ovaries by the 2 treatments, to compare the improvement of subjective symptoms using 11-point symptom score and postoperative clinical outcomes between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to investigate the improvement of postoperative vaginal bleeding by laparoscopic uterine artery ligation. Discussion Among treatment methods for symptomatic uterine fibroids with the preservation of uterus, laparoscopic uterine artery ligation is expected to have the efficacy like uterine artery embolization, which appeared to be safe for routine use with symptomatic relief. The

Evaluating the learning curve for robot-assisted laparoscopic radical cystectomy.

PubMed

Pruthi, Raj S; Smith, Angela; Wallen, Eric M

2008-11-01

We seek to describe the learning curve of robot-assisted laparoscopic radical cystectomy by evaluating some of the surgical, oncologic, and clinical outcomes in our initial experience with 50 consecutive patients undergoing this novel procedure. Fifty consecutive patients (representing our initial experience with robot-assisted cystectomy) underwent radical cystectomy and urinary diversion from January 2006 to December 2007. Several different metrics were used to evaluate the learning curve of this procedure, including estimated blood loss (EBL), operative (OR) time, pathologic outcomes, and complication rate. We evaluated patients as a continuous variable, divided into five distinct time periods (quintiles), and stratified by first half and second half of robotic experience. EBL was not significantly lower until the third quintile (patients 21-30), after which further significant reductions were not observed. Mean OR time declined between each quintile for the first 30 patients (1-10 v 11-20 v 21-30). No significant declines occurred after the third quintile (21-30). When evaluated as a continuous variable, the statistical cut point at which no further significant reductions were observed was after patient 20 for OR time. No differences were observed with regard to time to flatus, bowel movement, or hospital discharge. Furthermore, complications were not different between the initial 25 patients and the most recent patients. There has been no case of a positive margin, and there was only one inadvertent bladder entry. Lymph node yield has also not significantly changed over time. This report helps to define the learning curve associated with robot-assisted laparoscopic radical cystectomy for bladder cancer. Despite the higher OR times and blood loss that is observed early in the learning curve, no such compromises are observed with regard to these oncologic parameters even early in the experience.

Indications and complications of splenectomy for children with sickle cell disease.

PubMed

Al-Salem, Ahmed H

2006-11-01

Sickle cell anemia (SCA), which is characterized by high hemoglobin (Hb) F level and persistent splenomegaly into the older age group (up to 18 years of age) or even adults, is one of the commonest hemoglobinopathies in the Eastern Province of Saudi Arabia. This makes them liable to develop splenic complications requiring splenectomy. This is a review of our experience in the management of 134 children with SCA who had splenectomy as part of their management at our hospital, with emphasis given to the indications and complications of splenectomy. The medical records of all children who had splenectomy at our hospital were retrospectively reviewed for the following: age at splenectomy, sex, Hb electrophoresis, indication for splenectomy, preoperative investigations, type of surgery, spleen weight, histology, perioperative management, and postoperative complications. From 1990 to 2004, 170 children with various hematologic disorders had splenectomy at our hospital. Of these, 134 had SCA (118 had sickle cell disease and 16 had sickle-beta-thalassemia). Recurrent acute splenic sequestration crisis (ASSC) was the commonest indication for splenectomy in 103 (76.9%) patients, followed by hypersplenism in 18 (13.4%). Seven (5.2%) of our patients had splenectomy for splenic abscess (SA) and 2 had splenectomy for massive splenic infarction; 103 (61 boys, 42 girls) patients with a mean age of 7.6 years (range, 1.8-13 years) had splenectomy for ASSC. Their mean Hb F level was 20.5% (range, 9.2%-39.6%). Thirty-two of them had major attacks. Their Hb levels at the time of admission ranged from 1.4 to 4.1 g/dL (mean, 2.5 g/dL). The remaining 71 had minor recurrent attacks. Eighteen had splenectomy for hypersplenism and all had a significant increase in their blood parameters after splenectomy. Seven had splenectomy for SA. In 5 patients, Salmonella was the causative organism; in 1, it was Enterobacter sakazaki, whereas in 1, no organisms were identified. Two of our patients had

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

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

PubMed

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

2014-01-01

The objective of this study was to present the initial operative experience of solo surgeon single-port laparoscopic surgery (SPLS) in the laparoscopic treatment of benign gynecologic diseases and to investigate its feasibility and surgical outcomes. Using a novel homemade laparoscope-anchored instrument system that consisted of a laparoscopic instrument attached to a laparoscope and a glove-wound retractor umbilical port, we performed solo surgeon SPLS in 13 patients between March 2011 and June 2012. Intraoperative complications and postoperative surgical outcomes were determined. The primary operative procedures performed were unilateral salpingo-oophorectomy (n = 5), unilateral salpingectomy (n = 2), adhesiolysis (n = 1), and laparoscopically assisted vaginal hysterectomy (n = 5). Additional surgical procedures included additional adhesiolysis (n = 4) and ovarian drilling (n = 1).The primary indications for surgery were benign ovarian tumors (n = 5), ectopic pregnancy (n = 2), pelvic adhesion (infertility) (n = 1), and benign uterine tumors (n = 5). Solo surgeon SPLS was successfully accomplished in all procedures without a laparoscopic assistant. There were no intraoperative or postoperative complications. Our laparoscope-anchored instrument system obviates the need for an additional laparoscopic assistant and enables SPLS to be performed by a solo surgeon. The findings show that with our system, solo surgeon SPLS is a feasible and safe alternative technique for the treatment of benign gynecologic diseases in properly selected patients. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Asymptomatic Partial Splenic Infarction In Laparoscopic Floppy Nissen Fundoplication And Brief Literature Review

PubMed Central

Odabasi, Mehmet; Abuoglu, Haci Hasan; Arslan, Cem; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, Tolga

2014-01-01

Short gastric vessels are divided during the laparoscopic Nissen fundoplication resulting in splenic infarct in some cases. We report a case of laparoscopic floppy Nissen fundoplication with splenic infarct that was recognized during the procedure and provide a brief literature review. The patient underwent a laparoscopic floppy Nissen fundoplication. We observed a partial infarction of the spleen. She reported no pain. A follow-up computed tomography scan showed an infarct, and a 3-month abdominal ultrasound showed complete resolution. Peripheral splenic arterial branches have very little collateral circulation. When these vessels are occluded or injured, an area of infarction will occur immediately. Management strategies included a trial of conservative management and splenectomy for persistent symptoms or complications resulting from splenic infarct. In conclusion, we believe that the real incidence is probably much higher because many cases of SI may have gone undiagnosed during or following an operation, because some patients are asymptomatic. We propose to check spleen carefully for the possibility of splenic infarct. PMID:24833155

Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis

PubMed Central

Kim, Hye Jin; Park, Jun Seok; Park, Soo Yeun; Choi, Wohn Ho; Ryuk, Jong Pil

2012-01-01

Purpose We evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy. Methods From August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery. Results The median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis. Conclusion Laparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP. PMID:23166888

Splenectomy Fails to Provide Long-Term Protection Against Ischemic Stroke.

PubMed

Ran, Yuanyuan; Liu, Zongjian; Huang, Shuo; Shen, Jiamei; Li, Fengwu; Zhang, Wenxiu; Chen, Chen; Geng, Xiaokun; Ji, Zhili; Du, Huishan; Hu, Xiaoming

2018-06-01

Splenectomy before or immediately after stroke provides early brain protection. This study aims to explore the effect of splenectomy on long-term neurological recovery after stroke, which is currently lacking in the field. Adult male rats were randomized into splenectomy or sham groups and then subjected to 90 min of middle cerebral artery occlusion (MCAO). Spleen was removed right upon reperfusion or 3d after MCAO. Infarct volume, neurological functions, and peripheral immune cell populations were assessed up to 28d after stroke. The results show that delayed removal of spleen did not reduce brain tissue loss and showed no effect on sensorimotor function (Rotarod, beam balance, forelimb placing, grid walk, and adhesive removal tests) or cognitive function (Morris water maze). Spleen removal immediately upon reperfusion, although significantly reduced the infarct size and immune cell infiltration 3d after MCAO, also failed to promote long-term recovery. Flow cytometry analysis demonstrated that immediate splenectomy after MCAO resulted in a prolonged decrease in the percentage of CD3 + CD4 + and CD3 + CD8 + T cells in total lymphocytes as compared to non-splenectomy MCAO rats. In contrast, the percentage of CD3 - CD45RA + B cells was significantly elevated after splenectomy. As a result, the ratio of T/B cells was significantly reduced in stroke rats with splenectomy. In conclusion, delayed splenectomy failed to provide long-term protection to the ischemic brain or improve functional recovery. The acute neuroprotective effect achieved by early splenectomy after stroke cannot last for long term. This loss of neuroprotection might be related to the prolonged disturbance in the T cell to B cell ratio.

Laparoscopic-assisted tension-free vaginal mesh: an innovative approach to placing synthetic mesh: transvaginally for surgical correction of pelvic organ prolapse.

PubMed

Watanabe, Toyohiko; Inoue, Miyabi; Ishii, Ayano; Yamato, Toyoko; Yamamoto, Masumi; Sasaki, Katsumi; Kobayashi, Yasuyuki; Araki, Motoo; Uehara, Shinya; Saika, Takashi; Kumon, Hiromi

2012-01-01

Polypropylene mesh implants for the correction of pelvic organ prolapse (POP) are now available in Japan. We developed an innovative approach for correcting POP by placing polypropylene mesh transvaginally with laparoscopic assistance. From June 2007 through March 2010, sixteen consecutive patients with symptomatic stage 2 or 3 pelvic organ prolapse underwent the laparoscopic-assisted tension-free vaginal mesh procedure at Okayama University Hospital. All patients were evaluated before and at 1, 3, 6, and 12 months after surgery. Female sexual function was also evaluated with the Female Sexual Function Index (FSFI). The procedure was performed successfully without significant complications. Fifteen of 16 patients were considered anatomically cured (93.8%) at 12 months postoperatively. One patient with a recurrent stage 3 vaginal vault prolapse required sacral colpopexy six months postoperatively. Total FSFI scores improved significantly from 10.3 ± 1.3 at baseline to 18.0 ± 1.2 at 12 months after surgery. The laparoscopic-assisted trans-vaginal mesh is a safe, effective, and simple procedure for POP repairs. The procedure not only restores anatomic relationships but also improves sexual function.

Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer

PubMed Central

Pigazzi, Alessio; Marshall, Helen; Croft, Julie; Corrigan, Neil; Copeland, Joanne; Quirke, Phil; West, Nick; Rautio, Tero; Thomassen, Niels; Tilney, Henry; Gudgeon, Mark; Bianchi, Paolo Pietro; Edlin, Richard; Hulme, Claire; Brown, Julia

2017-01-01

Importance Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy. Objective To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. Design, Setting, and Participants Randomized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries, including 40 surgeons. Recruitment of patients was from January 7, 2011, to September 30, 2014, follow-up was conducted at 30 days and 6 months, and final follow-up was on June 16, 2015. Interventions Patients were randomized to robotic-assisted (n = 237) or conventional (n = 234) laparoscopic rectal cancer resection, performed by either high (upper rectum) or low (total rectum) anterior resection or abdominoperineal resection (rectum and perineum). Main Outcomes and Measures The primary outcome was conversion to open laparotomy. Secondary end points included intraoperative and postoperative complications, circumferential resection margin positivity (CRM+) and other pathological outcomes, quality of life (36-Item Short Form Survey and 20-item Multidimensional Fatigue Inventory), bladder and sexual dysfunction (International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index), and oncological outcomes. Results Among 471 randomized patients (mean [SD] age, 64.9 [11.0] years; 320 [67.9%] men), 466 (98.9%) completed the study. The overall rate of conversion to open laparotomy was 10.1%: 19 of 236 patients (8.1%) in the robotic-assisted laparoscopic group and 28 of 230 patients (12.2%) in the conventional laparoscopic group (unadjusted risk difference = 4.1% [95% CI, −1.4% to 9.6%]; adjusted odds ratio = 0.61 [95% CI, 0.31 to 1.21]; P = .16). The overall CRM+ rate was

A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery.

PubMed

Tam, Michael S; Kaoutzanis, Christodoulos; Mullard, Andrew J; Regenbogen, Scott E; Franz, Michael G; Hendren, Samantha; Krapohl, Greta; Vandewarker, James F; Lampman, Richard M; Cleary, Robert K

2016-02-01

Current data addressing the role of robotic surgery for the management of colorectal disease are primarily from single-institution and case-matched comparative studies as well as administrative database analyses. The purpose of this study was to compare minimally invasive surgery outcomes using a large regional protocol-driven database devoted to surgical quality, improvement in patient outcomes, and cost-effectiveness. This is a retrospective cohort study from the prospectively collected Michigan Surgical Quality Collaborative registry designed to compare outcomes of patients who underwent elective laparoscopic, hand-assisted laparoscopic, and robotic colon and rectal operations between July 1, 2012 and October 7, 2014. We adjusted for differences in baseline covariates between cases with different surgical approaches using propensity score quintiles modeled on patient demographics, general health factors, diagnosis, and preoperative co-morbidities. The primary outcomes were conversion rates and hospital length of stay. Secondary outcomes included operative time, and postoperative morbidity and mortality. A total of 2735 minimally invasive colorectal operations met inclusion criteria. Conversion rates were lower with robotic as compared to laparoscopic operations, and this was statistically significant for rectal resections (colon 9.0 vs. 16.9%, p < 0.06; rectum 7.8 vs. 21.2%, p < 0.001). The adjusted length of stay for robotic colon operations (4.00 days, 95% CI 3.63-4.40) was significantly shorter compared to laparoscopic (4.41 days, 95% CI 4.17-4.66; p = 0.04) and hand-assisted laparoscopic cases (4.44 days, 95% CI 4.13-4.78; p = 0.008). There were no significant differences in overall postoperative complications among groups. When compared to conventional laparoscopy, the robotic platform is associated with significantly fewer conversions to open for rectal operations, and significantly shorter length of hospital stay for colon operations, without increasing

An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches.

PubMed

Elhage, Oussama; Challacombe, Ben; Shortland, Adam; Dasgupta, Prokar

2015-02-01

To evaluate, in a simulated suturing task, individual surgeons’ performance using three surgical approaches: open, laparoscopic and robot-assisted. subjects and methods: Six urological surgeons made an in vitro simulated vesico-urethral anastomosis. All surgeons performed the simulated suturing task using all three surgical approaches (open, laparoscopic and robot-assisted). The time taken to perform each task was recorded. Participants were evaluated for perceived discomfort using the self-reporting Borg scale. Errors made by surgeons were quantified by studying the video recording of the tasks. Anastomosis quality was quantified using scores for knot security, symmetry of suture, position of suture and apposition of anastomosis. The time taken to complete the task by the laparoscopic approach was on average 221 s, compared with 55 s for the open approach and 116 s for the robot-assisted approach (anova, P < 0.005). The number of errors and the level of self-reported discomfort were highest for the laparoscopic approach (anova, P < 0.005). Limitations of the present study include the small sample size and variation in prior surgical experience of the participants. In an in vitro model of anastomosis surgery, robot-assisted surgery combines the accuracy of open surgery while causing lesser surgeon discomfort than laparoscopy and maintaining minimal access.

The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease.

PubMed

Novotný, Tomáš; Dvorák, Martin; Staffa, Robert

2011-02-01

Since the end of the 20th century, robot-assisted surgery has been finding its role among other minimally invasive methods. Vascular surgery seems to be another specialty in which the benefits of this technology can be expected. Our objective was to assess the learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease in a group of 40 patients. Between May 2006 and January 2010, 40 patients (32 men, 8 women), who were a median age of 58 years (range, 48-75 years), underwent 40 robot-assisted laparoscopic aortofemoral reconstructions. Learning curve estimations were used for anastomosis, clamping, and operative time assessment. For conversion rate evaluation, the cumulative summation (CUSUM) technique was used. Statistical analysis comparing the first and second half of our group, and unilateral-to-bilateral reconstructions were performed. We created 21 aortofemoral and 19 aortobifemoral bypasses. The median proximal anastomosis time was 23 minutes (range, 18-50 minutes), median clamping time was 60 minutes (range, 40-95 minutes), and median operative time was 295 minutes (range, 180-475 minutes). The 30-day mortality rate was 0%, and no graft or wound infection or cardiopulmonary or hepatorenal complications were observed. During the median 18-month follow-up (range, 2-48 months), three early graft occlusions occurred (7%). After reoperations, the secondary patency of reconstructions was 100%. Data showed a typical short learning curve for robotic proximal anastomosis creation with anastomosis and clamping time reduction. The operative time learning curve was flat, confirming the procedure's complexity. There were two conversions to open surgery. CUSUM analysis confirmed that an acceptable conversion rate set at 5% was achieved. Comparing the first and second half of our group, all recorded times showed statistically significant improvements. Differences between unilateral and bilateral reconstructions were not

A development of assistant surgical robot system based on surgical-operation-by-wire and hands-on-throttle-and-stick.

PubMed

Kim, Myungjoon; Lee, Chiwon; Park, Woo Jung; Suh, Yun Suhk; Yang, Han Kwang; Kim, H Jin; Kim, Sungwan

2016-05-20

Robot-assisted laparoscopic surgery offers several advantages compared with open surgery and conventional minimally invasive surgery. However, one issue that needs to be resolved is a collision between the robot arm and the assistant instrument. This is mostly caused by miscommunication between the surgeon and the assistant. To resolve this limitation, an assistant surgical robot system that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument. The system comprises two novel master interfaces (NMIs), a surgical instrument with a gripper actuated by a micromotor, and 6-axis robot arm. Two NMIs are attached to master tool manipulators of da Vinci research kit (dVRK) to control the proposed system simultaneously with patient side manipulators of dVRK. The developments of the surgical instrument and NMI are based on surgical-operation-by-wire concept and hands-on-throttle-and-stick concept from the earlier research, respectively. Tests for checking the accuracy, latency, and power consumption of the NMI are performed. The gripping force, reaction time, and durability are assessed to validate the surgical instrument. The workspace is calculated for estimating the clinical applicability. A simple peg task using the fundamentals of laparoscopic surgery board and an in vitro test are executed with three novice volunteers. The NMI was operated for 185 min and reflected the surgeon's decision successfully with a mean latency of 132 ms. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1000 times of gripping motion. The reaction time was 0.4 s. The workspace was calculated to be 8397.4 cm(3). Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test without any collision. Various experiments were conducted and it is verified that the proposed assistant

Minilaparotomy with a gasless laparoscopic-assisted procedure by abdominal wall lifting for ileorectal anastomosis in patients with slow transit constipation.

PubMed

Tomita, Ryouichi; Fujisak, Shigeru

2009-01-01

Total colectomy with ileorectal anastomosis (IRA) is the most widely adopted procedure. The aim of this study was to introduce a minimally invasive procedure, i.e., minilaparotomy with laparoscopic-assisted procedure, by abdominal wall lifting for IRA in patients with slow transit constipation (STC). Six STC patients (6 women, aged 40-69 years, mean age 56.3 years) underwent minilaparotomy with gasless laparoscopic-assisted approach by abdominal wall lifting for IRA. The present procedure involved a 7-cm lower abdominal median incision made at the beginning of the operation. 12 mm ports were also placed in the right and left upper abdominal quadrant positions. The upper abdominal wall was lifted by a subcutaneous Kirshner wire. The small wound was pulled upward and/or laterally by retractors (abdominal lifting) and conventional surgical instruments were used through the wound. Occasionally laparoscopic assistance was employed. The terminal ileum with total colon was brought out through the small wound and transected, approximately 5 cm from the ileocecal valve. The colon was also resected at the level of promontrium. Then, IRA was performed in the instruments. The total surgical time was 197.7 +/- 33.9 min and the mean estimated blood loss was 176.8 +/- 42.2 ml. There was no surgical mortality. Post-operative hospitalization was 8.1 +/- 2.1 days. Six months after surgery, they defecated 1.8 +/- 2.1 times daily, have no abdominal distension, pain, and incontinence. The patients also take no laxatives. All subjects were satisfied with this procedure. Minilaparotomy with gasless laparoscopic-assisted IRA by abdominal wall lifting could be a safe and efficient technique in the treatment of STC.

Robot-assisted laparoscopic prostatectomy for a giant prostate with retrieval of vesical stones.

PubMed

Singh, Iqbal; Hudson, Jon E; Hemal, Ashok K

2010-09-01

To report and describe the technique of robot assisted prostatectomy (RAP) and retrieval of vesical stones. We describe the technique of RAP and retrieval of vesical stones under endoscopic guidance. The relevant published English literature (Pub Med™) was also searched for giant enlargement of prostate glands in order to ascertain their management. An elderly, male with a BMI of 32.49, clinically diagnosed as a case of giant BPH (prior negative prostate biopsy) with vesical stones and severe LUTS, was successfully managed by modified robot assisted laparoscopic technique of prostatectomy with removal of bladder stones. The specimen weighed 384 g. The total ORT, estimated blood loss and hospital stay was 300 min, 600 cc and 3 days, respectively. The final histology was predominant BPH with an incidental focal adenocarcinoma within the distal left prostate. The patient is continent and doing fine at a follow up of 12 months with the serum PSA < 0.006 ng/ml. Giant prostatic enlargement is an uncommonly reported entity. Minimally invasive management of massively enlarged prostate with associated bladder stones is a challenging task. Traditionally such patients have been managed with open surgery. The present case of giant prostate enlargement (incidental localized prostate cancer) with vesical stones was successfully managed by a combination of robotic prostatectomy and removal of bladder stones under flexible endoscopic guidance. The technical problems and nuances associated with the technique of robotic assisted prostatectomy (RAP) for giant prostate enlargement have been discussed. To the best of our knowledge the present case is the largest (384 g) reported case of cancer prostate (concomitant vesical stone), to be removed by minimally invasive robot assisted laparoscopic technique in the English literature (PubMed™).

Hydrodynamics Analysis and CFD Simulation of Portal Venous System by TIPS and LS.

PubMed

Wang, Meng; Zhou, Hongyu; Huang, Yaozhen; Gong, Piyun; Peng, Bing; Zhou, Shichun

2015-06-01

In cirrhotic patients, portal hypertension is often associated with a hyperdynamic changes. Transjugular Intrahepatic Portosystemic Shunt (TIPS) and Laparoscopic splenectomy are both treatments for liver cirrhosis due to portal hypertension. While, the two different interventions have different effects on hemodynamics after operation and the possibilities of triggering PVT are different. How hemodynamics of portal vein system evolving with two different operations remain unknown. Based on ultrasound and established numerical methods, CFD technique is applied to analyze hemodynamic changes after TIPS and Laparoscopic splenectomy. In this paper, we applied two 3-D flow models to the hemodynamic analysis for two patients who received a TIPS and a laparoscopic splenectomy, both therapies for treating portal hypertension induced diseases. The current computer simulations give a quantitative analysis of the interplay between hemodynamics and TIPS or splenectomy. In conclusion, the presented computational model can be used for the theoretical analysis of TIPS and laparoscopic splenectomy, clinical decisions could be made based on the simulation results with personal properly treatment.

Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review.

PubMed

Cirocchi, R; Cochetti, G; Randolph, J; Listorti, C; Castellani, E; Renzi, C; Mearini, E; Fingerhut, A

2014-10-01

Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.

How to set up a robotic-assisted laparoscopic surgery center and training of staff.

PubMed

Lenihan, John P

2017-11-01

The use of computers to assist surgeons in the operating room has been an inevitable evolution in the modern practice of surgery. Robotic-assisted surgery has been evolving now for over two decades and has finally matured into a technology that has caused a monumental shift in the way gynecologic surgeries are performed. Prior to robotics, the only minimally invasive options for most Gynecologic (GYN) procedures including hysterectomies were either vaginal or laparoscopic approaches. However, even with over 100 years of vaginal surgery experience and more than 20 years of laparoscopic advancements, most gynecologic surgeries in the United States were still performed through an open incision. However, this changed in 2005 when the FDA approved the da Vinci Surgical Robotic System tm for use in gynecologic surgery. Over the last decade, the trend for gynecologic surgeries has now dramatically shifted to less open and more minimally invasive procedures. Robotic-assisted surgeries now include not only hysterectomy but also most all other commonly performed gynecologic procedures including myomectomies, pelvic support procedures, and reproductive surgeries. This success, however, has not been without controversies, particularly around costs and complications. The evolution of computers to assist surgeons and make minimally invasive procedures more common is clearly a trend that is not going away. It is now incumbent on surgeons, hospitals, and medical societies to determine the most cost-efficient and productive use for this technology. This process is best accomplished by developing a Robotics Program in each hospital that utilizes robotic surgery. Copyright © 2017. Published by Elsevier Ltd.

A comparative cost analysis of robot-assisted versus traditional laparoscopic partial nephrectomy.

PubMed

Hyams, Elias; Pierorazio, Philip; Mullins, Jeffrey K; Ward, Maryann; Allaf, Mohamad

2012-07-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as proliferation of robotic systems and patient demand for robot-assisted surgery. We sought to quantify the costs associated with the use of robotics for minimally invasive partial nephrectomy. A cost analysis was performed for 20 consecutive robot-assisted partial nephrectomy (RPN) and LPN patients at our institution from 2009 to 2010. Data included actual perioperative and hospitalization costs as well as professional fees. Capital costs were estimated using purchase costs and amortization of two robotic systems from 2001 to 2009, as well as maintenance contract costs. The estimated cost/case was obtained using total robotic surgical volume during this period. Total estimated costs were compared between groups. A separate analysis was performed assuming "ideal" robotic utilization during a comparable period. RALPN had a cost premium of +$1066/case compared with LPN, assuming actual robot utilization from 2001 to 2009. Assuming "ideal" utilization during a comparable period, this premium decreased to +$334; capital costs per case decreased from $1907 to $1175. Tumor size, operative time, and length of stay were comparable between groups. RALPN is associated with a small to moderate cost premium depending on assumptions regarding robotic surgical volume. Saturated utilization of robotic systems decreases attributable capital costs and makes comparison with laparoscopy more favorable. Purported clinical benefits of RPN (eg, decreased warm ischemia time, increased utilization of nephron-sparing surgery) need further study, because these may have cost implications.

Laparoscopic-assisted extracorporeal ovarian cystectomy: a new technique.

PubMed

Ikuma, Kenichino; Amin, Magdy; Yukio, Yamada; Hisato, Okuo; Yoshihiro, Ito; Shintaro, Ueda; Masako, Tanaka; Yasuki, Koyasu

2004-01-01

An increasing number of adnexal masses are currently managed laparoscopically, which has hampered progress regarding the different techniques of laparoscopic surgery. In this chapter, a modified application of surgical instrument was described in laparoscopic ovarian cystectomy-we named this device, Lap-Disc Mini. This new instrument has three rings, an inner flexible ring fixed to a middle ring by a rubber corset, and an additional dynamic outer ring that has a rubbery-like iris opening, which allows the application of different-sized trocars and extracorporeal ovarian cystectomy. This technique has proved to be effective and safe, especially in removing large ovarian cyst.

Benign paroxysmal positional vertigo secondary to laparoscopic surgery

PubMed Central

Shan, Xizheng; Wang, Amy; Wang, Entong

2017-01-01

Objectives: Benign paroxysmal positional vertigo is a common vestibular disorder and it may be idiopathic or secondary to some conditions such as surgery, but rare following laparoscopic surgery. Methods: We report two cases of benign paroxysmal positional vertigo secondary to laparoscopic surgery, one after laparoscopic cholecystectomy in a 51-year-old man and another following laparoscopic hysterectomy in a 60-year-old woman. Results: Both patients were treated successfully with manual or device-assisted canalith repositioning maneuvers, with no recurrence on the follow-up of 6 -18 months. Conclusions: Benign paroxysmal positional vertigo is a rare but possible complication of laparoscopic surgery. Both manual and device-assisted repositioning maneuvers are effective treatments for this condition, with good efficacy and prognosis. PMID:28255446

Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children.

PubMed

Ahmed, H; Youssef, M K; Salem, E A; Fawzi, A M; Desoky, E A E; Eliwa, A M; Sakr, A M N; Shahin, A M S

2016-02-01

Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides. The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children. A total of 40 children were enrolled into this prospective study; they were aged ≥ 6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3-mm 30° telescope. Another 3-mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25-30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried. The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence. The exploratory laparoscopy found contralateral patent processus vaginalis (CPPV) with a detection rate of 28.1%. Chan et al., Esposito et al., Toufique et al. and Niyogi et al. reported similar figures for laparoscopic contralateral hernia detection rates of 28

Evaluation of splenectomy as a risk factor for gastric dilatation-volvulus.

PubMed

Grange, Andrew M; Clough, William; Casale, Sue A

2012-08-15

To evaluate whether dogs undergoing splenectomy had an increased risk of gastric dilatation-volvulus (GDV), compared with a control group of dogs undergoing enterotomy. Retrospective case-control study. 219 dogs that underwent splenectomy for reasons other than splenic torsion (splenectomy group; n = 172) or enterotomy (control group; 47) without concurrent gastropexy. Medical records were reviewed for information on signalment, date of surgery, durations of surgery and anesthesia, reason for splenectomy, histopathologic findings (if applicable), whether gastropexy was performed, duration of follow-up, and date of death (if applicable). Follow-up information, including occurrence of GDV, was obtained via medical records review and a written client questionnaire. Reasons for splenectomy included splenic neoplasia, nonneoplastic masses, infarction, traumatic injury, and adhesions to a gossypiboma. Incidence of GDV following surgery was not significantly different between dogs of the splenectomy (14/172 [8.1 %]) and control (3/47 [6.4%]) groups. Median time to GDV for the 17 affected dogs was 352 days (range, 12 to 2,368 days) after surgery. Among dogs that underwent splenectomy, sexually intact males had a significantly higher incidence of GDV (4/16) than did castrated males and sexually intact or spayed females (10/156). Incidence of GDV among sexually intact male dogs did not differ between groups. Results did not support a recommendation for routine use of prophylactic gastropexy in dogs at the time of splenectomy. Other patient-specific risk factors should be assessed prior to recommending this procedure.

Results of a randomized trial of HERMES-assisted versus non-HERMES-assisted laparoscopic antireflux surgery.

PubMed

Luketich, J D; Fernando, H C; Buenaventura, P O; Christie, N A; Grondin, S C; Schauer, P R

2002-09-01

Speech recognition technology is a recent development in minimally invasive surgery. This study was designed to assess the impact of HERMES on operating room efficiency and user satisfaction. Patients undergoing laparoscopic antireflux operations by surgeons experienced in minimally invasive surgery were randomized to HERMES-assisted or standard laparoscopic operations. The variables of interest were circulating nurse's time spent adjusting devices that are voice-controlled by HERMES, number of adjustments to devices requested, and surgeon and nurse satisfaction measured on a scale from 1 (dissatisfied) to 10 (satisfied). A total of 30 cases were studied. In the non-HERMES cases, nurses were interrupted to make device adjustments an average of 15.3 times per case versus 0.33 times per case in the with-HERMES cases (p < 0.01). The interruptions during the non-HERMES cases averaged 4.35 min per case versus 0.16 min per case in the with-HERMES cases (p = 0.03). Average satisfaction scores for HERMES operations as opposed to non-HERMES operations were 9.2 versus 5.3 for nurses (p < 0.01) and 9.0 versus 5.1 for surgeons (p < 0.01). Physician and nurse acceptance of HERMES was very high because of the smoother interruption-free environment.

Splenectomy combined with gastrectomy and immunotherapy for advanced gastric cancer.

PubMed

Miwa, H; Orita, K

1983-06-01

We studied the effects of a splenectomy in combination with immunotherapy on the survival of patients who had undergone a total gastrectomy. It was found that a splenectomy was not effective against advanced gastric cancer at stage III, and that the spleen should be retained for immunotherapy. Splenectomy for gastric cancer at terminal stage IV, particularly in combination with immunotherapy, produced not only augmentation of cellular immunity, but also increased survival.

Systematic review of perioperative outcomes and complications after open, laparoscopic and robot-assisted radical cystectomy.

PubMed

Palazzetti, A; Sanchez-Salas, R; Capogrosso, P; Barret, E; Cathala, N; Mombet, A; Prapotnich, D; Galiano, M; Rozet, F; Cathelineau, X

2017-09-01

Radical cystectomy and regional lymph node dissection is the standard treatment for localized muscle-invasive and for high-risk non-muscle-invasive bladder cancer, and represents one of the main surgical urologic procedures. The open surgical approach is still widely adopted, even if in the last two decades efforts have been made in order to evaluate if minimally invasive procedures, either laparoscopic or robot-assisted, might show a benefit compared to the standard technique. Open radical cystectomy is associated with a high complication rate, but data from the laparoscopic and robotic surgical series failed to demonstrate a clear reduction in post-operative complication rates compared to the open surgical series. Laparoscopic and robotic radical cystectomy show a reduction in blood loss, in-hospital stay and transfusion rates but a longer operative time, while open radical cystectomy is typically associated with a shorter operative time but with a longer in-hospital admission and possibly a higher rate of high grade complications. Copyright © 2016. Publicado por Elsevier España, S.L.U.

Partial Splenectomy in the treatment of an adult with β thalassemia intermedia: A case report.

PubMed

Correia, João Guardado; Moreira, Nídia; Costa Almeida, Carlos Eduardo; Reis, Luís Simões

2017-01-01

Thalassemia is a common disease which treatment is often based on splenectomy. The risks associated with total splenectomy stimulated partial splenectomy as a potentially alternative therapy. A 45 year-old female patient with long term follow-up for β thalassemia intermedia started to develop signs of hypersplenism and iron overload. A partial splenectomy was performed and was observed a marked hematologic improvement while preserving the desired splenic function. Partial splenectomy proved to provide a persistent decrease in hemolytic rate while preserving the integrity of splenic phagocytic function, presenting itself as an effective alternative to total splenectomy. After being subjected to partial splenectomy, our patient experienced a sustained control of hemolysis and showed no signs of hypersplenism or iron overload. No splenic regrowth or infectious complications were observed. The major drawbacks of partial splenectomy are the increased risk of intra- and postoperative bleeding, splenic remnant torsion and splenic regrowth. Partial splenectomy is an alternative to total splenectomy for the treatment of adult β Thalassemia intermedia patients avoiding the risks associated with total splenectomy.

Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis.

PubMed

Memon, Sameer; Heriot, Alexander G; Murphy, Declan G; Bressel, Mathias; Lynch, A Craig

2012-07-01

Robot-assisted laparoscopic surgery is being performed more frequently for the minimally invasive management of rectal cancer. The objective of this meta-analysis was to compare the clinical and oncologic safety and efficacy of robot-assisted versus conventional laparoscopic surgery. A search of the Medline and Embase databases was performed for studies that compared clinical or oncologic outcomes of conventional laparoscopic proctectomy with robot-assisted laparoscopic proctectomy for rectal cancer. The methodological quality of the selected studies was critically assessed to identify studies suitable for inclusion. Meta-analysis was performed by a random effects model and analyzed by Review Manager. Clinical outcomes evaluated were conversion rates, operation times, length of hospital stay, and complications. Oncologic outcomes evaluated were circumferential margin status, number of lymph nodes collected, and distal resection margin lengths. Eight comparative studies were assessed for quality, and seven studies were included in the meta-analysis. Two studies were matched case-control studies, and five were unmatched. A total of 353 robot-assisted laparoscopic surgery proctectomy cases and 401 conventional laparoscopic surgery proctectomy cases were analyzed. Robotic surgery was associated with a significantly lower conversion rate (P=0.03; 95% confidence interval 1-12). There was no difference in complications, circumferential margin involvement, distal resection margin, lymph node yield, or hospital stay (P=NS). Robot-assisted surgery decreased the conversion rate compared to conventional laparoscopic surgery. Other clinical outcomes and oncologic outcomes were equivalent. The benefits of robotic rectal cancer surgery may differ between population groups.

Effects of laparoscopic instrument and finger on force perception: a first step towards laparoscopic force-skills training.

PubMed

Raghu Prasad, M S; Manivannan, M; Chandramohan, S M

2015-07-01

In laparoscopic surgery, no external feedback on the magnitude of the force exerted is available. Hence, surgeons and residents tend to exert excessive force, which leads to tissue trauma. Ability of surgeons and residents to perceive their own force output without external feedback is a critical factor in laparoscopic force-skills training. Additionally, existing methods of laparoscopic training do not effectively train residents and novices on force-skills. Hence, there is growing need for the development of force-based training curriculum. As a first step towards force-based laparoscopic skills training, this study analysed force perception difference between laparoscopic instrument and finger in contralateral bimanual passive probing task. The study compared the isometric force matching performance of novices, residents and surgeons with finger and laparoscopic instrument. Contralateral force matching paradigm was employed to analyse the force perception capability in terms of relative (accuracy), and constant errors in force matching. Force perception of experts was found to be better than novices and residents. Interestingly, laparoscopic instrument was more accurate in discriminating the forces than finger. The dominant hand attempted to match the forces accurately, whereas non-dominant hand (NH) overestimated the forces. Further, the NH of experts was found to be most accurate. Furthermore, excessive forces were applied at lower force levels and at very high force levels. Due to misperception of force, novices and residents applied excessive forces. However, experts had good control over force with both dominant and NHs. These findings suggest that force-based training curricula should not only have proprioception tasks, but should also include bimanual force-skills training exercises in order to improve force perception ability and hand skills of novices and residents. The results can be used as a performance metric in both box and virtual reality

Outcomes of infants undergoing robot-assisted laparoscopic pyeloplasty compared to open repair.

PubMed

Dangle, Pankaj P; Kearns, James; Anderson, Blake; Gundeti, Mohan S

2013-12-01

Robotic surgery has evolved from simple extirpative surgery to complex reconstructions even in infants. Data are lacking comparing surgical and direct costs to open approaches. We describe the feasibility, salient tips and outcomes of robot-assisted laparoscopic pyeloplasty compared to an open approach. We evaluated patients undergoing open pyeloplasty or robot-assisted laparoscopic pyeloplasty. Ten patients in each group met inclusion criteria. Mean patient age was 3.31 months in the open group and 7.3 months in the robotic group (p=0.02). Postoperative outcomes including length of stay (2.2 vs 2.1 days), estimated blood loss (6.5 vs 7.6 ml), days to regular diet (1 vs 1.1) and days to Foley catheter removal (1.3 vs 1.3) were similar between the open and robotic groups. Total operating time (199 vs 242 minutes) was significantly longer in the robotic group. Postoperative improvement in hydronephrosis was identical in both groups. Direct costs, excluding amortization, robotic cost, maintenance and depreciation, were $4,410 in the open group and $4,979 in the robotic group (p=0.10). In our preliminary experience robotic pyeloplasty in infants is feasible and safe. The immediate outcomes are similar to those of an open approach. The robotic technique in infants currently has the benefits of improved esthetic appearance, improved pain control and similar direct costs compared to the traditional open approach. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Port-Site Metastases and Chimney Effect of B-Ultrasound-Guided and Laparoscopically-Assisted Hyperthermic Intraperitoneal Perfusion Chemotherapy

PubMed Central

Zhang, Xiang-Liang; Gong, Yuan-Feng; Yan, Zhao-Fei; Wang, Shuai; Tang, Yun-Qiang; Cui, Shu-Zhong

2017-01-01

Purpose CO2 leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasis after laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis between B-ultrasound-guided and laparoscopically-assisted hyperthermic intraperitoneal perfusion chemotherapy (HIPPC). Materials and Methods Sixty-two patients with malignant ascites induced by gastrointestinal or ovarian cancer were divided into two groups to receive either B-ultrasound-guided or laparoscopically-assisted HIPPC. Clinical efficacy was assessed from the objective remission rate (ORR), the Karnofsky Performance Status (KPS) score, and overall survival. The incidence of port-site metastasis was compared between the two groups. Results Patients in the B-ultrasound (n=32) and laparoscopy (n=30) groups were comparable in terms of age, sex, primary disease type, volume of ascites, and free cancer cell (FCC)-positive ascites. After HIPPC, there were no significant differences between the B-ultrasound and laparoscopy groups in the KPS score change, ORR, and median survival time. The incidence of port-site metastasis after HIPPC was not significantly different between the B-ultrasound (3 of 32, 9.36%) and laparoscopy (3 of 30, 10%) groups, but significantly different among pancreatic, gastric, ovarian, and colorectal cancer (33.33, 15.79, 10.00, and 0.00%, p<0.001). Conclusion The chimney effect may not be the key reason for port-site metastasis after laparoscopy. Other factors may play a role, including the local microenvironment at the trocar site and the delivery of viable FCCs (from the tumor or malignant ascites) to the trauma site during laparoscopic surgery. PMID:28332353

Short-term impact of a robot-assisted laparoscopic prostatectomy 'mini-residency' experience on postgraduate urologists' practice patterns.

PubMed

McDougall, Elspeth M; Corica, Federico A; Chou, David S; Abdelshehid, Corollos S; Uribe, Carlos A; Stoliar, Gabriella; Sala, Leandro G; Khonsari, Sepi S; Eichel, Louis; Boker, John R; Ahlering, Thomas E; Clayman, Ralph V

2006-03-01

To assist practising urologists acquire and incorporate robot-assisted laparoscopic prostatectomy (RALP) into their practice, a 5 day mini-residency (M-R) programme with a mentor, preceptor and potential proctor experience was established at the University of California, Irvine, Yamanouchi Center for Urological Education. The follow-up results from the initial 21 RALP M-R participants are presented. Between September 2003 and September 2004, 21 urologists from six states and four countries underwent a RALP M-R. Each participant underwent 1:2 teacher:attendee instruction over a 5 day period, which included inanimate model skills training, animal/cadaver laboratory skills training and operating room observation experience. Participants were also offered a proctoring experience at their hospital if they so desired. A questionnaire survey was mailed 1-14 months (mean 7.2 months) following completion of the mini-residency and these results were tabulated and reviewed. A 100% response rate was achieved from the mailed questionnaires. The mean M-R participant age was 43 years (range 33-55 years). One-third of the M-R participants were practising in an academic environment. Most of the participants (55%) had no fellowship training. Of those with fellowship training (45%), three (15%) were in laparoscopy and three (15%) were in oncology; 25% of the participants were in large (>6 physicians), 25% in small (2-6 physicians) and 15% in solo practices; 70% of the participants were located in an urban setting. The majority of the participants (80%) had laparoscopic experience during residency training and had performed 20-60 laparoscopic cases prior to attending the M-R programme. Within 7.2 months after M-R (range 1-14 months), 95% of the participants were practising robot-assisted laparoscopic prostatectomy and 25% of the RALP M-R participants had also performed robotic-assisted laparoscopic pyeloplasty. Of the M-R participants, 38% availed themselves of the preceptor

Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: a case-control study.

PubMed

Sánchez, Alexis; Rodríguez, Omaira; Nakhal, Elias; Davila, Hugo; Valero, Rair; Sánchez, Renata; Pena, Romina; Visconti, Maria F

2012-09-01

Minimally invasive surgery has become the gold standard for the treatment of achalasia. The incorporation of robotic technology can improve many limitations of laparoscopic surgery, through, for example, the availability of three-dimensional vision, increasing the degrees of movement, avoiding the fulcrum effect and optimizing ergonomics. The aim of this study was to compare robotic-assisted laparoscopic Heller myotomy (RAHM) with laparoscopic Heller myotomy (LHM) in terms of efficacy and safety. Thirty-one patients with diagnosis of achalasia confirmed by esophagogram and manometry were included. Dysphagia and weight loss were the main complaints in both groups. 18 patients were treated with LHM and 13 patients with RAHM. There was no difference in mean operative time (76 ± 13 vs. 79 ± 20 min; P = 0.73). Intraoperative complications were less frequent in the robotic-assisted procedures (5.5% vs. 0%); however, this was a non-significant difference. 94.5-100% of patients had relief of their symptoms. We conclude that RAHM is a safe and effective procedure. The operative time is no longer than in LHM, but it is necessary to evaluate the technique in randomized clinical trials to determine its advantages in terms of intraoperative complications.

"Ipsilateral, high, single-hand, sideways"-Ruijin rule for camera assistant in uniportal video-assisted thoracoscopic surgery.

PubMed

Gao, Taotao; Xiang, Jie; Jin, Runsen; Zhang, Yajie; Wu, Han; Li, Hecheng

2016-10-01

Camera assistant plays a very important role in uniportal video-assisted thoracoscopic surgery (VATS), who acts as the eye of the surgeon, providing the VATS team with a stable and clear operating view. Thus, a good assistant should cooperate with surgeon and manipulate the camera expertly, to ensure eye-hand coordination. We have performed more than 100 uniportal VATS in the Department Of Thoracic Surgery in Ruijin Hospital. Based on our experiences, we summarized the method of holding camera, known as "ipsilateral, high, single-hand, sideways", which largely improves the comfort and fluency of surgery.

Structuralized box-trainer laparoscopic training significantly improves performance in complex virtual reality laparoscopic tasks.

PubMed

Laski, Dariusz; Stefaniak, Tomasz J; Makarewicz, Wojciech; Proczko, Monika; Gruca, Zbigniew; Sledziński, Zbigniew

2012-03-01

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. 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. 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. 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.

[Laparoscopic pelvic exenteration for cervical cancer relapse: preliminary study].

PubMed

Uzan, C; Rouzier, R; Castaigne, D; Pomel, C

2006-04-01

To determine the feasibility and short and midterm results of laparoscopic pelvic exenteration for cervical cancer relapse. Materials and methods. Five patients with centro-pelvic recurrence within 3 to 13 months after combined chemo-radiation therapy (associated to surgery for two cases) for cervical cancer tumors were included in a pilot study. The procedures consisted in a complete pelvic exenteration with colo-anal anastomosis and ileal-loop conduit for 2 patients, a posterior pelvic exenteration including uterus, vagina and rectum with colo-anal anastomosis for 1 patient, an anterior pelvic exenteration including bladder and vagina with an ileal-loop conduit for 1 patient and a anterior pelvic exenteration with a laparoscopic hand assisted Miami Pouch for 1 patient. The 5 procedures were successful with no conversion to laparotomy. Time of procedure ranged between 4 h 30 and 9 hours. Average blood loss was 370 cc. Three patients developed metastatic recurrences and died. The two patients with anterior exenteration are alive and free of disease 11 and 15 months after the procedure. Laparoscopic pelvic exenteration procedures are feasible. A larger series is necessary to determine the advantages of this technique compared to laparotomy.

Outcomes in the treatment of thrombotic thrombocytopenic purpura with splenectomy: a retrospective cohort study.

PubMed

Outschoorn, Ubaldo Martinez; Ferber, Andres

2006-12-01

The mainstay of treatment for thrombotic thrombocytopenic purpura (TTP) is plasma exchange (PE), but the role of splenectomy is still undefined. The records of all patients with TTP at a single center over a 20-year period were retrospectively reviewed. Response to plasma exchange was determined. The outcome of patients treated with splenectomy in the setting of TTP was evaluated. Sixty-one patients had been treated for TTP. Thirty-nine patients (64%) achieved complete remission (CR) with PE, nineteen (31%) of these achieving sustained CR and seventeen (28%) with relapsed TTP. Twenty patients (33%) had PE refractory TTP and two patients (3%) had PE dependent TTP. During this time period, 10 patients (16%) underwent splenectomy, four patients (7%) for PE dependent TTP, three (5%) for relapsed TTP, and three (5%) for refractory TTP. All of the patients achieved CR after splenectomy. Two patients who had undergone splenectomy had subsequent relapses, both with previously relapsed TTP. In relapsed patients the relapse rate after splenectomy was 0.27 events per patient year compared to 0.6 events per patient year before splenectomy. Median follow-up after splenectomy was 19 months (range 0.13-90 months). In conclusion, relapses in TTP can be managed successfully with additional PE or with splenectomy. PE dependent or refractory TTP can be successfully treated with splenectomy.

Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure.

PubMed

Ohno, Yasuharu; Morimura, Toshiya; Hayashi, Shin-ichi

2012-02-01

Even for pediatric patients, the use of laparoscopic appendectomy has been widely accepted, and three trocars usually are necessary to perform a laparoscopic appendectomy. However, single-port appendectomy for children represents an attractive alternative. To reduce the number of incisions and trocars, the authors have adopted a transumbilical laparoscopically assisted single-port appendectomy (TULAA) approach. This study aimed to evaluate the results of their single-channel, single-port appendectomy. A retrospective study of TULAA was performed during 12 years with 500 children ages 2-16 years (median, 10.2 years). The TULAA approach is a single-channel surgery using a 12 mm conventional single-port. The vertical incision through the umbilicus is used for laparoscopic access. Two laparoscopic instruments, a 5 mm telescope and a 5 mm grasper, are inserted simultaneously into the single-channel. The grasper holds the base of the appendix, and the appendix is exteriorized through the umbilical incision. Thereafter, a conventional appendectomy is performed extracorporeally. The TULAA procedure was successful for 416 patients (83.2%). These successful TULAA procedures required a mean surgery time of 44.5 min. The pathologic diagnosis of the appendix was acute for 59 patients, phlegmonous for 203 patients, gangrenous for 152 patients, and not detected for two patients. Complications occurred for 47 of these patients (11.3%). Most of the complications were associated with severe intraabdominal inflammation. Two patients needed reoperation under general anesthesia. Conversion to multitrocar surgery or open appendectomy was performed for 84 of the patients (16.8%). The TULAA procedure is a preferable operation for acute appendicitis in children because it is simple and provides good cosmetic results.

Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases.

PubMed

Patel, Vipul R; Palmer, Kenneth J; Coughlin, Geoff; Samavedi, Srinivas

2008-10-01

Robot-assisted laparoscopic radical prostatectomy (RALP) is an evolving minimally invasive treatment of for localized prostate cancer. We present our experience of 1500 consecutive cases with an analysis of perioperative outcomes. Fifteen hundred consecutive RALPs were performed by a single surgeon (VRP). Following Institutional Review Board approval, clinical coordinators performed prospective intraoperative and postoperative data collection. Functional outcomes were assessed using validated self-administered questionnaires. Mean OR time from skin incision to fascial closure (the time that the surgeon was present) was 105 minutes (55-300). Mean EBL was 111 cc (50-500). Ninety-seven percent of patients were discharged home on postoperative day 1. The overall complication rate was 4.3% with no mortalities. The positive margin rate (PMR) was 9.3% overall. PMR was 4% for pT2, 34% for T3 and 40% for pathologic stage T4. Our initial series represents one of the largest published series for perioperative outcomes of robotic assisted prostatectomy. Our data demonstrates the feasibility, safety and efficacy of the procedure.

Totally laparoscopic gastrectomy using intracorporeally stapler or hand-sewn anastomosis for gastric cancer: a single-center experience of 478 consecutive cases and outcomes.

PubMed

Chen, Ke; Wu, Di; Pan, Yu; Cai, Jia-Qin; Yan, Jia-Fei; Chen, Ding-Wei; Maher, Hendi; Mou, Yi-Ping

2016-04-19

Totally laparoscopic gastrectomy (TLG) using intracorporeal anastomosis has gradually become mature thanks to the advancements of laparoscopic surgical instruments and the accumulation of operative experience. The goal of this study is to review our institution's experience with TLG for the treatment of gastric cancer. A retrospective study was conducted to examine the short-term outcomes of TLG using intracorporeally stapler or hand-sewn anastomosis performed at Sir Run Run Shaw Hospital between March 2007 and June 2015. The details of intracorporeal anastomosis were described, and the clinicopathological data, surgical outcomes, and postoperative complications were evaluated. Four hundred seventy-eight patients were included in the study. Generally speaking, the patients could be divided into stapler or hand-sewn groups according to whether intracorporeal anastomosis was performed by only hand-sewn technique (n = 97) or only stapling devices (n = 381). For overall patients, the mean operation time and anastomotic time were 225.7 and 30.0 min, respectively. Postoperative complications were observed in 65 patients. All of the patients recovered well without perioperative death by conservative or surgical management. TLG using intracorporeally stapler or hand-sewn anastomosis is a reasonable option for the treatment of gastric cancer, with early data showing acceptable perioperative outcomes.

Sclerosing Angiomatoid Nodular Transformation: Laparoscopic Splenectomy as Therapeutic and Diagnostic Approach at the Same Time.

PubMed

Cipolla, Calogero; Florena, Ada Maria; Ferrara, Gabriella; Di Gregorio, Riccardo; Unti, Elettra; Giannone, Antonino G; Lazzaro, Luigi A; Graceffa, Giuseppa; Pantuso, Gianni

2018-01-01

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion with unknown etiopathogenesis and with definite features of imaging, histopathology, and immunohistochemistry. It was first described by Martel et al. in 2004, and to date, only 151 cases have been reported. We report a case of SANT of the spleen detected in a 66-year-old Caucasian, without comorbidities, presented to our department with epigastric pain. We, also, presented a review of the literature. SANT is a benign incidentally vascular condition in the majority of cases. The wide age and gender distribution in our review is in accordance with that in previous studies in English literature. In our opinion, splenectomy is the choice treatment because it is at the same time diagnostic and therapeutic in a definitive way.

Perceptual impairment and psychomotor control in virtual laparoscopic surgery.

PubMed

Wilson, Mark R; McGrath, John S; Vine, Samuel J; Brewer, James; Defriend, David; Masters, Richard S W

2011-07-01

It is recognised that one of the major difficulties in performing laparoscopic surgery is the translation of two-dimensional video image information to a three-dimensional working area. However, research has tended to ignore the gaze and eye-hand coordination strategies employed by laparoscopic surgeons as they attempt to overcome these perceptual constraints. This study sought to examine if measures related to tool movements, gaze strategy, and eye-hand coordination (the quiet eye) differentiate between experienced and novice operators performing a two-handed manoeuvres task on a virtual reality laparoscopic surgical simulator (LAP Mentor™). Twenty-five right-handed surgeons were categorised as being either experienced (having led more than 60 laparoscopic procedures) or novice (having performed fewer than 10 procedures) operators. The 10 experienced and 15 novice surgeons completed the "two-hand manoeuvres" task from the LAP Mentor basic skills learning environment while wearing a gaze registration system. Performance, movement, gaze, and eye-hand coordination parameters were recorded and compared between groups. The experienced surgeons completed the task significantly more quickly than the novices, used significantly fewer movements, and displayed shorter tool paths. Gaze analyses revealed that experienced surgeons spent significantly more time fixating the target locations than novices, who split their time between focusing on the targets and tracking the tools. A more detailed analysis of a difficult subcomponent of the task revealed that experienced operators used a significantly longer aiming fixation (the quiet eye period) to guide precision grasping movements and hence needed fewer grasp attempts. The findings of the study provide further support for the utility of examining strategic gaze behaviour and eye-hand coordination measures to help further our understanding of how experienced surgeons attempt to overcome the perceptual difficulties inherent in

Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

PubMed Central

Boyle, Soames; White, Richard H.; Brunson, Ann

2013-01-01

Patients with immune thrombocytopenia (ITP) who relapse after an initial trial of corticosteroid treatment present a therapeutic challenge. Current guidelines recommend consideration of splenectomy, despite the known risks associated with surgery and the postsplenectomy state. To better define these risks, we identified a cohort of 9976 patients with ITP, 1762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared with 1% in patients who did not undergo splenectomy; venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared with 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (<90 days; hazard ratio [HR] 5.4 [confidence interval (CI), 2.3-12.5]), but not late (≥90 days; HR 1.5 [CI, 0.9-2.6]) after splenectomy. There was increased risk of VTE both early (HR 5.2 [CI, 3.2-8.5]) and late (HR 2.7 [CI, 1.9-3.8]) after splenectomy. The cumulative incidence of sepsis was 11.1% among the ITP patients who underwent splenectomy and 10.1% among the patients who did not. Splenectomy was associated with a higher adjusted risk of sepsis, both early (HR 3.3 [CI, 2.4-4.6]) and late (HR 1.6 or 3.1, depending on comorbidities). We conclude that ITP patients post splenectomy are at increased risk for AbVTE, VTE, and sepsis. PMID:23637127

Use of robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy in a paediatric patient: problem encountered.

PubMed

Chan, Ivy H Y; Li, Florence H Q; Lan, Lawrence C L; Wong, Kenneth K Y; Yip, Peter K F; Tam, Paul K H

2015-10-01

This report is of robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy in a 12-year-old patient with detrusor underactivity and hereditary sensory neuropathy. The whole operation was performed in 555 minutes with no open conversion. The patient experienced one episode of stomal stenosis, which required dilatation. At 3-year follow-up, the patient had both stomal and urinary continence. This is a safe and effective procedure to create a means of urinary catheterisation with avoidance of a large unsightly scar and comparable clinical outcome to an open procedure.

Laparoscopic and ultrasound assisted management of gallstone ileus after biliointestinal bypass Case report and a review of literature.

PubMed

Zago, Mauro; Bozzo, Samantha; Centurelli, Andrea; Giovanelli, Alessandro; Vasino, Michele Ciocca

2016-05-24

To report about an additional case of biliary ileus after bariatric surgery is reported and extensively reviewing the literature on this topic. We reviewed the literature and found three cases of gallstone ileus (GI) that occurred after bariatric surgery. A 41 year old patient presented a GI eight years after a biliointestinal bypass (BIB) for morbid obesity. The patient complained of abdominal pain for two weeks. Computed tomography (CT) and abdominal ultrasound (US) allowed a preoperative diagnosis of GI and planning of surgical strategy. Surgical treatment was carried out through laparoscopic-assisted enterolithotomy alone procedure. This choice is supported discussing the related issues: morbidity, potential recurrence, eventual developing of gallbladder carcinoma. It is the first reported case of GI after BIB preoperatively diagnosed through CT scan and US, and treated with a laparoscopic assisted approach. Additional considerations concerning preoperative diagnosis, surgical strategy, technical details and follow-up can be usefully applied even in non post-bariatric biliary ileus. Biliointestinal bypass, Gallstone ileus, Laparoscopy, Ultrasonography.

Peritoneal macrophage and blood monocyte functions after open and laparoscopic-assisted cecectomy in rats.

PubMed

Lee, S W; Feingold, D L; Carter, J J; Zhai, C; Stapleton, G; Gleason, N; Whelan, R L

2003-12-01

It has been well established that open abdominal surgery results in systemic immunosuppression postoperatively; in contrast, laparoscopic surgery is associated with significantly better preserved systemic immune function. However, when intraperitoneal (local) immune function is considered, laparoscopic procedures done under a CO2 pneumoperitoneum (pneumo) have been shown to result in greater immunosuppression compared to that of open surgery. Few studies have simultaneously assessed systemic and local immune function. The purpose of this study was to assess peripheral blood mononuclear cell (PBMC) and peritoneal macrophage tumor necrosis factor-alpha (TNF-alpha) levels, H2O2 production, and MHC class II antigen expression after open and laparoscopically assisted cecectomy in a rat model. A total of 75 Sprague Dawley rats were used for three separate experiments. For each study, rats were randomly divided into three groups: anesthesia alone (AC), laparoscopic-assisted cecectomy (LC), and open cecectomy via full laparotomy (OP). A CO2 pneumo was used for laparoscopic operations. On postoperative day 1 the animals were sacrificed, macrophages were harvested via intraperitoneal lavage, and PBMCs were isolated from whole blood obtained by cardiac puncture. In experiment 1, macrophages and PBMC from each animal were stimulated with lipopolysaccharide, after which TNF-alpha levels of the supernatant were determined. In experiment 2, after stimulation with PMA, H2O2 release was assessed by measuring fluorescence. In experiment 3, via flow cytometry, the number of cells with surface MHC class II proteins were determined. Data from the three groups in each experiment were compared using analysis of variance Tukey-Kramer tests. Macrophages and PBMC from rats in the OP group released significantly more TNF-alpha than cells from rats in the LC ( p < 0.05) or AC ( p < 0.05) groups. Macrophages from rats in the OP group released significantly less H2O2 than cells from the AC ( p

Standardized technique for single-incision laparoscopic-assisted stoma creation.

PubMed

Miyoshi, Norikatsu; Fujino, Shiki; Ohue, Masayuki; Yasui, Masayoshi; Noura, Shingo; Wada, Yuma; Kimura, Ryuichiro; Sugimura, Keijiro; Tomokuni, Akira; Akita, Hirofumi; Kobayashi, Shogo; Takahashi, Hidenori; Omori, Takeshi; Fujiwara, Yoshiyuki; Yano, Masahiko

2016-08-10

To describe the procedure, efficacy, and utility of single-incision laparoscopic-assisted stoma creation (SILStoma) for transverse colostomy. Using single-incision laparoscopic surgery, we developed a standardized technique for SILStoma. Twelve consecutive patients underwent SILStoma for transverse colostomy at Osaka Medical Center for Cancer and Cardiovascular Diseases from April 2013 to March 2016. A single, intended stoma site was created with a 2.5-3.5 cm skin incision for primary access to the intra-abdominal space, and it functioned as the main port through which multi-trocars were placed. Clinical and operative factors and postoperative outcomes were evaluated. Patient demographics, including age, gender, body mass index, and surgical indications for intestinal diversion were evaluated. SILStoma was performed in nine cases without the requirement of additional ports. In the remaining three cases, 1-2 additional 5-mm ports were required for mobilization of the transverse colon and safe dissection of abdominal adhesions. No cases required conversion to open surgery. In all cases, SILStoma was completed at the initial stoma site marked preoperatively. No intraoperative or postoperative complications greater than Grade II (the Clavien-Dindo classification) were reported in the complication survey. Surgical site infection at stoma sites was observed in four cases; however, surgical interventions were not required and all infections were cured completely. In all cases, the resumption of bowel movements was observed between postoperative days 1 and 2. SILStoma for transverse loop colostomy represents a feasible surgical procedure that allows the creation of a stoma at the preoperatively marked site without any additional large skin incisions.

Early laparoscopic management of acute postoperative hemorrhage after initial laparoscopic surgery.

PubMed

Gong, Edward M; Zorn, Kevin C; Gofrit, Ofer N; Lucioni, Alvaro; Orvieto, Marcelo A; Zagaja, Gregory P; Shalhav, Arieh L

2007-08-01

The use of laparoscopic surgery has been well established for the management of abdominal emergencies. However, the value of this technique for postoperative hemorrhage in urology has not been characterized. We present our favorable experience with laparoscopic exploration after urologic surgery and suggest guidelines for laparoscopic management of post-laparoscopy bleeding. Three patients who developed hemorrhage shortly after laparoscopic urologic surgery and were managed by laparoscopic exploration were identified from a series of 910 laparoscopic urologic procedures performed at our institution from October 2002 to June 2006. Three patients, who were hemodynamically stable (two after robot-assisted laparoscopic prostatectomy, one after laparoscopic radical nephrectomy), required prompt surgical exploration for postoperative hemorrhage not stabilized by blood transfusion (mean 2.7 units) at a mean of 19.4 hours after initial surgery. Clots were evacuated with a 10-mm suction-irrigator. Two patients were found to have abdominal-wall arterial bleeding and were managed with suture ligation. The third patient demonstrated diffuse bleeding from the prostatic bed, which was controlled with Surgicel and FloSeal. Bleeding was efficiently controlled in all patients, and none required post-exploration transfusion. The mean post-exploration hospital stay was 2.3 days. Significant hemorrhage after urologic laparoscopy is a rare event. We found laparoscopic exploration to be an excellent way to diagnose and correct such hemorrhage in certain patients. Early diagnosis with clinical and hematologic studies, a lowered threshold for surgical exploration, and specific operative equipment may decrease patient morbidity and the need for open surgical exploration.

Clinical Outcomes of Splenectomy in Children: Report of the Splenectomy in Congenital Hemolytic Anemia (SICHA) Registry

PubMed Central

Rice, Henry E; Englum, Brian R; Rothman, Jennifer; Leonard, Sarah; Reiter, Audra; Thornburg, Courtney; Brindle, Mary; Wright, Nicola; Heeney, Matthew M; Smithers, Charles; Brown, Rebeccah L; Kalfa, Theodosia; Langer, Jacob C; Cada, Michaela; Oldham, Keith T; Scott, J Paul; St. Peter, Shawn; Sharma, Mukta; Davidoff, Andrew M.; Nottage, Kerri; Bernabe, Kathryn; Wilson, David B; Dutta, Sanjeev; Glader, Bertil; Crary, Shelley E; Dassinger, Melvin S; Dunbar, Levette; Islam, Saleem; Kumar, Manjusha; Rescorla, Fred; Bruch, Steve; Campbell, Andrew; Austin, Mary; Sidonio, Robert; Blakely, Martin L

2014-01-01

The outcomes of children with congenital hemolytic anemia (CHA) undergoing total splenectomy (TS) or partial splenectomy (PS) remain unclear. In this study, we collected data from 100 children with CHA who underwent TS or PS from 2005–2013 at 16 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a patient registry. We analyzed demographics and baseline clinical status, operative details, and outcomes at 4, 24, and 52 weeks after surgery. Results were summarized as hematologic outcomes, short-term adverse events (AEs) (≤ 30 days after surgery), and long-term AEs (31–365 days after surgery). For children with hereditary spherocytosis, after surgery there was an increase in hemoglobin (baseline 10.1 ± 1.8 gm/dl, 52 week 12.8 ± 1.6 gm/dl; mean ± SD), decrease in reticulocyte and bilirubin as well as control of symptoms. Children with sickle cell disease had control of clinical symptoms after surgery, but had no change in hematologic parameters. There was an 11% rate of short-term AEs and 11% rate of long-term AEs. As we accumulate more subjects and longer follow-up, use of a patient registry should enhance our capacity for clinical trials and engage all stakeholders in the decision-making process. PMID:25382665

Comparison of transumbilical laparoscopic-assisted appendectomy versus single incision laparoscopic appendectomy in children: which is the better surgical option?

PubMed

Boo, Yoon Jung; Lee, Yoon; Lee, Ji Sung

2016-08-01

Transumbilical laparoscopic-assisted appendectomy (TULA) is a single incision technique that exteriorizes the appendix through the umbilicus. The aim of this study was to compare the surgical outcomes of TULA with SILA in pediatric appendicitis. A retrospective review of medical records between April 2011 and April 2015 identified 250 pediatric patients who underwent single incision laparoscopic appendectomy. Of these, 137 patients underwent TULA and 113 patients underwent SILA. Measured outcomes included patients' demographics, clinical characteristics, operative time, length of stay, pain, and postoperative complications. TULA group had a shorter operative time than SILA group (28.93 vs. 49.19min, p<0.001). The use of rescue analgesics was more frequent in the SILA group (six cases (6.5%) vs. 19 cases (23.4%), p<0.001). There was no significant difference in cosmetic outcome between the two groups. However, TULA was associated with a lower complication rate (2/137, 1.5%) than SILA (11/113, 9.8%) (p=0.0035). In multiple logistic regression analysis, TULA was significantly associated with a lower complication rate (p=0.049). TULA is preferable to SILA for treating pediatric acute appendicitis because it is technically easier, results in better surgical outcomes, and provides the same excellent cosmetic results. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcomes analysis of laparoscopic resection of pancreatic neoplasms.

PubMed

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

2007-04-01

Experience with laparoscopic resection of pancreatic neoplasms remains limited. The purpose of this study is to critically analyze the indications for and outcomes after laparoscopic resection of pancreatic neoplasms. The medical records of all patients undergoing laparoscopic resection of pancreatic neoplasms from July 2000 to February 2006 were reviewed. Data are expressed as mean +/- standard deviation. Laparoscopic pancreatic resection was performed in 22 patients (M:F, 8:14) with a mean age of 56.3 +/- 15.1 years and mean body mass index (BMI) of 26.3 +/- 4.5 kg/m2. Nine patients had undergone previous intra-abdominal surgery. Indications for pancreatic resection were cyst (1), glucagonoma (1), gastrinoma (2), insulinoma (3), metastatic tumor (2), IPMT (4), nonfunctioning neuroendocrine tumor (3), and mucinous/serous cystadenoma (6). Mean tumor size was 2.4 +/- 1.6 cm. Laparoscopic distal pancreatectomy was attempted in 18 patients and completed in 17, and enucleation was performed in 4 patients. Laparoscopic ultrasound (n = 10) and a hand-assisted technique (n = 4) were utilized selectively. Mean operative time was 236 +/- 60 min and mean blood loss was 244 +/- 516 ml. There was one conversion to an open procedure because of bleeding from the splenic vein. The mean postoperative LOS was 4.5 +/- 2.0 days. Seven patients experienced a total of ten postoperative complications, including a urinary tract infection (UTI) (1), lower-extremity deep venous thrombosis (DVT) and pulmonary embolus (1), infected peripancreatic fluid collection (1), pancreatic pseudocyst (1), and pancreatic fistula (6). Five pancreatic fistulas were managed by percutaneous drainage. The reoperation rate was 4.5% and the overall pancreatic-related complication rate was 36.4%. One patient developed pancreatitis and a pseudocyst 5 months postoperatively, which was managed successfully with a pancreatic duct stent. There was no 30-day mortality. Laparoscopic pancreatic resection is safe and

Sclerosing Angiomatoid Nodular Transformation: Laparoscopic Splenectomy as Therapeutic and Diagnostic Approach at the Same Time

PubMed Central

Florena, Ada Maria; Ferrara, Gabriella; Di Gregorio, Riccardo; Unti, Elettra; Giannone, Antonino G.; Lazzaro, Luigi A.; Graceffa, Giuseppa; Pantuso, Gianni

2018-01-01

Introduction Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion with unknown etiopathogenesis and with definite features of imaging, histopathology, and immunohistochemistry. It was first described by Martel et al. in 2004, and to date, only 151 cases have been reported. Case Description We report a case of SANT of the spleen detected in a 66-year-old Caucasian, without comorbidities, presented to our department with epigastric pain. We, also, presented a review of the literature. Conclusions SANT is a benign incidentally vascular condition in the majority of cases. The wide age and gender distribution in our review is in accordance with that in previous studies in English literature. In our opinion, splenectomy is the choice treatment because it is at the same time diagnostic and therapeutic in a definitive way. PMID:29854543

Can video games be used to predict or improve laparoscopic skills?

PubMed

Rosenberg, Bradley H; Landsittel, Douglas; Averch, Timothy D

2005-04-01

Performance of laparoscopic surgery requires adequate hand-eye coordination. Video games are an effective way to judge one's hand-eye coordination, and practicing these games may improve one's skills. Our goal was to see if there is a correlation between skill in video games and skill in laparoscopy. Also, we hoped to demonstrate that practicing video games can improve one's laparoscopic skills. Eleven medical students (nine male, two female) volunteered to participate. On day 1, each student played three commercially available video games (Top Spin, XSN Sports; Project Gotham Racing 2, Bizarre Creations; and Amped 2, XSN Sports) for 30 minutes on an X-box (Microsoft, Seattle, WA) and was judged both objectively and subjectively. Next, the students performed four laparoscopic tasks (object transfer, tracing a figure-of-eight, suture placement, and knot-tying) in a swine model and were assessed for time to complete the task, number of errors committed, and hand-eye coordination. The students were then randomized to control (group A) or "training" (i.e., video game practicing; group B) arms. Two weeks later, all students repeated the laparoscopic skills laboratory and were reassessed. Spearman correlation coefficients demonstrated a significant relation between many of the parameters, particularly time to complete each task and hand-eye coordination at the different games. There was a weaker association between video game performance and both laparoscopic errors committed and hand-eye coordination. Group B subjects did not improve significantly over those in group A in any measure (P >0.05 for all). Video game aptitude appears to predict the level of laparoscopic skill in the novice surgeon. In this study, practicing video games did not improve one's laparoscopic skill significantly, but a larger study with more practice time could prove games to be helpful.

Unexpected hemorrhage during robot-assisted laparoscopic prostatectomy: a case report.

PubMed

Nakano, Shoko; Nakahira, Junko; Sawai, Toshiyuki; Kadono, Noriko; Minami, Toshiaki

2016-08-30

Robot-assisted laparoscopic prostatectomy is increasingly performed as a minimally invasive option for patients with organ-confined prostate cancer. This technique offers several advantages over other surgical methods. However, concerns have been raised over the effects of the steep head-down tilt necessary during the procedure. We present a case in which head-down positioning and abdominal insufflation masked the signs of an intraoperative hemorrhage. A 73-year-old Asian man developed severe hypotension caused by an unexpected hemorrhage during robot-assisted laparoscopic prostatectomy for prostate cancer. Although our patient's blood pressure steadily decreased during the procedure, his systolic blood pressure remained above 80 mmHg while he was tilted head downward at an angle of 28°. However, his blood pressure dropped immediately after he was returned to the horizontal position and abdominal insufflation - to create a pneumoperitoneum - was ceased at the end of surgery. We returned the patient to a head-down tilt to keep his blood pressure stable and began fluid infusion. Blood test results indicated that a hemorrhage was the cause of his hypotension. Open abdominal surgery was performed to stop the bleeding. The surgeons found blood pooling inside his abdomen from a longitudinal cut in a small arterial vessel in his abdominal wall, possibly a branch of his external iliac artery. The surgeons successfully controlled the hemorrhage and our patient was moved to our intensive care unit. Our patient recovered completely over the next few days, without any neurological deficits. We suspect that blood began to pool in our patient's superior abdomen during surgery, and that increased intra-abdominal pressure suppressed the hemorrhage. When our patient was returned to the horizontal position and insufflation of his abdomen was discontinued, the resulting increased rate of hemorrhage caused a sudden drop in blood pressure. Surgeons and anesthesiologists must

Intra-operative prostate motion tracking using surface markers for robot-assisted laparoscopic radical prostatectomy

NASA Astrophysics Data System (ADS)

Esteghamatian, Mehdi; Sarkar, Kripasindhu; Pautler, Stephen E.; Chen, Elvis C. S.; Peters, Terry M.

2012-02-01

Radical prostatectomy surgery (RP) is the gold standard for treatment of localized prostate cancer (PCa). Recently, emergence of minimally invasive techniques such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RARP) has improved the outcomes for prostatectomy. However, it remains difficult for the surgeons to make informed decisions regarding resection margins and nerve sparing since the location of the tumor within the organ is not usually visible in a laparoscopic view. While MRI enables visualization of the salient structures and cancer foci, its efficacy in LRP is reduced unless it is fused into a stereoscopic view such that homologous structures overlap. Registration of the MRI image and peri-operative ultrasound image using a tracked probe can potentially be exploited to bring the pre-operative information into alignment with the patient coordinate system during the procedure. While doing so, prostate motion needs to be compensated in real-time to synchronize the stereoscopic view with the pre-operative MRI during the prostatectomy procedure. In this study, a point-based stereoscopic tracking technique is investigated to compensate for rigid prostate motion so that the same motion can be applied to the pre-operative images. This method benefits from stereoscopic tracking of the surface markers implanted over the surface of the prostate phantom. The average target registration error using this approach was 3.25+/-1.43mm.

Intraoperative ultrasound-assisted enucleation of residual fibroids following laparoscopic myomectomy.

PubMed

Hao, Yan; Li, Si-Jing; Zheng, Ping; Wu, Xia; Sheng, Jie; Yuan, Dong-Lan; Zhou, Qi; Wei, Wei; Duan, Ai-Hong; Wu, Qing-Qing; Lu, Dan

2018-05-25

To investigate if intraoperative ultrasounds by laparoscopic and transvaginal ultrasonography (LUS and TVS) could improve enucleating the residual fibroids following laparoscopic myomectomy (LM). From March to December 2016, 78 women with uterine fibroids underwent LM, LUS and TVS were applied to detect residual fibroids and to guide surgeons to enucleate them after the visible fibroids were removed during LM operation. The total number of residual fibroids found by LUS was 140, and the total number found by TVS was 127 following LM (P = 0.03). LUS is statistically superior to TVS in the detection of residual fibroids in the anterior wall (P = 0.004), in the detection of intramural fibroids (P = 0.002), and in the detection of fibroids with a diameter ranging from 0.5 to 1 cm (P = 0.002). According to the total number of enucleated fibroids by LM, patients were divided into three groups (Group 1: 2 to 4, Group 2: 5 to 7 and Group 3: ≥8 fibroid counts). The percentages of patients in each group with residual fibroids at the end of surgery were 22.2%, 51.9% and 66.7% respectively. Both LUS and TVS are beneficial to surgical treatment of fibroids by assisting enucleation of residual fibroids following LM, while LUS is more effective in localizing residual fibroids than TVS. Copyright © 2018 Elsevier B.V. All rights reserved.

Retzius Space Preservation Technique for Robotic-Assisted Laparoscopic Radical Prostatectomy in a Kidney Transplant Patient: First Case in Thailand and Our First Experience.

PubMed

Jenjitranant, P; Sangkum, P; Sirisreetreerux, P; Viseshsindh, W; Patcharatrakul, S; Kongcharoensombat, W

2016-11-01

The aim of this work was to report our experience in robotic-assisted laparoscopic radical prostatectomy for the treatment of localized prostate cancer in a kidney transplant recipient. A 73-year-old man with chronic renal failure underwent living-donor kidney transplantation (KT) in 1993. His baseline creatinine after KT was ∼1.2 mg/dL. He developed lower urinary tract symptoms in 1999. He was diagnosed with benign prostatic hyperplasia and treated accordingly. He was followed regularly with the use of digital rectal examination and measurement of serum prostatic-specific antigen (PSA). In 2014, his serum PSA was 11.53 ng/mL. Prostate biopsy was done and revealed localized prostatic adenocarcinoma with a Gleason score of 7 (3+4). We performed robotic-assisted laparoscopic radical prostatectomy with the use of the Retzius space preservation technique. The patient underwent successful robotic-assisted laparoscopic radical prostatectomy without any complications. The operative time was 210 minutes with estimated blood loss of 250 mL. The patient tolerated the procedure well and was discharged on the 6th day after surgery with a retained Foley catheter. A cystogram was done on the 13th day after surgery and showed no urethrovesical anastomosis leakage. After Foley catheter removal, the patient could urinate normally without urinary incontinence. Pathologic analysis revealed positive surgical margin with no extraprostatic extension and no seminal vesical invasion. One month after the operation, PSA was 0.08 ng/mL and renal function remained stable. Robotic-assisted laparoscopic radical prostatectomy is technically feasible and safe for the treatment of localized prostate cancer in the renal transplant patient. The Retzius space preservation technique is helpful in minimizing the manipulation of transplanted kidney and urinary bladder during the operation, resulting in favorable postoperative renal function and continence outcome. Copyright © 2016 Elsevier Inc. All

Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center

PubMed Central

Cardenas-Goicoechea, Joel; Adams, Sarah; Bhat, Suneel B.; Randall, Thomas C.

2010-01-01

Objective To compare peri- and post-operative complications and outcomes of robotic-assisted surgical staging with traditional laparoscopic surgical staging for women with endometrial cancer. Methods A retrospective chart review of cases of women undergoing minimally invasive total hysterectomy and pelvic and para-aortic lymphadenectomy by a robotic-assisted approach or traditional laparoscopic approach was conducted. Major intraoperative complications, including vascular injury, enterotomy, cystotomy, or conversion to laparotomy, were measured. Secondary outcomes including operative time, blood loss, transfusion rate, number of lymph nodes retrieved, and the length of hospitalization were also measured. Results 275 cases were identified–102 patients with robotic-assisted staging and 173 patients with traditional laparoscopic staging. There was no significant difference in the rate of major complications between groups (p=0.13). The mean operative time was longer in cases of robotic-assisted staging (237 min vs. 178 min, p<0.0001); however, blood loss was significantly lower (109 ml vs. 187 ml, p<0.0001). The mean number of lymph nodes retrieved were similar between groups (p=0.32). There were no significant differences in the time to discharge, re-admission, or re-operation rates between the two groups. Conclusion Robotic-assisted surgery is an acceptable alternative to laparoscopy for minimally invasive staging of endometrial cancer. In addition to the improved ease of operation, visualization, and range of motion of the robotic instruments, robotic surgery results in a lower mean blood loss, although longer operative time. More data are needed to determine if the rates of urinary tract injuries and other surgical complications can be reduced with the use of robotic surgery. PMID:20144471

High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia.

PubMed

Kho, Steven; Andries, Benediktus; Poespoprodjo, Jeanne R; Commons, Robert J; Shanti, Putu A I; Kenangalem, Enny; Douglas, Nicholas M; Simpson, Julie A; Sugiarto, Paulus; Anstey, Nicholas M; Price, Ric N

2018-05-16

Splenectomy increase the risk of severe and fatal infections, however the risk of Plasmodium vivax malaria is unknown. We quantified the Plasmodium species-specific risks of malaria and other outcomes following splenectomy in patients attending a hospital in Papua, Indonesia. Records of all patients attending Mitra-Masyarakat Hospital 2004-2013 were reviewed, identifying those who underwent splenectomy. Subsequent risks of specific clinical outcomes within 12 months for splenectomized patients were compared to non-splenectomized patients from their first recorded hospital admission. In addition, patients splenectomized for trauma between 2015-2016 were followed prospectively for 14 months. Of the 10,774 non-pregnant patients aged 12-60 years hospitalized during 2004-2013, 67 underwent splenectomy. Compared to non-splenectomized inpatients, patients undergoing splenectomy had a 5-fold higher rate of malaria presentation within 12 months (Adjusted Hazard Ratio (AHR)=5.0 [95%CI:3.4-7.3], p<0.001). The rate was greater for P. vivax (AHR=7.8 [95%CI:5.0-12.3], p<0.001) compared to P. falciparum (AHR=3.0 [95%CI:1.7-5.4], p<0.001). Splenectomized patients had greater risk of being hospitalized for any cause (AHR=1.8 [95%CI:1.0-3.0], p=0.037) and, diarrheal illness (AHR=3.5 [95%CI:1.3-9.6], p=0.016). In the prospective cohort, 8 of 11 splenectomized patients had 18 episodes of malaria over 14 months, 12 episodes of P. vivax in 8 patients and 6 episodes of P. falciparum in 6 patients. Splenectomy is associated with a high risk of malaria, greater for P. vivax than P. falciparum. Eradication of P. vivax hypnozoites using primaquine (radical cure) and subsequent malaria prophylaxis is warranted in patients following splenectomy in malaria-endemic areas, particularly in the early post-operative period.

A study of using carbon nanoparticles to improve lymph nodes staging for laparoscopic-assisted radical right hemicolectomy in colon cancer.

PubMed

Pan, Lelin; Ye, Feng; Liu, Jing-Jing; Ba, Xiao-Qun; Sheng, Qin-Song

2018-04-16

This study aimed to analyze and evaluate the feasibility of using carbon nanoparticles (CNs) to track lymph nodes (LNs) metastases in right colon tumors, especially for patients who underwent laparoscopic-assisted radical right hemicolectomy. A total of 99 patients were enrolled in this retrospective study between November 2015 and September 2017 (control group n = 47). One day before surgery, 1 ml of CNs suspension was injected into the submucosal layer around the site of the primary lesions by colonoscopy. Then complete mesocolic excision (CME) of laparoscopic right hemicolectomy was performed. CNs-stained LNs were identified and counted from all dissected LNs after surgery. The dates showed that the number of total harvested LNs and the number of positive patients in the experimental group increased significantly compared with the control group (respectively, P < 0.01 and P < 0.05). The increase of positive percentage shifted some patients toward higher stage, although the total number of positive LNs changed a little bit. In addition, the duration for pathologist to dissect LNs became shorter (26.4 vs. 31.1 min, P < 0.05). Therefore, the CNs are not only a good tattoo in laparoscopic-assisted operation, but could be regarded as a better pathological evaluating tool for tumor treatment.

[Robotic laparoscopic cholecystectomy].

PubMed

Langer, D; Pudil, J; Ryska, M

2006-09-01

Laparoscopic approach profusely utilized in many surgical fields was enhanced by da Vinci robotic surgical system in range of surgery wards, imprimis in the United States today. There was multispecialized robotic centre program initiated in the Central Military Hospital in Prague in December 2005. Within the scope of implementing the da Vinci robotic system to clinical practice we executed robotic-assisted laparoscopic cholecystectomy. We have accomplished elective laparoscopic cholecystectomy using the da Vinci robotic surgical system. Operating working group (two doctors, two scrub nurses) had completed certificated foreign training. Both of the surgeons have many years experience of laparoscopic cholecystectomy. Operator controlled instruments from the surgeon's console, assistant placed clips on ends of cystic duct and cystic artery from auxiliary port after capnoperitoneum installation. We evacuated gallbladder in plastic bag from abdominal cavity in place of original paraumbilical port. We were exploiting three working arms in all our cases, holding surgical camera, electrocautery hook and Cadiere forceps. We had been observing procedure time, technical complications connected with robotic system, length of hospital stay and complication incidence rate. We managed to finish all operations in laparoscopic way. Group of our patients formed 11 male patients (35.5%) and 20 women (64.5%), mean aged 52.5 years in range of 27 77 years. The average operation procedure lasted 100 minutes, in the group of last 11 patients only 69 minutes. We recorded paraumbilical wound infections in 3 (9.7 %) patients. We had not experienced any technical problems with robotic surgical system. Length of hospital stay was 3 days. Considering our initial experience with robotic lasparoscopic cholecystectomy we evaluate da Vinci robotic surgical system to be safe and sophisticated operating manipulator which however does not substitute the surgeon key-role of controlling position and

Robotic Assistance by Impedance Compensation for Hand Movements While Manual Welding.

PubMed

Erden, Mustafa Suphi; Billard, Aude

2016-11-01

In this paper, we present a robotic assistance scheme which allows for impedance compensation with stiffness, damping, and mass parameters for hand manipulation tasks and we apply it to manual welding. The impedance compensation does not assume a preprogrammed hand trajectory. Rather, the intention of the human for the hand movement is estimated in real time using a smooth Kalman filter. The movement is restricted by compensatory virtual impedance in the directions perpendicular to the estimated direction of movement. With airbrush painting experiments, we test three sets of values for the impedance parameters as inspired from impedance measurements with manual welding. We apply the best of the tested sets for assistance in manual welding and perform welding experiments with professional and novice welders. We contrast three conditions: 1) welding with the robot's assistance; 2) with the robot when the robot is passive; and 3) welding without the robot. We demonstrate the effectiveness of the assistance through quantitative measures of both task performance and perceived user's satisfaction. The performance of both the novice and professional welders improves significantly with robotic assistance compared to welding with a passive robot. The assessment of user satisfaction shows that all novice and most professional welders appreciate the robotic assistance as it suppresses the tremors in the directions perpendicular to the movement for welding.

Ergonomic analysis of primary and assistant surgical roles.

PubMed

Zihni, Ahmed M; Cavallo, Jaime A; Ray, Shuddhadeb; Ohu, Ikechukwu; Cho, Sohyung; Awad, Michael M

2016-06-15

Laparoscopic surgery is associated with a high degree of ergonomic stress. However, the stress associated with surgical assisting is not known. In this study, we compare the ergonomic stress associated with primary and assistant surgical roles during laparoscopic surgery. We hypothesize that higher ergonomic stress will be detected in the primary operating surgeon when compared with the surgical assistant. One right-hand dominant attending surgeon performed 698 min of laparoscopic surgery over 13 procedures (222 min primary and 476 min assisting), whereas electromyography data were collected from bilateral biceps, triceps, deltoids, and trapezius muscles. Data were analyzed in 1-min segments. Average muscle activation as quantified by maximal voluntary contraction (%MVC) was calculated for each muscle group during primary surgery and assisting. We compared mean %MVC values with unpaired t-tests. Activation of right (R) biceps and triceps muscle groups is significantly elevated while operating when compared with assisting (R biceps primary: 5.47 ± 0.21 %MVC, assistant: 3.93 ± 0.11, P < 0.001; R triceps primary: 6.53 ± 0.33 %MVC, assistant: 5.48 ± 0.18, P = 0.002). Mean activation of the left trapezius muscle group is elevated during assisting (primary: 4.33 ± 0.26 %MVC, assistant: 5.70 ± 0.40, P = 0.024). No significance difference was noted in the other muscle groups (R deltoid, R trapezius, left [L] biceps, L triceps, and L deltoid). We used surface electromyography to quantify ergonomic differences between operating and assisting. Surgical assisting was associated with similar and occasionally higher levels of muscle activation compared with primary operating. These findings suggest that surgical assistants face significant ergonomic stress, just as operating surgeons do. Steps must be taken to recognize and mitigate this stress in both operating surgeons and assistants. Copyright © 2016 Elsevier Inc. All rights reserved.

Optimisation of fluorescence guidance during robot-assisted laparoscopic sentinel node biopsy for prostate cancer.

PubMed

KleinJan, Gijs H; van den Berg, Nynke S; Brouwer, Oscar R; de Jong, Jeroen; Acar, Cenk; Wit, Esther M; Vegt, Erik; van der Noort, Vincent; Valdés Olmos, Renato A; van Leeuwen, Fijs W B; van der Poel, Henk G

2014-12-01

The hybrid tracer was introduced to complement intraoperative radiotracing towards the sentinel nodes (SNs) with fluorescence guidance. Improve in vivo fluorescence-based SN identification for prostate cancer by optimising hybrid tracer preparation, injection technique, and fluorescence imaging hardware. Forty patients with a Briganti nomogram-based risk >10% of lymph node (LN) metastases were included. After intraprostatic tracer injection, SN mapping was performed (lymphoscintigraphy and single-photon emission computed tomography with computed tomography (SPECT-CT)). In groups 1 and 2, SNs were pursued intraoperatively using a laparoscopic gamma probe followed by fluorescence imaging (FI). In group 3, SNs were initially located via FI. Compared with group 1, in groups 2 and 3, a new tracer formulation was introduced that had a reduced total injected volume (2.0 ml vs. 3.2 ml) but increased particle concentration. For groups 1 and 2, the Tricam SLII with D-Light C laparoscopic FI (LFI) system was used. In group 3, the LFI system was upgraded to an Image 1 HUB HD with D-Light P system. Hybrid tracer-based SN biopsy, extended pelvic lymph node dissection, and robot-assisted radical prostatectomy. Number and location of the preoperatively identified SNs, in vivo fluorescence-based SN identification rate, tumour status of SNs and LNs, postoperative complications, and biochemical recurrence (BCR). Mean fluorescence-based SN identification improved from 63.7% (group 1) to 85.2% and 93.5% for groups 2 and 3, respectively (p=0.012). No differences in postoperative complications were found. BCR occurred in three pN0 patients. Stepwise optimisation of the hybrid tracer formulation and the LFI system led to a significant improvement in fluorescence-assisted SN identification. Preoperative SPECT-CT remained essential for guiding intraoperative SN localisation. Intraoperative fluorescence-based SN visualisation can be improved by enhancing the hybrid tracer formulation and

Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion.

PubMed

Shen, Jian Guo; Cheong, Jae Ho; Hyung, Woo Jin; Kim, Junuk; Choi, Seung Ho; Noh, Sung Hoon

2006-09-01

To investigate the interactions between splenectomy and perioperative transfusion in gastric cancer patients. Medical records of 449 gastric cancer patients who had undergone total gastrectomies for curative intent between 1991 and 1995 were reviewed. The influence of splenectomy on tumor recurrence and survival both in the transfused and nontransfused patients were evaluated by univariate and multivariate analysis. The recurrence rate in the splenectomy group was 48.1% as compared with 22.6% in the spleen-preserved group among transfused patients (P=.001); it was 40.7% compared with 26.5% among nontransfused patients (P=.086). There was no significant difference in the mean survival between the splenectomy group and the spleen-preserved group in a subgroup analysis by stage. Multivariate analysis identified splenectomy as an independent risk factor for recurrence but not as a predictor for survival among transfused patients. Splenectomy does not appear to abrogate the adverse effect of perioperative transfusion on prognosis in gastric cancer patients. Moreover, it may increase postoperative recurrence in transfused patients.

Laparoscopic resection of hilar cholangiocarcinoma.

PubMed

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

2015-10-01

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.

Born-again spleen. Return of splenic function after splenectomy for trauma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pearson, H.A.; Johnston, D.; Smith, K.A.

1978-06-22

We assessed splenic activity after splenectomy by interference phase microscopical examination of circulating red cells. Normal eusplenic children had a low number (<1%) of red cells with surface indentations or pits. About 20% of red cells of children who had electively been subjected to splenectomy for hematologic indications were pitted. Thirteen of 22 children who had had emergency splenectomy because of traumatic injury had a low percentage of pitted red cells, suggesting a return of splenic function. In five of these children a /sup 99m/Tc sulfur colloid scan demonstrated multiple nodules of recurrent splenic tissue. In contrast to the prevailingmore » opinion that splenosis is rare, we have found it to be a frequent occurrence. Return of splenic function may, in part, account for the low frequency with which overwhelming bacterial sepsis and meningitis have been documented after splenectomy for traumatic indications.« less

Training value of laparoscopic colorectal videos on the World Wide Web: a pilot study on the educational quality of laparoscopic right hemicolectomy videos.

PubMed

Celentano, V; Browning, M; Hitchins, C; Giglio, M C; Coleman, M G

2017-11-01

Instructive laparoscopy videos with appropriate exposition could be ideal for initial training in laparoscopic surgery, but unfortunately there are no guidelines for annotating these videos or agreed methods to measure the educational content and the safety of the procedure presented. Aim of this study is to systematically search the World Wide Web to determine the availability of laparoscopic colorectal surgery videos and to objectively establish their potential training value. A search for laparoscopic right hemicolectomy videos was performed on the three most used English language web search engines Google.com, Bing.com, and Yahoo.com; moreover, a survey among 25 local trainees was performed to identify additional websites for inclusion. All laparoscopic right hemicolectomy videos with an English language title were included. Videos of open surgery, single incision laparoscopic surgery, robotic, and hand-assisted surgery were excluded. The safety of the demonstrated procedure was assessed with a validated competency assessment tool specifically designed for laparoscopic colorectal surgery and data on the educational content of the video were extracted. Thirty-one websites were identified and 182 surgical videos were included. One hundred and seventy-three videos (95%) detailed the year of publication; this demonstrated a significant increase in the number of videos published per year from 2009. Characteristics of the patient were rarely presented, only 10 videos (5.4%) reported operating time and only 6 videos (3.2%) reported 30-day morbidity; 34 videos (18.6%) underwent a peer-review process prior to publication. Formal case presentation, the presence of audio narration, the use of diagrams, and snapshots and a step-by-step approach are all characteristics of peer-reviewed videos but no significant difference was found in the safety of the procedure. Laparoscopic videos can be a useful adjunct to operative training. There is a large and increasing amount of

Splenectomy reduces fibrosis and preneoplastic lesions with increased triglycerides and essential fatty acids in rat liver cirrhosis induced by a choline-deficient L-amino acid-defined diet.

PubMed

Oishi, Toshiyuki; Terai, Shuji; Iwamoto, Takuya; Takami, Taro; Yamamoto, Naoki; Sakaida, Isao

2011-05-01

  This study investigated whether splenectomy is of significance in non-alcoholic steatohepatitis (NASH).   Five-week-old Wistar rats were fed a choline-deficient diet for 8 weeks to create a NASH model. A sham-operation or splenectomy was then performed, and rats were killed 4 weeks later.   Liver fibrosis and liver preneoplastic lesions were significantly reduced in the splenectomy group compared to the sham-operation group, and α-smooth muscle actin (SMA) expression was significantly inhibited (liver fibrosis area: sham 8.63 ± 4.09%, splenectomy 5.45 ± 3.69%, P < 0.01; preneoplastic lesion size: sham 6.56 ± 3.68 ×10(6)  µm(2) /cm(2) , splenectomy 4.63 ± 3.27 ×10(6)  µm(2) /cm(2) , P < 0.05; the number of preneoplastic lesions: sham 8.33 ± 3.96/cm(2) , splenectomy 5.17 ± 1.80/cm(2) , P < 0.01; α-smooth muscle actin-positive area: sham 4.41 ± 2.48%, splenectomy 2.75 ± 1.66%, P < 0.01) On the other hand, liver triglycerides and essential fatty acids were significantly increased in the splenectomy group (liver triglycerides: sham 182 ± 35.0 mg/g, splenectomy 230 ± 35.0 mg/g, P < 0.05; liver linoleic acid: sham 17.2 ± 4.9 mg/g, splenectomy 23.3 ± 6.9 mg/g, P < 0.05; liver α-linolenic acid: sham 118 ± 36.6 µg/g, splenectomy 162 ± 51.4 µg/g, P < 0.05). In addition, expressions of hepatic fatty acid metabolism-related genes (e.g. acyl-CoA oxidase, liver carnitine palmitoyl-CoA transferase I, cytochrome P450 4A, long-chain acyl-CoA dehydrogenase and medium-chain acyl-CoA dehydrogenase) were significantly inhibited in the splenectomy group.   These findings suggest that spleen plays an important regulatory role in the fibrosis, preneoplastic lesion and lipid metabolism of liver in a rat choline-deficient L-amino acid model. © 2011 The Japan Society of Hepatology.

Trocar-site hernia at the 8-mm robotic port after robot-assisted laparoscopic prostatectomy: a case report and review of the literature.

PubMed

Tsu, James Hok-Leung; Ng, Ada Tsui-Lin; Wong, Jason Ka-Wing; Wong, Edmond Ming-Ho; Ho, Kwan-Lun; Yiu, Ming-Kwong

2014-03-01

Trocar-site hernia is an uncommon but serious complication after laparoscopic surgery as it frequently requires surgical intervention. We describe a 75-year-old man with Gleason score 4 + 3, clinical stage T1c prostate adenocarcinoma who underwent an uneventful robot-assisted transperitoneal laparoscopic radical prostatectomy. On post-operative day four, he developed symptoms of small bowel obstruction due to herniation and incarceration of the small bowels in a Spigelian-type hernia at the left lower quadrant 8-mm trocar site. Surgical exploration was performed via a mini-laparotomy to reduce the bowel and repair the fascial layers. A literature search was performed to review other cases of trocar-site hernia through the 8-mm robotic port after robot-assisted surgery and the suggested methods of prevention.

Minilaparoscopy-assisted transumbilical laparoscopic cholecystectomy.

PubMed

Lima, Geraldo José DE Souza; Leite, Rodrigo Fabiano Guedes; Abras, Gustavo Munayer; Pires, Livio José Suretti; Castro, Eduardo Godoy

2016-01-01

The role of laparoscopy in the modern surgery era is well established. With the prospect of being able to improve the already privileged current situation, new alternatives have been proposed, such as natural orifice endoscopic surgery (NOTES), the method for single transumbilical access (LESS - Laparo-endoscopic single-site surgery) and minilaparoscopy (MINI). The technique proposed by the authors uses a laparoscope with an operative channel like the flexible endoscope used in NOTES. All operative times are carried out through the umbilical trocar as in LESS, and assisted by a minilaparoscopy grasper. This new technic combines, and results from, the rationalization of technical particularities and synergy of these three approaches, seeking to join their advantages and minimize their disadvantages. RESUMO O papel da videolaparoscopia na era moderna da cirurgia encontra-se bem estabelecido. Com a perspectiva de ser possível melhorar a já privilegiada situação atual, novas alternativas têm sido propostas, como a cirurgia por orifícios naturais (NOTES), o método por acesso único transumbilical (LESS - Laparo-endoscopic single-site surgery) e a minilaparoscopia (MINI). A técnica proposta pelos autores utiliza-se de óptica com canal de trabalho como o endoscópio flexível do NOTES, executa-se todos os tempos operatórios pelo trocarte umbilical, como no LESS, e é assistido por pinça de minilaparoscopia. Esta nova técnica combina e resulta da racionalização de particularidades técnicas e do sinergismo destas três abordagens, buscando agregar suas vantagens e minimizar as suas desvantagens.

Laparoscopic Approach for Metachronous Cecal and Sigmoid Volvulus

PubMed Central

Greenstein, Alexander J.; Zisman, Sharon R.

2010-01-01

Background: Metachronous colonic volvulus is a rare event that has never been approached laparoscopically. Methods: Here we discuss the case of a 63-year-old female with a metachronous sigmoid and cecal volvulus. Results: The patient underwent 2 separate successful laparoscopic resections. Discussion and Conclusion: The following is a discussion of the case and the laparoscopic technique, accompanied by a brief review of colonic volvulus. In experienced hands, laparoscopy is a safe approach for acute colonic volvulus. PMID:21605523

Use of the Endoholder device during robotic-assisted laparoscopic radical prostatectomy: the "poor man's" fourth arm equivalent.

PubMed

Zorn, Kevin C; Gofrit, Ofer N; Zagaja, Gregory P; Shalhav, Arieh L

2008-02-01

During standard, six-port set-up, robotic-assisted laparoscopic radical prostatectomy (RLRP) using a three-arm daVinci system (DVS), two assistants are routinely required. The role of the second assistant is often limited to isometric traction during prostate dissection. Due to muscle fatigue and inability of the operator to see the operative field, frequent repositioning of the second assistant is often required. In an attempt to improve efficiency in such surgical situations, we describe the use of the Endoholder, an adjustable articulating instrument holder, to assist during RLRP. During 100 consecutive cases, the Endoholder provided quick, reproducible retraction to facilitate exposure. No complications occurred with its use. The device reduced the need for a dedicated second assistant to stand bedside. We have achieved significant improvements in the safety and efficiency of retraction of the rectum, bladder, and prostate during RLRP with the Endoholder. For urologists working with a three-armed DVS, use of the Endoholder may help facilitate tissue retraction during dissection.

Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital.

PubMed

Ahmad, Arif; Carleton, Jared D; Ahmad, Zoha F; Agarwala, Ashish

2016-09-01

The purpose of this study was to compare the operative and early perioperative outcomes of laparoscopic versus robotic-assisted Roux-en-Y gastric bypass procedures performed in a community hospital setting. The study was a chart review and analysis of the early perioperative outcomes of a total of 345 Roux-en-Y gastric bypass procedures performed by a single surgeon in a community hospital setting from January 2011 to October 2014. Of these, 173 procedures were performed laparoscopically and 172 were performed with robotic assistance utilizing the daVinci(®) surgical platform. Factors such as baseline patient characteristics, operative time, estimated blood loss (EBL), conversions to open procedure, complication rates, adverse events, length of stay (LOS), and return to the operating room for the two groups were retrospectively analyzed from a prospectively maintained database. Student's t test with unequal variances was used for statistical analysis, and a p value <0.05 was used for significance. There were no statistically significant differences in complication rates, EBL, or LOS between the two groups. There was a significant difference between the total operative times (135.30 ± 37.60 min for the laparoscopic procedure versus 154.84 ± 38.44 min for the robotic procedure, p < 0.05). There were no adverse intraoperative events, conversions to open procedures, leaks, strictures, returns to the operating room within 30 days, or mortalities in either group. Our study, which is the first of its kind to analyze the operative and early perioperative outcomes between laparoscopic and robotic-assisted Roux-en-Y gastric bypass procedures in the US community hospital setting, indicates that both are comparable in terms of safety, efficacy, and operative and early perioperative outcomes.

Association between previous splenectomy and gastric dilatation-volvulus in dogs: 453 cases (2004-2009).

PubMed

Sartor, Angela J; Bentley, Adrienne M; Brown, Dorothy C

2013-05-15

To evaluate the association between previous splenectomy and gastric dilatation-volvulus (GDV) in dogs. Multi-institutional retrospective case-control study. Animals-151 dogs treated surgically for GDV and 302 control dogs with no history of GDV. Computerized records of dogs evaluated via exploratory laparotomy or abdominal ultrasonography were searched, and dogs with GDV and dogs without GDV (control dogs) were identified. Two control dogs were matched with respect to age, body weight, sex, neuter status, and breed to each dog with GDV. Data were collected on the presence or absence of the spleen for both dogs with GDV and control dogs. Conditional logistic regression analysis was used to investigate the association of previous splenectomy with GDV. 6 (4%) dogs in the GDV group and 3 (1%) dogs in the control group had a history of previous splenectomy. The odds of GDV in dogs with a history of previous splenectomy in this population of dogs were 5.3 times those of dogs without a history of previous splenectomy (95% confidence interval, 1.1 to 26.8). For the patients in the present study, there was an increased odds of GDV in dogs with a history of splenectomy. Prophylactic gastropexy may be considered in dogs undergoing a splenectomy, particularly if other risk factors for GDV are present.

Open versus laparoscopic appendectomy.

PubMed

Herman, J; Duda, M; Lovecek, M; Svach, I

2003-01-01

To asses the role of laparoscopic appendectomy in the treatment of acute as well as chronic appendicitis on the basis of our own experiences. From the set of 849 patients treated with appendectomy (from January 1993 to December 2000) 331 were singled out, i.e.; those unable to work for some time and thus being on sickness benefit who asked for a medical certificate. They were operated on for either acute or chronic appendicitis. In our set of 331 patients (158 males, 173 females, the average age 29.4) open appendectomy was performed on 179 patients and laparoscopic appendectomy on 152. Laparoscopic appendectomy was performed in 43 males (28%) and 109 females (72%); open appendectomy in 115 males (64%) and 64 females (36%). Laparoscopic appendectomy took 53.7 +/- 18.1 minutes, open appendectomy took 43.6 +/- 8.99 minutes. The time of work disablement is longer in open appendectomy (open appendectomy: 41.2 +/- 9.91 days; laparoscopic appendectomy; 29.1 +/- 15.11 days). A significant difference (p < 0.00001) can be seen in the length of hospitalization (laparoscopic appendectomy: 5.0 +/- 2.75 days, open appendectomy: 8.3 +/- 2.83 days). Patients who undergo laparoscopic appendectomy spent less time in hospital, and they can return to work rather earlier. On the other hand the time of surgery is longer. Higher cost is compensated for with shorter hospitalization and early return to work.

“Ipsilateral, high, single-hand, sideways”—Ruijin rule for camera assistant in uniportal video-assisted thoracoscopic surgery

PubMed Central

Gao, Taotao; Xiang, Jie; Jin, Runsen; Zhang, Yajie; Wu, Han

2016-01-01

Camera assistant plays a very important role in uniportal video-assisted thoracoscopic surgery (VATS), who acts as the eye of the surgeon, providing the VATS team with a stable and clear operating view. Thus, a good assistant should cooperate with surgeon and manipulate the camera expertly, to ensure eye-hand coordination. We have performed more than 100 uniportal VATS in the Department Of Thoracic Surgery in Ruijin Hospital. Based on our experiences, we summarized the method of holding camera, known as “ipsilateral, high, single-hand, sideways”, which largely improves the comfort and fluency of surgery. PMID:27867573

Mentored retroperitoneal laparoscopic renal surgery in children: a safe approach to learning.

PubMed

Farhat, W; Khoury, A; Bagli, D; McLorie, G; El-Ghoneimi, A

2003-10-01

To review the feasibility of introducing advanced retroperitoneal renal laparoscopic surgery (RRLS) to a paediatric urology division, using the mentorship-training model. Although the scope of practice in paediatric urology is currently adapting endoscopic surgery into daily practice, most paediatric urologists in North America have had no formal training in laparoscopic surgery. The study included four paediatric urologists with 3-25 years of practice; none had had any formal laparoscopic training or ever undertaken advanced RRLS. An experienced laparoscopic surgeon (the mentor) assisted the learning surgeons over a year. The initial phases of learning incorporated detailed lectures, visualization through videotapes and 'hands-on' demonstration by the expert in the technique of the standardized steps for each type of surgery. Over 10 months, ablative and reconstructive RRLS was undertaken jointly by the surgeons and the mentor. After this training the surgeons operated independently. To prevent lengthy operations, conversion to open surgery was planned if there was no significant progression after 2 h of laparoscopic surgery. Over the 10 months of mentorship, 36 RRLS procedures were undertaken in 31 patients (28 ablative and eight reconstructive). In all cases the mentored surgeons accomplished both retroperitoneal access and the creation of a working space within the cavity. The group was able to initiate ablative RRLS but the mentor undertook all the reconstructive procedures. After the mentorship period, over 10 months, 12 ablative procedures were undertaken independently, and five other attempts at RRLS failed. Although the mentored approach can successfully and safely initiate advanced RRLS in a paediatric urology division, assessing the laparoscopic practice pattern after mentorship in the same group of trainees is warranted. Ablative RRLS is easier to learn for the experienced surgeon, but reconstructive procedures, e.g. pyeloplasty, require a high degree

Two-port laparoscopic appendectomy assisted with needle grasper comparison with conventional laparoscopic appendectomy.

PubMed

Donmez, Turgut; Hut, Adnan; Avaroglu, Huseyin; Uzman, Sinan; Yildirim, Dogan; Ferahman, Sina; Cekic, Erdinc

2016-08-01

The 2-port laparoscopic appendectomy technique (TLA) is between the conventional 3-port and single-port laparoscopic appendectomy surgeries. We compared postoperative pain and cosmetic results after TLA with conventional laparoscopic appendectomy (CLA) by a 3-port device. Patients undergoing TLA were matched with patients undergoing CLA between February 2015 and November 2015 at the same institution. Thirty-two patients underwent TLA with a needle grasper. The appendix was secured by a percutaneous organ-holding device (needle grasper), then removed through a puncture at McBurney's point. Another 38 patients underwent CLA. Patient demographics, operative details, and postoperative outcomes were collected and evaluated. One patient in the TLA group developed a wound infection and 1 patient in the CLA group developed a postoperative intra-abdominal abscess and 3 wound infections. There was no significant difference between the groups when comparing the length of hospital stay, time until oral intake, and other complications. The pain score in the first 12 hours after surgery was significanly higher in CLA group than the TLA group (P < 0.001). Operative time was significantly shorter in the CLA group compared to the TLA group (P < 0.001). TLA using a needle grasper was associated with a significantly lower pain score 12 hours after surgery, better cosmetic results, and lower cost, than the CLA 3-port procedure because of the fewer number of ports.

Cost-analysis comparison of robot-assisted laparoscopic radical cystectomy (RC) vs open RC.

PubMed

Lee, Richard; Chughtai, Bilal; Herman, Michael; Shariat, Shahrokh F; Scherr, Douglas S

2011-09-01

• To systematically review and compare the economic burden of open radical cystectomy (ORC) vs robot-assisted laparoscopic radical cystectomy (RALRC) with pelvic lymph node dissection and urinary diversion. • A Medline search was conducted to identify English language articles regarding RC with urinary diversion. The resulting articles were then further restricted by the terms 'laparoscopic', 'robotic', or 'robotic-assisted'.In all, three articles were identified. • Data from each of these articles were then collected on cost performance in addition to relevant clinical variables, such as length of stay (LOS), operative duration, and complication rates. • When possible, data were subdivided by ileal conduit (IC), continent cutaneous diversion (CCD), and orthotopic neobladder (ON) subgroups. • Direct costs resulting from ORC or RALRC with accompanying hospitalization were identified. The indirect costs of complications were considered. • Despite an increased materials cost, RALRC was less expensive than ORC when the cost of complications was considered. • RALRC was less expensive than ORC for IC and CCD, but the cost advantage deteriorated for ON. • The largest cost drivers cited in the published data were LOS, operative durations, and daily hospitalizations costs. • RALRC demonstrated shorter LOS compared with ORC, although this effect was insufficient to offset the increased cost of robotic surgery. • Complications materially affected cost performance. • Despite an increased materials cost, RALRC can be more cost efficient than ORC as a treatment for bladder cancer when the impact of complications are considered. • This effect is most pronounced for patients undergoing IC. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

The First Comparative Study of the Perioperative Outcomes Between Pure Laparoscopic Donor Hepatectomy and Laparoscopy-Assisted Donor Hepatectomy in a Single Institution.

PubMed

Takahara, Takeshi; Wakabayashi, Go; Nitta, Hiroyuki; Hasegawa, Yasushi; Katagiri, Hirokatsu; Umemura, Akira; Takeda, Daiki; Makabe, Kenji; Otsuka, Koki; Koeda, Keisuke; Sasaki, Akira

2017-07-01

In a statement from the second International Consensus Conference for Laparoscopic Liver Resection, adult-to-adult laparoscopic donor surgery was the earliest phase of development. It was recommended that the procedure be performed under institutional ethical approval and a reporting registry. At our institute, we started laparoscopy-assisted donor hepatectomy (LADH) in 2007 and changed to pure laparoscopic donor hepatectomy (PLDH) in 2012. This study included 40 living donors who underwent LADH and 14 live donors who underwent PLDH. We describe the technical aspects and outcomes of our donor hepatectomy from assist to pure and examine the liver allograft outcomes of the recipients after LADH and PLDH. There was significantly less blood loss in the PLDH group (81.07 ± 52.78 g) than that in the LADH group (238.50 ± 177.05 g), although the operative time was significantly longer in the PLDH group (454.93 ± 85.60 minutes) than in the LADH group (380.40 ± 44.08 minutes). And there were no significant differences in postoperative complication rate in the 2 groups. The liver allograft outcomes were acceptable and comparable with open living donor hepatectomy. By changing our routine approach from assist to pure, PLDH can be performed safely, with better exposure due to magnification, and with less blood loss under pneumoperitoneal pressure. PLDH, which has become our promising donor procedure, results in less blood loss, better cosmesis, and the donor's complete rehabilitation without deterioration in donor safety.

Transumbilical laparoscopic-assisted appendectomy is a useful surgical option for pediatric uncomplicated appendicitis: a comparison with conventional 3-port laparoscopic appendectomy

PubMed Central

Go, Doo Yeon; Lee, Ji Sung; Jung, Cheol Woong

2016-01-01

Purpose Transumbilical laparoscopic-assisted appendectomy (TULA) is a single incision technique that uses a combined intra- and extracorporeal method. The aim of this study was to compare surgical outcomes of TULA with conventional 3-port laparoscopic appendectomy (LA). Methods A retrospective review of medical records between 2010 and 2014 identified 303 pediatric patients who underwent LA with uncomplicated acute appendicitis. Of these, 85 patients underwent TULA and 218 patients underwent conventional LA. Demographic data, clinical characteristics, perioperative outcomes and postoperative complications were compared between the 2 groups. Results The mean operation time in the TULA group was 30.39 minutes, which was significantly shorter than that of the LA group (47.83 minutes) (P < 0.001). The first day of oral intake after surgery was earlier (1.05 days vs. 1.32 days; P < 0.001) and the length of hospital stay was also shorter (2.54 days vs. 3.22 days; P < 0.001) for the TULA group than the LA group. Furthermore, the postoperative complication rate was lower in the TULA group (1 of 85, 1.25%) compared to the LA group (19 of 218, 8.7%) (P = 0.018). Conclusion In conclusion, TULA procedure is recommended for uncomplicated appendicitis in children due to its simplicity and better postoperative outcomes. PMID:27478813

Comparison of shoulder load during power-assisted and purely hand-rim wheelchair propulsion.

PubMed

Kloosterman, Marieke G M; Eising, Hilde; Schaake, Leendert; Buurke, Jaap H; Rietman, Johan S

2012-06-01

Repetitive forces and moments are among the work requirements of hand-rim wheelchair propulsion that are related to shoulder injuries. No previous research has been published about the influence of power-assisted wheelchair propulsion on these work requirements. The purpose of our study was therefore to determine the influence of power-assisted propulsion on shoulder biomechanics and muscle activation patterns. We also explored the theoretical framework for the effectiveness of power-assisted propulsion in preventing shoulder injuries by decreasing the work requirements of hand-rim wheelchair propulsion. Nine non-wheelchair users propelled a hand-rim wheelchair on a treadmill at 0.9 m/s. Shoulder biomechanics, and muscle activation patterns, were compared between propulsion with and without power-assist. Propulsion frequency did not differ significantly between the two conditions (Wilcoxon Signed Rank test/significance level/effect size:4/.314/-.34). During power-assisted propulsion we found significantly decreased maximum shoulder flexion and internal rotation angles (1/.015/-.81 and 0/.008/-.89) and decreased peak force on the rim (0/.008/-.89). This resulted in decreased shoulder flexion, adduction and internal rotation moments (2/.021/-.77; 0/.008/-.89 and 1/.011/-.85) and decreased forces at the shoulder in the posterior, superior and lateral directions (2/.021/-.77; 2/.008/-.89 and 2/.024/-.75). Muscle activation in the pectoralis major, posterior deltoid and triceps brachii was also decreased (2/.038/-.69; 1/.015/-.81 and 1/.021/-.77). Power-assist influenced the work requirements of hand-rim wheelchair propulsion by healthy subjects. It was primarily the kinetics at rim and shoulder which were influenced by power-assisted propulsion. Additional research with actual hand-rim wheelchair users is required before extrapolation to routine clinical practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

Early post-splenectomy sepsis after missile injury in adults.

PubMed Central

Ellias, Y. A.; Elias, M. A.; Gorey, T. F.

1991-01-01

Early septic complications were studied in 292 patients operated on for penetrating missile injury of the abdomen with involvement of either the spleen or the liver, at Basrah Teaching Hospital between January 1983 and April 1986. Depending on associated injuries, patients with splenectomy were divided into three groups, the first with isolated splenic injury, the second with splenic and associated extra-intestinal organ injury, and the third with splenic and intestinal injuries with or without extra-intestinal organ injury. Patients with hepatic injury were classified similarly. Splenectomy was carried out for any degree of splenic injury. Grade I hepatic injuries were managed by débridement and suturing while major grades II-IV underwent segmentectomy or lobectomy. Patients were considered septic if they had any three of four clinical criteria: temperature higher than 39 degrees C; significant haemodynamic deterioration; respiratory alkalosis, or oliguria. Of the total, 79 were excluded due to: early transfer 51, incomplete records 8, perioperative death 11, and having combined splenic and hepatic injuries 9 (excluded by definition), leaving 104 (74.8%) patients with splenectomy and 109 (71.1%) with hepatic injury available for study. Sepsis developed in 48 (46.1%) of patients after splenectomy and in 28 (25.7%) with hepatic injury. This difference was significant (P greater than 0.005). In patients with isolated splenic injury, eight (25.8%) were septic while three (13.6%) of those with isolated hepatic injury developed sepsis. This was not significant (P = 0.32, Fisher's exact test). When either was associated with an injury to an extra-intestinal organ, 15 (50%) of the splenectomy group developed sepsis compared to five (23.8%) of the hepatic injury group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2042899

Live broadcast of laparoscopic surgery to handheld computers.

PubMed

Gandsas, A; McIntire, K; Park, A

2004-06-01

Thanks to advances in computer power and miniaturization technology, portable electronic devices are now being used to assist physicians with various applications that extend far beyond Web browsing or sending e-mail. Handheld computers are used for electronic medical records, billing, coding, and to enable convenient access to electronic journals for reference purposes. The results of diagnostic investigations, such as laboratory results, study reports, and still radiographic pictures, can also be downloaded into portable devices for later view. Handheld computer technology, combined with wireless protocols and streaming video technology, has the added potential to become a powerful educational tool for medical students and residents. The purpose of this study was to assess the feasibility of transferring multimedia data in real time to a handheld computer via a wireless network and displaying them on the computer screens of clients at remote locations. A live laparoscopic splenectomy was transmitted live to eight handheld computers simultaneously through our institution's wireless network. All eight viewers were able to view the procedure and to hear the surgeon's comments throughout the entire duration of the operation. Handheld computer technology can play a key role in surgical education by delivering information to surgical residents or students when they are geographically distant from the actual event. Validation of this new technology by conducting clinical research is still needed to determine whether resident physicians or medical students can benefit from the use of handheld computers.

A rare case of acute presentation of trocar site hernia from robot-assisted laparoscopic partial nephrectomy.

PubMed

Ng, Zi Qin; Pemberton, Richard; Tan, Patrick

2018-02-15

Trocar site hernia is not a common acute complication encountered after robot-assisted surgery, especially in the urological cohort of patients. A few case reports of small bowel obstruction secondary to incarceration by trocar site hernia have been described in gynaecological surgery and prostatectomies. As the clinical presentation is non-specific, late diagnosis has significant implication on morbidity and mortality. Here, we present a rare case of a patient with recent robot-assisted laparoscopic partial nephrectomy for a renal cell carcinoma presented with features of impending bowel obstruction secondary to incarcerated small bowel in the trocar site. We also reviewed the literature focusing on clinical features of trocar site hernia and preventive measures.

Preoperative planning and real-time assisted navigation by three-dimensional individual digital model in partial nephrectomy with three-dimensional laparoscopic system.

PubMed

Wang, Dongwen; Zhang, Bin; Yuan, Xiaobin; Zhang, Xuhui; Liu, Chen

2015-09-01

To evaluate the feasibility and effectiveness of preoperative planning and real-time assisted surgical navigation for three-dimensional laparoscopic partial nephrectomy under the guidance of three-dimensional individual digital model (3D-IDM) created using three-dimensional medical image reconstructing and guiding system (3D-MIRGS). Between May 2012 and February 2014, 44 patients with cT1 renal tumors underwent retroperitoneal laparoscopic partial nephrectomy (LPN) using a three-dimensional laparoscopic system. The 3D-IDMs were created using the 3D-MIRGS in 21 patients (3D-MIRGS group) between February 2013 and February 2014. After preoperative planning, operations were real-time assisted using composite 3D-IDMs, which were fused with two-dimensional retrolaparoscopic images. The remaining 23 patients underwent surgery without 3D-MIRGS between May 2012 and February 2013; 14 of these patients were selected as a control group. Preoperative aspects and dimensions used for an anatomical score, "radius; exophytic/endophytic; nearness; anterior/posterior; location" nephrometry score, tumor size, operative time (OT), segmental renal artery clamping (SRAC) time, estimated blood loss (EBL), postoperative hospitalization, the preoperative serum creatinine level and ipsilateral glomerular filtration rate (GFR), as well as postoperative 6-month data were compared between groups. All the SRAC procedures were technically successful, and each targeted tumor was excised completely; final pathological margin results were negative. The OT was shorter (159.0 vs. 193.2 min; p < 0.001), and EBL (148.1 vs. 176.1 mL; p < 0.001) was reduced in the 3D-MIRGS group compared with controls. No statistically significant differences in SRAC time or postoperative hospitalization were found between the groups. Neither group showed any statistically significant increases in serum creatinine level or decreases in ipsilateral GFR postoperatively. Preoperative planning and real-time assisted surgical

Learning curve for robotic-assisted laparoscopic rectal cancer surgery.

PubMed

Jiménez-Rodríguez, Rosa M; Díaz-Pavón, José Manuel; de la Portilla de Juan, Fernando; Prendes-Sillero, Emilio; Dussort, Hisnard Cadet; Padillo, Javier

2013-06-01

One of the main uses of robotic assisted abdominal surgery is the mesorectal excision in patients with rectal cancer. The aim of the present study is to analyse the learning curve for robotic assisted laparoscopic resection of rectal cancer. We included in our study 43 consecutive rectal cancer resections (16 females and 27 males) performed from January 2008 through December 2010. Mean age of patients was 66 ± 9.0 years. Surgical procedures included both abdomino-perineal and anterior resections. We analysed the following parameters: demographic data of the patients included in the study, intra- and postoperative data, time taking to set up the robot for operations (set-up or docking time), operative time, intra- and postoperative complications, conversion rates and pathological specimen features. The learning curve was analysed using cumulative sum (CUSUM) methodology. The procedures understudied included seven abdomino-perineal resections and 36 anterior resections. In our series of patients, mean robotic set-up time was 62.9 ± 24.6 min, and the mean operative time was 197.4 ± 44.3 min. Once we applied CUSUM methodology, we obtained two graphs for CUSUM values (operating time and success), both of them showing three well-differentiated phases: phase 1 (the initial 9-11 cases), phase 2 (the middle 12 cases) and phase 3 (the remaining 20-22 cases). Phase 1 represents initial learning; phase 2 plateau represents increased competence in the use of the robotic system, and finally, phase 3 represents the period of highest skill or mastery with a reduction in docking time (p = 0.000), but a slight increase in operative time (p = 0.007). The CUSUM curve shows three phases in the learning and use of robotic assisted rectal cancer surgery which correspond to the phases of initial learning of the technique, consolidation and higher expertise or mastery. The data obtained suggest that the estimated learning curve for robotic assisted rectal cancer

Preoperative fiducial coil placement facilitates robot-assisted laparoscopic excision of retroperitoneal small solitary metastasis of kidney cancer.

PubMed

Agrawal, Vineet; Sharma, Ashwani; Wu, Guan

2014-11-01

Image-guided fiducial markers are being used in surgery, especially in spine and breast surgery, and radiotherapy, allowing localization of tumor sites precisely. We report a case of fiducial coil use in a man undergoing a robot-assisted laparoscopic resection of a metastatic nodule under the ipsilateral diaphragm after robot-assisted partial nephrectomy performed 2 years ago for a left upper pole renal tumor. The fiducial coil facilitated the localization of the lesion, which would otherwise have been challenging because of its small size and location. In addition, the fiducial coil was helpful to avoid cutting into the lesion directly. Copyright © 2014 Elsevier Inc. All rights reserved.

Short-term effects of splenectomy on serum fibrosis indexes in liver cirrhosis patients.

PubMed

Kong, Degang; Chen, Xiuli; Lu, Shichun; Guo, Qingliang; Lai, Wei; Wu, Jushan; Lin, Dongdong; Zeng, Daobing; Duan, Binwei; Jiang, Tao; Cao, Jilei

2015-01-01

To determine the changing patterns of 4 liver fibrosis markers pre and post splenectomy (combined with pericardial devascularization [PCDV]) and to examine the short-term effects of splenectomy on liver fibrosis. Four liver fibrosis markers of 39 liver cirrhosis patients were examined pre, immediately post, 2 days post, and 1 week post (15 cases) splenectomy (combined with PCDV). The laminin (LN) level decreased immediately post surgery compared with the preoperative LN level (P < 0.05). The type IV collagen level decreased immediately post surgery compared with that pre surgery (P < 0.05), it significantly increased (P < 0.05) 2 days post surgery and significantly decreased 1 week post surgery (P < 0.05). Hyaluronic acid and the procollagen III N-terminal peptide levels increased significantly 2 days post surgery compared with that pre and immediately post surgery, they significantly decreased 1 week post surgery compared to 2 days post surgery (P < 0.05). In the short-term, the 4 liver fibrosis markers and the FibroScans post splenectomy showed characteristic changes, splenectomy may transiently initiate the degradation process of liver fibrosis.

The benefits of being a video gamer in laparoscopic surgery.

PubMed

Sammut, Matthew; Sammut, Mark; Andrejevic, Predrag

2017-09-01

Video games are mainly considered to be of entertainment value in our society. Laparoscopic surgery and video games are activities similarly requiring eye-hand and visual-spatial skills. Previous studies have not conclusively shown a positive correlation between video game experience and improved ability to accomplish visual-spatial tasks in laparoscopic surgery. This study was an attempt to investigate this relationship. The aim of the study was to investigate whether previous video gaming experience affects the baseline performance on a laparoscopic simulator trainer. Newly qualified medical officers with minimal experience in laparoscopic surgery were invited to participate in the study and assigned to the following groups: gamers (n = 20) and non-gamers (n = 20). Analysis included participants' demographic data and baseline video gaming experience. Laparoscopic skills were assessed using a laparoscopic simulator trainer. There were no significant demographic differences between the two groups. Each participant performed three laparoscopic tasks and mean scores between the two groups were compared. The gamer group had statistically significant better results in maintaining the laparoscopic camera horizon ± 15° (p value = 0.009), in the complex ball manipulation accuracy rates (p value = 0.024) and completed the complex laparoscopic simulator task in a significantly shorter time period (p value = 0.001). Although prior video gaming experience correlated with better results, there were no significant differences for camera accuracy rates (p value = 0.074) and in a two-handed laparoscopic exercise task accuracy rates (p value = 0.092). The results show that previous video-gaming experience improved the baseline performance in laparoscopic simulator skills. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Massive splenic infarction in children with sickle cell anemia and the role of splenectomy.

PubMed

Al-Salem, Ahmed H

2013-03-01

Massive splenic infarction (MSI) is a very rare condition. Few reports of splenic infarction of various etiologies including hematological and non-hematological causes have been published. On the other hand, MSI in patients with sickle cell anemia (SCA) is extremely rare. This report describes our experience with 15 children with SCA and MSI outlining aspects of presentation, diagnosis and management. The records of all children with MSI were retrospectively reviewed for age at diagnosis, sex, clinical features, precipitating factors, investigations, management and outcome. 15 children (11 M: 4 F) with SCA were treated for MSI. Their mean age was 10.9 years (6-17 years). All presented with severe left upper quadrant abdominal pain. In nine, this was associated with nausea and vomiting. Three were febrile and all had a tender splenomegaly. Their mean hemoglobin was 8.2 g/dl (5.7-11.3 g/dl), mean WBC was 10.97 × 10(3) mm(-3) (3.6 × 10(3)-22.3 × 10(3) mm(-3)) and mean platelet count was 263.3 × 10(3) mm(-3) (40 × 10(3)-660 × 10(3) mm(-3)). In seven, there was a precipitating cause including high altitude in two, acute chest syndrome in two, septicemia in two and severe vasooclusive crisis in one. Abdominal ultrasound and CT scan confirmed the diagnosis of MSI which involved more than half of the spleen in 12 and whole spleen in 3. All were treated with IV fluids, analgesia and blood transfusion where appropriate. Eleven had splenectomy because of persistent abdominal pain, three developed splenic abscess and underwent splenectomy and one settled on conservative treatment. Histology confirmed the diagnosis of splenic infarction in 11 and infarction with abscess in the remaining 3. MSI is extremely rare in children with SCA. It can develop spontaneously or precipitated by other factors namely high altitude, acute chest syndrome and severe stress. Most reported cases of splenic infarction are small in size, focal and can be treated conservatively. MSI, on the other

Randomized clinical trial of ligasure™ versus conventional splenectomy for injured spleen in blunt abdominal trauma.

PubMed

Amirkazem, Vejdan Seyyed; Malihe, Khosravi

2017-02-01

Spleen is the most common organ damaged in cases of blunt abdominal trauma and splenectomy and splenorrhaphy are the main surgical procedures that are used in surgical treatment of such cases. In routine open splenectomy cases, after laparotomy, application of sutures in splenic vasculature is the most widely used procedure to cease the bleeding. This clinical trial evaluates the role and benefits of the Ligasure™ system in traumatic splenectomy without using any suture materials and compares the result with conventional method of splenectomy. After making decision for splenectomy secondary to a blunt abdominal trauma, patients in control group (39) underwent splenectomy using conventional method with silk suture ligation of splenic vasculature. In the interventional group (41) a Ligasure™ vascular sealing system was used for ligating of the splenic vein and artery. The results of operation time, volume of intra-operation bleeding and post-operative complications were compared in both groups. The mean operation times in control and interventional group were 21 and 12 min respectively (p < 0.05). The average volume of bleeding in control group during open splenectomy was 280 cc, but in the interventional group decreased significantly to 80 ml (p < 0.05) using the Ligasure system. Post-operative complications such as bleeding were non-existent in both groups. The application of Ligasure™ in blunt abdominal trauma for splenectomy not only can decrease the operation time but also can decrease the volume of bleeding during operation without any additional increase in post-operative complications. This method is recommendable in traumatic splenic injuries that require splenectomy in order to control the bleeding as opposed to use of traditional silk sutures. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Should all distal pancreatectomies be performed laparoscopically?

PubMed

Merchant, Nipun B; Parikh, Alexander A; Kooby, David A

2009-01-01

Despite the relatively slow start of laparoscopic pancreatectomy relative to other laparoscopic resections, an increasing number of these procedures are being performed around the world. Operations that were once considered impossible to perform laparoscopically, such as pancreaticoduodenectomy and central pancreatectomy are gaining momentum. Technology continues to improve, as does surgical experience and prowess. There are both enough experience and data (though retrospective) to confirm that LDP with or without spleen preservation appears to be a safe treatment for benign or noninvasive lesions of the pancreas. Based on the fact that LDP can be performed with similar or shorter operative times, blood loss, complication rates, and length of hospital stay than ODP, it can be recommended as the treatment of choice for benign and noninvasive lesions in experienced hands when clinically indicated. It is very difficult to make clear recommendations with regard to laparoscopic resection of malignant pancreatic tumors due to the lack of conclusive data. As long as margins are negative and lymph node clearance is within accepted standards, LDP appears to have no untoward oncologic effects on outcome. Certainly more data, preferably in the manner of a randomized clinical trial, are needed before additional recommendations can be made. Potential benefits of laparoscopic resection for cancer include the ability to inspect the abdomen and abort the procedure with minimal damage if occult metastases are identified. This does not delay the onset of palliative chemotherapy, which would be the primary treatment in that circumstance. In fact, there is evidence to suggest that there is a greater likelihood of receiving systemic therapy if a laparotomy is avoided in patients who have radiologically occult metastases. Patients may also undergo palliative laparoscopic gastric and biliary bypass if indicated. Faster wound healing may also translate into a shorter waiting time before

Automated and electronically assisted hand hygiene monitoring systems: a systematic review.

PubMed

Ward, Melissa A; Schweizer, Marin L; Polgreen, Philip M; Gupta, Kalpana; Reisinger, Heather S; Perencevich, Eli N

2014-05-01

Hand hygiene is one of the most effective ways to prevent transmission of health care-associated infections. Electronic systems and tools are being developed to enhance hand hygiene compliance monitoring. Our systematic review assesses the existing evidence surrounding the adoption and accuracy of automated systems or electronically enhanced direct observations and also reviews the effectiveness of such systems in health care settings. We systematically reviewed PubMed for articles published between January 1, 2000, and March 31, 2013, containing the terms hand AND hygiene or hand AND disinfection or handwashing. Resulting articles were reviewed to determine if an electronic system was used. We identified 42 articles for inclusion. Four types of systems were identified: electronically assisted/enhanced direct observation, video-monitored direct observation systems, electronic dispenser counters, and automated hand hygiene monitoring networks. Fewer than 20% of articles identified included calculations for efficiency or accuracy. Limited data are currently available to recommend adoption of specific automatic or electronically assisted hand hygiene surveillance systems. Future studies should be undertaken that assess the accuracy, effectiveness, and cost-effectiveness of such systems. Given the restricted clinical and infection prevention budgets of most facilities, cost-effectiveness analysis of specific systems will be required before these systems are widely adopted. Published by Mosby, Inc.

Laparoscopic-assisted Rectus Sheath Block as a Novel Technique is Effective and Safe: A Randomized Controlled Trial.

PubMed

Miyazaki, Dai; Shichinohe, Toshiaki; Ebihara, Yuma; Kurashima, Yo; Murakami, Soichi; Noji, Takehiro; Nakamura, Toru; Tsuchikawa, Takahiro; Okamura, Keisuke; Hirano, Satoshi

2017-02-01

We developed laparoscopic-assisted rectus sheath block (LRSB) as a novel technique and report on its safety and effectiveness. Patients were randomly enrolled to an LRSB or control group (n=19 each). In the LRSB group, after the umbilical wound was closed, local anesthetic was injected transcutaneous at each of 4 sites (3 cm above and below the umbilicus bilaterally) with 10 mL of 0.25% levobupivacaine, laparoscopically. The control group received conventional postoperative pain management. The primary endpoint was visual analogue scale (VAS) pain score at the end of surgery. Secondary endpoints were VAS and Prince Henry pain scale after surgery, number of administrations of analgesics, and side effects of anesthesia. No significant differences in background were seen between groups. VAS at the end of surgery was significantly lower in the LRSB group than in controls (P<0.01). VAS and Prince Henry pain scale were significantly lower in the LRSB group from soon after surgery to postoperative day 2. No complications related to LRSB were encountered. LRSB was particularly effective at the end of surgery and pain scores were significantly lower in the LRSB group long after surgery. Our study shows LRSB is effective and safe for laparoscopic abdominal surgery.

Urinary tract-related quality of life after radical prostatectomy: open retropubic versus robot-assisted laparoscopic approach.

PubMed

Froehner, Michael; Koch, Rainer; Leike, Steffen; Novotny, Vladimir; Twelker, Lars; Wirth, Manfred P

2013-01-01

The best technique of radical prostatectomy--open retropubic versus robot-assisted surgery--is a subject of controversy. Between January 1st, 2007 and December 31st, 2011, 2,177 men underwent radical prostatectomy at our department. 252 (12%) cases were laparoscopic robot-assisted, the remainder open retropubic procedures. In Germany, certified prostate cancer centers are required to collect urinary tract-related outcome data after radical prostatectomy using the International Consultation of Incontinence Questionnaire Male Lower Urinary Tract Symptoms. The questionnaire data were used to compare both surgical approaches concerning the urinary tract-related outcome 1, 2 and 3 years postoperatively. Neither the voiding score nor the incontinence score or the bother scale sum differed between the two cohorts at any of the measurement times. Concerning continence recovery, in this series, there were no detectable differences between robot-assisted and open radical prostatectomy. Copyright © 2012 S. Karger AG, Basel.

Expert videotape analysis and critiquing benefit laparoscopic skills training of urologists.

PubMed

Nakada, Stephen Y; Hedican, Sean P; Bishoff, Jay T; Shichman, Steven J; Wolf, J Stuart

2004-01-01

Teaching laparoscopic skills has become the focus of the latest generation of hands-on laparoscopic courses. Thirty-four practicing urologists, ages 31 to 61 years (mean, 46.6 years) with laparoscopic experience (range, 0 to 200, mean, 27.6 cases), 32 of whom had taken prior American Urological Association (AUA) laparoscopy courses, participated in an AUA-sponsored hands-on laparoscopic skills course over a 2-day period in August 2002 or March 2003. They all took a knowledge assessment examination and performed standardized tasks (rope passing, ring placement, and laparoscopic suturing and knot tying) at the beginning and the end of the course with a videotape analysis and critique. Prior to the repeat-skills assessment, each participant was individually critiqued and instructed based on a videotape review of their initial performance. The urologists also participated in a porcine laboratory and a pelvic trainer session totaling 6 hours between skills assessments. None of the participants had performed significant laparoscopic suturing prior to the course. Using Wilcoxon's signed rank test, the participants improved from a mean of 119.32 seconds to 98.36 seconds with the rope pass (P = 0.0001), and with the ring placement from a mean of 9.70/minute to 12.09/minute (P = 0.0001). All participants had significantly fewer false passes (mean, 9.35 compared with 5.21) during repeat skills assessments (P = 0.0001). Participants improved from 0.54 sutures/minute to 1.22 sutures/ minute following the video critique and practice (P = 0.0001). Degree of laparoscopic experience (number of cases), age of the urologist, and precourse knowledge (examination score) had no significant bearing on results in the initial skills assessment or in the improvement of task time (Spearman correlation coefficients). Urologists with some laparoscopic experience (mean 27.6 cases) can improve laparoscopic skills using mentored videotape analysis and experience gained from a 2-day hands

Expert Videotape Analysis and Critiquing Benefit Laparoscopic Skills Training of Urologists

PubMed Central

Hedican, Sean P.; Bishoff, Jay T.; Shichman, Steven J.; Wolf, J. Stuart

2004-01-01

Introduction: Teaching laparoscopic skills has become the focus of the latest generation of hands-on laparoscopic courses. Methods: Thirty-four practicing urologists, ages 31 to 61 years (mean, 46.6 years) with laparoscopic experience (range, 0 to 200, mean, 27.6 cases), 32 of whom had taken prior American Urological Association (AUA) laparoscopy courses, participated in an AUA-sponsored hands-on laparoscopic skills course over a 2-day period in August 2002 or March 2003. They all took a knowledge assessment examination and performed standardized tasks (rope passing, ring placement, and laparoscopic suturing and knot tying) at the beginning and the end of the course with a videotape analysis and critique. Prior to the repeat-skills assessment, each participant was individually critiqued and instructed based on a videotape review of their initial performance. The urologists also participated in a porcine laboratory and a pelvic trainer session totaling 6 hours between skills assessments. None of the participants had performed significant laparoscopic suturing prior to the course. Results: Using Wilcoxon's signed rank test, the participants improved from a mean of 119.32 seconds to 98.36 seconds with the rope pass (P= 0.0001), and with the ring placement from a mean of 9.70/minute to 12.09/minute (P=0.0001). All participants had significantly fewer false passes (mean, 9.35 compared with 5.21) during repeat skills assessments (P=0.0001). Participants improved from 0.54 sutures/minute to 1.22 sutures/ minute following the video critique and practice (P=0.0001). Degree of laparoscopic experience (number of cases), age of the urologist, and precourse knowledge (examination score) had no significant bearing on results in the initial skills assessment or in the improvement of task time (Spearman correlation coefficients). Conclusion: Urologists with some laparoscopic experience (mean 27.6 cases) can improve laparoscopic skills using mentored videotape analysis and

Development and assessment of a hand assist device: GRIPIT.

PubMed

Kim, Byungchul; In, Hyunki; Lee, Dae-Young; Cho, Kyu-Jin

2017-02-21

Although various hand assist devices have been commercialized for people with paralysis, they are somewhat limited in terms of tool fixation and device attachment method. Hand exoskeleton robots allow users to grasp a wider range of tools but are heavy, complicated, and bulky owing to the presence of numerous actuators and controllers. The GRIPIT hand assist device overcomes the limitations of both conventional devices and exoskeleton robots by providing improved tool fixation and device attachment in a lightweight and compact device. GRIPIT has been designed to assist tripod grasp for people with spinal cord injury because this grasp posture is frequently used in school and offices for such activities as writing and grasping small objects. The main development objective of GRIPIT is to assist users to grasp tools with their own hand using a lightweight, compact assistive device that is manually operated via a single wire. GRIPIT consists of only a glove, a wire, and a small structure that maintains tendon tension to permit a stable grasp. The tendon routing points are designed to apply force to the thumb, index finger, and middle finger to form a tripod grasp. A tension-maintenance structure sustains the grasp posture with appropriate tension. Following device development, four people with spinal cord injury were recruited to verify the writing performance of GRIPIT compared to the performance of a conventional penholder and handwriting. Writing was chosen as the assessment task because it requires a tripod grasp, which is one of the main performance objectives of GRIPIT. New assessment, which includes six different writing tasks, was devised to measure writing ability from various viewpoints including both qualitative and quantitative methods, while most conventional assessments include only qualitative methods or simple time measuring assessments. Appearance, portability, difficulty of wearing, difficulty of grasping the subject, writing sensation, fatigability

Laparoscopic pancreatoduodenectomy with superior mesenteric artery-first approach and pancreatogastrostomy assisted by mini-laparotomy.

PubMed

Zimmitti, Giuseppe; Manzoni, Alberto; Addeo, Pietro; Garatti, Marco; Zaniboni, Alberto; Bachellier, Philippe; Rosso, Edoardo

2016-04-01

Laparoscopic pancreatoduodenectomy (LPD) is a complex procedure. Critical steps are achieving a negative retroperitoneal margin and re-establishing pancreatoenteric continuity minimizing postoperative pancreatic leak risk. Aiming at increasing the rate of R0 resection during pancreatoduodenectomy, many experienced teams have recommended the superior mesenteric artery (SMA)-first approach, consisting in early identification of the SMA at its origin, with further resection guided by SMA anatomic course. We describe our technique of LPD with SMA-first approach and pancreatogastrostomy assisted by mini-laparotomy. The video concerns a 77-year-old man undergoing our variant of LPD for a 2.5-cm pancreatic head mass. After kocherization, the SMA is identified above the left renocaval confluence and dissected-free from the surrounding tissue. Dissection of the posterior pancreatic aspect exposes the confluence between splenic vein, superior mesenteric vein (SMV), and portal vein. Following duodenal section, the common hepatic artery is dissected and the gastroduodenal artery sectioned at the origin. The first jejunal loop is divided, skeletonized, and passed behind the superior mesenteric vessel. Following pancreatic transection, the uncinate process is dissected from the SMV and the SMA is cleared from retroportal tissue rejoining the previously dissected plain. Laparoscopic choledocojejunostomy is followed by a mini-laparotomy-assisted pancreatogastrostomy, performed as previously described, and a terminolateral gastrojejeunostomy. Twelve patients underwent our variant of LPD (July 2013-May 2015). Female/male ratio was 3:1, median age 65 years (range 57-79), median operation duration 590 min (580-690), intraoperative blood loss 150 cl (100-250). R0 resection rate was 100 %, and the median number of resected lymph nodes was 24 (22-28). Postoperative complications were grade II in two patients and IIIa in one. Median postoperative length of stay was 16 days (14-21). LPD

Stepwise introduction of laparoscopic liver surgery: validation of guideline recommendations.

PubMed

van der Poel, Marcel J; Huisman, Floor; Busch, Olivier R; Abu Hilal, Mohammad; van Gulik, Thomas M; Tanis, Pieter J; Besselink, Marc G

2017-10-01

Uncontrolled introduction of laparoscopic liver surgery (LLS) could compromise postoperative outcomes. A stepwise introduction of LLS combined with structured training is advised. This study aimed to evaluate the impact of such a stepwise introduction. A retrospective, single-center case series assessing short term outcomes of all consecutive LLS in the period November 2006-January 2017. The technique was implemented in a stepwise fashion. To evaluate the impact of this stepwise approach combined with structured training, outcomes of LLS before and after a laparoscopic HPB fellowship were compared. A total of 135 laparoscopic resections were performed. Overall conversion rate was 4% (n = 5), clinically relevant complication rate 13% (n = 18) and mortality 0.7% (n = 1). A significant increase in patients with major LLS, multiple liver resections, previous abdominal surgery, malignancies and lesions located in posterior segments was observed after the fellowship as well as a decrease in the use of hand-assistance. Increasing complexity in the post fellowship period was reflected by an increase in operating times, but without comprising other surgical outcomes. A stepwise introduction of LLS combined with structured training reduced the clinical impact of the learning curve, thereby confirming guideline recommendations. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

[Application research of presacral space drainage tube combined with subcutaneous vacuum pressure suction in the laparoscopic-assisted abdominoperineal resection].

PubMed

Chen, Liqi; Zeng, Changqing; Chi, Liangjie; Huang, Liangxiang; Li, Jiandang

2017-08-25

To study the management for the perineal incision after laparoscopic-assisted abdominoperineal resection for rectal cancer. Clinical data of 87 patients undergoing laparoscopic Miles operation for lower rectal cancer from June 2009 to February 2014 were collected and studied. Presacral space drainage group: presacral space drainage tube was applied in 42 patients. Combined drainage group: presacral space drainage tube combined with subcutaneous vacuum pressure suction was applied in 45 cases. In combined drainage group, except the presacral drainage tube, another drainage tube was placed subcutaneously and connected to a negative pressure ball, which was fixed on the lateral anterior of perineal wound by the further incision and drainage. After subcutaneous tube was placed for 2 weeks, as drainage fluid was limpid and <15 ml/d for 3 days, meanwhile no obvious pelvic fluid was detected by ultrasound, and the wound healed quite well without redness and edema, then the subcutaneous tube with the negative pressure ball could be removed. There were 51 males and 36 females with the mean age of 26-78(56.9±10.8) years old. The laparoscopic Miles operation was successfully completed in all the cases without death and complications. The drainage tube was placed for 4-13(8.0±2.5) days in presacral space drainage group, and for 4-14(6.7±2.4) days in combined drainage group. The subcutaneous tube was placed for 14-24(15.8±3.0) days. The primary healing rate of perineal wound in presacral space drainage group and combined drainage group was 66.7%(28/42) and 91.1%(41/45) respectively, while the perineal wound infection rate was 21.4%(9/42) and 4.4%(2/45) respectively, whose differences between two groups were both significant (χ 2 =7.911, P=0.005 and χ 2 =5.674, P=0.017). Presacral space drainage tube combined with subcutaneous vacuum pressure suction in laparoscopic-assisted abdominoperineal resection for rectal cancer has better efficacy and lower infection rate for

A meta-analysis of robotic-assisted pancreatectomy versus laparoscopic and open pancreatectomy.

PubMed

Chen, Yigang; Yan, Jun; Yuan, Ziming; Yu, Song; Wang, Zhigang; Zheng, Qi

2013-12-01

To perform a meta-analysis of eligible studies from multiple medical centers to assess the safety, feasibility, and efficacy of robotic-assisted pancreatectomy (RP). We searched the electronic databases PubMed and EMBASE for studies comparing RP with laparoscopic pancreatectomy (LP) and open pancreatectomy (OP) for patients with pancreatic disease from June 2009 to June 2012. Continuous variables were pooled using the standardized mean difference (SMD) and odds ratio (OR), and dichotomous variables were pooled using the risk difference (RD) method. For all analyses, the 95% confidence interval (CI) was calculated. Three studies comparing RP and LP, and 4 studies comparing RP and OP were suitable for meta-analysis. Six published studies met the inclusion criteria. Our results showed that RP can reduce estimated blood loss and duration of hospitalization more than OP. For pancreatic fistula, there were no statistical differences between RP, OP, and LP, and no significant differences in intraoperative conversion rates between RP and LP. Robotic-assisted pancreatectomy may be able to increase microscopic negative margins of resection (R0) and spleen preserving rates. Robotic-assisted pancreatectomy was associated with increased R0 resection rates and spleen preserving rates than LP and OP. Moreover, RP can reduce estimated blood loss and duration of hospitalization more than OP. A robotic approach to pancreatectomy may be suited to patients with pancreatic disease.

Telesurgical laparoscopic cholecystectomy between two countries.

PubMed

Cheah, W K; Lee, B; Lenzi, J E; Goh, P M

2000-11-01

Telesurgery is a form of operative videoconferencing in which a remotely located surgeon observes a procedure through a camera and provides visual and auditory feedback to the operative site. With the use of more robotic devices in laparoscopic surgery, various forms of telesurgery have been tried. We describe the first two international telesurgical, telementored, robot-assisted laparoscopic cholecystectomies performed in the world, between the Johns Hopkins Institute, Baltimore, Maryland, USA, and the National University Hospital, Singapore.

Human error identification for laparoscopic surgery: Development of a motion economy perspective.

PubMed

Al-Hakim, Latif; Sevdalis, Nick; Maiping, Tanaphon; Watanachote, Damrongpan; Sengupta, Shomik; Dissaranan, Charuspong

2015-09-01

This study postulates that traditional human error identification techniques fail to consider motion economy principles and, accordingly, their applicability in operating theatres may be limited. This study addresses this gap in the literature with a dual aim. First, it identifies the principles of motion economy that suit the operative environment and second, it develops a new error mode taxonomy for human error identification techniques which recognises motion economy deficiencies affecting the performance of surgeons and predisposing them to errors. A total of 30 principles of motion economy were developed and categorised into five areas. A hierarchical task analysis was used to break down main tasks of a urological laparoscopic surgery (hand-assisted laparoscopic nephrectomy) to their elements and the new taxonomy was used to identify errors and their root causes resulting from violation of motion economy principles. The approach was prospectively tested in 12 observed laparoscopic surgeries performed by 5 experienced surgeons. A total of 86 errors were identified and linked to the motion economy deficiencies. Results indicate the developed methodology is promising. Our methodology allows error prevention in surgery and the developed set of motion economy principles could be useful for training surgeons on motion economy principles. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Operative technique and early experience for robotic-assisted laparoscopic nephroureterectomy (RALNU) using da Vinci Xi.

PubMed

Darwiche, Fadi; Swain, Sanjaya; Kallingal, George; Punnen, Sanoj; Manoharan, Murugesan; Parekh, Dipen J; Gonzalgo, Mark L

2015-01-01

Robotic-assisted laparoscopic nephroureterectomy (RALNU) has been previously utilized for management of upper tract urothelial carcinoma. The da Vinci Xi surgical system was released in April of 2014. We describe our operative technique and early experience for RALNU using the da Vinci Xi system highlighting unique features of this surgical platform. A total of 10 patients with a diagnosis of upper tract urothelial carcinoma underwent RALNU using the da Vinci Xi system between April and November of 2014. A novel, oblique "in line" robotic trocar configuration was utilized to access the upper abdomen (nephrectomy portion) and pelvis (bladder cuff excision) without undocking. The port hopping feature of da Vinci Xi was utilized to facilitate optimal, multi-quadrant visualization during RALNU. Robotic-assisted laparoscopic nephroureterectomy was successfully completed without open conversion in all 10 patients. Mean operative time was 184 min (range 140-300 min), mean estimated blood loss was 121 cc (range 60-300 cc), and mean hospital stay was 2.4 days. Final pathology demonstrated high grade urothelial carcinoma in all patients. Surgical margins were negative in all patients. No intra-operative complications were encountered. One patient developed a pulmonary embolus after being discharged. No patients required a blood transfusion. Mean patient follow-up was 130 days (range 15-210 days). The use of da Vinci Xi with a novel, oblique "in line" port configuration and camera port hopping technique allows for an efficient and reproducible method for RALNU without the need for repositioning the patient or the robot during surgery.

Retroperitoneoscopic living donor nephrectomy: initial experience with a unique hand-assisted approach.

PubMed

Capolicchio, J-P; Feifer, A; Plante, M K; Tchervenkov, J

2011-01-01

The retroperitoneoscopic (RP) approach to live donor nephrectomy (LDN) may be advantageous for the donor because it avoids mobilization of peritoneal organs and provides direct access to the renal vessels. Notwithstanding, this approach is not popular, likely because of the steeper learning curve. We feel that hand-assistance (HA) can reduce the learning curve and in this study, we present our experience with a novel hand-assist approach to retroperitoneoscopic live donor nephrectomy (HARP-LDN). Over a one-yr period, 10 consecutive patients underwent left HARP-LDN with a mean body mass index of 29 and three with prior left abdomen surgery. The surgical technique utilizes a 7 cm, muscle-sparing incision for the hand-port with two endoscopic ports. Operative time was an average of 155 min., with no open conversions. Mean blood loss was 68 mL, and warm ischemia time was 2.5 min. Hospital stay averaged 2.7 d with postoperative complications limited to one urinary retention. Our modified HARP approach to left LDN is safe, effective and can be performed expeditiously. Our promising initial results require a larger patient cohort to confirm the advantages of the hand-assisted retroperitoneal technique. © 2010 John Wiley & Sons A/S.

Transvaginal laparoscopically assisted endoscopic cholecystectomy: preliminary clinical results for a series of 43 cases in China.

PubMed

Niu, Jun; Song, Wei; Yan, Ming; Fan, Wei; Niu, Weibo; Liu, Enyu; Peng, Cheng; Lin, Pengfei; Li, Peng; Khan, Abdul Qadir

2011-04-01

Transvaginal cholecystectomy has been performed successfully at several research institutions worldwide using natural orifice transluminal endoscopic surgery (NOTES) techniques. However, it is a growing new surgical concept in China. Several technical challenges hinder the safe clinical application of NOTES. This study investigated transvaginal endoscopic cholecystectomy performed with the assistance of a single umbilical trocar and achieved helpful initial clinical experience. From May 2009 to April 2010, a total of 43 transvaginal human cholecystectomies were performed. A single umbilical trocar was used for safe access and laparoscopic assistance during the operation. After the gallbladder had been removed through the vagina, the colpotomy was closed with absorbable stitches under direct vision. In addition, Student's t-test was performed for two samples to estimate the superiority of NOTES over a conventional laparoscopic cholecystectomy (LC) operation. The procedure was successfully completed for all the patients. No intra- or post-operative complications occurred. The patients recovered promptly after surgery, and all were satisfied with ideal cosmetic outcomes. The postoperative pain, hospital stay, and cost of hospitalization with NOTES were much less than with conventional LC operations. Although endoscopic instruments specifically designed for NOTES are not available, the addition of an umbilical trocar is an optimal way to allow safe performance of NOTES procedures in an easily reproducible manner. The authors' initial experience demonstrates that this hybrid technique is potentially feasible and effective for reducing postoperative pain and recovery times while improving the cosmetic results of transvaginal cholecystectomy.

Novel type of peritoneocentesis trocar-assisted distal ventriculoperitoneal shunt placement with supervision via a one-port laparoscope

PubMed Central

Wang, Guangming; Yu, Jinlu; Luan, Yongxin; Han, Yanwu; Fu, Shuanglin

2017-01-01

Ventriculoperitoneal shunts (VPS) are the primary treatment for hydrocephalus and are associated with a high risk of complications, specifically in patients who are obese or have abdominal adhesions or shunt revisions. The present study describes the use of a novel type of peritoneal catheter peritoneocentesis trocar insertion with the assistance of a one-port laparoscope. A total of 36 patients with hydrocephalus underwent this novel type of peritoneocentesis trocar-assisted VPS. The distal shunt catheter was placed into the right subdiaphragmatic space and the catheter was traversed through a single hole drilled through the liver falciform ligament. The duration of the laparoscopic surgery ranged from 6–18 min (mean 10.4±1.6 min). No shunt-related infections or catheter malfunctions or injuries to the intra-abdominal organs occurred. The total abdominal incision length was 1.0 cm (0.5+0.5 cm). No laparoscopy-related complications were observed during follow-up assessments. The novel approach used in the current study is very easy to perform, and this method may significantly reduce the risk of malfunction complications. The presented method also has the advantages of reduced trauma and a simpler surgery. The current study indicated that this simple, minimally invasive procedure was beneficial for patients with hydrocephalus, specifically in cases of patients with obesity, peritoneal adhesions or shunt revisions. PMID:29042927

Novel type of peritoneocentesis trocar-assisted distal ventriculoperitoneal shunt placement with supervision via a one-port laparoscope.

PubMed

Wang, Guangming; Yu, Jinlu; Luan, Yongxin; Han, Yanwu; Fu, Shuanglin

2017-10-01

Ventriculoperitoneal shunts (VPS) are the primary treatment for hydrocephalus and are associated with a high risk of complications, specifically in patients who are obese or have abdominal adhesions or shunt revisions. The present study describes the use of a novel type of peritoneal catheter peritoneocentesis trocar insertion with the assistance of a one-port laparoscope. A total of 36 patients with hydrocephalus underwent this novel type of peritoneocentesis trocar-assisted VPS. The distal shunt catheter was placed into the right subdiaphragmatic space and the catheter was traversed through a single hole drilled through the liver falciform ligament. The duration of the laparoscopic surgery ranged from 6-18 min (mean 10.4±1.6 min). No shunt-related infections or catheter malfunctions or injuries to the intra-abdominal organs occurred. The total abdominal incision length was 1.0 cm (0.5+0.5 cm). No laparoscopy-related complications were observed during follow-up assessments. The novel approach used in the current study is very easy to perform, and this method may significantly reduce the risk of malfunction complications. The presented method also has the advantages of reduced trauma and a simpler surgery. The current study indicated that this simple, minimally invasive procedure was beneficial for patients with hydrocephalus, specifically in cases of patients with obesity, peritoneal adhesions or shunt revisions.

[A new low-cost webcam-based laparoscopic training model].

PubMed

Langeron, A; Mercier, G; Lima, S; Chauleur, C; Golfier, F; Seffert, P; Chêne, G

2012-01-01

To validate a new laparoscopy home training model (GYN Trainer®) in order to practise and learn basic laparoscopic surgery. Ten junior surgical residents and six experienced operators were timed and assessed during six laparoscopic exercises performed on the home training model. Acquisition of skill was 35%. All the novices significantly improved performance in surgical skills despite an 8% partial loss of acquisition between two training sessions. Qualitative evaluation of the system was good (3.8/5). This low-cost personal laparoscopic model seems to be a useful tool to assist surgical novices in learning basic laparoscopic skills. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Health resource use after robot-assisted surgery vs open and conventional laparoscopic techniques in oncology: analysis of English secondary care data for radical prostatectomy and partial nephrectomy.

PubMed

Hughes, David; Camp, Charlotte; O'Hara, Jamie; Adshead, Jim

2016-06-01

To evaluate postoperative health resource utilisation and secondary care costs for radical prostatectomy and partial nephrectomy in National Health Service (NHS) hospitals in England, via a comparison of robot-assisted, conventional laparoscopic and open surgical approaches. We retrospectively analysed the secondary care records of 23 735 patients who underwent robot-assisted (RARP, n = 8 016), laparoscopic (LRP, n = 6 776) or open radical prostatectomy (ORP, n = 8 943). We further analysed 2 173 patients who underwent robot-assisted (RAPN, n = 365), laparoscopic (LPN, n = 792) or open partial nephrectomy (OPN, n = 1 016). Postoperative inpatient admissions, hospital bed-days, excess bed-days and outpatient appointments at 360 and 1 080 days after surgery were reviewed. Patients in the RARP group required significantly fewer inpatient admissions, hospital bed-days and excess bed-days at 360 and 1 080 days than patients undergoing ORP. Patients undergoing ORP had a significantly higher number of outpatient appointments at 1 080 days. The corresponding total costs were significantly lower for patients in the RARP group at 360 days (£1679 vs £2031 for ORP; P < 0.001) and at 1 080 days (£3461 vs £4208 for ORP; P < 0.001). In partial nephrectomy, Patients in the RAPN group required significantly fewer inpatient admissions and hospital bed-days at 360 days compared with those in the OPN group; no significant differences were observed in outcomes at 1 080 days. The corresponding total costs were lower for patients in the RAPN group at 360 days (£779 vs £1242 for OPN, P = 0.843) and at 1 080 days (£2122 vs £2889 for ORP; P = 0.570). For both procedure types, resource utilisation and costs for laparoscopic surgeries lay at the approximate midpoint of those for robot-assisted and open surgeries. Our analysis provides compelling evidence to suggest that RARP leads to reduced long-term health resource utilisation and downstream cost savings compared with traditional

Hybrid laparoscopic and robotic ultrasound-guided radiofrequency ablation-assisted clampless partial nephrectomy.

PubMed

Nadler, Robert B; Perry, Kent T; Smith, Norm D

2009-07-01

To describe a clampless approach made possible by creating an avascular plane of tissue with radiofrequency ablation. Laparoscopic partial nephrectomy is slowly gaining acceptance as a method to treat small (<4 cm) and select moderate (<7 cm) renal masses. The intricacies of laparoscopic suturing, which result in prolonged warm ischemia times, have delayed the widespread acceptance of this technique among urologists. Laparoscopic suturing to close the collecting system was done using the da Vinci robot. An avascular plane of tissue from coagulation necrosis was achieved with the Habib 4X radiofrequency ablation device and the Rita 1500X generator. Typically, we used a power setting of 50 W but have found settings as low as 25 W necessary to provide hemostasis for larger vessels. The tumor was then sharply excised with a negative margin using robotic scissors and electrocautery to facilitate tissue cutting. Retrograde injection of methylthioninium chloride and saline through an externalized ureteral catheter allowed for precise sutured closure of the collecting system. FloSeal and BioGlue were then applied, making surgical bolsters or parenchymal sutures unnecessary. Intraoperative histologic evaluation of the surgical margin and repeat resection of the tumor bed was possible because the renal hilum was not clamped, and no warm ischemia was used. This technique, which combines the improving technologies of robotic surgery, intraoperative laparoscopic ultrasonography, and radiofrequency ablation, might make more surgeons comfortable with the intricacies of laparoscopic suturing and eliminate prolonged warm ischemia times. Overall, this method should result in more patients being able to undergo minimally invasive laparoscopic partial nephrectomy.

[Comparison of the safety and the costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and BillrothII(+Braun reconstruction--a single center prospective cohort study].

PubMed

Wang, Yinkui; Li, Ziyu; Shan, Fei; Zhang, Lianhai; Li, Shuangxi; Jia, Yongning; Chen, Yufan; Xue, Kan; Miao, Rulin; Li, Zhemin; Gao, Xiangyu; Yan, Chao; Li, Shen; Wu, Zhouqiao; Ji, Jiafu

2018-03-25

To compare the short-term safety and costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and Billroth II((BII() + Braun reconstruction after radical gastrectomy of distal gastric cancer. Clinical data from our prospective database of radical gastrectomy were systematically analyzed. The patients who underwent laparoscopic gastrectomy with uncut Roux-en-Y or BII(+ Braun reconstruction between March 1st, 2015 and June 30th, 2017 were screened out for further analysis. Both the reconstructions were completed by linear staplers. Uncut Roux-en-Y reconstruction was performed with a 45 mm no-knife linear stapler (ATS45NK) on the afferent loop below the gastrojejunostomy. Continuous variables were compared using independent samples t test or Mann-Whitney U. The frequencies of categorical variables were compared using Chi-squared or Fisher exact test. Eighty-one patients were in uncut Roux-en-Y group and 58 patients were in BII(+Braun group. There were no significant differences between uncut Roux-en-Y group and BII(+Braun group in median age (56.0 years vs. 56.5 years, P=0.757), gender (male/female, 52/29 vs. 46/12, P=0.054), history of abdominal surgery (yes/no, 10/71 vs. 4/54, P=0.293), neoadjuvant chemotherapy (yes/no, 21/60 vs. 11/47, P=0.336), BMI (thin/normal/overweight/obesity, 2/49/26/3 vs. 3/39/14/2, P=0.591), NRS 2002 score (1/2/3/4, 58/15/5/3 vs. 47/5/3/3, P=0.403), pathological stage (0/I(/II(/III(, 3/41/20/17 vs. 1/28/13/16, P=0.755), median tumor diameter in long axis (2.5 cm vs. 3.0 cm, P=0.278), median tumor diameter in short axis (2.0 cm vs. 2.0 cm, P=0.126) and some other clinical and pathological characteristics. There were no significant differences between uncut Roux-en-Y group and BII(+Braun group in morbidity of postoperative complication more severe than grade I([12.3% (10/81) vs. 17.2% (10/58), P=0.417], morbidity of anastomotic complication [1.2%(1/81) vs. 0, P=1.000] or hospitalization costs [(94000±14000) yuan vs.(95000�

Learning curve of robot-assisted laparoscopic radical prostatectomy for a single experienced surgeon: comparison with simultaneous laparoscopic radical prostatectomy.

PubMed

Ku, Ja Yoon; Ha, Hong Koo

2015-04-01

Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. Mean operation time and length of hospital stay for RARP and LRP were 145.5±43.6 minutes and 118.1±39.1 minutes, and 6.4±0.9 days and 6.6±1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.

Role of leptin in body temperature regulation and lipid metabolism following splenectomy.

PubMed

Rosa, T S; Amorim, C E N; Barros, C C; Haro, A S; Wasinski, F; Russo, F J; Bacurau, R F P; Araujo, R C

2015-12-01

The physiological changes in serum triglycerides and body temperature that are induced by splenectomy are poorly understood. Therefore, the aim of this study was to investigate parameters related to lipid and glucose metabolism, as well as thermoregulation, in splenectomized mice. Splenectomized and sham-operated WT mice (C57Bl/6) and ob/ob mice were randomly divided and treated with a standard or high fat diet, and several metabolic parameters and the body temperature were investigated. Splenectomy induced a significant increase in triglyceride levels regardless of the diet. It was found that the splenectomized WT mice showed greater serum leptin and insulin levels compared with the sham-operated mice. Additionally, the body temperatures of the splenectomized WT mice were greater than the body temperatures of the control animals regardless of diet; this result too was observed without any significant change in the temperature of the splenectomized ob/ob animals. The results suggest that splenectomy interferes with serum triglyceride metabolism and body temperature regardless of the fat content in the diet and that leptin is involved in the regulation of body temperature related to splenectomy.

Pre-bent instruments used in single-port laparoscopic surgery versus conventional laparoscopic surgery: comparative study of performance in a dry lab.

PubMed

Miernik, Arkadiusz; Schoenthaler, Martin; Lilienthal, Kerstin; Frankenschmidt, Alexander; Karcz, Wojciech Konrad; Kuesters, Simon

2012-07-01

Different types of single-incision laparoscopic surgery (SILS) have become increasingly popular. Although SILS is technically even more challenging than conventional laparoscopy, published data of first clinical series seem to demonstrate the feasibility of these approaches. Various attempts have been made to overcome restrictions due to loss of triangulation in SILS by specially designed SILS-specific instruments. This study involving novices in a dry lab compared task performances between conventional laparoscopic surgery (CLS) and single-port laparoscopic surgery (SPLS) using newly designed pre-bent instruments. In this study, 90 medical students without previous experience in laparoscopic techniques were randomly assigned to undergo one of three procedures: CLS, SPLS using two pre-bent instruments (SPLS-pp), or SPLS using one pre-bent and one straight laparoscopic instrument (SPLS-ps). In the dry lab, the participants performed four typical laparoscopic tasks of increasing difficulty. Evaluation included performance times or number of completed tasks within a given time frame. All performances were videotaped and evaluated for unsuccessful attempts and unwanted interactions of instruments. Using subjective questionnaires, the participants rated difficulties with two-dimensional vision and coordination of instruments. Task performances were significantly better in the CLS group than in either SPLS group. The SPLS-ps group showed a tendency toward better performances than the SPLS-pp group, but the difference was not significant. Video sequences and participants` questionnaires showed instrument interaction as the major problem in the single-incision surgery groups. Although SILS is feasible, as shown in clinical series published by laparoscopically experienced experts, SILS techniques are demanding due to restrictions that come with the loss of triangulation. These can be compensated only partially by currently available SILS-designed instruments. The future of

Laparoscopic management of diaphragmatic endometriosis by three different approaches.

PubMed

Roman, Horace; Darwish, Basma; Provost, Delphine; Baste, Jean-Marc

2016-08-01

To report our three surgical approaches in the management of diaphragmatic endometriosis. Video article presenting laparoscopic surgical techniques, with and without robotic assistance. University hospital. Nulliparas with deep endometriosis associated with multiple endometriosis lesions of the diaphragm. Laparoscopic approach in women who present with small black-pigmented diaphragmatic lesions, with or without infiltration of the diaphragm, which are ablated using plasma energy. Robotic-assisted laparoscopic route in larger deep infiltrating implants, which are resected. To avoid phrenic nerve injury, robotic-assisted thoracoscopy is preferred in large lesions involving the central tendon of the diaphragm. The steps of each technique are emphasized. Surgical technique reports in anonymous patients are exempted from ethical approval by the Institutional Review Board. Seven patients have been managed by these procedures from July 2015 to March 2016. Patients' functional outcomes were uneventful, with no phrenic nerve palsy or residual chest and right shoulder pain. By combining resection and ablation techniques, the laparoscopy and thoracoscopy route, conventional and robotic-assisted minimally invasive approach, we offer a surgical strategy that is as conservative as possible, with an aim to limit postoperative adhesions between the liver and the diaphragm, and avoid diaphragmatic paralysis. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

A Kalman-Filter-Based Common Algorithm Approach for Object Detection in Surgery Scene to Assist Surgeon's Situation Awareness in Robot-Assisted Laparoscopic Surgery

PubMed Central

2018-01-01

Although the use of the surgical robot is rapidly expanding for various medical treatments, there still exist safety issues and concerns about robot-assisted surgeries due to limited vision through a laparoscope, which may cause compromised situation awareness and surgical errors requiring rapid emergency conversion to open surgery. To assist surgeon's situation awareness and preventive emergency response, this study proposes situation information guidance through a vision-based common algorithm architecture for automatic detection and tracking of intraoperative hemorrhage and surgical instruments. The proposed common architecture comprises the location of the object of interest using feature texture, morphological information, and the tracking of the object based on Kalman filter for robustness with reduced error. The average recall and precision of the instrument detection in four prostate surgery videos were 96% and 86%, and the accuracy of the hemorrhage detection in two prostate surgery videos was 98%. Results demonstrate the robustness of the automatic intraoperative object detection and tracking which can be used to enhance the surgeon's preventive state recognition during robot-assisted surgery. PMID:29854366

Impact of laparoscopic surgery training laboratory on surgeon's performance

PubMed Central

Torricelli, Fabio C M; Barbosa, Joao Arthur B A; Marchini, Giovanni S

2016-01-01

Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination. PMID:27933135

Trifecta outcomes after robotic-assisted laparoscopic prostatectomy.

PubMed

Shikanov, Sergey A; Zorn, Kevin C; Zagaja, Gregory P; Shalhav, Arieh L

2009-09-01

To evaluate the trifecta outcomes following robotic-assisted laparoscopic prostatectomy (RALP) and compare the results applying definitions of continence and potency as reported in the literature vs validated questionnaire. The trifecta rate of achieving continence, potency, and undetectable prostate-specific antigen (PSA) following radical prostatectomy has been estimated to be approximately 60% at 1-2 years in open radical prostatectomy series. The definitions of continence and potency were not standardized, which poses difficulty in comparing published results. A prospective, institutional RALP database was analyzed for preoperatively continent and potent men with >/= 1 year follow-up after bilateral nerve-sparing surgery. Continence and potency were evaluated preoperatively and at 3, 6, 12, and 24 months after surgery by surgeon interview (subjective) and using University of California Los-Angeles Prostate Cancer Index self-administered questionnaire (objective). Biochemical recurrence was defined as a detectable (> 0.05 ng/mL), increasing PSA on 2 consecutive tests. Among 1362 consecutive RALPs, 380 patients were preoperatively potent and continent underwent surgery with bilateral nerve-sparing technique and had sufficient follow-up. Trifecta rates applying subjective continence and potency definitions were 34%, 52%, 71%, and 76% at 3, 6, 12, and 24 months, respectively. The corresponding trifecta rates using objective continence and potency definitions stood at 16%, 31%, 44%, and 44%. The difference was statistically significant at each time point (P < .0001). RALP provides trifecta outcome rates comparable to open surgery. The outcome rates vary significantly depending on the tools used for continence and potency evaluation.

[Splenectomy in osteomyelofibrosis. Indications and outcome].

PubMed

Böhner, H; Rötzscher, V M; Tirier, C; Heit, W; Greiner, J

1996-10-01

Osteomyelofibrosis is a myeloproliferative disorder in which fibrosis and sclerosis finally lead to bone marrow obliteration. Liver and spleen compensate for bone marrow loss with extramedullary hematopoiesis. In some patients the resulting splenomegaly causes severe symptoms such as local compression, thrombocytopenia and hemolytic anemia. In such patients, splenectomy is the only promising treatment, although it represents a significant risk.

Laparoscopic baseline ability assessment by virtual reality.

PubMed

Madan, Atul K; Frantzides, Constantine T; Sasso, Lisa M

2005-02-01

Assessment of any surgical skill is time-consuming and difficult. Currently, there are no accepted metrics for most surgical skills, especially laparoscopic skills. Virtual reality has been utilized for laparoscopic training of surgical residents. Our hypothesis is that this technology can be utilized for laparoscopic ability metrics. This study involved medical students with no previous laparoscopic experience. All students were taken into a porcine laboratory in order to assess two operative tasks (measuring a piece of bowel and placing a piece of bowel into a laparoscopic bag). Then they were taken into an inanimate lab with a Minimally Invasive Surgery Trainer-Virtual Reality (MIST-VR). Each student repeatedly performed one task (placing a virtual reality ball into a receptacle). The students' scores and times from the animate lab were compared with average economy of movement and times from the MIST-VR. The MIST-VR scored both hands individually. Thirty-two first- and second-year medical students were included in the study. There was statistically significant (P < 0.05) correlation between 11 of 16 possible relationships between the virtual reality trainer and operative tasks. While not all of the possible relationships demonstrated statistically significant correlation, the majority of the possible relationships demonstrated statistically significant correlation. Virtual reality may be an avenue for measuring laparoscopic surgical ability.

Hand gesture guided robot-assisted surgery based on a direct augmented reality interface.

PubMed

Wen, Rong; Tay, Wei-Liang; Nguyen, Binh P; Chng, Chin-Boon; Chui, Chee-Kong

2014-09-01

Radiofrequency (RF) ablation is a good alternative to hepatic resection for treatment of liver tumors. However, accurate needle insertion requires precise hand-eye coordination and is also affected by the difficulty of RF needle navigation. This paper proposes a cooperative surgical robot system, guided by hand gestures and supported by an augmented reality (AR)-based surgical field, for robot-assisted percutaneous treatment. It establishes a robot-assisted natural AR guidance mechanism that incorporates the advantages of the following three aspects: AR visual guidance information, surgeon's experiences and accuracy of robotic surgery. A projector-based AR environment is directly overlaid on a patient to display preoperative and intraoperative information, while a mobile surgical robot system implements specified RF needle insertion plans. Natural hand gestures are used as an intuitive and robust method to interact with both the AR system and surgical robot. The proposed system was evaluated on a mannequin model. Experimental results demonstrated that hand gesture guidance was able to effectively guide the surgical robot, and the robot-assisted implementation was found to improve the accuracy of needle insertion. This human-robot cooperative mechanism is a promising approach for precise transcutaneous ablation therapy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Role of splenectomy in the treatment of non-cirrhotic portal hypertension: about 3 cases].

PubMed

Belhamidi, Mohamed Said; Hammi, Salah Eddine; Bouzroud, Mohamed; Benmoussa, Mustapha; Ali, Abdelmounaim Ait; Bounaim, Ahmed

2017-01-01

Non-cirrhotic portal hypertension was first described by Guido BANTI in 1898 as a condition characterized by the association of portal hypertension with splenomegaly, anemia and healthy liver. The diagnosis was based on abdominal ultrasound, splenoportography and liver biopsy. Our study aimed to evaluate the role of splenectomy in non-cirrhotic portal hypertension. We conducted a retrospective study of 3 patients (2 women and 1 man) treated by our staff over the period January 2010 -September 2016. The diagnosis of idiopathic portal hypertension was based on the following criteria: portal hypertension, the presence of oesophageal varices associated with splenomegaly, the absence of cirrhosis or of other liver disorders responsible of portal hypertension. All patients underwent splenectomy. Outcome after splenectomy was marked by the standardization of clinical, radiological and biological signs of this disease associated with the absence of oesophageal varices recurrence. Splenectomy associated with ligation of oesophageal varices may be sufficient to treat this syndrome and especially its consequences without using splenorenal bypass.

Residents' performance in open versus laparoscopic bench-model cholecystectomy in a hands-on surgical course.

PubMed

Nebiker, Christian Andreas; Mechera, Robert; Rosenthal, Rachel; Thommen, Sarah; Marti, Walter Richard; von Holzen, Urs; Oertli, Daniel; Vogelbach, Peter

2015-07-01

Laparoscopy has become the gold standard for many abdominal procedures. Among young surgeons, experience in laparoscopic surgery increasingly outweighs experience in open surgery. This study was conducted to compare residents' performance in laparoscopic versus open bench-model task. In an international surgical skills course, we compared trainees' performance in open versus laparoscopic cholecystectomy in a cadaveric animal bench-model. Both exercises were evaluated by board-certified surgeons using an 8-item checklist and by the trainees themselves. 238 trainees with a median surgical experience of 24 months (interquartile range 14-48) took part. Twenty-two percent of the trainees had no previous laparoscopic and 62% no previous open cholecystectomy experience. Significant differences were found in the overall score (median difference of 1 (95% CI: 1, 1), p < 0.001), gallbladder perforation rate (73% vs. 29%, p < 0.001), safe dissection of the Calot's triangle (98% vs. 90%, p = 0.001) and duration of surgery (42 (13) minutes vs. 26 (10) minutes (mean differences 17.22 (95% CI: 15.37, 19.07), p < 0.001)), all favouring open surgery. The perforation rate in open and laparoscopic cholecystectomies was not consistently decreasing with increasing years of experience or number of previously performed procedures. Self-assessment was lower than the assessment by board-certified surgeons. Despite lower experience in open compared to laparoscopic cholecystectomy, better performance was observed in open task. It may be explained by a wider access with easier preparation. Open cholecystectomy is the rescue manoeuvre and therefore, it is important to provide also enough training opportunities in open surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs.

PubMed

Maki, Lynn C; Males, Kristina N; Byrnes, Madeline J; El-Saad, Anthony A; Coronado, George S

2017-12-01

There is contradicting information in the veterinary literature regarding canine splenectomy and the increased risk for subsequent gastric dilatation-volvulus. The main purpose of this study was to determine the rate of occurrence of gastric dilatation-volvulus following splenectomy in medium to large breed dogs compared with a control group undergoing other abdominal procedures. Follow-up was performed by reviewing the medical records and conducting phone interviews. Weight, gender, and presence of a hemoabdomen at the time of surgery were not significantly associated with occurrence of gastric dilatation-volvulus, while increasing age was. Ten of 238 (4%) dogs in the splenectomy group and 3/209 (1.4%) dogs in the control group subsequently developed gastric dilatation-volvulus, which was not significantly different ( P = 0.08). While the findings approach significance and support a need for future investigation, the current recommendation for gastropexy at time of splenic removal should be made on a case by case basis and while considering previously documented risk factors.

[Laparoscopic surgery for malignancies of the colon, rectum, and anus in Lithuania in 2008].

PubMed

Samalavicius, Narimantas Evaldas; Rudinskaite, Giedre; Pavalkis, Dainius; Latkauskas, Tadas; Kaselis, Nerijus; Sidlauskas, Zilvinas; Sniuolis, Pranas; Poskus, Tomas; Kvedaras, Vytautas; Strupas, Kestutis; Poskus, Eligijus

2009-01-01

THE OBJECTIVE OF THIS STUDY: was to analyze data on laparoscopic surgery for malignant diseases of the colon, rectum, and anus in Lithuania during the period of January 1, 2005, to February 15, 2008. During the above-mentioned period in Lithuania, 130 laparoscopic surgeries for malignancies of colon, rectum, and anus were performed in seven different hospitals. There were 73 males and 57 females with a mean age of 68 years (range, 35-85 years). Laparoscopic procedures were attempted in 140 cases. Out of them, 130 were completed laparoscopically; 10 operations were converted to open, and conversion rate was 7.1%. Twenty-seven (20.8%) patients had stage I, 45 (34.6%) stage II, 45 (34.6%) stage III, and 13 (10%) stage IV disease. Ninety-two (70.8%) patients underwent straight laparoscopic surgery and 38 (29.2%) - hand-assisted laparoscopic surgery. Time in surgery was from 50 to 365 min, with a mean of 183 min. During 130 operations, in 11 (8.5%) cases, blood vessels were ligated through specimen retrieval site. Out of 104 operations, where anastomosis was performed (23 abdominoperineal resections and 3 Hartmann's procedures), in 68 (65.4%) cases it was done laparoscopically and in 36 (34.6%) cases using conventional extracorporal suturing. Hospital stay ranged from 7 to 59 days, with a mean of 12 days. One (0.8%) patient died. Postoperative complications occurred in 27 (20.8%) cases. Reoperation rate was 4.6% (6 cases). Complications were as follows: suture insufficiency (3 cases), eventration (3 cases), wound infection (7 cases), intraperitoneal abscess (1 case), abdominal wall phlegmon (1 case), intra-abdominal infiltrate (1 case), perineal hematoma (1 case), proctovaginal fistula (2 case), intraoperative bleeding from uterus (1 case), urinary retention (4 cases), cystitis (1 case), pneumonia (1 case), acute cardiovascular insufficiently (1 case). In histological specimens, 10 lymph nodes were found on the average (range, 2 to 27). Laparoscopic surgery for

Superpixel-based structure classification for laparoscopic surgery

NASA Astrophysics Data System (ADS)

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

2016-03-01

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

Management of the ventriculo-peritoneal shunt in pediatric patients during robot-assisted laparoscopic urologic procedures.

PubMed

Marchetti, Pablo; Razmaria, Aria; Zagaja, Greg P; Gundeti, Mohan S

2011-02-01

Infection or malfunction of ventriculo-peritoneal (VP) shunts is a severe complication during laparoscopic surgery involving the gastrointestinal or urinary tract. It has been recently suggested to externalize the shunt or convert into a ventriculo-atrial shunt to prevent this complication with laparoscopic approach. Herein, we present a novel technique for management of the VP shunt during robot-assisted laparoscopic (RAL) urologic procedures. After port placement and diagnostic peritoneoscopy, an Endopouch bag (Ethicon Endo-Surgery) was inserted into the peritoneal cavity and the distal end of the shunt was placed into the pouch. The Endopouch suture was synched around the shunt and the pouch was placed in the subhepatic space during the surgery. The intraperitoneal pressure was maintained at 12 mm Hg during the entire procedure. Metronidazole, gentamicin, and vancomycin were administered as prophylaxis. Following the completion of the surgery and profuse irrigation of the peritoneal cavity, the shunt was repositioned within the peritoneum. We evaluated perioperative shunt-related complications. We used this technique in four patients with VP shunt undergoing RAL cystoplasty and appendicovesicostomy and/or colonic enema channel formation. The average age of the patient at surgery was 10.8 (7-14) years. One patient was converted to open because of failure to progress due to multiple adhesions and the shunt was externalized temporarily. At a mean follow-up of 13 (3-20) months, no shunt-related complications were seen. In our preliminary experience, the use of an intracorporeal Endopouch bag with controlled pneumoperitoneal pressure to protect the VP shunt may be an effective alternative to prevent complications related to it during RAL urologic surgery involving the gastrointestinal or urinary tract. Further studies will be needed to confirm our results.

Preemptive multimodal pain regimen reduces opioid analgesia for patients undergoing robotic-assisted laparoscopic radical prostatectomy.

PubMed

Trabulsi, Edouard J; Patel, Jitesh; Viscusi, Eugene R; Gomella, Leonard G; Lallas, Costas D

2010-11-01

Minimally invasive surgical techniques have many benefits, including reduced postoperative pain. Despite this, most patients require opioid analgesia, which can have significant side effects and toxicity. We report the first urologic study using multimodal analgesia with pregabalin, a gabapentinoid. The present retrospective study included 60 patients who underwent robotic-assisted laparoscopic radical prostatectomy. Of the 60 patients, 30 received multimodal treatment with pregabalin 150 mg, acetaminophen 975 mg, and celecoxib 400 mg orally 2 hours before the start of the procedure and continued postoperatively. These patients were compared with 30 consecutive previous patients, who had received a standard postoperative analgesic regimen with intravenous ketorolac 15 mg every 6 hours with oxycodone 5 mg and acetaminophen 325 mg, 1 to 2 tablets, every 4 hours as needed for pain. The patients in the multimodal treatment group had a significantly reduced intraoperative opioid requirement, as measured by the mean morphine equivalent dose administered (38.4 ± 2.73 mg vs 49.1 ± 2.65 mg; P < .01). The mean postoperative opioid use was also significantly reduced (10.7 ± 2.82 mg vs 26.2 ± 6.56 mg; P = .034), as was the mean total morphine equivalent dose administered (49.1 ± 2.7 mg vs 75.3 ± 4.6 mg; P < .001). The operative time, estimated operative blood loss, antiemetic use, postoperative creatinine and hemoglobin levels, and length of stay were similar in the 2 groups. No operative or treatment complications occurred in either group. The present retrospective review has indicated that a multimodal analgesic approach with pregabalin and celecoxib administered preoperatively decreases intraoperative and postoperative opioid use in patients undergoing robotic-assisted laparoscopic radical prostatectomy. Copyright © 2010 Elsevier Inc. All rights reserved.

Infectious complications after surgical splenectomy in children with sickle cell disease

PubMed Central

Monaco, Cypriano Petrus; Fonseca, Patricia Belintani Blum; Braga, Josefina Aparecida Pellegrini

2015-01-01

OBJECTIVE: To evaluate the frequency of infectious complications in children with sickle cell disease (SCD) after surgical splenectomy for acute splenic sequestration crisis. METHODS: Retrospective cohort of children with SCD who were born after 2002 and were regularly monitored until July 2013. Patients were divided into two groups: cases (children with SCD who underwent surgical splenectomy after an episode of splenic sequestration) and controls (children with SCD who did not have splenic sequestration and surgical procedures), in order to compare the frequency of invasive infections (sepsis, meningitis, bacteremia with positive blood cultures, acute chest syndrome and/or pneumonia) by data collected from medical records. Data were analyzed by descriptive statistical analysis. RESULTS: 44 patients were included in the case group. The mean age at the time of splenectomy was 2.6 years (1-6.9 years) and the mean postoperative length of follow-up was 6.1 years (3.8-9.9 years). The control group consisted of 69 patients with a mean age at the initial follow-up visit of 5.6 months (1-49 months) and a mean length of follow-up of 7.2 years (4-10.3 years).All children received pneumococcal conjugate vaccine. No significant difference was observed between groups in relation to infections during the follow-up. CONCLUSIONS: Surgical splenectomy in children with sickle cell disease that had splenic sequestration did not affect the frequency of infectious complications during 6 years of clinical follow-up. PMID:25913493

The European Academy laparoscopic “Suturing Training and Testing’’ (SUTT) significantly improves surgeons’ performance

PubMed Central

Sleiman, Z.; Tanos, V.; Van Belle, Y.; Carvalho, J.L.; Campo, R.

2015-01-01

The efficiency of suturing training and testing (SUTT) model by laparoscopy was evaluated, measuring the suturingskill acquisition of trainee gynecologists at the beginning and at the end of a teaching course. During a workshop organized by the European Academy of Gynecological Surgery (EAGS), 25 participants with three different experience levels in laparoscopy (minor, intermediate and major) performed the 4 exercises of the SUTT model (Ex 1: both hands stitching and continuous suturing, Ex 2: right hand stitching and intracorporeal knotting, Ex 3: left hand stitching and intracorporeal knotting, Ex 4: dominant hand stitching, tissue approximation and intracorporeal knotting). The time needed to perform the exercises is recorded for each trainee and group and statistical analysis used to note the differences. Overall, all trainees achieved significant improvement in suturing time (p < 0.005) as measured before and after completion of the training. Similar significantly improved suturing time differences (p < 0.005) were noted among the groups of trainees with different laparoscopic experience. In conclusion a short well-guided training course, using the SUTT model, improves significantly surgeon’s laparoscopic suturing ability, independently of the level of experience in laparoscopic surgery. Key words: Endoscopy, laparoscopic suturing, psychomotor skills, surgery, teaching, training suturing model. PMID:26977264

Bladder injuries during laparoscopic orchiopexy: incidence and lessons learned.

PubMed

Hsieh, Michael H; Bayne, Aaron; Cisek, Lars J; Jones, Eric A; Roth, David R

2009-07-01

Laparoscopic orchiopexy is a safe operation. However, the bladder can be injured during creation of the transperitoneal tunnel for the cryptorchid testis. We reviewed our experience with this complication. We searched the operative notes of patients who had undergone laparoscopic orchiopexy between August 15, 2002 and October 1, 2008, and identified bladder injuries and their treatment. A total of 93 patients underwent laparoscopic orchiopexies for 101 undescended testes during the study interval, with 3 procedures resulting in bladder injuries. The 3 operations varied with regard to whether the injury was recognized intraoperatively or postoperatively, and repaired in an open or laparoscopic fashion. Bladder injury during laparoscopic orchiopexy is a rare but serious complication that can be managed by an open or laparoscopic approach. We recommend placement of a urethral catheter and syringe assisted drainage of all urine from the bladder at the beginning of the operation, careful perivesical dissection particularly in children with prior inguinal surgery, filling and emptying of the bladder during the procedure, and maintaining a high index of suspicion especially when hematuria is observed.

Reduction of wound infections in laparoscopic-assisted colorectal resections by plastic wound ring drapes (REDWIL)?--A randomized controlled trial.

PubMed

Lauscher, J C; Grittner, F; Stroux, A; Zimmermann, M; le Claire, M; Buhr, H J; Ritz, J P

2012-10-01

Surgical site infections (SSIs) are frequent complications in colorectal surgery and may lead to burst abdomen, incisional hernia, and increased perioperative costs. Plastic wound ring drapes (RD) were introduced some decades ago to protect the abdominal wound from bacteria and reduce SSIs. There have been no controlled trials examining the benefit of RD in laparoscopic colorectal surgery. The Reduction of wound infections in laparoscopic assisted colorectal resections by plastic wound ring drapes (REDWIL) trial was thus designed to assess their effectiveness in preventing SSIs after elective laparoscopic colorectal resections. REDWIL is a randomized controlled monocenter trial with two parallel groups (experimental group with RD and control group without RD). Patients undergoing elective laparoscopic colorectal resection were included. The primary endpoint was SSIs. Secondary outcomes were colonization of the abdominal wall with bacteria, reoperations/readmissions, early/late postoperative complications, and cost of hospital stay. The duration of follow-up was 6 months. Between January 2008 and October 2010, 109 patients were randomly assigned to the experimental or control group (with or without RD). Forty-six patients in the RD group and 47 patients in the control group completed follow-up. SSIs developed in ten patients with RD (21.7 %) and six patients without RD (12.8 %) (p = 0.28). An intraoperative swab taken from the abdominal wall was positive in 66.7 % of patients with RD and 57.5 % without RD (p = 0.46). The number of species cultured within one swab was significantly higher in those without RD (p = 0.03). The median total inpatient costs including emergency readmissions were 3,402 ± 4,038 in the RD group and 3,563 ± 1,735 in the control group (p = 0.869). RD do not reduce the rate of SSIs in laparoscopic colorectal surgery. The inpatient costs are similar with and without RD.

Conventional versus robot-assisted laparoscopic Nissen fundoplication: a comparison of postoperative acid reflux parameters.

PubMed

Frazzoni, Marzio; Conigliaro, Rita; Colli, Giovanni; Melotti, Gianluigi

2012-06-01

Laparoscopic Nissen fundoplication (LNF) is a technically demanding surgical procedure designed to cure gastroesophageal reflux disease (GERD). It represents an alternative to life-long medical therapy and the only recommended treatment modality to overcome refractoriness to proton pump inhibitor (PPI) therapy. The recent development of robotic systems prompted evaluation of their use in antireflux surgery. Between 1997 and 2000, in a PPI-responsive series we found postoperative normalization of esophageal acid exposure time (EAET) in most but not all cases. Between 2007 and 2009, in a PPI-refractory series we found postoperative normalization of EAET in all cases. We decided to analyze retrospectively our prospectively collected data to evaluate whether differences other than the conventional or robot-assisted technique could justify postoperative differences in acid reflux parameters. Baseline demographic, endoscopic, and manometric parameters were compared between the two series of patients, as well as postoperative manometric and acid reflux parameters. There were no significant differences in the baseline demographic, endoscopic, and manometric characteristics between the two groups of patients. The median lower esophageal sphincter tone increased significantly, and the median EAET decreased significantly after conventional as well as after robot-assisted LNF. The median postoperative EAET was significantly lower in the robot-assisted (0.2%) than in the conventional LNF group (1%; P = 0.001). Abnormal EAET values were found in 6 of 44 (14%) and in 0 of 44 cases after conventional and robot-assisted LNF, respectively (P = 0.026). Robot-assisted LNF provided a significant gain in postoperative acid reflux parameters compared with the conventional technique. In a challenging clinical setting, such as PPI-refractoriness, in which the efficacy of endoscopic or pharmacological treatment modalities is only moderate, even a small therapeutic gain can be clinically

Full High-definition three-dimensional gynaecological laparoscopy--clinical assessment of a new robot-assisted device.

PubMed

Tuschy, Benjamin; Berlit, Sebastian; Brade, Joachim; Sütterlin, Marc; Hornemann, Amadeus

2014-01-01

To investigate the clinical assessment of a full high-definition (HD) three-dimensional robot-assisted laparoscopic device in gynaecological surgery. This study included 70 women who underwent gynaecological laparoscopic procedures. Demographic parameters, type and duration of surgery and perioperative complications were analyzed. Fifteen surgeons were postoperatively interviewed regarding their assessment of this new system with a standardized questionnaire. The clinical assessment revealed that three-dimensional full-HD visualisation is comfortable and improves spatial orientation and hand-to-eye coordination. The majority of the surgeons stated they would prefer a three-dimensional system to a conventional two-dimensional device and stated that the robotic camera arm led to more relaxed working conditions. Three-dimensional laparoscopy is feasible, comfortable and well-accepted in daily routine. The three-dimensional visualisation improves surgeons' hand-to-eye coordination, intracorporeal suturing and fine dissection. The combination of full-HD three-dimensional visualisation with the robotic camera arm results in very high image quality and stability.

Therapeutic advances: Single incision laparoscopic hepatopancreatobiliary surgery

PubMed Central

Chang, Stephen Kin Yong; Lee, Kai Yin

2014-01-01

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

Laparoscopic distal pancreatectomy preserving the spleen and splenic vessels for benign and low-grade malignant pancreatic neoplasm.

PubMed

Ikeda, Tetsuo; Yoshiya, Shohei; Toshima, Takeo; Harimoto, Norifumi; Yamashita, Youichi; Ikegami, Toru; Yoshizumi, Tomoharu; Soejima, Yuji; Shirabe, Ken; Maehara, Yoshihiko

2013-03-01

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is expected to be less invasive than laparoscopic distal pancreatectomy with splenectomy. However, there are few reports regarding the details of the procedure for LSPDP, and its safety remains unclear. This study aimed to evaluate the feasibility and safety of LSPDP. Six patients underwent LSPDP from March 2009 to February 2013 in our center, and their clinical data and outcomes were reviewed retrospectively. A total of six laparoscopic distal pancreatic resections were attempted in four female and two male patients. All of the operations were successful, with an average operative time of 290.7 min (range: 211-377 min) and an average blood loss of 43.5 g (range: 0-142 g). The mean hospital stay was 11.8 days (range: 9-17days). No obvious pancreatic fistulas occurred, although pseudocysts at the stump of the pancreas were recognized in three patients on CT scans performed at 7 days postoperatively. Postoperative pathological examinations revealed two cases of serous cystadenoma in the body and tail of the pancreas, one case of serous oligocystic adenoma, one case of mucinous cystadenoma, one case of neuroendocrine tumor, and one case of solid-pseudopapillary neoplasm. LSPDP is minimally invasive, safe, and feasible for the management of benign pancreatic tail tumors, with the advantages of earlier recovery and less morbidity from complications.

[Robot assisted Frykman-Goldberg procedure. Case report].

PubMed

Zubieta-O'Farrill, Gregorio; Ramírez-Ramírez, Moisés; Villanueva-Sáenz, Eduardo

2017-12-01

Rectal prolapse is defined as the protrusion of the rectal wall through the anal canal; with a prevalence of less than 0.5%. The most frequent symptoms include pain, incomplete defecation sensation with blood and mucus, fecal incontinence and/or constipation. The surgical approach can be perineal or abdominal with the tendency for minimal invasion. Robot-assisted procedures are a novel option that offer technique advantages over open or laparoscopic approaches. 67 year-old female, who presented with rectal prolapse, posterior to an episode of constipation, that required manual reduction, associated with transanal hemorrhage during defecation and occasional fecal incontinence. A RMI defecography was performed that reported complete rectal and uterine prolapse, and cystocele. A robotic assisted Frykman-Goldberg procedure wass performed. There are more than 100 surgical procedures for rectal prolapse treatment. We report the first robot assisted procedure in Mexico. Robotic assisted surgery has the same safety rate as laparoscopic surgery, with the advantages of better instrument mobility, no human hand tremor, better vision, and access to complicated and narrow areas. Robotic surgery as the surgical treatment is a feasible, safe and effective option, there is no difference in recurrence and function compared with laparoscopy. It facilitates the technique, improves nerve preservation and bleeding. Further clinical, prospective and randomized studies to compare the different minimal invasive approaches, their functional and long term results for this pathology are needed. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Commentary on "a matched comparison of perioperative outcomes of a single laparoscopic surgeon versus a multisurgeon robot-assisted cohort for partial nephrectomy." Ellison JS, Montgomery JS, Wolf Jr JS, Hafez KS, Miller DC, Weizer AZ, Department of Urology, University of Michigan, Ann Arbor, MI, USA: J Urol 2012;188(1):45-50.

PubMed

Kane, Christopher

2013-02-01

Minimally invasive nephron sparing surgery is gaining popularity for small renal masses. Few groups have evaluated robot-assisted partial nephrectomy compared to other approaches using comparable patient populations. We present a matched pair analysis of a heterogeneous group of surgeons who performed robot-assisted partial nephrectomy and a single experienced laparoscopic surgeon who performed conventional laparoscopic partial nephrectomy. Perioperative outcomes and complications were compared. All 249 conventional laparoscopic and robot-assisted partial nephrectomy cases from January 2007 to June 2010 were reviewed from our prospectively maintained institutional database. Groups were matched 1:1 (108 matched pairs) by R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines) nephrometry score, transperitoneal vs retroperitoneal approach, patient age and hilar nature of the tumor. Statistical analysis was done to compare operative outcomes and complications. Matched analysis revealed that nephrometry score, age, gender, tumor side and American Society of Anesthesia physical status classification were similar. Operative time favored conventional laparoscopic partial nephrectomy. During the study period robot-assisted partial nephrectomy showed significant improvements in estimated blood loss and warm ischemia time compared to those of the experienced conventional laparoscopic group. Postoperative complication rates, and complication distributions by Clavien classification and type were similar for conventional laparoscopic and robot-assisted partial nephrectomy (41.7% and 35.0%, respectively). Robot-assisted partial nephrectomy has a noticeable but rapid learning curve. After it is overcome the robotic procedure results in perioperative outcomes similar to those achieved with conventional laparoscopic partial nephrectomy done by an experienced surgeon. Robot-assisted

Matched comparison of primary versus salvage laparoscopic pyeloplasty.

PubMed

Ambani, Sapan N; Yang, David Y; Wolf, J Stuart

2017-06-01

To compare our experience with salvage laparoscopic pyeloplasty, using a matched control set of primary laparoscopic pyeloplasty patients. We retrospectively reviewed patients who underwent laparoscopic pyeloplasty from 1996 to 2014 by a single surgeon. At least 12 months of follow-up was required. Salvage patients were matched 1:3 with primary patients. Matching was based on age ±5 years, body mass index (BMI) ±5, and type of pyeloplasty (dismembered vs. non-dismembered). Primary outcome was failure as defined as re-intervention following laparoscopic pyeloplasty (does not include temporary stenting without definitive retreatment). Of 128 laparoscopic pyeloplasty procedures, ten were salvage. These patients were matched to 26 patients who underwent a primary laparoscopic pyeloplasty in a 1:3 manner. One salvage pyeloplasty failed to match due to BMI, and the closest matches were made. Four salvage patients had one overlapping match, reducing the primary group to 26 patients. There were no differences in pre-, intra-, and postoperative variables between groups, except for operative time (salvage 247 min, primary 175 min, p = 0.03). With similar duration of radiologic and symptomatic follow-up, there was no significant difference in the rate of freedom from intervention. When matching for factors that could affect success, salvage laparoscopic pyeloplasty performed as well as primary pyeloplasty except for a longer operative time. In experienced hands, salvage laparoscopic pyeloplasty for ureteropelvic junction obstruction recurrence after prior pyeloplasty is a safe and effective procedure, and should be considered an excellent alternative to the more commonly recommended endopyelotomy.

Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease.

PubMed

Rosero, Eric B; Kho, Kimberly A; Joshi, Girish P; Giesecke, Martin; Schaffer, Joseph I

2013-10-01

Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy. Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P=.002). In a propensity-matched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80% compared with 8.85%, relative risk 0.99, 95% confidence interval [CI] 0.89-1.09, P=.910). There was a lower incidence of blood transfusions in robotic cases (2.1% compared with 3.1%; P<.001), but patients undergoing robotic hysterectomy were more likely to experience postoperative pneumonia (relative risk 2.2, 95% CI 1.24-3.78, P=.005). The median cost of hospital care was $9,788 (interquartile range $7,105-12,780) for robotic hysterectomy and $7,299 (interquartile range $5,650-9,583) for laparoscopic hysterectomy (P<.001). Hospital costs were on average $2,489 (95% CI $2,313-2,664) higher for patients undergoing robotic hysterectomy. The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more. : II.

Impact of hand dominance, gender, and experience with computer games on performance in virtual reality laparoscopy.

PubMed

Grantcharov, T P; Bardram, L; Funch-Jensen, P; Rosenberg, J

2003-07-01

The impact of gender and hand dominance on operative performance may be a subject of prejudice among surgeons, reportedly leading to discrimination and lack of professional promotion. However, very little objective evidence is available yet on the matter. This study was conducted to identify factors that influence surgeons' performance, as measured by a virtual reality computer simulator for laparoscopic surgery. This study included 25 surgical residents who had limited experience with laparoscopic surgery, having performed fewer than 10 laparoscopic cholecystectomies. The participants were registered according to their gender, hand dominance, and experience with computer games. All of the participants performed 10 repetitions of the six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) within 1 month. Assessment of laparoscopic skills was based on three parameters measured by the simulator: time, errors, and economy of hand movement. Differences in performance existed between the compared groups. Men completed the tasks in less time than women ( p = 0.01, Mann-Whitney test), but there was no statistical difference between the genders in the number of errors and unnecessary movements. Individuals with right hand dominance performed fewer unnecessary movements ( p = 0.045, Mann-Whitney test), and there was a trend toward better results in terms of time and errors among the residence with right hand dominance than among those with left dominance. Users of computer games made fewer errors than nonusers ( p = 0.035, Mann-Whitney test). The study provides objective evidence of a difference in laparoscopic skills between surgeons differing gender, hand dominance, and computer experience. These results may influence the future development of training program for laparoscopic surgery. They also pose a challenge to individuals responsible for the selection and training of the residents.

Robotic-assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation.

PubMed

Zorn, Kevin C; Gofrit, Ofer N; Orvieto, Marcelo A; Mikhail, Albert A; Zagaja, Gregory P; Shalhav, Arieh L

2007-03-01

Robotic-assisted laparoscopic radical prostatectomy (RLRP) is increasingly becoming an alternative to open and laparoscopic radical prostatectomy in the treatment of localized prostate cancer. RLRP has been associated with low morbidity, short convalescence and comparable oncologic and functional outcomes. We report our initial experience of 300 consecutive cases with selective use of interfascial nerve preservation (IFNP). Between February 2003 and September 2005, 300 consecutive men underwent RLRP at our institution. Patients were followed prospectively with validated questionnaires. Mean operative time was 282 minutes with an estimated blood loss of 273 ml. The intra-operative complication rate was 2.3% with no mortality. Return to baseline (RTB) urinary function and subjective continence at 12 months were 71% and 90.2%, respectively. RTB sexual function and subjective potency at 12 months were 53% and 80.4%, respectively. Overall, the positive surgical margin (PSM) rate was 20.9%: 15.1% for pT2 and 52.1% for pT3 disease and 93.1% had an undetectable PSA (<0.1 ng/mL) with a mean follow-up of 17.3 months. Fifty-four percent of PSMs occured in a poster-lateral (PL) location. Retrospectively, IFNP was performed in 86.5% and 62.5% of pT2 and pT3 PSMs, respectively. Pathologic-T3 PSMs were found to occur significantly more often in a PL location when ipsilateral IFNP was performed when compared to non-IFNP (73% vs 33%, p=0.05). IFNP appears to result in favorable return of potency, however, postero-lateral PSMs appear to occur more frequently with this technique. Proper patient selection for robotic surgery and nerve-preservation appears to be critical in order to reduce PSM and optimize the oncologic efficacy of this technology.

Surgical outcomes of total laparoscopic hysterectomy with 2-dimensional versus 3-dimensional laparoscopic surgical systems.

PubMed

Yazawa, Hiroyuki; Takiguchi, Kaoru; Imaizumi, Karin; Wada, Marina; Ito, Fumihiro

2018-04-17

Three-dimensional (3D) laparoscopic surgical systems have been developed to account for the lack of depth perception, a known disadvantage of conventional 2-dimensional (2D) laparoscopy. In this study, we retrospectively compared the outcomes of total laparoscopic hysterectomy (TLH) with 3D versus conventional 2D laparoscopy. From November 2014, when we began using a 3D laparoscopic system at our hospital, to December 2015, 47 TLH procedures were performed using a 3D laparoscopic system (3D-TLH). The outcomes of 3D-TLH were compared with the outcomes of TLH using the conventional 2D laparoscopic system (2D-TLH) performed just before the introduction of the 3D system. The 3D-TLH group had a statistically significantly shorter mean operative time than the 2D-TLH group (119±20 vs. 137±20 min), whereas the mean weight of the resected uterus and mean intraoperative blood loss were not statistically different. When we compared the outcomes for 20 cases in each group, using the same energy sealing device in a short period of time, only mean operative time was statistically different between the 3D-TLH and 2D-TLH groups (113±19 vs. 133±21 min). During the observation period, there was one occurrence of postoperative peritonitis in the 2D-TLH group and one occurrence of vaginal cuff dehiscence in each group, which was not statistically different. The surgeon and assistant surgeons did not report any symptoms attributable to the 3D imaging system such as dizziness, eyestrain, nausea, and headache. Therefore, we conclude that the 3D laparoscopic system could be used safely and efficiently for TLH.

Need and availability of assistive devices to compensate for impaired hand function of individuals with tetraplegia.

PubMed

Wäckerlin, Stephanie; Gemperli, Armin; Sigrist-Nix, Diana; Arnet, Ursina

2018-06-04

Context/Objective To evaluate the availability and self-declared unmet need of assistive devices to compensate for impaired hand function of individuals with tetraplegia in Switzerland. Design Cross-sectional survey. Setting Community. Participants Individuals with tetraplegia, aged 16 years or older, living in Switzerland. Interventions not applicable. Outcome Measures The self-report availability and unmet need of 18 assistive devices for impaired hand function was analyzed descriptively. The availability of devices was further evaluated stratified by sex, age, SCI severity, independence in grooming, time since injury, living situation, working status, and income. Associations between availability of devices and person characteristics were investigated using logistic regression analysis. Results Overall 32.7% of participants had any assistive device for impaired hand function at their disposal. The most frequent devices were adapted cutlery (14.8%), type supports (14.1%), environmental control systems (11.4%), and writing orthosis (10.6%). In the bivariate analysis several factors showed significant associations with at least one assistive device. Nevertheless, when controlling for potential confounding in multivariate analysis only independence in grooming (adapted cutlery, environmental control systems, type support, speech recognition software), SCI severity (writing orthosis, type support), and sex (adapted kitchenware) remained significantly associated with the availability of the mentioned assistive devices. The self-declared unmet need was generally low (0.7% - 4.3%), except for adapted kitchenware with a moderate unmet need (8.9%). Conclusion This study indicates that most individuals with tetraplegia in Switzerland are adequately supplied with assistive devices to compensate for impaired hand function. The availability depends mainly on SCI severity and independence in grooming.

Ureteral injury during gynecological laparoscopic surgeries: report of twelve cases.

PubMed

Gao, Jin-Song; Leng, Jin-Hua; Liu, Zhu-Feng; Shen, Keng; Lang, Jing-He

2007-03-01

To investigate ureteral injury during gynecological laparoscopic surgeries. From January 1990 to December 2005, 12 868 gynecological laparoscopic surgeries were conducted in Peking Union Medical College Hospital with 12 ureteral injuries reported. The present study investigated several aspects, including surgical indications, uterine size, pelvic adhesion, operative procedures, symptoms, diagnostic time and methods, injury site and type, subsequent treatment, and prognosis. The incidence of ureteral injury was 0.093% (12/12 868) in all cases, 0.42% (11/2 586) in laparoscopic hysterectomy [laparoscopically assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH)], and 0.01% (1/10 282) in non-LAVH surgeries. Enlarged uterus, pelvic adhesion, and endometrosis were risk factors associated with ureteral injury. Only one injury was found intraoperatively while others were found postoperatively. The injury sites were at the pelvic brim (2 cases) or the lower part of ureter (10 cases). Patients were treated with ureteral stenting (effective in 2 cases) or laparotomy and open repair. Prognoses were favorable in most cases. Most laparoscopic ureteral injuries occur during laparoscopic hysterectomy. Further evaluation is required when ureteral injury is suspected, and surgical repair is the major treatment for ureteral injury.

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

PubMed Central

Kim, Say-June; Lee, Sang Chul

2015-01-01

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

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

PubMed

Kim, Say-June; Lee, Sang Chul

2015-04-21

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

Robotic-assisted laparoscopic surgery: recent advances in urology.

PubMed

Autorino, Riccardo; Zargar, Homayoun; Kaouk, Jihad H

2014-10-01

The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Resveratrol Reduces the Incidence of Portal Vein System Thrombosis after Splenectomy in a Rat Fibrosis Model

PubMed Central

Xu, Meng; Xue, Wanli; Ma, Zhenhua; Bai, Jigang

2016-01-01

Purpose. To investigate the preventive effect of resveratrol (RES) on the formation of portal vein system thrombosis (PVST) in a rat fibrosis model. Methods. A total of 64 male SD rats, weighing 200–300 g, were divided into five groups: Sham operation, Splenectomy I, Splenectomy II, RES, and low molecular weight heparin (LMWH), with the former two groups as nonfibrosis controls. Blood samples were subjected to biochemical assays. Platelet apoptosis was measured by flow cytometry. All rats were euthanized for PVST detection one week after operation. Results. No PVST occurred in nonfibrosis controls. Compared to Splenectomy II, the incidences of PVST in RES and LMWH groups were significantly decreased (both p < 0.05). Two rats in LMWH group died before euthanasia due to intra-abdominal hemorrhage. In RES group, significant decreases in platelet aggregation, platelet radical oxygen species (ROS) production, and increase in platelet nitric oxide (NO) synthesis and platelet apoptosis were observed when compared with Splenectomy II (all p < 0.001), while in LMWH group only significant decrease in platelet aggregation was observed. Conclusion. Prophylactic application of RES could safely reduce the incidence of PVST after splenectomy in cirrhotic rat. Regulation of platelet function and induction of platelet apoptosis might be the underlying mechanisms. PMID:27433290

Surgical approach to right colon cancer: From open technique to robot. State of art

PubMed Central

Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

2016-01-01

This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

Surgical approach to right colon cancer: From open technique to robot. State of art.

PubMed

Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

2016-08-27

This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques.

PubMed

Morelli, Luca; Tartaglia, Dario; Bronzoni, Jessica; Palmeri, Matteo; Guadagni, Simone; Di Franco, Gregorio; Gennai, Andrea; Bianchini, Matteo; Bastiani, Luca; Moglia, Andrea; Ferrari, Vincenzo; Fommei, Enza; Pietrabissa, Andrea; Di Candio, Giulio; Mosca, Franco

2016-11-01

The role of the da Vinci Robotic System ® in adrenal gland surgery is not yet well defined. The goal of this study was to compare robotic-assisted surgery with pure laparoscopic surgery in a single center. One hundred and 16 patients underwent minimally invasive adrenalectomies in our department between June 1994 and December 2014, 41 of whom were treated with a robotic-assisted approach (robotic adrenalectomy, RA). Patients who underwent RA were matched according to BMI, age, gender, and nodule dimensions, and compared with 41 patients who had undergone laparoscopic adrenalectomies (LA). Statistical analysis was performed using the Student's t test for independent samples, and the relationship between the operative time and other covariates were evaluated with a multivariable linear regression model. P < 0.05 was considered significant. Mean operative time was significantly shorter in the RA group compared to the LA group. The subgroup analysis showed a shorter mean operative time in the RA group in patients with nodules ≥6 cm, BMI ≥ 30 kg/m 2 and in those who had previous abdominal surgery (p < 0.05). Results from the multiple regression model confirmed a shorter mean operative time with RA with nodules ≥6 cm (p = 0.010). Conversion rate and postoperative complications were 2.4 and 4.8 % in the LA group and 0 and 4.8 % in the RA group. In our experience, RA shows potential benefits compared to classic LA, in particular on patients with nodules ≥6 cm, BMI ≥ 30 kg/m2, and with previous abdominal surgery.

Management of deep infiltrating endometriosis by laparoscopic route with robotic assistance: 3-year experience.

PubMed

Abo, C; Roman, H; Bridoux, V; Huet, E; Tuech, J-J; Resch, B; Stochino, E; Marpeau, L; Darwish, B

2017-01-01

To assess the feasibility of deep endometriosis surgery using robotic assistance, benefits and limits of this approach. Case-series study enrolling patients managed for deep infiltrating endometriosis (DIE) using robotic assistance in our department between September 2011 and March 2014 (NCT02294825). Self-questionnaires including pain and digestive symptoms were filled in preoperatively and 1 year after surgery. Thirty-five patients were enrolled in the series. They represented 54% of patients managed for gynecological disease by laparoscopic route with robotic assistance during the study period, and 14% of patients managed for deep endometriosis in our department. Follow-up averaged 24±8 months, and no patient was lost to follow-up. Thirty-two patients had rectal involvement: rectal shaving was performed in 25 patients, disc excision in 3 and colorectal resection in 4. Three patients had bladder resection. Thirteen patients presented with deep endometriosis of the ureters: ureterolysis was performed in 11 of them, and resection of the ureter followed by reimplantation into the bladder in 2 patients. One major complication (Clavien IIIb) was recorded in a patient presenting with necrosis of the right ureter on postoperative day 5. Nine patients tried to conceive after surgery and 8 have already become pregnant (88.9%). One year after surgery, self-questionnaires revealed a significant decrease in pain symptoms and significant improvement in several item values of gastrointestinal standardized questionnaires. Surgical management of DIE is feasible using robotic assistance. However, data available in the literature and our own experience do not definitively support the hypothesis of the superiority of robotic assistance in the management of DIE. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Single-Incision Laparoscopic Total Colectomy

PubMed Central

Ojo, Oluwatosin J.; Carne, David; Guyton, Daniel

2012-01-01

Background and Objectives: To present our experience with a single-incision laparoscopic total colectomy, along with a literature review of all published cases on single-incision laparoscopic total colectomy. Methods: A total of 22 cases were published between 2010 and 2011, with our patient being case 23. These procedures were performed in the United States and United Kingdom. Surgical procedures included total colectomy with end ileostomy, proctocolectomy with ileorectal anastomosis, and total proctocolectomy with ileopouch-anal anastomosis. Intraoperative and postoperative data are analyzed. Results: Twenty-two of the 23 cases were performed for benign cases including Crohns, ulcerative colitis, and familial adenomatous polyposis. One case was performed for adenocarcinoma of the cecum. The mean age was 35.3 years (range, 13 to 64), the mean body mass index was 20.1 (range, 19 to 25), mean operative time was 175.9 minutes (range, 139 to 216), mean blood loss was 95.3mL (range, 59 to 200), mean incision length was 2.61cm (range, 2 to 3). Average follow-up was 4.6 months with 2 reported complications. Conclusions: Single-incision laparoscopic total colectomy is feasible and safe in the hands of an experienced surgeon. It has been performed for both benign and malignant cases. It is comparable to the conventional multi-port laparoscopic total colectomy. PMID:22906326

Splenectomy in massive tropical splenomegaly: two-to six-year follow-up in 14 patients.

PubMed

Vriend, W H; Hoffman, S L; Silaban, T; Zaini, M

1988-10-01

Between 1978 and 1982, 14 patients underwent splenectomy for disabling massive splenomegaly at the Regency Hospital in Wamena in the highlands of Irian Jaya, Indonesia. All patients were clinically diagnosed as having tropical splenomegaly syndrome (hyperreactive malarial splenomegaly), but in no case was the diagnosis confirmed. In May 1984 nurses and physicians caring for these 14 patients were asked to fill in a questionnaire regarding the patients' conditions. Two to 6 years after splenectomy, 8 of the 14 patients were alive and able to work; at least 6 of the 8 at normal or near normal capacity. One patient died 4 days after surgery and 5 died from 2 to 20 months after surgery. We conclude that splenectomy is beneficial for some highly selected patients with the clinical diagnosis of tropical splenomegaly syndrome.

Comparative Study of Hand-Sutured versus Circular Stapled Anastomosis for Gastrojejunostomy in Laparoscopy Assisted Distal Gastrectomy.

PubMed

Seo, Su Hyun; Kim, Ki Han; Kim, Min Chan; Choi, Hong Jo; Jung, Ghap Joong

2012-06-01

Mechanical stapler is regarded as a good alternative to the hand sewing technique, when used in gastric reconstruction. The circular stapling method has been widely applied to gastrectomy (open orlaparoscopic), for gastric cancer. We illustrated and compared the hand-sutured method to the circular stapling method, for Billroth-II, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. Between April 2009 and May 2011, 60 patients who underwent laparoscopy assisted distal gastrectomy, with Billroth-II, were enrolled. Hand-sutured Billroth-II was performed in 40 patients (manual group) and circular stapler Billroth-II was performed in 20 patients (stapler group). Clinicopathological features and post-operative outcomes were evaluated and compared between the two groups. Nosignificant differences were observed in clinicopathologic parameters and post-operative outcomes, except in the operation times. Operation times and anastomosis times were significantly shorter in the stapler group (P=0.004 and P<0.001). Compared to the hand-sutured method, the circular stapling method can be applied safely and more efficiently, when performing Billroth-II anastomosis, after laparoscopy assisted distal gastrectomy in patients with gastric cancer.

Laparoscopic Spleen Removal (Splenectomy)

MedlinePlus

... Series SAGES Masters Program Facebook Collaboratives Acute Care Surgery Bariatric Biliary Colorectal Flexible Endoscopy (upper or lower) Foregut Hernia Robotics The SAGES HPB/Solid Organ Program The SAGES ...

Variant adrenal venous anatomy in 546 laparoscopic adrenalectomies.

PubMed

Scholten, Anouk; Cisco, Robin M; Vriens, Menno R; Shen, Wen T; Duh, Quan-Yang

2013-04-01

Knowing the types and frequency of adrenal vein variants would help surgeons identify and control the adrenal vein during laparoscopic adrenalectomy. To establish the surgical anatomy of the main vein and its variants for laparoscopic adrenalectomy and to analyze the relationship between variant adrenal venous anatomy and tumor size, pathologic diagnosis, and operative outcomes. In a retrospective review of patients at a tertiary referral hospital, 506 patients underwent 546 consecutive laparoscopic adrenalectomies between April 22, 1993, and October 21, 2011. Patients with variant adrenal venous anatomy were compared with patients with normal adrenal venous anatomy regarding preoperative variables (patient and tumor characteristics [size and location] and clinical diagnosis), intraoperative variables (details on the main adrenal venous drainage, any variant venous anatomy, duration of operation, rate of conversion to hand-assisted or open procedure, and estimated blood loss), and postoperative variables (transfusion requirement, reoperation for bleeding, duration of hospital stay, and histologic diagnosis). Laparoscopic adrenalectomy. Prevalence of variant adrenal venous anatomy and its relationship to tumor characteristics, pathologic diagnosis, and operative outcomes. Variant venous anatomy was encountered in 70 of 546 adrenalectomies (13%). Variants included no main adrenal vein identifiable (n = 18), 1 main adrenal vein with additional small veins (n = 11), 2 adrenal veins (n = 20), more than 2 adrenal veins (n = 14), and variants of the adrenal vein drainage to the inferior vena cava and hepatic vein or of the inferior phrenic vein (n = 7). Variants occurred more often on the right side than on the left side (42 of 250 glands [17%] vs. 28 of 296 glands [9%], respectively; P = .02). Patients with variant anatomy compared with those with normal anatomy had larger tumors (mean, 5.1 vs 3.3 cm, respectively; P < .001), more pheochromocytomas (24 of 70 [35%] vs

Homemade laparoscopic simulators for surgical trainees.

PubMed

Khine, Myo; Leung, Edward; Morran, Chris; Muthukumarasamy, Giri

2011-06-01

Laparoscopic surgery has become increasingly popular in recent times. Laparoscopic skills and dexterity can be improved by using simulators. We provide a step-by-step guide with diagrams to build an individual homemade laparoscopic trainer box, which is easily available and affordable. We collected the required material for our homemade trainer box from a local DIY shop and purchased a high-definition (HD) webcam online. We used a 12-litre plastic storage box and mounted the webcam inside the lid of the plastic box. The ultraslim energy-saving fluorescent light was mounted behind the webcam. Holes were made in the plastic lid and patched with circular pieces of Neoprene to accommodate the insertion of laparoscopic instruments. The trainer box can be built in 3 hours. The trainer box weighs 1.2 kg with a light source, and is easily portable. It was demonstrated to a cohort of surgical trainees and they were very receptive, and liked the idea of an easy to assemble, low-cost trainer box with high-quality images. Our homemade trainer box offers HD vision that can be viewed on a personal computer, and the webcam is adjustable so it gives hands-free stability. It is built with a lightweight plastic box so it can be easily carried around by a trainee. This simple, inexpensive, easy-to-build trainer box makes a perfect solution for individuals who want to practise basic laparoscopic skills at home or in the workplace. © Blackwell Publishing Ltd 2011.

Acute Central Retinal Vein Occlusion Secondary to Reactive Thrombocytosis after Splenectomy

PubMed Central

Oncel Acir, Nursen; Borazan, Mehmet

2014-01-01

The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. The patient was treated with steroids for papilledema and administered coumadin and aspirin. The symptoms resolved, and the findings returned to normal within three weeks. Current paper emphasizes that, besides other well-known thrombotic events, reactive thrombocytosis after splenectomy may cause central retinal vein occlusion, which may be the principal symptom of this risky complication. Thus, it can be concluded that followup for thrombocytosis and antithrombotic treatment, when necessary, are essential for these cases. PMID:25276452

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

Laparoscopic Puestow: lateral pancreaticojejunostomy.

PubMed

Biteman, Benjamin R; Harr, Jeffrey N; Brody, Fred

2016-12-01

Chronic pancreatitis is a painful inflammatory disease that leads to progressive and irreversible destruction of pancreatic parenchyma [1]. A lateral pancreaticojejunostomy, also known as the Puestow procedure, is performed for symptomatic chronic pancreatitis associated with a dilated pancreatic duct secondary to calcifications or strictures [4]. An open approach is used traditionally due to the complexity of the case, and there have only been a handful of laparoscopic case reports [2]. This video depicts a laparoscopic lateral pancreaticojejunostomy for chronic pancreatitis. A 45-year-old gentleman with a 20-year history of chronic alcohol abuse presented with diffuse abdominal pain. His pain was worse postprandially and associated with loose stools. A computed tomography scan revealed multiple calcified deposits within the body and tail of the pancreas, and a dilated pancreatic duct measuring 1.4 cm with a proximal obstructing calcified stone. A 5-port foregut technique was used, and a 15-cm pancreatic ductotomy was performed with an ultrasonic scalpel. Calcified stones were cleared from the duct, and a roux-en-y pancreaticojejunostomy was performed using a hand-sewn technique. The patient had a relatively uncomplicated hospital course with return of bowel function on postoperative day 4. His patient-controlled analgesic device was discontinued on post operative day 3. He was ambulating, tolerating a regular diet and discharged home on postoperative day 5. At 12- and 26-month follow-up, he remains off narcotics, but still requires 1-2 tabs of pancreatic enzyme replacement per meal. Most importantly, he has not had any alcohol for over 2 years. The two primary goals in treating chronic pancreatitis include long-term pain relief and improvements in quality of life [3]. For patients with chronic pancreatitis and a dilated pancreatic duct, a laparoscopic lateral pancreaticojejunostomy may be an effective approach to decrease pain and improve quality of life.

An ergonomic study of the optimum operating table height for laparoscopic surgery.

PubMed

Berquer, R; Smith, W D; Davis, S

2002-03-01

Laparoscopic surgery requires the use of longer instruments than open surgery, thus changing the relation between the height of the surgeon's hands and the desirable height of the operating room table. The optimum height of the operating room table for laparoscopic surgery is investigated in this study. Twenty-one surgeons performed a two-handed, one-fourth circle cutting task using a laparoscopic video system and laparoscopic instruments positioned at five instrument handle heights relative to subjects' elbow height (-20, -10, 0, +10, and +20 cm) by adjusting the height of the trainer box. Subjects rated the difficulty and discomfort experienced during each task on a visual analog scale. Skin conductance (SC) was measured in Micromhos via paired surface electrodes placed near the ulnar edge of the palm of the right (cutting) hand. The mean electromyographic (EMG) signal from the right deltoid and trapezius muscles was measured. Arm orientation was measured in three dimensions using a magnetometer/accelerometer. Signals were acquired using analog circuitry and digitally sampled using a National Instruments DAQCard 700 connected to a Macintosh PowerBook 5300c running LabVIEW software. Statistical analysis was carried out by analysis of variance and post hoc testing. Statistically significant changes were found in the subjective rating of discomfort (p <0.002), deltoid EMG (p <0.0006), trapezius EMG (p <0.0001), and arm elevation (p <0.0001) between instrument handle heights. SC values and task times did not change significantly. Discomfort and difficulty ratings were lowest when instrument handles were positioned at elbow height. EMG values and arm elevation all decreased with lower instrument height. This study suggests that the optimum table height for laparoscopic surgery should position the laparoscopic instrument handles close to surgeons' elbow level to minimize discomfort and upper arm and shoulder muscle work. This corresponds to an approximate table height

Development of virtual reality exercise of hand motion assist robot for rehabilitation therapy by patient self-motion control.

PubMed

Ueki, Satoshi; Nishimoto, Yutaka; Abe, Motoyuki; Kawasaki, Haruhisa; Ito, Satoshi; Ishigure, Yasuhiko; Mizumoto, Jun; Ojika, Takeo

2008-01-01

This paper presents a virtual reality-enhanced hand rehabilitation support system with a symmetric master-slave motion assistant for independent rehabilitation therapies. Our aim is to provide fine motion exercise for a hand and fingers, which allows the impaired hand of a patient to be driven by his or her healthy hand on the opposite side. Since most disabilities caused by cerebral vascular accidents or bone fractures are hemiplegic, we adopted a symmetric master-slave motion assistant system in which the impaired hand is driven by the healthy hand on the opposite side. A VR environment displaying an effective exercise was created in consideration of system's characteristic. To verify the effectiveness of this system, a clinical test was executed by applying to six patients.

An economic analysis of robotically assisted hysterectomy.

PubMed

Wright, Jason D; Ananth, Cande V; Tergas, Ana I; Herzog, Thomas J; Burke, William M; Lewin, Sharyn N; Lu, Yu-Shiang; Neugut, Alfred I; Hershman, Dawn L

2014-05-01

To perform an econometric analysis to examine the influence of procedure volume, variation in hospital accounting methodology, and use of various analytic methodologies on cost of robotically assisted hysterectomy for benign gynecologic disease and endometrial cancer. A national sample was used to identify women who underwent laparoscopic or robotically assisted hysterectomy for benign indications or endometrial cancer from 2006 to 2012. Surgeon and hospital volume were classified as the number of procedures performed before the index surgery. Total costs as well as fixed and variable costs were modeled using multivariable quantile regression methodology. A total of 180,230 women, including 169,324 women who underwent minimally invasive hysterectomy for benign indications and 10,906 patients whose hysterectomy was performed for endometrial cancer, were identified. The unadjusted median cost of robotically assisted hysterectomy for benign indications was $8,152 (interquartile range [IQR] $6,011-10,932) compared with $6,535 (IQR $5,127-8,357) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing surgeon and hospital volume. The unadjusted median cost of robotically assisted hysterectomy for endometrial cancer was $9,691 (IQR $7,591-12,428) compared with $8,237 (IQR $6,400-10,807) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing hospital volume from $2,471 for the first 5 to 15 cases to $924 for more than 50 cases. Based on surgeon volume, robotically assisted hysterectomy for endometrial cancer was $1,761 more expensive than laparoscopy for those who had performed fewer than five cases; the differential declined to $688 for more than 50 procedures compared with laparoscopic hysterectomy. The cost of robotic gynecologic surgery decreases with increased procedure volume. However, in all of the scenarios modeled, robotically assisted hysterectomy remained substantially more costly than laparoscopic

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.

Evaluation of hands-on seminar for reduced port surgery using fresh porcine cadaver model.

PubMed

Poudel, Saseem; Kurashima, Yo; Shichinohe, Toshiaki; Kitashiro, Shuji; Kanehira, Eiji; Hirano, Satoshi

2016-01-01

The use of various biological and non-biological simulators is playing an important role in training modern surgeons with laparoscopic skills. However, there have been few reports of the use of a fresh porcine cadaver model for training in laparoscopic surgical skills. The purpose of this study was to report on a surgical training seminar on reduced port surgery using a fresh cadaver porcine model and to assess its feasibility and efficacy. The hands-on seminar had 10 fresh porcine cadaver models and two dry boxes. Each table was provided with a unique access port and devices used in reduced port surgery. Each group of 2 surgeons spent 30 min at each station, performing different tasks assisted by the instructor. The questionnaire survey was done immediately after the seminar and 8 months after the seminar. All the tasks were completed as planned. Both instructors and participants were highly satisfied with the seminar. There was a concern about the time allocated for the seminar. In the post-seminar survey, the participants felt that the number of reduced port surgeries performed by them had increased. The fresh cadaver porcine model requires no special animal facility and can be used for training in laparoscopic procedures.

Evaluation of hands-on seminar for reduced port surgery using fresh porcine cadaver model

PubMed Central

Poudel, Saseem; Kurashima, Yo; Shichinohe, Toshiaki; Kitashiro, Shuji; Kanehira, Eiji; Hirano, Satoshi

2016-01-01

BACKGROUND: The use of various biological and non-biological simulators is playing an important role in training modern surgeons with laparoscopic skills. However, there have been few reports of the use of a fresh porcine cadaver model for training in laparoscopic surgical skills. The purpose of this study was to report on a surgical training seminar on reduced port surgery using a fresh cadaver porcine model and to assess its feasibility and efficacy. MATERIALS AND METHODS: The hands-on seminar had 10 fresh porcine cadaver models and two dry boxes. Each table was provided with a unique access port and devices used in reduced port surgery. Each group of 2 surgeons spent 30 min at each station, performing different tasks assisted by the instructor. The questionnaire survey was done immediately after the seminar and 8 months after the seminar. RESULTS: All the tasks were completed as planned. Both instructors and participants were highly satisfied with the seminar. There was a concern about the time allocated for the seminar. In the post-seminar survey, the participants felt that the number of reduced port surgeries performed by them had increased. CONCLUSION: The fresh cadaver porcine model requires no special animal facility and can be used for training in laparoscopic procedures. PMID:27279391

Procedural key steps in laparoscopic colorectal surgery, consensus through Delphi methodology.

PubMed

Dijkstra, Frederieke A; Bosker, Robbert J I; Veeger, Nicolaas J G M; van Det, Marc J; Pierie, Jean Pierre E N

2015-09-01

While several procedural training curricula in laparoscopic colorectal surgery have been validated and published, none have focused on dividing surgical procedures into well-identified segments, which can be trained and assessed separately. This enables the surgeon and resident to focus on a specific segment, or combination of segments, of a procedure. Furthermore, it will provide a consistent and uniform method of training for residents rotating through different teaching hospitals. The goal of this study was to determine consensus on the key steps of laparoscopic right hemicolectomy and laparoscopic sigmoid colectomy among experts in our University Medical Center and affiliated hospitals. This will form the basis for the INVEST video-assisted side-by-side training curriculum. The Delphi method was used for determining consensus on key steps of both procedures. A list of 31 steps for laparoscopic right hemicolectomy and 37 steps for laparoscopic sigmoid colectomy was compiled from textbooks and national and international guidelines. In an online questionnaire, 22 experts in 12 hospitals within our teaching region were invited to rate all steps on a Likert scale on importance for the procedure. Consensus was reached in two rounds. Sixteen experts agreed to participate. Of these 16 experts, 14 (88%) completed the questionnaire for both procedures. Of the 14 who completed the first round, 13 (93%) completed the second round. Cronbach's alpha was 0.79 for the right hemicolectomy and 0.91 for the sigmoid colectomy, showing high internal consistency between the experts. For the right hemicolectomy, 25 key steps were established; for the sigmoid colectomy, 24 key steps were established. Expert consensus on the key steps for laparoscopic right hemicolectomy and laparoscopic sigmoid colectomy was reached. These key steps will form the basis for a video-assisted teaching curriculum.

[Infectious complications after surgical splenectomy in children with sickle cell anemia disease].

PubMed

Monaco Junior, Cypriano Petrus; Fonseca, Patricia Belintani Blum; Braga, Josefina Aparecida Pellegrini

2015-01-01

To evaluate the frequency of infectious complications in children with sickle cell disease (SCD) after surgical splenectomy for acute splenic sequestration crisis. Retrospective cohort of children with SCD who were born after 2002 and were regularly monitored until July 2013. Patients were divided into two groups: cases (children with SCD who underwent surgical splenectomy after an episode of splenic sequestration) and controls (children with SCD who did not have splenic sequestration and surgical procedures), in order to compare the frequency of invasive infections (sepsis, meningitis, bacteremia with positive blood cultures, acute chest syndrome and/or pneumonia) by data collected from medical records. Data were analyzed by descriptive statistical analysis. 44 patients were included in the case group. The mean age at the time of splenectomy was 2.6 years (1-6.9 years) and the mean postoperative length of follow-up was 6.1 years (3.8-9.9 years). The control group consisted of 69 patients with a mean age at the initial follow-up visit of 5.6 months (1-49 months) and a mean length of follow-up of 7.2 years (4-10.3 years). All children received pneumococcal conjugate vaccine. No significant difference was observed between groups in relation to infections during the follow-up. Surgical splenectomy in children with sickle cell disease that had splenic sequestration did not affect the frequency of infectious complications during 6 years of clinical follow-up. Copyright © 2015 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

The role of tactile feedback in grip force during laparoscopic training tasks.

PubMed

Wottawa, Christopher R; Cohen, Jeremiah R; Fan, Richard E; Bisley, James W; Culjat, Martin O; Grundfest, Warren S; Dutson, Erik P

2013-04-01

Laparoscopic minimally invasive surgery has revolutionized surgical care by reducing trauma to the patient, thereby decreasing the need for medication and shortening recovery times. During open procedures, surgeons can directly feel tissue characteristics. However, in laparoscopic surgery, tactile feedback during grip is attenuated and limited to the resistance felt in the tool handle. Excessive grip force during laparoscopic surgery can lead to tissue damage. Providing additional supplementary tactile feedback may allow subjects to have better control of grip force and identification of tissue characteristics, potentially decreasing the learning curve associated with complex minimally invasive techniques. A tactile feedback system has been developed and integrated into a modified laparoscopic grasper that allows forces applied at the grasper tips to be felt by the surgeon's hands. In this study, 15 subjects (11 novices, 4 experts) were asked to perform single-handed peg transfers using these laparoscopic graspers in three trials (feedback OFF, ON, OFF). Peak and average grip forces (newtons) during each grip event were measured and compared using a Wilcoxon ranked test in which each subject served as his or her own control. After activating the tactile feedback system, the novice subject population showed significant decreases in grip force (p < 0.003). When the system was deactivated for the third trial, there were significant increases in grip force (p < 0.003). Expert subjects showed no significant improvements with the addition of tactile feedback (p > 0.05 in all cases). Supplementary tactile feedback helped novice subjects reduce grip force during the laparoscopic training task but did not offer improvements for the four expert subjects. This indicates that tactile feedback may be beneficial for laparoscopic training but has limited long-term use in the nonrobotic setting.

Improved Image-Guided Laparoscopic Prostatectomy

DTIC Science & Technology

2011-08-01

standard daVinci tool . The ultrasound probe is driven by a Sonix RP ultrasound system (Ultrasonix Medical Corp., Richmond BC Canada), which provides...probe (Intuitive Surgical, Sunnyvale, CA) was integrated with the daVinci surgical system for use in Robot-Assisted Laparoscopic Prostatectomy (RALP...laparoscopy using the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA). The surgical robot introduces many benefits, including three

Robotic-assisted laparoscopic radical cystectomy: history, techniques and outcomes.

PubMed

Liss, Michael A; Kader, A Karim

2013-06-01

Robotic-assisted radical cystectomy (RARC) is a less invasive means of performing the radical cystectomy operation, which holds promise for improved patient morbidity. We review the history, technique and current literature pertaining to RARC and place the current results in context with the open procedure. All articles regarding RARC found in PubMed after January 2000 were examined. We selected articles that appeared in high-impact journals, had large patient population size (>80 patients), or were novel in technique or findings. We chose key laparoscopic articles to give reference to the history in transition to robotic radical cystectomy. In addition, we chose classic articles from open radical cystectomy to give reference regarding the newer robotic perioperative outcomes. Studies suggest that a 20-patient learning curve is needed to reach an operative time of 6.5 h, with 30 surgeries performed to reach lymph node counts in excess of 20 (International Robotic Cystectomy Consortium). The only randomized surgical trial comparing open and robotic techniques showed equivalent lymph node yield, which may be surgeon and volume dependent. Literature demonstrates lower estimated blood loss, transfusion rates, early return of bowel function and decreased complications in early small series. RARC and urinary diversion are still early in development and limited to centers with extensive robotic experience and volume, although adoption of the robotic approach is becoming more common. Early studies have shown promise to reduce complications with equivalent oncologic results.

Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: protocol for a randomized controlled trial.

PubMed

Grochola, Lukasz Filip; Soll, Christopher; Zehnder, Adrian; Wyss, Roland; Herzog, Pascal; Breitenstein, Stefan

2017-02-09

Recent advances in robotic technology suggest that the utilization of the da Vinci Single-Site™ platform for cholecystectomy is safe, feasible and results in a shorter learning curve compared to conventional single-incision laparoscopic cholecystectomy. Moreover, the robot-assisted technology has been shown to reduce the surgeon's stress load compared to standard single-incision laparoscopy in an experimental setup, suggesting an important advantage of the da Vinci platform. However, the above-mentioned observations are based solely on case series, case reports and experimental data, as high-quality clinical trials to demonstrate the benefits of the da Vinci Single-Site™ cholecystectomy have not been performed to date. This study addresses the question whether robot-assisted Single-Site™ cholecystectomy provides significant benefits over single-incision laparoscopic cholecystectomy in terms of surgeon's stress load, while matching the standards of the conventional single-incision approach with regard to peri- and postoperative outcomes. It is designed as a single centre, single-blinded randomized controlled trial, which compares both surgical approaches with the primary endpoint surgeon's physical and mental stress load at the time of surgery. In addition, the study aims to assess secondary endpoints such as operating time, conversion rates, additional trocar placement, intra-operative blood loss, length of hospital stay, costs of procedure, health-related quality of life, cosmesis and complications. Patients as well as ward staff are blinded until the 1 st postoperative year. Sample size calculation based on the results of a previously published experimental setup utilizing an estimated effect size of surgeon's comfort of 0.8 (power of 0.8, alpha-error level of 0.05, error margin of 10-15%) resulted in a number of 30 randomized patients per arm. The study is the first randomized controlled trial that compares the da Vinci Single Site™ platform to

The "halo effect" in Korea: change in practice patterns since the introduction of robot-assisted laparoscopic radical prostatectomy.

PubMed

Sung, Ee-Rah; Jeong, Wooju; Park, Sung Yul; Ham, Won Sik; Choi, Young Deuk; Hong, Sung Joon; Rha, Koon Ho

2009-03-01

Acquisition of the da Vinci surgical system (Intuitive Surgical, Mountain View, USA) has enabled robot-assisted surgery to become an acceptable alternative to open radical prostatectomy (ORP). Implementation of robotics at a single institution in Korea induced a gradual increase in the number of performances of robot-assisted laparoscopic radical prostatectomy (RALP) to surgically treat localized prostate cancer. We analyzed the impact of robotic instrumentation on practice patterns among urologists and explain the change in value in ORP and RALP-the standard treatment and the new approach or innovation of robotic technology. The overall number of prostatectomies has increased over time because the number of RALPs has grown drastically whereas the number of OPRs did not decrease during the period of evaluation. Our experience emphasizes the potential of RALP to become the gold standard in the treatment of localized prostate cancer in various parts of the world.

General surgery training without laparoscopic surgery fellows: the impact on residents and patients.

PubMed

Linn, John G; Hungness, Eric S; Clark, Sara; Nagle, Alexander P; Wang, Edward; Soper, Nathaniel J

2011-10-01

To evaluate resident case volume after discontinuation of a laparoscopic surgery fellowship, and to examine disparities in patient care over the same time period. Resident case logs were compared for a 2-year period before and 1 year after discontinuing the fellowship, using a 2-sample t test. Databases for bariatric and esophageal surgery were reviewed to compare operative time, length of stay (LOS), and complication rate by resident or fellow over the same time period using a 2-sample t test. Increases were seen in senior resident advanced laparoscopic (Mean Fellow Year = 21 operations vs Non Fellow Year = 61, P < 0.01), esophageal (1 vs 11, P < .01) and bariatric volume (9 vs 36, P < .01). Junior resident laparoscopic volume increased (P < 0.05). No difference in LOS or complication rate was seen with resident vs fellow assistant. Operative time was greater for gastric bypass with resident assistant (152 ± 51 minutes vs 138 ± 53, P < .05). Discontinuing a laparoscopic fellowship significantly increases resident case volume in laparoscopic surgery. Operative time for complex operations may increase in the absence of a fellow. Other patient outcomes are not affected by this change. Copyright © 2011 Mosby, Inc. All rights reserved.

Comparative Study of Hand-Sutured versus Circular Stapled Anastomosis for Gastrojejunostomy in Laparoscopy Assisted Distal Gastrectomy

PubMed Central

Seo, Su Hyun; Kim, Min Chan; Choi, Hong Jo; Jung, Ghap Joong

2012-01-01

Purpose Mechanical stapler is regarded as a good alternative to the hand sewing technique, when used in gastric reconstruction. The circular stapling method has been widely applied to gastrectomy (open orlaparoscopic), for gastric cancer. We illustrated and compared the hand-sutured method to the circular stapling method, for Billroth-II, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. Materials and Methods Between April 2009 and May 2011, 60 patients who underwent laparoscopy assisted distal gastrectomy, with Billroth-II, were enrolled. Hand-sutured Billroth-II was performed in 40 patients (manual group) and circular stapler Billroth-II was performed in 20 patients (stapler group). Clinicopathological features and post-operative outcomes were evaluated and compared between the two groups. Results Nosignificant differences were observed in clinicopathologic parameters and post-operative outcomes, except in the operation times. Operation times and anastomosis times were significantly shorter in the stapler group (P=0.004 and P<0.001). Conclusions Compared to the hand-sutured method, the circular stapling method can be applied safely and more efficiently, when performing Billroth-II anastomosis, after laparoscopy assisted distal gastrectomy in patients with gastric cancer. PMID:22792525

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

Laparoscopic approach to Meckel's diverticulum.

PubMed

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

2014-07-07

To retrospective review the laparoscopic management of Meckel Diverticulum (MD) in two Italian Pediatric Surgery Centers. 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. 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

Conscious motor processing and movement self-consciousness: two dimensions of personality that influence laparoscopic training.

PubMed

Malhotra, Neha; Poolton, Jamie M; Wilson, Mark R; Fan, Joe K M; Masters, Rich S W

2014-01-01

Identifying personality factors that account for individual differences in surgical training and performance has practical implications for surgical education. Movement-specific reinvestment is a potentially relevant personality factor that has a moderating effect on laparoscopic performance under time pressure. Movement-specific reinvestment has 2 dimensions, which represent an individual's propensity to consciously control movements (conscious motor processing) or to consciously monitor their 'style' of movement (movement self-consciousness). This study aimed at investigating the moderating effects of the 2 dimensions of movement-specific reinvestment in the learning and updating (cross-handed technique) of laparoscopic skills. Medical students completed the Movement-Specific Reinvestment Scale, a psychometric assessment tool that evaluates the conscious motor processing and movement self-consciousness dimensions of movement-specific reinvestment. They were then trained to a criterion level of proficiency on a fundamental laparoscopic skills task and were tested on a novel cross-handed technique. Completion times were recorded for early-learning, late-learning, and cross-handed trials. Propensity for movement self-consciousness but not conscious motor processing was a significant predictor of task completion times both early (p = 0.036) and late (p = 0.002) in learning, but completion times during the cross-handed trials were predicted by the propensity for conscious motor processing (p = 0.04) rather than movement self-consciousness (p = 0.21). Higher propensity for movement self-consciousness is associated with slower performance times on novel and well-practiced laparoscopic tasks. For complex surgical techniques, however, conscious motor processing plays a more influential role in performance than movement self-consciousness. The findings imply that these 2 dimensions of movement-specific reinvestment have a differential influence in the learning and updating

Comparison of Robotic and Laparoscopic Hysterectomy for Benign Gynecologic Disease

PubMed Central

Rosero, Eric B.; Kho, Kimberly A.; Joshi, Girish P.; Giesecke, Martin; Schaffer, Joseph I.

2013-01-01

Objective Utilization of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared to laparoscopic hysterectomy. Methods Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. Results Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically-assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P=0.002). In a propensity-matched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80 vs. 8.85%; relative risk [RR], 0.99; 95% confidence interval [CI], 0.89 to 1.09; P=0.910). There was a lower incidence of blood transfusions in robotic cases (2.1% vs. 3.1%; P<0.001, but patients undergoing robotic hysterectomy were more likely to experience postoperative pneumonia (RR= 2.2; 95% CI, 1.24 to 3.78; P=0.005). The median cost of hospital care was $9788 (IQR, $7105-$12780) for RH and $7299 (IQR, $5650-$9583) for LH (P<0.001. Hospital costs were on average $2489 (95% CI, $2313 to $2664) higher for patients undergoing robotic hysterectomy. Conclusion The utilization of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more. PMID:24084534

Laparoscopic Surgery

MedlinePlus

... Main ACG Site ACG Patients Home / Digestive Health Topic / Laparoscopic Surgery Laparoscopic Surgery Basics Overview What is laparoscopic surgery? ... with your doctor whether some type of laparoscopic surgery is most suitable for your ... Topics Abdominal Pain Syndrome Belching, Bloating, and Flatulence Common ...

Laparoscopic radiofrequency ablation-assisted enucleation of Xp11.2 translocation renal cell carcinoma: A case report

PubMed Central

XU, LINFENG; YANG, RONG; WANG, WEI; ZHANG, YIFEN; GAN, WEIDONG

2014-01-01

The current study presents a case of Xp11.2 translocation renal cell carcinoma (Xp11.2 RCC) in a 30-year-old female. The patient was referred to The Affiliated Drum Tower Hospital of the Medical College of Nanjing University (Nanjing, Jiangsu, China) due to a right renal tumor without evident symptoms, which was found by a routine physical examination. A computed tomography (CT) scan indicated that the mass exhibited cystic and solid components. The patient underwent laparoscopic radiofrequency ablation-assisted enucleation. Immunohistochemistry revealed intense nuclear staining for transcription factor E3 protein in the cancer cells. The patient was diagnosed with Xp11.2 RCC. The urological and radiological outcomes remained satisfactory after >2.5 years of follow-up. PMID:25120696

Laparoscopic radiofrequency ablation-assisted enucleation of Xp11.2 translocation renal cell carcinoma: A case report.

PubMed

Xu, Linfeng; Yang, Rong; Wang, Wei; Zhang, Yifen; Gan, Weidong

2014-09-01

The current study presents a case of Xp11.2 translocation renal cell carcinoma (Xp11.2 RCC) in a 30-year-old female. The patient was referred to The Affiliated Drum Tower Hospital of the Medical College of Nanjing University (Nanjing, Jiangsu, China) due to a right renal tumor without evident symptoms, which was found by a routine physical examination. A computed tomography (CT) scan indicated that the mass exhibited cystic and solid components. The patient underwent laparoscopic radiofrequency ablation-assisted enucleation. Immunohistochemistry revealed intense nuclear staining for transcription factor E3 protein in the cancer cells. The patient was diagnosed with Xp11.2 RCC. The urological and radiological outcomes remained satisfactory after >2.5 years of follow-up.

Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients.

PubMed

Qi, Xingshun; Han, Guohong; Ye, Chun; Zhang, Yongguo; Dai, Junna; Peng, Ying; Deng, Han; Li, Jing; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Zhang, Xintong; Wang, Ran; Guo, Xiaozhong

2016-07-19

BACKGROUND Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. MATERIAL AND METHODS All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS Overall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152-61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247-276.949; clinically significant PVST: OR=40.415, 95%CI=3.895-419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953-0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895-0.980; clinically significant PVST: OR=0.935, 95%CI=0.891-0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909-0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST. CONCLUSIONS Splenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction.

Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients

PubMed Central

Qi, Xingshun; Han, Guohong; Ye, Chun; Zhang, Yongguo; Dai, Junna; Peng, Ying; Deng, Han; Li, Jing; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Zhang, Xintong; Wang, Ran; Guo, Xiaozhong

2016-01-01

Background Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. Material/Methods All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results Overall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152–61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247–276.949; clinically significant PVST: OR=40.415, 95%CI=3.895–419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953–0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895–0.980; clinically significant PVST: OR=0.935, 95%CI=0.891–0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909–0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST. Conclusions Splenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction. PMID:27432511

Literature review of the energy sources for performing laparoscopic colorectal surgery

PubMed Central

Hotta, Tsukasa; Takifuji, Katsunari; Yokoyama, Shozo; Matsuda, Kenji; Higashiguchi, Takashi; Tominaga, Toshiji; Oku, Yoshimasa; Watanabe, Takashi; Nasu, Toru; Hashimoto, Tadamichi; Tamura, Koichi; Ieda, Junji; Yamamoto, Naoyuki; Iwamoto, Hiromitsu; Yamaue, Hiroki

2012-01-01

Laparoscopic surgery for colorectal disease has become widespread as a minimally invasive treatment. This is important because the increasing availability of new devices allows us to perform procedures with a reduced length of surgery and decreased blood loss. We herein report the results of a literature review of energy sources for laparoscopic colorectal surgery, focused especially on 6 studies comparing ultrasonic coagulating shears (UCS) and other instruments. We also describe our laparoscopic dissection techniques using UCS for colorectal cancer. The short-term outcomes of surgeries using UCS and Ligasure for laparoscopic colorectal surgery were superior to conventional electrosurgery. Some authors have reported that the length of surgery or blood loss when Ligasure was used for laparoscopic colorectal surgery is less than when UCS was used. On the other hand, a recent study demonstrated that there were no significant differences between the short-term outcomes of UCS and Ligasure for laparoscopic colorectal surgery. It is therefore suggested that the choice of technique used should be made according to the surgeon’s preference. We also describe our laparoscopic dissection techniques using UCS (Harmonic ACE) for colorectal cancer with regard to the retroperitoneum dissection, dissection technique, dissection technique around the feeding artery, and various other dissection techniques. We therefore review the outcomes of using various energy sources for laparoscopic colorectal surgery and describe our laparoscopic dissection techniques with UCS (Harmonic ACE) for colorectal cancer. PMID:22347536

An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite.

PubMed

Canda, Abdullah Erdem; Asil, Erem; Balbay, Mevlana Derya

2011-02-01

A case of moving ileal Taenia saginata parasites is presented with demonstrative images. We came across the parasites surprisingly while performing robot-assisted laparoscopic radical cystoprostatectomy with intracorporeal Studer pouch urinary diversion. We recommend stool sample evaluation in the preoperative period for possible presence of intestinal parasitic diseases, particularly in patients with bladder cancer who are admitted from areas with an increased incidence of intestinal parasitic diseases, before opening the bowel segments during surgery to perform radical cystectomy and urinary diversion.

Oncologic results of laparoscopic liver resection for malignant liver tumors.

PubMed

Akyuz, Muhammet; Yazici, Pinar; Yigitbas, Hakan; Dural, Cem; Okoh, Alexis; Aliyev, Shamil; Aucejo, Federico; Quintini, Cristiano; Fung, John; Berber, Eren

2016-02-01

There are scant data regarding oncologic outcomes of laparoscopic liver resection (LLR). The aim of this study is to analyze the oncologic outcomes of LLR for malignant liver tumors (MLT). This was a prospective IRB-approved study of 123 patients with MLT undergoing LLR. Kaplan-Meier disease-free (DFS) and overall survival (OS) was calculated. Tumor type was colorectal in 61%, hepatocellular cancer in 21%, neuroendocrine in 5% and others in 13%. Mean tumor size was 3.2 ± 1.9 cm and number of tumors 1.6 ± 1.2. A wedge resection or segmentectomy was performed in 63.4%, bisegmentectomy in 24.4%, and hemihepatectomy in 12.2%. Procedures were totally laparoscopic in 67% and hand-assisted in 33%. Operative time was 235.2 ± 94.3 min, and conversion rate 7.3%. An R0 resection was achieved in 90% of patients and 94% of tumors. Median hospital stay was 3 days. Morbidity was 22% and mortality 0.8%. For patients with colorectal liver metastasis, DFS and OS at 2 years was 47% and 88%, respectively. This study shows that LLR is a safe and efficacious treatment for selected patients with MLT. Complete resection and margin recurrence rate are comparable to open series in the literature. © 2015 Wiley Periodicals, Inc.

Laparoscopic right-sided colonic resection with transluminal colonoscopic specimen extraction

PubMed Central

Kayaalp, Cuneyt; Kutluturk, Koray; Yagci, Mehmet Ali; Ates, Mustafa

2015-01-01

AIM: To study the transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance at laparoscopic colonic surgery. METHODS: The diagnoses of our patients were Crohn’s disease, carcinoid of appendix and adenocarcinoma of cecum. We preferred laparoscopic total mesocolic resections. Colon and terminal ileum were divided with endoscopic staplers. A colonoscope was placed per anal and moved proximally in the colon till to reach the colonic closed end under the laparoscopic guidance. The stump of the colon was opened with laparoscopic scissors. A snare of colonoscope was released and the intraperitoneal complete free colonic specimen was grasped. Specimen was moved in to the colon with the help of the laparoscopic graspers and pulled gently through the large bowel and extracted through the anus. The open end of the colon was closed again and the ileal limb and the colon were anastomosed intracorporeally with a 60-mm laparoscopic stapler. The common enterotomy orifice was closed in two layers with a running intracorporeal suture. RESULTS: There were three patients with laparoscopic right-sided colonic resections and their specimens were intended to remove through the remnant colon by colonoscopy but the procedure failed in one patient (adenocarcinoma) due to a bulky mass and the specimen extraction was converted to transvaginal route. All the patients had prior abdominal surgeries and had related adhesions. The operating times were 210, 300 and 500 min. The lengths of the specimens were 13, 17 and 27 cm. In our cases, there were no superficial or deep surgical site infections or any other complications. The patients were discharged uneventfully within 4-5 d and they were asymptomatic after a mean 7.6 mo follow-up (ranged 4-12). As far as we know, there were only 12 cases reported yet on transcolonic extraction of the proximal colonic specimens by colonoscopic assistance after laparoscopic resections. With our cases, success rate of the

Assessment of individual hand performance in box trainers compared to virtual reality trainers.

PubMed

Madan, Atul K; Frantzides, Constantine T; Shervin, Nina; Tebbit, Christopher L

2003-12-01

Training residents in laparoscopic skills is ideally initiated in an inanimate laboratory with both box trainers and virtual reality trainers. Virtual reality trainers have the ability to score individual hand performance although they are expensive. Here we compared the ability to assess dominant and nondominant hand performance in box trainers with virtual reality trainers. Medical students without laparoscopic experience were utilized in this study (n = 16). Each student performed tasks on the LTS 2000, an inanimate box trainer (placing pegs with both hands and transferring pegs from one hand to another), as well as a task on the MIST-VR, a virtual reality trainer (grasping a virtual object and placing it in a virtual receptable with alternating hands). A surgeon scored students for the inanimate box trainer exercises (time and errors) while the MIST-VR scored students (time, economy of movements, and errors for each hand). Statistical analysis included Pearson correlations. Errors and time for the one-handed tasks on the box trainer did not correlate with errors, time, or economy measured for each hand by the MIST-VR (r = 0.01 to 0.30; P = NS). Total errors on the virtual reality trainer did correlate with errors on transferring pege (r = 0.61; P < 0.05). Economy and time of both dominant and nondominant hand from the MIST-VR correlated with time of transferring pegs in the box trainer (r = 0.53 to 0.77; P < 0.05). While individual hand assessment by the box trainer during 2-handed tasks was related to assessment by the virtual reality trainer, individual hand assessment during 1-handed tasks did not correlate with the virtual reality trainer. Virtual reality trainers, such as the MIST-VR, allow assessment of individual hand skills which may lead to improved laparoscopic skill acquisition. It is difficult to assess individual hand performance with box trainers alone.

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

PubMed

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

2016-08-01

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

Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study.

PubMed

Sarlos, Dimitri; Kots, Lavonne; Stevanovic, Nebojsa; Schaer, Gabriel

2010-05-01

Robotic surgery, with its technical advances, promises to open a new window to minimally invasive surgery in gynaecology. Feasibility and safety of this surgical innovation have been demonstrated in several studies, and now a critical analysis of these new developments regarding outcome and costs is in place. So far only a few studies compare robotic with conventional laparoscopic surgery in gynaecology. Our objective was to evaluate our initial experience performing total robot-assisted hysterectomy with the da Vinci surgical system and compare peri-operative outcome and costs with total laparoscopic hysterectomy. For this prospective matched case-control study at our institution, peri-operative data from our first 40 consecutive total robot-assisted hysterectomies for benign indications were recorded and matched 1:1 with total laparoscopic hysterectomies according to age, BMI and uterus weight. Surgical costs were calculated for both procedures. Surgeons' subjective impressions of robotics were evaluated with a self-developed questionnaire. No conversions to laparotomy or severe peri-operative complications occurred. Mean operating time was 109 (113; 50-170) min for the robotic group and 83 (80; 55-165) min for the conventional laparoscopic group. Mean postoperative hospitalisation for robotic surgery was 3.3 (3; 2-6) days versus 3.9 (4; 2-7) days for the conventional laparoscopic group. Average surgical cost of a robot-assisted laparoscopic hysterectomy was 4067 euros compared to 2151 euros for the conventional laparoscopic procedure at our institution. For the robotic group wider range of motion of the instruments and better ergonomics were considered to be an advantage, and lack of direct access to the patient was stated as a disadvantage. Robot-assited hysterectomy is a feasible and interesting new technique with comparable outcome to total laparoscopic hysterectomy. Operating times of total laparoscopic hysterectomy seem to be achieved quickly especially for

Immunomodulation by splenectomy or by FTY720 protects the heart against ischemia reperfusion injury.

PubMed

Goltz, D; Huss, S; Ramadori, E; Büttner, R; Diehl, L; Meyer, R

2015-11-01

The pathogenesis of myocardial ischemia-reperfusion injury (MI/R) involves an inflammatory response in the myocardium undergoing reperfusion. Modulation of this response by splenectomy constitutes an option to protect the heart from MI/R. To mimic the effect of splenectomy in a pharmacological approach, the sphingosine-1-phosphate agonist FTY720 was applied at the onset of reperfusion. In a closed chest model of MI/R, infarct size was assessed by triphenyltetrazolium chloride staining after 1 h of ischemia and 24 h of reperfusion, and by Masson trichrome staining 21 days after reperfusion in splenectomised mice, mice post-conditioned with FTY720 IP (1 mg/kg), and controls. In addition, hemodynamic parameters were recorded after 24 h and 21 days by catheterization. Infarct size, and immune cell invasion of phagocytic monocytes investigated by FACS after 24 h of reperfusion were significantly reduced by both splenectomy, and FTY720 treatment. Evaluation after 21 days of reperfusion revealed that FTY720 treated animals had an improved hemodynamic outcome compared to placebo treated as well as splenectomised animals. FTY720 treatment reduced cell injury as effectively as splenectomy by lowering the number of phagocytic monocytes invading the myocardium and ameliorated hemodynamic outcome within the first 21 days. © 2015 Wiley Publishing Asia Pty Ltd.

Changes in T and B blood lymphocytes after splenectomy.

PubMed Central

Millard, R E; Banerjee, D K

1979-01-01

The blood lymphocytes of 37 splenectomised patients were analysed by means of T and B lymphocyte surface markers. Sixteen patients had had a splenectomy for non-haematological and 21 for haematological reasons. The results show that 15 had normal numbers of T and B cells; decreased T cells were found in two patients, raised B cells in seven, raised T and B cells in eight, and raised T cells in five patients. Increased numbers of 'null' cells were observed in some patients, especially in those with raised B cells. Follow-up studies indicate that raised levels of T and B cells can be established by one to three months post-splenectomy and may persist, although in some patients the cells fall to normal levels. The lymphocyte proliferative response to phytohaemagglutinin and Concanavalin A in vitro was normal in eight out of nine patients with raised T cells and was depressed in one patient, possibly due to an intrinsic cell defect. PMID:316436

Laparoscopic Total Extraperitoneal Hernia Repair Outcomes

PubMed Central

Bresnahan, Erin R.

2016-01-01

Background and Objectives: Laparoscopic inguinal hernia repair has become increasingly popular as an alternative to open surgery. The purpose of this study was to evaluate the safety and effectiveness of the laparoscopic total extraperitoneal procedure with the use of staple fixation and polypropylene mesh. Methods: A retrospective chart review examined outcomes of 1240 laparoscopic hernia operations in 783 patients, focusing on intraoperative and early postoperative complications, pain, and time until return to work and normal physical activities. Results: There were no intraoperative complications in this series; 106 patients experienced early postoperative complications across 8 evaluated categories: urinary retention (4.1%), seroma (3.0%), testicular/hemiscrotal swelling (1.9%), testicular atrophy (0%), hydrocele (0.6%), mesh infection (0.1%), and neurological symptoms (transient, 1.0%; persistent, 0.2%). Patients used an average of 5.6 Percocet pills after the procedure, and mean times until return to work and normal activities, including their routine exercise regimen, were 3.0 and 3.8 days, respectively. Conclusion: Complication rates and convalescence times were considered equivalent or superior to those found in other studies assessing both laparoscopic and open techniques. The usage of multiple Endostaples did not result in increased neurologic complications in the early postoperative period when compared with findings in the literature. In the hands of an experienced surgeon, total extraperitoneal repair is a safe, effective alternative to open inguinal hernia repair. PMID:27493471

Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers.

PubMed

Villamere, James; Gebhart, Alana; Vu, Stephen; Nguyen, Ninh T

2015-07-01

Robotic-assisted general and bariatric surgery is gaining popularity among surgeons. The aim of this study was to analyze the utilization and outcome of laparoscopic versus robotic-assisted laparoscopic techniques for common elective general and bariatric surgical procedures performed at Academic Medical Centers. We analyzed data from University HealthSystem Consortium clinical database from October 2010 to February 2014 for all patients who underwent laparoscopic versus robotic techniques for eight common elective general and bariatric surgical procedures: gastric bypass, sleeve gastrectomy, gastric band, antireflux surgery, Heller myotomy (HM), cholecystectomy (LC), colectomy, rectal resection (RR). Utilization and outcome measures including demographics, in-hospital mortality, major complications, 30-day readmission, length of stay (LOS), and costs were compared between techniques. 96,694 laparoscopic and robotic procedures were analyzed. Utilization of the robotic approach was the highest for RR (21.4%), followed by HM (9.1%). There was no significant difference in in-hospital mortality or major complications between laparoscopic versus robotic techniques for all procedures. Only two procedures had improved outcome associated with the robotic approach: robotic HM and robotic LC had a shorter LOS compared to the laparoscopic approach (2.8 ± 3.6 vs. 2.3 ± 2.1; respectively, p < 0.05 for HM and 2.9 ± 2.4 vs. 2.3 ± 1.7; respectively, p < 0.05 for LC). Costs were significantly higher (21%) in the robotic group for all procedures. A subset analysis of patients with minor/moderate severity of illness showed similar results. This national analysis of academic centers showed a low utilization of robotic-assisted laparoscopic elective general and bariatric surgical procedures with the highest utilization for rectal resection. Compared to conventional laparoscopy, there were no observed clinical benefits associated with the robotic approach, but there was a

Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot-assisted laparoscopic surgery.

PubMed

Hefermehl, Lukas J; Largo, Remo A; Hermanns, Thomas; Poyet, Cédric; Sulser, Tullio; Eberli, Daniel

2014-08-01

To assess critical heat spread of cautery instruments used in robot-assisted laparoscopic (RAL) surgery. Thermal spread along bovine musculofascial tissues was examined by infrared camera, histology and enzyme assay. Currently used monopolar, bipolar and ultrasonic laparoscopic instruments were investigated at various power settings and application times. The efficacy of using an additional Maryland clamp as a heat sink was evaluated. A temperature of 45 °C was considered the threshold temperature for possible nerve damage. Monopolar instruments exhibited a mean (sem) critical thermal spread of 3.5 (2.3) mm when applied at 60 W for 1 s. After 2 s, the spread was >20 mm. For adjustable bipolar instruments the mean (sem) critical thermal spread was 2.2 (0.6) mm at 60 W and 1 s, and 3.6 (1.3) mm at 2 s. The PK and LigaSure forceps had mean (sem) critical thermal spreads of 3.9 (0.8) and 2.8 (0.6) mm respectively, whereas the ultrasonic instrument reached 2.9 (0.8) mm. Application of an additional Maryland clamp as a heat sink, significantly reduced the thermal spread. Histomorphometric analyses and enzyme assay supported these findings. All coagulation devices used in RAL surgery have distinct thermal spreads depending on power setting and application time. Cautery may be of concern due to lateral temperature spread, causing potential damage to sensitive structures including nerves. Our results provide surgeons with a resource for educated decision-making when using coagulation devices during robotic procedures. © 2013 The Authors. BJU International © 2013 BJU International.

Improvement of Hand Movement on Visual Target Tracking by Assistant Force of Model-Based Compensator

NASA Astrophysics Data System (ADS)

Ide, Junko; Sugi, Takenao; Nakamura, Masatoshi; Shibasaki, Hiroshi

Human motor control is achieved by the appropriate motor commands generating from the central nerve system. A test of visual target tracking is one of the effective methods for analyzing the human motor functions. We have previously examined a possibility for improving the hand movement on visual target tracking by additional assistant force through a simulation study. In this study, a method for compensating the human hand movement on visual target tracking by adding an assistant force was proposed. Effectiveness of the compensation method was investigated through the experiment for four healthy adults. The proposed compensator precisely improved the reaction time, the position error and the variability of the velocity of the human hand. The model-based compensator proposed in this study is constructed by using the measurement data on visual target tracking for each subject. The properties of the hand movement for different subjects can be reflected in the structure of the compensator. Therefore, the proposed method has possibility to adjust the individual properties of patients with various movement disorders caused from brain dysfunctions.

Integration of Hands-On Team Training into Existing Curriculum Improves Both Technical and Nontechnical Skills in Laparoscopic Cholecystectomy.

PubMed

Caskey, Robert C; Owei, Lily; Rao, Raghavendra; Riddle, Elijah W; Brooks, Ari D; Dempsey, Daniel T; Morris, Jon B; Neylan, Christopher J; Williams, Noel N; Dumon, Kristoffel R

Nontechnical skills are an essential component of surgical education and a major competency assessed by the ACGME milestones project. However, the optimal way to integrate nontechnical skills training into existing curricula and then objectively evaluate the outcome is still unknown. The aim of this study was to determine the effect laparoscopic team-based task training would have on the nontechnical skills needed for laparoscopic surgery. 9 PGY-1 residents underwent an established training curriculum for teaching the knowledge and technical skills involved in laparoscopic cholecystectomy. Initial training involved a didactic session, expert-led practice on a porcine model in a simulated operating room and laparoscopic skills practice on a virtual reality trainer. Residents then performed a laparoscopic cholecystectomy on the same porcine model as a preintervention test. Three to four months following this, residents were subjected to specific nontechnical skills training involving 2 simple team-based laparoscopic tasks. They then practiced a further 4 to 6 hours on the virtual reality trainer. A repeat postintervention laparoscopic cholecystectomy was then performed 3 to 4 months after nontechnical skills training. Both the preintervention and postintervention laparoscopic cholecystectomies were audiovisually recorded and then evaluated by 2 independent surgeons in a blinded fashion. Technical skills were assessed using objective structured assessment of technical skills (OSATS) and a technique specific rating scale (TRS) that we developed for laparoscopic cholecystectomy. Nontechnical skills were assessed using nontechnical skills for surgeons (NOTSS). Residents also completed a survey at the beginning and end of the training. Tertiary care, university based teaching institution. A total of 9 general surgery residents at the intern level. The mean OSATS score improved from 13.7 ± 1.24 to 26.7 ± 0.31 (p < 0.001), the mean TRS score improved from 6 ± 0.46 to 13

Gallbladder removal - laparoscopic - discharge

MedlinePlus

Cholecystectomy laparoscopic - discharge; Cholelithiasis - laparoscopic discharge; Biliary calculus - laparoscopic discharge; Gallstones - laparoscopic discharge; Cholecystitis - laparoscopic discharge

Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications.

PubMed

Murphy, Declan G; Bjartell, Anders; Ficarra, Vincenzo; Graefen, Markus; Haese, Alexander; Montironi, Rodolfo; Montorsi, Francesco; Moul, Judd W; Novara, Giacomo; Sauter, Guido; Sulser, Tullio; van der Poel, Henk

2010-05-01

Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. RALP has the following principal downsides: (1) device failure occurs in 0.2-0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be

Robotic assisted laparoscopic repair of a symptomatic ureterosciatic hernia.

PubMed

Regelman, Mikhail; Raman, Jay D

2016-04-01

Ureterosciatic hernias (USH) are a rare entity and to date there have been limited case reports detailing their presentation, diagnosis, and management. Until recently, repair of ureterosciatic hernias has been performed via open, endoscopic, or purely laparoscopic approaches. We present the second known published case of a robotic approach to the USH repair with detailed outline of the surgical technique accompanied by video recording from the operative procedure.

Is splenectomy a dyslipidemic intervention? Experimental response of serum lipids to different diets and operations.

PubMed

Paulo, Danilo N S; Paulo, Isabel Cal; Morais, Alvaro A C; Kalil, Mitre; Guerra, Alvino J; Colnago, Geraldo L; Faintuch, Joel

2009-01-01

Spleen removal may be recommended during organ transplantation in ABO-incompatible recipients as well as for hypoperfusion of the grafted liver, besides conventional surgical indications, but elevation of serum lipids has been observed in certain contexts. Aiming to analyze the influence of two dietary regimens on lipid profile, an experimental study was conducted. Male Wistar rats (n = 86, 333.0 +/- 32.2 g) were divided in four groups: group 1: controls; group 2: sham operation; group 3: total splenectomy; group 4: subtotal splenectomy with upper pole preservation; subgroups A (cholesterol reducing chow) and B (cholesterol-rich mixture) were established, and diet was given during 90 days. Total cholesterol (Tchol), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and triglycerides were documented. After total splenectomy, hyperlipidemia ensued with cholesterol-reducing chow. Tchol, LDL, VLDL, triglycerides, and HDL changed from 56.4 +/- 9.2, 24.6 +/- 4.7, 9.7 +/- 2.2, 48.6 +/- 11.1, and 22.4 +/- 4.3 mg/dL to 66.9 +/- 11.4, 29.9 +/- 5.9, 10.9 +/- 2.3, 54.3 +/- 11.4, and 26.1 +/- 5.1 mg/dL, respectively. Upper pole preservation inhibited abnormalities of Tchol, HDL, VLDL, and triglycerides, and LDL decreased (23.6 +/- 4.9 vs. 22.1 +/- 5.1, P = 0.002). Higher concentrations were triggered by splenectomy and cholesterol-enriched diet (Tchol 59.4 +/- 10.1 vs. 83.9 +/- 14.3 mg/dL, P = 0.000), and upper-pole preservation diminished without abolishing hyperlipidemia (Tchol 55.9 +/- 10.0 vs. 62.3 +/- 7.8, P = 0.002). After splenectomy, hyperlipidemia occurred with both diets. Preservation of the upper pole tended to correct dyslipidemia in modality A and to attenuate it in subgroup B. (c) 2008 Wiley-Liss, Inc.

Robotic-assisted repair of iatrogenic ureteral ligation following robotic-assisted hysterectomy.

PubMed

Kalisvaart, Jonathan F; Finley, David S; Ornstein, David K

2008-01-01

Ureteral injuries, while rare, do occur during gynecologic procedures. The expansion of laparoscopic and robotic pelvic surgical procedures increases the risk of ureteral injury from these procedures and suggests a role for minimally invasive approaches to the delayed repair of ureteral injuries. We present, to our knowledge, the first case of delayed robotic-assisted ureteral deligation and ureterolysis following iatrogenic ureteral injury occurring during a robotic abdominal hysterectomy. We present a case report and review of the literature. A 57-year-old female underwent a seemingly uncomplicated robotic-assisted laparoscopic total abdominal hysterectomy and bilateral oophorectomy for symptomatic fibroids. On postoperative day 8, she presented with persistent right flank pain. Imaging studies revealed high-grade ureteral obstruction consistent with suture ligation of the right ureter. She underwent successful robotic-assisted ureteral deligation and ureterolysis. Her postoperative course was unremarkable, and she was discharged home on postoperative day 1 from the deligation. Robotic-assisted management of complications from urologic or gynecologic surgery is technically feasible. This can potentially preserve the advantages to the patient that are being seen from the initial less-invasive surgery.

Parietal seeding of unsuspected gallbladder carcinoma after laparoscopic cholecystectomy.

PubMed

Marmorale, C; Scibé, R; Siquini, W; Massa, M; Brunelli, A; Landi, E

1998-01-01

Laparoscopic cholecystectomy (VALC) represents the treatment of choice for the symptomatic gallstones. However the occurrence of an adenocarcinoma of the gallbladder results a controindication for this surgical technique. We present a case of a 52 years old woman who underwent a VALC; histology revealed a gallbladder adenocarcinoma. For this reason the patient underwent a second operation that is right hepatic trisegmentectomy. Six months later the patient presented with a parietal recurrence at the extraction site of the gallbladder. We discuss the possible mechanism responsible for carcinomatous dissemination during laparoscopic surgery and we raccommend the use of some procedures in order to limit the risk and eventually to treat a neoplastic parietal seeding. These complications suggest the problem about the utility and the future played by video assisted laparoscopic surgery in the diagnosis and treatment of intraabdominal malignancies.

Pneumomediastinum and subcutaneous emphysema after successful laparoscopic supra-cervical hysterectomy

PubMed Central

Godwin, Ofikwu; Adu, Albert K.; Ramcharan, Alexius

2017-01-01

Abstract Laparoscopic hysterectomy is a commonly performed gynecological procedure. Although the outcomes are favorable, severe life threatening complications such as pneumothorax, pneumomediastinum and subcutaneous emphysema can occur during laparoscopy secondary to carbon dioxide insufflation. We report a 46-year-old female who was scheduled for laparoscopic-assisted supra-cervical hysterectomy for uterine fibroids. Patient tolerated the procedure and there were no intra-operative complications. Post operatively she developed hypercarbia, subcutaneous emphysema and pneumomediastinum. She was managed conservatively. This case demonstrates a rare occurrence of subcutaneous emphysema and pneumomediastinum after supra-cervical hysterectomy. PMID:28775841

Death during laparoscopy: can 1 gas push out another? Danger of argon electrocoagulation.

PubMed

Sezeur, Alain; Partensky, Christian; Chipponi, Jacques; Duron, Jean-Jacques

2008-08-01

We report the death of a young man during a laparoscopic partial splenectomy performed with an argon plasma coagulator to remove a benign cyst. The report analyzes the very particular mechanism of a gas embolism, which caused death here. This analysis leads us to recommend a close attention on the use of argon coagulators during laparoscopy. The aim of this article is to draw surgeons' attention to the conclusions of a court-ordered expert assessment intended to elucidate the mechanisms responsible for the death of a 20-year-old man during a laparoscopic partial splenectomy performed with an argon plasma coagulator to remove a benign cyst.

Robot-like dexterity without computers and motors: a review of hand-held laparoscopic instruments with wrist-like tip articulation

PubMed Central

Anderson, Patrick L.; Lathrop, Ray A.; Webster, Robert J.

2018-01-01

Introduction Conventional manual laparoscopic instruments for minimally invasive surgery have limited dexterity within the patient, making procedures challenging. Surgical robotic systems offer enhanced articulation, but at substantial financial costs. This has motivated the development of high-dexterity, low-cost laparoscopic instruments. Areas covered This article reviews both commercial and academic results on creating fully mechanical (i.e. non-robotic) laparoscopic instruments that provide wrists or wrist-like dexterity within the patient. We review the state of the art in the development of these mechanical instruments, focusing on the surgeon interface, wrist mechanism, and the kinematic mapping between the two. Expert commentary Current articulated mechanical laparoscopic instruments exhibit a wide range of designs, with no clear consensus on what makes such devices easy to use. As these technologies mature, user studies are needed to determine surgeon preferences. Articulated, low-cost instruments have the potential to impact the minimally invasive surgery market if they provide compelling benefits to surgeons. PMID:26808896

Robot-like dexterity without computers and motors: a review of hand-held laparoscopic instruments with wrist-like tip articulation.

PubMed

Anderson, Patrick L; Lathrop, Ray A; Webster, Robert J

2016-07-01

Conventional manual laparoscopic instruments for minimally invasive surgery have limited dexterity within the patient, making procedures challenging. Surgical robotic systems offer enhanced articulation, but at substantial financial costs. This has motivated the development of high-dexterity, low-cost laparoscopic instruments. This article reviews both commercial and academic results on creating fully mechanical (i.e. non-robotic) laparoscopic instruments that provide wrists or wrist-like dexterity within the patient. We review the state of the art in the development of these mechanical instruments, focusing on the surgeon interface, wrist mechanism, and the kinematic mapping between the two. Expert commentary: Current articulated mechanical laparoscopic instruments exhibit a wide range of designs, with no clear consensus on what makes such devices easy to use. As these technologies mature, user studies are needed to determine surgeon preferences. Articulated, low-cost instruments have the potential to impact the minimally invasive surgery market if they provide compelling benefits to surgeons.

Prospective study on laser-assisted laparascopic partial nephrectomy

NASA Astrophysics Data System (ADS)

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

2012-02-01

Introduction: Developments in laparoscopic partial nephrectomy (LPN) opened a demand for surgical tools compatible with laparoscopic manipulations to make laser assisted technique safe, feasible and reproducible. Warm ischemia and bleeding during laparoscopic partial nephrectomy place technical constraints on surgeons. Therefore it was the aim to develop a safe and effective laser assisted partial nephrectomy technique without need for ischemia. Patients and methods: A diode laser emitting light at 1318nm in cw mode was coupled into a bare fibre (core diameter 600 μm) thus able to transfer up to 100W to the tissue. After dry lab experience, a total of 10 patients suffering from kidney malformations underwent laparoscopic/retroperitoneoscopic partial nephrectomy. Clinically, postoperative renal function and serum c-reactive protein (CRP) were monitored. Laser induced coagulation depth and effects on resection margins were evaluated. Demographic, clinical and follow-up data are presented. Using a commercial available fibre guidance instrument for lanringeal intervention, the demands on an innovative laser fibre guidance instrument for the laser assisted laparoscopic partial nephrectomy (LLPN) are summarized. Results: Overall, all laparascopic intervention were succesfull and could be performed without conversion to open surgery. Mean operative time and mean blood loss were comparable to conventional open and laparascopic approaches. Laser assisted resection of the kidney tissue took max 15min. After extirpation of the tumours all patients showed clinical favourable outcome during follow up period. Tumour sizes were measured to be up 5cm in diameter. The depth of the coagulation on the removed tissue ranged between <1 to 2mm without effect on histopathological evaluation of tumours or resection margin. As the surface of the remaining kidney surface was laser assisted coagulated after removal. The sealing of the surface was induced by a slightly larger coagulation

Age-stratified outcomes after robotic-assisted laparoscopic radical prostatectomy.

PubMed

Zorn, Kevin C; Mendiola, Frederick P; Rapp, David E; Mikhail, Albert A; Lin, Shang; Orvieto, Marcelo A; Zagaja, Gregory P; Shalhav, Arieh L

2007-01-01

We sought to evaluate post-operative return of urinary and sexual function in men undergoing robotic-assisted laparoscopic radical prostatectomy (RLRP). Prospective assessment of urinary continence and sexual function was performed in patients undergoing RLRP. Subjective assessment involved the use of the validated RAND-36 Item Health Survey/UCLA Prostate Cancer Index questionnaire. Questionnaires were completed pre-operatively and at 1, 3, 6 and 12 months post-operatively. Subset analyses were performed to assess the effect of age on functional outcomes. A total of 338 consecutive patients underwent RLRP between February 2003 and August 2005. Included patients for evaluation comprised of 21, 129, and 150 patients, aged <50, 50-59, and ≥60 years old, respectively. Kaplan-Meier curve analysis demonstrated that younger men (<60 years) achieved subjective continence significantly earlier than older age group (≥60 years) (P = 0.02). Continence rates, however, equalized among all age groups at 1 year follow-up. Younger men (<50 years) also demonstrated a quicker and greater return of sexual function (P = 0.01), which persisted through assessment at 1 year post-operatively. Our results suggest that younger men may have an earlier return of continence and potency when compared to men > 60 years. Despite this finding, continence outcomes appear to be equal among age groups after 1 year of follow-up. Moreover, men < 60 years continue to report superior potency outcomes compared to men > 60 years at 1 year post-operatively. Such findings are valuable in counseling patients undergoing RLRP.

Cost-effectiveness analysis of the treatment of large leiomyomas: laparoscopic assisted vaginal hysterectomy versus abdominal hysterectomy.

PubMed

Mittapalli, Raja; Fanning, James; Flora, Robert; Fenton, Bradford W

2007-05-01

The purpose of this study was to perform a cost-effectiveness analysis comparing the treatment of large leiomyomas by laparoscopic assisted vaginal hysterectomy (LAVH) versus abdominal hysterectomy (AH). Twenty consecutive LAVH were compared to 20 consecutive AH for leiomyoma > or = 250 g. Hospital costs were obtained through Healthcare cost accounting system. The 6 principles of cost-effectiveness analysis were used. The groups were similar in respect to age, weight, race, medical comorbidities, blood loss, and operative time. Median uterine weight (513 g) was approximately 20% > for LAVH. Length of stay and pain was significantly less for LAVH. Total hospital cost for AH was approximately 12% less expensive ($4394 vs $5023, P = .18). Because of multiple benefits of LAVH versus AH and no significant difference in cost, we believe LAVH is an acceptable treatment for large leiomyoma.

Section 17. Laparoscopic and minimal incisional donor hepatectomy.

PubMed

Choi, YoungRok; Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk

2014-04-27

Living donor hepatectomy is now a well-established surgical procedure. However, a large abdominal incision is still required, which results in a large permanent scar, especially for a right liver graft. This report reviews our techniques of minimally invasive or minimal incisional donor hepatectomy using a transverse incision.Twenty-five living donors underwent right hepatectomy with a transverse incision and 484 donors with a conventional incision between April 2007 and December 2012. Among the donors with a transverse incision, two cases were totally laparoscopic procedures using a hand-port device; 11 cases were laparoscopic-assisted hepatectomy (hybrid technique), and 14 cases were open procedures using a transverse incision without the aid of the laparoscopic technique. Currently, a hybrid method has been exclusively used because of the long operation time and surgical difficulty in totally laparoscopic hepatectomy and the exposure problems for the liver cephalic portion during the open technique using a transverse incision.All donors with a transverse incision were women except for one. Twenty-four of the grafts were right livers without middle hepatic vein (MHV) and one with MHV. The donors' mean BMI was 21.1 kg/m. The median operation time was 355 minutes, and the mean estimated blood loss was 346.1±247.3 mL (range, 70-1200). There was no intraoperative transfusion. These donors had 29 cases of grade I [14 pleural effusions (56%), 11 abdominal fluid collections (44%), 3 atelectasis (12%), 1bile leak (4%)], 1 case of grade II (1 pneumothorax) and two cases of grade III complications; two interventions were needed because of abdominal fluid collections by Clavien-Dindo classification. Meanwhile, donors with a conventional big incision, which included the Mercedes-Benz incision or an inverted L-shaped incision, had 433 cases of grade I, 19 cases of grade II and 18 cases of grade III complications. However, the liver enzymes and total bilirubin of all donors

Performance evaluation of haptic hand-controllers in a robot-assisted surgical system.

PubMed

Zareinia, Kourosh; Maddahi, Yaser; Ng, Canaan; Sepehri, Nariman; Sutherland, Garnette R

2015-12-01

This paper presents the experimental evaluation of three commercially available haptic hand-controllers to evaluate which was more suitable to the participants. Two surgeons and seven engineers performed two peg-in-hole tasks with different levels of difficulty. Each operator guided the end-effector of a Kuka manipulator that held surgical forceps and was equipped with a surgical microscope. Sigma 7, HD(2) and PHANToM Premium 3.0 hand-controllers were compared. Ten measures were adopted to evaluate operators' performances with respect to effort, speed and accuracy in completing a task, operator improvement during the tests, and the force applied by each haptic device. The best performance was observed with the Premium 3.0; the hand-piece was able to be held in a similar way to that used by surgeons to hold conventional tools. Hand-controllers with a linkage structure similar to the human upper extremity take advantage of the inherent human brain connectome, resulting in improved surgeon performance during robotic-assisted surgery. Copyright © 2015 John Wiley & Sons, Ltd.

Training in Basic Laparoscopic Surgical Skills: Residents Opinion of the New Nintendo Wii-U Laparoscopic Simulator.

PubMed

Overtoom, Evelien M; Jansen, Frank-Willem; van Santbrink, Evert J P; Schraffordt Koops, Steven E; Veersema, Sebastiaan; Schreuder, Henk W R

Serious games are new in the field of laparoscopic surgical training. We evaluate the residents׳ opinion of a new laparoscopic simulator for the Nintendo Wii-U platform. Prospective questionnaire study. Participants received a standardized introduction and completed level 3 and 4 of the game "Underground." They filled out a questionnaire concerning demographics and their opinion on realism, usefulness, suitability, haptic feedback, and home training-use of the game. Two tertiary teaching hospitals. Obstetrics and gynaecology residents postgraduate year 1 to 6 (n = 59) from several European countries. Subjects (n = 59) were divided into 2 groups based on laparoscopic experience: Group A (n = 38) and Group B (n = 21). The realism of different aspects of the game received mean scores around 3 on a 5-point Likert scale. The hand-eye coordination was regarded most useful for training with a mean of 3.92 (standard deviation 0.93) and the game was considered most suitable for residents in the first part of their postgraduate training with a mean of 3.73 (standard deviation 0.97). Both groups differed especially concerning their opinion of the usefulness of the game as a training tool. Most residents liked the new serious game for the Nintendo Wii-U. The usefulness and suitability as a laparoscopic training tool were rated at an acceptable to high level. However, the game does require improvements such as inclusion of a good scoring system before it can be integrated in resident training curricula. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Outcomes assessment in men undergoing open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted radical prostatectomy.

PubMed

Kowalczyk, Keith J; Yu, Hua-Yin; Ulmer, William; Williams, Stephen B; Hu, Jim C

2012-02-01

To review the various methods of outcomes assessment used for effectiveness studies comparing retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), and robotic-assisted laparoscopic prostatectomy (RALP). A review of the peer reviewed literature was performed for reported series of RRP, LRP, and RALP using Pubmed and MEDLINE with emphasis on comparing perioperative, functional, and oncologic outcomes. Common methods used for outcomes assessment were categorized and compared, highlighting the pros and cons of each approach. The majority of the literature comparing RRP, LRP, and RALP comes in the form of observational data or administrative data from secondary datasets. While randomized controlled trials are ideal for outcomes assessment, only one such study was identified and was limited. Non-randomized observational studies contribute to the majority of data, however are limited due to retrospective study design, lack of consistent endpoints, and limited application to the general community. Administrative data provide accurate assessment of operative outcomes in both academic and community settings, however has limited ability to convey accurate functional outcomes. Non-randomized observational studies and secondary data are useful resources for assessment of outcomes; however, limitations exist for both. Neither is without flaws, and conclusions drawn from either should be viewed with caution. Until standardized prospective comparative analyses of RRP, LRP, and RALP are established, comparative outcomes data will remain imperfect. Urologic researchers must strive to provide the best available outcomes data through accurate prospective data collection and consistent outcomes reporting.

Laparoscopic adhesiolysis: consensus conference guidelines.

PubMed

Vettoretto, N; Carrara, A; Corradi, A; De Vivo, G; Lazzaro, L; Ricciardelli, L; Agresta, F; Amodio, C; Bergamini, C; Borzellino, G; Catani, M; Cavaliere, D; Cirocchi, R; Gemini, S; Mirabella, A; Palasciano, N; Piazza, D; Piccoli, M; Rigamonti, M; Scatizzi, M; Tamborrino, E; Zago, M

2012-05-01

Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice. A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts. Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection. Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

Design and Preliminary Feasibility Study of a Soft Robotic Glove for Hand Function Assistance in Stroke Survivors

PubMed Central

Yap, Hong Kai; Lim, Jeong Hoon; Nasrallah, Fatima; Yeow, Chen-Hua

2017-01-01

Various robotic exoskeletons have been proposed for hand function assistance during activities of daily living (ADL) of stroke survivors. However, traditional exoskeletons involve the use of complex rigid systems that impede the natural movement of joints, and thus reduce the wearability and cause discomfort to the user. The objective of this paper is to design and evaluate a soft robotic glove that is able to provide hand function assistance using fabric-reinforced soft pneumatic actuators. These actuators are made of silicone rubber which has an elastic modulus similar to human tissues. Thus, they are intrinsically soft and compliant. Upon air pressurization, they are able to support finger range of motion (ROM) and generate the desired actuation of the finger joints. In this work, the soft actuators were characterized in terms of their blocked tip force, normal and frictional grip force outputs. Combining the soft actuators and flexible textile materials, a soft robotic glove was developed for grasping assistance during ADL for stroke survivors. The glove was evaluated on five healthy participants for its assisted ROM and grip strength. Pilot test was performed in two stroke survivors to evaluate the efficacy of the glove in assisting functional grasping activities. Our results demonstrated that the actuators designed in this study could generate desired force output at a low air pressure. The glove had a high kinematic transparency and did not affect the active ROM of the finger joints when it was being worn by the participants. With the assistance of the glove, the participants were able to perform grasping actions with sufficient assisted ROM and grip strength, without any voluntary effort. Additionally, pilot test on stroke survivors demonstrated that the patient's grasping performance improved with the presence and assistance of the glove. Patient feedback questionnaires also showed high level of patient satisfaction and comfort. In conclusion, this paper

The new laparoscopic proctocolectomy training (in soft cadaver).

PubMed

Pattana-arun, Jirawat; Udomsawaengsup, Suthep; Sahakitrungruang, Chucheep; Tansatit, Tanvaa; Tantiphlachiva, Kasaya; Rojanasakul, Arun

2005-09-01

The purpose of the present study was to evaluate the quality of preservation (tissue plane, named vessels identification, consistency of colon and rectum), quality of performing procedures, difficulties and problems and finally the satisfaction of surgeons in laparoscopic proctocolectomy in soft cadaver. Colorectal Division, Department of Surgery and Surgical Training Center Department of Anatomy, Faculty of Medicine, Chulalongkorn University. Prospective descriptive study 10 soft cadavers were scheduled for laparoscopic proctocolectomy. The procedures (colon-rectum mobilization and named vessels identification) were performed by 14 experienced surgeons (8 colorectal surgeons) and assisted by surgical residents. The quality of preservation, successfulness and the satisfaction in performing the procedures were recorded using questionnaires for evaluation. The preservation was very good in every aspect especially tissue plane between colon, mesocolon and retroperitoneum which was clearly dissected, same asfasciapropria of rectum. The named vessels and the tissue consistency were very well preserved and tolerated to laparoscopic equipment handling. The surgeons were satisfied with the tissue handling and dissections. There were two difficulties, the first was air leakage but simply corrected with purse string suture and the second was unflavored smell which was not concerned. Laparoscopic proctocolectomy could be completely performed in soft cadaver. Laparoscopic proctocolectomy could be performed in soft cadavers with great satisfaction. Repeated practice is possible, so the surgeons can gain their experiences outside the operating theatre. This success may shorten the learning curve and may be the new era in cadaver-based training.

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

NASA Astrophysics Data System (ADS)

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

2014-03-01

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

Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl4-induced liver fibrosis.

PubMed

Wang, Ming-Jun; Ling, Wen-Wu; Wang, Hong; Meng, Ling-Wei; Cai, He; Peng, Bing

2016-12-14

To investigate the diagnostic performance of liver stiffness measurement (LSM) by elastography point quantification (ElastPQ) in animal models and determine the longitudinal changes in liver stiffness by ElastPQ after splenectomy at different stages of fibrosis. Liver stiffness was measured in sixty-eight rabbits with CCl 4 -induced liver fibrosis at different stages and eight healthy control rabbits by ElastPQ. Liver biopsies and blood samples were obtained at scheduled time points to assess liver function and degree of fibrosis. Thirty-one rabbits with complete data that underwent splenectomy at different stages of liver fibrosis were then included for dynamic monitoring of changes in liver stiffness by ElastPQ and liver function according to blood tests. LSM by ElastPQ was significantly correlated with histologic fibrosis stage ( r = 0.85, P < 0.001). The optimal cutoff values by ElastPQ were 11.27, 14.89, and 18.21 kPa for predicting minimal fibrosis, moderate fibrosis, and cirrhosis, respectively. Longitudinal monitoring of the changes in liver stiffness by ElastPQ showed that early splenectomy (especially F1) may delay liver fibrosis progression. ElastPQ is an available, convenient, objective and non-invasive technique for assessing liver stiffness in rabbits with CCl 4 -induced liver fibrosis. In addition, liver stiffness measurements using ElastPQ can dynamically monitor the changes in liver stiffness in rabbit models, and in patients, after splenectomy.

Ingenious laparoscopic knife.

PubMed

Goel, Rajiv; Modi, Pranjal

2007-06-01

Retroperitoneoscopic ureterolithotomy may be an option in selected group of patients. We present our cost effective, reliable ingenious laparoscopic knife of ureteric incision during retroperitoneoscopic ureterolithotomy. Ingenious laparoscopic knife is made by firmly tying stab knife to 5 mm laparoscopic instrument. This knife is passed through 10-mm renal angle port for making ureteric incision. Ingenious laparoscopic knife has been successfully used in 22 patients with no intraoperative and postoperative complications. Ingenious laparoscopic knife is cost effective, reliable instrument for ureteric incision during retroperitoneoscopic ureterolithotomy.

Development of a novel ex vivo porcine laparoscopic Heller myotomy and Nissen fundoplication training model (Toronto lap-Nissen simulator).

PubMed

Ujiie, Hideki; Kato, Tatsuya; Hu, Hsin-Pei; Bauer, Patrycja; Patel, Priya; Wada, Hironobu; Lee, Daiyoon; Fujino, Kosuke; Schieman, Colin; Pierre, Andrew; Waddell, Thomas K; Keshavjee, Shaf; Darling, Gail E; Yasufuku, Kazuhiro

2017-06-01

Surgical trainees are required to develop competency in a variety of laparoscopic operations. Developing laparoscopic technical skills can be difficult as there has been a decrease in the number of procedures performed. This study aims to develop an inexpensive and anatomically relevant model for training in laparoscopic foregut procedures. An ex vivo , anatomic model of the human upper abdomen was developed using intact porcine esophagus, stomach, diaphragm and spleen. The Toronto lap-Nissen simulator was contained in a laparoscopic box-trainer and included an arch system to simulate the normal radial shape and tension of the diaphragm. We integrated the use of this training model as a part of our laparoscopic skills laboratory-training curriculum. Afterwards, we surveyed trainees to evaluate the observed benefit of the learning session. Twenty-five trainees and five faculty members completed a survey regarding the use of this model. Among the trainees, only 4 (16%) had experience with laparoscopic Heller myotomy and Nissen fundoplication. They reported that practicing with the model was a valuable use of their limited time, repeating the exercise would be of additional benefit, and that the exercise improved their ability to perform or assist in an actual case in the operating room. Significant improvements were found in the following subjective measures comparing pre- vs. post-training: (I) knowledge level (5.6 vs. 8.0, P<0.001); (II) comfort level in assisting (6.3 vs. 7.6, P<0.001); and (III) comfort level in performing as the primary surgeon (4.9 vs. 7.1, P<0.001). The trainees and faculty members agreed that this model was of adequate fidelity and was a representative simulation of actual human anatomy. We developed an easily reproducible training model for laparoscopic procedures. This simulator reproduces human anatomy and increases the trainees' comfort level in performing and assisting with myotomy and fundoplication.

Robot-assisted partial nephrectomy vs laparoscopic cryoablation for the small renal mass: redefining the minimally invasive 'gold standard'.